Carbon Micro/Nano Machining toward Miniaturized Device: Structural Engineering, Large-Scale Fabrication, and Performance Optimization.

With the rapid development of micro/nano machining, there is an elevated demand for high-performance microdevices with high reliability and low cost. Due to their outstanding electrochemical, optical, electrical, and mechanical performance, carbon materials are extensively utilized in constructing microdevices for energy storage, sensing, and optoelectronics. Carbon micro/nano machining is fundamental in carbon-based intelligent microelectronics, multifunctional integrated microsystems, high-reliability portable/wearable consumer electronics, and portable medical diagnostic systems. Despite numerous reviews on carbon materials, a comprehensive overview is lacking that systematically encapsulates the development of high-performance microdevices based on carbon micro/nano structures, from structural design to manufacturing strategies and specific applications. This review focuses on the latest progress in carbon micro/nano machining toward miniaturized device, including structural engineering, large-scale fabrication, and performance optimization. Especially, the review targets an in-depth evaluation of carbon-based micro energy storage devices, microsensors, microactuators, miniaturized photoresponsive and electromagnetic interference shielding devices. Moreover, it highlights the challenges and opportunities in the large-scale manufacturing of carbon-based microdevices, aiming to spark further exciting research directions and application prospectives.

Analysis on the changes of objective indicators of dry eye after implantable collamer lens (ICL) implantation surgery.

PURPOSE: To explore whether implantable collamer lens implantation has any effect on the postoperative objective indicators of dry eye and to determine the severity of its influence on each indicator. METHODS: This prospective observational trial was performed in the Department of Ophthalmology of West China Hospital and was approved by the Biomedical Ethics Sub-Committee of the West China Hospital of Sichuan University. A total of 89 non-dry eye patients (178 eyes in total) who received ICL implantation surgery at West China Hospital of Sichuan University were enrolled. The noninvasive keratograph tear film breakup time (NIKBUT), noninvasive keratograph tear meniscus height (NIKTMH), score of lipid layer, score of meibomian gland function, and hyperemia index were obtained via the OCULUS Keratograph for all subjects before surgery and at 1 week, 1 month, and 3 months after surgery. The fluorescein tear film breakup time (FBUT), corneal fluorescein staining score (CFS), and Schirmer test I were also measured at the same time. RESULTS: A total of 178 eyes completed the 1-week and 1-month follow-up, and 40 eyes completed the 3-month follow-up. Compared with the preoperative baseline, there was no significant difference in the NIKBUT or the corneal fluorescein staining score at each follow-up time point (P > 0.05, P > 0.05, P > 0.05). The FBUT and Schirmer test I at 1 week, 1 month, and 3 months after surgery were significantly higher than the preoperative baseline (P < 0.01, P < 0.01, P < 0.01). The NIKTMH and the score of lipid layer were significantly lower than the preoperative baseline at 1 week, 1 month, and 3 months after surgery (P < 0.01, P < 0.01, P < 0.05). The score of meibomian gland function and hyperemia index were significantly lower than the preoperative baseline 1 week after surgery (P < 0.01). CONCLUSION: ICL implantation has no adverse effect on the occurrence of postoperative dry eye, but it reduces the basal tear secretion of patients after surgery and has adverse effects on the indices of meibomian gland function in the short term postoperatively.

The effect of irrigation and aspiration on the corneal endothelial cell density in patients undergoing Implantable Collamer Lens with a central hole implantation for myopia correction.

PURPOSE: In the conventional technique, viscoelastic agents are typically rinsed away with balanced salt solution (BSS), but it may lead to a series of complications such as viscoelastic residue, anterior chamber instability and intraoperative TICL rotation. The utilization of irrigation and aspiration (I/A) has been shown to be effective in maintaining anterior chamber stability, reducing the incidence of postoperative high intraocular pressure, and minimizing postoperative fundus complications. However, there is a lack of previous studies investigating the impact of I/A on corneal endothelial cells during ICL implantation. The objective of this study was to examine the effect of I/A on corneal endothelial cells in patients undergoing myopia correction through implantation of Implantable Collamer Lens with a central hole (V4c ICL). METHODS: A retrospective selection was made of 344 eyes from 172 patients who underwent V4c ICL implantation and I/A to remove viscoelastic agent from the anterior chamber between 2021 and 2022. The intraocular pressure (IOP) was measured at 1 h, 2 h and 3 h after surgery. Corneal endothelial cell density (ECD), coefficient of variation in cell size (CV), standard deviation of cell area (SD), and percentage of hexagonal cells (HEX) were evaluated at 1 week postoperatively to assess corneal endothelial cells. The first two represent polymegethism or morphological variation, while the third parameter represents the degree of polymorphism of the corneal endothelial cells. Electronic medical records were utilized for data collection purpose. RESULTS: All surgeries proceeded without complications. The IOP was 16.50 ± 3.42 mmHg (range: 11.5-22.3 mmHg) prior to surgery and increased to 21.25 ± 5.61 mmHg (range: 9.5-34.8 mmHg), 19.85 ± 5.18 mmHg (range: 11.4-36.2 mmHg) and finally settled at an average of 18.81 ± 4.57 mmHg (range: 10.1-38.8 mmHg) at the respective time points of 1 h, 2 h and 3 h after surgery. The preoperative ECD was recorded as being approximately 3004 ± 295 cell/mm2, which exhibited a marginal decreased of 1.17% postoperatively, resulting in an average ECD value of 2969 ± 303 cell/mm2 one week after surgery (P = 0.12). Similarly, the preoperative CV was determined as 31.10 ± 3.78%, and it experienced a slight reduction with an average CV value of 30.74 ± 3.77% at week after surgery (P = 0.21). And, the preoperative SD was reported as 104.76 ± 17.26, and it remained virtually unchanged with an average SD value of 104.85 ± 18.75 at one week after surgery (P = 0.95). The preoperative HEX was calculated as 55.38 ± 8.94%, and it remained its stability with an average HEX value of 55.45 ± 8.73% one week after surgery (P = 0.92). CONCLUSION: The utilization of I/A led to a slight decrease in postoperative ECD when compared to conventional surgical techniques. Nevertheless, the reduction in ECD remained within acceptable limits, taking into accout the avervantaged it offered, such as stabilization of the anterior chamber and decreased occurrence of viscoelastic residue after surgery. It is challenging to anticipate the long-term safety of corneal endothelial cells based on current short-term studies. However, this study provides a valuable reference indicating that neither anterior chamber irrigation nor I/A aspiration have an adverse impact on the safety of corneal endothelial cells in the short term. Further research is imperative to enhance our understanding of their effects over an extended period.

Deep learning classification of uveal melanoma based on histopathological images and identification of a novel indicator for prognosis of patients.

BACKGROUND: Deep learning has been extensively used in digital histopathology. The purpose of this study was to test deep learning (DL) algorithms for predicting the vital status of whole-slide image (WSI) of uveal melanoma (UM). METHODS: We developed a deep learning model (Google-net) to predict the vital status of UM patients from histopathological images in TCGA-UVM cohort and validated it in an internal cohort. The histopathological DL features extracted from the model and then were applied to classify UM patients into two subtypes. The differences between two subtypes in clinical outcomes, tumor mutation, and microenvironment, and probability of drug therapeutic response were investigated further. RESULTS: We observed that the developed DL model can achieve a high accuracy of > = 90% for patches and WSIs prediction. Using 14 histopathological DL features, we successfully classified UM patients into Cluster1 and Cluster2 subtypes. Compared to Cluster2, patients in the Cluster1 subtype have a poor survival outcome, increased expression levels of immune-checkpoint genes, higher immune-infiltration of CD8 + T cell and CD4 + T cells, and more sensitivity to anti-PD-1 therapy. Besides, we established and verified prognostic histopathological DL-signature and gene-signature which outperformed the traditional clinical features. Finally, a well-performed nomogram combining the DL-signature and gene-signature was constructed to predict the mortality of UM patients. CONCLUSIONS: Our findings suggest that DL model can accurately predict vital status in UM patents just using histopathological images. We found out two subgroups based on histopathological DL features, which may in favor of immunotherapy and chemotherapy. Finally, a well-performing nomogram that combines DL-signature and gene-signature was constructed to give a more straightforward and reliable prognosis for UM patients in treatment and management.

Development of interface haze after femtosecond laser-assisted in situ keratomileusis with accelerated corneal crosslinking: a case series.

BACKGROUND: Femtosecond laser-assisted in situ keratomileusis (FS-LASIK) with accelerated corneal crosslinking (FS-LASIK Xtra) is a recent procedure to achieve safer corneal ablation in myopic patients with borderline corneal thickness. Despite its well-accepted effectiveness, the development of remarkable interface haze is a potential concern but has rarely been reported and discussed. METHODS: We report for the first time a case series of 11 eyes of 7 patients who developed typical interface haze 1-3 months after FS-LASIK Xtra for the correction of myopia with astigmatism, with intensity grades ranging from 0.5 + to 3 + at the time of onset. RESULTS: The preclinical spherical diopters of the 7 patients ranged from - 2.25 D to - 9.25 D and cylindrical diopters ranged from - 0.25 D to - 2.50 D. The haze tended to be self-limiting, and topical anti-inflammatory therapy was given to moderate and severe cases, who responded well to treatment. CONCLUSIONS: The development of clinically significant interface haze is a relatively rare complication after FS-LASIK Xtra but tends to have a higher incidence and intensity compared to conventional stromal surgery such as FS-LASIK. Timely treatment and close follow-up are essential to patients undertaking FS-LASIK Xtra.

Paediatric traumatic cataracts in Southwest China: epidemiological profile.

BACKGROUND: Paediatric traumatic cataracts are an important but preventable cause of acquired blindness. Understanding the epidemiology of paediatric traumatic cataracts is a prerequisite for prevention. This study aimed to characterize the epidemiological profile of paediatric traumatic cataracts in southwest China. METHODS: The medical records of children (age range, 0-14 years old) who developed traumatic cataracts following open-globe injuries and were hospitalized at the Department of Ophthalmology at West China Hospital, between January 2011 and December 2020 were retrospectively analyzed. The demographic data, causes of injuries, posttraumatic complications, and visual acuity were recorded and analysed. RESULTS: A total of 716 eyes from 716 patients were analysed in this study, including 521 (72.8%) males and 195 females in a gender ratio of 2.67:1; 117 of the patients were of ethnic minorities. Paediatric traumatic cataracts occurred more frequently in winter (32.5%). Sharp metal objects (scissors/knives/needles/sheet metal/nails/darts) - induced ocular injuries accounted for the highest proportion, followed by botanical sticks (wooden sticks /bamboo sticks /bamboo skewers)-induced injuries, and then stationery items (pencils/pens/rulers/paper)-induced injuries. The majority (68.7%) of the patients were aged 2-8 years, and the peak range of age was 4 - 6 years. The injuries were a result of penetrating trauma in 64.9% of patients, and blunt force trauma in the remainder (35.1%). Additionally, 131 (18.3%) cases developed posttraumatic infectious endophthalmitis after injuries. Patients with eye injuries caused by needles (P < 0.001), wooden sticks (P = 0.016), and bamboo skewers (P = 0.002) were at a greater risk of developing infectious endophthalmitis. The most common identified foreign organism was Streptococcus, which accounted for 42% (21/50) of all culture-positive specimens and was sensitive to vancomycin. Among the children who were younger than 5 years, 44.4% (55/124) of those with traumatic cataracts presented a corrected distance visual acuity less than or equal to 0.1 after undergoing cataract surgery, but among the children who were older than 5 years, this proportion was significantly smaller, just 20.4% of children aged 6-10 years (P < 0.001) and 18.4% of children aged 11-14 years (P < 0.001). CONCLUSION: The main causative agents of paediatric traumatic cataracts in southwest China were sharp metal objects, botanical sticks, and stationery items. Specific preventive measures are essential to reduce the incidence of paediatric traumatic cataract.

A Sensitive and Reversible Labeling Strategy Enables Global Mapping of the Core-Fucosylated Glycoproteome on Cell Surfaces.

Core fucosylation, the attachment of α1,6-fucose to the innermost N-acetylglucosamine (GlcNAc) residue of N-glycans, has a strong relationship with tumor growth, invasion, metastasis, prognosis, and immune evasion by regulating many membrane proteins. However, details about the functional mechanism are still largely unknown due to the lack of an effective analytical method to identify cell-surface core-fucosylated glycoproteins, and especially glycosylation sites. Here, we developed a sensitive and reversible labeling strategy for probing core fucosylation, by which core-fucosylated glycoproteins that located on cell-surface were selectively tagged by a biotinylated probe with high sensitivity. The labeled probe can be further broken enzymatically after the capture by affinity resin. The on-bead traceless cleavage allowed the global mapping of core-fucosylated glycoproteins and glycosylation sites by mass spectrometry (MS). The profile of core-fucosylated glycoproteome provides an in-depth understanding of the biological functions of core fucosylation.

Synergistic Effects of Selenophene and Extended Ladder-Type Donor Units for Efficient Polymer Solar Cells.

Two pairs of polymer donor materials based on indacenodithiophene (IDT) and indacenodithieno[3,2-b]thiophene (IDTT) as the donor units are synthesized. Thiophene or selenophene is introduced as the π-bridge units and electron-deficient fluorine-substituted quinoxaline is used as acceptor unit. Selenophene-containing polymers PIDT-DFQ-Se and PIDTT-DFQ-Se show redshifted absorption and narrower bandgaps. Combined with IDTT donor unit, PIDTT-DFQ-Se shows the highest absorption coefficient. Both the IDTT unit and selenophene unit have positive effects on the hole mobilities, making PIDTT-DFQ-Se the highest one. The best power conversion efficiency of 7.4% is obtained from devices based on PIDTT-DFQ-Se:[6,6]-phenyl C71 butyric acid methyl ester (PC71 BM) with a Jsc of 12.6 mA cm-2 , a Voc of 0.89 V, and a fill factor (FF) of 0.66.

Thymic stromal lymphopoietin is expressed in human corneal stromal cells and secreted upon protease-activated receptor 1 activation.

Thymic stromal lymphopoietin (TSLP) is an interleukin-7 (IL-7) like cytokine that triggers inflammatory responses through activating dendritic cell. It is demonstrated to be involved in a number of disorders, including cancer, gastrointestinal diseases, and autoimmune diseases. In addition, TSLP is also found to be able to induce itch sensation by directly activating the itch sensory neurons. The expression of human TSLP is detected in various tissues such as heart, liver, testis, and prostate. In this study, we report that TSLP was expressed in the human corneal stromal cells, the highly specialized cells that are critical for the function of the cornea. Furthermore, we found that activation of the protease-activated receptor 1 (PAR1) induced secretion of TSLP by the corneal stromal cells. Beside the canonical activator thrombin, PAR1 can also be activated by a few matrix metalloproteases (MMPs) such as MMP1 and MMP13. Since MMPs including MMP1 and MMP13 are upregulated in many corneal diseases as well as the corneal wound healing process, we proposed that TSLP might function as the link between increased protease activity and inflammatory responses or itch sensation in the corneas. © 2017 IUBMB Life, 69(8):606-610, 2017.

The Future of Checkpoint Inhibitors in Uveal Melanoma: A Narrative Review.

INTRODUCTION: Immune checkpoint inhibitors have made tremendous progress over the last decade in the treatment of cutaneous melanoma, but their application in uveal melanoma treatment is less successful, owing in part to the immunological privilege of the eye and the liver, the most frequent site of metastasis. Nevertheless, the therapeutic outcomes reported currently are less pessimistic. METHODS: In this review, we provide an overview of recent studies of immune checkpoint inhibitors in uveal melanoma and its metastasis and classify studies in this field into three groups: monotherapy of immune checkpoint inhibitors, dual-agent immune checkpoint inhibitors, and immune checkpoint inhibitors combined with other systemic or regional therapies. RESULTS: Briefly, monotherapy with immune checkpoint inhibitors performed poorly. Dual-agent immune checkpoint inhibitors had slightly better outcomes than traditional treatments, especially in specific patient populations. As for the combination therapy, the combination with other systemic therapies did not show superiority over dual-agent immune checkpoint inhibitors, but combination with hepatic regional therapies was quite promising. Moreover, research on emerging checkpoints is currently limited to the stage of mechanistic studies. CONCLUSION: We propose that immune checkpoint inhibitors remain alternative treatments for patients with uveal melanoma, but factors such as cost-effectiveness should also be taken into account. The combination therapy with immune checkpoint inhibitors deserves to be further explored.

DTVF: A User-Friendly Tool for Virulence Factor Prediction Based on ProtT5 and Deep Transfer Learning Models.

Virulencefactors (VFs) are key molecules that enable pathogens to evade the immune systems of the host. These factors are crucial for revealing the pathogenic processes of microbes and drug discovery. Identification of virulence factors in microbes become an important problem in the field of bioinformatics. To address this problem, this study proposes a novel model DTVF (Deep Transfer Learning for Virulence Factor Prediction), which integrates the ProtT5 protein sequence extraction model with a dual-channel deep learning model. In the dual-channel deep learning model, we innovatively integrate long short-term memory (LSTM) with convolutional neural networks (CNNs), creating a novel integrated architecture. Furthermore, by incorporating the attention mechanism, the accuracy of VF detection was significantly enhanced. We evaluated the DTVF model against other excellent-performing models in the field. DTVF demonstrates superior performance, achieving an accuracy rate of 84.55% and an AUROC of 92.08% on the benchmark dataset. DTVF shows state-of-the-art performance in this field, surpassing the existing models in nearly all metrics. To facilitate the use of biologists, we have also developed an interactive web-based user interface version of DTVF based on Gradio.

Sustained and Efficient Delivery of Antivascular Endothelial Growth Factor by the Adeno-associated Virus for the Treatment of Corneal Neovascularization: An Outlook for Its Clinical Translation.

Corneal diseases represent 5.1% of all eye defects and are the fourth leading cause of blindness globally. Corneal neovascularization can arise from all conditions of chronic irritation or hypoxia, which disrupts the immune-privileged state of the healthy cornea, increases the risk of rejection after keratoplasty, and leads to opacity. In the past decades, significant progress has been made for neovascular diseases of the retina and choroid, with plenty of drugs getting commercialized. In addition, to overcome the barriers of the short duration and inadequate penetration of conventional formulations of antivascular endothelial growth factor (VEGF), multiple novel drug delivery systems, including adeno-associated virus (AAV)-mediated transfer have gone through the full process of bench-to-bedside translation. Like retina neovascular diseases, corneal neovascularization also suffers from chronicity and a high risk of recurrence, necessitating sustained and efficient delivery across the epithelial barrier to reach deep layers of the corneal stroma. Among the explored methods, adeno-associated virus-mediated delivery of anti-VEGF to treat corneal neovascularization is the most extensively researched and most promising strategy for clinical translation although currently although, it remains predominantly at the preclinical stage. This review comprehensively examines the necessity, benefits, and risks of applying AAV vectors for anti-VEGF drug delivery in corneal vascularization, including its current progress and challenges in clinical translation.

Design and Simulation of a 19-Electrode MEMS Piezoelectric Thin-Film Micro-Deformable Mirror for Ophthalmology.

This study presents a numerical simulation-based investigation of a MEMS (micro-electromechanical systems)technology-based deformable mirror employing a piezoelectric film for fundus examination in adaptive optics. Compared to the classical equal-area electrode arrangement model, we optimize the electrode array for higher-order aberrations. The optimized model centralizes electrodes around the mirror center, which realizes low-voltage driving with high-accuracy correction. The optimized models exhibited commendable correction abilities, achieving a unidirectional displacement of 5.74 µm with a driven voltage of 15 V. The voltage-displacement relationship demonstrated high linearity at 0.99. Furthermore, the deformable mirror's influence matrix was computed, aligning with the Zernike standard surface shape of the order 1-3. To quantify aberration correction capabilities, fitting residuals for both models were calculated. The results indicate an average removal of 96.8% of aberrations to the human eye. This underscores that the optimized model outperforms the classical model in correcting high-order aberrations.

Long-term observation of V4c implantable collamer lenses implantation for moderate to extreme high myopia correction: five years follow-up.

BACKGROUND: This study aims to assess the long term effectiveness, safety, predictability and stability of V4c implantable collamer lenses (ICL) for correction of moderate to extreme high myopia. METHODS: We reviewed 125 eyes from 64 patients who implanted V4c ICL at the Refractive Surgery Center of West China Hospital in Chengdu, China, between May 2015 and January 2017. The median spherical equivalent was -11.50 D (interquartile range [IQR]: -13.00 to -9.00 D). We followed up with the patients over five years and evaluated several parameters, including uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), axial length, refractive error, endothelial cell density (ECD), intraocular pressure (IOP), white-to-white distance (WTW), and vault. We performed a correlation analysis to explore the potential impacts on vault following implantation. RESULTS: The median safety index (postoperative CDVA/preoperative CDVA) during the last follow-up was 1.00 (interquartile range [IQR]: 1.00-1.20), and the efficacy indices (postoperative UDVA/preoperative CDVA) were 1.20 (IQR: 1.00-1.25), 1.20 (IQR: 1.00-1.33), and 0.8 (IQR: 0.65-1.00) at postoperative 1 week, 1 month, and 5 years, respectively. At the five-year mark, 16% of the eyes were within ±0.50 D of expected correction, and 73% were within ±2.00 D. No significant difference in ECD was observed between pre-operative and post-operative measurements. Compared to baseline, we observed a significant increase in IOP at the one-week follow-up, which decreased significantly at the one-month visit. Furthermore, we identified ICL size and spherical equivalent (SE) as independent variables in a multiple linear regression model that accurately predicted the five-year vault after surgery. CONCLUSION: In conclusion, V4c ICL implantation is an effective and safe treatment for moderate to extreme high myopia with good predictability and stability over the long-term.

Stromal lenticule addition keratoplasty with corneal crosslinking for corneal ectasia secondary to FS-LASIK: a case series.

AIM: To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty (SLAK) with corneal crosslinking (CXL) on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo. The lenticules were collected from patients undertaking small incision lenticule extraction (SMILE) for the correction of myopia. Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength. RESULTS: All surgeries were conducted successfully with no significant complications. Their best corrected visual acuity (BCVA) ranged from 0.05 to 0.8-2 before surgery. The pre-operational total corneal thickness ranged from 345-404 µm and maximum keratometry (Kmax) ranged from 50.8 to 86.3. After the combination surgery, both the corneal keratometry (range 55.9 to 92.8) and total corneal thickness (range 413-482 µm) significantly increased. Four out of 5 patients had improvement of corneal biomechanical parameters (reflected by stiffness parameter A1 in Corvis ST). However, 3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze. Despite the onset of corneal edema right after SLAK, the corneal topography and thickness generally stabilized after 3mo. CONCLUSION: SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia. Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.

Association of outer retinal and choroidal alterations with neuroimaging and clinical features in posterior cortical atrophy.

BACKGROUND: Posterior cortical atrophy (PCA) is a rare condition characterized by early-onset and progressive visual impairment. Individuals with PCA have relatively early-onset and progressive dementia, posing certain needs for early detection. Hence, this study aimed to investigate the association of alterations in outer retinal and choroidal structure and microvasculature with PCA neuroimaging and clinical features and the possible effects of apolipoprotein E(APOE) ε4 allele on outer retinal and choroidal alterations in participants with PCA, to detect potential ocular biomarkers for PCA screening. METHODS: This cross-sectional study included PCA and age- and sex-matched healthy control participants from June 2022 to December 2023. All participants with PCA completed a comprehensive neurological evaluation. All participants were recorded baseline information and underwent an ophthalmic evaluation. Quantitative analyses were performed using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). Adaptive optics scanning laser ophthalmoscopy (AO-SLO) was performed in some patients. In participants with PCA, the influence of APOE ε4 on outer retinal and choroidal alterations and the correlation of outer retinal and choroidal alterations with PCA neuroimaging and clinical features in participants with PCA were investigated. RESULTS: A total of 28 participants (53 eyes) with PCA and 56 healthy control participants (112 eyes) were included in the current study. Compared with healthy control participants, participants with PCA had significantly reduced outer retinal thickness (ORT) (p < 0.001), choriocapillaris vessel density (VD) (p = 0.007), choroidal vascular index (CVI) (p = 0.005) and choroidal vascular volume (CVV) (p = 0.003). In participants with PCA, APOE ε4 carriers showed thinner ORT (p = 0.009), and increased choriocapillaris VD (p = 0.004) and CVI (p = 0.004). The PCA neuroimaging features were positively associated with the ORT, CVI and CVV. Furthermore, differential correlations were observed of PCA clinical features with the CRT, CVV and CVI. CONCLUSIONS: Our findings highlighted the association of outer retinal and choroidal alterations with PCA neuroimaging and clinical features in participants with PCA. Noninvasive SS-OCT and SS-OCTA can provide potential biomarkers for the diagnosis and management of PCA, improving awareness of PCA syndrome among ophthalmologists, neurologists, and primary care providers.

Recent advances in medicinal compounds related to corneal crosslinking.

Corneal crosslinking (CXL) is the recognized technique to strengthen corneal collagen fibers through photodynamic reaction, aiming to halt progressive and irregular changes in corneal shape. CXL has greatly changed the treatment for keratoconus (KCN) since it was introduced in the late 1990's. Numerous improvements of CXL have been made during its developing course of more than 20 years. CXL involves quite a lot of materials, including crosslinking agents, enhancers, and supplements. A general summary of existing common crosslinking agents, enhancers, and supplements helps give a more comprehensive picture of CXL. Either innovative use of existing materials or research and development of new materials will further improve the safety, effectiveness, stability, and general applicability of CXL, and finally benefit the patients.

Effects of different rehabilitation training on balance function in stroke patients: a systematic review and network meta-analysis.

Introduction: Stroke is a major noninfectious disease that endangers patients' health. About 83% of patients have some degree of balance dysfunction. Rehabilitation training is an effective means to improve the balance function of stroke patients. The aim of this meta-analysis was to assess which of the eight rehabilitation training methods was more effective in promoting balance recovery. Material and methods: Eight studies of rehabilitation training to improve balance function in stroke patients were searched in PubMed, Scopus, Web of Science, Embase, Cochrane, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases. Data extraction was carried out by two independent researchers. The improvement in balance function included in the study was measured using the Berg Balance Scale (BBS). A random effects model was used to assess the mean difference in these values between patients who received different rehabilitation training and controls. Results: A total of 46 randomized controlled trials (RCTs) were included, including 3741 patients. Meta-analysis results showed that the clinical effectiveness in promoting balance recovery in stroke patients was ranked as follows: core stability training (odds ratio (OR) = 14.98, 95% confidence interval (CI): 8.18-27.44) > whole-body vibration training (OR = 10.27, 95% CI: 4.36-24.18) > mirror therapy (OR = 5.15, 95% CI: 2.40-11.04). Conclusions: This results suggested that core stability was more beneficial for improving balance function in stroke patients.

A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia.

AIM: To compare the subjective and objective visual quality between small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (tPRK) in patients with low and moderate myopia. METHODS: Patients undertaking SMILE or tPRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period. Objective evaluation [visual acuity test, manifest refraction, wavefront aberrations, the total cut-off value of the total modulation transfer function (MTFcut-off), and Strehl ratio (SR)] and subjective evaluation of visual quality (quality-of-life questionnaire) were conducted before surgery and at days 1, 7, 30, and 90 after surgery. RESULTS: A total of 47 patients (94 eyes) with SMILE and 22 patients (22 eyes) with tPRK were enrolled. The uncorrected visual acuity (UCVA) was better in SMILE patients on day 7 after surgery (1.13±0.13 vs 0.99±0.17, t=4.85, P<0.001) but was comparable at days 30 and 90. At day 90, the SMILE group had a lower spherical equivalent (SE) than the tPRK group (0.04±0.31 vs 0.19±0.43, t=2.08, P=0.042). Total higher order aberrations (HOAs) were induced in both surgical types, which were more evident in the tPRK group with 3-mm pupil diameter (0.16±0.07 vs 0.11±0.05, t=4.27, P<0.001) and 5-mm pupil diameter (0.39±0.17 vs 0.36±0.11, t=2.33, P=0.022). The MTFcut-off and SR showed a trend of improvement in both SMILE and tPRK patients but were statistically better in the SMILE group with both pupil diameters. There was a significant improvement of contrast sensitivity (CS) over baseline levels at the spatial frequency of 18 cycles/degree (c/d) in the SMILE group (F=2.72, P=0.033) and at 3 c/d (F=3.03, P=0.031), 12 c/d (F=3.72, P=0.013), and 18 c/d (F=4.62, P=0.004) in the tPRK group. The subjective quality of life questionnaire showed a steady improvement in the SMILE group (F=8.31, P<0.001) but not the tPRK group. CONCLUSION: SMILE and tPRK are both safe and effective ways to correct low and moderate myopia. A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.