Comparison of three fundus inspection methods during phacoemulsification in diabetic white cataract.

AIM: To investigate whether Wild Field Imaging System (WFIS SW-8000), 25G endoilluminator, and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with suspicious diabetic retinopathy (DR) during phacoemulsification, especially in cases of white cataract. METHODS: A cross-sectional study was carried out. A total of 204 dense diabetic cataractous eyes of 204 patients with suspected DR treated from April 2020 to March 2021 were included. Phacoemulsification combined with intraocular lens implantation was performed. Following the removal of the lens opacity, the 25G endo-illuminator, fundus photography, and iOCT were performed successively. Optical coherence tomography (OCT) and/or fundus fluorescein angiography (FFA) were used to verify the fundus findings postoperatively. Intraoperative and postoperative results were compared to verify the accuracy of intraoperative diagnosis in each group. RESULTS: Intraoperative and postoperative examinations revealed 58 and 62 eyes with DR, respectively (positive rate, 28.43% and 30.39%, respectively). During the phacoemulsification, WFIS SW-8000 detected 44 eyes with DR (the detection rate, 70.97%); 25G endo-illuminator found 56 eyes with DR (the detection rate, 90.32%); iOCT found 46 eyes with DR (the detection rate, 74.19%); and 58 eyes with DR were found by combining the three methods (the detection rate, 93.55%). There were statistically significant differences in the diagnostic sensitivity for DR among the methods (χ2=16.36, P=0.001). CONCLUSION: WFIS SW-8000, 25G endo-illuminator, iOCT, and especially their combination can be used to inspect the fundus and detect DR intraoperatively; they are helpful for the timely diagnosis and treatment of DR in patients with dense cataract.

Concentrations of glucose metabolites in the aqueous humour of diabetic cataract eyes.

PURPOSE: Glucose metabolism underpins diabetic cataracts (DCs), but the relationship between the two remains unclear. Here, we tested the aqueous humour (AH) of patients with DCs to elucidate glucose metabolite levels. METHODS: In this study, aqueous humour (AH) samples were collected preoperatively from DC eyes (n = 37) and age-related cataract eyes (n = 37) from 74 patients (74 eyes) undergoing uncomplicated cataract surgery. The content of glucose, pyruvate, L-lactate were detected by biochemical methods and advanced glycation end-products (AGEs) was detemined using enzyme-linked immunosorbent assay (ELISA) technique. Furthermore, the ratios of glucose/pyruvate and L-lactate/pyruvate in the AH were calculated. In addition, we calculated the correlation between glucose levels and AGEs in the AH. RESULTS: The concentrations of glucose, pyruvate and AGEs in the DC group were higher than those in the control group. Significantly lower levels of L-lactate in the AH were found in the DC group. We calculated the glucose/pyruvate ratio and the L-lactate/pyruvate ratio in the AH, which showed that glucose metabolism was changed in the AH from DC patients. Interestingly, we observed that AGEs in the AH were significantly correlated with increased anterior chamber glucose permeability. A stronger correlation was found in the subgroups of male patients, younger patients, and patients with poor glycaemic control status. CONCLUSIONS: Comparison of the levels of glucose metabolism-related products in the AH in the DC group highlight a potential pathological mechanism for DC from a glucose metabolism perspective. The findings indicated an alteration in the metabolic pathways of energy metabolism and amino acids in the AH of DC patients.

Expression profile analysis to identify potential gene changes induced by dexamethasone in the trabecular meshwork.

AIM: To investigate potential gene changes in trabecular meshwork (TM) induced by dexamethasone (DEX) in steroid-induced glaucoma (SIG). METHODS: The expression data of 24 cases from a public functional genomics data were sorted to identify the mechanisms of action of DEX on the TM. The relationships of the differentially expressed genes (DEGs) were enriched using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. In addition, the hub genes were screened by the Search Tool for the Retrieval of Interacting Genes Database (STRING) and Cytoscape tools. Finally, human TM cells (HTMCs) were treated with DEX to preliminarily explore the function of hub genes. RESULTS: Totally 47 DEGs, including 21 downregulated and 26 upregulated genes were identified. The primary enriched results of the DEGs consisted of inflammatory response, extracellular matrix (ECM), negative regulation of cell proliferation, TNF signalling pathway and the regulation of tryptophan channels by inflammatory mediators. Subsequently, pro-melanin-enriched hormone (PMCH) and Bradykinin B1 receptor (BDKRB1) were screened as hub genes. It is verified in GSE37474 data set. Western blot and quantitative real-time polymerase chain reaction (qPCR) results showed that protein and RNA expression levels of BDKRB1 were significantly decreased after DEX treatment, while PMCH was not significantly changed. CONCLUSION: BDKRB1 may be a key gene involved in SIG onset, providing a suitable therapeutic target for improving the prognosis of SIG patients.

Doxycycline Suppresses Vasculogenic Mimicry in Human Pterygium Fibroblasts.

PURPOSE: To explore the effect of doxycycline on vasculogenic mimicry (VM) formation and the potential mechanism in human pterygium fibroblasts in order to find novel targets for pterygium therapy. METHODS: First, we demonstrate the existence of VM in 73 pterygium specimens by CD31 and periodic acid Schiff (PAS) dual staining. Then we used cell counting kit-8, clone formation assay and flow cytometry to prove the inhibitory effect of doxycycline on cell proliferation and apoptosis. The VM formation was evaluated through wound healing assay, cell transwell assay and three-dimensional cell culture combined with PAS staining. Finally, we used Western blot to testify the correlation of the VM and the factors in protein level preliminarily. RESULTS: Our results showed that VM existed in human pterygium specimens exactly. Otherwise, in human pterygium fibroblasts, doxycycline induced a dose-dependent inhibitory effect on cell proliferation and apoptosis induction. Besides, doxycycline significantly suppressed vasculogenic mimicry tube formation, cell migration and invasion. Furthermore, doxycycline impaired the expression of MMP-9, MMP-2 and VEGF which may related to pterygium VM formation. CONCLUSIONS: Doxycycline decelerated pterygium progression might be through inhibiting VM formation according to the downregulation of MMP-9, MMP-2 and VEGF, which may provide the basis of further studies involving doxycycline for pterygium treatment.

Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery.

AIM: To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. METHODS: This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. RESULTS: Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P<0.01). The surgically-induced astigmatism was 1.02±0.54 D. The correction index (ratio of target induced astigmatism and surgically-induced astigmatism: 0.72±0.36) as well as the magnitude of error (difference between surgically-induced astigmatism and target induced astigmatism: -0.29±0.51) represented a slight under correction. For angle of error, the arithmetic mean was 1.11±13.70, indicating no significant systematic alignment errors. CONCLUSION: Femtosecond-assisted steepest-meridian clear corneal incision is a fast, customizable, adjustable, precise, and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

Ganoderic acid A protects lens epithelial cells from UVB irradiation and delays lens opacity.

A contributory role of oxidative stress and protection by antioxidant nutrients have been suspected in cataract formation. Ganoderic acid A (GAA), an effective lanostane triterpene, is widely reported as an antioxidant. The aim of this study is to investigate the potential effects of GAA on cataract formation. After lens epithelial cells (LECs) were exposed to UVB radiation for different periods, cell viability, apoptosis-related protein levels, malondialdehyde (MDA) and superoxide dismutase (SOD) activities were monitored. We found that cell viability, the Bcl-2/Bax ratio and SOD activity were increased, while Cleaved caspase-3 levels and MDA activity were decreased compared with those in UVB-impaired LECs after GAA treated. Furthermore, GAA activated PI3K/AKT in UVB-impaired LECs and effectively delayed the occurrence of lens opacity in vitro. In conclusion, these findings demonstrated that GAA exhibited protective functions in SRA01/04 cells and rat lenses against UVB-evoked impairment through elevating cell viability and antioxidant activity, inhibiting cell apoptosis, activating the PI3K/AKT pathway and delaying lens opacity.

Folate-Modified Photoelectric Responsive Polymer Microarray as Bionic Artificial Retina to Restore Visual Function.

A high-optical-resolution artificial retina system that accurately communicates with the optic nerve is the main challenge in the modern biological science and bionic field. Here, we developed a bionic artificial retina possessing phototransduction "cells" with measurements even smaller than that of the neural cells. Using the technique of micrometer processing, we constructed a pyramid-shape periodic microarray of a photoreceptor. Each "sensing cell" took advantage of polythiophene derivative/fullerene derivative (PCBM) as a photoelectric converter. Because folic acid played an essential role in eye growth, we particularly modified the polythiophene derivatives with folic acid tags. Therefore, the artificial retina could enlarge the contact area and even recognize the nerve cells to improve the consequence of nerve stimulation. We implanted the artificial retina into blinded rats' eyes. Electrophysiological analysis revealed its recovery of photosensitive function 3 months after surgery. Our work provides an innovative idea for fabricating a high-resolution bionic artificial retina system. It shows great potential in artificial intelligence and biomedicine.

Effects of steep-axis incision on corneal curvature in one-handed phacoemulsification.

AIM: To examine the effects of one-handed phacoemulsification with steep-axis incision on corneal curvature and analyze surgically induced astigmatism (SIA) on the true net power, anterior and posterior corneal surfaces. METHODS: Patients with cataracts underwent one-handed phacoemulsification with a 2.4-mm steep-axis of clear corneal incision (CCI) based on true net power. CCI was created under the guidance of Verion. Central corneal thickness (CCT), keratometry readings of the true net power and anterior and posterior corneal surface were obtained using Pentacam. Biometry, such as axial length, anterior chamber depth (ACD) and white-to-white (WTW) were performed using Lenstar pre- and 3mo post-operatively. RESULTS: The study evaluated 68 eyes of 65 patients. The mean age was 65.93±9.40y; CCT was 529.21±37.40 µm; WTW was 11.59±0.35 mm. Regarding true net power, keratometric value at the flattest corneal meridian for the 3-mm central zone (Ks) was significantly decreased postoperatively (P=0.031). Keratometric value at the steepest corneal meridian for the 3-mm central zone (Kf) was increased postoperatively (P>0.05). Astigmatism of true net power was 1.21±0.56 D preoperatively and significantly decreased to 1.02±0.58 D postoperatively (P=0.021). On the anterior corneal surface, no significant difference in Ks and Kf was noted pre- versus postoperatively. Anterior corneal astigmatism was 1.08±0.51 D preoperatively and significantly decreased to 0.87±0.46 D postoperatively (P=0.002). On the posterior corneal surface, Ks and Kf were significantly increased postoperatively (all P<0.05), and posterior corneal astigmatism also increased (P=0.008). The SIA values of true net power and the anterior and posterior corneal surfaces at 3mo postoperatively were 1.26±0.63 D (range: 0.11 to 2.80 D), 1.05±0.54 D (range: 0.23 to 2.40 D), and 0.21±0.17 D (range: 0.01 to 0.07 D), respectively. CONCLUSION: One-handed phacoemulsification with steep-axis incision can effectively decrease astigmatism of true net power and anterior corneal astigmatism. In the same surgery, the difference in personal SIA potentially originated from a difference in personal corneal thickness and diameter, both CCT and WTW distance should always be measured preoperatively when planning steep-axis phacoemulsification.

Prevalences and causes of vision impairment in elderly Chinese: a socioeconomic perspective of a comparative report nested in Jiangsu Eye Study.

AIM: To survey the prevalence and causes of visual impairment/blindness among elderly Chinese from different socioeconomic status in community-based design. METHODS: Cluster-sampling randomly selected residents from Binhu and Funing District, two areas representing different socioeconomic levels in China with Binhu in an advanced status and Funing in less-developed area. The participants subjected to ophthalmic examination. The presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) were recorded. Visual impairment and blindness were defined according to World Health Organization criteria. The causes of visual impairment/blindness were identified by ophthalmic examination and/or questionnaire. The socioeconomic status included the per capita gross domestic product, numbers of hospital with ophthalmic service and the number of ophthalmologists per 1 million residents. RESULTS: We successfully included 12 867 participants form 2 areas in this study. The prevalence of PVA impairment (<20/63 to ≥20/400) in the better eye was 5.4% in Binhu and 23.6% in Funing, while the prevalence of blindness (<20/400) was 0.9% in Binhu and 2.3% in Funing. With BCVA, the prevalence of visual impairment was 2.4% in Binhu and 6.4% in Funing, while the prevalence of blindness was 0.8% in Binhu and 1.6% in Funing. The participants with older age and female gender had higher prevalence in visual impairment and blindness. The highest prevalences of vision impairment and blindness evaluated by BCVA at >80y age group reached 20.4% and 6.3% respectively. The prevalences of vision impairment and blindness evaluated by BCVA were 3.5% and 1.0% in male and 5.0% and 1.3% in female. The above differences were statistically significant (P<0.05). The predominant causes of visual impairment and blindness were cataract, retinal disorders and uncorrected refractive error in both areas. The socioeconomic status was associated with visual impairment and blindness. CONCLUSION: This community-based study build a sufficient sample size for an ophthalmic survey. Our data show the disparities on socioeconomic development and genders in visual impairment and blindness in China. Special emphasis of ophthalmic service should be placed on females and less-developed area.

[Cautious choice of new intraocular lenses in patients with cataract rehabilitation surgery in China].

We must choose new intraocular lenses (IOL) cautiously and strictly in patients with cataract rehabilitation surgery in China because of following reasons. Firstly, there are no differences in visual acuity between traditional poly-methylmethacrylate (PMMA) IOL implantation group and new IOL (multifocal IOL, aspherical IOL) implantation group. Secondarily, there are many factors which affect visual performance after cataract surgery. Thirdly, many patients with cataract can not afford new intraocular lenses .Fourthly, there are several faultiness and clinical problems in new intraocular lenses. Therefore, correct selection of IOL should be affordable PMMA IOL in cataract rehabilitation surgery in China.

[Experimental study on the treatment of non-tuberculous mycobacterial keratitis].

OBJECTIVE: To explore the optimal treatment for non-tuberculous mycobacterial keratitis (NTMK). METHODS: Experimental study.Fifty-one New Zealand white rabbits were inoculated with non-tuberculous mycobacteria (NTM) to establish the animal model of NTMK. Eyes with NTMK were randomly divided into 7 groups and topically treated with amikacin (2.5%) (B), gatifloxacin (3%) (C), azithromycin (1%) (D), amikacin (2.5%) plus gatifloxacin(3%) (E) , amikacin (2.5%) plus gatifloxacin (3%) combined with debridement (F), early lamellar keratoplasty (G) and balanced salt water (as a control) (A). All the drugs were administered 8 times per day within initial 7 days followed by 4 times per day after 1 week. The clinical manifestations of each rabbit were observed and recorded every week. The score of clinical manifestations before and after treatment does not meet the normal distribution, so it was presented by the median ± quantile interval and compared with rank sum test and SNK test. Fisher exact test was used to compare differences in the distribution of presenting the healing rate of keratitis. RESULTS: After 1 week treatment, six eyes were cured in group G, and none were cured in other groups, the scores of clinical manifestations of group B, C, D, E, F and G were 6 ± 4, 8 ± 2, 6 ± 4, 8 ± 3, 7 ± 4, 3 ± 1, they were higher than that of group A (q = 20.36, 11.43, 19.21, 16.93, 18.64, 37.50, P < 0.05). After 2 weeks, the scores of group B, C, E, F and G were higher than that of group A (q = 23.50, 16.71, 15.21, 12.43, 30.87, P < 0.05), and the healing rate of group G was higher than that of group A. After 3 weeks, the score of clinical manifestations of group B, D, F and G was higher than that of group A, and the healing rate of group F and G was higher than that of group A. After 4 weeks, the inflammation of group F and G were healed, and a little inflammation remained in the eye of group A. The score of clinical manifestations of group D, E, F and G was higher than that of group A. None was detected in the bacterial culture after 4 weeks. In histopathological examination, there were integrated and proliferated corneal epithelium, fibroblast cells proliferation in the eyes of experimental groups was found, while corneal cells edema, stroma degeneration and necrosis with lymphocytes and plasma cells in the ulcerated lesion in the corneal stromal of group A. CONCLUSIONS: Amikacin, gatifloxacin or azithromycin is effective in arresting NTM, while antibiotic combined with debridement is more effective and early lamellar keratoplasty is the most rapid and thorough treatment of NTMK.

[The protective effect of photochromic intraocular lens on visible light-induced lesion in cultured retinal pigment epithelium].

OBJECTIVE: To evaluate the protective effect of photochromic intraocular lens (IOL) on visible light-induced lesion in cultured retinal pigment epithelium (RPE). METHODS: It was a experimental study. A human retinal pigment epithelium cell line (ARPE-19) was used to study the protective role. Cells from the same passage were divided into the control, light exposure only, light exposure plus colorless IOL (FV-60A), light exposure plus photochromic IOL (BV-60A), light exposure plus yellow IOL (Acrysof Natural IOL) groups. The treatments were performed when the cells grew to 90% confluency. All cells were irradiated with visible light at an illumination intensity of 60 000-61 000 lux. After the treatments, we assessed 1: cells' viability by methyl thiazolyl tetrazolium (MTT) assay; 2: the extent of apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL), observing changes in the ultrastructure by transmission electron microscopy (TEM), and performing Hoechst staining to measure the apoptosis index (AI); 3: examining vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) levels in the culture medium by enzyme linked immunosorbent assay (ELISA). RESULTS: Measurements of the cell viability of the five groups were (0.61 ± 0.01), (0.39 ± 0.01), (0.46 ± 0.01), (0.57 ± 0.01), and (0.58 ± 0.02), respectively. Apoptosis was significantly activated by visible light as observed in TUNEL staining and TEM. The AIs of the five groups were (0.99 ± 0.65)%, (9.28 ± 0.59)%, (6.54 ± 0.37)%, (4.69 ± 0.74)%, and (2.72 ± 0.67)%, respectively. The levels of VEGF in the five groups were (3931.64 ± 25.26) ng/L, (5459.38 ± 42.69) ng/L, (4800.55 ± 42.12) ng/L, (4561.21 ± 46.27) ng/L, and (4420.35 ± 28.66) ng/L, respectively. The levels of PEDF in the five groups were (182.85 ± 1.68) µg/L, (156.52 ± 0.64) µg/L, (155.57 ± 3.43) µg/L, (167.57 ± 2.88) µg/L, and (170.90 ± 2.99) µg/L, respectively. Comparing the photochromic IOL group with the yellow IOL group, there was no difference in cell viability (q = 0.94) and PEDF levels (q = 1.51) (P > 0.05), but there was a significant difference between the AI (q = 5.04) and VEGF levels (q = 6.78) (P < 0.05). Comparing the photochromic IOL group with the colorless IOL group, there were significant differences in cell viability (q = 18.92) , AI (q = 4.78) , VEGF (q = 11.52) and PEDF levels (q = 4.96) (P < 0.05). CONCLUSIONS: Photochromic IOL can abate the degree of acute photodamage of RPE. The protective efficiency was the highest when using the yellow Acrysof Natural IOL, followed by photochromic IOL and colorless IOL.

Improvement in visual function and quality of life following a blindness prevention surgery program in a rural area of Eastern China.

The aim of this study was to assess the changes in visual function (VF) and quality of life (QOL) among patients following blindness prevention surgery in a rural area of Eastern China. The prospective study selected cataract patients via mobile eye screening camps. VF and QOL questionnaires originally developed by Fletcher et al were completed prior to and 6 months after surgery. Small-incision cataract surgery (SICS) with posterior chamber intraocular lens (IOL) implantation was performed on patients by a blindness prevention surgery group. The VF and QOL scores of 178 cataract patients preoperatively were 48.58±31.18 and 65.97±26.77, respectively. The scores decreased in proportion to decreasing vision status. The VF and QOL scale scores were significantly correlated with the vision grade of the patient (rVF=-17.2093, t=-10.87, P<0.001, rQOL=-13.1399, t=-8.87, P<0.001) and age (rVF=-0.6505, t=-3.87, P<0.001, rQOL=- 0.3309, t=-2.10, P=0.037). A total of 131 patients responded to the second survey, VF and QOL scores increased significantly over a six-month postoperative period (VF=83.21±16.40, P<0.001; QOL=86.53±16.33, P<0.001). The VF scale scores were correlated with the grade of vision and residence area, the QOL scale scores were correlated with the grade of vision and gender. The VF and QOL of patients were significantly improved by performing SICS with posterior chamber IOL implantation collectively in a short period in rural areas of Eastern China. It is important to follow-up cataract patients postoperatively as untreated complications of the surgery may affect the stability of VF and QOL postoperatively.

[Prevalence and surgical status of cataract among adults aged 50 years or above in rural Jiangsu Province].

OBJECTIVE: To survey the prevalence, operative status, surgical coverage rate and social burden rate of cataract blindness among older adults aged 50 years or above in 2 typical counties (district) of Jiangsu Province, China in 2010. METHODS: Cluster sampling was used in randomly selected 12 867 individuals aged 50 years or above in 58 clusters in Funing County of Northern Jiangsu and Binhu District of Southern Jiangsu. Among them, 12 053 individuals received visual acuity and eye examinations (response rate 93.8%). Lens and cataract operative status were evaluated by slit-lamp biomicroscope. Data bank was established by Epidata3.0 Software. Statistical analyses were performed with Stata/SE Statistical Software, version 10.0. Confidence intervals and P values (significant at P < 0.05) for prevalence of cataract, surgical coverage rate of cataract, social burden rate and surgical outcomes of cataract blindness were calculated with adjustment for clustering effects and stratification associated with the sampling design. RESULTS: Among 12 503 individuals, there were 2208 cases of cataract with a prevalence of 18.3%. The prevalence of cataract was higher in the aged, female and lower-income persons (P < 0.05). Among 2208 cataract patients, cataract surgery was performed in 263 cases (11.9%). The surgical coverage rate of cataract was 59.7% and the social burden rate of cataract blindness 1.93%. The social burden rate of cataract blindness was higher in the aged persons (P < 0.01). In 357 eyes with cataract surgery, the rate of intraocular lens implantation was 85.7%. At Binhu, 71.0% of eyes with cataract surgery underwent phacoemulsification. At Funing, 73.6% of eyes underwent modern extra-capsular surgery respectively. Post-operative presenting and best corrected visual acuity over 0.7 was 11.2% and 19.6% of operated eyes respectively. The main causes of post-operative eyes with worse visual acuity (< 0.3) were post-capsular opacity and retinal disorders. CONCLUSION: Cataract is the most common and important eye disease that may lead into blindness and severe visual impairment among older adults aged 50 years or above. The coverage rate of cataract surgery is higher in Jiangsu province than in other provinces. The visual outcomes of surgery is less than ideal. An important task in blindness prevention of Jiangsu province still is the elimination of cataract blindness and the improvement of visual outcomes for cataract surgery in the future.

[Cataract surgery rate and its impacting factors in Jiangsu Province in 2012].

OBJECTIVE: To survey the cataract surgery rate (CSR) according to the report data and its influencing factors of Jiangsu Province in 2012 so as to further improve CSR in China. METHODS: Through government websites in 2012, gross domestic product (GDP) and GDP per capital of 13 cities in Jiangsu Province and 7 counties of Nantong City reported to the Ministry of Health in China were collected to calculate CSR. The relationship between GDP and CSR of Jiangsu Province and Nantong City were analyzed with Spearman's rank correlation, and the differences in the proportion of cataract surgery between government and private hospitals were analyzed by Chi-square test. RESULTS: CSR in Jiangsu Province in 2012 was 939 cases per million population per year. Nantong City had the highest CSR (1362 cases per million population per year) and Suqian City the lowest (129 cases per million population per year). The GDP of 13 cities in Jiangsu Province had a positive correlation with CSR (spearman r = 0.59, P = 0.03), but there was no significant correlation with GDP per capital (spearman r = 0.50, P = 0.08). No significant correlation existed between GDP, GDP per capital and CSR of 7 counties of Nantong City (spearman r = -0.04, P = 0.94; spearman r = -0.29, P = 0.53). The proportion of private hospitals of Nantong was 33.3% and surgery cases were 4557 (45.9%). The CSR of Rugao County in 2012 was 3317 cases per million population per year. CONCLUSION: Socioeconomic level may be related with CSR. Providing village cataract screening services and lowering surgical costs help to boost CSR in China.

Association of angiotensin-converting enzyme gene 2350 G/A polymorphism with diabetic retinopathy in Chinese Han population.

The angiotensin-converting enzyme (ACE) gene is one of the most studied candidate genes related to diabetic retinopathy (DR). ACE 2350 G/A polymorphism (rs4343) is known among the polymorphisms of this gene to have the most significant effect on plasma ACE concentrations. The aim of the present study was to investigate the relationship between 2350 G/A polymorphism of ACE gene and the susceptibility of DR in Chinese Han population. A case-control study for 145 type 2 diabetes mellitus (DM) patients, including 63 type 2 DM without DR (NDR) and 82 type 2 DM with DR (DR), and 90 subjects of age, gender matched normal controls (NC group) was performed. ACE 2350 G/A genotypes were identified by polymerase chain reaction and restriction digestion in all study participants. The distribution of the ACE 2350 G/A genotypes (GG, GA, and AA) was 35.56, 45.55, and 18.89 % in the NC group, 28.57, 46.03, and 25.40 % in the NDR group, and 15.85, 46.34, and 37.81 % in the DR group, respectively. There were no significant differences in either genotype frequency distribution (P = 0.5266) or allele frequency distribution (P = 0.2425) between the NC group and NDR group. However, the distribution of genotype frequency (P = 0.0026) and allele frequency (P = 0.0003) in the DR group showed a significant difference when compared to that of NC group (P = 0.0075). Moreover, there was statistical difference in allele frequency distribution (P = 0.0328) between the DR group and the NDR group. No statistical differences were observed between ACE 2350 G/A polymorphism and the diabetes duration or types of DR. Results obtained in this study indicate that ACE 2350 G/A polymorphism is associated with DR in Han Chinese patients with type 2 DM.

[How to develop molecular epidemiology in conventional epidemiology survey on eye diseases in China].

Molecular epidemiology is a new branch of eye epidemiology that combines theories and methods in both epidemiology and molecular biology. The definition of molecular epidemiology is to use biological and, in particular, genetic markers (nucleic acid, protein) as measures for detecting the propensity of a disease developing, or as an indicator of a disease or an exposure in the studies of disease distribution. Molecular epidemiology has the same objectives as conventional ophthalmic epidemiology in a defined population. The main designs used in ophthalmic molecular epidemiology include descriptive study, case control study, and nested case control study. Currently, molecular experimental techniques mainly include single nucleotide polymorphism, ELISA, protein and mRNA array, microRNA and the study of epigenetic markers. Gene susceptibility biomarker is one of the most commonly used molecular markers. The findings of ophthalmic molecular epidemiology studies can be used to design personalized therapy. Undoubtedly, ophthalmic molecular epidemiology will evolve and develop in the new era for the prevention and control of complex eye diseases such as age-related macular degeneration, cataract, glaucoma and diabetic retinopathy.

[Prevalence of blindness and moderate and severe visual impairment among adults aged 50 years or above in Qidong City of Jiangsu Province: the China Nine-Province Survey].

OBJECTIVE: To estimate the prevalence of blindness and low vision among older adults aged > or = 50 years in Qidong City of Jiangsu Province, China, in 2006. METHODS: Cluster sampling was used in randomly selecting 5662 individuals aged > or = 50 years from September to December 2006 in 16 clusters in Qidong City. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. All participants were enumerated through village registers followed door-to-door visits. Eligible individuals were invited to receive visual acuity measurement and eye examination. Statistical analyses were performed using Stata/SE Statistical Software, release 9.0. Chi-square test was used to investigate the association of age, gender and education with presenting and best corrected visual acuity. RESULTS: Five thousands six hundreds and sixty-two individuals were recruited, the response rate was 90.80%. Based on the criteria of World Health Organization visual impairment classification in 1973,91 persons were diagnosed as blindness, 175 persons were diagnosed as moderate and severe visual impairment defined as best corrected visual acuity, the prevalence of blindness and moderate and severe visual impairment were 1.77% and 3.40% respectively. One hundred and thirteen persons were diagnosed as blindness, 354 persons were diagnosed as moderate and severe visual impairment defined as presenting visual acuity, the prevalence of blindness and moderate and severe visual impairment were 2.20% and 6.89% respectively. The prevalence of blindness and moderate and sever visual impairment was higher in aged (trend Chi2 = 825.16, P = 0.000), female (Chi2 = 19.85, P = 0.001), and illiterate persons (trend Chi2 = 329. 85, P = 0.000). The leading cause of blindness was cataract. CONCLUSIONS: Blindness and low vision are associated with older age and illiterates in Qidong City. According to presenting visual acuity, the causes leading to blindness and low vision are, in descending order, cataract, ocular fundus disease, refractive error and cornea disease.

[Prevalence and surgery status of cataract among adults aged 50 years or above in Qidong City of Jiangsu Province: the China Nine-Province Survey].

OBJECTIVE: To estimate the prevalence of cataract, the rate of cataract surgical coverage rate,and the rate of cataract-blindness social burden among older adults aged 50 years or above in Qidong City of Jiangsu Province, China, in 2006. METHODS: Cluster sampling was used in randomly selected 5662 individuals aged 50 years or above in 16 clusters in Qidong City. 5141 individuals received visual acuity and eye examination from September to December 2006. Lens and cataract operation status were evaluated by slit lamp. Multiple logistic regression analysis was employed to analyzed the prevalence of cataract, cataract surgical coverage rate, cataract blindness social burden rate and outcomes of surgery among different ages, sex and educational background. RESULTS: In 5141 individuals, 1098 cases of cataract were found, the prevalence of cataract was 21.35% among adults aged 50 or above. The prevalence of cataract was higher in the aged, female, illiterate persons (P < 0.01). In 89 eyes with cataract surgery, 25.84% and 42.70% of eyes were performed by the modern extra-capsular surgery and Phacoemulsification respectively. The rate of intraocular lens implantation was 69. 66%. Post-operative presenting and best corrected visual acuity more than 0.7 was 24.70% and 48.31% of operated eyes respectively. The main causes of the post-operated eyes with worse visual acuity were retinal disorders post-capsular opacity and glaucoma. The cataract surgical coverage rate was 37.96%, and the cataract blindness social burden rate was 2.10%. The cataract blindness social burden rate was higher in the aged persons (P < 0.01). CONCLUSIONS: Cataract is the most common and important eye disease that may lead into blindness and severe visual impairment among older adults aged 50 years or above. The cataract surgical coverage rate is not so high in Qidong City, and even lower in the aged persons. The first important task in blindness prevention still is the elimination of cataract blindness. The visual outcomes of the cataract surgery should be further improved in the future.