Study of myopia progression and risk factors in Hubei children aged 7-10 years using machine learning: a longitudinal cohort.

BACKGROUND: To investigate the trend of refractive error among elementary school students in grades 1 to 3 in Hubei Province, analyze the relevant factors affecting myopia progression, and develop a model to predict myopia progression and the risk of developing high myopia in children. METHODS: Longitudinal study. Using a cluster-stratified sampling method, elementary school students in grades 1 to 3 (15,512 in total) from 17 cities in Hubei Province were included as study subjects. Visual acuity, cycloplegic autorefraction, and height and weight measurements were performed for three consecutive years from 2019 to 2021. Basic information about the students, parental myopia and education level, and the students' behavioral habits of using the eyes were collected through questionnaires. RESULTS: The baseline refractive errors of children in grades 1 ~ 3 in Hubei Province in 2019 were 0.20 (0.11, 0.27)D, -0.14 (-0.21, 0.06)D, and - 0.29 (-0.37, -0.22)D, respectively, and the annual myopia progression was - 0.65 (-0.74, -0.63)D, -0.61 (-0.73, -0.59)D and - 0.59 (-0.64, -0.51)D, with the prevalence of myopia increasing from 17.56%, 20.9%, and 34.08% in 2019 to 24.16%, 32.24%, and 40.37% in 2021 (Χ2 = 63.29, P < 0.001). With growth, children's refractive error moved toward myopia, and the quantity of myopic progression gradually diminished. (F = 291.04, P = 0.027). The myopia progression in boys was less than that in girls in the same grade (P < 0.001). The change in spherical equivalent refraction in myopic children was smaller than that in hyperopic and emmetropic children (F = 59.28, P < 0.001), in which the refractive change in mild myopia, moderate myopia, and high myopia children gradually increased (F = 73.12, P < 0.001). Large baseline refractive error, large body mass index, and high frequency of eating sweets were risk factors for myopia progression, while parental intervention and strong eye-care awareness were protective factors for delaying myopia progression. The nomogram graph predicted the probability of developing high myopia in children and found that baseline refraction had the greatest predictive value. CONCLUSION: Myopia progression varies by age, sex, and myopia severity. Baseline refraction is the most important factor in predicting high myopia in childhood. we should focus on children with large baseline refraction or young age of onset of myopia in clinical myopia prevention and control.

Effects of slanted bilateral lateral recession vs conventional bilateral lateral recession on convergence insufficiency intermittent exotropia: a prospective study.

AIM: To observe the surgical effects of slanted bilateral lateral recession (S-BLR) versus conventional bilateral lateral recession (C-BLR) in convergence insufficiency intermittent exotropia (CI-IXT). METHODS: Using a randomized, double-blind, prospective design, 22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included. Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery. All patients were followed up for 12mo. Near deviation, distant deviation, and near-distance difference (NDD) were measured in all patients. RESULTS: Twelve months after surgery, NDD improvement was 10 (8, 13) prismatic degrees (PD) in S-BLR group and 3 (1, 6) PD in C-BLR group (P=0.011). The near deviation of S-BLR group was 0 (-2, 2) PD, while that of C-BLR group was -4 (-6, -3) PD (P=0.005). Before and after surgery, the difference in the distant deviation between the two groups was not statistically significant. There was no statistically significant difference in near stereopsis between the two groups (P=0.380) at 12mo. The success rate at 12mo after operation was 90.91% and 72.73% in the two groups (P=0.280). CONCLUSION: CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR, which indicates S-BLR is a safe and effective operation pattern.

Clinical efficacy of botulinum toxin type A on acute acquired comitant esotropia.

AIM: To investigate the effects of micro-injection of botulinum toxin A (BTXA) on acute acquired comitant esotropia (AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1st, 2019 to July 1st, 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline (except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was (+20.24±6.80)Δ at near and (+24.76±6.43)Δ at distance, while (+5.15±5.85)Δ at near and (+7.30±6.17)Δ at distance 6mo after treatment (P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis (>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis (300-800 seconds of arc), macular stereopsis (70-200 seconds of arc) and central concave stereopsis (≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients (6.07%) showed subconjunctival hemorrhage; three patients (9.09%) showed limited eye movement and one patient (3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up. CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.

The Effect of Different Treatment Methods on Acute Acquired Concomitant Esotropia.

Objective: The application of botulinum toxin type A (BTXA) in the treatment of paralytic strabismus has been recognized, but there are few studies on the treatment of acute acquired comitant esotropia (AACE). This study was aimed to investigate the clinical characteristics of AACE and compare the therapeutic effects of BTXA and traditional surgery. Methods: 78 patients with AACE in Renmin Hospital of Wuhan University between March 2019 and March 2021 were reviewed. The relevant medical records of the patients were collected, and they were divided into surgical group (n = 46) and botulinum toxin type A (BTXA) group (n = 32) according to different treatment approaches. The surgical group was treated with squint correction, whereas the BTXA group was treated with microinjection of BTXA in MR. Eye alignment, esotropia, stereopsis, and complications were examined before and after treatment in both groups. Results: The refractive status of 78 patients with AACE was mostly myopic refractive error. In general, the angle of esotropia at distance was larger than which at near, with a statistically significant difference. At follow-up assessments of 1 week, 1 month, 3 months, and 6 months after treatment, the total effective rates of the surgical group and the BTXA group were 100% and 90.48%, respectively. The residual angle of esotropia of both groups was lower after treatment. Additionally, the incidence rate of complications in the BTXA group was significantly lower than that in the surgical group. Conclusion: AACE occurs mostly in people with myopic refractive errors and is associated with prolonged near work. Besides surgical treatment, micro-injection of BTXA is also an effective and safe treatment for AACE.

A machine-learning approach to discerning prevalence and causes of myopia among elementary students in Hubei.

OBJECTIVE: Our aim is to establish a machine-learning model that will enable us to investigate the key factors influencing the prevalence of myopia in students. METHODS: We performed a cross-sectional study that included 16,653 students from grades 1-3 across 17 cities in Hubei Province. We used questionnaires to discern levels of participation in potential factors contributing to the development of myopia. The relative importance of potential contributors was ranked using machine-learning methods. The students' visual acuity (VA) was measured and those with logMAR VA of > 0.0 underwent a autorefraction test to determine students' refraction status. RESULTS: The prevalence of myopia in grades 1, 2, and 3 was 14.70%, 20.54% and 28.93%, respectively. Myopia rates among primary school students in provincial capital city (32.35%) were higher than those in other urban (23.03%) and rural (14.82%) areas. Children with non-myopic parents, only one myopic parent, or both parents having myopia exhibited myopic rates of 16.36%, 25.18%, and 41.37%, respectively. Myopia prevalence was higher in the students who continued to use their eyes at close range for a long time and lower in those engaged longer in outdoor activities. The machine-learning model determined that the top three contributing factors were the students' age (0.36), followed by place of residence (0.34), starting age of education (0.21). CONCLUSION: The overall prevalence of myopia was 21.52%. Children's age and place of residence were the important influencing factors, but genetics and environmental were also played key roles in myopia development.

Clinical characteristics and aetiology of acute acquired comitant esotropia.

CLINICAL RELEVANCE: Acute acquired comitant esotropia (AACE) is characterised by the acute onset of diplopia which affects work and life. BACKGROUND: To describe the clinical characteristics and discuss the aetiology of acute acquired comitant esotropia. METHODS: The medical records of 51 patients with AACE were retrospectively analysed, and their age, occupation, daily average time spent on near work, angle of deviation, refractive error and aetiology were analysed. RESULTS: The age at onset of AACE was eight to 55 years. Thirty-nine patients were aged 12 to 36 years (76.5%), and 42 patients (82.4%) were myopic. The angle of deviation was 20Δ (12Δ to 35Δ) during near fixation and 25Δ (18Δ to 40Δ) during distance fixation. The deviation during distance fixation was larger than that during near fixation, the difference being statistically significant (p < 0.001). The daily average time of near work before onset was 9.0 h (8.0 h to 10.0 h); 35 patients (68.6%) spent more than 8 h performing near work. Their occupations included students, accountants, information technology staff, and those who required electronic use for a long time. There is no correlation between the angle of deviation and the time of near work (p > 0.05). Among the 51 patients, three had intracranial diseases. Diplopia resolved in 47 cases following treatment. The angle of deviation post-treatment was 0Δ (0Δ to 5Δ) during near and 0Δ (0Δ to 3Δ) during distance fixation. CONCLUSION: AACE occurs mostly in myopic older children and adults. The onset of esotropia is related to long-term near work. AACE patients mostly present an angle of deviation that is larger during distance than near fixation. Intracranial disease is an infrequent but important cause of AACE that needs to be excluded in all cases.

Thermal decomposition based fabrication of dimensionally stable Ti/SnO2-RuO2 anode for highly efficient electrocatalytic degradation of alizarin cyanin green.

In this work, Ti/SnO2-RuO2 dimensionally stable anode has been successfully fabricated via thermal decomposition method and further used for highly efficient electrocatalytic degradation of alizarin cyanin green (ACG) dye wastewater. The morphology, crystal structure and composition of Ti/SnO2-RuO2 electrode are characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and X-ray fluorescence spectroscopy (XRF), respectively. The result of accelerated life test suggests that as-prepared Ti/SnO2-RuO2 anode exhibits excellent electrochemical stability. Some parameters, such as reaction temperature, initial pH, electrode spacing and current density, have been investigated in detail to optimize the degradation condition of ACG. The results show that the decolorization efficiency and chemical oxygen demand removal efficiency of ACG reach up to 80.4% and 51.3% after only 40 min, respectively, under the optimal condition (reaction temperature 25 °C, pH 5, electrode spacing 1.0 cm and current density 3 mA cm-2). Furthermore, the kinetics analysis reveals that the process of electrocatalytic degradation of ACG follows the law of quasi-first-order kinetics. The excellent electrochemical activity demonstrates that the Ti/SnO2-RuO2 electrode presents a favorable application prospect in the electrochemical treatment of anthraquinone dye wastewater.

Fabrication of Co/Pr co-doped Ti/PbO2 anode for efficiently electrocatalytic degradation of ß-naphthoxyacetic acid.

The existence of ß-naphthoxyacetic acid (BNOA) pesticide in water system has aroused serious environmental problem because of its potential toxicity for humans and organisms. Therefore, exploiting an efficient method without secondary pollution is extremely urgent. Herein, a promising Ti/PbO2-Co-Pr composite electrode has been successfully fabricated through simple one-step electrodeposition for efficiently electrocatalytic degradation of BNOA. Compared with Ti/PbO2, Ti/PbO2-Co and Ti/PbO2-Pr electrodes, Ti/PbO2-Co-Pr electrode with smaller pyramidal particles possesses higher oxygen evolution potential, excellent electrochemical stability and outstanding electrocatalytic activity. The optimal degradation condition is assessed by major parameters including temperature, initial pH, current density and Na2SO4 concentration. The degradation efficiency and chemical oxygen demand removal efficiency of BNOA reach up to 94.6% and 84.6%, respectively, under optimal condition (temperature 35 °C, initial pH 5, current density 12 mA cm-2, Na2SO4 concentration 8.0 g L-1 and electrolysis time 3 h). Furthermore, Ti/PbO2-Co-Pr electrode presents economic energy consumption and superior repeatability. Finally, the possible degradation mechanism of BNOA is put forward according to the main intermediate products identified by liquid chromatography-mass spectrometer. The present research paves a new path to degrade BNOA pesticide wastewater with Ti/PbO2-Co-Pr electrode.

Optimized terbium doped Ti/PbO2 dimensional stable anode as a strong tool for electrocatalytic degradation of imidacloprid waste water.

The presence of pesticides in water has emerged as a momentous environmental issue over the past decades. Herein, a terbium doped Ti/PbO2 (denoted as Ti/PbO2-Tb) dimensionally stable Ti/PbO2-Tb anode has been successfully prepared by one-step electrodeposition path for electrocatalytic degradation of imidacloprid (IMD) wastewater with high efficiency. Ti/PbO2-Tb electrode presents higher oxygen evolution potential, lower charge transfer resistance, stronger stability, longer service lifetime and outstanding electrocatalytic activity than Ti/PbO2 electrode. The optimum condition for IMD oxidation is obtained by analyzing the effects of some critical operating parameters including temperature, initial pH, current density and electrolyte concentration. It is proved that 70.05% of chemical oxygen demand and 76.07% of IMD are removed after 2.5 h of degradation under current density of 8 mA cm-2, pH 9, temperature 30 °C and 7.0 g L-1 NaCl electrolyte. In addition, the electrode displays commendable energy saving property as well as favorable reusability. The degradation mechanism of IMD is proposed by analyzing the intermediates identified by LC-MS. The present research provides a feasible strategy to degrade IMD wastewater by Ti/PbO2-Tb electrode.

[A study of refractive state in premature infants without retinopathy of prematurity and full-term children at the age of 0 to 6].

OBJECTIVE: To investigate the development of the refractive status in premature infants full-term children aged 0 to 6 years old. METHOD: Case control study. One thousand one hundred and sixtyfour premature infants and One thousand one hundred and ninety-one full-term children were collected from September 2011 to September 2012 in Renmin Hospital of Wuhan University, among them, one thousand and eighty-eight premature infants premature infants (2 176 eyes) without retinopathy of prematurity (ROP) and one thousand one hundred and two cases of full-term children (2 204 eyes) were included in the study. Refraction with cycloplegic retinoscopy was determined. The corneal curvatures and axial lengths of premature infants aged 3 to 6 years old were measured by Optical coherence interferometry. RESULTS: (1) The incidence of myopia and astigmatism were 9.1% and 35.4% in premature infants aged 0 to 6 years old, and 4.4%, 18.9% in full-term children. (2) The spherical diopter, cylindrical lens diopter and spherical equivalent degree were (1.15 ± 0.87), (0.84 ± 0.71) and (1.47 ± 0.28) D, three types of refractive value reduced progressively along with increasing age. (3) Changes in spherical equivalent degree in preterm children are associated with axial length, corneal curvature, gestational age, birth weight and age (r = -0.232, 0.112, 0.117, 0.254, -0.215, P = 0.000, 0.009, 0.008, 0.000, 0.001). CONCLUSIONS: The incidence of myopia of premature infants without ROP was higher than that of full-term children; The emmetropization of premature infants begins earlier than full-term children.

[The gene mutation screening of a family with congenital fibrosis of the extraocular muscles associated with corpus callosum agenesis].

OBJECTIVE: To identify TUBB3 gene mutations in a Chinese family with congenital fibrosis of the extraocular muscle associated with corpus callosum agenesis. METHODS: We have found a family with CFEOM associated with corpus callosum agenesis, including 4 affected individuals in three generations of 11 familial members. 4 affected individuals were sequenced by direct TUBB3 sequencing, 4 unaffected individuals in the family and 100 cases of unrelated normal person as a control. RESULTS: This family is in line with Mendelian autosomal dominant inheritance. Clinical manifestations belongs to CFEOM3. All affected individuals were detected with TUBB3 c.1249G > A mutation, the mutation is in exon 4, resulting in wild-type gene encoding the Aspartic acid ( Asp or D ) replaced .by Asparagine (Asn or N ). CONCLUSION: Our study supports that TUBB3 gene mutation c.1249G > A (p. Asp417Asn), is the underlying molecular pathogenesis of this family with CFEOM3.

Effect of recombinant adeno-associated virus mediated transforming growth factor-beta1 on corneal allograft survival after high-risk penetrating keratoplasty.

Corneal transplantation is one of the most common and successful transplant surgeries performed around the world. However, the high-risk corneal transplantation remains a high level of corneal graft failure. Gene transfer of immunomodulatory molecules is considered as one potential strategy in preventing allograft rejection. It is worthy evaluating the effects of the immunemodulating agent on corneal allograft rejection. The purpose of this paper is to investigate the effects and mechanisms of recombinant adeno-associated virus mediated transforming growth factor-beta1 (rAAV-TGF-beta1) on corneal allograft survival using a high-risk rat model after penetrating keratoplasty (PKP). The mean survival time (MST) of corneal grafts was observed and immuno-histochemical staining of TGF-beta1 and Ox-62 was performed in the study. The MST showed significant prolongation in the rAAV-TGF-beta1 group compared to the allograft group. The rejection index (RI) at day 10 revealed was significantly greater in the allograft group than that of the other two groups. Besides the increase of TGF-beta1, the expression of Ox-62 decreasing in rAAV-TGF-beta1 transplanted recipients was detected after transplantation. In short, treatment with rAAV-TGF-beta1 prolongs corneal allograft survival and inhibits the Ox-62 expression in grafts after high-risk PKP.

[A family of congenital fibrosis of extraocular muscles associated with naso-sinusitis].

OBJECTIVE: To clinically characterize a collected family of congenital fibrosis of extraocular muscles associated with naso-sinusitis, then determine the genetic location of the disease gene by linkage analysis to approach the etiopathogenesis of CFEOM on gene. METHODS: A CFEOM family (fifteen cases suffering from congenital general fibrosis syndrome in four generations of 41 members) was collected. All the suffers were correlated with clinical ophthalmic and thin-sectioned magnetic resonance imaging across the orbit and the brain-stem level to determine its clinical classification and genetic characteristics. The family was tested for linkage analysis to two known autosomal dominant CFEOM loci on chromosome 12p11. 2-q12 (FEOM1 ) and 16q24 (FEOM3). RESULTS: All the suffers had congenital unilateral or bilateral blepharoptosis, head tilt, chin lift, primary gaze fixed in a hypo-and exotropic position, forced duction testing positive. But vertical and horizontal positions of the eye and restriction of eye movement were different among affected individuals. Furthermore, MRI examinations showed that all the incidence of those families associated with naso-sinusitis and hypertrophic inferior turbinate, and the juveniles with hypertrophic adenoid. Pedigree shows that the family were in line with the characteristics of autosomal dominant inheritance. According to the genetic characteristics and clinical manifestations, the genetic family should be referred as CFEOM3. The lod scores for D12S331, D12S59 and D12S1668 were between 1 and 3, and the maximum lod score was 2. 19 for D12S1048, but the lod scores for D16S520, D16S498 and D16S2621 were both < 1.0. CONCLUSION: This family is best classified as CFEOM3 and linkage with D12S331, D12S59 and D12S1668.

[Magnetic resonance imaging features in two Chinese family with congenital fibrosis of extraocular muscles].

OBJECTIVE: The aim of this article was to investigate the structural basis of ocular motility and visual abnormalities in humans with congenital fibrosis of the extraocular muscles (CFEOM). METHODS: 17 volunteers from 2 CFEOM pedigrees Clinical ophthalmic and motility examed and 18 normal control subjects were correlated with thin-sectioned magnetic resonance imaging (MRI) across the orbit and the brain-stem level. RESULTS: Subjects with CFEOM had severe bilateral blepharoptosis, limited supraduction, and variable ophthalmoplegia. In affected subjects, MRI demonstrated atrophy of the levator palpebrae superioris, all EOMs, and the optic nerves, and small or absent orbital motor nerves. The oculomotor nerve was most severely hypoplastic, but the abducens was also affected. Subjects with CFEOM exhibited subclinical but highly significant reduction from normal in mean optic nerve size (P < 0.05). There are also some difference between the two CFEOM pedigrees. CONCLUSIONS: These findings suggest that neuronal disease is primary in CFEOM, with myopathy arising secondary to abnormal innervation and the oculomotor nucleus and trochlear nucleus of the abnormalities defects.

[Evaluation of visual function after congenital cataract extraction].

OBJECTIVE: To evaluate visual development after extraction of congenital cataract in young patients. METHODS: This was a retrospective clinical study. Forty one congenital cataract patients (62 eyes) at 0-3 years old were divided into 4 groups: <0.5 year old, > or =0.5 and <1 year old, > or =1 and <2 years old and > or =2 years old. Capsulectomy and cataract aspiration combined with anterior vitrectomy were performed in all cases. After the operation, patients were treated with optical correction by spectacles and visual training with occlusion therapy. Flash visual evoked potential (F-VEP)was examined by using Mini stimulator 3 days and 12 weeks after surgery. VISTON visual plasticity system was used to assess visual acuity 1 week and 12 weeks after surgery. RESULTS: VEP examination revealed that P100 latent time was reduced by visual training 3 months after surgery as compared with that of 3 days after surgery. Both P100 amplitude and visual acuity were increased. The younger patients obtained the better improvement. The group for lower than 0. 5 year old recovered best. CONCLUSION: Congenital cataract patients should be operated as early as possible and wear suitable spectacles for optical correction and undertake visual training after surgery, these procedures play a significant role for visual development and improvement in these patients.

[Antisense vascular endothelial growth factor suppressed corneal neovascularization in rats].

OBJECTIVE: To explore whether recombinant adeno-associated virus mediated antisense vascular endothelial growth factor (rAAV-aVEGF) gene transfer inhibits the development of corneal neovascularization (CNV) in a rat model. METHODS: rAAV-aVEGF(165) and recombinant adeno-associated virus mediated Lacz (rAAV-Lacz) were constructed by three-plasmid cotransfection methods. Forty-eight Sprague-Dawley (SD) rats were divided into two groups randomly. CNV were induced in vivo by alkaline cauterization of the central cornea. Twenty-four rats were injected with rAAV-aVEGF(165) (10(10) pfu/ml) into conjunctiva; another rats were injected with rAAV-Lacz (10(10) pfu/ml) into conjunctiva as controls. The Lacz gene expression was evaluated by 5-bromo-4-chloro-3-indolyl-beta-D-galactoside (X-gal) immunohistochemical staining. 1 to 30 days post-cautery, CNV was evaluated by morphometric analysis, and expression of VEGF was evaluated by immunohistochemistry. RESULTS: Two days later, 21.36% +/- 1.07% Lacz gene expression was detected in conjunctival sac in control group. 30 d later, 28.02% +/- 1.16% Lacz gene remained expression. Morphometric analysis and immunohistochemistry demonstrated rAAV-mediated antisense VEGF(165) significantly inhibited CNV. The VEGF(165) protein was decreased post-cautery compared to control group injected with. rAAV-Lacz (F = 1639.22, F = 2187.16, F = 719.17, P < 0.01). CONCLUSIONS: This study suggests that rAAV-aVEGF(165) can sufficiently inhibit the cautery-induced CNV, and the effect is associated with the inhibition of VEGF production.