Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes.

BACKGROUND: Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. METHODS: We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. RESULTS: Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. CONCLUSIONS: Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Protective Effects of Anthocyanins Extracted from Vaccinium Uliginosum on 661W Cells Against Microwave-Induced Retinal Damage.

OBJECTIVE: To study the protective effect of anthocyanins extracted from Vaccinium Uliginosum (VU) on retinal 661W cells against microwave radiation induced retinal injury. METHODS: 661W cells were divided into 6 groups, including control, model [661W cells radiated by microwave (30 mW/cm2, 1 h)] and VU groups [661W cells pretreated with anthocyanins extracted from VU (25, 50, 100 and 200 µg/mL, respectively) for 48 h, and radiated by microwave 30 mW/cm2, 1 h]. After treatment with different interventions, the cell apoptosis index (AI) was determined using Heochst staining; contents of malonaldehyde (MDA), glutataione (GSH), and activity of superoxide dismutase (SOD) were measured. mRNA expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1(HO-1) were detected by real time quantitative polymerase chain reaction, and the expression of HO-1 protein was examined by Western blot analysis. Nucleus and cytoplasm were separated and Nrf2 protein expression was further verified by Western blot analysis. RESULTS: There was significant difference in AI among the groups (F=322.83, P<;0.05). Compared with the control group, AI was significantly higher in the model group and was lower in 4 VU-pretreated groups (P<;0.05). Linear regression analysis showed the decline of AI was in a dose-dependent manner with VU treatment (r=0.8419, P<;0.05). The MDA and GSH contents of 661W cells in VU-treated groups were significantly lower than the model group (P<;0.05). Compared with the model group, the SOD activity in the VU-treated groups (50, 100 and 200 µg/mL) was significantly higher (all P<;0.05). The Nrf2 and HO-1 mRNA expressions were slightly increased after irradiation, and obviously increased in 100 µg/mL VU-treated group. After irradiation, the relative expressions of HO-1 and Nrf2 proteins in nucleus were slightly increased (P<;0.05), and the changes in cytoplasm were not obvious, whereas it was significantly increased in both nucleus and cytoplasm in the VU treatment groups. CONCLUSIONS: Anthocyanins extracted from VU could reduce apoptosis, stabilize cell membrane, and alleviate oxidant injury of mouse retinal photoreceptor 661W cells. The mechanism might be through activating Nrf2/HO-1 signal pathway and inducing HO-1 transcription and translation.

Predictive model and risk analysis for diabetic retinopathy using machine learning: a retrospective cohort study in China.

OBJECTIVE: Aiming to investigate diabetic retinopathy (DR) risk factors and predictive models by machine learning using a large sample dataset. DESIGN: Retrospective study based on a large sample and a high dimensional database. SETTING: A Chinese central tertiary hospital in Beijing. PARTICIPANTS: Information on 32 452 inpatients with type-2 diabetes mellitus (T2DM) were retrieved from the electronic medical record system from 1 January 2013 to 31 December 2017. METHODS: Sixty variables (including demography information, physical and laboratory measurements, system diseases and insulin treatments) were retained for baseline analysis. The optimal 17 variables were selected by recursive feature elimination. The prediction model was built based on XGBoost algorithm, and it was compared with three other popular machine learning techniques: logistic regression, random forest and support vector machine. In order to explain the results of XGBoost model more visually, the Shapley Additive exPlanation (SHAP) method was used. RESULTS: DR occurred in 2038 (6.28%) T2DM patients. The XGBoost model was identified as the best prediction model with the highest AUC (area under the curve value, 0.90) and showed that an HbA1c value greater than 8%, nephropathy, a serum creatinine value greater than 100 µmol/L, insulin treatment and diabetic lower extremity arterial disease were associated with an increased risk of DR. A patient's age over 65 was associated with a decreased risk of DR. CONCLUSIONS: With better comprehensive performance, XGBoost model had high reliability to assess risk indicators of DR. The most critical risk factors of DR and the cut-off of risk factors can be found by SHAP method to render the output of the XGBoost model clinically interpretable.

An online diabetic retinopathy screening tool for patients with type 2 diabetes.

AIM: To develop a useful diabetic retinopathy (DR) screening tool for patients with type 2 diabetes mellitus (T2DM). METHODS: A DR prediction model based on the Logistic regression algorithm was established on the development dataset containing 778 samples (randomly assigned to the training dataset and the internal validation dataset at a ratio of 7:3). The generalization capability of the model was assessed using an external validation dataset containing 128 samples. The DR risk calculator was developed through WeChat Developer Tools using JavaScript, which was embedded in the WeChat Mini Program. RESULTS: The model revealed risk factors (duration of diabetes, diabetic nephropathy, and creatinine level) and protective factors (annual DR screening and hyperlipidemia) for DR. In the internal and external validation, the recall ratios of the model were 0.92 and 0.89, respectively, and the area under the curve values were 0.82 and 0.70, respectively. CONCLUSION: The DR screening tool integrates education, risk prediction, and medical advice function, which could help clinicians in conducting DR risk assessments and providing recommendations for ophthalmic referral to increase the DR screening rate among patients with T2DM.

Is diabetic retinopathy affected by diabetes type? A retrospective study using electronic medical record data from patients with latent autoimmune diabetes in adults, type 1 diabetes, and type 2 diabetes.

AIMS: To determine whether the occurrence of diabetic retinopathy (DR) and its related factors are affected by diabetes type (latent autoimmune diabetes in adults [LADA], type 1 diabetes mellitus [T1DM], type 2 diabetes mellitus [T2DM]). METHODS: LADA patients were matched for age (± 2 years) and sex to T1DM (1:1) and T2DM (1:2) patients. Retrieved variables included demographic characteristics, diabetes history, laboratory test findings, and history of DR screening, etc. Multiple logistic regression analysis was applied to identify influencing factors of DR. A decision tree was used to explore interactions between diabetes type and other influencing factors of DR. RESULTS: We included 110 LADA, 101 T1DM, and 220 T2DM patients. DR prevalence was 26.4% in LADA patients, lower than that in T1DM (50.5%) and T2DM (47.7%) patients (P < 0.001). Logistic regression analysis demonstrated that diabetes duration (OR = 1.15, 95% CI: 1.1-1.26, P < 0.001) and diabetic nephropathy (DN) (OR = 42.39, 95% CI: 10.88-165.11, P < 0.001) were independent risk factors for DR, and regular DR screening (OR = 0.33, 95% CI: 0.16-0.69, P = 0.003) was an independent protective factor. Decision tree analysis showed that in patients without DN with a diabetes duration of at least 10.5 years, T1DM and LADA patients had a higher incidence of DR than T2DM patients (72.7% vs. 55.1%). CONCLUSIONS: The prevalence of DR in diabetes patients was affected by diabetes duration, DN occurrence, and regular DR screening. Diabetes type indirectly affects DR occurrence through its interaction with diabetes duration and DN. Correct LADA diagnosis is necessary, and DR screening needs to be well-implemented.

Ag@TiO2 Nanoprisms with Highly Efficient Near-Infrared Photothermal Conversion for Melanoma Therapy.

Melanoma is a primary reason of death from skin cancer and associated with high lethality. Photothermal therapy (PTT) has been developed into a powerful cancer treatment technique in recent years. Here, we created a low-cost and high-performance PTT agent, Ag@TiO2 NPs, which possesses a high photothermal conversion efficiency of ≈65 % and strong near-infrared (NIR) absorption about 808 nm. Ag NPs were synthesized using a two-step method and coated with TiO2 to obtain Ag@TiO2 NPs by a facile sol-gel method. Because of the oxide, Ag@TiO2 NPs exhibit remarkable high photothermal conversion efficiencies and biocompatibility in vivo and in vitro. Cytotoxicity and therapeutic efficiency of photothermal cytotoxicity of Ag@TiO2 NPs were tested in B16-F10 cells and C57BL/6J mice. Under light irradiation, the elevated temperature causes cell death in Ag NPs-treated (100 µg mL-1 ) cells in vitro (both p<0.01). In the case of subcutaneous melanoma tumor model, Ag@TiO2 NPs (100 µg mL-1 ) were injected into the tumor and irradiated with a 808 nm laser of 2 W cm-2 for 1 minute. As a consequence, the tumor volume gradually decreased by NIR laser irradiation with only a single treatment. The results demonstrate that Ag@TiO2 NPs are biocompatible and an attractive photothermal agent for cutaneous melanoma by local delivery.

A novel GPR143 mutation in a Chinese family with X­linked ocular albinism type 1.

Ocular albinism type 1 (OA1) is a genetic disorder characterized by reduced eye pigmentation and nystagmus, which is often accompanied by decreased visual acuity, strabismus and other symptoms, whereas skin and hair color remain normal. The present study aimed to assess the clinical features and perform genotype analysis of a family with OA1, and to determine the disease­causing mutation. A total of 18 family members (nine affected patients and nine normal subjects) from Hainan, China, were recruited to the present study in December 2017. A detailed clinical ophthalmic examination was performed for all participants, including a visual acuity test, anterior segment slit lamp examination, eye fundus examination and optical coherence tomography. Mutations in the G protein­coupled receptor 143 (GPR143) gene were determined by DNA sequencing assays and polymerase chain reaction assays for deletions; all exon coding sequences, exons at the 5'­ and 3'­ends, and non­coding region sequences of intron splicing were assessed. Within the family, nine male patients exhibited disease occurrence at the age of 0­6 months. All patients presented with different degrees of iris depigmentation, horizontal jerk nystagmus, foveal hypoplasia and reduced visual acuity. The fundus of only one patient exhibited choroid coloboma; in the remaining patients, their fundi exhibited different degrees of irregular retinal depigmentation. The mutation c.360+5G>T in the GPR143 gene was identified in this family. In conclusion, the present study identified the splicing mutation c.360+5G>T in the GPR143 gene in a Chinese family with OA1 and successfully identified the site. To the best of our knowledge, there have been no previous reports regarding this mutation in any major genome databases; therefore, this outcome may enrich the mutation spectrum of the GPR143 gene.

A new perspective for analyzing clinical characteristics of idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome.

PURPOSE: We aimed to analyze the clinical characteristics of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Furthermore, we aimed to correlate the number and location of retinal aneurysms with the size of retinal non-perfusion area and neovascularization. METHODS: Six patients with IRVAN syndrome (1 male and 5 females, age 5-38 years) were enrolled in this study. Fundus fluorescein angiography (FFA) was used to determine the total number of retinal aneurysms, number of aneurysms within the first branch of the retinal artery, minimum distance between the non-perfusion margin and the optic disc, and the number of retinal aneurysms in each quadrant, as well as the type of neovascularization. RESULTS: The size of the non-perfusion area was positively correlated with the total number of retinal aneurysms, the number of aneurysms within the first branch of the retinal artery, and the number of retinal aneurysms in each quadrant (P < 0.05). During the 5-year follow-up, one patient exhibited a dynamic change in the number and location of retinal aneurysms. CONCLUSIONS: In IRVAN syndrome, the number and location of retinal aneurysms correlate with the size of retinal non-perfusion area and type of neovascularization.

Research Advances in Biomarkers for Demyelinating Optic Neuritis.

Optic neuritis refers to all inflammatory diseases in the optic nerve. The most common type is demyelinating optic neuritis. Biomarkers can indicate its pathophysiological process and thus are useful in disease diagnosis and treatment. This article reviews the known biomarkers for demyelinating optic neuritis.

Removal of the eye in a tertiary care center of China: a retrospective study on 573 cases in 20 years.

AIM: To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS: A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed. RESULTS: Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%. CONCLUSION: Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.

Sirtuin 1 regulates lipid metabolism associated with optic nerve regeneration.

Injury to the optic nerve may lead to axonal degeneration, followed by the gradual death of retinal ganglion cells (RGCs), which results in irreversible vision loss. In the present study the mechanism of optic nerve injury, and the following regeneration and repair processes associated with sirtuin 1 (SIRT1)­regulated lipid metabolism were analyzed. In addition, the treatment of optic nerve injury using resveratrol was investigated. A rat model of optic nerve damage was prepared, and rats were divided into control, model and resveratrol groups. The model rats (with optic nerve damage) were treated with phosphate­buffered saline or resveratrol once a day for seven, 14 and 21 days. The rats were then sacrificed and the optic nerve was dissected. The expression levels of SIRT1, sterol regulatory element­binding protein 2 (SREBP­2) and 3­hydroxy­3­methylglutaryl­CoA reductase (HMGCR) mRNA in the optic nerve were measured by reverse transcription­quantitative polymerase chain reaction, and the protein expression of SIRT1, SREBP2 and HMGCR was evaluated by western blotting. In addition, the cholesterol level of the optic nerve was assessed. The retina was excised and the surviving RGCs were observed and counted. The morphology of the RGCs in the rat model of optic nerve injury changed; however, the degree of damage in rats treated with resveratrol was relatively small. The number of surviving RGCs and the cholesterol level in the RGCs from the model rats was observed to be restored by treatment with resveratrol following optic nerve damage. Additionally, the expression levels of SIRT1, SREBP­2 and HMGCR mRNA and protein were restored by resveratrol treatment in the rats with optic nerve damage. Thus, resveratrol reversed certain features of the optic nerve injury damage via SIRT1 and SREBP­2­associated signaling pathways and the downstream regulated gene, HMGCR. Furthermore, resveratrol promoted cholesterol synthesis in, and repair of, RGCs. Therefore, SIRT1 may serve as a promising novel target for the treatment of optic nerve damage.

Nuclear respiratory factor-2α and adenosine triphosphate synapses in rat primary cortical neuron cultures: The key role of adenosine monophosphate-activated protein kinase.

Nuclear respiratory factor­2α (NRF­2α) is an important transcription factor that regulates mitochondrial oxidative phosphorylation and regeneration. NRF­2α regulates mitochondrial transcription factors (mTF)A and B, and mitochondrial DNA by indirectly regulating the mitochondrial respiratory enzyme chain subunit. In addition, NRF­2α is involved in the mitochondrial energy metabolism. Peroxisome proliferator­activated receptor γ coactivator 1α (PGC­1α), is an important transcription coactivator of NRF­2α. Adenosine monophosphate­activated protein kinase (AMPK) is considered an important effector in the regulation of the energy metabolism balance of nervous system microenvironments. However, the signaling mechanism underlying the energy coupling of PGC­1α and NRF­2α in visual cortical neurons remains to be elucidated. The present study used a primary culture system of rat visual cortical neurons in order to investigate whether AMPK is involved in the regulation of NRF­2α and PGC­1α expression in cortical neurons. The results of the present study indicated that KCl depolarization rapidly activated AMPK, and significantly increased the expression levels of PGC­1α, NRF­2α and mtTFA, as well as adenosine triphosphate production in cultured neurons. Similarly, the AMPK agonists 5­aminoimidazole­4­carboxamide riboside and resveratrol significantly increased the mRNA expression levels of PGC­1α and NRF­2α in cultured neurons. These responses were blocked by compound C, an AMPK inhibitor. In conclusion, AMPK is an important transcriptional regulator of the neuronal excitation response, and exerts its regulatory effects via the PGC­1α/NRF­2α signaling pathway.

Correlation of in vivo and in vitro methods in measuring choroidal vascularization volumes using a subretinal injection induced choroidal neovascularization model.

BACKGROUND: In vivo quantification of choroidal neovascularization (CNV) based on noninvasive optical coherence tomography (OCT) examination and in vitro choroidal flatmount immunohistochemistry stained of CNV currently were used to evaluate the process and severity of age-related macular degeneration (AMD) both in human and animal studies. This study aimed to investigate the correlation between these two methods in murine CNV models induced by subretinal injection. METHODS: CNV was developed in 20 C57BL6/j mice by subretinal injection of adeno-associated viral delivery of a short hairpin RNA targeting sFLT-1 (AAV.shRNA.sFLT-1), as reported previously. After 4 weeks, CNV was imaged by OCT and fluorescence angiography. The scaling factors for each dimension, x, y, and z (µm/pixel) were recorded, and the corneal curvature standard was adjusted from human (7.7) to mice (1.4). The volume of each OCT image stack was calculated and then normalized by multiplying the number of voxels by the scaling factors for each dimension in Seg3D software (University of Utah Scientific Computing and Imaging Institute, available at http://www.sci.utah.edu/cibc-software/seg3d.html). Eighteen mice were prepared for choroidal flatmounts and stained by CD31. The CNV volumes were calculated using scanning laser confocal microscopy after immunohistochemistry staining. Two mice were stained by Hematoxylin and Eosin for observing the CNV morphology. RESULTS: The CNV volume calculated using OCT was, on average, 2.6 times larger than the volume calculated using the laser confocal microscopy. The correlation statistical analysis showed OCT measuring of CNV correlated significantly with the in vitro method (R 2 =0.448, P = 0.001, n = 18). The correlation coefficient for CNV quantification using OCT and confocal microscopy was 0.693 (n = 18, P = 0.001). CONCLUSIONS: There is a fair linear correlation on CNV volumes between in vivo and in vitro methods in CNV models induced by subretinal injection. The result might provide a useful evaluation of CNV both for the studies using CNV models induced by subretinal injection and human AMD studies.

Peripapillary retinal nerve fiber layer changes in preclinical diabetic retinopathy: a meta-analysis.

BACKGROUND: Diabetic retinopathy is a microvascular neurodegenerative disorder in diabetic patients. Peripapillary retinal nerve fiber layer changes have been described in patients with preclinical diabetic retinopathy, but study results have been inconsistent. OBJECTIVE: To assess changes in peripapillary retinal nerve fiber layer thickness in diabetic patients with preclinical diabetic retinopathy. METHODS: A literature search was conducted through PubMed, EMBASE, Web of Science and Cochrane Library. Case-control studies on RNFL thickness in preclinical diabetic retinopathy patients and healthy controls were retrieved. A meta-analysis of weighted mean difference and a sensitivity analysis were performed using RevMan 5.2 software. RESULTS: Thirteen case-control studies containing 668 diabetic patients and 556 healthy controls were selected. Peripapillary RNFL thickness was significantly reduced in patients with preclinical diabetic retinopathy compared to healthy controls in studies applying Optical Coherence Tomography (-2.88 µm, 95%CI: -4.44 to -1.32, P = 0.0003) and in studies applying Scanning Laser Polarimeter (-4.21 µm, 95%CI: -6.45 to -1.97, P = 0.0002). Reduction of RNFL thickness was significant in the superior quadrant (-3.79 µm, 95%CI: -7.08 to -0.50, P = 0.02), the inferior quadrant (-2.99 µm, 95%CI: -5.44 to -0.54, P = 0.02) and the nasal quadrant (-2.88 µm, 95%CI: -4.93 to -0.82, P = 0.006), but was not significant in the temporal quadrant (-1.22 µm, 95%CI: -3.21 to 0.76, P = 0.23), in diabetic patients. CONCLUSION: Peripapillary RNFL thickness was significantly decreased in preclinical diabetic retinopathy patients compared to healthy control. Neurodegenerative changes due to preclinical diabetic retinopathy need more attention.

Early spatiotemporal characterization of microglial activation in the retinas of rats with streptozotocin-induced diabetes.

BACKGROUND: Microglial activation has been recognized as a neuropathological feature in diabetic retinopathy. But the early spatiotemporal characterization of microglial activation in the retina and the optic nerve of diabetic animals has not been fully investigated. The purpose of this study was to investigate early sequential changes of microglia in the retinas of rats with streptozotocin-induced diabetes. Microglia in the optic nerves of rats with streptozotocin-induced diabetes were also studied. METHODS: In 4-week, 8-week, and 12-week diabetic and normal control rats, microglial activation in the retinas and optic nerves was evaluated by immunolabeling with OX-42 antibody. Density, proportion of activation, and laminar distribution of retinal microglia were quantified. The retinal mRNA level of Iba-1, a microglial-specific marker, was measured by real-time PCR. RESULTS: The density of retinal microglia was not different between diabetic and control rats, but the proportion of activated microglia increased significantly in diabetic rats at each time point. The proportion of microglia increased obviously in the nerve fiber layer and the ganglion cell layer while decreasing in the inner plexiform layer in 12-week diabetic rats. Moreover, retinal Iba-1 mRNA expression increased in 8-week and 12-week diabetic rats. Processes of microglia in the optic nerves of control rats were aligned with the long axis of nerve fibers, while the alignment was disturbed in diabetic rats. CONCLUSIONS: Morphology, proportion of activation, distribution, and mRNA expression of retinal microglia changed characteristically with the progression of the disease in early-stage diabetic rats.

Role of lutein supplementation in the management of age-related macular degeneration: meta-analysis of randomized controlled trials.

OBJECTIVE: The conduct of this meta-analysis aimed at examining the individual role of lutein as a dietary supplement in improving conditions of age-related macular degeneration (AMD) from the data generated from randomized controlled trials (RCTs). METHOD: The literature search was made in multiple electronic databases. Eligibility criteria were RCTs that recruited AMD patients or individuals at risk and evaluated lutein supplementation efficacy against placebo. The quality of the trials was assessed by using the Jadad scale. The meta-analysis was conducted under the fixed effect model with RevMan software by calculating the mean differences of the changes from baseline of both lutein and placebo groups. Parameters of interest were macular pigment optical density (MPOD) and visual acuity (VA) in logMAR (minimum angle of resolution). Heterogeneity was determined by χ(2) and I(2) and publication bias was assessed by visual examination of funnel plots. RESULTS: After following predetermined inclusion and exclusion criteria, five RCTs that recruited 445 participants were selected for the meta-analysis. It has been found that lutein treatment was associated with a significant improvement in MPOD, with mean differences between lutein and placebo groups in the changes from baseline of 0.09 (95% CI: 0.06, 0.12; p < 0.00001). VA also improved with a mean difference between lutein and placebo groups in the changes from baseline of -0.04 (95% CI-0.07, 0.00; p = 0.05). Statistical heterogeneity was not apparent. CONCLUSION: A statistically highly significant effect of lutein supplementation has been observed for improving the MPOD, whereas the improvement in VA was milder. A daily dose of 10 mg was found as effective as higher doses in this meta-analysis. However, the number of input studies is not adequate for conclusive evidence.

The involvement of high mobility group 1 cytokine and phospholipases A2 in diabetic retinopathy.

BACKGROUND: Diabetic retinopathy, the main microvascular complications of diabetes and one of the leading causes of blindness worldwide. Interesting reports on the role of inflammatory/proangiogenic high mobility group 1 (HMGB-1) cytokine and phospholipases A2 (PLA2) in neovascularization have diverted our concentration to reveal whether HMGB-1 and PLA2 plays role in diabetic retinopathy. METHODS: We performed our study in streptozotocin (STZ)-induced diabetic rat model. The expression levels of the cytokines, chemokines, and cell adhesion molecules in retinal tissues were evaluated by quantitative RT-PCR. HMGB-1 and PLA2 protein levels along with VEGF, TNF-α, IL-1ß and ICAM-1 levels were also measured. RESULTS: We observed the retinal pericytes, endothelial injury/death and breakdown of blood-retinal barrier (BRB). The protein expression of HMGB-1, PLA2 and IL-1ß were significantly increased in micro vessels from retina of diabetic rats. Diabetic rats had also high retinal levels of VEGF, ICAM-1 and TNF-α. Further investigation revealed that pericyte death is mediated by HMGB-1-induced cytotoxic activity of glial cells, while HMGB-1 can directly mediate endothelial cell death. Similarly, increased expression of PLA2 represents the diabetic mediated alteration of BRB, perhaps up regulating the VEGF. CONCLUSIONS: Our data suggest that HMGB-1 and PLA2 involved in retinal pericyte and endothelial injury and cell death in diabetic retinopathy. From this study, we suggest that HMGB-1 and PLA2 may be interesting targets in managing diabetic retinopathy.

Evaluation of the safety of sclerotomy incision in patients with choroidal colobomas with/without associated microcornea.

PURPOSE: Whether the position of the ora serrata is normal in patients with choroidal colobomas remains unknown. The aim of this study was to measure the distance between the ora serrata and limbus in these patients and define safe sclerotomy sites for standard three-port pars plana vitrectomy. METHODS: Twelve patients with choroidal colobomas with normal corneas (Group 1) and 11 patients with choroidal colobomas with microcornea (Group 2) were included in the study. Twelve patients with simple retinal detachment served as control subjects. All participants underwent vitrectomy. The distance between the limbus and ora serrata, corneal diameter, and ocular axial length were measured. RESULTS: The average corneal diameter was 10.9 mm in Group 1, 7.9 mm in Group 2, and 11.4 mm in the control group. The average distance between the limbus and ora serrata was 6.3 mm in Group 1, 7.6 mm in Group 2, and 6.2 mm in the control group. There were significant differences in the distance between the limbus and ora serrata among the 3 groups (analysis of variance test, P < 0.05). CONCLUSION: Our study confirmed that it is safe to perform a sclerotic puncture 4 mm posterior to the limbus for vitrectomy in patients with choroidal colobomas with or without microcornea.

When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature.

OBJECTIVE: To report 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis (LASIK) and discuss the continually increasing number of cases in China. METHODS: A multicentre retrospective survey of eye injuries was carried in 31 military hospitals from January 2006 to December 2011. Detailed information from the medical records of all 92 cases with a history of prior LASIK treatment were collected and summarised, with respect to visual acuity (VA), flap condition, treatment and final outcome. All Chinese publications relevant to late traumatic flap complications in Chinese patients were retrieved and summarised. RESULTS: 92 inpatients (92 eyes) underwent LASIK surgery; 45 of these had traumatic LASIK flap complications. Flap dislocation was the commonest and most needed surgical repair. VA after treatment was good and no statistically significant difference was observed when compared with the 47 cases without flap complications. 109 articles related to late traumatic flap complications after LASIK were retrieved from four Chinese document databases. There were 550 cases of late traumatic flap complications. From 2004, case reports became more common; 10 or more cases were reported in some case series. VA of most cases was good and there was no remarkable vision loss after treatment. CONCLUSIONS: Late traumatic flap complications after LASIK have become more frequent in China, although the prognosis of most cases is good.

A new classification for epidemiological study of mechanical eye injuries.

OBJECTIVE: Considering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study, we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT. METHODS: A retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010. All medical records of inpatients with eye injuries were reviewed. A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries. All mechanical eye injuries were tried to be classified using BETT. While some eye injuries were difficult to categorize. We recorded the injury type and case number. A new classification based on BETT was also used for the same project. RESULTS: Of 10 718 patients (11 227 eyes) with mechanical eye injuries, the following cases cannot be classified by BETT: 1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury, 1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury, 271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB), 77 (89) contusion, 9 (11) lamellar laceration associated with OSFB or OWFB, 29 (30) rupture associated with OSFB, OWFB or intraocular foreign body and 60 (62) lace- ration associated with OSFB or OWFB. While according to our new classification, all eye injuries can be categorized without any difficulty. CONCLUSION: Difficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study, which can be solved by our new eye injury classification to some extent. It is hoped that other ophthalmologists present better ones to make the classification more perfect.