Giant retinal pigment epithelium tears with membranous nephropathy: a case report and literature review.

BACKGROUND: Kidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy and light-chain deposition disease. However, pigment epithelium tears associated with membranous nephropathy have not been reported or systematically analysed. CASE PRESENTATION: A 68-year-old man presented with decreased right eye visual acuity. Optical coherence tomography (OCT) revealed cystic macular edema, localized serous detachment of the retina and loss of the outer retinal structure in the right eye and retinal pigment epithelium detachment (PED) combined with serous detachment of the retina in the left eye. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) revealed giant RPE tears in the right eye and exudative age-related macular degeneration in the left eye. The patient also suffered from severe membranous nephropathy-autoimmune glomerulonephritis. Renal biopsy immunofluorescence revealed a roughly granular pattern, with immunoglobulin G (IgA), immunoglobulin G (IgG), IgM, complement C3(Components 3), λ light chain and κ light chain subepithelial staining. CONCLUSIONS: It is hypothesized that severe membranous nephropathy caused immune complex deposition on the surface of Bruch membrane, resulting in weakened adhesion between the RPE and Bruch membrane and impaired RPE pump function, combined with age-related macular degeneration, leading to giant RPE tears in the right eye. Close attention should be given to the ocular condition of patients with membranous nephropathy to facilitate timely treatment and avoid serious consequences.

Vitreous management in Yamane's technique for crystalline lens dislocation: anterior vitrectomy or PPV?

OBJECTIVE: To study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation for crystalline lens dislocation. METHODS: Fifty-three patients (56 eyes) with crystalline lens subluxation/dislocation were enrolled in this retrospective interventional study. Patients received anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation. Main outcome measures were postoperative BCVA and surgical complications. Proportion of spontaneous PVD and preoperative undetected retinal holes/degeneration (PURH/D) were recorded. RESULTS: Twenty-four eyes were treated with anterior vitrectomy (Group AnV) and 32 eyes with pars plana vitrectomy (Group PPV). Overall incidence of PURH/D was 10.7% (6/56). Spontaneous PVD occurred in 68.8% (24/32) in Group PPV. During six months follow-up, one case of postoperative RRD and one case of choroidal detachment occurred in Group AnV. There was no significant difference between anterior vitrectomy and PPV in the final BCVA and postoperative complications. CONCLUSION: Anterior or pars plana vitrectomy, which are both applicable in YAMANE technique for crystalline lens dislocation, exhibit similar surgical outcomes. Patient's age, PVD status and PURH helps to determine the route of vitrectomy. Pediatric patients might be potential candidates for transcorneal vitreolensectomy. For adult, PURH managed with total vitrectomy and intraoperative lase retinopexy might be beneficial to decrease the incidence of postoperative RRD.

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation.

AIM: To investigate the effect of Cionni-modified capsular tension ring (CTR) implantation in patients with severely traumatic subluxated cataracts. METHODS: All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed. Corrected distance visual acuity (CDVA), extent of zonulysis, intraocular lens (IOL) position, intraoperative presentation, and complications were assessed. The primary outcomes included IOL centration stability and other postoperative complications. RESULTS: Twenty patients (20 eyes) were included in this study. The mean age in this study was 58.0±11.3y, and the average follow-up time was 17.3±12.8mo. Capsule bags were saved by Cionni-modified CTR. Nine eyes (45%) underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber. The preoperative mean CDVA was 0.83±0.24 logMAR, and the postoperative average CDVA was 0.23±0.30 logMAR (P<0.05). The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm, respectively; the vertical and horizontal IOL tilt after surgery was 5.5°±2.5° and 6.1°±2.2°, respectively. None of the eyes had obvious IOL decentration during the follow-up time. Eight eyes (40%) had posterior capsule opacification (PCO) that was severe enough to cause poor vision. Neodymium: YAG laser capsulotomy were performed on these eyes when the CTR was stabilized. CONCLUSION: With the help of Cionni-modified CTR, capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

Self-rescue technique and Yamane's technique in situ: Management of intraoperative haptic slippage.

Haptic slippage is a frequently encountered and technically demanding complication in Yamane's surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and self-rescue technique, Yamane's technique in situ is applicable when the haptic of dislocated intraocular lens suits for flange-making.

Research on Assistant Diagnosis of Fundus Optic Neuropathy Based on Deep Learning.

PURPOSE: The purpose of this study was to use the neural network to distinguish optic edema (ODE), and optic atrophy from normal fundus images and try to use visualization to explain the artificial intelligence methods. METHODS: Three hundred and sixty-seven images of ODE, 206 images of optic atrophy, and 231 images of normal fundus were used, which were provided by two hospitals. A set of image preprocessing and data enhancement methods were created and a variety of different neural network models, such as VGG16, VGG19, Inception V3, and 50-layer Deep Residual Learning (ResNet50) were used. The accuracy, recall, F1-score, and ROC curve under different networks were analyzed to evaluate the performance of models. Besides, CAM (class activation mapping) was utilized to find the focus of neural network and visualization of neural network with feature fusion. RESULTS: Our image preprocessing and data enhancement method significantly improved the accuracy of model performance by about 10%. Among the networks, VGG16 had the best effect, as the accuracy of ODE, optic atrophy and normal fundus were 98, 90, and 95%, respectively. The macro-average and micro-average of VGG16 both reached 0.98. From CAM we can clearly find out that the focus area of the network is near the optic cup. From feature fusion images, we can find out the difference between the three types fundus images. CONCLUSION: Through image preprocessing, data enhancement, and neural network training, we applied artificial intelligence to identify ophthalmic diseases, acquired the focus area through CAM, and identified the difference between the three ophthalmic diseases through neural network middle layers visualization. With the help of assistant diagnosis, ophthalmologists can evaluate cases more precisely and more clearly.

Modified Yamane technique with a 26-gauge needle: single corneal incision and simplified haptic insertion.

A modified Yamane technique with a 26-gauge needle for aphakia correction is described. Single corneal or corneoscleral incision is set at 12 o'clock. The 26-gauge needles are used to make 2 angled incisions parallel to the limbus to fix the haptics of a 3-piece intraocular lens. The modifications provide an easier and safer way of haptic insertion into the needle tip and decreases the possibility of bending or breaking the haptic.

A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer.

The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.

Immunomodulatory Effect of Irreversible Electroporation Alone and Its Cooperating With Immunotherapy in Pancreatic Cancer.

Emerging studies have showed irreversible electroporation (IRE) focused on pancreatic cancer (PC). However, the effects of IRE treatment on the immune response of PC remain unknown. Moreover, there are few studies on the therapeutic effect of IRE combining with immunotherapy on PC. Thus, we review recent advances in our understanding of IRE alone and its working with immunotherapy towards the immune response of PC, discussing potential opportunities for exploring future treatment strategies.

Characteristics of fixation patterns and their relationship with visual function of patients with idiopathic macular holes after vitrectomy.

To analyze the relationships between the fixation location and the visual function of idiopathic macular hole (IMH) patients with macular integrity assessment (MAIA) examination preoperatively and 3 months postoperatively. This was a retrospective case analysis. Forty-three eyes of 43 patients diagnosed with IMH were included in this study. The best corrected visual acuity (BCVA) assessments, optical coherence tomography (OCT) and MAIA examinations were performed before surgery and 1 week, 1 month and 3 months after surgery. The relationships between MAIA parameters and visual acuity were assessed by correlation analysis. Grouping by fixation location with the foveola (2°) as the centre, the locations could be divided into five groups, including foveolar, temporal, nasal, inferior and superior fixation. The mean macular sensitivity (MMS) of the macular area was correlated with the BCVA in the IMH patients before and 3 months after surgery (before surgery P = 0.00, after surgery P = 0.00). The MMS could be used as a good indicator for evaluating visual function in IMH patients. There was a significant difference in fixation location before and after the operation (P = 0.01). The preoperative fixation location of IMH patients was mainly in the superior area, while postoperatively moved to the foveola and nasal areas. Paying attention to the changes of fixation locations in IMH patients may provide new clues for further improving postoperative visual function.

Expression of α-Klotho Is Downregulated and Associated with Oxidative Stress in the Lens in Streptozotocin-induced Diabetic Rats.

Purpose: Oxidative stress, an imbalance between the production of reactive oxygen species and antioxidant defenses, plays an important role in the pathogenesis of diabetic cataract. The lens in diabetes mellitus (DM) has been shown to exhibit impaired antioxidant defenses, but the underlying mechanisms remain poorly understood. Accumulating evidence reveals that Klotho family genes can regulate antioxidant defenses and prevent oxidative stress in multiple tissues. Here, we examined whether DM alters Klotho expression in the lens and if so, whether altered Klotho expression is associated with oxidative stress in the lens in DM.Methods: Male Wistar rats were divided into DM and control groups. DM was induced by injection of streptozotocin (STZ, 60 mg/kg ip) and control rats were injected with vehicle. Twelve weeks after DM induction, levels of α-Klotho in plasma, expression of α- and γ-Klotho, and nuclear factor erythroid 2-related factor 2 (Nrf2), and levels of antioxidants superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione (GSH) and oxidative stress marker malondialdehyde (MDA) in the lens were measured.Results: Diabetic rats had markedly higher blood glucose concentrations and lower plasma α-Klotho levels than control rats. Both α- and γ-Klotho were expressed in the lens in diabetic and control rats. The expression of α-Klotho but not γ-Klotho in the lens was downregulated in diabetic rats, which was accompanied by reduced expression of nuclear Nrf2 and levels of all antioxidants and increased levels of MDA. Moreover, expression of α-Klotho in the lens was positively correlated with expression of nuclear Nrf2 and levels of all antioxidants, but negatively correlated with levels of MDA.Conclusions: These findings suggest that DM selectively reduces α-Klotho levels in the circulation and lens, which may attenuate transcriptional activity of Nrf2 and impair antioxidant defenses in response to oxidative insults, contributing to oxidative stress and cataract formation in DM.

Metabolomic Profiling of the Aqueous Humor in Patients with Wet Age-Related Macular Degeneration Using UHPLC-MS/MS.

Assessing metabolomic alterations in age-related macular degeneration (AMD) can provide insights into its pathogenesis. We compared the metabolomic profiles of the aqueous humor between wet AMD patients (n = 26) and age- and sex-matched patients undergoing cataract surgery without AMD as controls (n = 20). A global untargeted metabolomics study was performed using ultra-high-performance liquid chromatography tandem mass spectrometry. Univariate analysis after the false discovery correction showed 18 significantly altered metabolites among the 291 metabolites measured. These differential metabolomic profiles pointed to three interconnected metabolic pathways: a compromised carnitine-associated mitochondrial oxidation pathway (carnitine, deoxycarnitine, N6-trimethyl-l-lysine), an altered carbohydrate metabolism pathway (cis-aconitic acid, itaconatic acid, and mesaconic acid), which plays a role in senescence and immunity, and an activated osmoprotection pathway (glycine betaine, creatine), which potentially contributes to the pathogenesis of the disease. These results suggested that metabolic dysfunction in AMD is mitochondrial-centered and may provide new insights into the pathophysiology of wet AMD and novel therapeutic strategies.

Risk factors for glial cell proliferation after idiopathic macular hole repair with internal limiting membrane flap.

BACKGROUND: To study the influencing factors for different healing patterns of patients with idiopathic macular holes (IMH) after vitrectomy surgery performed with the internal limiting membrane (ILM) flap technique. METHODS: This study was a retrospective, consecutive, observational case series study. We recruited 52 IMH patients who underwent vitrectomy with the ILM flap technique. The participants were divided into 2 groups: group A (25 patients), without significant glial cell proliferation in the macular area on postoperative optical coherence tomography (OCT); and group B (27 patients), with significant glial cell proliferation. The postoperative visual acuity (VA), external limiting membrane (ELM) and ellipsoid zone (EZ) recovery characteristics were compared between the two groups. RESULTS: There were statistically significant differences in minimum linear diameter (MLD) of the macular hole and postoperative VA (p = 0.02, 2.81 E-4 respectively) between the two groups. Compared with patients in group A, patients in group B had poorer VA and EZ recovery in the first 12 months after surgery, and a longer ELM recovery period. The OCT results showed that patients in group B had more extensive ILM filling in the macular area after surgery than patients in group A. CONCLUSION: The presence of aberrant glial cell proliferation was related to a larger MLD of the IMH, and the filling approach for the ILM during the operation was related to the postoperative healing pattern and vision acuity.

Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography.

The purpose of the present study was to investigate whether contrast-enhanced ultrasonography (CEUS) in combination with ultrasound elastography (UE) is able to accurately predict the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer patients. A total of 65 breast cancer patients who received NAC at the First Affiliated Hospital of Zhejiang University (Hangzhou, China) between February 2016 and August 2017 and were recruited for the present study. Prior to and after NAC, examination by CEUS, UE or their combination was performed. Pathological results were obtained at the end of each chemotherapy cycle, based on which 41 cases were assigned to the response group and 24 to the non-response group. Kappa values were 0.710, 0.434 and 0.836 for CEUS, UE and CEUS+UE, respectively. The area under the receiver operating characteristic curves for CEUS, UE and CEUS+UE for determining the response to NAC was 0.864 [95% confidence interval (CI), 0.765-0.964], 0.715 (95% CI, 0.579-0.850) and 0.910 (95% CI, 0.826-0.993), respectively. It was identified that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS+UE were higher than those of CEUS and US individually. The prediction accuracy was 89.2, 90.8 and 100% for CEUS, UE and their combination, respectively. CEUS and UE have their own advantages in evaluating the clinical efficacy of NAC in breast cancer, and a higher accuracy was achieved when the two techniques were applied in combination. Therefore, a combination of CEUS and UE may be a preferred method for the clinical assessment of the efficacy of NAC in breast cancer patients.

Prompt 27-gauge sutureless transconjunctival vitrectomy for bleb-associated endophthalmitis.

PURPOSE: To summarize the characters of 6 bleb-associated endophthalmitis (BAE) cases and to report the outcomes of prompt 27-gauge sutureless transconjunctival vitrectomy to treat these cases. METHODS: Retrospective, non-randomized, consecutive case series of patients diagnosed with bleb-associated endophthalmitis who underwent prompt 27-gauge vitrectomy. RESULTS: The interval to get bleb-associated endophthalmitis from previous surgery was variant from 2 weeks to 36 months. Most of the patients experienced eye pain. The visual acuity was affected quickly. All the patients presented with hypopyon, fibrinous reaction, and vitreous wick. The size of the hypopyon was from 2 to 4 mm. Two patients came with intraocular lenses. Prompt 27-gauge sutureless transconjunctival vitrectomy was performed on all patients with bleb-associated endophthalmitis. None of the patients experienced complications of sutureless vitrectomy such as hypotony or wound leak. The improvement of best corrected visual acuity (BCVA) was significant in four of six patients. The improvement of BCVA was statistically calculated by using logMAR VA (p < 0.01). The intraocular pressure (IOP) in all six patients reduced after the surgery. At 6 months' follow-up, four patients with diffuse blebs had normal IOPs while two patients with cystic or encapsulated blebs had uncontrolled IOPs (> 21 mmHg) and received pressure-lowering agents. CONCLUSIONS: BAE is associated with substantial visual morbidity. Prompt 27-gauge sutureless transconjunctival vitrectomy is an effective and safe way for treating bleb-associated endophthalmitis.

Minimally Invasive Repetitive UVA Irradiation along with Riboflavin Treatment Increased the Strength of Sclera Collagen Cross-Linking.

OBJECTIVE: This study aimed to investigate the efficacy of minimally invasive repetitive UVA irradiation along with riboflavin treatment on sclera collagen cross-linking in rabbits. METHOD: Forty-eight healthy adult New Zealand white rabbits were randomly divided into four groups: pseudosurgery group (group I), single-irradiation group (group II), duplicate-irradiation group (group III), and triplicate-irradiation group (group IV), with 12 rabbits in each group. For the single-irradiation group, a specially made LED light source was inserted through a minimally invasive conjunctival incision to gain close contact with the sclera for irradiation, and for the repetitive irradiation groups, the above experimental procedure was repeated once or twice every other week. Biomechanical parameters of the sclera including ultimate stress (σ) and 8% Young's modulus (E) were compared among the groups. RESULTS: In comparison with control group I, the ultimate stress of group II, group III, and group IV increased by 80.1%, 107.9%, and 182.1%, respectively, and their 8% Young's modulus increased by 106.1%, 159.5%, and 208.5%, respectively, one day after surgery (P < 0.01). CONCLUSION: Repetitive minimally invasive UVA irradiation with riboflavin significantly increased biomechanical strength of the sclera in the irradiated area, and biomechanical strength increased with repeated times of irradiation.

The Effects of Scleral Collagen Cross-Linking Using Glyceraldehyde on the Progression of Form-Deprived Myopia in Guinea Pigs.

To investigate the effects of collagen cross-linking using glyceraldehyde on the biomechanical properties of the sclera and the axial elongation of form-deprived myopia in the guinea pig. Thirty-six guinea pigs were randomly assigned to four groups: FDM (form-deprived myopia); FDMG (form-deprived myopia treated with glyceraldehyde); FDMS (form-deprived myopia treated with 0.9% isotonic sodium chloride); and normal control (free of form-deprivation). FDM was achieved in the right eye using a latex facemask. The right eye in FDMG was treated with a posterior subtenon injection of 0.5 M glyceraldehyde; 0.9% isotonic sodium chloride was administered to the right eye in FDMS group using the same method. Axial length, refraction, and stress-strain of the sclera were measured at scheduled time points. The treated eyes were also examined histologically by light microscopy. It was found that glyceraldehyde treatment significantly increased the stiffness of the sclera in the FDM eyes and abnormalities have not been observed in the retina and optic nerve of the treated eyes. But the development of myopia was not affected.

Correlation of macular choroidal thickness with concentrations of aqueous vascular endothelial growth factor in high myopia.

PURPOSE: To investigate the association of both aqueous and serum vascular endothelial growth factor (VEGF) levels and macular choroidal thickness in high myopia. MATERIALS AND METHODS: VEGF concentrations were measured in aqueous and serum samples via enzyme-linked immunosorbent assay (ELISA) and compared between high myopia (n = 36 eyes, 36 patients) and normal control (n = 42 eyes, 42 patients) eyes. Macular choroidal thickness, the distance from the retinal pigment epithelium (RPE) to the scleral interface, was determined via enhanced depth-imaging optical coherence tomography (EDI-OCT). Axial length was measured using the intraocular (IOL) lens Master. RESULTS: Aqueous levels of VEGF from high myopia patients were significantly lower compared with those from control persons (61.4 ± 27.6 versus 122.6 ± 52.4 pg/ml; p < 0.001), respectively. Macular choroidal thickness of high myopia patients was significantly lower compared with that of control persons (111.1 ± 45.0 versus 230.6 ± 81.8 µm; p < 0.001), respectively. Aqueous levels of VEGF were significantly associated with both macular choroidal thickness (R(2)= 0.641; p < 0.001) and axial length (R(2)= 0.679; p < 0.001) in high myopia patients. In addition, there was a significantly negative correlation between macular choroidal thickness and axial length (R(2)= 0.69; p < 0.001). However, no correlation between serum VEGF and either macular choroidal thickness or axial length was detected in high myopia patients (R(2)= 0.009; p = 0.59; R(2)= 0.00002; p = 0.981). CONCLUSIONS: Macular choroidal thickness was significantly correlated with aqueous, but not serum, levels of VEGF in highly myopic eyes. Macular choroidal thickness may be of predictive value for identifying aqueous VEGF levels in high myopia patients and may, thus, be a useful prognostic modality.

[Experimental study of glyceraldehyde cross-linking of posterior scleral on FDM in guinea pigs].

OBJECTIVE: The purpose of this study is to observe the effects of glyceraldehyde cross-linking on sclera biomechanical strength and experimental myopia. METHODS: 50 three weeks aged guinea pigs were randomly divided into 5 groups: A, B, C, D, E. Each group had 10 guinea pigs. The right eye was set as the experimental eye, the left eye was used as control. Group A: 7 days mask; Group B: 21 days mask, plus physiological saline retrobulbar injection at mask day 1, 8, 15; Group C: 21 days mask, plus 0.05 mol/L glyceraldehyde retrobulbar injection at mask day 1, 8, 15; Group D: 21 days mask, plus 0.5 mol/L glyceraldehyde retrobulbar injection at mask day 1, 8, 15; Group E: normal control group. Several parameters of 7 guinea pigs of each group were measured before and after deprivation (mask day 7, 14, 21), including ocular axial length, refractive error, ultimate stress (σmax) (MPa), ultimate strain(εmax) (%) and 6% elastic modulus (MPa). The effects of glyceraldehyde on adjacent tissues of the rest 3 guinea pigs were detected by histopathological and immunohistochemical studies. Differences between experiment eyes and contralateral, eyes were compared with paired t test and correlative analysis. RESULTS: The experimental eyes appeared the increase of the the vitreous cavity length, the axial length and myopia after deprivation. In group A, group B and group C, the differences of the length of the vitreous cavity (group A (2.991 ± 0.078) mm, group B (2.961 ± 0.038) mm and group C (2.936 ± 0.021) mm), the axial length(group A (7.263 ± 0.133) mm, group B (7.732 ± 0.099) mm and group C (7.665 ± 0.055) mm) and refractive error (group A (-2.214 ± 2.881) D, group B (-4.525 ± 2.415) D and group C (-1.607 ± 0.866) D) between the experimental eye and the fellow eye was statistically significant (vitreous cavity = 3.234, 4.758, 7.608; Pvitreous cavity = 0.018, 0.002, 0.001; axial = 3.198,, 4.758, 7.608; Paxial = 0.019, 0.002, 0.000; refraction = -7.120, -4.020, -6.334; Prefraction = 0.000, 0.005, 0.001). In group D and group E, there is no difference between deprived eye and control eye about the length of the vitreous chamber as well as axial length (vitreous = 0.542, -0.646; Pvitreous cavity = 0.607, 0.539; axial = 0.542, -0.646; Paxial = 0.607, 0.539). The experimental eye ((-3.921 ± 0.874)D) and the fellow eye ((-3.321 ± 1.205)D) of group D, the difference of diopter was statistically significant (refraction = -3.154, Prefraction = 0.020). At the end of the experiment, the change of diopter of experimental eye of group B, C, D, E was significantly different (F = 61.249, P = 0.000). The difference of diopter change between group B ((8.800 ± 0.616) D), group C ( (7.236 ± 2.198) D), group D ( (6.271 ± 1.112) D) and the normal control group ((0.934 ± 0.158) D) was statistically significant (PB = 0.000, PC = 0.000, PD = 0.000). At the end of the experiment, the ultimate stress and 6% elastic modulus of group B experimental eye was (7.988 ± 3.677) MPa (P = 0.002) and (19.938 ± 4.871) MPa (P = 0.001), decreased 10.06% and 34.17% respectively. On the other hand the ultimate strain was (28.6 ± 3.6) % (P = 0.034), increased 19.17%. After the cross-linking treatment, the ultimate stress and 6% elastic modulus of group C experimental eye was (9.244 ± 0.806) MPa (P = 0.001) and (26.180 ± 4.388) MPa (P = 0.031) , decreased 23.13% and 13.34%, the ultimate strain was (26.2 ± 1.0) % (P = 0.016) , increased 12.93% separately. The ultimate stress of group D experimental eye was (12.476 ± 2.507) MPa (P = 0.580), decreased 5.50%, 6% elastic modulus was (30.446 ± 3.410) MPa (P = 0.314), increased 6.53%, ultimate strain was (23.8 ± 1.8) % (P = 0.253), decreased 4.42% respectively. Ultrastructure examination showed that, decreased scleral thickness with fibers lined up in order, without inflammatory cells Infiltration. Expressions of matrix metalloproteinases-2(MMP-2) mainly decrease in the episcleral tissue. The stroma of choroid, and the outer plexiform layer. CONCLUSIONS: Glyceraldehyde is a safe and effective cross-linking agent that could significantly enhance the sclera biomechanical strength. Glyceraldehyde cross-linking method could effectively control the development of myopia in animal model.

New modified iris suture technique for pupillary dilation in aphakic eyes during vitreoretinal surgery.

To describe a modified simple iris suture for pupillary dilation technique during vitrectomy in cases with a miotic pupil. Four translimbal incisions were created with a sharp straight blade at 1:30, 10:30, 4:30, and 7:30 o'clock, respectively. The straight needle of 10-0 polypropylene suture and a Sinskey IOL hook was used to displace the pupillary margin toward the limbus. In 3 cases, four sutures caused a 6-mm to 9-mm square-shaped pupil, and the pupil was allowed to return to a smaller size at the end of the operation. It is simple and may reduce postoperative complications.

Combined suture-in-needle and scleral tunnel technique for scleral fixation of intraocular lens.

We describe an intraocular lens (IOL) fixation technique that combines suture-in-needle and scleral tunnel techniques. A 10-0 polypropylene suture is inserted into the barrel of a 27-gauge sharp needle to tie the IOL haptic, and scleral tunnels are created to bury the knots for transscleral IOL fixation. The modification of the traditional scleral fixation technique simplifies the creation of a scleral covering and decreases harmful manipulations of the needle passing through the vitreous cavity.