Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery.

PURPOSE: To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS). SETTING: Department of Ophthalmology, Shanghai Aier Eye Hospital, China. DESIGN: A retrospective, observational study. METHODS: Patients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months. RESULTS: 101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group. CONCLUSIONS: Panoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient's corneal astigmatism.

Detection of shallow anterior chamber depth from two-dimensional anterior segment photographs using deep learning.

BACKGROUND: The purpose of this study was to implement and evaluate a deep learning (DL) approach for automatically detecting shallow anterior chamber depth (ACD) from two-dimensional (2D) overview anterior segment photographs. METHODS: We trained a DL model using a dataset of anterior segment photographs collected from Shanghai Aier Eye Hospital from June 2018 to December 2019. A Pentacam HR system was used to capture a 2D overview eye image and measure the ACD. Shallow ACD was defined as ACD less than 2.4 mm. The DL model was evaluated by a five-fold cross-validation test in a hold-out testing dataset. We also evaluated the DL model by testing it against two glaucoma specialists. The performance of the DL model was calculated by metrics, including accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS: A total of 3753 photographs (1720 shallow AC and 2033 deep AC images) were assigned to the training dataset, and 1302 photographs (509 shallow AC and 793 deep AC images) were held out for two internal testing datasets. In detecting shallow ACD in the internal hold-out testing dataset, the DL model achieved an AUC of 0.86 (95% CI, 0.83-0.90) with 80% sensitivity and 79% specificity. In the same testing dataset, the DL model also achieved better performance than the two glaucoma specialists (accuracy of 80% vs. accuracy of 74 and 69%). CONCLUSIONS: We proposed a high-performing DL model to automatically detect shallow ACD from overview anterior segment photographs. Our DL model has potential applications in detecting and monitoring shallow ACD in the real world. TRIAL REGISTRATION: http://clinicaltrials.gov , NCT04340635 , retrospectively registered on 29 March 2020.

Protection of MCC950 against Alzheimer's disease via inhibiting neuronal pyroptosis in SAMP8 mice.

Neuronal dysfunction and loss are thought to be one of the causes of cognitive impairment in Alzheimer's disease (AD), but the specific mechanism of neuronal loss in the pathogenesis of AD remains controversial. This study explored the role of NLRP3 inflammasome-induced neuronal pyroptosis in neuronal loss of AD, and pioneered the use of NLRP3 inhibitor MCC950 to intervene in the treatment of senescence-accelerated mouse prone 8 (SAMP8) mice. In vitro, human primary neurons (HPNs) pretreated with MCC950 were stimulated with amyloid-ß1-42 (Aß1-42), and it was found that MCC950 significantly reduced the neurotoxicity of Aß1-42 by inhibiting neuronal pyroptosis. In vivo, SAMP8 mice were randomly divided into vehicle-treated group and MCC950-treated group, and it was found that MCC950 also played a positive role in treatment. The intervention of MCC950 improved the spatial memory ability and brain histological morphology of SAMP8 mice, and reduced the deposition of amyloid-ß in the brain. Furthermore, MCC950 was found to inhibit the overexpressions of NLRP3, caspase-1, and GSDMD, which were the response factors of pyroptosis in SAMP8 mouse neurons, by immunofluorescence staining. In this study, we found that neuronal pyroptosis induced by the NLRP3/caspase-1/GSDMD axis was an important factor in neuronal loss of AD, and revealed that MCC950 might be a potential AD therapeutic agent.

Impact of COVID-19 pandemic on a world-wide private ophthalmic practice.

Purpose: To assess the impact of the COVID-19 pandemic on a worldwide private ophthalmic practice. Design: In this retrospective study, we reviewed the 2020 monthly outpatient and surgical volume of refractive, cataract, and retinal disease in Aier Eye clinics/hospitals of different regions, including the United States, Germany, Spain, Italy, and six major cities in China (Wuhan, Beijing, Shanghai, Shenyang, Urumqi and Yili). All of these data were compared to those of the same period of 2019. Results: Overall, during the early stage (2020 January to 2020 April) of COVID-19 outbreak, the outpatient and surgical volume of three main type ocular diseases (refractive, cataract and retinal surgery) showed an obvious reduction and reached the bottom in February in China. The data from the United States, Germany, Spain and Italy revealed the same trend, but the visit count nadir occurred until April, which is consistent with the spread trend of COVID-19 disease around the world. The average change rates of surgery volume (refractive, cataract and retinal surgery) in Chinese centers are 5.59%, -26.38%, 11.76%. The change rates of refractive (REF) and cataract volumes (CAT) in the United States are -8.62% and -10.58%, in Germany are -13.71% and -20.49%, in Spain are 15.35% and 27.97%, in Italy are 30.43% and -22.64%. In addition, the optometry outpatient volumes keep going up since May, with an average increasing rate of 21.18%, ranging from 7.43% to 49.51%. Conclusion: In conclusion, in this global chain of eye care units, the visit volumes of cataract, retinal and refractive changed significantly with the spread of COVID-19 pandemic. Among them, cataract surgery was the most affected sub-specialty, and refractive surgery and optometry volumes showed a potential growth in the near future. Therefore, medical institutions should make corresponding adjustments to the disease diagnosis and treatment strategies.

Systematic evaluation of machine learning-enhanced trifocal IOL power selection for axial myopia cataract patients.

PURPOSE: This study aimed to evaluate and optimize intraocular lens (IOL) power selection for cataract patients with high axial myopia receiving trifocal IOLs. DESIGN: A multi-center, retrospective observational case series was conducted. Patients having an axial length ≥26 mm and undergoing cataract surgery with trifocal IOL implanted were studied. METHODS: Preoperative biometric and postoperative outcome data from 139 eyes were collected to train and test various machine learning (ML) models (support vector machine, linear regression, and stacking regressor) using five-fold cross-validation. The models' performance was further validated externally using data from 48 eyes enrolled from other hospitals. Performance of seven IOL calculation formulas (BUII, Kane, EVO, K6, DGS, Holladay I, and SRK/T) were examined with and without ML models. RESULTS: The results of cross-validation revealed improvements across all IOL calculation formulas, especially for K6 and Holladay I. The model increased the percentage of eyes with a prediction error (PE) within ±0.50 D from 71.94% to 79.14% for K6, and from 35.25% to 51.80% for Holladay I. In external validation involving 48 patients from other centers, six out of seven formulas demonstrated a reduction in the mean absolute error (MAE). K6's PE within ±0.50 D improved from 62.50% to 77.08%, and Holladay I from 16.67% to 58.33%. CONCLUSIONS: In this study, we conducted a comprehensive evaluation of seven IOL power calculation formulas in high axial myopia cases and explored the effectiveness of the Stacking Regressor model in augmenting their accuracy. Of these formulas, K6 and Holladay I exhibited the most significant improvements, suggesting that integrating ML may have varying levels of effectiveness across different formulas but holds substantial promise in improving the predictability of IOL power calculations in patients with long eyes.

Intraocular lens constant optimization in toric intraocular lens calculation using keratometry and total corneal power.

PURPOSE: To evaluate intraocular lens (IOL) constant optimization in toric IOL calculation with keratometry (K) and total corneal refractive power (TCRP). METHODS: Predicted spherical equivalent (SE) and residual astigmatism (RA) with K and TCRP were retrospectively calculated using the Haigis, Holladay 1, and SRK/T formulae and optimized IOL constants. The results of the Barrett calculator and the Abulafia-Koch formula with K were also calculated. The median absolute error in SE (MedAE-SE), mean absolute error in RA (MAE-RA), and centroid error (CE) were analyzed. RESULTS: Seventy-nine eyes of 71 patients implanted with toric IOLs were included. With K, there were no significant differences between the results before and after constant optimization using all the formulae. With TCRP, constant optimization significantly reduced MedAE-SE; however, significantly increased MAE-RA and CE using the Holladay 1 and SRK/T formulae. MedAE-SE, MAE-RA, and CE using the Haigis formula did not show significant differences. The difference in the predicted RA before and after constant optimization increased with IOL toricity. The MedAE-SE predicted by TCRP was significantly higher than that predicted by K despite constant optimization. The MAE-RA and CE predicted by TCRP were significantly lower than those predicted by K without posterior corneal astigmatism optimization; however, were not significantly different from those predicted by the Barrett and Abulafia-Koch formulae. CONCLUSIONS: Constant optimization is recommended when using the TCRP in toric IOL calculations, particularly for patients with large astigmatism. However, TCRP did not yield more accurate results than optimized K in toric IOL calculations despite constant optimization.

Blocking GSDME-mediated pyroptosis in renal tubular epithelial cells alleviates disease activity in lupus mice.

An increase in apoptosis and/or defects in the clearance of apoptotic cells resulting in massive secondary necrosis have been recognized as the main causes of systemic lupus erythematosus (SLE). Recent findings have revealed that gasdermin E (GSDME)-mediated pyroptosis is a mechanism associated with secondary necrosis. We aimed to investigate the effects of GSDME-mediated pyroptosis on disease activity in lupus mice. In vivo, high levels of GSDME expression were observed in the renal tubules of pristane-induced lupus (PIL) mice and SLE patients. In lupus mice, GSDME knockout or SP600125 administration effectively ameliorated lupus-like features by inhibiting GSDME-mediated renal tubular epithelial cell pyroptosis. In vitro, treatment with tumour necrosis factor-α (TNF-α) plus cycloheximide (CHX) or SLE sera induced HK2 cells to undergo pyroptosis in a caspase-3- and GSDME-dependent manner. Likewise, SP600125 significantly reduced GSDME expression and decreased pyroptosis in HK2 cells. GSDME-mediated pyroptosis may be associated with SLE pathogenesis, and targeting GSDME may be a potential strategy for treating SLE.

Attenuation of Rheumatoid Arthritis Through the Inhibition of Tumor Necrosis Factor-Induced Caspase 3/Gasdermin E-Mediated Pyroptosis.

OBJECTIVE: To determine the role of gasdermin E (GSDME)-mediated pyroptosis in the pathogenesis and progression of rheumatoid arthritis (RA), and to explore the potential of GSDME as a therapeutic target in RA. METHODS: The expression and activation of caspase 3 and GSDME in the synovium, macrophages, and monocytes of RA patients were determined by immunohistochemistry, immunofluorescence, and Western blot analysis. The correlation of activated GSDME with RA disease activity was evaluated. The pyroptotic ability of monocytes from RA patients was tested, and the effect of tumor necrosis factor (TNF) on caspase 3/GSDME-mediated pyroptosis of monocytes and macrophages was investigated. In addition, collagen-induced arthritis (CIA) was induced in mice lacking Gsdme, and the incidence and severity of arthritis were assessed. RESULTS: Compared to cells from healthy controls, monocytes and synovial macrophages from RA patients showed increased expression of activated caspase 3, GSDME, and the N-terminal fragment of GSDME (GSDME-N). The expression of GSDME-N in monocytes from RA patients correlated positively with disease activity. Monocytes from RA patients with higher GSDME levels were more susceptible to pyroptosis. Furthermore, TNF induced pyroptosis in monocytes and macrophages by activating the caspase 3/GSDME pathway. The use of a caspase 3 inhibitor and silencing of GSDME significantly blocked TNF-induced pyroptosis. Gsdme deficiency effectively alleviated arthritis in a mouse model of CIA. CONCLUSION: These results support the notion of a pathogenic role of GSDME in RA and provide an alternative mechanism for RA pathogenesis involving TNF, which activates GSDME-mediated pyroptosis of monocytes and macrophages in RA. In addition, targeting GSDME might be a potential therapeutic approach for RA.

Analysis of Lens Thickness Distribution Based on Swept-Source Optical Coherence Tomography (SS-OCT).

OBJECTIVE: This study aimed to analyze the distribution of lens thickness (LT) and its associations in age-related cataract patients based on swept-source optical coherence tomography (SS-OCT). METHODS: This cross-sectional study included 59,726 Chinese age-related cataract patients. Only right-eye data were included in the study. Repeated measures of ocular parameters were performed using an IOL Master 700 device. The distributions of ocular biometric data including anterior chamber depth (ACD), LT, axial length (AL), central corneal thickness (CCT), white-to-white (WTW), and mean keratometry (MK) and their associations with age were assessed. The anterior segment (AS) was measured as the sum of CCT, ACD, and LT, while the vitreous chamber depth (VCD) was calculated as the difference between AL and AS. The values of LT : AL, AS : AL, and VCD : AL in different AL groups and their changes are the main outcome measures used to observe the proportion of the anterior and posterior segments of the eye. RESULTS: Biometric data were available for 59,726 individuals. The mean age was 68.81 years (range = 40-100); 40.62% were male and 59.38% were female. Mean anterior chamber depth (ACD) was 3.02 ± 0.44 mm, mean LT was 4.51 ± 0.44 mm, mean axial length (AL) was 23.89 ± 1.92 mm, mean central corneal thickness (CCT) was 0.53 ± 0.03 mm, mean white-to-white (WTW) was 11.64 ± 0.44 mm, and mean keratometry (MK) was 44.27 ± 1.65 diopter. Female patients had shorter AL, shallower ACD, smaller CCT and WTW, decreased LT, and steeper corneas (p < 0.005). ACD revealed the strongest negative correlation (p ≤ 0.001, r = -0.682) with LT. Age (p ≤ 0.001, r = 0.348) showed a moderate positive correlation, whereas MK (p ＜ 0.05, r = 0.011), CCT (p ≤ 0.001, r = 0.041) had a weak positive correlation and WTW (p ≤ 0.001, r = -0.034) had a weak negative correlation with LT. A nonlinear correlation was found between LT and AL. LT increased with age in both males and females. LT changed variably in eyes with AL less than 27 mm, LT decreased as AL increased, then LT gradually increased as AL increased in extremely long and extra-long eyes (p ≤ 0.001). LT : AL and AS : AL decreased as AL increased, VCD : AL gradually increased as AL increased in highly myopic eyes, and VCD : AL increased by about 0.01 for every 1 mm increase in AL. CONCLUSIONS: Among Chinese age-related cataract patients, we found LT to have the strongest relation with ACD. The lens was thicker in elderly patients and women. The correlation between LT and AL is not a simple negative correlation; with the increase of age, LT decreases first and then increases. The proportion of VCD is constantly rising with the elongation of AL.

Development and validation of deep learning algorithms for automated eye laterality detection with anterior segment photography.

This paper aimed to develop and validate a deep learning (DL) model for automated detection of the laterality of the eye on anterior segment photographs. Anterior segment photographs for training a DL model were collected with the Scheimpflug anterior segment analyzer. We applied transfer learning and fine-tuning of pre-trained deep convolutional neural networks (InceptionV3, VGG16, MobileNetV2) to develop DL models for determining the eye laterality. Testing datasets, from Scheimpflug and slit-lamp digital camera photography, were employed to test the DL model, and the results were compared with a classification performed by human experts. The performance of the DL model was evaluated by accuracy, sensitivity, specificity, operating characteristic curves, and corresponding area under the curve values. A total of 14,468 photographs were collected for the development of DL models. After training for 100 epochs, the DL models of the InceptionV3 mode achieved the area under the receiver operating characteristic curve of 0.998 (with 95% CI 0.924-0.958) for detecting eye laterality. In the external testing dataset (76 primary gaze photographs taken by a digital camera), the DL model achieves an accuracy of 96.1% (95% CI 91.7%-100%), which is better than an accuracy of 72.3% (95% CI 62.2%-82.4%), 82.8% (95% CI 78.7%-86.9%) and 86.8% (95% CI 82.5%-91.1%) achieved by human graders. Our study demonstrated that this high-performing DL model can be used for automated labeling for the laterality of eyes. Our DL model is useful for managing a large volume of the anterior segment images with a slit-lamp camera in the clinical setting.

Assessment of Generative Adversarial Networks for Synthetic Anterior Segment Optical Coherence Tomography Images in Closed-Angle Detection.

Purpose: To develop generative adversarial networks (GANs) that synthesize realistic anterior segment optical coherence tomography (AS-OCT) images and evaluate deep learning (DL) models that are trained on real and synthetic datasets for detecting angle closure. Methods: The GAN architecture was adopted and trained on the dataset with AS-OCT images collected from the Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, synthesizing open- and closed-angle AS-OCT images. A visual Turing test with two glaucoma specialists was performed to assess the image quality of real and synthetic images. DL models, trained on either real or synthetic datasets, were developed. Using the clinicians' grading of the AS-OCT images as the reference standard, we compared the diagnostic performance of open-angle vs. closed-angle detection of DL models and the AS-OCT parameter, defined as a trabecular-iris space area 750 µm anterior to the scleral spur (TISA750), in a small independent validation dataset. Results: The GAN training included 28,643 AS-OCT anterior chamber angle (ACA) images. The real and synthetic datasets for DL model training have an equal distribution of open- and closed-angle images (all with 10,000 images each). The independent validation dataset included 238 open-angle and 243 closed-angle AS-OCT ACA images. The image quality of real versus synthetic AS-OCT images was similar, as assessed by the two glaucoma specialists, except for the scleral spur visibility. For the independent validation dataset, both DL models achieved higher areas under the curve compared with TISA750. Two DL models had areas under the curve of 0.97 (95% confidence interval, 0.96-0.99) and 0.94 (95% confidence interval, 0.92-0.96). Conclusions: The GAN synthetic AS-OCT images appeared to be of good quality, according to the glaucoma specialists. The DL models, trained on all-synthetic AS-OCT images, can achieve high diagnostic performance. Translational Relevance: The GANs can generate realistic AS-OCT images, which can also be used to train DL models.

Comparison of Ocular Biometry Profiles in Urban and Rural Cataract Candidates in Eastern China.

PURPOSE: To compare ocular biometric parameters between urban and rural cataract patients in Shanghai, China. METHODS: A study of ocular biometry records from urban and rural hospitals was performed for cataract patients at least 50 years of age. The ocular biometrical parameters, which were measured with partial coherence laser interferometry (IOL Master, Zeiss), were axial length (AL), anterior chamber depth (ACD), radius of corneal curvature (K, including steep/flat/average K), astigmatism, and axis. Only the right eye record of each patient was analysed. RESULTS: Ocular biometric data included 2839 urban patients (73.15 ± 9.54 years) and 2646 rural patients (73.64 ± 7.32 years). Mean AL, ACD, and K were 24.35 ± 2.34 mm, 3.14 ± 0.58 mm, and 44.38 ± 1.52 D, respectively, in urban patients and 23.58 ± 1.70 mm, 3.08 ± 0.57 mm, and 44.53 ± 1.50 D, respectively, in rural patients. The urban subjects had significantly longer axial lengths (in both univariate and multivariate linear regression analyses) and deeper ACDs (in univariate analysis) than rural subjects (p < 0.01). There was no significant difference in steep K, flat K, and average K between the two groups. With-the-rule (WTR) corneal astigmatism was found in 1787 eyes (32.58%), against-the-rule (ATR) corneal astigmatism was found in 2727 eyes (49.72%), and oblique corneal astigmatism was found in 971 eyes (17.70%). CONCLUSIONS: We report biometry and astigmatism data in a large cohort of urban and rural adult subjects for the first time. In our study, a short AL, shallow ACD, and axis turned in an ATR direction had higher prevalence rates in the rural subjects. This profile of ocular biometric data and corneal astigmatism will be helpful in planning for intraocular lens (IOL) power calculations and astigmatism correction in subjects in different locations.

Activated coagulation is associated with the disease activity of axial spondyloarthritis.

BACKGROUND: Activation of the coagulation system has been related to disease activity in some inflammatory diseases. Here, we aimed to investigate the relationship between coagulation function and the disease activity of axial spondyloarthritis (axSpA). METHODS: This study retrospectively recruited 144 axSpA patients and 55 healthy controls. The patients were divided into an active group (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI ≥ 4) and a remission group (BASDAI < 4). The coagulation, inflammatory and clinical parameters were detected. The correlations between these parameters were analyzed with Spearman's correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to compare the values of these variables in discriminating disease activity. Furthermore, binary logistic regression analysis was used to assess the risk factors for axSpA disease activity. RESULTS: Fibrinogen (FIB) was increased in the axSpA group compared to healthy controls (P < 0.001). Additionally, FIB and D-dimer were higher in the active group than in the remission group (P < 0.05, respectively). FIB and D-dimer were positively correlated with ESR, CRP, BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) (P < 0.05, respectively). The area under the curve (AUC) of FIB was higher than that of ESR, CRP and D-dimer. The optimal cut-off value of FIB was 3.23 g/L, with a specificity of 62.0% and sensitivity of 75.0%. FIB (OR = 4.335, 95% CI: 1.262-14.888, P = 0.020) and BASFI score (OR = 1.878, 95% CI: 1.441-2.448, P < 0.001) were independent risk factors affecting disease activity. CONCLUSION: Activated coagulation is closely related to the disease activity of axSpA. FIB and D-dimer might be novel indicators for monitoring the disease activity of axSpA.

Altered Resting-State EEG Microstate in Idiopathic Sudden Sensorineural Hearing Loss Patients With Tinnitus.

In order to clarify the central reorganization in acute period of hearing loss, this study explored the aberrant dynamics of electroencephalogram (EEG) microstates and the correlations with the features of idiopathic sudden sensorineural hearing loss (ISSNHL) and tinnitus. We used high-density EEG with 128 channels to investigate alterations in microstate parameters between 25 ISSNHL patients with tinnitus and 27 healthy subjects. This study also explored the associations between microstate characteristics and tinnitus features. Microstates were clustered into four categories. There was a reduced presence of microstate A in amplitude, coverage, lifespan, frequency and an increased presence of microstate B in frequency in ISSNHL patients with tinnitus. According to the syntax analysis, a reduced transition from microstate C to microstate A and an increased transition from microstate C to microstate B were found in ISSNHL subjects. In addition, the significant negative correlations were found between Tinnitus Handicap Inventory (THI) scores and frequency of microstate A as well as between THI scores and the probability of transition from microstate D to microstate A. While THI was positively correlated with the transition probability from microstate D to microstate B. To sum up, the significant differences in the characteristics of resting-state EEG microstates were found between ISSNHL subjects with tinnitus and healthy controls. This study suggests that the alterations of central neural networks occur in acute stage of hearing loss and tinnitus. And EEG microstate may be considered as a useful tool to study the whole brain network in ISSNHL patients.