Cataract surgery complications in a patient with brittle cornea syndrome and Ehlers-Danlos syndrome type six: A case report.

Purpose: This case report delineates the intricacies and challenges encountered in cataract surgery in Ehlers-Danlos syndrome type VI presenting with advanced Keratoglobus (KG), severe cataract and brittle cornea. Observations: Despite meticulous planning and intraoperative precautions, including phacoemulsification with reduced intraocular pressure (low bottle height), the patient experienced corneal ruptures necessitating a shift to Extra Capsular Cataract Extraction (ECCE). Postoperative management involved corneal suturing and vigilant follow-up. Conclusions and Importance: Cataract surgery in patients with brittle cornea poses significant challenges due to extreme corneal fragility. Exhaustive pre-operative assessment, careful intraoperative techniques, and vigilant postoperative care are paramount for successful outcomes in these complex cases.

Comparative Analysis of Accuracy, Readability, Sentiment, and Actionability: Artificial Intelligence Chatbots (ChatGPT and Google Gemini) versus Traditional Patient Information Leaflets for Local Anesthesia in Eye Surgery.

Background and Aim: Eye surgeries often evoke strong negative emotions in patients, including fear and anxiety. Patient education material plays a crucial role in informing and empowering individuals. Traditional sources of medical information may not effectively address individual patient concerns or cater to varying levels of understanding. This study aims to conduct a comparative analysis of the accuracy, completeness, readability, tone, and understandability of patient education material generated by AI chatbots versus traditional Patient Information Leaflets (PILs), focusing on local anesthesia in eye surgery. Methods: Expert reviewers evaluated responses generated by AI chatbots (ChatGPT and Google Gemini) and a traditional PIL (Royal College of Anaesthetists' PIL) based on accuracy, completeness, readability, sentiment, and understandability. Statistical analyses, including ANOVA and Tukey HSD tests, were conducted to compare the performance of the sources. Results: Readability analysis showed variations in complexity among the sources, with AI chatbots offering simplified language and PILs maintaining better overall readability and accessibility. Sentiment analysis revealed differences in emotional tone, with Google Gemini exhibiting the most positive sentiment. AI chatbots demonstrated superior understandability and actionability, while PILs excelled in completeness. Overall, ChatGPT showed slightly higher accuracy (scores expressed as mean ± standard deviation) (4.71 ± 0.5 vs 4.61 ± 0.62) and completeness (4.55 ± 0.58 vs 4.47 ± 0.58) compared to Google Gemini, but PILs performed best (4.84 ± 0.37 vs 4.88 ± 0.33) in terms of both accuracy and completeness (p-value for completeness <0.05). Conclusion: AI chatbots show promise as innovative tools for patient education, complementing traditional PILs. By leveraging the strengths of both AI-driven technologies and human expertise, healthcare providers can enhance patient education and empower individuals to make informed decisions about their health and medical care.

The impact of vitamin E, vitamin B6, and niacin intake on cataract incidence based on NHANES 2005-2008 data.

Objective: This investigation aims to elucidate the correlations between dietary intakes of vitamin E, B6, and niacin and the incidence of cataracts, utilizing the comprehensive NHANES 2005-2008 dataset to affirm the prophylactic roles of these nutrients against cataract formation. Methods: Using data from the NHANES 2005-2008 cycles, this analysis concentrated on 7,247 subjects after exclusion based on incomplete dietary or cataract data. The identification of cataracts was determined through participants' self-reported ophthalmic surgical history. Nutritional intake was gauged using the automated multiple pass method, and the data were analyzed using logistic and quantile regression analyses to investigate the relationship between vitamin consumption and cataract prevalence. Results: Our analysis identified significant inverse associations between the intake of vitamins E, B6, and niacin and the risk of cataract development. Specifically, higher intakes of vitamin B6 (OR = 0.85, 95% CI = 0.76-0.96, p = 0.0073) and niacin (OR = 0.98, 95% CI = 0.97-1.00, p = 0.0067) in the top quartile were significantly associated with a reduced likelihood of cataract occurrence. Vitamin E intake showed a consistent reduction in cataract risk across different intake levels (OR = 0.96, 95% CI = 0.94-0.99, p = 0.0087), demonstrating a nonlinear inverse correlation. Conclusion: The outcomes indicate that elevated consumption of vitamin B6 and niacin, in conjunction with regular vitamin E intake, may have the potential to delay or prevent cataract genesis. These results suggest a novel nutritional strategy for cataract prevention and management, advocating that focused nutrient supplementation could be instrumental in preserving eye health and reducing the risk of cataracts. Further research is recommended to validate these findings and establish optimal dosages for maximum benefit.

Clinical management of eye diseases: carotenoids and their nanoformulations as choice of therapeutics.

Eye diseases, such as age-related macular degeneration (AMD) and diabetic retinopathy (DR), impose a substantial health cost on a worldwide scale. Carotenoids have emerged as intriguing candidates for pharmacological treatment of various disorders. Their therapeutic effectiveness, however, is hindered by poor solubility and vulnerability to degradation. Nanocarriers, such as nanoparticles, liposomes, and micelles, provide a transformational way to overcome these limits. This review explores the pharmacological potential of carotenoids, namely lutein, zeaxanthin, and astaxanthin, to treat several ocular disorders. The main emphasis is on their anti-inflammatory and antioxidant actions, which help to counteract inflammation and oxidative stress, crucial factors in the development of AMD and DR. The review evaluates the significant benefits of nano-formulated carotenoids, such as improved bioavailability, higher cellular absorption, precise administration to particular ocular tissues, and greater biostability, which make them superior to conventional carotenoids. Some clinical studies on the beneficial properties of carotenoids in eye diseases are discussed. Furthermore, safety and regulatory concerns are also taken into account. Ultimately, carotenoids, especially when created in their nano form, have significant potential for safeguarding eyesight and enhancing the overall well-being of several individuals afflicted with vision-endangering eye diseases.

Prevalence and Associated Factors of Cataract, Cataract Surgery and Postoperative Outcome in an Old Population in Russia: The Ural Very Old Study.

Purpose: To assess prevalence of cataract and cataract surgery in a very old population in Russia. Design: Population-based study. Participants: The Ural Very Old Study included 1526 (81.1%) participants of 1882 eligible individuals aged >85 years. Methods: Series of ophthalmological examinations. Main Outcome Measures: Prevalence of cataract and cataract surgery. Results: The study included 1163 (76.3%) individuals with lens information. Cataract surgery had been performed in 469 right eyes (41.0%; 95% confidence interval [CI]: 38.1-43.9) (92.1% with posterior chamber intraocular lens [IOL]; 4.7% with multifocal IOL) and 479 left eyes (41.6%; 95% CI: 38.7-44.4) (92.7% with posterior chamber IOL; 4.2% with multifocal IOL). Cataract surgery had been performed in at least one eye for 610 (52.5%) individuals. Higher prevalence of previous cataract surgery correlated (multivariable analysis) with lower IOP (OR: 0.92; 95% CI: 0.88-0.95), glaucomatous optic nerve damage stage (OR: 1.20; 95% CI: 1.05-1.36), and better visual acuity (OR: 0.67; 95% CI: 0.51-0.89). Postoperative best corrected visual acuity was reduced to moderate-to-severe vision impairment (MSVI) in 202 eyes (44.6%; 95% CI: 40.0-49.2) and to blindness in 53 eyes (11.7%; 95% CI: 8.7-14.7). Causes of postoperative MSVI were age-related macular degeneration (AMD) (34.2%), glaucoma (13.9%), and secondary cataract (5.4%). Causes for blindness were AMD (24.5%), glaucoma (18.9%), corneal opacifications (15.8%) and myopic macular degeneration (11.3%). Yttrium Aluminum Garnet-laser capsulotomy had been performed in 6 (1.3%) of 469 right eyes and 12 (2.5%) of 479 left eyes. Prevalence of nuclear cataract and cortical cataract was 604/671 (90.0% in phakic eyes; 51.9% in the whole study population) and 97.9% eyes (48.4% in total study population). Cataract caused bilateral MSVI and blindness in 28.2% (95% CI: 25.6-30) and 2.9% (95% CI: 1.9-3.9), respectively, of all study participants. Conclusions: Despite a relatively high prevalence of cataract surgery, this multiethnic cohort >85 years of aged from Russia showed a high prevalence of cataract-related MSVI and blindness. Main causes for postoperative MSVI (prevalence: 44.6%) and blindness (prevalence: 11.7%) were AMD, glaucoma, corneal opacifications, and myopic macular degeneration. Almost all individuals aged 85+ years need cataract surgery, despite limited chance of postoperative good vision. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of ocular biometric parameters between two swept-source optical coherence tomography devices and Scheimpflug tomography in patients with cataract.

AIM: To assess and compare the variations and agreements across different ocular biometric parameters using swept-source optical coherence tomography (SS-OCT) and Scheimpflug tomography in patients diagnosed with cataract. METHODS: This prospective case series was conducted at Tianjin Medical University Eye Hospital. In total, 212 eyes from 212 patients scheduled for phacoemulsification were included. Eyes were evaluated preoperatively using two SS-OCT devices (IOLMaster700 and CASIA2) and Scheimpflug tomography (Pentacam). Central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AQD), white-to-white distance (WTW), flat simulated keratometry (Kf), steep simulated keratometry (Ks), mean keratometry (Km), and total corneal keratometry (TKm) were measured. Intraclass correlation coefficient (ICC), 95% confidence intervals (CI) and limits of agreement (LoA) widths were conducted to assess differences and correlations between devices. RESULTS: All parameters, except for Ks, were significantly different. Pairwise comparison revealed no significant differences between keratometry obtained by IOLMaster 700 and Pentacam. LoA widths of all paired comparisons for Ks were >0.80 D. Except for WTW between IOLMaster 700 and CASIA2 and between CASIA2 and Pentacam, other Pearson's coefficients between devices showed a strong correlation (all r>0.95). The ICC of WTW (ICC=0.438, 95%CI 0.167-0.625) showed poor reliability. The reliability of CCT, ACD, and AQD was excellent (all ICC>0.95), whereas that of TKm was good (ICC=0.827, 95%CI 0.221-0.939). A significant linear correlation was also observed among devices. CONCLUSION: The ocular parameters derived from the use of IOLMaster700, CASIA2, and Pentacam exhibit significant discrepancies; as such, measurements from these devices should not be deemed as interchangeable.

Pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries under topical anesthesia.

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients' intraoperative experience in second-eye cataract surgeries.

EVA NEXUS-Phaco performance study.

AIM: To investigate a novel phacoemulsification system "EVA NEXUS" (D.O.R.C., Dutch Opthalmic Research Center) in comparison to the existing system "EVA" in clinical use. And to compare both phacoemulsification systems in terms of efficiency, safety and postoperative inflammatory activity. METHODS: In this study standardized cataract surgery was performed on both eyes of the study participant, using the "EVA system" (control group, n=20) on one eye and the "EVA NEXUS system" (intervention group, n=20) on the other eye. Only patients with cataract LOCS Grading 1-3 and no accompanying eye diseases were included in this study. A total of 20 patients were included in this study, with each treatment arm including 20 eyes. During surgery a 0.1 mL aqueous humor sample was collected 1min after phacoemulsification to measure the total prostaglanin E2 concentrations using an enzyme-linked immunosorbent assay. The endothelial cell count, visual and refractive outcomes, and anterior chamber flare were evaluated preoperatively, and 1d, 1wk, and 3mo postoperatively. RESULTS: There were no statistically significant differences between both groups regarding intraoperative safety parameters including effective phacoemulsification time (P=0.904), balanced saline solution flow (P=0.701) and total surgery time (P=0.565). Postoperative prostaglandin E2 levels, anterior chamber flare as well as endothelial cell loss tended to be lower in the NEXUS-Group, however not being statistically significant (P=0.718; 0.164; 0.486). Both systems provided similar clinical outcomes, regarding best corrected visual acuity and refractive parameters, showing no statistically significant differences between both groups. CONCLUSION: Both systems show a high level of safety and efficency with similar results in terms of safety parameters including postoperative inflammatory activity and endothelial cell loss as well as visual and refractive outcomes. Although statistically not significant, the EVA NEXUS system tends to cause less postoperative inflammation with lower prostaglandin E2 levels and lower anterior chamber flare values.

Risk Factors for Postoperative Refractive Error in New-Generation Intraocular Lens Calculation Formulas.

Purpose: We examined differences in the accuracy of three intraocular lens (IOL) calculation formulas: the traditional Sanders-Retzlaff-Kraff/Theoretical (SRK/T) formula; the Barrett Universal II (BU II) formula, which is a new-generation IOL calculation formula; and the postoperative spherical equivalent prediction using artificial intelligence and linear algorithms developed by Debellemanière, Gatinel, and Saad formula (PEARL-DGS [PEARL]) formula, and evaluated factors that cause postoperative refractive error (PE). Patients and Methods: The study included 205 patients (205 eyes) with a mean age of 75.2 ± 8.7 years who underwent cataract surgery at our institution from December 2018 to October 2023. The PE of the three IOL calculation formulas was calculated and compared. Multivariate logistic regression analysis was performed with a PE higher than ±0.50 D as the dependent variable, and age, sex, axial length (AL), mean keratometry (mean K), anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW) as independent variables. Results: The mean PE (ME) ± standard deviation of the SRK/T, BU II, and PEARL formulas was 0.11 ± 0.52, 0.11 ± 0.50, and 0.21 ± 0.50 D, respectively. MEs of the three IOL calculation formulas were significantly different from 0 (p < 0.01). The median absolute error (MedAE) was not significantly different among the three IOL calculation formulas (p = 0.83). The percentage of PE within ±0.50 D was not significantly different among the three IOL calculation formulas (p = 0.13). Multivariate logistic regression analysis showed that the significantly associated factors with PE higher than ±0.50 D were AL, ACD, and LT for the SRK/T formula, sex and LT for the BU II formula, and LT for the PEARL formula (all p < 0.05). Conclusion: In the BU II and PEARL formulas, AL was excluded as a factor affecting PE, indicating that LT was a risk factor.

Parameters influencing the effectiveness of femtosecond laser-assisted capsulotomy in white cataract surgery.

Purpose: To explore the parameters that may influence the effectiveness of femtosecond laser-assisted capsulotomy in white cataract surgery and its cutoff points. Design: A retrospective case series. Methods: This retrospective case series study enrolled patients with white cataract who had undergone surgery at Changsha Aier Eye Hospital from July 2018 to January 2020. All patients underwent femtosecond laser-assisted capsulotomy using a contact femtosecond laser device (LenSx, Alcon Laboratories, USA). The sex, age, corrected distance visual acuity (CDVA), intraocular pressure (IOP), axial length (AL), lens thickness (LT), anterior chamber depth (ACD) and mean keratometry (Km) were recorded. All eyes were divided into successful capsulotomy group and unsuccessful capsulotomy group according to the capsulotomy integrity. Both groups were compared and two-sample t-test was used in order to find the optimal cutoff points of the parameters. Results: 60 eyes of 59 patients were included in the study. A successful capsulotomy was achieved in 36 eyes (60 %), while unsuccessful capsulotomy occurred in 24 eyes (40 %). Although no significant differences were observed in sex (P = 0.704), AL (P = 0.598) and Km (P = 0.873) between both groups, LT (P < 0.01), ACD (P = 0.014) and age (P < 0.01) were significantly different; a LT of 5.21 mm was found to be the optimal cutoff point. Conclusions: Femtosecond laser-assisted capsulotomy in white cataract is safe and effective. LT, ACD and age may influence the effectiveness of femtosecond laser-assisted capsulotomy in patients with white cataracts. LT is the main associated parameter and 5.21 mm is the optimal cutoff point for LT.

Incidence and Characteristics of Intraocular Lens Dislocation in South Korea from 2002 to 2021: A Nationwide Population-based Study.

Purpose: This study aimed to analyze the incidence and characteristics of intraocular lens (IOL) dislocation after cataract surgery in South Korea. Methods: We retrospectively analyzed the incidence of IOL dislocation after cataract surgery in patients diagnosed between 2002 and 2021. Data of all pseudophakic patients who underwent secondary IOL or IOL exchange surgeries due to IOL dislocation were extracted from the Korean National Health Insurance System (KNHIS) database and the Korean Standard Classification of Diseases-7 codes. The incidence per 1,000,000 person-years and corresponding 95% confidence intervals (CIs) were calculated. Results: Between 2002 and 2021, 39,965 (0.82 %) of the 4,848,125 pseudophakic patients were diagnosed with IOL dislocation and surgically treated. The incidence of IOL dislocation requiring surgery in pseudophakic patients was 28,900/1,000,000 person-years (95% CI: 28,431-29,369), comprising 57,800 cases in male and 10,800 in female patients (95% CI: male: 56,730-58,870 vs. 95% CI: female patients: 10,523-11,077), and mean male-to-female ratio was 5.35. The incidence rate peaked in younger age group below 40 years, showing 107,000 per 1,000,000 person-years (95% CI: 102,900-111,100), and the average age of IOL dislocation requiring surgery was 68.1 ± 10.7 years. The average time lapse from cataract surgery to secondary IOL surgery due to IOL dislocation was 4.1±4.7 years (median, 2.2 years), and the number of secondary IOL surgery due to dislocation of artificial lens rapidly occurred 10 years after cataract surgery among all age groups. Conclusions: The incidence of IOL dislocation requiring surgery was higher in younger and male patients. Our findings could be expected to aid establishing future healthcare policies for South Korean populations with an increased risk of IOL dislocation after cataract surgery.

Change in Iridotrabecular Contact and Intraocular Pressure after Phacoemulsification in Primary Angle Closure Disease Spectrum.

Purpose: To compare changes in the swept-source anterior segment optical coherence tomography (SS AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle closure disease (PACD). Methods: A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, and 6 months. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A: primary angle closure suspect or primary angle closure; group B: primary angle closure glaucoma). The changes in IOP and anterior chamber angle (ACA) parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction. Results: Preoperatively, there was no significant difference in IOP (16.3 ± 2.5 vs 16.9 ± 3.2 mmHg, P=0.297) between the two groups, but the number of glaucoma medications used (0.6 ± 1.0 vs 2.0 ± 0.9, P<0.001) was greater in group B. Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7, 0.9 ± 0.8, P<0.001). ACA parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index (5.6 ± 7.0 vs 10.7 ± 12.1, P=0.014) was significantly greater in group B. A greater change in the ITC index was related to a greater degree of IOP reduction (beta coefficient = 0.429, P<0.001). Conclusions: Eyes with PACG had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum, and required a greater number of glaucoma medications to maintain a similar level of IOP.

Effect of Lipiflow (Thermal Pulsation) on Ocular Surface Disease Management After Cataract Surgery.

Purpose: The aim of the current study was to investigate the efficacy of Thermal pulsation treatment, completed one month prior to cataract surgery, as a means of eliminating or significantly mitigating the exacerbating effects of cataract surgery on dry eye patients. Setting: Glendale, Arizona. Design: Prospective, longitudinal, non-masked, randomized clinical investigation. Methods: The treatment group received Thermal pulsation therapy approximately 1 month prior to undergoing immediate sequential, same-day bilateral cataract surgery. The control group did not receive pre-operative Thermal pulsation but had cataract surgery performed in the same way, approximately 1 month after their baseline visit. Subjective questionnaires and objective clinical findings were evaluated at baseline, 1, 3, and 6 months after cataract surgery in the treatment group and control group. Results: A total of 62 patients were randomized into two groups of 31 representing 124 eyes. Subjective improvement was observed in the treatment group with OSDI and SPEED II scores. Mean (SD) of the OSDI improved significantly (p<0.01) from 56.98 (18.30) from visit 1 to 14.73 (12.22) at visit 4, and the mean (SD) of the SPEED II scores improved significantly (p=0.01) from 13.84 (6.12) during visit 1 to 7.1 (5.00) at visit 4 in the treatment group. Conclusion: Pre-operative Thermal pulsation treatment in patients with dry eye secondary to MGD appears to reduce dry eye symptoms after cataract surgery. Expectations should be moderated by the fact that the reduction in symptoms appears to reduce prior to 3 months post-op after cataract surgery.

Sulforaphane and ophthalmic diseases.

Sulforaphane (SFN) is an organosulfur compound categorized as an isothiocyanate (ITC), primarily extracted from cruciferous vegetables like broccoli and cabbage. The molecular formula of sulforaphane (SFN) is C6H11NOS2. SFN is generated by the hydrolysis of glucoraphanin (GRP) through the enzyme myrosinase, showing notable properties including anti-diabetic, anti-inflammatory, antimicrobial, anti-angiogenic, and anticancer attributes. Ongoing clinical trials are investigating its potential in diseases such as cancer, neurodegenerative diseases, diabetes-related complications, chronic kidney disease, cardiovascular disease, and liver diseases. Several animal carcinogenesis models and cell culture models have shown it to be a very effective chemopreventive agent, and the protective effects of SFN in ophthalmic diseases have been linked to multiple mechanisms. In murine models of diabetic retinopathy and age-related macular degeneration, SFN delays retinal photoreceptor cell degeneration through the Nrf2 antioxidative pathway, NF-κB pathway, AMPK pathway, and Txnip/mTOR pathway. In rabbit models of keratoconus and cataract, SFN has been shown to protect corneal and lens epithelial cells from oxidative stress injury by activating the Keap1-Nrf2-ARE pathway and the Nrf-2/HO-1 antioxidant pathway. Oral delivery or intraperitoneal injection at varying concentrations are the primary strategies for SFN intake in current preclinical studies. Challenges remain in the application of SFN in eye disorders due to its weak solubility in water and limited bioavailability because of the presence of blood-ocular barrier systems. This review comprehensively outlines recent research on SFN, elucidates its mechanisms of action, and discusses potential therapeutic benefits for eye disorders such as age-related macular degeneration (AMD), diabetic retinopathy (DR), cataracts, and other ophthalmic diseases, while also indicating directions for future clinical research to achieve efficient SFN treatment for ophthalmic diseases.

Slit2 Promotes H2O2-Induced Lens Epithelial Cells Oxidative Damage and Age-Related Cataract.

PURPOSE: To analyze the role of Slit2 in lens epithelial cell oxidative damage and its underlying mechanism. METHODS: Human lens epithelial cells (SRA01/04 cells) and rat transparent lens were cultured with H2O2 to establish cell oxidative stress models and rat cataract models. Immunohistochemistry, quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot assays were employed to detect Slit2 levels within age-related cataracts(ARC) lens anterior capsule samples, rat cataract models, and cell oxidative stress models. In this study, qRT-PCR and Western blot assays were performed to derermine E-cadherin, N-cadherin, occludens1(ZO-1), α-SMA(α­smooth muscle actin), Bcl-2, Bax, p-AKT, and AKT levels. In addition, Flow cytometry were performed to examine reactive oxygen species (ROS) and cell apoptosis. Cell viability, invasion, and migration were detected by CCK8, Transwell, and Wound healing. RESULTS: Increased expression of Slit2 was found in ARC lens anterior capsule samples, H2O2-induced rat cataract models, and Human lens epithelial cells (HLECs) oxidative stress models. H2O2 significantly increased cell apoptosis and ROS generation, also accelerating cell migration, invasion, and epithelial-mesenchymal transition (EMT). In addition, H2O2 treatment repressed AKT phosphorylation and cell viability. Knock-down of Slit2 promoted cell viability and AKT phosphorylation levels, as well as repressed cell invasion, migration, apoptosis, ROS production and EMT. CONCLUSION: Slit2 promoted lens epithelial cells oxidative stress damage via the AKT signalling pathways, providing a novel insight in ARC treatment.

Utilization of apple vision pro in ophthalmic surgery: A pilot study.

PURPOSE: This paper explores the application of Apple Vision Pro in ophthalmic surgery, assessing its potential benefits in providing real-time imaging overlay, surgical guidance, and collaborative opportunities. MATERIALS AND METHOD: The device was worn by 10 ophthalmic surgeons during eyelid malposition surgery. All surgeons performed the entire surgery while wearing the visor. At the end of procedure, all operators had to rate Apple Vision Pro visor according to 10 specific item and system usability scale (SUS) questionnaire. RESULTS: The surgeons used the Apple Vision Pro during the entire procedure, and the results were positive, with high ratings for practicality, freedom of movement, integration into workflow, and learning. All surgeons rated the Apple Vision Pro above 85/100 in the SUS. CONCLUSION: The incorporation of Apple Vision Pro in oculoplastic surgery offers several advantages, including improved visualization, enhanced precision, and streamlined communication among surgical teams. According to our preliminary results Apple Vision Pro could represents a valuable tool in ophthalmic surgery, with implications for enhancing surgical techniques and advancing XR research in the surgical field.

Investigating the etiology of ocular changes in Monodactylus argenteus housed in a shoaling ring exhibit.

OBJECTIVE: To evaluate the pathologic ocular changes in a population of aquarium-housed Monodactylus argenteus and investigate potential underlying causes for the large number of affected fish in this exhibit. ANIMALS: 11 Monodactylus argenteus were evaluated from a shoaling ring exhibit within an aquarium, and 19 control fish without ocular abnormalities were obtained from commercial fish suppliers. METHODS: Physical and ocular examinations were performed antemortem. Postmortem samples of liver, heart, dorsal epaxial muscle, and lenses of affected and control fish were analyzed for amino acid profiles. The aqueous humor from affected and control fish was collected postmortem, and osmolality was analyzed. Tissues from affected and control fish were submitted for histopathology. RESULTS: Ocular abnormalities in affected fish included corneal lesions, cataracts, lens capsule rupture, and unilateral left-sided lens luxation and buphthalmos. Lens luxation and buphthalmos were directly correlated. Aqueous humor osmolality in control fish differed significantly compared to affected fish but was not correlated to lens abnormality score. Affected fish had significantly lower lens concentrations of arginine, asparagine, glycine, isoleucine, serine, and tyrosine than control fish. One affected fish had severe buphthalmos, cataracts, and panophthalmitis caused by gram-positive cocci. CONCLUSIONS: Cataracts and traumatic lesions were common in affected M argenteus. Dietary amino acid content and aqueous humor osmolality imbalances were not likely a cause of the cataracts. Differences in lens amino acid concentrations between affected and control fish may be related to cataract formation. CLINICAL RELEVANCE: Consideration of species-appropriate tank parameters may mitigate ocular lesions including cataracts in aquarium fish.

Mendelian randomization implicates causal association between epigenetic age acceleration and age-related eye diseases or glaucoma endophenotypes.

BACKGROUND: Age-related eye diseases (AREDs) have become increasingly prevalent with the aging population, serving as the leading causes of visual impairment worldwide. Epigenetic clocks are generated based on DNA methylation (DNAm) levels and are considered one of the most promising predictors of biological age. This study aimed to investigate the bidirectional causal association between epigenetic clocks and common AREDs or glaucoma endophenotypes. METHODS: Instrumental variables for epigenetic clocks, AREDs, and glaucoma endophenotypes were obtained from corresponding genome-wide association study data of European descent. Bidirectional two-sample Mendelian randomization (MR) was employed to explore the causal relationship between epigenetic clocks and AREDs or glaucoma endophenotypes. Multivariable MR (MVMR) was used to determine whether glaucoma endophenotypes mediated the association of epigenetic clocks with glaucoma. Multiple sensitivity analyses were conducted to confirm the robustness of MR estimates. RESULTS: The results showed that an increased intrinsic epigenetic age acceleration (HorvathAge) was significantly associated with an increased risk of primary open-angle glaucoma (OR = 1.04, 95% CI 1.02 to 1.06, P = 6.1E-04). The epigenetic age acceleration (EEA) of HannumAge was related to a decreased risk of primary angle-closure glaucoma (OR = 0.92, 95% CI 0.86 to 0.99, P = 0.035). Reverse MR analysis showed that age-related cataract was linked to decreased HannumAge (ß = -0.190 year, 95% CI -0.374 to -0.008, P = 0.041). The EEA of HannumAge (ß = -0.85 µm, 95% CI -1.57 to -0.14, P = 0.019) and HorvathAge (ß = -0.63 µm, 95% CI -1.18 to -0.08, P = 0.024) were associated with decreased central corneal thickness (CCT). PhenoAge was related to an increased retinal nerve fiber layer thickness (ß = 0.06 µm, 95% CI 0.01 to 0.11, P = 0.027). MVMR analysis found no mediation effect of CCT in the association of HannumAge and HorvathAge with glaucoma. DNAm-based granulocyte proportions were significantly associated with presbyopia, rhegmatogenous retinal detachment, and intraocular pressure (P < 0.05). DNAm-based plasminogen activator inhibitor-1 levels were significantly related to age-related macular degeneration and intraocular pressure (P < 0.05). CONCLUSION: The present study revealed a causal association between epigenetic clocks and AREDs. More research is warranted to clarify the potential mechanisms of the biological aging process in AREDs.

Autosomal Recessive ADAMTSL4-Related Isolated Ectopia Lentis in the Ohio Old Order Amish and Mennonite Communities.

Purpose: To present a series of 4 patients from the Ohio Amish or Mennonite populations with isolated ectopia lentis. Methods: A case series was evaluated. Results: Four cases with bilateral lens subluxations were diagnosed with a homozygous c.767_786del pathogenic variant in ADAMTSL4. Their ages ranged from 2 to 22 years. Three cases were symptomatic and were managed surgically with lensectomy, vitrectomy, and endolaser photocoagulation with or without secondary intraocular lens (IOL) implantation. One asymptomatic patient was observed. The postoperative visual acuity ranged from 20/20 to 20/60 in nonamblyopic eyes. Conclusions: The pathogenic homozygous c.767_786del variant in ADAMTSL4 may be a cause of bilateral isolated ectopia lentis in the Ohio Amish and Mennonite populations, likely as a result of a founder effect. Vitrectomy and lens extraction with or without secondary IOL implantation may lead to good visual outcomes. There were no cases of retinal detachment.

NCME-Net: Nuclear cataract mask encoder network for intelligent grading using self-supervised learning from anterior segment photographs.

Cataracts are a leading cause of blindness worldwide, making accurate diagnosis and effective surgical planning critical. However, grading the severity of the lens nucleus is challenging because deep learning (DL) models pretrained using ImageNet perform poorly when applied directly to medical data due to the limited availability of labeled medical images and high interclass similarity. Self-supervised pretraining offers a solution by circumventing the need for cost-intensive data annotations and bridging domain disparities. In this study, to address the challenges of intelligent grading, we proposed a hybrid model called nuclear cataract mask encoder network (NCME-Net), which utilizes self-supervised pretraining for the four-class analysis of nuclear cataract severity. A total of 792 images of nuclear cataracts were categorized into the training set (533 images), the validation set (139 images), and the test set (100 images). NCME-Net achieved a diagnostic accuracy of 91.0 % on the test set, a 5.0 % improvement over the best-performing DL model (ResNet50). Experimental results demonstrate NCME-Net's ability to distinguish between cataract severities, particularly in scenarios with limited samples, making it a valuable tool for intelligently diagnosing cataracts. In addition, the effect of different self-supervised tasks on the model's ability to capture the intrinsic structure of the data was studied. Findings indicate that image restoration tasks significantly enhance semantic information extraction.