Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography.

Purpose: To evaluate the ability of swept-source optical coherence tomography angiography (SS-OCTA) to assess lid margin vascularity. Methods: This prospective, cross-sectional trial enrolled 125 participants, including 15 control subjects and 110 meibomian gland dysfunction (MGD) patients. Lid margin blood flow density (LMBFD) was obtained using SS-OCTA. LMBFD was assessed for repeatability in 54 of 125 participants and for reproducibility in 23 of 125 participants. The efficacy of LMBFD was validated in the 125 participants, who were divided into mild (n = 46), moderate (n = 42), and severe groups (n = 37) according to the lid margin vascularity severity shown in the slit-lamp photographs. Correlations between LMBFD and MG-related parameters, such as ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), cornea fluorescein staining (CFS), lid margin score (LMS), and meibomian gland expressibility (ME), were analyzed in all 125 participants. Results: Repeatability and reproducibility coefficients were satisfactorily high in the scan mode with a scan area of 6 mm × 6 mm (intraclass correlation coefficient [ICC] repeatability = 0.905; ICC reproducibility = 0.986) and a scan area of 9 mm × 9 mm (ICC repeatability = 0.888; ICC reproducibility = 0.988). The LMBFD gradually increased in the mild, moderate, and severe groups (P < 0.001). LMBFD was significant correlated with OSDI (r = 0.290, P = 0.001), FTBUT (r = -0.195, P = 0.030), CFS (r = 0.352, P < 0.001), ME (r = 0.191, P = 0.033), and LMS (r = 0.370, P < 0.001). Conclusions: LMBFD may be a noninvasive, repeatable, reproducible, and efficient index for the quantitative evaluation of eyelid margin vascularity in the future. Translational Relevance: We demonstrated that SS-OCTA has the potential to evaluate the eyelid margin vascularity in MGD patients and guide future treatment strategies in clinics.

Unsupervised Learning Based on Meibography Enables Subtyping of Dry Eye Disease and Reveals Ocular Surface Features.

Purpose: This study aimed to establish an image-based classification that can reveal the clinical characteristics of patients with dry eye using unsupervised learning methods. Methods: In this study, we analyzed 82,236 meibography images from 20,559 subjects. Using the SimCLR neural network, the images were categorized. Data for each patient were averaged and subjected to mini-batch k-means clustering, and validated through consensus clustering. Statistical metrics determined optimal category numbers. Using a UNet model, images were segmented to identify meibomian gland (MG) areas. Clinical features were assessed, including tear breakup time (BUT), tear meniscus height (TMH), and gland atrophy. A thorough ocular surface evaluation was conducted on 280 cooperative patients. Results: SimCLR neural network achieved clustering patients with dry eye into six image-based subtypes. Patients in different subtypes harbored significantly different noninvasive BUT, significantly correlated with TMH. Subtypes 1 and 5 had the most severe MG atrophy. Subtype 2 had the highest corneal fluorescent staining (CFS). Subtype 4 had the lowest TMH, whereas subtype 5 had the highest. Subtypes 3 and 6 had the largest MG areas, and the upper MG areas of a person's bilateral eyes were highly correlated. Image-based subtypes are related to meibum quality, CFS, and morphological characteristics of MG. Conclusions: In this study, we developed an unsupervised neural network model to cluster patients with dry eye into image-based subtypes using meibography images. We annotated these subtypes with functional and morphological clinical characteristics.

Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation.

Purpose: To describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation. Methods: Twenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed. Results: The age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed. Conclusion: Nd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure.

Meibomian gland morphological changes in ocular herpes zoster patients based on AI analysis.

Varicella-zoster virus (VZV) infections result in a series of ophthalmic complications. Clinically, we also discover that the proportion of dry eye symptoms was significantly higher in patients with herpes zoster ophthalmicus (HZO) than in healthy individuals. Meibomian gland dysfunction (MGD) is one of the main reasons for dry eye. Therefore, we hypothesize that HZO may associate with MGD, affecting the morphology of meibomian gland (MG) because of immune response and inflammation. The purpose of this study is to retrospectively analyze the effect of HZO with craniofacial herpes zoster on dry eye and MG morphology based on an Artificial intelligence (AI) MG morphology analytic system. In this study, 26 patients were diagnosed as HZO based on a history of craniofacial herpes zoster accompanied by abnormal ocular signs. We found that the average height of all MGs of the upper eyelid and both eyelids were significantly lower in the research group than in the normal control group (p < 0.05 for all). The average width and tortuosity of all MGs for both upper and lower eyelids were not significantly different between the two groups. The MG density of the upper eyelid and both eyelids were significantly lower in the HZO group than in the normal control group (p = 0.020 and p = 0.022). Therefore, HZO may lead to dry eye, coupled with the morphological changes of MGs, mainly including a reduction in MG density and height. Moreover, it is important to control HZO early and timely, which could prevent potential long-term severe ocular surface injury.

Uneven Meibomian Gland Dropout in Patients with Meibomian Gland Dysfunction and Demodex Infestation.

The purpose of this study was to compare the differences between uneven meibomian gland (MG) atrophy with and without Demodex infestation based on the index of uneven atrophy score (UAS). In this retrospective cohort study, 158 subjects were recruited, including 66 subjects in the Demodex-positive MGD group, 49 subjects in the Demodex-negative MGD group, and 43 subjects as normal control. No significant difference was verified in OSDI, TMH, TBUT, CFS, lid margin score, and meibograde (all p > 0.05) between the Demodex-positive MGD group and the Demodex-negative MGD group. The UAS index of the upper eyelid or both eyelids was significantly higher in the Demodex-positive group in comparison with the normal control group and Demodex-negative group and the difference was statistically significant between the three groups. The UAS was significantly positive correlation with OSDI (r = 0.209, p < 0.05), lid margin score (r = 0.287, p < 0.001), and meibograde (r = 0.356, p < 0.001), which has a significant negative correlation with TBUT (r = −0.248, p < 0.05). Thus, Demodex infestation can cause uneven MG atrophy and we propose a novel index of UAS, which is used to evaluate uneven atrophy of MGs and as a morphological index of Demodex infestation.

Metagenomic profiling of ocular surface microbiome changes in Demodex blepharitis patients.

Purpose: To compare the ocular surface and meibum microbial communities of humans with Demodex Blepharitis (DB) and healthy controls. Methods: Conjunctival sac and meibum samples from 25 DB patients and 11 healthy controls were analyzed using metagenomic next-generation sequencing (mNGS). Results: The alpha-diversity of the conjunctival sac microbiome of the DB group (observed, Chao1, ACE) was lower than that of the control group, whereas all meibum diversity indicators were similar. In conjunctival samples, the relative abundance (RA) of the phylum Proteobacteria was significantly higher (p=0.023), and the RA of both phyla Actinobacteria and Firmicutes was significantly lower (p=0.002, 0.025, respectively) in the DB group than that in the control group. In meibum samples, the RA of the phyla Proteobacteria and Actinobacteria were similar, whereas that of the phylum Firmicutes was significantly lower in the DB group (p=0.019) than that in the control group. Linear discriminant analysis with effect size measurement of the conjunctival and meibum microbiomes showed that Sphingobium sp. YG1 and Acinetobacter guillouiae were enriched in the DB group. Sphingobium sp. YG1, Acinetobacter guillouiae and Pseudomonas putida in the DB group were related to more severe ocular surface clinical parameters. Discriminative genera's principal coordinate analysis separated all control and DB microbiomes into two distinct clusters. Conclusions: Proteobacteria's increased prevalence may indicate ocular microbial community instability. The species Sphingobium sp. YG1 and Acinetobacter guillouiae are potentially pathogenic bacterial biomarkers in DB. Demodex infection mainly affects the ocular surface microbiome rather than penetrating deeper into the meibomian gland.

Uneven Index: A Digital Biomarker to Prompt Demodex Blepharitis Based on Deep Learning.

Purpose: To evaluate ocular surface manifestations and morphological changes in meibomian glands (MGs) based on artificial intelligence (AI) analysis in patients with Demodex blepharitis. Methods: In this retrospective study, 115 subjects were enrolled, including 64 subjects with Demodex blepharitis and 51 subjects without Demodex blepharitis as control group. Morphological indexes were evaluated for height, width, tortuosity, MG density, total variation, and the three types of corrected total variation as Uneven indexes. Results: There were no statistically significant differences in all MGs' average tortuosity and width between the two groups. The average height of all MGs and MG density were significantly lower in the Demodex blepharitis group than control group. The total variation and two types of Uneven indexes were significantly higher in the Demodex blepharitis group than in the control group. Especially the Uneven Index of total variation/MG density had an AUC of 0.822. And the sensitivity and specificity were 59.4% and 92.2%, respectively, at a cut-off value of 3971.667. In addition, Demodex blepharitis was associated with significantly lower meibum quality and expressibility, severe atrophy of MGs, a higher ocular surface disease index (OSDI), and more instability of the tear film. Conclusion: Demodex mites are strongly associated with morphological changes in the MGs and may cause uneven gland atrophy. Therefore, the novel characteristic parameter, the Uneven index, may serve as a digital biomarker to evaluate uneven atrophy of MGs and prompt Demodex blepharitis.

Meibomian Gland Density: An Effective Evaluation Index of Meibomian Gland Dysfunction Based on Deep Learning and Transfer Learning.

We aimed to establish an artificial intelligence (AI) system based on deep learning and transfer learning for meibomian gland (MG) segmentation and evaluate the efficacy of MG density in the diagnosis of MG dysfunction (MGD). First, 85 eyes of 85 subjects were enrolled for AI system-based evaluation effectiveness testing. Then, from 2420 randomly selected subjects, 4006 meibography images (1620 upper eyelids and 2386 lower eyelids) graded by three experts according to the meiboscore were analyzed for MG density using the AI system. The updated AI system achieved 92% accuracy (intersection over union, IoU) and 100% repeatability in MG segmentation after 4 h of training. The processing time for each meibography was 100 ms. We discovered a significant and linear correlation between MG density and ocular surface disease index questionnaire (OSDI), tear break-up time (TBUT), lid margin score, meiboscore, and meibum expressibility score (all p < 0.05). The area under the curve (AUC) was 0.900 for MG density in the total eyelids. The sensitivity and specificity were 88% and 81%, respectively, at a cutoff value of 0.275. MG density is an effective index for MGD, particularly supported by the AI system, which could replace the meiboscore, significantly improve the accuracy of meibography analysis, reduce the analysis time and doctors' workload, and improve the diagnostic efficiency.

Macular Morphologic and Microvascular Analysis in Pseudophakic Children with Previous Pediatric Cataract Using Optical Coherence Tomography Angiography.

INTRODUCTION: The macular morphologic and microvascular changes in children with pseudophakia after pediatric cataract surgery remain unknown. The aim of this study was to analyze macular morphologic and microvascular remodeling in children with pseudophakia after pediatric cataract surgery using optical coherence tomography angiography (OCTA). METHODS: Consecutive cases between December 1, 2018, and November 31, 2020 were recruited. Sixty-one participants (31 pseudophakic children and 30 healthy controls) met the inclusion criteria and were included for final analysis. OCTA was used to measure macular vascular density, the foveal avascular zone (FAZ), and macular thickness. The parameters were compared between pseudophakic and healthy eyes using binary logistic regression, with adjustment for the effect of refractive error, age, and axial length. RESULTS: Compared with normal eyes, a significantly reduced area of the FAZ (p = 0.042), increased superficial foveal vascular density (p = 0.033), and increased inner and outer foveal thickness (p = 0.034 and 0.029, respectively) were noted in pseudophakic eyes. The deep parafoveal vascular density was generally lower in eyes with cataracts (p ≤ 0.044). The inner foveal thickness was positively correlated with the superficial foveal vascular density (r = 0.889, p < 0.001) and negatively correlated with the area of the FAZ (r = -0.903, p < 0.001). The outer foveal thickness was positively correlated with the deep foveal vascular density (r = 0.399, p = 0.002). CONCLUSIONS: Morphological and microvascular remodeling in children with previous pediatric cataract indicates foveal underdevelopment. The underlying mechanism requires further investigation.

Posterior Capsular Outcomes of Pediatric Cataract Surgery With In-The-Bag Intraocular Lens Implantation.

Aim: To investigate the change of posterior capsular outcomes of pediatric cataract surgery with primary in-the-bag intraocular lens (IOL) implantation. Methods: We conducted a case series of pediatric cataract children who underwent cataract extraction with primary in-the-bag IOL implantation, posterior capsulorhexis or vitrectorhexis, and limited anterior vitrectomy at the Eye Hospital of Wenzhou Medical University between 2016 and 2019. Digital retro-illumination photographs of pediatric eyes were obtained at baseline and 6 months, 12 months, and the last visit postoperatively. Capsular outcomes of the posterior capsular opening area (PCOA) and lens reprolifration area at those time points were compared. Correlations between the PCOA and influential factors, such as age at surgery, axial growth, and follow-up duration, were analyzed. The study was registered at register.clinicaltrials.gov (NCT04803097). Results: Data of 23 patients (27 eyes) were used in the final analysis. During follow-up, the PCOA enlarged at a rate of 0.29-0.32 mm2/month during the first six months postoperatively and 0.05-0.08 mm2/month over the next 1-2 years. Six months postoperatively, the PCOA enlargement statistically and positively correlated with the follow-up duration and axial growth. The area of lens reprolifration was 0.46 ± 1.00 mm2 at six months postoperatively and then remained stable. Conclusion: The PCOA enlarged rapidly within the first six months after the pediatric cataract surgery with primary IOL implantation. Six months postoperatively, the enlargement of PCOA was positively correlated with follow-up duration and axial growth. Posterior capsulorhexis or capsulectomy should be performed with a diameter of 3.0 to 4.0 mm for good visual axis transparency and the protection of in-the-bag IOL.

Glaucoma and risk factors three years after congenital cataract surgery.

BACKGROUND: This study aimed to identify the incidence of and risk factors for postoperative glaucoma-related adverse events at various time points after congenital cataract surgery. METHODS: This retrospective cohort study enrolled 259 eyes from 174 patients (surgical age ≤ 7 years) who underwent congenital cataract surgery. All surgical procedures were conducted at the Eye Hospital of Wenzhou Medical University between May 2011 and March 2019. Patients were classified into group 1 [primary intraocular lens (IOL) implantation, N = 111 eyes], group 2 (secondary IOL implantation, N = 85 eyes), and group 3 (no IOL implantation, N = 63 eyes). We recorded demographic factors and incidence and risk factors for glaucoma-related adverse events. RESULTS: Glaucoma-related adverse events occurred in 21 (8.1%) eyes, whereas 27 (10.4%) eyes developed steroid-induced ocular hypertension. The percentage of glaucoma-related adverse events was 0%, 1.2%, 1.2%, 1.6%, 4.0%, and 8.9% at 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery, respectively. Sixteen (18.8%), five (7.9%), and zero eyes developed glaucoma-related adverse events in groups 2, 3, and 1, respectively. Family history of congenital cataract [hazard ratio (HR), 50.463; 95% confidence interval (CI), 7.051-361.139; P < 0.001], preoperative central corneal thickness (CCT) [HR, 1.021; 95% CI, 1.009-1.034; P = 0.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558-9.804; P = 0.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344-10.417; P = 0.012] were identified as predictors of postoperative glaucoma-related adverse events. CONCLUSIONS: Family history of congenital cataract, thicker preoperative CCT, smaller preoperative HCD, and thinner preoperative LT are the main risk factors of postoperative glaucoma-related adverse events. Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic.

Association between Iris Biological Features and Corneal Biomechanics in Myopic Eyes.

PURPOSE: Iris biological features such as surface features and profile characteristics reflected the development of iris stroma and microvessels. Iris vessels and microcirculation are still lack of effective detection methods, and we can directly observe only the iris surface biological characteristics. This cross-sectional study evaluated the association between iris surface biological features and corneal biomechanics in young adults with myopia. METHODS: We recruited 152 patients with myopia aged ≥18 years, from the Eye Hospital of Wenzhou Medical University, who had complete Corneal Visualization Scheimpflug Technology (Corvis ST) data and graded iris surface features. Iris surface features included crypts, furrows, and color measured from digital slit lamp images. The biomechanical properties of the cornea were assessed using Corvis ST. Only 1 eye of each participant was randomly selected for analysis. Associations between the iris surface features and corneal biomechanics were analyzed using linear regression models. The grade of iris crypts, furrows, and color and corneal biomechanical parameters measured with Corvis ST was the main outcome measures. RESULTS: The iris crypts were significantly associated with deflection amplitude at the first applanation (A1 DLA, ß = 0.001, P = 0.013), A1 delta arc length (A1 dArcL) (ß = -0.001, P = 0.01), maximum delta arc length (dArcLM) (ß = -0.004, P = 0.03), and stiffness at the first applanation (SP-A1) (ß = -2.092, P = 0.016). The iris furrows were only associated with integrated radius (ß = -0.212, P = 0.025). Iris color was found not related with corneal biomechanical parameters measured via Corvis ST. CONCLUSIONS: Iris surface features were associated with corneal biomechanical properties in myopic eyes; more iris crypts were associated with lower corneal stiffness while more extensive furrows were related with higher corneal stiffness. Iris crypts and furrows may provide useful information on corneal biomechanical properties in myopic eyes.

Prospective trial of a 2940 nm Er:YAG laser for the treatment of meibomian gland dysfunction.

PURPOSE: The primary objective was to evaluate the efficacy and safety of Er:YAG laser treatment for meibomian gland dysfunction (MGD) in a prospective study. METHODS: A total of 128 eyes from 64 patients with MGD were enrolled to receive either three Er:YAG laser treatments with meibomian gland expression (MGX) or MGX-alone treatment sessions at 3-week intervals. The Standard Patient Evaluation of Eye Dryness (SPEED) validated questionnaire; fluorescein breakup time of the tear film (FBUT); corneal fluorescein staining (CFS); lid margin abnormalities; meibomian gland morphology (meiboscore); lower tear meniscus height (TMH); and assessment of 15 meibomian glands in the lower eyelids, including total meibomian gland secretion quality (TMGS), the number of glands secreting any liquid (GSAL), and the number of glands yielding optimal clear liquid secretion (GYCL), were assessed at day (D)0, D21, D42, and D63 for the Er:YAG-MGX group and D0 and D63 for the MGX group. RESULTS: At D63, significant decreases in SPEED scores and lid margin abnormalities as well as significant increases in FBUT, TMGS, and GSAL were observed in both groups (all p < 0.05). The Er:YAG-MGX group showed a significantly better improvement in SPEED scores, TMGS, and GYCL than the MGX group (all p < 0.05). CONCLUSION: Although preliminary, the study results of Er:YAG laser treatment for dry eye syndrome caused by MGD are promising. Er:YAG laser treatment may be a new direction for managing MGD. TRIAL REGISTRATION: The study was registered at www.chictr.org.cn : ChiCTR1900026004.

A Novel Quantitative Index of Meibomian Gland Dysfunction, the Meibomian Gland Tortuosity.

Purpose: To quantitatively measure meibomian gland (MG) tortuosity in meibomian gland dysfunction (MGD) patients and normal controls and to observe the efficacy of evaluating MG tortuosity for the diagnosis of MGD. Methods: This cross-sectional study enrolled 32 obstructive MGD patients and 28 normal volunteers. Clinical assessments were performed, including symptom questionnaires, tear meniscus height, tear break-up time (TBUT), corneal fluorescein staining, lid margin abnormality, MG expressibility, and meibography. The meibomian gland tortuosity and meibomian gland density were measured by VIA software. Results: The mean age of the patients in the MGD group was 33.28 ± 9.28 years, and that of the normal controls was 25.25 ± 11.19 years. The average tortuosity of all MGs in the MGD patients was significantly larger than in the normal controls (P< 0.05). We further stratified the MGD patients into symptomatic MGD and asymptomatic groups. The average tortuosity of all MGs and of the central eight MGs was significantly higher in the symptomatic MGD patients than in the asymptomatic MGD patients (P< 0.05). Significant linear correlations were found between MG tortuosity and the lid margin score, meiboscore, meibum expressibility score, and TBUT (P< 0.05). When the diagnosis of obstructive MGD was based on the tortuosity of the central eight MGs of both eyelids, the sensitivity and specificity were 100% and 100%, respectively. Conclusions: MG tortuosity is an effective index to delineate MG morphology and to diagnose MGD, especially for the diagnosis of early-stage MGD. Translation Relevance: Calculating tortuosity quantitatively may play an important role in the diagnosis of MGD.

Comparison of the Accuracy of IOL Power Calculation Formulas for Pediatric Eyes in Children of Different Ages.

PURPOSE: This study aims to compare the accuracy of five intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, and Holladay 2) for pediatric eyes in children of different ages. METHODS: In this prospective study, patients who received cataract surgery and IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of 5 formulas at 1 month postoperatively and performed subgroup analysis with the patients divided into three groups according to their ages at the time of surgery as follows: group 1 (age ≤ 2 years, 35 eyes), group 2 (2 years < age < 5 years, 38 eyes), and group 3 (age > 5 years, 29 eyes). RESULTS: 75 patients (102 eyes) were enrolled in this study. The Haigis formula got the smallest PE among all formulas in all three groups. With regard to APE, there were no statistical differences among the formulas except group 2, with the SRK/T formula a little smaller, the Holladay 2 formula a little larger in group 1, and the Haigis formula a little smaller in group 3. In group 2, the Haigis formula had the lowest APE (0.87 ± 0.61 D), while the Holladay 2 formula had the largest (1.71 ± 1.20 D, p < 0.001), followed by the Holladay 1 formula (1.51 ± 1.07 D, p=0.002). On comparing the percentage of APE within 0.5 D and 1.0 D obtained with 5 formulas in each group, there were no statistical differences. The SRK/T formula and the Holladay 1 formula showed the highest percentage (40.00% and 60.00%) in group 1. While the Haigis formula got the highest percentage in less than 0.5 D (34.21%) and less than 1 D (60.53%) in group 2. In group 3, the Holladay 2 formula and the Haigis formula got the highest percentage less than 0.5 D (58.62%) and less than 1 D (79.31%). The multiple linear regression indicated that the age at the time of surgery was a significant factor affecting the accuracy of APE; after removing the age, AL was the only factor that affected the accuracy of APE. CONCLUSION: The SRK/T and the Holladay 1 formulas were relatively accurate in patients younger than 2 years old, while the Haigis formula performed better in patients older than 2.

Characterization of Meibomian Gland Atrophy and the Potential Risk Factors for Middle Aged to Elderly Patients With Cataracts.

Purpose: To explore the characteristics of meibomian gland (MG) atrophy and its potential risk factors in the age-related cataract population. Methods: Patients who underwent cataract surgery at age 40 or older were enrolled in this study. Preoperative clinical measurement records were obtained, including lipid layer thickness, tear meniscus height, noninvasive breakup time, and meiboscore. The meibomian gland atrophy ratio (MGAR) was measured by the ImageJ software. Univariate regression analysis and multivariate regression analysis were used to analyze the risk factors for MG atrophy. Results: Female patients had less atrophy of the MG compared with male patients. The MGAR, meiboscore, tear meniscus height (TMH), and lipid layer thickness (LLT) gradually increased with age. However, the noninvasive breakup time decreased with age. The multivariate regression analysis indicated that dyslipidemia and increased triglyceride levels were identified as independent protective factors for MG atrophy. We further stratified the model by sex, and the following results showed only in the female patients with dyslipidemia and increased triglyceride had decreased MG atrophy. No significant correlation was observed between MG atrophy and tear film parameters including TMH, noninvasive breakup time, and LLT. Conclusions: Our study suggests that age, sex, and diabetes are potential risk factors for MG atrophy. In addition, dyslipidemia and increased triglyceride levels are independent protective factors for MG atrophy in the elderly female population. Translational Relevance: MG atrophy is the leading cause of meibomian gland dysfunction. To study the characteristics and risk factors of MG atrophy in cataract patients would be helpful to predict and prevent postoperative development of MGD.

Iridocorneal Angle and Anterior Segment Structure of Eyes in Children with Cataract.

OBJECTIVE: To evaluate the morphology of iridocorneal angle and anterior segment in eyes of children with cataract. METHODS: In this prospective cross-sectional study, we included eyes of children with bilateral cataract as well as unilateral cataract and fellow eyes. The iridocorneal angle was evaluated using gonioscopy. We compared the preoperative structures of iridocorneal angle and anterior segment between cataractous eyes and fellow eyes. The grading of iridocorneal angle and anatomical changes were analyzed. RESULTS: We finally recruited 55 eyes of 55 children with bilateral cataract and 41 cataractous eyes and 33 fellow eyes of 41 children with unilateral cataract. The fellow eyes were used as a control group. The iridocorneal angle was open in eyes with pediatric cataract when compared to control eyes. The eyes with cataract exhibited more pigments on the trabecular meshwork than control eyes did (unilateral cataract vs. control, p = 0.013; bilateral cataract vs. control, p = 0.002). The eyes with cataract exhibited a smaller cornea than control eyes (unilateral cataract vs. control, p = 0.031; bilateral cataract vs. control, p < 0.001). CONCLUSIONS: The iridocorneal angle is open in the eyes of children with cataract. Eyes with increased pigments on the trabecular meshwork need to be carefully monitored and surgeons should to be on the alert for postoperative glaucoma.

Corneal decompensation due to spontaneous absorption of lens and anterior dislocation of lens capsule: A case report.

RATIONALE: Spontaneous absorption of lenses or cataracts is rare. However, lens capsule attachment to the endothelium combined with corneal decompensation can still occur. PATIENT CONCERNS: An 81-year-old male presented with left eye pain and bulbar conjunctival injection for 6 months. Diffuse corneal edema and inferior bullous lesions were observed by slit-lamp microscopy. Following examination with swept-source optical coherence tomography, we could clearly identify a membrane structure adherent to the corneal endothelium, as well as a lens not in situ. In vivo confocal microscopy found decreased corneal endothelial density of 745 ±â€Š46 cells per mm in the left eye. DIAGNOSIS: Lens dislocation and spontaneous absorption, combined with corneal decompensation were diagnosed. INTERVENTIONS: Surgical removal of the membrane structure combined with anterior vitrectomy was performed. OUTCOMES: The patient's symptoms were partly relieved. However, the corneal endothelial decompensation could not be entirely reversed. In vivo confocal microscopy verified that corneal endothelium was in situ and the density was not significantly changed in the left eye. LESSONS: This case study reports a rare dislocation and spontaneous absorption of lens without any trauma or subsequent surgery. Moreover, it demonstrates corneal endothelial decompensation due to the lens capsule adhering to the corneal endothelium. Timely intervention is required to remove the dislocated lens and prevent complications.

Influence of angle kappa and angle alpha on visual quality after implantation of multifocal intraocular lenses.

PURPOSE: To assess the influence of angle kappa (κ) and angle alpha (α) on visual quality after multifocal intraocular lens (IOL) implantation. SETTING: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China. DESIGN: Prospective case series. METHODS: Patients with cataract had phacoemulsification with TECNIS Symfony IOL implantation. The preoperative angle κ and angle α were measured using the iTrace device. Distance, intermediate, and near visual acuities were recorded 3 months postoperatively. The Optical Quality Analyzing System was used to measure the objective scatter index (OSI), modulation transfer function (MTF) cutoff frequency, and Strehl ratio. A patient questionnaire was also administered. RESULTS: The study comprised 29 patients (57 eyes). Monocularly, the mean postoperative logarithm of the minimum angle of resolution (logMAR) uncorrected distance, intermediate, and near visual acuities were 0.03 ± 0.09 (SD), 0.05 ± 0.11, and 0.11 ± 0.09, respectively. The mean postoperative logMAR corrected distance, distance-corrected intermediate, and distance-corrected near visual acuities were -0.01 ± 0.05, 0.04 ± 0.09, and 0.11 ± 0.08, respectively. The mean OSI, MTF cutoff, and Strehl ratio were 1.27 ± 0.84, 32.03 ± 10.80 cycles per degree, and 0.17 ± 0.05, respectively. The OSI (r = 0.398, P = .005), MTF (r = -0.437, P = .002), and Strehl ratio (r = -0.419, P = .003) values were significantly correlated with angle κ. There was no correlation with angle α. CONCLUSIONS: Angle κ affected the objective visual quality multifocal after IOL implantation. The decision to implant a multifocal IOL should be carefully considered for patients with a large angle κ.

Clinical Analysis: Aqueous-Deficient and Meibomian Gland Dysfunction in Patients With Primary Sjogren's Syndrome.

Objective: To examine the time course of aqueous-deficient and meibomian gland dysfunction (MGD) in patients with primary Sjogren's Syndrome (pSS). Methods: This prospective study was conducted on pSS female patients in the Department of Rheumatism of the Second Affiliated Hospital, School of Medicine, Zhejiang University. The age-matched MGD female patients without pSS (non-SS-MGD) were recruited as MGD controls from the Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University. After providing written informed consent, the patients underwent an eye examination and completed an Ocular Surface Disease Index questionnaire that assessed the symptoms of dry eye disease. The subjects were evaluated using Schirmer I test (SIt), tear meniscus height (TMH), noninvasive keratographic break-up time (NIKBUT), corneal fluorescein staining (CFS), and meibomian gland evaluation (meibomian gland infrared, lid margin score, expressible meibomian glands number and the secretions quality). The patients were divided into two groups: early stage (≤3 years) and late stage (>3 years) according to their medical history of dry eye. The data were analyzed using SPSS 20.0. Results: There were 49 pSS and 52 non-SS-MGD female patients enrolled in this study from 1 January 2018 to 30 December 2018. There were no differences in age (49.38 ± 10.32 and 48.69 ± 13.57 years) and dry eye medical history (48.44 ± 40.16 and 47.79 ± 37.85 months) between the two groups. When the medical history was ≤3 years, the average SIt and TMH of the pSS patients were significantly smaller than those of the patients with MGD. However, the signs related to the MGD did not show a significant difference between the two groups. When the medical history was >3 years, both the SIt and TMH and the signs related to MGD in pSS group were significantly more severe than the MGD group. Conclusions: Our results demonstrated that 3 years may be an important time node for the dry eye development in pSS patients, before this, the lacrimal glands received a greater influence, and then the meibomian glands began to be greatly affected.