Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes.

BACKGROUND/OBJECTIVES: To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal break detection in cataractous eyes. SUBJECTS/METHODS: We consecutively enrolled 126 cataract patients (including 246 eyes) with no comorbidities that could decrease best corrected visual acuity (BCVA). Three index tests (USG, nonmydriatic UWF, and mydriatic IDO) were performed preoperatively to screen for retinal breaks. One week after cataract extraction, a dilated IDO examination was repeated for the definitive diagnosis of retinal break as the reference standard. The sensitivity, specificity, Youden index (YI), and predictive values of each index test were calculated according to postoperative ophthalmoscopic findings. A deep-learning nomogram was developed to quantify the risk of retinal break presence using patients' baseline data and findings reported from preoperative ophthalmic tests. RESULTS: Fifty-two eyes (21%) were excluded from appropriate preoperative UWF imaging because of massive lens opacity. The BCVA cutoff point with maximum YI indicating UWF applicability was 0.6 logMAR (YI = 0.3; area under curve [AUC] = 0.7). Among all 246 eyes, preoperative IDO, USG, and UWF showed fair interobserver agreement (all κ > 0.2). According to postoperative IDO findings, the index tests with the highest sensitivity and specificity were USG (100%) and preoperative IDO (99%), respectively. CONCLUSIONS: For cataractous eyes without vision-impairing comorbidities, a BCVA better than 0.6 logMAR (Snellen acuity, 20/80) allows for appropriate nonmydriatic standard UWF imaging. In a high-volume clinic equipped with skilled ophthalmic examiners, screening with USG followed by directed IDO allows the efficient identification of retinal breaks in cataractous eyes.

Novel compound heterozygous variants in LTBP2 associated with relative anterior microphthalmos.

PURPOSE: Relative anterior microphthalmos (RAM) is a rare congenital defect associated with severe vision impairment that is primarily caused by genetic alterations. The purpose of this study was to identify the causative genetic variants in two Chinese families with RAM with an autosomal recessive inheritance pattern. METHODS: DNA samples were obtained from two probands and their family members. Targeted next-generation sequencing (NGS) was used to screen 425 genes associated with inherited eye diseases to identify possible disease-causing variants in the two patients. Sanger sequencing was subsequently used to validate the results in both families. RESULTS: The targeted NGS panel identified potentially causative novel variants of the latent transforming growth factor beta binding protein 2 (LTBP2) gene in the two RAM families: a missense variant (c.2771C > T; p.Ala924Val) and an intronic variant (c.4582 + 9A > G) in Family A and a different missense variant (c.5239C > A; p.Arg1747Ser) and a synonymous variant (c.951G > A; p.Pro317Pro) in Family B. These four novel variants all cosegregated with the disease phenotype. CONCLUSION: To our knowledge, this is the first study to report novel LTBP2 gene variants related to RAM. Considering the importance of LTBP2 in ocular development, we provide initial insights into the potential pathogenic mechanisms of LTBP2 in RAM.

Influence of Ocular Biometry Parameters on the Predictive Accuracy of IOL Power Formulas in Patients with High Myopia.

INTRODUCTION: The aim of this study was to investigate the influence of ocular biometry parameters on the predictive accuracy of 10 intraocular lens (IOL) power formulas in patients with high myopia (HM). METHODS: We analyzed 202 eyes of 202 patients. The ocular biometry was determined preoperatively using an IOLMaster 700. The associations between the biometry parameters and the prediction error (PE) 1 month postoperatively were assessed. HM was defined as an axial length exceeding 26.50 mm. RESULTS: In patients with HM (n = 108), the K6, Emmetropia Verifying Optical (EVO), Olsen, and Barrett Universal II (BUII) formulas had the lowest absolute PEs among the 10 formulas. The ocular biometry parameters were not associated with the PE of K6, EVO, Olsen, or BUII. A longer axial length in HM eyes was associated with myopic outcomes by Kane, Hoffer QST, and VRF and hyperopic outcomes by Holladay 2 and T2. Steeper keratometry, a deeper anterior chamber, and a thicker lens were associated with a hyperopic shift in HM eyes when using VRF, Kane, and Hoffer QST, respectively. In patients without HM (n = 94), there was no difference between the formulas in absolute PE. The significant associations between the biometry parameters and PE in patients with HM were not present in patients without HM. CONCLUSIONS: K6, EVO, Olsen, and BUII displayed high accuracy in HM eyes and were not influenced by preoperative biometry parameters. For the remaining formulas, the preoperative keratometry, anterior chamber depth, lens thickness, and axial length were possible error sources underlying an inaccurate IOL power prediction in patients with HM.

A Comparative Study on the Accuracy of IOL Calculation Formulas in Nanophthalmos and Relative Anterior Microphthalmos.

PURPOSE: We sought to compare the prediction accuracy of 6 intraocular lens (IOL) formulas, namely, the Haigis, Hoffer Q, Holladay I, SRK/T, Barrett Universal II and Hoffer QST formulas, in microphthalmic eyes, including those with nanophthalmos and relative anterior microphthalmos (RAM). DESIGN: Retrospective case series. METHODS: Twenty-six eyes with nanophthalmos (axial length [AL] 16.84 ± 1.36 mm, range 15.25 mm-19.82 mm) and 12 eyes with RAM (corneal diameter 8.41 ± 0.92 mm, range 7.00 mm-9.50 mm) receiving cataract surgery were included. The IOL Master 500 was used for biometry; thus, lens thickness (LT) was omitted in the IOL power calculation. The mean and median arithmetic and absolute prediction errors (PEs) of the 6 original calculation formulas, the absolute PEs of the 6 formulas after optimization, and the proportion of PEs within ±0.25 diopters (D), ±0.5 D, ±1 D, and ±2 D with each formula were compared. The factors influencing PE were analyzed by multivariate regression. RESULTS: In the nanophthalmos group, the overall prediction results were shifted to myopia. The original Haigis formula had the smallest median absolute PE (1.61 D, P < 0.001), and the optimized Haigis formula had the highest proportion of PEs within ±0.25 D, ±0.5 D, and ±1 D. In the RAM group, the overall prediction results were not significantly different from 0 (P > .05). No significant difference was found among the formulas before optimization (P = .146) and after optimization (P = .161), but the optimized Barrett Universal II formula had the highest proportion of PEs within ±1 D and ±2 D. CONCLUSIONS: When omitting the LT parameter in the calculation, the Haigis formula was the most accurate in cataract patients with nanophthalmos (AL <20 mm) among the 6 IOL calculation formulas, and the Barrett Universal II formula had the highest accuracy in cataract patients with RAM (corneal diameter ≤9.5 mm).

Signal transducer and activator of transcription 3 and cancer associated fibroblasts jointly generate chemo-resistance and affect prognosis in epithelial ovarian cancer / 中华妇产科杂志

Objective: To investigate the mechanism of signal transducer and activator of transcription 3 (STAT3) and cancer associated fibroblasts (CAF) jointly generate chemo-resistance in epithelial-ovarian cancer and their effect on prognosis. Methods: A total of 119 patients with high-grade ovarian serous cancer who received surgery in Cancer Hospital of Chinese Academy of Medical Sciences from September 2009 to October 2017 were collected. The clinico-pathological data and follow-up data were complete. Multivariate Cox regression model was used to analyze the prognostic factors. Ovarian cancer tissue chips of patients in our hospital were prepared. EnVision two-step method immunohistochemistry was used to detect the protein expression levels of STAT3, the specific markers of CAF activation, fibroblast activating protein (FAP), and type Ⅰ collagen (COL1A1) secreted by CAF. The relationship between the expression of STAT3, FAP, COL1A1 protein and drug resistance and prognosis of ovarian cancer patients was analyzed, and the correlation between the expression of three proteins was analyzed. These results were verified through the gene expression and prognostic information of human ovarian cancer tissues collected in the GSE26712 dataset of gene expression omnibus (GEO) database. Results: (1) Multivariate Cox regression model analysis showed that chemotherapy resistance was an independent risk factor for overall survival (OS) of ovarian cancer (P<0.001). (2) The expression levels of STAT3, FAP, and COL1A1 proteins in chemotherapy resistant patients were significantly higher than those in chemotherapy sensitive patients (all P<0.05). Patients with high expression of STAT3, FAP, and COL1A1 had significantly shorter OS than those with low expression (all P<0.05). According to the human ovarian cancer GSE26712 dataset of GEO database, patients with high expression of STAT3, FAP, and COL1A1 also showed shorter OS than patients with low expression (all P<0.05), the verification results were consistent with the detection results of ovarian cancer patients in our hospital. (3) Correlation analysis showed that the protein level of STAT3 was positively correlated with FAP and COL1A1 in our hospital's ovarian cancer tissue chips (r=0.47, P<0.001; r=0.30, P=0.006), the analysis of GEO database GSE26712 dataset showed that the expression of STAT3 gene and FAP, COL1A1 gene were also significantly positively correlated (r=0.31, P<0.001; r=0.52, P<0.001). Conclusion: STAT3 and CAF could promote chemotherapy resistance of ovarian cancer and lead to poor prognosis.

Associations between anterior segment biometry and high axial myopia in 3438 cataractous eyes in the Chinese population.

BACKGROUND: To investigate the associations between anterior segment biometry and high axial myopia in cataractous eyes in the Chinese population. METHODS: Data on 3438 eyes from 3438 subjects were analyzed in this cross-sectional study. Anterior segment biometry, axial length measurements, and intraocular pressure evaluation were implemented using an Oculus Pentacam HR, a Zeiss IOLMaster 500, and a Nidek TonoRef II, respectively. A multivariate-adjusted logistic model and a multivariate-adjusted linear model were used for statistical analysis. RESULTS: The mean age of the subjects was 62.2 ± 10.6 years, and 56.4% were female. There were 2665 subjects with high axial myopia (axial length, ≥26.50 mm) and 773 without (axial length, < 26.50 mm). The characteristics independently associated with high axial myopia included lower total corneal refractive power, a more negative Q value, greater total corneal astigmatism, greater white-to-white corneal diameter, greater anterior chamber depth, and higher intraocular pressure (all P <  0.05). In addition, greater axial length correlated with a thicker temporal cornea and a thinner nasal cornea (both P <  0.001). CONCLUSIONS: For cataractous eyes, high axial myopia was associated with corneal flattening, increased total corneal astigmatism, anterior segment enlargement, and intraocular pressure elevation. The findings may inform the choice of intraocular lenses and the calculation of their power, help improve the surgical practice of refractive cataract procedures, and provide useful information on the centration and stability of intraocular lenses.

Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes.

BACKGROUND: To investigate the decentration and tilt of plate-haptic multifocal intraocular lenses (MfIOLs) in myopic eyes. METHODS: Myopic (axial length [AXL] > 24.5 mm) and non-myopic (21.0 mm < AXL ≤ 24.5 mm) cataract eyes were enrolled in this prospective study and randomly assigned to receive implantation of Zeiss AT LISA tri 839MP lenses (Group A) or Tecnis ZMB00 lenses (Group B). In total, 122 eyes of 122 patients were available for analysis. Decentration and tilt of MfIOLs, high-order aberrations (HOAs), and modulation transfer functions (MTFs) were evaluated using the OPD-Scan III aberrometer 3 months postoperatively. Subjective symptoms were assessed with a Quality of Vision questionnaire. RESULTS: Near and distance visual acuities, tilt and horizontal decentration did not differ between the two groups, postoperatively. However, myopic eyes of Group B showed greater vertical decentration than those of Group A (- 0.17 ± 0.14 mm vs. -0.03 ± 0.09 mm, respectively), particularly when the MfIOLs were placed horizontally or obliquely. Overall decentration of myopic eyes was greater in Group B than in Group A (0.41 ± 0.15 mm vs. 0.16 ± 0.10 mm, respectively). In Group B, AXL was negatively correlated with vertical decentration and positively correlated with overall decentration. No such correlations were found in Group A. Intraocular total HOAs, coma, trefoil and spherical aberrations were lower in Group A than in Group B for a 6.0 mm pupil among myopic eyes. Generally, Group A had better MTFs and fewer subjective symptoms than Group B among myopic eyes. CONCLUSIONS: Plate-haptic design of MfIOLs may be a suggested option for myopic cataract eyes due to the less inferior decentration and better visual quality postoperatively.

Case Series: Slight Intraocular Lens Malpositioning as a Potential Cause of Vision Loss.

SIGNIFICANCE: The cases illustrate an insidious cause of decreased visual acuity after cataract surgery. PURPOSE: The purpose of this study was to identify cases of postoperative vision loss caused by slight intraocular lens (IOL) malpositioning after cataract surgery. CASE REPORTS: Three patients presented with visual acuity decreased after cataract surgery. Silt-lamp examination before mydriasis revealed no abnormalities in two of the patients; mild IOL inferonasal decentration was found by the trifocal IOL diffraction ring in the third patient. Manifest refraction of these patients showed remarkable astigmatism with low corneal astigmatism. After pupil dilation, slight IOL decentration and tilt were observed in all patients, which were further confirmed using the Scheimpflug imaging system. Wavefront aberrometry showed a high level of ocular higher-order aberrations, most of which were derived from intraocular aberrations. CONCLUSIONS: Inconspicuous IOL malpositioning is one of the reasons responsible for decreased vision acuity after cataract surgery, which may not be easily identified by slit-lamp examination. High astigmatism and ocular higher-order aberrations derived from malpositioned IOL can be important clues.

How many challenges we may encounter in anterior megalophthalmos with white cataract: a case report.

BACKGROUND: Anterior megalophthalmos is a rare congenital disease which mainly features enlargement of the anterior segment. Cataract surgeries in anterior megalophthalmos can be challenging due to the anatomical anomalies while the studies upon the surgical design have been less integrated. CASE PRESENTATION: A 37-year-old woman presented with progressively blurred vision in the right eye after a transient fever 10 months ago. Her ocular history included hypermetropia with a spherical equivalent of + 4.00 OU. The review of systems showed bilateral varus deformity of distal interphalangeal joints on the little fingers. The patient denied family history of hereditary ocular diseases and her sister was born with uterus didelphys. On initial examinations, the corrected distance visual acuity was hand motion OD and 20/33 OS. Her intraocular pressure was 15 mmHg OD and 16 mmHg OS. Horizontal corneal diameter was 14 mm OD and 13.88 mm OS and axial length was 24.87 mm OD and 25 mm OS. Anterior segment photography showed bilateral iridal atrophy with deficiency in pupillary dilation and white cortically mature cataract in the right eye. Inspection by anterior segment optical coherence tomography indicated bilateral augmented anterior chambers with backward iridal concave on horizontal orientation. Ultrasound biomicroscopy showed partially peripheral anterior synechiae and pectinate ligaments at chamber angle in both eyes and opacified lens with the apparently elongated suspensory ligaments in the right eye. A deliberately selected 1-piece foldable intraocular lens (IOL) with frame haptics was implanted after phacoemulsification for good IOL stability. During the follow-up, the visual rehabilitation appeared relatively good and a lower degree of IOL dislocation comparing with existing reports was verified by OPD-Scan III aberrometry. CONCLUSIONS: We presented the challenges and the original findings from a case of congenital anterior megalophthalmos with white cataract who underwent phacoemulsification and IOL implantation. This is the first report describing the comparison of the different IOL power calculation formulas in anterior megalophthalmos. Compared to the SRK/T and the Holladay II formulas, the Haigis formula could be a more accurate choice for the IOL calculation in anterior megalophthalmos according to our case. Moreover, the deliberate selection of IOLs is essential for IOL stability in these patients.

Expression and clinical significance of Atg3 and Atg5 genes in bone marrow mononuclear cells isolated from children with acute leukemia / 中华实用儿科临床杂志

Objective To detect the expression of autophagy-related gene Atg3 and Atg5 in bone marrow mononuclear cells (BMMNCs) from children with acute leukemia(AL),so as to explore the relationship between autophagy and the pathogenesis of AL in children.Methods Seventy-four bone marrow specimens were obtained from children with AL in the First Affiliated Hospital of Zhengzhou University Pediatrics Hematology Ward,including 37 cases of initially diagnosed AL without any treatment,28 cases of AL in complete remission,9 cases of refractory or relapse AL and 28 bone marrow specimens from children without tumor were also collected as the control group.BMMNCs were separated by Lydroxypropylmethyl Cellulose.After BMMNCs were stained by Monodansylcadaverine,the autophagy phenomenon was observed by using fluorescence microscope,and the ratio of autophagy was detected by using flow cytometry.Reverse transcription polymerase chain reaction(RT-PCR) was used to detect the expression of Atg3 mRNA and Atg5 mRNA in each group.Results It was found that autophagy phenomenon was more common in the initially diagnosed group and the refractory/relapse group,and the autophagy ratio in both groups was respectively (17.07 ±2.31) ％,(15.37 ± 1.59) ％,respectively,which were obviously higher than that of the control group (2.71 ± 1.57) ％ and that of the complete remission group.The differences were statistically significant (t =28.29,20.96,all P ＜ 0.01).The autophagy ratio in complete remission group was (3.48 ± 1.94) ％,and compared with the control group,the difference was of no statistical significance(t =1.634,P ＞ 0.05).The autophagy ratio in the refractory/relapse group higher than that in the complete remission group (t =16.61,P ＜ 0.05).The expressions of Atg3 mRNA and Atg5 mRNA in initially diagnosed group and refractory/relapse group were higher than those of the complete remission group and control group,and the differences were statistically significant (F =67.592,106.160,all P ＜ 0.008) ; the difference between complete remission group and control group was of no statistical significance (P ＞ 0.008).Conclusions The autophagy ratio and the expressions of Atg3 mRNA and Atg5 mRNA in initially diagnosed group and the refractory/ relapse group were both obviously higher.It was revealed that higher autophagy activity,which was caused by upregulated expressions of Atg3 mRNA and Atg5 mRNA,had a closely connection with the mechanism of occurrence,development and resistance of AL in children.