The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study.

BACKGROUND: To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors. METHODS: In this population-based, cross-sectional study, a total of 3170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis. RESULTS: The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6, 28.0, 15.0, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20-1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95% CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). CONCLUSIONS: There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.

Diabetic Retinopathy, Visual Impairment, and the Risk of Six-Year Death: A Cohort Study of a Rural Population in China.

PURPOSE: The aim of this study was to explore the association between diabetic retinopathy (DR) and the risk of 6-year death, as well as the association between visual impairment (VI) and the risk of 6-year death in a rural Chinese population of age ≥30 years. METHODS: This was a population-based cohort study. In 2006-2007, 6,830 subjects aged ≥30 years were recruited from 13 villages in Northern China through clustered randomization. In 2012-2013, a 6-year follow-up was further done. Six different proportional hazards models, with different confounders adjusted, were used to explore the association between baseline DR and risk of death. RESULTS: 5,570 subjects were included in this study by our inclusion and exclusion criteria. Four hundred and ten (7.36%) subjects died by follow-up. The median ages of the dead subjects and survived subjects were 67 (interquartile range [IQR]: 58-72) years and 52 (IQR: 42-58) years (Z = 21.979, p < 0.001). Male accounted for 62.20 and 44.92% among the dead and survived subjects (χ2 = 45.591, p < 0.001). Besides, compared with those survived, the dead were found to be with lower education (χ2 = 109.981, p < 0.001), lower marriage rate (χ2 = 101.341, p < 0.001), lower income (χ2 = 123.763, p < 0.001), higher proportion of smoking (χ2 = 8.869, p = 0.003), higher systolic blood pressure (Z = 10.411, p < 0.001), lower body mass index (Z = -3.302, p = 0.001), larger spherical equivalent error (Z = 4.248, p < 0.001), lower intraocular pressure (Z = -4.912, p < 0.001), smaller anterior chamber depth (Z = -9.186, p < 0.001), larger length thickness (Z = 11.069, p < 0.001), higher fast blood glucose level (Z = 5.650, p < 0.001), higher total cholesterols (Z = 2.015, p = 0.044), higher low-density lipoprotein (Z = 2.024, p = 0.043), and higher proportion of drug usage (χ2 = 56.108, p < 0.001). Besides, the dead subjects were more likely to be with VI, glaucoma, cataract, age-related macular degeneration, diabetes, and DR. Hundred and forty-eight subjects were diagnosed with DR at baseline, and 33 (22.30%) of them were dead before follow-up. By adjusting all relative confounders in a proportional hazards model, DR was found to be a risk factor of 6-year death, the hazard ratio was 1.739 (95% confidence intervals: 1.080, 2.803). Another 5 different statistical models with different confounders adjusted also revealed a statistically significant association between DR and 6-year death. The association between VI and 6-year death was not statistically significant. CONCLUSIONS: DR increased the risk of 6-year death in a rural Chinese population aged ≥30 years, while VI did not.

Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: a meta-analysis.

BACKGROUND: To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted. METHODS: A comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction. RESULTS: There were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance [MD = 0.02, 95%CI: (- 0.03,0.06)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (- 0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD = 0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (- 0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) [MD = 0.18, 95%CI: (0.12, 0.24) for UIVA and MD = 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA (UDVA) and corrected distance visual acuity (CDVA) [MD = 0.01, 95%CI: (- 0.01,0.04) for UDVA; MD = 0.00, 95%CI: (- 0.01,0.01) for CDVA]. The postoperative refraction of bifocal group was similar to that of trifocal group [MD = -0.08, 95% CI: (- 0.19, 0.03) for spherical equivalent; MD = -0.09, 95%CI: (- 0.21, 0.03) for cylinder; MD = -0.09, 95% CI: (- 0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR = 0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR = 1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR = 0.98, 5% CI: (0.86, 1.12) for patient satisfaction]. CONCLUSION: Patients receiving trifocal IOLs, especially AT LISA tri 839 M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs.

[Influence of artificial insemination with donor sperm on the pregnancy outcomes and safety of the offspring].

OBJECTIVE: To investigate the factors influencing the pregnancy outcomes of artificial insemination with donor sperm (AID), improve the pregnancy rate, and evaluate the safety of the offspring. METHODS: We retrospectively analyzed 7,761 cycles of AID for 5,109 infertile couples performed between July 1, 2005 and June 30, 2013 in the Center of Reproductive Medicine of Shenyang No 204 Hospital, the outcomes of pregnancy, and the incidence of birth defects. RESULTS: Totally, 2 252 clinical pregnancies were achieved by AID, in which the pregnancy rate per cycle was 29. 02% and the cumulative pregnancy rate was 44. 08%. The clinical pregnancy rate was remarkably higher in the females of ≤ 35 years than in those of > 35 years old (30.31% vs 20.18%, P < 0.01), in the women with < 5-year infertility than in those with > 5-year infertility (30.83% vs 28.16%, P < 0.01), and in the patients of the ovarian stimulation group than in those of the natural cycle group (33.22% vs 28.68%, P < 0.01) The clinical pregnancy rate was the highest in the first treatment cycle (29.87%), with statistically significant difference from the fourth cycle (23.61%) (P < 0.05), but not between the other cycles (P > 0.05). There were 28 cases of birth defects in the offspring (1.40%), including 6 cases (21.43%) involving the cardiovascular system, 4 (14.29%) involving the musculoskeletal system, 3 (10.71%) involving the urogenital system, 3 (10.71%) involving the central nervous system, 2 cases (7.14%) of cleft lip and palate, 2 (7.14%) involving the respiratory system, 2 (7.14%) involving the gastrointestinal digestive system, and other anomalies. CONCLUSION: Female age, infertility duration, and ovarian stimulation treatment are important factors influencing the clinical pregnancy rate of AID. Artificial insemination with cryopreserved donor sperm does not increase the incidence of birth defects, which is considered as a relatively safe technique of assisted reproduction.

Retinal neuronal MCP-1 induced by AGEs stimulates TNF-α expression in rat microglia via p38, ERK, and NF-κB pathways.

PURPOSE: Retinal microglia can be activated by retinal neuronal monocyte chemoattractant protein-1 (MCP-1) and play a pivotal role in early retinal degeneration. The current study investigates the pathways via which retinal neuronal MCP-1 stimulates tumor necrosis factor-α (TNF-α) expression in rat microglia. METHODS: Primary rat retinal neurons and microglia were separated and cocultured in a Transwell apparatus. The levels of TNF-α mRNA and soluble TNF-α produced by the microglia in response to advanced glycation end product (AGE)-induced retinal neuronal MCP-1 were measured with real-time PCR and enzyme-linked immunosorbent assay (ELISA). The ability of neuronal MCP-1 to stimulate microglia activation was examined by preexposing the retinal neurons to AGEs and an MCP-1 antibody or by pretreating microglia with AGEs and siRNA specific for CC-chemokine receptor 2 (CCR2) knockdowns. Additionally, we investigated the effects of microglial activation on neuronal MCP-1-induced nuclear factor-κB (NF-κB) activation and phosphorylation of mitogen-activated protein kinases (MAPKs). RESULTS: Stimulation with AGEs significantly increased the expression of TNF-α mRNA and soluble TNF-α in the microglial cells. Retinal neurons that had been pretreated with AGEs and an MCP-1 antibody or microglia that were CCR2 knockdowns displayed greatly reduced TNF-α secretion. Using signaling pathway-specific inhibitors, we showed that blocking the p38, extracellular signal-regulated kinase (ERK), and NF-κB signaling pathways significantly reduced the expression of TNF-α by retinal neuronal MCP-1-stimulated microglia. CONCLUSIONS: This study indicates that TNF-α was released from the activated microglia induced by retinal neuronal MCP-1 via the p38, ERK, and NF-κB pathways, but not c-Jun N-terminal kinase (JNK), which may be an important finding in diabetic retinopathy pathogenesis.

Seroprevalence of B. pertussis infection and the changes of specific antibody levels in health care workers during the first two years of COVID-19 in Wuhu, China.

BACKGROUND: The reported number of pertussis cases declined after the implementation of COVID-19 prevention and control measures, however, the burden of pertussis among adults in China remains largely unknown. Additionally, the waning of natural antibody level has also rarely been assessed. METHODS: A total of 762 healthcare workers (HCWs) who had underwent the health examinations in 2021 and 2022 were included. Serum anti-PT IgG and IgA levels were determined by ELISA. Recent B. pertussis infection was defined as anti-PT IgG ≥100 IU/ml and/or anti-PT IgA ≥10 IU/ml. RESULTS: In 2021, the seroprevalence of recent B. pertussis infection was 10.1 %, and those HCWs in outpatient department had a higher percentage (18.6 %), and geometric mean concentration (GMC) (6.3 IU/ml) than those in other departments. This seroprevalence decreased to 2.4 % in 2022, although the difference remained significant. In the 77 subjects with recent B. pertussis infection in 2021, anti-PT IgG was undetectable in 18 cases the following year. Majority (68/76) of the subjects with anti-PT IgA ≥10 IU/ml in 2021 no longer had detected this antibody in 2022. Among 95 pertussis cases, approximately 60.0 % of cases reported no history of cough. Among those with a documented cough history, 36 cases with suspected pertussis courses who had never been diagnosed. Prolonged cough with nocturnal exacerbation (29/38) was the most commonly reported clinical symptom, and whoop was confirmed in six cases. Uroclepsia and syncopes during the cough attacks were reported by three and one subjects, respectively. One case presented with subconjunctival hemorrhage and tensionic purpura during the course. CONCLUSIONS: The results suggested a high prevalence of B. pertussis infection among HCWs. The presence of unrecognized adult pertussis cases and the rapid waning of antibody indicate the need to improve clinical management for suspected pertussis in adults, and to updated immunization schedule after childhood program.

Seroprevalence of tetanus and pertussis antibodies among health care workers in Wuhu, China.

This study aimed to elucidate the seroprevalence of antibodies to tetanus and pertussis among Chinese health care workers. Blood specimens from health care workers were collected during the 2021 annual medical examination at the First People's Hospital of Wuhu. Commercial ELISA kits were employed to quantify serum IgG antibodies against tetanus toxin (anti-TT IgG) and both IgG and IgA antibodies against pertussis toxin (anti-PT IgG, anti-PT IgA). A concentration of anti-TT IgG exceeding 0.1 IU/ml was deemed seroprotective against tetanus, while concentrations of anti-PT IgG ≥ 50 IU/ml or anti-PT IgA ≥ 15 IU/ml were indicative of a prior pertussis infection. The overall seroprotective rate for anti-TT IgG stood at 10.43% (92/882), with the highest seroprotective rate (13.91%) in the 20-29 age group, followed by the 30-39 age group (10.57%), 40-49 age group (5.80%), and 50-59 age group (5.63%). Eighteen (2.04%) of the studied subjects were positive to anti-PT IgG, and the positive rate in 20-39 age group and 40-59 age group was 1.19% (8/673) and 4.78% (10/209), respectively. Thirty (3.40%) subjects displayed anti-PT IgG levels ≥100 IU/ml and/or anti-PT IgA ≥ 15 IU/ml, suggesting a recent pertussis infection within the preceding year. Over half (503/882, 57.03%) had undetectable anti-PT IgG antibodies. The majority of health care workers in China appear susceptible to tetanus and pertussis, and a significant subset has experienced pertussis infection. The implementation of booster vaccinations against these diseases for Chinese health care workers is recommended.

Study of 27 aqueous humor cytokines in patients with type 2 diabetes with or without retinopathy.

PURPOSE: To compare the changes in the levels of 27 aqueous humor cytokines between nondiabetic controls and patients with type 2 diabetes and to ascertain the association of these cytokines with diabetic retinopathy (DR). METHODS: Undiluted aqueous humor samples were obtained from 102 nondiabetic patients (102 eyes) and 136 consecutive diabetic patients (136 eyes) who were divided into nine groups according to the Early Treatment of Diabetic Retinopathy Study severity scale. The concentrations of 27 cytokines in the aqueous humor samples were measured using a multiplex bead immunoassay. RESULTS: Compared with the nondiabetic controls, the diabetic patients had significantly higher concentrations of interleukin-1ß (IL-1ß; p<0.001), IL-6 (p<0.001), IL-8 (p<0.001), monocyte chemoattractant protein-1 (p<0.001), interferon gamma-induced protein-10 (p<0.001), and vascular endothelial growth factor (p<0.001) in the aqueous humor. However, the IL-10 (p=0.002) and IL-12 (p=0.013) concentrations were significantly lower for the diabetic patients. There were no significant differences in the concentrations of other cytokines between the diabetic patients and the controls. The IL-1ß, IL-6, IL-8, monocyte chemoattractant protein-1, and interferon gamma-induced protein-10 levels in the aqueous humor increased as the severity of DR increased. The correlation was significant. However, the vascular endothelial growth factor concentration was not correlated with the severity of DR. In addition, the IL-10 and IL-12 levels in the aqueous humor decreased as the severity of DR increased, and this negative correlation was significant. CONCLUSIONS: Various cytokines associated with inflammation and angiogenesis may contribute to the pathogenesis of DR, and chemokines may be more closely related to the development of this disease.

Aqueous cytokines as predictors of macular edema in non-diabetic patients following uncomplicated phacoemulsification cataract surgery.

PURPOSE: To ascertain whether cytokines in the aqueous humor can predict macular edema (ME) in non-diabetic patients following uncomplicated phacoemulsification cataract surgery. METHODS: Undiluted aqueous humor samples were obtained from 288 consecutive non-diabetic patients (288 eyes; 132 men and 156 women) who underwent cataract surgery. Macular edema was defined as an increase in the foveal center point thickness (FCPT) more than 30% from the preoperative baseline using optical coherence tomography 4 weeks after cataract surgery. The concentrations of 27 cytokines were measured in aqueous humor samples using the multiplex bead immunoassay. RESULTS: No major intraoperative complications occurred. The incidence of ME was 8.13% (23 patients) 4 weeks after cataract surgery. Compared to the ME (-) patients, the concentrations of interleukin-1ß (IL-1ß; p=0.016), IL-6 (p=0.013), monocyte chemotactic protein-1 (MCP-1; p=0.030), and vascular endothelial growth factor (VEGF; p=0.033) in the ME (+) patients were significantly higher. In addition, the aqueous humor levels of IL-1ß (r=0.376), IL-6 (r=0.418), MCP-1 (r=0.348), and VEGF (r=0.375) positively correlated with the postoperative FCPT. However, the aqueous humor levels of IL-10 (p=0.017) were significantly lower in patients with ME and were negatively correlated with the postoperative FCPT (r=-0.424). CONCLUSIONS: IL-1ß, IL-6, MCP-1, VEGF, and IL-10 may be potential predictors of postoperative macular thickness in non-diabetic patients following uncomplicated phacoemulsification cataract surgery.

Analyzing Anatomical Factors Contributing to Angle Closure Based on Anterior Segment Optical Coherence Tomography Imaging.

PURPOSE: To analyze anatomical factors contributing to angle closure based on anterior segment optical coherence tomography (AS-OCT) imaging. METHODS: A total of 238 patients with angle closure and 1122 normal controls were consecutively recruited for this study. Participants' eyes were imaged using AS-OCT under the same darkened ambient light conditions. The following parameters were analyzed: central anterior chamber depth (ACD); anterior chamber area (ACA); anterior chamber volume (ACV), anterior chamber width (ACW); corneal diameter (CD); posterior cornea curvature (PCC); anterior cornea curvature (ACC); maximum iris thickness (ITM); iris thickness at 750 um (IT750) and 2000 um (IT2000) from the scleral spur; iris curvature (IC); iris area (IA); lens vault (LV); angle opening distance (AOD); trabecular iris space area at 500 um (TISA500) and 750 um (TISA750) from the scleral spur; angle recess area (ARA). Lasso regression models were used to detect the collinearity of parameters. The multivariable logistic regression was performed to determine the independent association between angle closure and those parameters included in Lasso regression model. Also Factor analysis was performed to extract a few underlying factors (components) from these parameters. RESULTS: Lasso regression showed that ACD, ACV, PCC, IT750, IT2000 and LV were screened in the model. The multivariable logistic regression indicated that ACV, PCC, IT750 and LV were significantly associated with angle closure. Factor analyses revealed that 4 factors, each with its closely associated clusters of variables, produced the best results: ACA, ACV and ACD (Factor 1); LV, tIC and nIC, (Factor 2); ACW, CD and PCC (Factor 3); and tITM, tIT2000, tIT750, nIT2000 and nIT750 (Factor 4). CONCLUSIONS: Four separate mechanisms were showed to be involved in the pathogenesis of angle closure, from anterior chamber dimensions, lens, iris and cornea respectively. The parameters ACV, PCC, IT750, and LV are more predominant in determining angle closure.

Case Report: Various Clinical Manifestations Caused by Varicella-Zoster Virus in a Family.

A family cluster of varicella-zoster virus (VZV) infections was reported. Four family members (two children and their parents) continuously develop varicella after the grandmother's herpes zoster. The unvaccinated 16-month-old infant and his mother developed primary varicella with atypical clinical presentation; however, his 28-year-old father presented with a typical generalized vesicular rash. His vaccinated 4-year-old sister was clinically mild, which could be defined as a breakthrough varicella case. They infected the same virus strain but presented various clinical forms.

Predictors of angle widening after laser iridotomy in Chinese patients with primary angle-closure suspect using ultrasound biomicroscopy.

AIM: To assess the predictive value of baseline parameters of ultrasound biomicroscopy (UBM) for angle widening after prophylactic laser peripheral iridotomy (LPI) in patients with primary angle-closure suspect (PACS). METHODS: Angle-opening distance (AOD), trabecular iris angle (TIA), iris thickness, trabecular-ciliary process angle, and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI. Iris convexity (IC), iris insertion, angulation, and ciliary body (CB) size and position were graded. Uni- and multivariate regression analyses were used to determine factors predicting the change in AOD (ΔAOD500, calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC. RESULTS: In 94 eyes of 94 patients with PACS, LPI led to angle widening with increases in AOD500 and TIA (P<0.01). Multivariable regression analysis showed that IC (P<0.001), CB position (P=0.007) and iris insertion (P=0.049) were significantly predictive for ΔAOD500. All quadrants were categorized into extreme IC (27.8%), moderate IC (62.3%), and absent IC (9.9%) subgroups. The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants. The AOD500 increased by 55%, and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants. CONCLUSION: In PACS patients, quadrants with greater iris bowing predict substantial angle widening after LPI. Quadrants with a flatter iris, anteriorly positioned CB, and basal iris insertion are associated with less angle widening after LPI. Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.

Quantitative iris parameters and association with narrow angles.

PURPOSE: To investigate the relationship between quantitative iris parameters (iris curvature [I-Curv], iris area [I-Area], and iris thickness) and the presence of narrow angles. DESIGN: Cross-sectional, community-based study. PARTICIPANTS: We recruited 2047 subjects >50 years old without ophthalmic symptoms from a community clinic in Singapore. METHODS: All subjects underwent gonioscopy and anterior segment optical coherence tomography (AS-OCT) under dark conditions. An eye was considered to have narrow angles if the posterior pigmented trabecular meshwork was not visible for >/=180 degrees on nonindentation gonioscopy with the eye in the primary position. Customized software was used on horizontal AS-OCT scans to measure I-Curv, I-Area, and iris thickness 750 mum (IT750) and 2000 mum (IT2000) from the scleral spur. The average of both temporal and nasal measured values of the right eye was used for analysis. MAIN OUTCOME MEASURES: The association between iris parameters and narrow angles on gonioscopy. RESULTS: Iris parameters from 1465 eyes (71.6%) were available for analysis. Of these, 315 subjects (21.5%) had narrow angles. The mean I-Curv (0.366 vs 0.259 mm; P<0.020), IT750 (0.476 vs 0.453 mm; P<0.001), and IT2000 (0.491 vs 0.482 mm; P = 0.010) were greater in persons with than without narrow angles. After adjusting for age, gender, anterior chamber depth, axial length, and pupil size, the greater I-Curv, I-Area, IT750, and IT2000 were significantly associated with narrow angles (odds ratio [OR] 2.5 and 95% confidence interval [CI], 1.3-5.1; OR, 2.7 and 95% CI, 1.6-4.8; OR, 2.6 and 95% CI, 1.6-4.1; OR, 2.7 and 95% CI, 1.5-4.7, comparing 4th with 1st quartile for each parameter, respectively). In stratified analysis, women and subjects aged >/=60 years had stronger associations for most iris parameters with narrow angles than men and younger subjects. CONCLUSIONS: Quantitative iris parameters (I-Curv, I-Area, and iris thickness) are independently associated with narrow angles, particularly in women and older subjects. These data provide further insights into the pathogenesis of angle closure in Singaporeans. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019.

BACKGROUND: Vision loss is an important public health issue in China, but a detailed understanding of national and regional trends in its prevalence and causes, which could inform health policy, has not been available. This study aimed to assess the prevalence, causes, and regional distribution of vision impairment and blindness in China in 1990 and 2019. METHODS: Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used to estimate the prevalence of moderate and severe vision impairment and blindness in China and compare with other Group of 20 (G20) countries. We used GBD methodology to systematically analyse all available demographic and epidemiological data at the provincial level in China. We compared the age-standardised prevalences across provinces, and the changes in proportion of vision loss attributable to various eye diseases in 1990 and 2019. We used two different counterfactual scenarios with respect to population structure and age-specific prevalence to assess the contribution of population growth and ageing to trends in vision loss. FINDINGS: In 2019, the age-standardised prevalence was 2·57% (uncertainty interval [UI] 2·28-2·86) for moderate vision impairment, 0·25% (0·22-0·29) for severe vision impairment, and 0·48% (0·43-0·54) for blindness in China, which were all below the global average, but the prevalence of moderate and severe vision impairment had increased more rapidly than in other G20 countries from 1990 to 2019. The prevalence of vision loss increased with age, and the main causes of vision loss varied across age groups. The leading causes of vision impairment in China were uncorrected refractive error, cataract, and macular degeneration in both 1990 and 2019 in the overall population. From 1990 to 2019, the number of people with moderate vision impairment increased by 133·67% (from 19·65 to 45·92 million), those with severe vision impairment increased by 147·14% (from 1·89 to 4·67 million), and those with blindness increased by 64·35% (from 5·29 to 8·69 million); in each case, 20·16% of the increase could be explained by population growth. The contributions to these changes by population ageing were 87·22% for moderate vision impairment, 116·06% for severe vision impairment, and 99·22% for blindness, and the contributions by age-specific prevalence were 26·29% for moderate vision impairment, 10·91% for severe vision impairment, and -55·04% for blindness. The prevalence and specific causes of vision loss differed across provinces. INTERPRETATION: Although a comprehensive national policy to prevent blindness is in place, public awareness of visual health needs improving, and reducing the prevalence of moderate and severe vision impairment should be prioritised in future work. FUNDING: China National Key Research and Development Programme and Beijing Municipal Special Funds for Medical Research on Public Welfare Development and Reform.

Uncontrolled Hypertension Is Common in Glaucoma Clinics.

BACKGROUND: To determine the magnitude of uncontrolled hypertension and smoking among patients visiting an eye clinic, and ascertain if referral to care providers is effective. METHODS: Information on smoking status and blood pressure (BP) was collected among patients ≥18 years visiting an eye clinic. Those with high BP (systolic: ≥140 mm Hg and/or diastolic: ≥90 mm Hg) received a pamphlet on harms of hypertension on vision and were referred to a primary care physician. Smokers received a pamphlet on negative effects of smoking on vision and were offered referral to a tobacco quitline. Patients were followed up for referral outcome within 10 weeks from screening. RESULTS: Screening: A total of participants screened included 140 (29.5%) with high BP and 31 (6.6%) current smokers. In the high BP group, 92 (66%) subjects were previously diagnosed with hypertension. Follow-up: Of the 140 participants with elevated BP, 84 (60%) responded to follow-up. Among these 84 participants, 57 (67.9%) had consulted primary care, of whom 5 (8.8%) reported being newly diagnosed with hypertension, and 11 (19.3%) reported a change in their antihypertensive prescription. Among the 31 smokers, 24 (77.4%) were willing for quitline referral. Sixteen (66.7%) of these patients responded to follow-up, 8 (50%) of whom reported participation in a smoking-cessation program with 1 patient (6.3%) successfully quitting smoking. CONCLUSIONS: Nearly one-third of patients attending an eye clinic had elevated BP, and a smaller, but substantial, number of patients were current smokers. Eye clinics may serve as point for identification and referral of these patients with unmet needs.

Design, methodology, and preliminary results of the follow-up of a population-based cohort study in rural area of northern China: Handan Eye Study.

BACKGROUND: Handan Eye Study (HES), a large population-based cohort study in rural area of northern China, was one of the few studies focusing on the major eye diseases of rural Chinese population. The aim of this study was to introduce the design, methodology and to assess the data quality of the follow-up phase of HES. METHODS: All participants were recruited in Yongnian county of Handan city between 2012 and 2013. Main outcomes were measured by visual quality scales and ocular examinations. We performed the Chi-square test to make comparison of categorical data among groups, One-way analysis of variance and Kruskal-Wallis test was applied to make comparison of continuous data among groups, a post-hoc test was done to make further pairwise comparison. Inter-class correlation coefficients (ICCs) and Kappa coefficients were used to evaluate the consistency between different operators. Logistic regression was used to explore the influence factors of death, odds ratio (OR) and 95% confidence interval (CI) were used to estimate the effect size of each influence factor. RESULTS: The follow-up rate was 85.3%. Subjects were classified into three groups: the follow-up group (n = 5394), the loss to follow-up group (n = 929), and the dead group (n = 507), comparison of their baseline information was done. Compared with the other two groups, age of the dead group (66.52 ±â€Š10.31 years) was the oldest (Z = 651.293, P < 0.001), male proportion was the highest (59.0%) (χ = 42.351, P < 0.001), only 65.9% of the dead finished middle school education (Z = 205.354, P < 0.001). The marriage percentage, body mass index (BMI), best-corrected visual acuity (BCVA), and intra-ocular pressure of the dead group was the lowest either. Spherical equivalent error (SER) of the dead group was the highest. Besides, history of smoking, hypertension, diabetes, and heart disease were more common in the dead group. Multivariate analysis showed that age (OR = 1.901, 95% CI: 1.074-1.108), gender (OR = 0.317, 95% CI: 0.224-0.448), and BCVA (OR = 0.282, 95% CI: 0.158-0.503) were associated with death. While between the follow-up group and the loss to follow-up group, there was only difference on age, gender, BMI, systolic blood pressure and SER. The Cronbach coefficients of all scales used in the follow-up were ≥0.63 and the cumulative variances were ≥0.61, indicating good reliability and validity. The ICCs and Kappa coefficients between different operators were ≥0.69. CONCLUSIONS: HES has a high follow-up rate and a low risk of loss to follow-up bias. Age, gender, and BCVA are influence factors of death. Specifically, male subjects are at a higher risk of death than female, age is a risk factor of death while BCVA is a protective factor for death.

Efficacy and safety of vitrectomy for congenital cataract surgery: a systematic review and meta-analysis based on randomized and controlled trials.

PURPOSE: To explore the effectiveness and safety of vitrectomy for congenital cataract surgery. METHODS: We searched PubMed, Science Direct, The Cochrane Library, China National Knowledge Infrastructure and the Wanfang Database. Two researchers extracted data and assessed paper quality independently. Posterior capsule opacification (PCO) or visual axis opacification (VAO), reoperation rate, visual acuity, intraocular lenses (IOL) deposit, synechias, uveitis, secondary glaucoma, low-contrast sensitivity and IOL decentration were compared. RESULTS: We included 11 randomized controlled trials (RCTs) with 634 congenital cataract eyes. Cases of posterior capsule opacification in vitrectomy group were significantly less than that of control group, with risk ratio (RR) of 0.15 [95% confidence interval (CI): 0.09, 0.26], and there was no heterogeneity (I2  = 0%, p = 0.94). Reoperation rate in vitrectomy group was lower than that of control group either (RR = 0.40, 95%CI: 0.17, 0.94), and there was no heterogeneity (I2  = 0%, p = 0.85). Best-corrected visual acuity (BCVA) measured in LogMAR unit of vitrectomy group was smaller, with a mean difference (MD) of -0.17 (95%CI: -0.28, -0.05), and I2 was only 22%, indicating of a small heterogeneity. No statistical difference was found between two groups on IOL deposit (RR = 1.23, 95%CI: 0.70, 2.17), and the heterogeneity was small (I2  = 16%, p = 0.31). No statistical difference was found between two groups on synechias (RR = 1.08, 95%CI: 0.60, 1.94), with a quite small heterogeneity (I2  = 3%, p = 0.38). No statistical difference was found between two groups on uveitis (RR = 0.55, 95%CI: 0.15, 2.01), and there was no heterogeneity (I2  = 0%, p = 0.94). There was no statistical difference on IOP either, with a MD of 0.25 (95%CI: -1.56, 2.07), and there was no heterogeneity (I2  = 0%). Egger's test showed that there was no publication bias for all assessed outcomes. Low-contrast sensitivity was better in the vitrectomy group. And no evidence indicated vitrectomy could lead to a higher risk on secondary glaucoma or IOL decentration. CONCLUSION: Vitrectomy helps lower the PCO risk and reoperation risk after congenital cataract surgery, and also, vitrectomy helps patients gain a better BCVA and achieve a better low-contrast sensitivity, with no trade-off on IOP control, IOL deposit, synechias, uveitis and secondary glaucoma. We recommend performing vitrectomy during congenital cataract surgery.

Multifocal versus monofocal intraocular lenses for age-related cataract patients: a system review and meta-analysis based on randomized controlled trials.

We compare multifocal intraocular lenses (MFIOLs) to monofocal IOLs for visual acuity (VA), contrast sensitivity, and adverse events using data from 21 randomized controlled trials with 2951 subjects. There was no statistical difference between uncorrected distance VA and corrected distance VA. Compared with monofocal IOLs, MFIOLs showed a better performance on uncorrected intermediate VA measured at 60 cm and uncorrected near VA; the mean differences were -0.06 (95% confidence interval [CI]: -0.10, -0.03) and -0.13 (95% CI: -0.20, -0.07). Distance-corrected intermediate VA and distance-corrected near VA were measured wearing distance correction. MFIOLs performed better than monofocal IOLs on distance-corrected intermediate VA at 60 cm and distance-corrected near VA; the mean differences were -0.09 (95% CI: -0.12, -0.06) and -0.31 (95% CI: -0.43, -0.19). The contrast sensitivity of the MFIOL group was lower than that of the monofocal IOL group; mean difference was -0.06 (95% CI: -0.11, -0.02). More patients were spectacle free in the MFIOL group; the risk ratio was 2.86 (95% CI: 1.73, 4.73). More patients were troubled by glare and halos in the MFIOL group; the risk ratios were 1.91 (95% CI: 1.24, 2.95) and 3.08 (95% CI: 2.11, 4.49). We conclude that, compared with monofocal IOLs, MFIOLs give patients better near vision and intermediate vision at 60 cm, both corrected and uncorrected. Patients undergoing MFIOLs implantation are more likely to be spectacle free but have a higher risk of glare, halos, and lower contrast sensitivity.

[Applications of anterior segment optical coherence tomography in ophthalmology].

The background, technical characteristics and operation procedures of anterior segment optical coherence tomography (OCT) are introduced. The ophthalmic applications of this technique are summarized. The initial studies showed that anterior segment OCT can be a promising tool for the observation of image and analysis of the cornea, the imaging and biological measuring of the anterior chamber, the observation of image and quantitative evaluation of the anterior chamber angle, the observation of image and assessment of phakic intraocular lenses, the observation of image and evaluation of trabeculectomy blebs as well as the observation of ocular accommodation.

Purification, characterization and anti-fatigue activity of polysaccharide fractions from okra (Abelmoschus esculentus (L.) Moench).

The aim of this study was to investigate the anti-fatigue activity of polysaccharide fractions from Abelmoschus esculentus (L.) Moench (AE) in mice. After crude polysaccharide (CAEP) was extracted from AE and purified by DEAE cellulose-52 column, two polysaccharide fractions (AEP-1 and AEP-2) were obtained. The structural analysis suggested that AEP-1 and AEP-2 were a RG-I polysaccharide and an AG-II polysaccharide, respectively. According to the results of the weight-loaded swimming test, compared with the negative control group, the CAEP, AEP-1 and AEP-2 treatment groups could prolong the swimming time, decrease serum urea nitrogen (SUN) and blood lactic acid (BLA), and increase hepatic glycogen (HG) and muscle glycogen (MG), which indicated that okra polysaccharides have an effective anti-fatigue activity. Furthermore, our study exhibited the anti-fatigue mechanism of okra polysaccharide was correlated with retarding the accumulation of creatine kinase (CK) and lactate dehydrogenase (LDH) in serum, and enhancing succinate dehydrogenase (SDH), adenosine triphosphate (ATP) and adenosine triphosphatase (ATPase) levels. In addition, the anti-fatigue activity of AEP-1 was stronger than that of AEP-2, and significantly better than that of CAEP. Therefore, AEP-1 and AEP-2 may be the main active anti-fatigue functional substances of AE.