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Zhang Y, Du Y, Wang A, Zhou X, Lu Y, Zhu X. Outcomes of Cataract Surgery in Eyes With Axial Length > 33 mm. Am J Ophthalmol 2024; 265:137-146. [PMID: 38701876 DOI: 10.1016/j.ajo.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To evaluate the visual outcomes and perioperative complications for cataract surgery in eyes with axial length (AL) >33.0 mm. DESIGN Prospective clinical cohort study. METHODS One hundred twenty-two eyes with moderate high myopia (26.0 mm ≤ AL < 28.0 mm, control group), and 118 eyes with extreme high myopia (AL > 33.0 mm, EHM group) were followed up after cataract surgery (1 week and 1 year post-op). Myopic maculopathy grading according to ATN system, best-corrected visual acuity (BCVA), and complications were compared. RESULTS Postoperatively, BCVA in the EHM group improved significantly at both visits (both P < .001), despite being worse than that of the control group (both P < .05). The EHM group exhibited greater hyperopic refractive errors (P < .001), which were found to be associated with more severe T grade, longer AL, poorer second follow-up BCVA, and smaller anterior capsular opening (ACO) area. A higher incidence of retinal detachment and a more constricted ACO were observed in the EHM group (P = .030 and <.001, respectively), with the latter being significantly associated with longer AL and the absence of capsular tension ring (both P < .05). No difference in BCVA was found between the aphakic and pseudophakic eyes in the EHM group at both visits (both P > .05). CONCLUSION Cataract surgery improves vision of eyes with AL >33 mm, yet the increased risk of perioperative complications requires attention. Leaving these eyes aphakic might be effective and safe in the long term.
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Affiliation(s)
- Yinglei Zhang
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Yu Du
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Anjian Wang
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital (A.W.), Nagoya, Aichi, Japan
| | - Xingtao Zhou
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Yi Lu
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Xiangjia Zhu
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China.
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Du Y, Meng J, He W, Qi J, Lu Y, Zhu X. Complications of high myopia: An update from clinical manifestations to underlying mechanisms. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:156-163. [PMID: 39036706 PMCID: PMC11260019 DOI: 10.1016/j.aopr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Background High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge. Main text High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain. Conclusions High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.
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Affiliation(s)
- Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Lin X, Ma D, Yang J. Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches. Front Med (Lausanne) 2024; 11:1366576. [PMID: 38439904 PMCID: PMC10911763 DOI: 10.3389/fmed.2024.1366576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.
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Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Elhusseiny AM, Salim S. Cataract surgery in myopic eyes. Curr Opin Ophthalmol 2023; 34:64-70. [PMID: 36473016 DOI: 10.1097/icu.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We discuss the preoperative, intraoperative, and postoperative considerations for cataract surgery in eyes with high myopia. We also reviewed the recent literature on refractive outcomes and complications of cataract surgery in myopic eyes. RECENT FINDINGS Several novel intraocular lens (IOL) power calculation formulas have recently been developed to optimize refractive outcomes. Haigis formula is the most accurate among the third-generation IOL formulas. Novel formulas such as Barrett Universal II, Kane, and modified Wang-Koch adjustment for Holladay I formula provide a better refractive prediction compared with old formulas. Intraoperatively, the chopping technique is preferred to minimize pressure on weak zonules and reduce the incidence of posterior capsule rupture. Anterior capsular polishing is recommended to reduce the risk of postoperative capsular contraction syndrome (CCS). Postoperatively, complications such as refractive surprises, intraocular pressure spikes, and CCS remain higher in myopic eyes. Only 63% of myopic patients with axial length more than 26 mm achieve a visual acuity at least 20/40 after cataract surgery, mainly because of coexisting ocular comorbidities. SUMMARY There are multiple preoperative, intraoperative, and postoperative considerations when performing cataract surgery in myopic eyes. Further research is needed to optimize the refractive outcomes in these eyes and determine the best IOL formula. Surgeons should be adept and knowledgeable with different techniques to manage intraoperative complications.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Yan W, Zhang Y, Cao J, Yan H. TGF-β2 levels in the aqueous humor are elevated in the second eye of high myopia within two weeks after sequential cataract surgery. Sci Rep 2022; 12:17974. [PMID: 36289352 PMCID: PMC9606117 DOI: 10.1038/s41598-022-22746-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023] Open
Abstract
Transforming growth factor-β (TGF-β) is the critical regulator of physiological and pathological conditions in lens. The TGF-β signaling pathway is closely associated with high myopia patients. Thirty eyes from fifteen patients with high myopia who received sequential cataract surgery were enrolled in this prospective study. Ten cataract patients with non-myopia were chosen as a control group. Aqueous humor (AH) samples were used to detect the levels of TGF-β1, TGF-β2, and TGF-β3 in both groups. Compared with the non-myopic cataracts patient group, the highly myopic cataracts group had a significantly higher TGF-β2 (P = 0.019). Besides, the level of TGF-β2 of the second eye was significantly higher than that in the first eye in high myopia cataract patients group (P = 0.037). And TGF-β1 showed significant differences with age and axial length of high myopia cataract patients. Therefore, TGF-β2 may contribute to the development of high myopia and cataract surgery increased the expression of TGF-β2.
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Affiliation(s)
- Weijia Yan
- grid.440588.50000 0001 0307 1240Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated Northwestern Polytechnical University, Xi’an, 710004 Shaanxi China ,grid.7700.00000 0001 2190 4373Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Yaping Zhang
- grid.440588.50000 0001 0307 1240Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated Northwestern Polytechnical University, Xi’an, 710004 Shaanxi China
| | - Junguo Cao
- grid.7700.00000 0001 2190 4373Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Hong Yan
- grid.440588.50000 0001 0307 1240Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated Northwestern Polytechnical University, Xi’an, 710004 Shaanxi China
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Yang S, Jiang H, Nie K, Feng L, Fan W. Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules. BMC Ophthalmol 2021; 21:19. [PMID: 33413210 PMCID: PMC7792360 DOI: 10.1186/s12886-020-01772-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. METHODS A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. RESULTS Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. CONCLUSION CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.
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Affiliation(s)
- Shangfei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Tsai CY, Chen CT, Lin CH, Liao CC, Hua K, Hsu CH, Chen CF. Proteomic analysis of Exosomes derived from the Aqueous Humor of Myopia Patients. Int J Med Sci 2021; 18:2023-2029. [PMID: 33850473 PMCID: PMC8040407 DOI: 10.7150/ijms.51735] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Myopia is the most common refractive vision disorder. In recent years, several studies have suggested that the alteration of the exosomal protein levels in the aqueous humor (AH) is associated with the development of several eye diseases. Therefore, we aimed to explore the exosomal protein profile of the AH from myopia patients. Methods: Exosomes were isolated from the AH. The quality, concentration, and size distribution of exosomes for each patient were measured using nanoparticle tracking analysis system. Then, the exosomal proteins were purified and digested by trypsin for liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Results: There was no significant difference observed between the myopia and control when comparing the concentration and size distribution of exosomes in the AH for each sample. Based on LC-MS/MS analysis, myopia patients had higher and more complex exosomal peptide content. We found two proteins that were common in AH exosomes and eight proteins that were highly expressed in the myopia group. Conclusions: Our results provide pioneering findings for the exploration of the exosomal protein profile in myopia development. Further studies may provide significant information for the diagnosis, clinical treatment, and prognosis of myopia.
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Affiliation(s)
- Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,MS Program in Transdisciplinary Long Term Care, Fu Jen Catholic University, New Taipei City, Taiwan.,Community Medicine Research Center and Institution of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chueh-Tan Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Hui Lin
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Chung Liao
- Metabolomics-Proteomics Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kate Hua
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Chinese Medicine, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Chian-Feng Chen
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Zhao Y, Deng X, Chang P, Hu M, Li Z, Zhang F, Ding X, Zhao Y. Expression Profiles of Inflammatory Cytokines in the Aqueous Humor of Children after Congenital Cataract Extraction. Transl Vis Sci Technol 2020; 9:3. [PMID: 32855850 PMCID: PMC7422780 DOI: 10.1167/tvst.9.8.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate the change in cytokine microenvironment of the aqueous humor (AH) after surgery in children with congenital or developmental cataracts. Methods AH samples were obtained from 59 eyes diagnosed with a congenital or developmental cataract. Thirty-three of these eyes were aphakic following previous cataract surgery and were scheduled for secondary intraocular lens (IOL) implantation. Additionally, AH samples from 26 eyes that had not undergone surgery were taken. AH samples were then analyzed for 16 different inflammatory immune mediators using multiplex bead immunoassays and enzyme-linked immunosorbent assay (ELISA). Results The mean interval between secondary IOL implantation and original cataract surgery was 24.85 months (range, 9–60 months). Levels of IL-6, IP-10 (CXCL10), MCP-1 (CCL2), and IL-2 were significantly elevated in the AH of eyes after surgery compared to eyes that did not undergo surgery (P < 0.001, P = 0.047, P = 0.006, P = 0.012, respectively). There was significant correlation between the levels of TGF-β2 and intraocular pressure (IOP) in postsurgical and nonsurgical eyes (r = 0.532, P = 0.006; r = 0.57, P = 0.001). Postsurgical outcomes, such as iris adhesions, capsular fibrosis, and capsular contraction, were found not to be significantly associated with cytokine levels in the AH after surgery; however, IL-6 levels in capsular exposure eyes were significantly higher than those in cortical closure eyes (P = 0.023). Conclusions To our knowledge, this is the first study to report significantly increased proinflammatory cytokine levels in the AH after congenital cataract extraction in children. Our study also suggests that this proinflammatory state may be maintained for a prolonged period of time. Overall, these results give us insight into the relationship between the inflammatory cytokine microenvironment of the aqueous humor and potential long-term complications following congenital cataract surgery. Translational Relevance The inflammatory cytokine microenvironment of the aqueous humor might help explain potential long-term complications after surgery in patients with congenital or developmental cataracts.
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Affiliation(s)
- Yinying Zhao
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Xiaohui Deng
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Pingjun Chang
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Man Hu
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Zhangliang Li
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Fan Zhang
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Xixia Ding
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Yune Zhao
- The Eye Hospital of Wenzhou Medical University, Hangzhou, China
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Meng J, He W, Rong X, Miao A, Lu Y, Zhu X. Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes. EYE AND VISION 2020; 7:17. [PMID: 32280721 PMCID: PMC7137526 DOI: 10.1186/s40662-020-00186-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/17/2020] [Indexed: 12/18/2022]
Abstract
Background To investigate the decentration and tilt of plate-haptic multifocal intraocular lenses (MfIOLs) in myopic eyes. Methods Myopic (axial length [AXL] > 24.5 mm) and non-myopic (21.0 mm < AXL ≤ 24.5 mm) cataract eyes were enrolled in this prospective study and randomly assigned to receive implantation of Zeiss AT LISA tri 839MP lenses (Group A) or Tecnis ZMB00 lenses (Group B). In total, 122 eyes of 122 patients were available for analysis. Decentration and tilt of MfIOLs, high-order aberrations (HOAs), and modulation transfer functions (MTFs) were evaluated using the OPD-Scan III aberrometer 3 months postoperatively. Subjective symptoms were assessed with a Quality of Vision questionnaire. Results Near and distance visual acuities, tilt and horizontal decentration did not differ between the two groups, postoperatively. However, myopic eyes of Group B showed greater vertical decentration than those of Group A (− 0.17 ± 0.14 mm vs. -0.03 ± 0.09 mm, respectively), particularly when the MfIOLs were placed horizontally or obliquely. Overall decentration of myopic eyes was greater in Group B than in Group A (0.41 ± 0.15 mm vs. 0.16 ± 0.10 mm, respectively). In Group B, AXL was negatively correlated with vertical decentration and positively correlated with overall decentration. No such correlations were found in Group A. Intraocular total HOAs, coma, trefoil and spherical aberrations were lower in Group A than in Group B for a 6.0 mm pupil among myopic eyes. Generally, Group A had better MTFs and fewer subjective symptoms than Group B among myopic eyes. Conclusions Plate-haptic design of MfIOLs may be a suggested option for myopic cataract eyes due to the less inferior decentration and better visual quality postoperatively.
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Affiliation(s)
- Jiaqi Meng
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Wenwen He
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China.,2Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,4Key NHC key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xianfang Rong
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Ao Miao
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Yi Lu
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China.,2Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,4Key NHC key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiangjia Zhu
- 1Eye Institute, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China.,2Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,4Key NHC key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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Lu Q, He W, Qian D, Lu Y, Zhu X. Measurement of crystalline lens tilt in high myopic eyes before cataract surgery using swept-source optical coherence tomography. EYE AND VISION 2020; 7:14. [PMID: 32161773 PMCID: PMC7059675 DOI: 10.1186/s40662-020-00176-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/09/2020] [Indexed: 01/19/2023]
Abstract
Background To measure the crystalline lens tilt in eyes with various degrees of myopia before cataract surgery using swept-source optical coherence tomography (SS-OCT). Methods We used SS-OCT (IOLMaster 700) to scan 131 emmetropic eyes (axial length < 24.5 mm), 25 mild/moderate myopic eyes (axial length 24.5-26 mm), and 123 high myopic eyes (52, 29, and 42 eyes with axial lengths of 26-28, 28-30, and > 30 mm, respectively) as part of the routine preoperative examination before cataract surgery. SS-OCT involved B-scans along six meridians. The data were analyzed to assess the magnitude and orientation of the lens tilt and their correlation with other optical biometric parameters. Result The mean tilt was 3.36 ± 0.98° in emmetropic eyes, 3.07 ± 1.04° in mild/medium myopic eyes, and 2.35 ± 1.01° in high myopic eyes. Tilt correlated significantly and inversely with axial length (Pearson's r = - 0.427, P < 0.001). The crystalline lens tilt predominantly faced the upper outer quadrant relative to the visual axis, symmetrically in both eyes, with mean angles of 24.32° and 147.36° in the right and left eyes, respectively. The variability in the lens tilt direction increased with increasing axial length (χ2 test, P < 0.001). Conclusion The magnitude of crystalline lens tilt decreased with increasing axial length. The direction of tilt was predominantly towards the upper outer quadrant in both eyes. The variability in the tilt orientation increased with increasing axial length. Trial registration NIH (clinicaltrial.gov), NCT03062085. Registered 23 February 2017.
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Affiliation(s)
- Qiang Lu
- 1Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,2Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,3Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Wenwen He
- 1Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,2Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,3Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Dongjin Qian
- 1Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,2Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,3Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Yi Lu
- 1Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,2Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,3Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Xiangjia Zhu
- 1Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,2Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,3Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
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Zhu X, Du Y, Truscott RJW, He W, Zhou P, Lu Y. Profiling and Bioinformatic Analysis of Differentially Expressed Cytokines in Aqueous Humor of High Myopic Eyes - Clues for Anti-VEGF Injections. Curr Eye Res 2019; 45:97-103. [PMID: 31405302 DOI: 10.1080/02713683.2019.1648833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate the aqueous humor growth factor profile in high myopic eyes and analyze the interaction of differentially expressed cytokines.Methods: A case-control study including aqueous humor samples from 36 high myopic patients and 32 controls was conducted. Quantibody® Human Growth Factor Array was used to screen the presence of 40 growth factors in aqueous humor. Expressions of differential growth factors were validated by Bio-Plex ProTM multiplex bead-based immunoassay. Protein-protein interaction (PPI) and gene ontology (GO) analyses were performed.Results: Growth differentiation factor 15 (GDF-15), hepatocyte growth factor (HGF), and platelet-derived growth factor (PDGF)-AA were found to be significantly higher and vascular endothelial growth factor (VEGF) was detected to be lower in high myopic eyes (all P = .03). Multi-plex bead-based assay further validated the differential expressions of four growth factors and all of them were significantly correlated with axial length (P < .001). Twenty-six proteins were mapped into PPI network and positive regulation of cell migration, cellular component movement, and cell motility were the most enriched biological processes based on GO analysis.Conclusions: Differential expressed cytokines that indicates a distinctive intraocular microenvironment in high myopic eyes might provide clues for pathological changes within high myopic eyes after anti-VEGF injections.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Eye Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai
| | - Yu Du
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Eye Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai
| | - Roger J W Truscott
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Wenwen He
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Eye Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai
| | - Peng Zhou
- HongQiao Medical Center, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Eye Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai
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Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet 2017; 390:600-612. [PMID: 28242111 DOI: 10.1016/s0140-6736(17)30544-5] [Citation(s) in RCA: 526] [Impact Index Per Article: 75.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 12/11/2022]
Abstract
An estimated 95 million people worldwide are affected by cataract. Cataract still remains the leading cause of blindness in middle-income and low-income countries. With the advancement of surgical technology and techniques, cataract surgery has evolved to small-incisional surgery with rapid visual recovery, good visual outcomes, and minimal complications in most patients. With the development of advanced technology in intraocular lenses, the combined treatment of cataract and astigmatism or presbyopia, or both, is possible. Paediatric cataracts have a different pathogenesis, surgical concerns, and postoperative clinical course from those of age-related cataracts, and the visual outcome is multifactorial and dependent on postoperative visual rehabilitation. New developments in cataract surgery will continue to improve the visual, anatomical, and patient-reported outcomes. Future work should focus on promoting the accessibility and quality of cataract surgery in developing countries.
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Affiliation(s)
- Yu-Chi Liu
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore
| | - Mark Wilkins
- Department of Cornea and External Eye Disease, Moorfields Eye Hospital, London, UK
| | - Terry Kim
- Department of Cornea and External Disease, Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Boris Malyugin
- Department of Cataract and Implant Surgery, S Fyodorov Eye Microsurgery State Institution, Moscow, Russia
| | - Jodhbir S Mehta
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Department of Clinical Sciences, Duke-NUS Medical School, Singapore.
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