Publications by authors named "A-Yong Yu"

42 Publications

Repeatability and Agreement of Two Swept-Source Optical Coherence Tomographers for Anterior Segment Parameter Measurements.

J Glaucoma 2022 Jul 20;31(7):602-608. Epub 2022 Jan 20.

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University.

Purpose: The aim was to evaluate the repeatability and agreement of two swept-source optical coherence tomographers for anterior segment parameters in healthy subjects.

Patients And Methods: Automated mark of scleral spur and angle recess for the CASIA2 and manual mark of scleral spur and angle recess for the Anterion were performed, and then the measurement values of the related parameters were automatically generated. Subjects with pupil diameter (PD) differing by <15% between the 2 devices were included. PD, lens vault (LV), anterior chamber depth (ACD), angle to angle distance (ATA), anterior chamber width (ACW), anterior chamber angle (ACA), angle opening distance (AOD), and trabecular iris space area (TISA) were measured in the horizontal images with both CASIA2 and Anterion. Intraclass correlation coefficient (ICC) was used to evaluate intradevice repeatability. Bland-Altman plots were performed to assess the agreement between the 2 devices.

Results: Thirty-five right eyes of 35 subjects were included with a mean age of 25.60±3.00 years. The CASIA2 showed moderate to good intradevice repeatability (ICCs ranged from 0.786 to 0.989) whereas the Anterion showed good intradevice repeatability (ICCs ranged from 0.921 to 0.998) for anterior segment parameters. Compared with the CASIA2, the Anterion offered larger values of ACA500/750, AOD500/750, and TISA500/750 but smaller values of PD, LV, ACD, ATA, and ACW. Good agreement for PD, ACD, ATA, and ACW was detected with 95% limits of agreement of -1.02 to 1.02 mm, -0.11 to 0.14 mm, -0.17 to 0.19 mm, -0.13 to 0.28 mm, respectively. Poor agreement for LV, ACA500/750, AOD500/750, and TISA500/750 was achieved with the 2 devices.

Conclusions: Anterion outperformed CASIA2 on intradevice repeatability. While agreement was noted for some parameters using manual Anterion and automated CASIA2 approaches, poor agreement of LV and angle parameters indicates that measurements from these optical coherence tomography devices should not be considered interchangeable.
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http://dx.doi.org/10.1097/IJG.0000000000001989DOI Listing
July 2022

A One-Step Electrochemical Aptasensor Based on Signal Amplification of Metallo Nanoenzyme Particles for Vascular Endothelial Growth Factor.

Front Bioeng Biotechnol 2022 9;10:850412. Epub 2022 May 9.

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.

In this study, a one-step electrochemical aptasensor was developed to detect the biomarker vascular endothelial growth factor (VEGF), an important protein in the pathogenesis of many retinal diseases, including age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity, and retinal vein occlusion. The aptamer has a good affinity and can rapidly identify and capture VEGF based on its unique structure. We designed a VEGF aptasensor based on the aptamer recognition and complex metallo nanoenzyme particles as an electron exchange center and bridge between capture DNA and electrode. The aptamers maintained the hairpin structure to avoid nonspecific surface adsorption and expose the capture sequence outwards when the target was inexistent. Conversely, the aptamers opened the hairpin structure to release space to accomplish binding between VEGF and DNA, resulting in increased impedance. The performance of the electrochemical aptasensor is detected by electrochemical impedance spectroscopy (EIS). The limit of detection by EIS was as low as 8.2 pg ml, and the linear range was 10 pg ml-1 μg ml. The electrochemical aptasensor also showed high specificity and reproducibility.
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http://dx.doi.org/10.3389/fbioe.2022.850412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124786PMC
May 2022

Habitual Coffee Consumption Increases Risk of Primary Open-Angle Glaucoma: A Mendelian Randomization Study.

Ophthalmology 2022 May 10. Epub 2022 May 10.

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; National Clinical Research Center for Ocular Disease, Wenzhou, Zhejiang, China. Electronic address:

Purpose: To explore whether there is a causal relationship between coffee consumption and primary open-angle glaucoma (POAG).

Design: Two-sample Mendelian randomization (MR).

Participants: The single-nucleotide polymorphisms (SNPs) associated with coffee consumption (including phenotypes 1 and 2) were selected from a genome-wide association study (GWAS) involving 121 824 individuals of European descent. Coffee intake from the MRC-IEU UK Biobank was also used to identify instruments for coffee intake. Summary-level data for POAG were obtained from the largest publicly available meta-analyses involving 16 677 POAG cases and 199 580 controls of European descent.

Methods: The inverse variance-weighted (IVW) method was the main MR analysis, whereas weighted-median, weighted mode-based estimate (MBE), MR Pleiotropy RESidual Sum and Outlier (PRESSO) test, and MR-Egger regression were used for sensitivity analysis.

Main Outcome Measures: Diagnosis of POAG.

Results: Three sets of instrumental variables were used to evaluate the causal association between coffee consumption and POAG risk. Results showed that genetically predicted higher coffee consumption phenotype 1 (cups/day) was significantly associated with higher risk of POAG (odds ratio [OR], 1.241; 95% confidence interval [CI], 1.041-1.480; P = 0.016). Genetically predicted higher coffee consumption phenotype 2 (high vs. no/low) was also significantly associated with higher risk of POAG (OR, 1.155; 95% CI, 1.038-1.284; P = 0.008, using the IVW method). Moreover, genetically predicted higher coffee intake from the MRC-IEU UK Biobank OpenGWAS was significantly associated with a higher risk of POAG (OR, 1.727; 95% CI, 1.230-2.425; P = 0.002, using the IVW method). Sensitivity analyses confirmed that the findings were robust to possible pleiotropy.

Conclusions: These findings provide the genetic evidence that higher coffee consumption is associated with a higher risk of POAG. Given that coffee is widely consumed, our findings provide new insights into potential strategies to prevent and manage POAG.
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http://dx.doi.org/10.1016/j.ophtha.2022.04.027DOI Listing
May 2022

Comparison of acquisition rate and agreement of axial length with two swept-source optical coherence tomographers and a partial coherence interferometer.

Graefes Arch Clin Exp Ophthalmol 2022 Apr 30. Epub 2022 Apr 30.

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China.

Purpose: To assess the acquisition rate and agreement of axial length (AL) measurements with the OA-2000, Anterion, and IOLMaster 500 in cataractous patients.

Methods: In total, 298 eyes of 191 cataractous patients were enrolled and scanned with the three devices in random order. The success rate of AL measurements per device was calculated and a chi-square test was utilized to identify the differences in acquisition rate between the three devices. Logistic regression analysis was applied to evaluate the association of different cataract types and severity with the AL measurement acquisition rate. Bland-Altman plots were mapped to appraise the agreement of AL values.

Results: AL measurements were successfully achieved in 288 eyes (96.64%) with the OA-2000, in 282 eyes (94.30%) with the Anteiron, and in 246 eyes (82.55%) with the IOLMaster 500. Significant differences in the acquisition rate were found between either of the SS-OCT devices and IOLMaster 500 by chi-square analysis (P < 0.001). No significant difference was noted between OA-2000 and Anterion. Increasing severity of posterior subcapsular cataract was associated with a higher failure rate with the IOLMaster 500. Bland-Altman analysis identified good agreement between the three biometers with narrow 95% limits of agreement.

Conclusions: The OA-2000 and Anterion showed similarly higher acquisition rate of AL measurements than IOLMaster 500 in cataractous patients. Good agreement for AL values was found between the three biometers in cataractous patients.
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http://dx.doi.org/10.1007/s00417-022-05681-yDOI Listing
April 2022

Causal Associations of Thyroid Function and Age-Related Macular Degeneration: A Two-Sample Mendelian Randomization Study.

Am J Ophthalmol 2022 07 14;239:108-114. Epub 2022 Feb 14.

From the Eye Hospital and School of Ophthalmology and Optometry (X.L., M.W., Y.Z., G.S.A-Y.Y), Wenzhou Medical University, Wenzhou, Zhejiang, China; National Clinical Research Center for Ocular Disease (X.L., M.W., Y.Z., G.S.A-Y.Y), Wenzhou, Zhejiang, China. Electronic address:

Purpose: To determine whether causal association lies between thyroid function and age-related macular degeneration (AMD) risk in human beings.

Design: Two-sample Mendelian randomization (MR) study.

Methods: The single-nucleotide polymorphisms associated with free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were selected from a genome-wide association study (GWAS) of 72,167 individuals of European descent. Summary-level data for AMD were obtained from a GWAS published by the International Age-related Macular Degeneration Genomics Consortium of 33,526 individuals (16,144 cases and 17,832 controls). An inverse-variance-weighted (IVW) method was the main MR analysis. Maximum likelihood, weighted median, MR-Egger, MR-pleiotropy residual sum outlier methods were used for the sensitivity analysis.

Results: An increase of 1 SD in genetically predicted FT4 levels was found to be significantly associated with an 18.9 % increase in the overall AMD risk (P = .005). In the multivariable MR analysis controlling for TSH level, the causal effect of FT4 level on the risk of AMD remained (odds ratio [OR] = 1.207, P = .004). A 1-SD increase in TSH levels was nominally associated with a 10.0% decrease in the overall AMD risk (P = .032). After adjusting for FT4 level by multivariable MR analysis, no direct causal relationship was found between TSH level and AMD risk (95% CI = 0.810, 1.125, P = .582).

Conclusions: Genetic variants predisposing to higher FT4 levels within the normal range were associated with higher AMD risk. Further studies are required to understand the mechanism underlying this putative causal relationship.
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http://dx.doi.org/10.1016/j.ajo.2022.01.026DOI Listing
July 2022

Repeatability of a new swept-source optical coherence tomographer and agreement with other three optical biometers.

Graefes Arch Clin Exp Ophthalmol 2022 Jul 16;260(7):2271-2281. Epub 2022 Feb 16.

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, People's Republic of China.

Purpose: To investigate the repeatability of Anterion and compare the agreement of ocular biometric measurements and predicted intraocular lens (IOL) powers with other three optical biometers.

Methods: Flat keratometry (Kf), steep keratometry (Ks), J0 and 45 vectors, central cornea thickness (CCT), anterior chamber depth (ACD), and axial length (AL) from the Anterion, IOLMaster 700, Lenstar LS 900, and OA-2000 were recorded. The IOL powers were calculated with the Hoffer Q, Holladay 1, SRK/T, and Haigis formulas. The repeatability was evaluated using the within-subject standard deviation (Sw), repeatability coefficient (RC), coefficient of variation (COV), and intraclass correlation coefficient (ICC). Inter-device agreement between the four biometers was assessed with the 95% limits of agreement.

Results: In total, 101 right eyes of 101 participants were enrolled. The Anterion showed good repeatability for all the included biometric parameters with all the CoV ≤ 0.30% and ICC ≥ 0.930 except for J45 with moderate repeatability (ICC was 0.849). Good agreement was found among the four devices for Kf, Ks, J0, J45, ACD, and AL. Generally, wide 95% LoA was found for the predicted IOL powers with the four IOL calculation formulas between the four devices.

Conclusions: The Anterion showed good repeatability of biometric measurements for most parameters. Good agreement among the four optical biometers was achieved for all the parameters except for CCT and the predicted IOL power. The AL values exhibited the best repeatability with Anterion and the best agreement among the biometers in our study.
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http://dx.doi.org/10.1007/s00417-022-05579-9DOI Listing
July 2022

Reply.

Authors:
A-Yong Yu

J Refract Surg 2022 Feb 1;38(2):143. Epub 2022 Feb 1.

Wenzhou, China.

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http://dx.doi.org/10.3928/1081597X-20220103-02DOI Listing
February 2022

Novel SOX2 mutation in autosomal dominant cataract-microcornea syndrome.

BMC Ophthalmol 2022 Feb 11;22(1):70. Epub 2022 Feb 11.

The Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Background: Congenital cataract-microcornea syndrome (CCMC) is characterized by the association of congenital cataract and microcornea without any other systemic anomaly or dysmorphism. Although several causative genes have been reported in patients with CCMC, the genetic etiology of CCMC is yet to be clearly understood.

Purpose: To unravel the genetic cause of autosomal dominant family with CCMC.

Methods: All patients and available family members underwent a comprehensive ophthalmologic clinical examination in the hospital by expert ophthalmologists and carried out to clinically diagnosis. All the patients were screened by whole-exome sequencing and then validated using co-segregation by Sanger sequencing.

Results: Four CCMC patients from a Chinese family and five unaffected family members were enrolled in this study. Using whole-exome sequencing, a missense mutation c.295G > T (p.A99S, NM_003106.4) in the SOX2 gene was identified and validated by segregation analysis. In addition, this missense mutation was predicted to be damaging by multiple predictive tools. Variant p.Ala99Ser was located in a conservation high mobility group (HMG)-box domain in SOX2 protein, with a potential pathogenic impact of p.Ala99Ser on protein level.

Conclusions: A novel missense mutation (c.295G > T, p.Ala99Ser) in the SOX2 gene was found in this Han Chinese family with congenital cataract and microcornea. Our study determined that mutations in SOX2 were associated with CCMC, warranting further investigations on the pathogenesis of this disorder. This result expands the mutation spectrum of SOX2 and provides useful information to study the molecular pathogenesis of CCMC.
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http://dx.doi.org/10.1186/s12886-022-02291-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840263PMC
February 2022

Topography-Guided Versus Wavefront-Optimized LASIK for Myopia With and Without Astigmatism: A Meta-analysis.

J Refract Surg 2021 Oct 1;37(10):707-714. Epub 2021 Oct 1.

Purpose: To evaluate the differences in efficacy, predictability, safety, and visual quality between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) for the treatment of myopia with and without astigmatism.

Methods: A comprehensive literature search of PubMed, Embase, the Cochrane library, Web of Science, and ClinicalTrials was used to identify randomized controlled trials (RCTs) comparing TCAT-LASIK with WFO-LASIK for myopia with and without astigmatism up to September 2020. The references of all searched literature were checked as supplements. Literature was screened according to the inclusion and exclusion criteria and relative data were extracted. RevMan software version 5.3.0 (Cochrane Collaboration) was used for meta-analysis.

Results: A total of seven RCTs (1,168 eyes) were included. There were no statistically significant differences in the ratio of uncorrected distance visual acuity of 20/20 or better (relative risk [RR] = 1.01, 95% CI [0.97 to 1.06], = .64) and 20/16 or better (RR = 0.96, 95% CI [0.80 to 1.16], = .69). Compared with WFO-LASIK, TCAT-LASIK achieved a higher proportion of postoperative manifest refractive spherical equivalent within ±0.50 diopters of the target (RR = 1.06, 95% CI [1.02 to 1.11], = .003) and less surgically induced higher order aberrations (weighted mean difference [WMD] = -0.11, 95% CI [-0.15 to -0.0], < .00001), spherical aberrations (WMD = -0.04, 95% CI [-0.05 to -0.03], < .00001), and coma (WMD = -0.15, 95% CI [-0.28 to -0.01], = .03). No patient lost two or more lines of distance-corrected visual acuity postoperatively in the two groups.

Conclusions: This meta-analysis suggests that both TCATLASIK and WFO-LASIK show excellent efficacy, predictability, and safety for myopia. TCAT-LASIK exhibited more accurate postoperative refraction predictability and less surgically induced higher order aberrations, spherical aberrations, and coma. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term. .
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http://dx.doi.org/10.3928/1081597X-20210709-01DOI Listing
October 2021

Reliability and agreement of the central and mid-peripheral corneal thickness measured by a new Scheimpflug based imaging.

Ann Transl Med 2021 Jul;9(14):1136

Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.

Background: To assess the intra-observer repeatability and inter-observer reproducibility of central corneal thickness (CCT) and mid-peripheral corneal thickness (MPCT) measurements using a new Scheimpflug imaging instrument (Scansys) and compare the agreement with the rotating Scheimpflug corneal tomographer (Pentacam HR).

Methods: The same well-trained operator performed the measuring using the two devices, after which Scansys measurements were repeated by another operator. Both instruments required three consecutive measurements per subject. Corneal thickness measurements were obtained by each instrument, including CCT, thinnest corneal thickness (TCT), pupil corneal thickness (PCT), and MPCT. Test-retest repeatability (TRT), within-subject coefficient of variation (CoV), and intra-class correlation coefficient (ICC) were used to evaluate repeatability and reproducibility. A paired t-test was used to compare the differences between Scansys and Pentacam, and the agreement was compared with Bland-Altman plots.

Results: This study enrolled 112 healthy subjects. The CoV were <0.91% and 0.55% for repeatability and reproducibility, respectively. The ICC was close to 1 in all measurements. For intra-observer repeatability in the CT region, TRT was <10.30 µm. Moreover, TRT was <15.26 µm within the CT region. The paired -test showed significant differences in all corneal thickness measurements (P<0.001). The central region and CT agreement were high, but the largest range of 95% limits of agreement (LoA) appeared in the CT.

Conclusions: The new Scheimpflug imaging instrument showed excellent intra-observer repeatability and inter-observer reproducibility for corneal thickness measurements. The agreement analysis suggested that Scansys and Pentacam could be interchangeably used between the central region and CT, except CT.
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http://dx.doi.org/10.21037/atm-20-7895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350684PMC
July 2021

Microenvironment-Triggered Degradable Hydrogel for Imaging Diagnosis and Combined Treatment of Intraocular Choroidal Melanoma.

ACS Nano 2020 11 11;14(11):15403-15416. Epub 2020 Nov 11.

School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang, China.

Human choroidal melanoma (HCM) is one of the most common primary intraocular tumors and easily provokes liver metastases owing to the lack of sensitive and noninvasive therapeutic methods. Concerning the imaging diagnostics and therapeutic predicaments for choroidal melanoma, we designed microenvironment-triggered degradable hydrogels ([email protected]:Dox-FA) based on ultrasmall (<5 nm) rare-earth nanoparticles (RENPs) with enhanced NIR-II luminescence. The ultrasmall diameter can significantly enhance the NIR-II luminescence performance of RENPs. RENPs were encapsulated by a dual-response PNIPAM hydrogel, which could release drug by responding to heat energy and glutathione under the tumor microenvironment. The / NIR-II imaging detection and antitumor activity were also compared systematically after different treatment conditions on ocular choroidal melanoma-1 cells and tumor-bearing mice, respectively. Besides, the degradability of the hydrogel composites under physiological conditions could be conducive to enhance the photothermal-chemotherapeutic effect and alleviate long-term biological toxicity. Our work on the microenvironment-triggered hydrogels with enhanced NIR imaging and easy metabolism may provide a promising strategy for sensitive and noninvasive imaging and phototherapy in ocular tumors.
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http://dx.doi.org/10.1021/acsnano.0c06000DOI Listing
November 2020

Cornea Iris Lens Contact With Air-Puff Tonometry.

JAMA Ophthalmol 2020 10 8;138(10):e200892. Epub 2020 Oct 8.

Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.0892DOI Listing
October 2020

Comparison of Anterior Ocular Biometric Measurements Using Swept-Source and Time-Domain Optical Coherence Tomography.

J Ophthalmol 2020 4;2020:9739878. Epub 2020 Sep 4.

School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Purpose: To compare central corneal thickness (CCT), aqueous depth (AQD), and anterior chamber depth (ACD) measurements using the swept-source (CASIA SS-1000, Tomey, Japan) and time-domain (Visante, Carl Zeiss Meditec, USA) anterior segment optical coherence tomographers (OCT) in normal eyes.

Methods: Sixty-eight eyes of 68 subjects were included. Three consecutive scans of each subject were obtained using both devices in a random order by one experienced operator. Standard deviation ( ), coefficient of repeatability (CoR), coefficients of variation (CoV), and intraclass correlation coefficients (ICC) were used to evaluate the intraoperator repeatability. Agreement was assessed using the Bland-Altman plots and 95% limits of agreement (LoA).

Results: All measurements of the swept-source OCT (SS-OCT) and time-domain OCT (TD-OCT) showed high repeatability with low CoR (CCT: 2.34 m and 6.16 m; AQD: 0.05 mm and 0.09 mm; ACD: 0.06 mm and 0.09 mm), low CoV (CCT: 0.16% and 0.42%; AQD: 0.61% and 0.97%; ACD: 0.53% and 0.83%), and high ICC (>0.98). The mean CCT with SS-OCT was slightly thicker than the results with TD-OCT (difference = 4.55 ± 2.62 m, < 0.001). There was no statistically significant difference in AQD or ACD measurements between the two devices (0.01 ± 0.05 mm, =0.111; 0.02 ± 0.05 mm, =0.022, respectively). The 95% LoA between the SS-OCT and TD-OCT were -0.59 to 9.69 m for CCT, -0.10 to 0.12 mm for AQD, and -0.09 to 0.12 mm for ACD.

Conclusions: High levels of repeatability and agreement were found between the two devices for all three parameters, suggesting interchangeability. SS-OCT demonstrated superior repeatability compared with TD-OCT.
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http://dx.doi.org/10.1155/2020/9739878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487088PMC
September 2020

Corneal biomechanical properties in myopic eyes evaluated via Scheimpflug imaging.

BMC Ophthalmol 2020 Jul 11;20(1):279. Epub 2020 Jul 11.

School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Background: To investigate the biomechanical properties of the cornea in myopic eyes using corneal visualization Scheimpflug technology (Corvis ST). The relationships between the biomechanical properties of the cornea and the degree of myopia were also investigated.

Methods: 265 eyes of 265 subjects were included. Based on spherical equivalent (SE) in diopters (D), participants were divided into four groups: low myopia/control (SE: - 0.50 to - 3.00D), moderate myopia (SE: - 3.00 to - 6.00D), high myopia (SE: - 6.00 to - 10.00D) and severe myopia (SE greater than - 10.00D). Axial length (AL), anterior segment parameters, and corneal biomechanical properties were obtained with the Lenstar LS900, Pentacam HR and Corvis ST, respectively.

Results: Mean (±SD) SE was - 7.29 ± 4.31D (range: - 0.63 to - 25.75D). Mean AL was 26.31 ± 1.82 mm (range: 21.87 to 31.94 mm). Significant differences were detected within the four groups in terms of six corneal biomechanical parameters: deformation amplitude (DA), time from start until second applanation (A2-time), length of flattened cornea at the second applanation (A2-length), corneal velocity during the first and second applanation (A2-velocity), time from start to highest concavity (HC-time), and central curvature at highest concavity (HC radius). AL was positively associated with DA whereas negatively associated with A1-velocity and A2-length. SE was positively associated with A2-time, HC-time and A2-velocity, whereas negatively associated with DA. IOP was positively associated with four corneal biomechanical parameters and negatively associated with three parameters.

Conclusions: Eyes with severe myopia showed greater DA, lesser A2 time, HC time, and faster A2-velocity compared to low to high myopia. This suggests the cornea becomes weaker and more deformable with elongation of axial length with corresponding increases in myopia. DA, A2-time and A2-velocity could be useful corneal biomechanical indicators in patients with myopia.
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http://dx.doi.org/10.1186/s12886-020-01530-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353814PMC
July 2020

Network Meta-analysis of No-History Methods to Calculate Intraocular Lens Power in Eyes With Previous Myopic Laser Refractive Surgery.

J Refract Surg 2020 Jul;36(7):481-490

Purpose: To systematically compare and rank the predictability of no-history intraocular lens (IOL) power calculation methods after myopic laser refractive surgery.

Methods: PubMed, Embase, the Cochrane Library, and the U.S. trial registry (www.ClinicalTrial.gov) were used to systematically search trials published up to August 2019. Included were case series studies reporting the following outcomes in patients with cataract undergoing phacoemulsification after laser refractive surgery: percentage of eyes with a refractive prediction error (PE) within ±0.50 and ±1.00 diopters (D), mean absolute error (MAE), and median absolute error (MedAE). A network meta-analysis was conducted using the STATA software version 13.1 (STATACorp LLC).

Results: Nineteen studies involving 1,098 eyes and 19 formulas were identified. A network meta-analysis for the percentage of eyes with a PE within ±0.50 D found that ray-tracing (Okulix), intraoperative aberrometry (Optiwave Refractive Analysis [ORA]), BESSt, and Seitz/Speicher/Savini (Triple-S) (D-K SRK/T), and Fourier-Domain OCT-Based formulas were more predictive than the Wang/Koch/Maloney, Shammas-PL, modified Rosa, Ferrara, and Equivalent K reading at 4.5 mm using the Double-K Holladay 1 formulas. With regard to ranking, the top four formulas as per the surface under the cumulative ranking curve (SUCRA) values for the percentage of eyes with a PE within ±0.50 D were the Okulix, ORA, BESSt, and Triple-S (D-K SRK/T). With regard to MAE, the ORA showed lower errors when compared to the Shammas-PL formula. In this regard, the top four formulas based on the SUCRA values were the Triple-S, BESSt, ORA, and Fourier-Domain OCT-Based formulas. The SToP (SRK/T), ORA, Fourier-Domain OCT-Based, and BESSt formulas had the lowest MedAE.

Conclusions: Considering all three outcome measures of highest percentages of eyes with a PE within ±0.50 and ±1.00 D, lowest MAE, and lowest MedAE, the top three no-history formulas for IOL power calculation in eyes with previous myopic corneal laser refractive surgery were: ORA, BESSt, and Triple-S (D-K SRK/T). [J Refract Surg. 2020;36(7):481-490.].
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http://dx.doi.org/10.3928/1081597X-20200519-04DOI Listing
July 2020

A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology.

Eye Vis (Lond) 2020 7;7:19. Epub 2020 Apr 7.

Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China.

The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.
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http://dx.doi.org/10.1186/s40662-020-00187-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136699PMC
April 2020

A novel ophthalmic viscosurgical device-free phakic intraocular lens implantation makes myopic surgery safer.

Eye Vis (Lond) 2020 7;7:18. Epub 2020 Apr 7.

The Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China.

Purpose: To assess the efficacy and safety of a novel ophthalmic viscosurgical device-free (OVD-free) method for posterior chamber phakic intraocular lens (PIOL) implantation in myopic eyes.

Methods: In this retrospective cohort study, the medical records of myopic eyes that underwent PIOL (Implantable Collamer Lens, ICL) implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed. A total of 49 eyes with complete data that met follow up requirements (2 h, 1 day, 1 week, 3 months postoperatively) were recruited. Based on the surgical techniques used, the eyes were divided into the OVD-free method group and the standard method group. The clinical data, including intraocular pressure (IOP), corrected distance visual acuity (CDVA) and spherical equivalent (SE), at each follow-up were collected for comparison. Endothelial cell loss and complications were also investigated.

Results: Twenty-one eyes received the standard method, and 28 eyes received the OVD-free method. A rise in IOP > 22 mmHg at 2 h was noted in 14 eyes (66.7%) in the standard group and none (0%) in the OVD-free group ( < 0.001). The rise in IOP from baseline was significantly higher at 2 h in the standard group (10.5 ± 5.2 mmHg vs. 2.2 ± 3.3 mmHg, difference: 8.3, 95% CI 5.8 to 10.8;  < 0.001). There was a significant difference in the time course of LogMAR CDVA changes between the two groups ( = 0.047). The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day (- 0.076, 95% CI - 0.134 to - 0.018;  = 0.012), 1 week (- 0.071, 95% CI - 0.135 to - 0.007;  = 0.03), but not at 3 months (- 0.046, 95% CI - 0.107 to 0.015;  = 0.134). There was no significant difference in the time course of SE changes between the two groups ( = 0.471;  = 0.705). In the OVD-free group, mean endothelial cell loss was 4.6% at 3 months (2522 ± 281 vs. 2407 ± 226 cells/mm, difference: -115, 95% CI - 295 to 65;  = 0.187). No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.

Conclusions: The OVD-free method is safe and efficient for ICL implantation. It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devices-related complications without causing additional complications.
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http://dx.doi.org/10.1186/s40662-020-00185-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137322PMC
April 2020

Expanding the Phenotypic and Genotypic Landscape of Nonsyndromic High Myopia: A Cross-Sectional Study in 731 Chinese Patients.

Invest Ophthalmol Vis Sci 2019 09;60(12):4052-4062

The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, National Clinical Research Center for Ophthalmology, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Wenzhou, China.

Purpose: High myopia (HM) is defined as a refractive error worse than -6.00 diopter (D). This study aims to update the phenotypic and genotypic landscape of nonsyndromic HM and to establish a biological link between the phenotypic traits and genetic deficiencies.

Methods: A cross-sectional study involving 731 participants varying in refractive error, axial length (AL), age, myopic retinopathy, and visual impairment. The phenotypic traits were analyzed by four ophthalmologists while mutational screening was performed in eight autosomal causative genes. Finally, we assessed the clinical relevance of identified mutations under the guidance of the American College of Medical Genetics and Genomics.

Results: The relationship between refractive error and AL varied in four different age groups ranging from 3- to 85-years old. In adult groups older than 21 years, 1-mm increase in AL conferred 10.84% higher risk of pathologic retinopathy (Category ≥2) as well as 7.35% higher risk of low vision (best-corrected visual acuities <0.3) with P values < 0.001. The prevalence rates of pathologic retinopathy and low vision both showed a nonlinear positive correlation with age. Forty-five patients were confirmed to harbor pathogenic mutations, including 20 novel mutations. These mutations enriched the mutational pool of nonsyndromic HM to 1.5 times its previous size and enabled a statistically significant analysis of the genotype-phenotype correlation. Finally, SLC39A5, CCDC111, BSG, and P4HA2 were more relevant to eye elongation, while ZNF644, SCO2, and LEPREL1 appeared more relevant to refracting media.

Conclusions: Our findings shed light on how multiple HM-related phenotypes are associated with each other and their link with gene variants.
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http://dx.doi.org/10.1167/iovs.19-27921DOI Listing
September 2019

Three-Dimensional Morphology Study of Capsule in Pseudophakic Eyes with High-Speed Swept-Source Optical Coherence Tomography.

Curr Eye Res 2019 06 30;44(6):607-613. Epub 2019 Jan 30.

a School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University , Wenzhou , Zhejiang , China.

Purpose: To study the capsule morphology in pseudophakic eyes on the three-dimensional level using high-speed swept-source optical coherence tomography (SSOCT).

Methods: This study collected patients with age-related cataract and divided them into two groups according to the anterior capsule and intraocular lens (IOL) optic relationship: total anterior capsule overlap (360°, Group-T) and partial anterior capsule overlap (<360°, Group-P). One standard SSOCT radial scanning was performed in all eyes at 1 day, 1 week, 1 month, and 3 months postoperatively.

Results: Thirty-two eyes from 25 patients were enrolled in the Group-T and 17 eyes from 13 patients in the Group-P. No eyes achieved complete adhesion between IOL optic and posterior capsule at 1 day after the surgery. However, the rate of complete adhesion was low (15/49, 30.6%) even at 3 months postoperatively and there was no statistically difference between Group-T and Group-P (21.9% vs. 47.1%, > 0.05). At 1 day, 1 week, 1 month, and 3 months after the surgery, the capsule bend index (CBI) in the Group-T was 0.02 ± 0.09, 1.35 ± 1.48, 3.60 ± 0.54, and 3.88 ± 0.19, respectively. CBI rises linearly during the first month and the rise goes stable relatively with the great reduction of standard deviation in the following 2 months (All < 0.05). The anterior capsule opening area and diameter were both reduced in the first month, and then they both became stable.

Conclusions: With square-edge IOL, posterior capsule opacification risk is still high in most eyes at 3 months postoperatively for the complete adhesion of posterior capsule and IOL was only achieved in 30.6% eyes. IOL-in-bag may be driven by the significant capsule bag changes especially in the first month postoperatively.
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http://dx.doi.org/10.1080/02713683.2019.1570275DOI Listing
June 2019

Age-Related Changes in Corneal Spherical Aberration.

J Refract Surg 2018 Nov;34(11):760-767

Purpose: To analyze the age-related changes in corneal spherical aberration (CSA) and higher order aberrations (HOAs) and to develop a novel model to estimate the change in CSA with age.

Methods: This was a cross-sectional study of the right eyes of 3,769 patients. Anterior corneal spherical aberration (ASA), posterior corneal spherical aberration (PSA), total corneal spherical aberration (TSA), and the root mean square of corneal HOAs were measured using a Scheimpflug tomographer. Smoothed fitting curves were plotted as a function of age and the average change in spherical aberration was calculated for different ages.

Results: The mean magnitude of ASA, PSA, TSA, and HOAs (6 and 4 mm) were 0.270 ± 0.111, -0.144 ± 0.031, 0.228 ± 0.120, 0.453 ± 0.194, and 0.141 ± 0.075 µm, respectively. All parameters showed a statistically significant non-linear change with age. The age after which the aberrations increased at a faster rate, namely the turning points of age, were 39 years for ASA, PSA, TSA, and 6-mm HOAs (95% confidence interval [CI]: 35 to 42, 36 to 41, 36 to 42, and 35 to 56 years, respectively) and 46 years for 4-mm HOAs (95% CI: 36 to 56 years). There were significant increases in increment rates after the turning points. The average change of TSA was -0.013 µm/10 years from 18 to 39 years and 0.057 µm/10 years after 39 years. There were statistically significant correlations between ASA and TSA (r = 0.976, P < .001) and PSA and TSA (r = 0.192, P < .001), but not between ASA and PSA (r = -0.003, P = .835).

Conclusions: CSA and HOAs increased non-linearly with age and became more positive after 39 and 46 years of age, respectively. Based on the increment rates and turning points of age, a novel model is provided to help calculate the value required to compensate for the increasing CSA associated with the aging cornea. [J Refract Surg. 2018;34(11):760-767.].
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http://dx.doi.org/10.3928/1081597X-20181011-01DOI Listing
November 2018

Changes and Diurnal Variation of Visual Quality after Orthokeratology in Myopic Children.

J Ophthalmol 2018 15;2018:3174826. Epub 2018 Oct 15.

The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Purpose: To assess the changes and the diurnal variation of visual quality after orthokeratology in myopic children.

Methods: Forty-four eyes of 22 subjects with a mean age of 10.55 ± 1.53 years (8 to 14 years) were enrolled in this prospective study. Their spherical equivalent ranged from -1.25 to -4.25 diopters (D) and astigmatism was less than 1.00 D. Parameters including corneal curvature, ocular objective scatter index (OSI), the modulation transfer function (MTF), root mean square of ocular and corneal wavefront aberrations, and contrast sensitivity function (CSF) were measured before and at two time points during the same day after 1 month of orthokeratology.

Results: After orthokeratology, uncorrected visual acuity (UCVA) and spherical equivalent were significantly improved from baseline ( < 0.001), and their diurnal variation was not significant (=0.083, 0.568). OSI increased from 0.29 ± 0.15 to 0.65 ± 0.31 ( < 0.001). MTF decreased significantly ( < 0.01). Corneal curvature and ocular total aberration decreased ( < 0.001), while the ocular and corneal higher-order aberration increased significantly ( < 0.01). The CSF under photopic condition decreased at 3 cpd (=0.006) and increased at 18 cpd (=0.012). The diurnal variation of CSF at 18 cpd under mesopic and high glare conditions and at 12 cpd under photopic condition was significant (=0.002, 0.01, 0.017).

Conclusions: Orthokeratology can effectively improve UCVA and high spatial frequency CSF by decreasing the low-order aberrations. However, MTF and CSF at low spatial frequency decreased because of the increase of intraocular scattering and high-order aberrations. Meanwhile, CSF at high spatial frequency fluctuates significantly at two times during the same day after 1 month orthokeratology.
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http://dx.doi.org/10.1155/2018/3174826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205316PMC
October 2018

Age-Related Changes in Corneal Astigmatism.

J Refract Surg 2017 Oct;33(10):696-703

Purpose: To analyze the changes in corneal astigmatism as a function of age and develop a novel model to estimate corneal astigmatic change according to age.

Methods: This was a cross-sectional study of right eyes of 3,769 individuals. Total corneal astigmatism, keratometric astigmatism, anterior corneal astigmatism, and posterior corneal astigmatism were measured by a Scheimpflug tomographer. Smoothing fitting curves of polar values of corneal astigmatism as a function of age were drawn and average changes in corneal astigmatism at different ages were calculated.

Results: Two turning points of age on total corneal astigmatism were 36 and 69 years. The average change of total corneal astigmatism toward against-the-rule astigmatism was 0.13 diopters (D)/10 years from 18 to 35 years, 0.45 D/10 years from 36 to 68 years, and decreased after 69 years, mainly caused by anterior corneal astigmatism. The mean magnitude of posterior corneal astigmatism was -0.33 D and exceeded 0.50 D in 14.27% of eyes. The vectorial difference between total corneal astigmatism and keratometric astigmatism was correlated with posterior corneal astigmatism, polar value of anterior corneal astigmatism, age, and corneal higher order aberrations (r = 0.636; standard partial regression coefficients were 0.479, -0.466, 0.282, and 0.196, respectively; all P < .001). Based on the non-linear model to estimate corneal astigmatic change with age, a formula was developed to calculate recommended correction of astigmatism according to age and astigmatic type.

Conclusions: The rate of change of total corneal astigmatism showed a non-linear trend toward against-the-rule astigmatism, which was low at young and old age, high at middle age, and should be taken into account when performing surgery to correct astigmatism. [J Refract Surg. 2017;33(10):696-703.].
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http://dx.doi.org/10.3928/1081597X-20170718-04DOI Listing
October 2017

Investigation of a real-time location system of corneal astigmatic axis.

Eye Vis (Lond) 2017 14;4:21. Epub 2017 Sep 14.

The Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, (325000) Zhejiang People's Republic of China.

Background: To construct a real-time computerized location system (RCLS) to analyze and display the axis of corneal astigmatism and to compare its accuracy with the Scheimpflug method.

Methods: Fifty-seven eyes of 39 volunteers with corneal astigmatism more than 1.00 diopter (D) were recruited. The RCLS was composed of a circular light-emitting diode (LED) light source, surgical microscope, surgical video system, computer and self-programming image analysis software. Scheimpflug imaging measurements (Pentacam HR, Oculus, Wetzlar, Germany) were performed on all subjects to determine the axis and power of corneal astigmatism. Thereafter, the axis of corneal astigmatism was analyzed in real-time and displayed by the RCLS on supine position, and videos were recorded. The MB-Ruler 4.0 software was used to measure the astigmatic axis. The accuracy of the RCLS was compared with the Scheimpflug method.

Results: The RCLS was able to display the axis of corneal astigmatism in real-time. The axial deviation of corneal astigmatism between the two methods was 0.63 ± 3.78° when astigmatism was 1.00 to 2.00 D and decreased to 0.06 ± 1.38° when astigmatism was greater than 2.00 D. A linear correlation of astigmatic axis was noted between the two methods: Axis = 1.01 × Axis - 1.02 (R = 0.998,  < 0.001). The Bland-Altman analysis revealed that the RCLS agreed sufficiently well with the Scheimpflug method.

Conclusions: The RCLS can accurately analyze and display the axis for corneal astigmatism greater than 1.00 D in real-time. The RCLS simplifies marking procedures and may have potential clinical application to improve the postoperative visual outcomes in surgical correction of corneal astigmatism.
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http://dx.doi.org/10.1186/s40662-017-0086-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597999PMC
September 2017

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism.

Eye Vis (Lond) 2017 18;4:20. Epub 2017 Aug 18.

The Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang People's Republic of China.

Background: To compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism.

Methods: This study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years.

Results: Preoperatively, the mean manifest spherical equivalent (SE) was -14.14 ± 2.12 D in the TICL group and -14.83 ± 2.79 D in the AK + ICL group ( = 0.28), and the mean manifest refractive cylinder, -2.87 ± 1.09 D and -2.58 ± 0.85 D, respectively ( = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group ( = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively ( = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group ( = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups.

Conclusions: Both TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.

Trial Registration: NCT03202485.
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http://dx.doi.org/10.1186/s40662-017-0085-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561629PMC
August 2017

In Vivo Observation of Lens Regeneration in Rat Using Ultra-Long Scan Depth Optical Coherence Tomography.

Invest Ophthalmol Vis Sci 2016 12;57(15):6615-6623

The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Purpose: To evaluate morphologic changes of lens regeneration in rats in vivo after extracapsular lens extraction (ECLE) by ultra-long scan depth optical coherence tomography (UL-OCT).

Methods: A total of 42 Sprague-Dawley rats were used in this study. We performed ECLE on the right eyes of animals in the surgery group (n = 34). Biomicroscopy and UL-OCT scans were carried out for the surgery group immediately (within 1 hour postoperatively) and at days 1 and 3, weeks 1 and 2, and months 1, 2, and 3 postoperatively. After in vivo examination, three animals of the surgery group were euthanized at each time point for histology study, while the other 10 animals were examined continuously at those time points. The regenerated lens was evaluated in OCT images at 2 and 3 months postoperatively. The control group consisted of eight untreated rats that had OCT examination at the age of 5 months.

Results: Lens regeneration could be observed from 2 weeks postoperatively. Regeneration was mainly at the peripheral capsular bag in the first month and central region thereafter. The average thickness of regenerated lenses was 2222 ± 309 and 2324 ± 352 μm at 2 and 3 months, respectively. Regeneration was faster in the first 2 months and slowed down thereafter. Although anterior capsule opening and posterior capsule adhesion and wrinkling existed, the regenerated lens still could form a relatively regular shape, however, the size was much smaller than that of the normal lenses from rats with the same age.

Conclusions: Ultra-long OCT provides longitudinal data of the process of lens regeneration on a single individual rat in vivo, which may allow one to follow and compare the lens regenerative process under different interventions or therapy after ECLE in rats.
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http://dx.doi.org/10.1167/iovs.16-19363DOI Listing
December 2016

Safety of femtosecond laser-assisted cataract surgery: assessment of aqueous humour and lens capsule.

Acta Ophthalmol 2016 Nov 25;94(7):e534-e540. Epub 2016 Apr 25.

The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Purpose: To investigate the effect of femtosecond laser-assisted cataract surgery (FLACS) on aqueous humour and lens capsule.

Methods: This prospective randomized comparative study enrolled 19 eyes that underwent FLACS as the trial group and 20 eyes that underwent conventional phacoemulsification as the control group. The femtosecond laser platform (LLS-fs 3D; LensAR, Orlando, FL, USA) was used to generate capsulotomy (laser energy 8 μJ) and lens fragmentation (laser energy 10 μJ). Morphology of the cutting edge and cells of anterior capsule was assessed by light microscopy. The proteins in the aqueous humour were identified by mass spectrometry (Ultraflex III TOF/TOF; Bruker Dalton, Bremen, Germany). Electrolyte in the aqueous humour was detected by a chemistry analyzer (Aeroset Clinical Chemistry Analyzer; Abbott Laboratories, Abbott Park, IL, USA).

Results: The cutting edge of anterior capsule was saw-tooth-shaped under magnification of 200× and 400× in the trial group, while it was smooth in the control group. Intact cells were found in the boundary area next to the cutting edge of anterior capsule in both groups. β-Crystallin B1, γ-crystallin S and transferrin were detected in the aqueous humour in the trial group. The concentrations of K , Na and Cl in the aqueous humour in the trial group differed significantly from those in the control group (p = 0.02, 0.03 and 0.04, respectively).

Conclusion: Femtosecond laser-assisted cataract surgery (FLACS) causes release of transferrin and crystallin from lens to aqueous humour and results in significant changes in the concentrations of K , Na and Cl in aqueous humour. However, these changes due to FLACS have no clinical significance or toxicity.
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http://dx.doi.org/10.1111/aos.13022DOI Listing
November 2016

Assessment of Tear Film Optical Quality Dynamics.

Invest Ophthalmol Vis Sci 2016 07;57(8):3821-7

Purpose: To investigate tear film optical quality dynamics by analyzing the postblink temporal changes of objective scatter index (OSI).

Methods: A total of 109 myopic subjects without symptoms of dry eye and 32 myopic subjects diagnosed with dry eye disease were recruited in this cross-sectional study. The right eye for each subject was analyzed. Serial measurements of OSI were performed for 20 seconds in the interval of 0.5 second using a double-pass instrument, and 10 successive seconds of nonblinking immediately after a blink was selected to analyze the tear film optical quality dynamics. The tear breakup time (TBUT) was also measured. The mean OSI in 10 successive seconds and the correlation coefficient between OSI and time were analyzed.

Results: For subjects without symptoms of dry eye, 109 eyes were divided into two categories based on the correlation coefficient between OSI and time: category A (without positive correlation) and category B (with positive correlation). Categories A and B were further divided into four categories based on the mean OSI for 10 seconds: category A1 (36.7%, lower than 1.00); category A2 (33.0%, equal to or greater than 1.00); category B1 (13.8%, lower than 1.00), and category B2 (16.5%, equal to or greater than 1.00). Dry eye subjects were set as category C for comparison. There was no significant difference in the TBUT among the five categories (A1, A2, B1, B2, C) except between category C and category A1 (P < 0.01) and category C and category A2 (P < 0.05).

Conclusions: Dynamic changes of OSI after blinking showed variations even in clinically asymptomatic subjects, and four categories of tear film were proposed based on the optical quality dynamics. The procedure using serial measurements of OSI as a noninvasive and objective method may have potential applications for detecting preclinical phase of dry eye disease in asymptomatic subjects.
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http://dx.doi.org/10.1167/iovs.15-18985DOI Listing
July 2016

A Cataract Surgery Training Program: 2-Year Outcome After Launching.

J Surg Educ 2016 Sep-Oct;73(5):761-7. Epub 2016 Apr 29.

The Cincinnati Eye Institute, University of Cincinnati, Cincinnati, Ohio.

Background: To investigate whether a short-term training program can produce competent cataract surgeons.

Methods: This observational pilot study enrolled 12 trainees who could not perform phacoemulsification independently. The training consisted of 2 phases. During the first 3-month phase, trainees were taught phacoemulsification through wet laboratory exposure and deliberate practice in patients at the training center in the Eye Hospital of Wenzhou Medical University in China. The second phase consisted of performing 50 cases at the trainees׳ home institution with supports from instructors of the first phase. Trainees׳ surgical results were followed-up. The surgical skill as measured by the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) and surgical outcomes were analyzed.

Results: During the first phase trainees performed 193.3 ± 95.4 wet laboratory cases and 557 eyes in patients. The complication rate was 0.54%. The OSCAR scores improved significantly (p < 0.01) in the first phase. At the second phase, all the trainees could carry out phacoemulsification at their home hospital and the complication rate was 1.87%. During the long-term follow-up, 4936 cases of phacoemulsification were performed and the complication rate was 0.87%.

Conclusions: Trainees succeeded in performing phacoemulsification safely and skillfully through a limited short period of training by wet laboratory exposure, deliberate practice in patients, and frequent formative feedback provided by the OSCAR tool.
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http://dx.doi.org/10.1016/j.jsurg.2016.03.012DOI Listing
March 2017

The efficacy and safety of posterior scleral reinforcement using genipin cross-linked sclera for macular detachment and retinoschisis in highly myopic eyes.

Br J Ophthalmol 2016 11 25;100(11):1470-1475. Epub 2016 Feb 25.

The Eye Hospital of Wenzhou Medical University, Wenzhou, China.

Background/aims: To evaluate the efficacy and safety of posterior scleral reinforcement (PSR) using genipin cross-linked sclera as the material to treat macular detachment and retinoschisis, both without macular hole, in highly myopic eyes.

Methods: Twenty-one patients with highly myopic eyes (24 eyes) with macular detachment and retinoschisis were treated sequentially with genipin cross-linked PSR and were followed for at least 1 year after surgery. The best-corrected visual acuity (BCVA), spherical equivalent (SE) power, axial length (AL), optical coherence tomography, and the complications were evaluated.

Results: The mean SE decreased from -13.81±4.67 D preoperatively to -9.64±4.86 D postoperatively, while the improvement in the logMAR BCVA values was from 1.24±0.57 before surgery to 1.03±0.57 after surgery. The preoperative AL (29.73±2.31 mm) was decreased (28.08±2.08 mm) after the operation. The retina in 21 eyes (87.5%) was successful reattached and the macular detachment was significantly decreased in two eyes; a macular hole occurred in one eye.

Conclusions: For at least a 1 year period of follow-up, PSR with genipin cross-linked sclera was safe and effective to treat macular detachment and retinoschisis in high myopia when a macular hole was not present. The reinforcement effect tended to be stabilised and maintained for 6 months after treatment.
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http://dx.doi.org/10.1136/bjophthalmol-2015-308087DOI Listing
November 2016

Pupil Dilation with Intracameral Epinephrine Hydrochloride during Phacoemulsification and Intraocular Lens Implantation.

J Ophthalmol 2016 20;2016:4917659. Epub 2016 Jan 20.

The Eye Hospital of Wenzhou Medical University, Wenzhou 325000, China.

Objective. To investigate mydriatic effect of intracamerally injected epinephrine hydrochloride during phacoemulsification and intraocular lens (IOL) implantation. Methods. Eighteen cataract patients for bilateral phacoemulsification were enrolled. To dilate pupil, one eye was randomly selected to receive intracamerally 1 mL epinephrine hydrochloride 0.001% for 1 minute after corneal incision (intracameral group), and the contralateral eye received 3 drops of compound tropicamide 0.5% and phenylephrine 0.5% at 5-minute intervals 30 minutes before surgery (topical group). Pupil diameters were measured before corneal incision, before ophthalmic viscoelastic device (OVD) injection, after OVD injection, before IOL implantation, and at the end of surgery. Results. At each time point, the mean pupil diameter in the intracameral group was 2.20 ± 0.08, 5.09 ± 0.20, 6.76 ± 0.19, 6.48 ± 0.18, and 5.97 ± 0.24 mm, respectively, and in the topical group it was 7.98 ± 0.15, 7.98 ± 0.15, 8.53 ± 0.14, 8.27 ± 0.16, and 7.93 ± 0.20 mm, respectively. The topical group consistently had larger mydriatic effects than the intracameral group (P < 0.05). The onset of mydriatic effect was rapid in the intracameral group. There was no difference in surgical performance or other parameters between groups. Conclusions. Intracameral epinephrine hydrochloride appears to be an alternative to the mydriatic modalities for phacoemulsification and IOL implantation. In comparison with topical mydriatics, intracameral epinephrine hydrochloride offers easier preoperative preparation, more rapid pupil dilation, and comparable surgical performance.
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http://dx.doi.org/10.1155/2016/4917659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745390PMC
February 2016
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