Electroacupuncture alleviates ciliary muscle cell apoptosis in lens-induced myopic guinea pigs through inhibiting the mitochondrial signaling pathway.

AIM: To investigate the effect of electroacupuncture (EA) on the mitochondria-dependent apoptotic signaling pathway in the ciliary muscle of guinea pigs with negative lens-induced myopia (LIM). METHODS: Guinea pigs were randomly divided into normal control (NC) group, LIM group, LIM+SHAM acupoint (LIM+SHAM) group, and LIM+EA group. Animals in the NC group received no intervention, while those in other three groups were covered with -6.0 diopter (D) lenses on right eyes. Meanwhile, animals in the LIM+EA group received EA at Hegu (LI4) combined with Taiyang (EX-HN5) acupoints, while those in the LIM+SHAM group were treated at sham points. After treatments for 1, 2, and 4wk, morphological changes in ciliary muscles were observed with hematoxylin and eosin (H&E) staining and nick end labeling (TUNEL), and the expression of the mitochondrial apoptotic signaling pathway-related molecules in ciliary muscles was measured by real-time quantitative polymerase chain reaction (qPCR) and Western blot. Additionally, the adenosine triphosphate (ATP) contents were also determined in ciliary muscles. RESULTS: Axial length increased significantly in the LIM and LIM+SHAM groups and decreased in the LIM+EA group. The ciliary muscle fibers were broken and destroyed in both LIM and LIM+SHAM groups, whereas those in the LIM+EA group improved significantly. TUNEL assay showed the number of apoptotic cells increased in the LIM and LIM+SHAM groups, whereas reduced in the LIM+EA group. ATP contents showed a significant decrease in the LIM and LIM+SHAM groups, whereas increased after EA treatment. Compared with the NC group, the dynamin-related protein 1 (DRP1), Caspase3, and apoptotic protease activator 1 (APAF1) levels were significantly increased in the LIM group and decreased in the LIM+EA group. CONCLUSION: The results provide evidence of EA inhibiting the development of myopia by regulating the mitochondrial apoptotic signaling pathway.

Inhibitory Effect of Jinkui Shenqi Pills on Glucocorticoid-Enhanced Axial Length Elongation in Experimentally Myopic Guinea Pigs.

OBJECTIVE: To explore the underlying mechanism of inhibition by Jinkui Shenqi Pills (JKSQP) on glucocorticoid-enhanced axial length elongation in experimental lens-induced myopia (LIM) guinea pigs. METHODS: Sixty 2-week old male guinea pigs were randomly divided into 4 groups with 15 guinea pigs in each group, according to the random numbers generated by SPSS software: control, LIM, saline and JKSQP groups. The control group includes animals with no treatment, while the guinea pigs in the other 3 groups received lens-induced myopization on the right eyes throughout the experiment (for 8 weeks). The saline and JKSQP groups were given daily intraperitoneal injections of 10 mg/kg hydrocortisone for 2 consecutive weeks at the same time, and then orally administered either saline or JKSQP [13.5 g/(kg•d) for 6 consecutive weeks. Body weight, anal temperature and animal appearance were observed and recorded to evaluate the GC-associated symptoms. The ocular parameters, including refraction and axial length, were measured by streak retinoscopy and A-scan ultrasonography, respectively. The levels of plasma hormones associated with the hypothalamic-pituitary-adrenal axis (HPAA), including free triiodothyronine, free thyroxine, estradiol and testosterone, were measured by radioimmunoassay, and cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate were measured by enzyme-linked immunosorbent assay. In addition, the mRNA and protein expressions of retinal amphiregulin (AREG) was measured by quantitative real-time polymerase chain reaction and Western blotting, respectively. RESULTS: JKSQP effectively increased body weight and anal temperature, improved animal appearance and suppressed axial length elongation in glucocorticoid-enhanced myopic guinea pigs with normalization of 4 HPAA-associated plasma hormones (all P<0.05). The plasma level of cAMP was significantly increased, whereas the plasma level of cGMP and the mRNA and protein expressions of retinal AREG were decreased after treatment with JKSQP (all P<0.05). CONCLUSION: JKSQP exhibited a significant inhibitory effect on axial length elongation with decreased expression of AREG in the retina, and normalized 4 HPAA-associated plasma hormones and the expression of cAMP and cGMP in GC-enhanced myopic guinea pigs.

Intravitreal injection of fibrillin 2 (Fbn2) recombinant protein for therapy of retinopathy in a retina-specific Fbn2 knock-down mouse model.

Mutations in the extracellular matrix gene Fibrillin-2 (FBN2) are related to genetic macular degenerative disorders including age-related macular degeneration (AMD) and early-onset macular degeneration (EOMD). It was reported that the retinal protein expression of FBN2 was reduced in patients with AMD and EOMD. The effect of exogenously supplied fbn2 recombinant protein on fbn2-deficiency-related retinopathy was not known. Here we investigated the efficacy and molecular mechanism of intravitreally applied fibrin-2 recombinant protein in mice with fbn2-deficient retinopathy. The experimental study included groups (all n = 9) of adult C57BL/6J male mice which underwent no intervention, intravitreal injection of adeno-associated virus (AAV) empty vector or intravitreal injection of AAV-sh-fbn2 (adeno-associated virus for expressing short hairpin RNA for fibrillin-2) followed by three intravitreal injections of fbn2 recombinant protein, given in intervals of 8 days in doses of 0.30 µg, 0.75 µg, 1.50 µg, and 3.00 µg, respectively. Eyes with intravitreally applied AAV-sh-fbn2 as compared to eyes with injection of AAV-empty vector or developed an exudative retinopathy with involvement of the deep retinal layers, reduction in axial length and reduction in ERG amplitudes. After additional and repeated application of fbn2 recombinant protein, the retinopathy improved with an increase in retinal thickness and ERG amplitude, the mRNA and protein expression of transforming growth factor-beta (TGF-ß1) and TGF-ß binding protein (LTBP-1) increased, and axial length elongated, with the difference most marked for the dose of 0.75 µg of fbn2 recombinant protein. The observations suggest that intravitreally applied fbn2 recombinant protein reversed the retinopathy caused by an fbn2 knockdown.

Synaptosomal Actin Dynamics in the Developmental Visual Cortex Regulate Behavioral Visual Acuity in Rats.

Purpose: Synaptosomal actin dynamics are essential for synaptic structural stability. Whether actin dynamics are involved in structural and functional synaptic plasticity within the primary visual cortex (V1) or behavioral visual acuity in rats has still not been thoroughly investigated. Methods: Synaptosome preparation and western blot analysis were used to analyze synaptosomal actin dynamics. Transmission electron microscopy was used to detect synaptic density and mitochondrial area alterations. A visual water maze task was applied to assess behavioral visual acuity. Microinjection of the actin polymerization inhibitor or stabilizer detected the effect of actin dynamics on visual function. Results: Actin dynamics, the mitochondrial area, and synaptic density within the area of V1 are increased during the critical period for the development of binocularity. Microinjection of the actin polymerization inhibitor cytochalasin D into the V1 decreased the mitochondrial area, synaptic density, and behavioral visual acuity. Long-term monocular deprivation reduced actin dynamics, the mitochondrial area, and synaptic density within the V1 contralateral to the deprived eye compared with those ipsilateral to the deprived eye and impaired visual acuity in the amblyopic eye. In addition, the mitochondrial area, synaptic density, and behavioral visual acuity were improved by stabilization of actin polymerization by jasplakinolide microinjection. Conclusions: During the critical period of visual development of binocularity, synaptosomal actin dynamics regulate synaptic structure and function and play roles in behavioral visual acuity in rats.

Neuroprotective effect of targeted regulatory Nrf2 gene on rats with acute brain injury induced by carbon monoxide poisoning.

Oxidative stress has been considered as an important cause of neurocyte damage induced by carbon monoxide (CO) poisoning; however, the precise mechanisms are not fully understood. The study aimed to elucidate the molecular mechanism and the neuroprotective effect of targeted regulatory nuclear factor erythroid2-related factor 2 (Nrf2) gene on acute brain injury in CO poisoning rats. An acute CO poisoning rat model was established by CO inhalation in hyperbaric oxygen chamber and followed by the administration of Nrf2 gene-loaded lentivirus. Mitochondrial membrane potential (ΔΨM), the levels of Nrf2, glutamate-cysteine ligase catalytic subunit (GCLC), catalase (CAT) and glutathione peroxidase (GSH-Px), and cell apoptosis were determined in brain tissue in rats. We found that CO poisoning could decrease ΔΨm of cells, slightly increase the expressions of Nrf2 and GCLC at mRNA and protein levels, reduce CAT and GSH-Px, and thus initiate apoptosis process. The Nrf2 gene treatment could obviously enhance the expressions of Nrf2 at mRNA and protein levels, and increase the concentrations of CAT and GSH-Px, maintain the ΔΨm of cells in brain tissue, significantly inhibit cell apoptosis as compared with the CO poisoning group (p < .05). These findings suggest that CO poisoning could induce oxidative stress and impair mitochondrial function of cells in brain tissue. The administration of Nrf2 gene could notably strengthen the antioxidant capacity of cells through regulating the downstream genes of Nrf2/antioxidant responsive element signal pathway, and positively protect cells against brain injury induced by acute severe CO poisoning.

Cytotoxic effect of specific T cells from mice with experimental autoimmune uveitis on murine photoreceptor cells.

AIM: To investigate the cytotoxic effect of specific T cells from mice with experimental autoimmune uveitis (EAU) as well as their secreted interferon (IFN)-γ and interleukin (IL)-17A on murine photoreceptor (661W) cells. METHODS: An EAU model was established in female mice by injection of interphotoreceptor retinoid binding protein (IRBP) emulsion supplemented with complete Freund's adjuvant (CFA) and Mycobacterium tuberculosis (TB). On day 12 after induction of EAU, specific T cells from spleen and lymph node tissues were isolated and cultured for 4d and the levels of IFN-γ and IL-17A in the supernatants were determined by enzyme-linked immunosorbent assays (ELISAs). T cells and their supernatants were added to 661W cells to observe the alteration of cell morphology; IFN-γ and IL-17A were separately added to 661W cells to observe the effect of IFN-γ and IL-17A on cell proliferation. RESULTS: The levels of IFN-γ and IL-17A in the T cell supernatants were 1568.64±38.79 pg/mL and 1456.57±46.98 pg/mL, respectively. The supernatants apparently inhibited 661W cell proliferation (P<0.05). T cells could also attach to the surface of 661W cells, and IFN-γ showed a more serious cytotoxic effect on 661W cells than IL-17A, inhibiting cell proliferation (P<0.01). CONCLUSION: IFN-γ and IL-17A from T cells of EAU mice model can exert cytotoxic effects on murine photoreceptor cell proliferation, and IFN-γ shows more serious cytotoxic effects on murine photoreceptor cells than IL-17A.

Differences in ocular biometry between urban and rural children matched by refractive error: the Shandong Children Eye Study.

PURPOSE: To determine the differences in mean ocular dimensions between urban and rural children and identify possible influencing factors. METHODS: This work uses previously published data from the Shandong Children Eye Study, which was based on a random cluster sampling applied to a cross-sectional school-based study design in the rural Guanxian County and Weihai city. All children underwent auto-refractometry and biometry under cycloplegia. RESULTS: The study included 3290 children (aged 9.35 ± 2.93 years), consisting of 888 pairs of boys and 757 pairs of girls matched by sex, age and refractive error (each pair matching one child from urban cohort with one from the rural cohort). Overall urban children were significantly taller and heavier than rural children (t-test; p < 0.001), which was confirmed for all age groups for weight. Urban ocular axial lengths were significantly longer by 0.23 mm compared to the rural population (t-test; p < 0.001), mostly in younger children and boys. Meanwhile, corneal curvatures were flatter in the urban cohort by 0.08 mm (p < 0.001). This association of axial length with urban vs rural region was reduced in magnitude by 69.7% after accounting for height. CONCLUSIONS: For the same, matched refractive error, children from urban regions had significantly longer eyes and flatter corneal curvature than rural children. Since corneal curvature is defined during the first 2 years of life, early environmental factors may be the source of these differences in ocular dimensions.

Amphiregulin Antibody and Reduction of Axial Elongation in Experimental Myopia.

To examine the mechanism of ocular axial elongation in myopia, guinea pigs (age: 2-3weeks) which either underwent unilateral or bilateral lens-induced myopization (group 1) or which were primarily myopic at baseline (group 2) received unilateral intraocular injections of amphiregulin antibody (doses: 5, 10, or 15µg) three times in intervals of 9days. A third group of emmetropic guinea pigs got intraocular unilateral injections of amphiregulin (doses: 0.25, 0.50 or 1.00ng, respectively). In each group, the contralateral eyes received intraocular injections of Ringer's solution. In intra-animal inter-eye comparison and intra-eye follow-up comparison in groups 1 and 2, the study eyes as compared to the contralateral eyes showed a dose-dependent reduction in axial elongation. In group 3, study eyes and control eyes did not differ significantly in axial elongation. Immunohistochemistry revealed amphiregulin labelling at the retinal pigment epithelium in eyes with lens-induced myopization and Ringer's solution injection, but not in eyes with amphiregulin antibody injection. Intraocular injections of amphiregulin-antibody led to a reduction of lens-induced axial myopic elongation and of the physiological eye enlargement in young guinea pigs. In contrast, intraocularly injected amphiregulin in a dose of ≤1ng did not show a significant effect. Amphiregulin may be one of several essential molecular factors for axial elongation.

N-Butylphthalide Improves Cognitive Function in Rats after Carbon Monoxide Poisoning.

Cognitive impairment is the most common neurologic sequelae after carbon monoxide (CO) poisoning, and the previous investigations have demonstrated that N-Butylphthalide (NBP) could exert a broad spectrum of neuroprotective properties. The current study aimed to investigate the effect of NBP on cognitive dysfunction in rats after acute severe CO poisoning. Rats were randomly divided into a normal control group, a CO poisoning group and a CO+NBP group. The animal model of CO poisoning was established by exposure to CO in a chamber, and then all rats received hyperbaric oxygen therapy once daily, while rats in CO+NBP group were administered orally NBP (6 mg/ 100g) by gavage twice a day additionally. The results indicated that CO poisoning could induce cognitive impairment. The ultrastructure of hippocampus was seriously damaged under transmission electron microscopy, and the expressions of calpain 1 and CaMK II proteins were significantly elevated after CO exposure according to the analysis of immunofluorescence staining and western blot. NBP treatment could evidently improve cognitive function, and maintain ultrastructure integrity of hippocampus. The expression levels of both calpain 1 and CaMK II proteins in CO+NBP group were considerably lower than that of CO poisoning group (P < 0.05). Taken together, this study highlights the molecular mechanism of cognitive dysfunction in rats after CO exposure via the upregulation of both calpain 1 and CaMK II proteins. The administration of NBP could balance the expressions of calpain 1 and CaMK II proteins and improve cognitive function through maintaining ultrastructural integrity of hippocampus, and thus may play a neuroprotective role in brain tissue in rats with CO poisoning.

Corneal diameter and associated parameters in Chinese children: the Shandong Children Eye Study.

BACKGROUND: To assess the corneal diameter and its associations in children. DESIGN: Cross-sectional school-based study. PARTICIPANTS: Six thousand twenty-six children aged 4-18 years were included in the Shandong Children Eye Study. METHODS: Horizontal corneal diameter was measured by laser interferometry-based ocular biometry. MAIN OUTCOME MEASURES: Horizontal corneal diameter. RESULTS: Corneal diameter measurements were available for 5970 (99.1%) children. In multivariate analysis, larger horizontal corneal diameter (mean: 12.02 ± 0.38 mm; range: 10.1-15.0 mm) was associated with longer corneal curvature radius longer axial length, male gender, younger maternal age, rural region of habitation and lower intraocular pressure measurements. Higher prevalence of abnormally large corneas (macrocorneas; horizontal diameter ≥ 12.76 mm; mean value +2 × standard deviations; mean: 2.6%; 95% CI: 2.2, 3.0) was associated with longer corneal curvature radius, longer axial length, younger maternal age and male gender. Higher prevalence of abnormally small corneas (horizontal diameter ≤ 11.24mm; mean value -2 × standard deviations; mean: 2.4%; 95% CI: 2.0, 2.8) was correlated with shorter corneal curvature radius, shorter axial length and urban region of habitation. Neither abnormally large nor small corneas were correlated with time spent indoors/outdoors. CONCLUSIONS: In 4 to 18-year-old children, larger corneal diameter was associated most strongly with flatter corneal curvature, followed by longer axial length and male gender. Corneal diameter was independent of age beyond an age of 4 years. Abnormally large and abnormally small corneas may be defined as being ≥12.76 and ≤11.24 mm in diameter, respectively. Corneal diameter was not correlated with time spent indoors/outdoors.

Evaluation of Ex-PRESS implantation combined with phacoemulsification in primary angle-closure glaucoma.

To evaluate the safety and efficacy of Ex-PRESS (R50) implantation combined with phacoemulsification in primary angle-closure glaucoma (PACG) patients with cataract.Twenty-four eyes of 24 patients with unregulated PACG underwent combined cataract and glaucoma surgery. After phacoemulsification and intraocular lens implantation, the Ex-PRESS (R-50) was inserted into the anterior chamber under a scleral flap. The intraocular pressure (IOP), best corrected visual acuity (BCVA), number of medications, and complications were recorded preoperatively as well as postoperatively on day 7 and at 1, 3, 6, and 12 months.The mean follow-up was 16.4 ±â€Š2.5 months (range 14-21 months) and the mean age of the patients was 64.7 ±â€Š6.8 years (range 56-78 years). The mean IOP was 20.4 ±â€Š5.4 mm Hg preoperatively and decreased to 10.2 ±â€Š2.8, 13.1 ±â€Š2.7, 14.9 ±â€Š4.1, 14.3 ±â€Š3.9, and 14.0 ±â€Š3.6 mm Hg on day 7 and at 1, 3, 6, and 12 months after surgery (all P < 0.005). At 12 months, the mean BCVA was 0.62 ±â€Š0.33 and the number of medications was 0.3 ±â€Š0.6. Most of complications were resolved spontaneously and conservatively.The Ex-PRESS implantation combined with phacoemulsification cataract extraction is safe and effective for reducing IOP and antiglaucoma medications in PACG patients with cataract.

Stereoacuity and Related Factors: The Shandong Children Eye Study.

OBJECTIVE: To assess stereoacuity in a population-based sample of children and to examine ocular and systemic parameters related to stereoacuity. METHODS: Using a random cluster sampling method, four- to 18-year-old children from kindergartens, elementary schools, junior high schools and senior high schools from a rural area and an urban area in the East Chinese province of Shandong were included in the school-based cross-sectional study. All participants underwent a comprehensive eye examination including assessment of cycloplegic refraction and measurement of stereoacuity using the Titmus Stereo test. RESULTS: Out of 6364 eligible children, 5780 (90.8%) children with a mean age of 10.1 ± 3.2 years (range: 4 to 18 years) participated. Mean (± standard deviation) stereoacuity was 50.2 ± 50.6 arc seconds. Stereoacuity improved significantly (P<0.01) from the age group of 4 years to the age group of 6 to 7 years, then showed a plateau, deteriorated (P = 0.001) for both sexes from the age group of 9 years to the age group of 12 years (P<0.001), after which it improved (P = 0.001) again in the age group of 16 years or older to the pre-puberty values. In multivariate analysis, larger angle of binocular disparity (i.e., lower stereoacuity) was significantly associated with lower best corrected visual acuity (logMAR; P<0.001), higher intereye difference in refractive error (spherical equivalent) (P<0.001), higher cylindrical refractive error (P<0.001), higher refractive error (spherical value; P<0.001), higher intereye difference in best corrected visual acuity (logMAR) (P = 0.001), higher intereye difference in axial length (P = 0.001), and rural region of habitation (P = 0.006). CONCLUSIONS: Stereoacuity as tested with the Titmus Stereo test improved significantly from an age of 4 years to an age of 6 and 7 years, then remained constant, temporarily deteriorated for both sexes in pre-puberty and puberty, after which it improved again to pre-puberty or better values at the age of 16 years or older. Lower stereoacuity was associated with lower best corrected visual acuity and higher intereye difference in best corrected visual acuity, higher cylindrical and spherical refractive errors, higher inter-eye difference in refractive error, higher intereye difference in axial length, and rural region of habitation.

Zinc oxide nanoparticles inhibit expression of manganese superoxide dismutase via amplification of oxidative stress, in murine photoreceptor cells.

OBJECTIVES: As a parenchymal cell, the photoreceptor is more susceptible to alterations in outer micro-environmental conditions than other cells. In the present study, we aimed to investigate inhibitory effects of zinc oxide (ZnO) nanoparticles on expression of manganese superoxide dismutase (MnSOD) in murine photoreceptor-derived cells. MATERIALS AND METHODS: We investigated effects of ZnO nanoparticles on murine photoreceptor cell viability and on expression and activity of MnSOD using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, immunofluorescence analysis, flow cytometry, quantitative real-time PCR and enzyme-linked immunosorbent assay (ELISA). RESULTS: ZnO nanoparticles were found to have higher cytotoxic effects in concentration- and time-dependent manners, to elevate intracellular levels of hydrogen peroxide and hydroxyl radicals, and thus to induce overproduction of reactive oxygen species (ROS) and collapse of mitochondrial membrane potential, leading to cell damage. Moreover, ZnO nanoparticles also significantly reduced expression of MnSOD at both the mRNA and protein levels, reduced its activity, and further aggravated oxidative stress-mediated cell damage. CONCLUSION: Overall, ZnO nanoparticle-induced cytotoxicity was associated with elevated levels of oxidative stress due to overproduction of ROS and reduced expression and activity of MnSOD.

Prevalence and Associations of Anisometropia in Children.

PURPOSE: To describe prevalence and associations of anisometropia in children. METHODS: The cross-sectional school-based study included children aged 4 to 18 years. RESULTS: The study included 6025 (94.7%) of 6364 eligible children. Mean refractive anisometropia was 0.37 ± 0.57 diopters (median: 0.25 diopters; range: 0-7.88 diopters; prevalence [≥1 diopter]: 7.0% ± 0.3%). In multivariate analysis (regression coefficient r: 0.66), higher refractive anisometropia was associated with older age (P < 0.001; ß: 0.07; B: 0.01; 95% CI: 0.01-0.02), higher maternal education level (P < 0.001; ß: 0.04; B: 0.02; 95% CI: 0.01-0.03), more total time spent indoors reading or writing (P = 0.001; ß: 0.04; B: 0.01; 95% CI: 0.01-0.02), larger intereye difference in axial length (P < 0.001; ß: 0.57; B: 1.20; 95% CI: 1.15-1.24), shorter mean axial length of both eyes (P = 0.03; ß: -0.03; B: -0.02; 95% CI: -0.03 to -0.001), larger intereye difference in best corrected visual acuity (BCVA) (P < 0.001; ß: 0.14; B: 1.83; 95% CI: 1.54-2.12), and lower stereoacuity (P < 0.001; ß: 0.08; B: 0.31; 95% CI: 0.22-0.39). Refractive anisometropia showed a U-shaped correlation with refractive error. Higher anisomyopia was associated (r: 0.57) with older age (P = 0.001; ß: 0.05; B: 0.006; 95% CI: 0.002-0.009), higher level of paternal education (P = 0.001; ß: 0.01; B: 0.01; 95% CI: 0.01-0.02), more total time spent indoors reading or writing (P = 0.01; ß: 0.03; B: 0.01; 95% CI: 0.00-0.01), larger intereye difference in axial length (P < 0.001; ß: 0.22; B: 0.26; 95% CI: 0.23-0.29), greater myopic refractive error (P < 0.001; ß: -0.46; B: -0.07; 95% CI: -0.08 to -0.07), and lower corneal astigmatism (P < 0.001; ß: -0.10; B: -0.06; 95% CI: -0.08 to -0.05). In the same multivariate model, hyperopic anisometropia was not significantly associated with time spent indoors with reading (P = 0.18). Cylindrical anisometropia (mean: 0.30 ± 0.32 diopters; prevalence [≥1 diopter]: 3.7% ± 0.2%) increased with higher refractive anisometropia (P < 0.001; ß: 0.16; B: 0.09; 95% CI: 0.08-0.11), greater myopic refractive error (P < 0.001; ß: -0.06; B: -0.01; 95% CI: -0.01 to -0.01), higher corneal astigmatism (P < 0.001; ß: -0.22; B: -0.15; 95% CI: -0.17 to -0.13), and lower mean BCVA (P < 0.001; ß: 0.11; B: 0.90; 95% CI: 0.68-1.17). CONCLUSIONS: In 4- to 18-year-old children, refractive anisometropia and anisomyopia increased with systemic parameters such as age, parental education level, and lifestyle of the children, for example, more time spent indoors reading or writing. In contrast, hyperopic anisometropia and cylindrical anisometropia were not related with lifestyle parameters.

Efficacy and economic analysis of Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a systematic review and Meta-analysis.

AIM: To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy (Trab) for uncontrolled glaucoma. METHODS: Clinical trials were identified by electronic databases (PubMed, EMBASE, ISI Web of science and Cochrane library), and data, such as intraocular pressure (IOP), the complete and qualified success rate, the postoperative complications and the cost, were exacted from these relevant studies. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and were pooled using a random-effects model. RESULTS: Eleven relevant publications and two abstracts met the inclusion criteria. The efficacy of Ex-PRESS was similar to that of Trab in the percentage of IOP reduction (IOPR %) at 1, 2y (WMD: -2.01; 95% CI: -7.92-3.90; P=0.50 and WMD: 2.89; 95% CI: -8.05-13.83; P=0.60, respectively). Ex-PRESS possessed a significant higher complete and qualified success rate (OR: 1.59; 95% CI: 1.07-2.35; P=0.02 and OR: 1.74; 95% CI: 1.06-2.86; P=0.03, respectively). Moreover, Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab (OR: 0.39; 95% CI: 0.21-0.72; P=0.003 and OR: 0.27; 95% CI: 0.10-0.69; P=0.003, respectively). However, there was no consistent result on the cost between the two groups according to the previous three studies. CONCLUSION: Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP, yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab. Nevertheless, whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.

Axial Length and Associated Factors in Children: The Shandong Children Eye Study.

PURPOSE: To investigate ocular axial length (AL) in Chinese children. METHODS: The Shandong Children Eye Study included 6,364 children aged 4-18 years. RESULTS: Longer AL (mean 23.45 ± 1.20 mm, range 18.80-28.59 mm) was associated (multivariate analysis; correlation coefficient r2: 0.61) with older age (p < 0.001, standardized correlation coefficient ß = 0.35, unstandardized regression coefficient B = 0.13, 95% confidence interval [CI] 0.12, 0.15), male gender (p < 0.001, ß = -0.24, B = -0.10, 95% CI -0.29, -0.19), urban region (p < 0.001, ß = 0.10, B = 0.25, 95% CI 0.20, 0.31), body height (p < 0.001, ß = 0.22, B = 0.02, 95% CI 0.01, 0.02), maternal education (p < 0.001, ß = 0.07, B = 0.07, 95% CI 0.05, 0.10), paternal myopia (p < 0.001, ß = 0.09, B = 0.26, 95% CI 0.20, 0.33), maternal myopia (p < 0.001, ß = 0.08, B = 0.23, 95% CI 0.17, 0.30), more time spent indoors reading/writing (p < 0.001, ß = 0.05, B = 0.03, 95% CI 0.02, 0.04), less time spent outdoors (p = 0.005, ß = -0.03, B = -0.01, 95% CI -0.02, -0.003), longer corneal curvature radius (p < 0.001, ß = 0.36, B = 1.63, 95% CI 1.53, 1.74) and higher intraocular pressure (p = 0.008, ß = 0.03, B = 0.01, 95% CI 0.004, 0.02). High axial myopia (AL ≥26.0 mm) present in 202 children (3.4 ± 0.2%, 95% CI 2.92, 3.84) was associated with less time spent outdoors (p = 0.002, odds ratio 0.92, 95% CI 0.87, 0.97) in multivariate analysis. CONCLUSIONS: In children in the less developed Eastern Chinese province of Shandong, the prevalence of high axial myopia was >10% among 16-year-olds. A modifiable factor associated with higher prevalence of high axial myopia was less time spent outdoors.

Influence of Yanyankang Powder on Th1/Th2 in rats with experimental autoimmune uveitis.

OBJECTIVE: To study the influence of Yanyankang powder on Th1/Th2 in rats with experimental autoimmune uveitis (EAU). METHODS: The EAU models were induced in Lewis rats by immunization with interphotoreceptor retinoid binding protein (IRBP) 1177-1191 in complete Freund's adjuvant. The rats were randomly divided into 3 groups: a model control group, a Yanyankang group, and a prednisone group, 9 rats in each group. The model control group was intervened with saline solution by gavage. The Yanyankang group was intervened with Yanyankang powder 4 g/(kg day) by gavage. The prednisone group were intervened with prednisone acetate tablets 5 mg/(kg d) by gavage. All groups were intervened after immunization once every 2 days for 18 days and monitored by slit-lamp biomicroscopy daily until day 18. The levels of gamma interferon (INF-γ) and interleukin-10 (IL-10) in the supernatants of T cells were determined by enzyme-linked immunosorbent assay. Polymerase chain reaction (PCR) technology was used for measuring Th1 and Th2 related cytokine mRNA expressions. RESULTS: Slighter intraocular inflammation was found in the Yanyankang group and the prednisone group than the control group. The levels of the IFN-γ and IL-10 in the supernatants of the spleen lymph node cells were 382.33±6.30, 155.87±4.46 µg/L in the Yanyankang group and 270.93±7.76, 265.32±11.88 µg/L in the prednisone group. Both had significant differences compared with the control group (941.53±8.59, 20.67±4.65 µg/L; =0.01). The PCR results showed the same tendency. CONCLUSION: Yanyankang powder showed favorable effects in the rats with EAU by influencing the function of Th1 and Th2 cells.