Effect of visual perception training on binocular visual function reconstruction in patients after strabismus surgery.

AIM: To explore the effect of visual perception learning software training (VPT) on binocular visual function reconstruction in children with intermittent exotropia after strabismus surgery. METHODS: Ninety children with intermittent exotropia admitted to our hospital from June 2018 to December 2018 were included, and randomly divided into VPT and control groups. Children in the control group received basic binocular vision training, while those in the VPT group received VPT after strabismus surgery. Tertiary visual function, visual perception function, Newcastle Control Score (NCS), and ocular position retraction rate were compared at 3 and 12mo after the surgery. RESULTS: At 3 and 12mo after the surgery, the proportion of simultaneous perception, binocular fusion version and binocular stereo vision in the VPT group was conspicuously higher than that in the control group (P<0.05). After the vision training, the binocular visual perception functions of children in both groups were significantly improved compared with that before training (P<0.05). Interestingly, the grating sharpness, texture perception and texture motion perception in the VPT group were dramatically better than control group (P<0.01). The NCS in the VPT group was significantly lower than that in the control group (P<0.05). The ocular position retraction rate in the VPT group was significantly lower than that in the control group at 12mo (8.89% vs 26.67%, P=0.03). CONCLUSION: VPT effectively promotes binocular visual function reconstruction in intermittent exotropia children after strabismus surgery and reduces the strabismus severity and ocular position retraction rate.

Chimeric deletion mutation of rpoC2 underlies the leaf-patterning of Clivia miniata var. variegata.

KEY MESSAGE: The deletion mutated rpoC2 leads to yellow stripes of Clivia miniata var. variegata by down regulating the transcription of 28 chloroplast genes and disturbing chloroplast biogenesis and thylakoid membrane development. Clivia miniata var. variegata (Cmvv) is a common mutant of Clivia miniata but its genetic basis is unclear. Here, we found that a 425 bp deletion mutation of chloroplast rpoC2 underlies the yellow stripes (YSs) of Cmvv. Both RNA polymerase PEP and NEP coexist in seed-plant chloroplasts and the ß″ subunit of PEP is encoded by rpoC2. The rpoC2 mutation changed the discontinuous cleft domain required to form the PEP central cleft for DNA binding from 1103 to 59 aa. RNA-Seq revealed that 28 chloroplast genes (cpDEGs) were all down-regulated in YSs, of which, four involved in chloroplast protein translation and 21 of photosynthesis system (PS)I, PSII, cytochrome b6/f complex and ATP synthase are crucial for chloroplast biogenesis/development. The accuracy and reliability of RNA-Seq was verified by qRT-PCR. Moreover, the chlorophyll (Chl) a/b content, ratio of Chla/Chlb and photosynthetic rate (Pn) of YS decreased significantly. Meanwhile, chloroplasts of the YS mesophyll cells were smaller, irregular in shape, contain almost no thylakoid membrane, and even proplastid was found in YS. These findings indicate that the rpoC2 mutation down-regulated expression of the 28 cpDEGs, which disturb chloroplast biogenesis and its thylakoid membrane development. Thus, there are not enough PSI and II components to bind Chl, so that the corresponding areas of the leaf are yellow and show a low Pn. In this study, the molecular mechanism of three phenotypes of F1 (Cmvv ♀ × C. miniata ♂) was revealed, which lays a foundation for the breeding of variegated plants.

Sucrose promotes branch-thorn occurrence of Lycium ruthenicum through dual effects of energy and signal.

Lycium ruthenicum is an important ecoeconomic thorny shrub. In this study, the L. ruthenicum plants of a clone showed two types of 'fewer leaves without thorn' and 'more leaves with thorns' under the same condition after transplanting. Microscopic observation revealed that the apical buds of the thornless (Thless) and thorny (Thorny) branches should be selected as materials for further study. RNA-Seq analysis showed that the KEGG pathway of starch and sucrose metabolism and differentially expressed genes of sugar transport protein 13 (SUT13), sucrose synthase (SUS), trehalose-phosphate phosphatase (TPP) and trehalose-phosphate synthase (TPS) were significantly up-regulated in Thorny. The results of qRT-PCR confirmed the accuracy and credibility of the RNA-Seq. The content of sucrose in Thorny was significantly higher than that in Thless, but the content of trehalose-6-phosphate (T6P) was opposite. Leaf-clipping treatments reduced sucrose content and inhibited the occurrence/development of branch-thorns; exogenous sucrose of 16 g l-1 significantly promoted the occurrence and growth of branch-thorns, and the promotion effects were significantly higher than those treated with non-metabolizable sucrose analogs (isomaltolose and melitose). These findings suggested that sucrose might play a dual role of energy and signal in the occurrence of branch-thorns. Higher sucrose supply in apical buds from more leaves promoted the occurrence of branch-thorns via a lower content of T6P and higher expression levels of SUS, TPP and TPS, whereas fewer leaves inhibited the occurrence. The molecular hypothesis model of the leaf number/sucrose supply regulating the occurrence of branch-thorns in L. ruthenicum was established in the study, which provides foundation for breeding both Thless L. ruthenicum and Thless types of other species.

Combinations of Scheimpflug tomography, ocular coherence tomography and air-puff tonometry improve the detection of keratoconus.

PURPOSE: To determine whether combinations of devices with different measuring principles, supported by artificial intelligence (AI), can improve the diagnosis of keratoconus (KC). METHODS: Scheimpflug tomography, spectral-domain optical coherence tomography (SD-OCT), and air-puff tonometry were performed in all eyes. The most relevant machine-derived parameters to diagnose KC were determined using feature selection. The normal and forme fruste KC (FFKC) eyes were divided into training and validation datasets. The selected features from a single device or different combinations of devices were used to develop models based on random forest (RF) or neural networks (NN) trained to distinguish FFKC from normal eyes. The accuracy was determined using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity. RESULTS: 271 normal eyes, 84 FFKC eyes, 85 early KC eyes, and 159 advanced KC eyes were included. A total of 14 models were built. Air-puff tonometry had the highest AUC for detecting FFKC using a single device (AUC = 0.801). Among all two-device combinations, the highest AUC was accomplished using RF applied to selected features from SD-OCT and air-puff tonometry (AUC = 0.902), followed by the three-device combination with RF (AUC = 0.871) with the best accuracy. CONCLUSION: Existing parameters can precisely diagnose early and advanced KC, but their diagnostic ability for FFKC could be optimized. Applying an AI algorithm to a combination of air-puff tonometry with Scheimpflug tomography or SD-OCT could improve FFKC diagnostic ability. The improvement in diagnostic ability by combining three devices is modest.

The mechanism of bud dehyperhydricity by the method of 'starvation drying combined with AgNO3' in Lycium ruthenicum.

Micropropagation is very important for rapid clonal propagation and scientific research of woody plants. However, the micropropagated materials usually show hyperhydricity, which seriously hinders application of the micropropagation. Lycium ruthenicum is an important species of eco-economic forests. Herein, treatment of 'starvation and drying combined with 30 µM AgNO3' (SDCAg+) removed serious hyperhydricity of L. ruthenicum buds regenerated from its green-inflorescence-explants, and then gene expression, metabolites of various phytohormones, chloroplasts, chlorophyll (Chl) and total soluble proteins of the hyperhydric and dehyperhydric leaves were compared and analyzed. The results suggested that the SDCAg+ treatment might remove hyperhydricity of L. ruthenicum through: reducing water uptake; increasing water loss; up-regulating the expression of chloroplast-ribosomal-protein genes from nuclear genome; down-regulating the expression of cytoplasmic-ribosomal-protein genes; up-regulating the synthesis of the total soluble proteins; restoring the lamellar structure of chloroplast grana and matrix; improving Chl synthesis and reducing Chl metabolism; increasing expression of light-harvesting Chl protein complex genes and content of Chla and b; up-regulating both photosynthesis and starch and sucrose metabolism KEGG pathways; up-regulating abscisic acid, salicylic acid and their signaling; down-regulating cytokinin, jasmonic acid, jasmonoyl-l-isoleucine and their signaling. Also, the above events interact to form a regulatory network of dehyperhydricity by SDCAg+ treatment. Overall, the study indicated key genes/pathways and physiological/subcellular changes involved in dehyperhydricity and then established a dehyperhydric mechanism model of L. ruthenicum. This not only proposed clues for preventing or removing hyperhydricity but also laid foundations for molecular breeding of L. ruthenicum and other species.

The branch-thorn occurrence of Lycium ruthenicum is associated with leaf DNA hypermethylation in response to soil water content.

BACKGROUND: Lycium ruthenicum is an eco-economic shrub which can exist in two forms, thorny and thornless under varying soil moisture conditions. The aim of this study was to determine if the two forms of L. ruthenicum were influenced by soil water content (SWC) and to test the three-way link among SWC, occurrence of branch-thorn and DNA methylation modification. METHODS AND RESULTS: Here, pot experiment was carried out to reveal the influence of SWC on the occurrence of branch-thorn and then paraffin sections, scanning electron microscope and methylation-sensitive amplification polymorphism(MSAP) analysis were used to determine the three-way link among SWC, branch-thorn occurrence and DNA methylation. The results showed that (a) soil drought promoted the development of thorn primordium into branch-thorn and (b) branch-thorn covered axillary bud to protect it against drought and other stresses; (c) the branch-thorn occurrence response to drought was correlated with hypermethylation of CCGG sites and (d) thorny and thornless plants of a clone were distinguished successfully based on the MSAP profiles of their leaves. CONCLUSIONS: Branch-thorns of the L. ruthenicum clone, which occurred in response to drought, covered axillary buds to protect them against drought and other stresses; thorn primordium of the clone did not develop into branch-thorn under the adequate soil moisture condition. The occurrence and absence of the branch-thorns were correlated with the hyper- and hypo-methylation, respectively. We proposed that the branch-thorn plasticity might be an adjustment strategy for the environment, which seems to support the theory of "Use in, waste out".

A novel micropropagation of Lycium ruthenicum and epigenetic fidelity assessment of three types of micropropagated plants in vitro and ex vitro.

Lycium ruthenicum is an excellent eco-economic shrub. Numerous researches have been conducted for the function of its fruits but scarcely focused on the somaclonal variation and DNA methylation. An efficient micropropagation protocol from leaves and stems of L. ruthenicum was developed in this study, in which not only the leaf explants but also the stem explants of L. ruthenicum were dedifferentiated and produced adventitious buds/multiple shoots on one type of medium. Notably, the efficient indirect organogenesis of stem explants was independent of exogenous auxin, which is contrary to the common conclusion that induction and proliferation of calli is dependent on exogenous auxin. We proposed that sucrose supply might be the crucial regulator of stem callus induction and proliferation of L. ruthenicum. Furthermore, results of methylation-sensitive amplified polymorphism (MSAP) showed that DNA methylation somaclonal variation (MSV) of CNG decreased but that of CG increased after acclimatization. Three types of micropropagated plants (from leaf calli, stem calli and axillary buds) were epigenetically diverged more from each other after acclimatization and the ex vitro micropropagated plants should be selected to determine the fidelity. In summary, plants micropropagated from axillary buds and leaves of L. ruthenicum was more fidelity and might be suitable for preservation and propagation of elite germplasm. Also, leaf explants should be used in transformation. Meanwhile, plants from stem calli showed the highest MSV and might be used in somaclonal variation breeding. Moreover, one MSV hotspot was found based on biological replicates. The study not only provided foundations for molecular breeding, somaclonal variation breeding, preservation and propagation of elite germplasm, but also offered clues for further revealing novel mechanisms of both stem-explant dedifferentiation and MSV of L. ruthenicum.

A Comprehensive Strategy for Laser Corneal Refractive Surgery during the COVID-19 Epidemic in a Tertiary Teaching Hospital in Wenzhou, China.

The novel coronavirus pneumonia COVID-19 is caused by the novel coronavirus SARS-CoV-2, which is highly contagious, has a long incubation period, and can be detected in patients' tears and conjunctival secretions. In this study, we describe our experience regarding the necessary protective measures that need to be taken during ophthalmic examination and treatment. The authors reviewed the clinical work arrangements during the epidemic situation at the Eye Hospital of Wenzhou Medical University in China and analyzed the prevention and control measures that were applied during the laser corneal refractive surgery process. The comprehensive protection protocol, which was established throughout the entire process, included both horizontal (medical staff-patient, medical staff-medical staff, and patient-patient) and vertical (preoperative, intraoperative, and postoperative transmission assessment) approach and was mainly focused on strengthening the protection against potential aerosol transmission that may occur during intraocular pressure measurements and laser ablation. The described and proposed protocol, along with the further guidelines followed by the medical personnel, proved to be efficacious and contributed significantly to the control of the COVID-19 outbreak and the protection of both the patients and the medical staff.

A novel ophthalmic viscosurgical device-free phakic intraocular lens implantation makes myopic surgery safer.

PURPOSE: To assess the efficacy and safety of a novel ophthalmic viscosurgical device-free (OVD-free) method for posterior chamber phakic intraocular lens (PIOL) implantation in myopic eyes. METHODS: In this retrospective cohort study, the medical records of myopic eyes that underwent PIOL (Implantable Collamer Lens, ICL) implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed. A total of 49 eyes with complete data that met follow up requirements (2 h, 1 day, 1 week, 3 months postoperatively) were recruited. Based on the surgical techniques used, the eyes were divided into the OVD-free method group and the standard method group. The clinical data, including intraocular pressure (IOP), corrected distance visual acuity (CDVA) and spherical equivalent (SE), at each follow-up were collected for comparison. Endothelial cell loss and complications were also investigated. RESULTS: Twenty-one eyes received the standard method, and 28 eyes received the OVD-free method. A rise in IOP > 22 mmHg at 2 h was noted in 14 eyes (66.7%) in the standard group and none (0%) in the OVD-free group (p < 0.001). The rise in IOP from baseline was significantly higher at 2 h in the standard group (10.5 ± 5.2 mmHg vs. 2.2 ± 3.3 mmHg, difference: 8.3, 95% CI 5.8 to 10.8; p < 0.001). There was a significant difference in the time course of LogMAR CDVA changes between the two groups (p = 0.047). The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day (- 0.076, 95% CI - 0.134 to - 0.018; p = 0.012), 1 week (- 0.071, 95% CI - 0.135 to - 0.007; p = 0.03), but not at 3 months (- 0.046, 95% CI - 0.107 to 0.015; p = 0.134). There was no significant difference in the time course of SE changes between the two groups (p = 0.471; p = 0.705). In the OVD-free group, mean endothelial cell loss was 4.6% at 3 months (2522 ± 281 vs. 2407 ± 226 cells/mm2, difference: -115, 95% CI - 295 to 65; p = 0.187). No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period. CONCLUSIONS: The OVD-free method is safe and efficient for ICL implantation. It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devices-related complications without causing additional complications.

Constructing self-adhesive and robust functional films on titanium resistant to mechanical damage during dental implanting.

HYPOTHESIS: Osseointegration can be enhanced by introducing bioactive polyelectrolyte-multilayer films on implant surfaces. To guarantee films to function successfully in use, keeping structural integrity during implanting is necessary, which requires films with strong adhesion and cohesion to resist the mechanical damage. Catechol is considered as the origin of amazing adhesion of mussels. We hypothesize that catechol functionalization of polyelectrolytes enables film construction on implants in a non-aggressive way, and helps films resist mechanical damages during implanting. EXPERIMENTS: With lipopolysaccharide-amine nanopolymersomes (NPs), catechol-functionalized hyaluronic acid and NPs (cHA, cNPs) as a polycation, polyanion and primer, respectively, catechol-functionalized polyelectrolyte-multilayer films (cPEMs) were constructed on substrates via Layer-by-layer self-assembly. Effects of catechol functionalization on construction, surface properties, assembly mechanisms, structural integrity, mechanical properties and cytotoxicity of cPEMs were studied. FINDINGS: Self-adhesive cPEMs can be constructed on substrates, which grow exponentially and are driven by coordination, covalent bonding, electrostatic interactions, hydrogen bonding, etc. cPEMs with suitable catechol concentrations can resist mechanical damage to keep structural integrity in simulated clinical implantation, show stronger adhesion and cohesion than non-catechol-functionalized films in nanoscratch and nanoindentation tests, and are non-cytotoxic to MSCs. With excellent drug-loading and cytosolic-delivery capacity of NPs, cPEM is promising in improving osseointegration of implants.

Repeatability of Cornea and Sublayer Thickness Measurements Using Optical Coherence Tomography in Corneas of Anomalous Refractive Status.

PURPOSE: To assess the repeatability of epithelial, stromal, and total corneal thickness measurements with spectral-domain optical coherence tomography (SD-OCT; RTVue-XR; Optovue, Inc., Fremont, CA) in patients with myopia, keratoconus, and corneas after transepithelial photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: A total of 352 eyes of 352 patients (75 myopic, 68 post-transepithelial PRK, 61 post-SMILE, 75 post-FS-LASIK, 20 mild keratoconus, and 53 advanced keratoconus eyes) were included. The epithelial, stromal, and total corneal thickness were recorded from the pachymetric map in the following four zones: (1) central 2-mm region, (2) eight paracentral regions within 2- to 5-mm diameter, (3) eight midperipheral regions within 5- to 7-mm diameter, and (4) eight peripheral regions within 7- to 9-mm diameter. Three successive scans were performed to evaluate the repeatability. RESULTS: For all zones up to 9-mm diameter, the coefficient of variation (CoV) for epithelial thickness measurements ranged from 1.7% to 3.5% for myopia, 2.6% to 6.2% for post-transepithelial PRK, 2.3% to 4.7% for post-SMILE, 4.0% to 6.3% for post-FS-LASIK, 2.5% to 6.2% for mild keratoconus, and 3.5% to 8.0% for advanced keratoconus. The CoV for stromal and total thickness measurements ranged from 0.2% to 2.0% for myopia, 0.7% to 4.2% for post-transepithelial PRK, 0.3% to 2.4% for post-SMILE, 0.3% to 1.9% for post-FS-LASIK, 0.6% to 3.0% for mild keratoconus, and 1.0% to 5.9% for advanced keratoconus. CONCLUSIONS: RTVue-XR SD-OCT showed excellent repeatability when generating the pachymetric map in myopic eyes. Measurements, especially for epithelial thickness, were relatively more variable for corneas with keratoconus and those having undergone keratorefractive surgery. [J Refract Surg. 2019;35(9):600-605.].

Changes and Diurnal Variation of Visual Quality after Orthokeratology in Myopic Children.

PURPOSE: To assess the changes and the diurnal variation of visual quality after orthokeratology in myopic children. METHODS: Forty-four eyes of 22 subjects with a mean age of 10.55 ± 1.53 years (8 to 14 years) were enrolled in this prospective study. Their spherical equivalent ranged from -1.25 to -4.25 diopters (D) and astigmatism was less than 1.00 D. Parameters including corneal curvature, ocular objective scatter index (OSI), the modulation transfer function (MTF), root mean square of ocular and corneal wavefront aberrations, and contrast sensitivity function (CSF) were measured before and at two time points during the same day after 1 month of orthokeratology. RESULTS: After orthokeratology, uncorrected visual acuity (UCVA) and spherical equivalent were significantly improved from baseline (P < 0.001), and their diurnal variation was not significant (P=0.083, 0.568). OSI increased from 0.29 ± 0.15 to 0.65 ± 0.31 (P < 0.001). MTF decreased significantly (P < 0.01). Corneal curvature and ocular total aberration decreased (P < 0.001), while the ocular and corneal higher-order aberration increased significantly (P < 0.01). The CSF under photopic condition decreased at 3 cpd (P=0.006) and increased at 18 cpd (P=0.012). The diurnal variation of CSF at 18 cpd under mesopic and high glare conditions and at 12 cpd under photopic condition was significant (P=0.002, 0.01, 0.017). CONCLUSIONS: Orthokeratology can effectively improve UCVA and high spatial frequency CSF by decreasing the low-order aberrations. However, MTF and CSF at low spatial frequency decreased because of the increase of intraocular scattering and high-order aberrations. Meanwhile, CSF at high spatial frequency fluctuates significantly at two times during the same day after 1 month orthokeratology.

Comparative transcriptome profiling of genes and pathways involved in leaf-patterning of Clivia miniata var. variegata.

Clivia miniata var. variegata (Cmvv) typically possesses yellow- and green-striped leaves. The striped plant not only has a high ornamental value but also be suitable for photosynthesis and chloroplast development research. Our previous study had revealed that yellow stripes (YSs) of Cmvv leaves contain chlorophyll-less ineffective chloroplasts. However, mechanism of Cmvv variegation is yet to be investigated. In the study, transcriptomes of both the YSs and green stripes (GSs) from single Cmvv leaves were compared using high-throughput sequencing. A total of 688 differential expression genes (DEGs) were identified based on biological replications. The qRT-PCR results indicated that transcriptome profiles accurately reflected global transcriptome differences between YSs and GSs. Subcellular localization analysis suggested that 56 DEG proteins were targeted to chloroplasts, and might be involved in anterograde signaling and leaf patterning. Moreover, the DEGs were mostly enriched in photosynthesis and plant-pathogen interaction KEGG pathways. Meanwhile, there should be coordination interaction between the two pathways. Seven of the eight DEGs involved in photosynthesis KEGG pathway were chloroplast-encoded genes and distributed among different cistrons of chloroplast DNA (cpDNA) large single copy regions (LSC) which are more prone to mutation. It was proposed that the YSs were caused by mutation(s) in cpDNA LSC. Thus, when the primary zygote of Cmvv was chimeric in LSC, leaf might be yellow- and green-striped. The study would give new insights into plant variegation and offers candidate genes to guide future research attempting to breed variegated plants.

Posterior corneal surface differences between non-laser in situ keratomileusis (LASIK) and 10-year post-LASIK myopic eyes.

PURPOSE: To evaluate the posterior corneal surface differences between non-laser in situ keratomileusis (LASIK) and 10-year post-LASIK myopic eyes. METHODS: The study included 130 eyes from 65 patients, who were treated with myopic LASIK 10 years ago. In addition, 130 eyes from 65 unoperated myopic patients of matching present age and preoperative refraction were divided into control group. Data on the posterior corneal surface and anterior chamber were obtained from Pentacam software and compared between the groups. Postoperative visual acuity (VA) and refractive error were also analysed. RESULTS: The mean preoperative spherical equivalent (SE) was -6.99 ± 1.78 dioptre (D) in the LASIK group. Ten years after surgery, the mean SE was -0.45 ± 1.22 D, the efficacy index was 0.98, and the safety index was 1.01. The posterior corneal elevations of the LASIK group at 2 mm corneal diameter were significantly lower than those of the control group. However, posterior corneal elevations at 6 mm corneal diameter were higher in the LASIK group than the controls (p < 0.01 for all). The mean Q-values of posterior corneal surface demonstrated significant positive direction compared to that of control eyes at 6 and 7 mm corneal diameters (p < 0.05 for both). At the thinnest point of the cornea, the anterior chamber depths were shallower in the LASIK group than in controls. Meanwhile, the anterior chamber volumes (ACV) were smaller in the LASIK group than in the control group. CONCLUSION: Our results demonstrated that the posterior corneal surface tends to show signs of central flattening and peripheral steepening 10 years after myopic LASIK surgery compared to that of non-operated myopic eyes.

Application of case teaching in genetics courses to students majoring in forestry.

Undergraduate students majoring in forestry generally reflect that genetics is one of the most difficult compul-sory courses, because the traditional teaching method is difficult to satisfy their needs. According to the theoretical charac-teristics of forestry and actual demands of the students, in the light of teaching and research experience in recent years, we adopted a series of typical genetic cases such as 'opening coffin to identify relatives', stem-throne of Lycium ruthenicum Murr, and magic powers in Harry Potter. Our practices revealed that the case teaching in genetics could train good personality traits, learning abilities and creativity of the students, stimulate their interests and initiatives in learning, and increase systematic learning.

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism.

BACKGROUND: To compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism. METHODS: This study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years. RESULTS: Preoperatively, the mean manifest spherical equivalent (SE) was -14.14 ± 2.12 D in the TICL group and -14.83 ± 2.79 D in the AK + ICL group (P = 0.28), and the mean manifest refractive cylinder, -2.87 ± 1.09 D and -2.58 ± 0.85 D, respectively (P = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group (P = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively (P = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group (P = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups. CONCLUSIONS: Both TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism. TRIAL REGISTRATION: NCT03202485.

In Vivo Observation of Lens Regeneration in Rat Using Ultra-Long Scan Depth Optical Coherence Tomography.

Purpose: To evaluate morphologic changes of lens regeneration in rats in vivo after extracapsular lens extraction (ECLE) by ultra-long scan depth optical coherence tomography (UL-OCT). Methods: A total of 42 Sprague-Dawley rats were used in this study. We performed ECLE on the right eyes of animals in the surgery group (n = 34). Biomicroscopy and UL-OCT scans were carried out for the surgery group immediately (within 1 hour postoperatively) and at days 1 and 3, weeks 1 and 2, and months 1, 2, and 3 postoperatively. After in vivo examination, three animals of the surgery group were euthanized at each time point for histology study, while the other 10 animals were examined continuously at those time points. The regenerated lens was evaluated in OCT images at 2 and 3 months postoperatively. The control group consisted of eight untreated rats that had OCT examination at the age of 5 months. Results: Lens regeneration could be observed from 2 weeks postoperatively. Regeneration was mainly at the peripheral capsular bag in the first month and central region thereafter. The average thickness of regenerated lenses was 2222 ± 309 and 2324 ± 352 µm at 2 and 3 months, respectively. Regeneration was faster in the first 2 months and slowed down thereafter. Although anterior capsule opening and posterior capsule adhesion and wrinkling existed, the regenerated lens still could form a relatively regular shape, however, the size was much smaller than that of the normal lenses from rats with the same age. Conclusions: Ultra-long OCT provides longitudinal data of the process of lens regeneration on a single individual rat in vivo, which may allow one to follow and compare the lens regenerative process under different interventions or therapy after ECLE in rats.

A Cataract Surgery Training Program: 2-Year Outcome After Launching.

BACKGROUND: To investigate whether a short-term training program can produce competent cataract surgeons. METHODS: This observational pilot study enrolled 12 trainees who could not perform phacoemulsification independently. The training consisted of 2 phases. During the first 3-month phase, trainees were taught phacoemulsification through wet laboratory exposure and deliberate practice in patients at the training center in the Eye Hospital of Wenzhou Medical University in China. The second phase consisted of performing 50 cases at the trainees׳ home institution with supports from instructors of the first phase. Trainees׳ surgical results were followed-up. The surgical skill as measured by the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) and surgical outcomes were analyzed. RESULTS: During the first phase trainees performed 193.3 ± 95.4 wet laboratory cases and 557 eyes in patients. The complication rate was 0.54%. The OSCAR scores improved significantly (p < 0.01) in the first phase. At the second phase, all the trainees could carry out phacoemulsification at their home hospital and the complication rate was 1.87%. During the long-term follow-up, 4936 cases of phacoemulsification were performed and the complication rate was 0.87%. CONCLUSIONS: Trainees succeeded in performing phacoemulsification safely and skillfully through a limited short period of training by wet laboratory exposure, deliberate practice in patients, and frequent formative feedback provided by the OSCAR tool.

Safety of femtosecond laser-assisted cataract surgery: assessment of aqueous humour and lens capsule.

PURPOSE: To investigate the effect of femtosecond laser-assisted cataract surgery (FLACS) on aqueous humour and lens capsule. METHODS: This prospective randomized comparative study enrolled 19 eyes that underwent FLACS as the trial group and 20 eyes that underwent conventional phacoemulsification as the control group. The femtosecond laser platform (LLS-fs 3D; LensAR, Orlando, FL, USA) was used to generate capsulotomy (laser energy 8 µJ) and lens fragmentation (laser energy 10 µJ). Morphology of the cutting edge and cells of anterior capsule was assessed by light microscopy. The proteins in the aqueous humour were identified by mass spectrometry (Ultraflex III TOF/TOF; Bruker Dalton, Bremen, Germany). Electrolyte in the aqueous humour was detected by a chemistry analyzer (Aeroset Clinical Chemistry Analyzer; Abbott Laboratories, Abbott Park, IL, USA). RESULTS: The cutting edge of anterior capsule was saw-tooth-shaped under magnification of 200× and 400× in the trial group, while it was smooth in the control group. Intact cells were found in the boundary area next to the cutting edge of anterior capsule in both groups. ß-Crystallin B1, γ-crystallin S and transferrin were detected in the aqueous humour in the trial group. The concentrations of K+ , Na+ and Cl- in the aqueous humour in the trial group differed significantly from those in the control group (p = 0.02, 0.03 and 0.04, respectively). CONCLUSION: Femtosecond laser-assisted cataract surgery (FLACS) causes release of transferrin and crystallin from lens to aqueous humour and results in significant changes in the concentrations of K+ , Na+ and Cl- in aqueous humour. However, these changes due to FLACS have no clinical significance or toxicity.

The efficacy and safety of posterior scleral reinforcement using genipin cross-linked sclera for macular detachment and retinoschisis in highly myopic eyes.

BACKGROUND/AIMS: To evaluate the efficacy and safety of posterior scleral reinforcement (PSR) using genipin cross-linked sclera as the material to treat macular detachment and retinoschisis, both without macular hole, in highly myopic eyes. METHODS: Twenty-one patients with highly myopic eyes (24 eyes) with macular detachment and retinoschisis were treated sequentially with genipin cross-linked PSR and were followed for at least 1 year after surgery. The best-corrected visual acuity (BCVA), spherical equivalent (SE) power, axial length (AL), optical coherence tomography, and the complications were evaluated. RESULTS: The mean SE decreased from -13.81±4.67 D preoperatively to -9.64±4.86 D postoperatively, while the improvement in the logMAR BCVA values was from 1.24±0.57 before surgery to 1.03±0.57 after surgery. The preoperative AL (29.73±2.31 mm) was decreased (28.08±2.08 mm) after the operation. The retina in 21 eyes (87.5%) was successful reattached and the macular detachment was significantly decreased in two eyes; a macular hole occurred in one eye. CONCLUSIONS: For at least a 1 year period of follow-up, PSR with genipin cross-linked sclera was safe and effective to treat macular detachment and retinoschisis in high myopia when a macular hole was not present. The reinforcement effect tended to be stabilised and maintained for 6 months after treatment.