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Summary Background Ocular changes are traditionally associated with only a few hepatobiliary diseases. These changes are non-specific and have a low detection rate, limiting their potential use as clinically independent diagnostic features. Therefore, we aimed to engineer deep learning models to establish associations between ocular features and major hepatobiliary diseases and to advance automated screening and identification of hepatobiliary diseases from ocular images. Methods We did a multicentre, prospective study to develop models using slit-lamp or retinal fundus images from participants in three hepatobiliary departments and two medical examination centres. Included participants were older than 18 years and had complete clinical information; participants diagnosed with acute hepatobiliary diseases were excluded. We trained seven slit-lamp models and seven fundus models (with or without hepatobiliary disease [screening model] or one specific disease type within six categories [identifying model]) using a development dataset, and we tested the models with an external test dataset. Additionally, we did a visual explanation and occlusion test. Model performances were evaluated using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and F1* score. Findings Between Dec 16, 2018, and July 31, 2019, we collected data from 1252 participants (from the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University, the Department of Infectious Diseases of the Affiliated Huadu Hospital of Southern Medical University, and the Nantian Medical Centre of Aikang Health Care [Guangzhou, China]) for the development dataset; between Aug 14, 2019, and Jan 31, 2020, we collected data from 537 participants (from the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University and the Huanshidong Medical Centre of Aikang Health Care [Guangzhou, China]) for the test dataset. The AUROC for screening for hepatobiliary diseases of the slit-lamp model was 0·74 (95% CI 0·71–0·76), whereas that of the fundus model was 0·68 (0·65–0·71). For the identification of hepatobiliary diseases, the AUROCs were 0·93 (0·91–0·94; slit-lamp) and 0·84 (0·81–0·86; fundus) for liver cancer, 0·90 (0·88–0·91; slit-lamp) and 0·83 (0·81–0·86; fundus) for liver cirrhosis, and ranged 0·58–0·69 (0·55–0·71; slit-lamp) and 0·62–0·70 (0·58–0·73; fundus) for other hepatobiliary diseases, including chronic viral hepatitis, non-alcoholic fatty liver disease, cholelithiasis, and hepatic cyst. In addition to the conjunctiva and sclera, our deep learning model revealed that the structures of the iris and fundus also contributed to the classification. Interpretation Our study established qualitative associations between ocular features and major hepatobiliary diseases, providing a non-invasive, convenient, and complementary method for hepatobiliary disease screening and identification, which could be applied as an opportunistic screening tool. Funding Science and Technology Planning Projects of Guangdong Province; National Key RD Guangzhou Key Laboratory Project; National Natural Science Foundation of China.

AIM: To compare the visual outcomes of children with small (≤3 mm) posterior polar cataracts (PPC) and posterior lenticonus who had cataract extraction surgery with the visual outcomes of those who were managed conservatively. METHODS: Children who initially had small PPC and posterior lenticonus who were followed up over 1-year period were retrospective reviewed in the study. Patients receiving surgery were compared with those receiving conservative therapy. The axial length, keratometry, refraction, best-corrected visual acuity (BCVA), and strabismus measurements were recorded. Lens morphology, i.e., the location, size, and depth of the cataract lesion, was measured with a Scheimpflug imaging system. To help control for baseline differences in the groups, patients were matched with controls by propensity score methodology. RESULTS: The study evaluated 60 patients (30 in the surgery group and 30 in the conservative therapy group) after matching by propensity score. Patients who underwent cataract surgery showed greater BCVA improvements (0.36±0.24 logMAR) than patients who were treated without surgery (0.22±0.26 logMAR; P=0.036). Surgery was effective in patients with a rear projection length (RPL) less than 1.0 mm and a pretreatment BCVA worse than 0.52 logMAR. CONCLUSION: Children with small PPC and posterior lenticonus who undergo cataract surgery experience greater BCVA improvements than those managed conservatively. Certain patients presenting with a RPL less than 1.0 mm and a pretreatment BCVA of 0.52 logMAR or worse may benefit from surgery.

IMPORTANCE There is no clear consensus on which intraocular lens (IOL) power calculation formula provides the best refractive prediction in the paediatric population. BACKGROUND To evaluate the predictability of desired postoperative refractive outcomes by using six IOL formulas in paediatric cataract cases. DESIGN Retrospective case series. PARTICIPANTS A total of 377 eyes in 377 paediatric patients (

Purpose: To evaluate the choroidal thickness (CT) in children with congenital aniridia in comparison with age-matched controls. Methods: This was a cross-sectional, observational study that included 64 eyes of 32 children with congenital aniridia (aged 5-12 years) and 80 eyes of 40 healthy subjects who were age-matched. In all subjects, subfoveal choroidal thickness (SFCT) was assessed at 750-μm intervals from the fovea to 1.5 mm in the temporal and nasal directions with spectral-domain optical coherence tomography (SD-OCT). Results: The mean SFCT was 207.67 ± 30.99 µm in the aniridic eyes. This SFCT was significantly thinner than that in control eyes (288.55 ± 30.06 µm) (P < .001). The SFCTs at 1.5 mm and 0.75 mm intervals in the temporal and nasal directions from the fovea were also significantly thinner in eyes with aniridia than control eyes (P < .001).There was a significant negative correlation between the SFCT and axial length in eyes with aniridia (B = -10.60, 95%CI = -19.31~-1.89, P = .017). Conclusions: The subfoveal and parafoveal CTs were significantly thinner in eyes with congenital aniridia than in control eyes. These choroidal changes could open up a new way for the research related to the pathophysiology of congenital aniridia.

PReCIS:: The overall incidence of postoperative suspected glaucoma and glaucoma after congenital cataract surgery is low; however, the identification of the associated risk factors helps to monitor susceptible individuals and to provide real-time surveillance and timely intervention. Purpose Pediatric patients who have undergone surgery for congenital or infantile cataracts have a risk of developing suspected glaucoma and glaucoma, but the current evidence does not address our understanding of the incidence and associated risk factors of suspected glaucoma/glaucoma for application in clinical standard care. Therefore, this study investigated the incidence of and risk factors for suspected glaucoma/glaucoma in patients who have undergone surgery for congenital/infantile cataracts. Methods This study used a prospective cohort of 241 eyes from 241 patients who were 10 years of age or younger and who had undergone congenital/infantile cataract surgeries and were recruited from January 2011 to December 2016 at the Zhongshan Ophthalmic Center. Pediatric patients who underwent cataract surgery were classified into 2 groups according to intraocular lens (IOL) implantation. The patients' baseline characteristics and the incidence and risk factors for suspected glaucoma/glaucoma were assessed. Results The incidence of suspected glaucoma after cataract surgery was 10.70% [26 of 241 eyes; 95% confidence interval (CI), 6.88%-14.70%]. The rate of suspected glaucoma developing into glaucoma was 26.92% (7 of 26 eyes; 95% CI, 9.87%-43.97%), and the incidence of glaucoma was 2.90% (7 of 241 eyes; 95% CI, 0.79%-5.03%). Our study revealed that the incidence of suspected glaucoma/glaucoma in patients who did not receive IOL implantation was 13.91% (21 of 151 eyes; 95% CI, 8.39%-19.42%), and the incidence in patients who received IOL implantation was 5.56% (5 of 90 eyes; 95% CI, 8.23%-10.28%). The preoperative central corneal thickness (hazard ratio, 1.003; 95% CI, 1.001 to 1.004; P=0.004) and a family history of congenital cataracts (hazard ratio, 2.314; 95% CI, 1.004-5.331; P=0.049) were significant risk factors in patients without IOL implantation. Patient age at the time of cataract surgery was not a statistically significant risk factor for the development of suspected glaucoma/glaucoma in patients without IOL implantation. Conclusions Identification of the incidence of and risk factors for suspected glaucoma/glaucoma may help clinicians monitor susceptible individuals and provide timely surveillance and interventions in a clinical setting. Age at the time of cataract surgery was not a risk factor for suspected glaucoma/glaucoma in patients without IOL implantation, and this may allow the timing window for pediatric cataract surgery to be expanded and support new insights into the optimal timing of surgery for standard care.

Aim To study the change in ocular refraction in patients with pediatric cataracts (PCs) after lens extraction. Methods A total of 1258 patients who were undergoing cataract extraction with/without intraocular lens (IOL) implantation were recruited during preoperative examinations between Jan 2010 and Oct 2013. Patient ages ranged from 1.5mo to 14y. Follow-ups were conducted at 1wk, 1, and 3mo postoperatively and every 3mo in the first year, then 6mo thereafter. Ocular refraction [evaluated as spherical equivalent (SE)] and yearly myopic shift (YMS) were recorded and statistically analyzed among patients with age at surgery, baseline ocular refraction, gender, postoperative time and laterality (bilateral vs unilateral). Results By Dec 31st 2015, 1172 participants had been followed for more than 2y. The median follow-up period was 3y. The critical factors affecting the ocular refraction of PC patients were baseline ocular refraction, postoperative time for both aphakic and pseudophakic eyes. YMS grew most rapidly in young childhood and early adolescence. Conclusion After lens surgeries, ocular refraction in PC patients shows an individual difference of change. Further concerns should be raising to monitor the rapid myopic shift at early adolescence of these patients.

Reliable validated methods are necessary to verify the performance of diagnosis and therapy-assisted models in clinical practice. However, some validated results have research bias and may not reflect the results of real-world application. In addition, the conduct of clinical trials has executive risks for the indeterminate effectiveness of models and it is challenging to finish validated clinical trials of rare diseases. Real world data (RWD) can probably solve this problem. In our study, we collected RWD from 251 patients with a rare disease, childhood cataract (CC) and conducted a retrospective study to validate the CC surgical decision model. The consistency of the real surgical type and recommended surgical type was 94.16%. In the cataract extraction (CE) group, the model recommended the same surgical type for 84.48% of eyes, but the model advised conducting cataract extraction and primary intraocular lens implantation (CE + IOL) surgery in 15.52% of eyes, which was different from the real-world choices. In the CE + IOL group, the model recommended the same surgical type for 100% of eyes. The real-recommended matched rates were 94.22% in the eyes of bilateral patients and 90.38% in the eyes of unilateral patients. Our study is the first to apply RWD to complete a retrospective study evaluating a clinical model, and the results indicate the availability and feasibility of applying RWD in model validation and serve guidance for intelligent model evaluation for rare diseases.

PURPOSE: To compare outcomes of in-the-bag versus ciliary sulcus secondary intraocular lens (IOL) implantation for pediatric aphakia. DESIGN: Prospective interventional case series. METHODS: SETTING: institutional. PATIENT: Two hundred and two children (355 aphakic eyes) diagnosed as congenital cataracts and undergoing cataract extraction before 24 months of age. INTERVENTION: Pediatric aphakic eyes underwent either in-the-bag or ciliary sulcus secondary IOL implantation according to the amount of residual lens capsule and were followed for three years postoperatively. MAIN OUTCOME MEASURES: Adverse events (AEs), IOL tilt and decentration, best corrected visual acuity (BCVA) in operative eye. RESULTS: One hundred forty-four eyes (40.6%, 89 children) received in-the-bag IOL implantation (capsular group) and 211 (59.4%, 132 children) underwent ciliary sulcus IOL implantation (sulcus group). Kaplan-Meier curves showed that the time-dependent incidence of glaucoma-related adverse events (GRAEs) (P=0.005) and any AEs (P=0.002) were higher in the sulcus group. In-the-bag IOL implantation was a strong protective factor against GRAE (HR, 0.08, 95CI:0.01∼0.53; P=0.009) and any AEs (HR, 0.21 95CI: 0.08∼0.57; P=0.002). Clinically significant IOL decentration (>0.4mm) was more common in the sulcus group compared to the capsular group (vertical decentration: 29.8% vs. 15.7%, P=0.005; horizontal decentration: 30.3% vs. 9.35%, P

BackgroundCataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals.MethodsData were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency.ResultsThe ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (−3.33 to 29.94) and 118.08 (−132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008).ConclusionsThis study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.

Visual neuroadaptation is believed to play an important role in determining the final visual outcomes following intraocular lens (IOL) implantation. To investigate visual neuroadaptation in patients with age-related cataracts (ARCs) after phacoemulsification with multifocal and monofocal IOL implantation, we conducted a prospective, controlled clinical trial in Zhongshan Ophthalmology Center. This study included 22 patients with bilateral ARCs: 11 patients underwent phacoemulsification and multifocal IOL (Mu-IOL) implantation, and 11 patients underwent phacoemulsification and monofocal IOL (Mo-IOL) implantation. Visual disturbances (glare and halos), visual function (including visual acuity, retinal straylight, contrast sensitivity, and visual evoked potentials) and visual cortical function (fractional amplitude of low-frequency fluctuations, fALFF) in Bowman’s areas 17–19 as the region of interest were assessed before and after surgeries. The results showed that the fALFF values of the visual cortex in the Mu-IOL group decreased at 1 week postoperatively and recovered to baseline at 3 months and then improved at 6 months, compared with preoperative levels (at a whole-brain threshold of P < 0.05, AlphaSim-corrected, voxels > 228, repeated measures analysis of variance). Significantly increased fALFF values in the visual cortex were detected 1 week after surgery in the Mo-IOL group and decreased to baseline at 3 and 6 months. The fALFF of the lingual gyrus was negatively correlated with visual disturbances (P < 0.05). To conclude, early postoperative visual neuroadaptation was detected in the Mu-IOL group by resting-state fMRI analysis. The different changing trends of postoperative fALFF values in the two groups indicated distinct neuroadaptations patterns after Mu-IOL and Mo-IOL implantation.

This meta-analysis studied toric intraocular lens (IOL) alignment accuracy using image-guided and manual marking methods by comparing the axis misalignment of toric IOLs, percentage of eyes with toric IOL axis misalignment within ±5 degrees, postoperative astigmatism, difference vector, and postoperative uncorrected distance visual acuity. The methodological quality was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. Continuous variables were analyzed using weighted mean differences, and dichotomous variables were compared using the odds ratio. Five studies comprising a total of 257 eyes were analyzed. For heterogeneity, neither sensitivity analysis nor the Egger test detected statistical findings. The image-guided marking group had smaller toric IOL axis misalignment (P .00001), less postoperative astigmatism (P = .003), and a smaller difference vector (P .00001) than the manual marking group. The overall evidence from the studies indicates that image-guided marking is better than manual marking, resulting in less axis misalignment, a smaller difference vector, and less postoperative astigmatism.

AIM: To investigate the behavioral and psychological disorders and the prevalence of parent ratings of attention deficit hyperactivity disorder (ADHD) symptoms among children with bilateral congenital cataracts (CCs). METHODS: This cross-sectional study investigated children with bilateral CC aged 3-8y (CC group) using Conners' Parent Rating Scale-48 (CPRS-48) from July to December 2016. The abnormal rates of psychological symptoms in CC children and normal vision (NV) children were compared using the Chi-square test. The scores of CC children were compared with those of NV children and the Chinese urban norm using the independent samples t-test and one-sample t-test, respectively. RESULTS: A total of 262 valid questionnaires were collected. The ratio of CC children to NV children was 119:143. The overall rate of psychological symptoms in CC children was 2.28 times higher than that in NV children (46.22% vs 20.28%, Pearson's χ(2)=20.062; P

AIM: To evaluate the effect of different lens constant optimization methods on the accuracy of intraocular lens (IOL) power calculation formulas for highly myopic eyes. METHODS: This study comprised 108 eyes of 94 consecutive patients with axial length (AL) over 26 mm undergoing phacoemulsification and implantation of a Rayner (Hove, UK) 920H IOL. Formulas were evaluated using the following lens constants: manufacturer's lens constant, User Group for Laser Interference Biometry (ULIB) constant, and optimized constant for long eyes. Results were compared with Barrett Universal II formula, original Wang-Koch AL adjustment method, and modified Wang-Koch AL adjustment method. The outcomes assessed were mean absolute error (MAE) and percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 diopter (D). The nonparametric method, Friedman test, was used to compare MAE performance among constants. RESULTS: Optimized constants could significantly reduce the MAE of SRK/T, Hoffer Q, and Holladay 1 formulas compared with manufacturer's lens constant, whereas the percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 D had no statistically significant differences. Optimized lens constant for long eyes alone showed non-significant refractive advantages over the ULIB constant. Barrett Universal II formula and formulas with AL adjustment showed significantly higher accuracy in highly myopic eyes (P

Corneal neovascularization (CNV) is one of the major causes of severe disorders in ocular surface. Subconjunctival administration provides a localized and effective delivery of anti-angiogenic agents to inhibit neovascularization. In the present study, the ABA triblock copolymer of poly(D,L-lactic-co-glycolic acid)-block-poly(ethylene glycol)-block-poly(D,L-lactic-co-glycolic acid) (PLGA-PEG-PLGA) was used as a sustained drug delivery carrier for metformin (MET) and levofloxacin hydrochloride (LFH). Both drugs and PLGA-PEG-PLGA copolymers could be easily dissolved in water at low or room temperature and the mixed solution could form a drug-loaded thermosensitive hydrogel in terms of body temperature response. The in vitro release investigation displayed a sustained release of MET and LFH from the formulation for one month. The in vivo efficacy of subconjunctival injection of the MET + LFH loaded thermosensitive hydrogel in inhibiting CNV was evaluated on a mouse model of corneal alkali burn. Compared with the single administration of MET or LFH loaded thermosensitive hydrogel, the MET + LFH loaded thermosensitive hydrogel remarkably inhibited the formation of CNV. The sustained release of MET and an antibiotic (LFH) provides synergistic therapeutic outcome. As a result, the co-delivery of MET and LFH using PLGA-PEG-PLGA thermosensitive hydrogel by subconjunctival injection has great potential for ocular anti-angiogenic therapy.

Background The ideal surgical timings for cataract extraction (CE) and intraocular lens (IOL) implantation are vital for vision reconstruction in patients with childhood cataract (CC), yet they still remain controversial. We aimed to analyze the real-world practical pattern of surgical timings of CE and IOL implantations among a large number of Chinese CC patients. Materials and methods This cross-sectional, database study included CC inpatients from the *** over a 10-year period (from January 2005 to December 2014). Binary logistic regression and multiple linear regression analyses were performed to identify the factors affecting the timings of CE and IOL implantation. Results In the primary surgical stage, the mean ages of patients performed with CE (n = 839) and CE + IOL implantation (n = 1582) were 9.99 ± 18.21 months (5th-95th percentiles: 2–21) and 82.99 ± 52.99 months (5th-95th percentiles: 24–194), respectively. Surgical age, laterality, and axial length were identified as three factors (area under the curve [AUC]: 0.96, 95% CI: 0.94–0.97; Youden index: 0.86) affecting surgical procedure selection (CE or CE + IOL implantation) in the primary surgical stage. The time intervals between primary CE and secondary IOL implantation in bilateral (n = 311) and unilateral (n = 90) aphakia were 38.25 ± 16.84 months (5th-95th percentiles: 18–72) and 25.87 ± 10.56 months (5th-95th percentiles: 11–48), with significant difference (p Conclusions The timings of CE and IOL implantation mainly varied with the age and laterality. This study may provide data-based clinical experience for ophthalmologists regarding CE and IOL implantation of CC in China and other countries with similar socioeconomic conditions.

Background Most previous studies of circulating tumor cells (CTCs) are based on the CellSearch platform, but CellSearch has a number of limitations. This study aimed to use the LiquidBiopsy system and immunofluorescence to test the human epidermal growth factor receptor 2 (HER2) status of CTCs in patients with breast cancer. Materials and Methods The LiquidBiopsy system was used to detect HER2-positive (HER2 + ) cells in whole blood by microfluidic immunomagnetic bead screening and immunofluorescence assay, according to the manufacturer;s instructions. HER2 expression on CTCs was assessed using the Ariol system, calibrated through spiking experiments of 100 cells (BT474, SKBR3, A431, and MDA-MB-231) and 2.5 × 10 7 white blood cells/mL from healthy donors. Seventy-one patients with breast cancer and 107 non-cancer donors consented to provide blood. Results Based on breast cancer cell lines experiments, HER2 + CTCs were defined as CTCs with HER2 immunofluorescence intensity ≥ 3.5 times higher than the CD45 immunofluorescence intensity (100% sensitivity and 99.9% specificity). Among the 71 patients with breast cancer, 31 (43.7%) had HER2 + tumor. Among the HER2 + patients, 41.9% (13/31) were found to be HER2 + based on CTC ≥ 1, and 25.8% (8/31) were positive based on CTC ≥ 3. In HER2-negative patients by pathologic examination, 1 (2.5%) patient was found to have ≥ 3 HER2 + CTCs, whereas 15 (37.5%) patients had ≥ 1 HER2 + CTC. HER2 + CTCs were detected at all stages, even in early breast cancer, but the detection rate was higher in metastatic breast cancer. Conclusion This proof-of-concept study strongly suggests that HER2 + CTCs can be detected using the LiquidBiopsy system.

Purpose To study the morphology of the posterior lens cortex and posterior capsules (PCs) in pediatric patients with posterior lens opacities using intraoperative optical coherence tomography (iOCT). Setting Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Design A prospective observational study. Methods Pediatric patients with posterior lens opacities were imaged using iOCT during cataract surgery. The morphology of the posterior lens cortex and PC, along with the common patterns to indicate PC integrity, were assessed. Moreover, posterior capsule rent during surgery was observed. Results A total of 62 eyes from 53 patients were included. The mean age of patients was 3.8 years. Four morphological variants of posterior lens opacity were observed: Type I (54.8%, 34/62) with intact PC; Type II (32.3%, 20/62) with intact PC, which protruded into the anterior vitreous; Type III (4.8%, 3/62) with deficient PC and an inability to delineate PC and type IV (8.1%, 5/62) with dense opacity and an inability to characterize the posterior cortex and PC. Phacoemulsification could be performed in types I and II. In types III and IV, manual nucleus removal was performed instead of phacoemulsification. Three cases (100%) of type III PC dehiscence developed during surgery, while no cases developed PC dehiscence of other types. Conclusion The morphology of the PC and posterior lens cortex in pediatric posterior lens opacities could be categorized and PC integrity could be assessed using iOCT, which was useful to guide surgical strategies and increase safety in preexisting posterior capsular dehiscence in pediatric cataract surgery.

Purpose. To introduce an effective method for separating extensive posterior synechiae and those located under or adjacent to surgical incisions. Methods. Pediatric patients who had been subjected to cataract surgery and developed troublesome posterior synechiae requiring secondary intraocular lens (IOL) implantation were recruited. All patients underwent microperipheral iridectomy at the 12 o’clock position. Then, an ophthalmic viscosurgical device was injected into the posterior chamber through the iris fistula to mechanically separate the posterior synechiae, using scissors to cut robust posterior synechiae if necessary. The results of posterior synechiolysis and the position of the implanted IOL were analyzed. Results. Sixteen patients (median age, 51.56 months; range, 28–80 months) were included. The scope of posterior synechia in clock was 4.42 (range, 1–10). All troublesome posterior synechiae were successfully separated using the microperipheral iridectomy method, and all patients underwent IOL implantation in the ciliary sulcus. There was one case of peripheral iridectomy-related early intraoperative bleeding; no bleeding was observed at the end of surgery. Conclusions. Microperipheral iridectomy is a useful method for the management of troublesome posterior synechiae during secondary IOL implantation in pediatric patients, which makes secondary IOL implantation an easier and safer method in some challenging cases.

To investigate the demographics and distribution of corneal astigmatism before cataract surgery in patients from western China and to compare and analyze these findings with those of patients in southern China.Clinical-based cross-sectional study.Patients undergoing cataract surgery in the People's Hospital of Xinjiang Uygur Autonomous Region from February 2012 to August 2019 were recruited. Preoperative keratometric data measured by performing preoperative bilateral partial coherence interferometry (IOLMaster), and patient demographics were recorded and analyzed.This study comprised 12,236 eyes of 7065 patients with a mean age of 64.75 ± 9.66 years, and 52.77% of the patients were female. The mean axial length was 23.14 ± 0.96 mm. Astigmatism ranged from 0 diopters (D) to 6.94 D, with a mean of 1.28 D. Corneal astigmatism was between 0.25 D and 1.25 D in 53.71% of eyes, 1.25 D or higher in 39.06% eyes, and less than 0.25 D in 7.23% of eyes. Astigmatism was with the rule (WTR) in 41.94% of the patients and against the rule (ATR) in 38.80% of patients. The mean flat and steep keratometry measurement was 43.19 ± 1.50 D and 44.24 ± 1.62 D, respectively. After matching, corneal astigmatism in western China was 1.30 ± 1.03 D, and it was significantly higher than that in southern China (0.98 ± 0.67 D,Corneal astigmatism in patients before cataract surgery in western China was mainly between 0.25 D and 1.25 D. Compared with patients in southern China, patients in western China are younger, have a much higher degree of astigmatism, and have a higher proportion of WTR astigmatism.

BACKGROUND: Although influencing the severity of postoperative intraocular inflammation of congenital cataract, the developmental characteristics of cytokine profile in the aqueous humor during childhood had not been described. And its relationship with the inflammatory response after intraocular surgery remained unsolved. METHODS: Preoperative aqueous humor samples were collected from 65 eyes of congenital cataract patients (CC group) and 13 eyes of age-related cataract patients (ARC group) from January 2015 to May 2017. The concentrations of 22 cytokines were measured. Differences in concentrations between the CC and ARC groups were described. Correlation analysis, least absolute shrinkage and selection operator (LASSO) and multivariate linear regression were then used to investigate the dynamic changes in the cytokine profile with age and their relationships with the postoperative inflammatory response. RESULTS: The concentrations of granulocyte colony stimulating factor (G-CSF), interferon (IFN)-α2, interleukin (IL)-1α and IL-7 were higher in the CC group than in the ARC group, while the concentrations of epidermal growth factor (EGF), granulocyte-macrophage colony stimulating factor (GM-CSF), IL-10, IL-12p70, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, and tumor necrosis factor (TNF)-α were more abundant in the ARC group (P

Purpose. To investigate the demographics and distribution of corneal astigmatism before cataract surgery in patients from western China and to compare and analyze these findings with those of patients in southern China. Setting. People’s Hospital of Xinjiang Uygur Autonomous Region. Design. Clinical-based cross-sectional study. Methods. Patients undergoing cataract surgery in the People’s Hospital of Xinjiang Uygur Autonomous Region from February 2012 to August 2019 were recruited. Preoperative keratometric data measured by performing preoperative bilateral partial coherence interferometry (IOLMaster), and patient demographics were recorded and analyzed. Results. This study comprised 12,236 eyes of 7065 patients with a mean age of 64.75 ± 9.66 years, and 52.77% of the patients were female. The mean axial length was 23.14 ± 0.96 mm. Astigmatism ranged from 0 diopters (D) to 6.94 D, with a mean of 1.28 D. Corneal astigmatism was between 0.25 D and 1.25 D in 53.71% of eyes, 1.25 D or higher in 39.06% eyes, and less than 0.25 D in 7.23% of eyes. Astigmatism was with the rule (WTR) in 41.94% of the patients and against the rule (ATR) in 38.80% of patients. The mean flat and steep keratometry measurement was 43.19 ± 1.50 D and 44.24 ± 1.62 D, respectively. After matching, corneal astigmatism in western China was 1.30 ± 1.03 D, and it was significantly higher than that in southern China (0.98 ± 0.67 D, P<0.001). After matching, the proportion of WTR astigmatism was 40.99% in western China, which was also significantly higher than the proportion (26.46%) in southern China (P<0.001). Conclusion. Corneal astigmatism in patients before cataract surgery in western China was mainly between 0.25 D and 1.25 D. Compared with patients in southern China, patients in western China are younger, have a much higher degree of astigmatism, and have a higher proportion of WTR astigmatism.

This study characterized conjunctival microvascular morphological and haemodynamic responses after anti-inflammatory treatment in dry eye (DE).Twenty-five patients with moderate DE (17 females and 8 males aged 48 ± 16 years) who underwent anti-inflammatory therapy (0.1% fluorometholone) and 25 healthy subjects (20 females and 5 males aged 48 ± 17 years) recruited as controls were enrolled. The conjunctival blood flow rate (BFR), blood flow velocity (BFV) and vessel diameter were measured by functional slit-lamp biomicroscopy (FSLB). DE symptoms and signs were assessed. All measurements were performed at baseline and at 30 and 60 days after commencement of treatment.At baseline, the conjunctival BFR, BFV, and vessel diameter were higher in the DE group than in the control group (p 0.05). The BFR, BFV and corneal fluorescein staining (CFS) scores decreased at 60 days after therapy compared to at baseline and 30 days (all pThis study characterized conjunctival microvascular responses to anti-inflammatory treatment in DE patients. The results suggest that conjunctival BFV and BFR can be used as dynamic markers for treatment efficacy in DE.

Background Visual function and brain function decline concurrently with aging. Notably, cataract patients often present with accelerated age-related decreases in brain function, but the underlying mechanisms are still unclear. Optical structures of the anterior segment of the eyes, such as the lens and cornea, can be readily reconstructed to improve refraction and vision quality. However, the effects of visual restoration on human brain function and structure remain largely unexplored. Methods A prospective, controlled clinical trial was conducted. Twenty-six patients with bilateral age-related cataracts (ARCs) who underwent phacoemulsification and intraocular lens implantation and 26 healthy controls without ARC, matched for age, sex, and education, were recruited. Visual functions (including visual acuity, visual evoke potential, and contrast sensitivity), the Mini-Mental State Examination and functional magnetic resonance imaging (including the fractional amplitude of low-frequency fluctuations and grey matter volume variation) were assessed for all the participants and reexamined for ARC patients after cataract surgery. This trial was registered with ClinicalTrials.gov (NCT02644720). Findings Compared with the healthy controls, the ARC patients presented decreased brain functionality as well as structural alterations in visual and cognitive-related brain areas preoperatively. Three months postoperatively, significant functional improvements were observed in the visual and cognitive-related brain areas of the patients. Six months postoperatively, the patients' grey matter volumes in these areas were significantly increased. Notably, both the function and structure in the visual and cognitive-related brain areas of the patients improved significantly and became comparable to those of the healthy controls 6 months postoperatively. Interpretation We demonstrated that ocular reconstruction can functionally and structurally reverse cataract-induced brain changes. The integrity of the eye is essential for maintaining the structure and function of the brain within and beyond the primary visual pathway., Highlights • Cataract patients with reduced visual function presented a simultaneous decrease in brain function and grey matter volume. • Cataract surgery can reverse cerebral changes in both visual and cognitive-related regions associated with visual decline. • The integrity of the eye is essential for maintaining the structure and function of the brain. The eyes and brain are anatomically and functionally connected. Age related cataract (ARC) is associated with structural and functional impairments of the brain. However, whether these changes are reversible after cataract surgery is largely unknown. We assessed the patients based on subjective cognitive evaluations and objective functional magnetic resonance imaging before and after surgery. Significant improvements in brain function and increases in the grey matter volumes of the visual, cognitive-related, and somatosensory brain areas were observed, demonstrating that the impaired brain function and structure of ARC patients can be reversed after restoration of visual acuity.

IMPORTANCE Visual outcome after intraocular lens (IOL) implantation in long eyes is considerably affected by IOL power calculation. Various formulas have been designed to achieve an accurate IOL power prediction. However, controversy about the accuracy remains. BACKGROUND To evaluate the accuracy of IOL power calculation formulas in long eyes. DESIGN Meta-analysis. PARTICIPANTS Patients with ocular axial length (AL) over 24.5 mm. METHODS A comprehensive search in PubMed, EMBASE, Cochrane Data Base of Systematic Reviews and the Cochrane Central Register of Controlled Trials were conducted by September, 2017. The weighted mean differences of mean absolute errors (MAE) and the odds ratio of percentage of eyes within ±0.50D of prediction error among formulas were analysed. MAIN OUTCOMES MEASURES Between-group differences of MAE among formulas. RESULTS Eleven observational studies, involving 4047 eyes, were enrolled. Six formulas for IOL power calculation were compared: Barrett Universal II, Haigis, Holladay 2, SRK/T, Hoffer Q and Holladay 1. The MAE of Barrett Universal II was statistically lower than that of Holladay 2 (mean difference, MD = -0.04D, P = 0.0002), SRK/T (MD = -0.05D, P

While intraocular lens (IOL) implantation is the only effective treatment for vision restoration in cataract patients, it is always suffering from the related complications after surgery. A leading post-implantation complication, posterior capsule opacification (PCO), is induced by the adhesion and proliferation of residual lens epithelial cells (LECs) on the IOL surface and posterior capsule. In recent years, various surface modified IOLs have been developed to reduce the incidence of PCO, however, these IOLs are rarely resistant to biofouling while maintaining close contact with the posterior capsule. This study reports a complex surface-functionalized hydrophobic acrylic IOL, namely (NT+LLL)-IOL, which can effectively prevent intraocular inflammation and the development of PCO. The surface of the hydrophobic IOL was functionalized with nanotopography and covalently conjugated with “liquid-like” polydimethylsiloxane brush. The (NT+LLL)-IOL was capable of inhibiting intraocular inflammatory responses triggered by bioadhesion and preventing residual LECs migration-induced PCO. Furthermore, the (NT+LLL)-IOL possessed advantages of optical transparency, excellent biocompatibility, and mechanical robustness despite the liquid-like layer coating. After in vivo implantation for 60 days, the (NT+LLL)-IOL could maintain optical properties by inhibiting intraocular inflammation, fibrous LEC proliferation, and further PCO occurrence, in contrast to the pristine IOLs which were prone to induce PCO after implantation. This technology provides a promising opportunity to develop an implantable IOL with reduced risks of post-operative complications and thus greatly beneficial for cataract patients.

Importance Intraocular lens (IOL) power selection is a critical factor affecting visual outcome after IOL implantation in short eyes. Many formulas have been developed to achieve a precise prediction of the IOL power. However, controversy regarding the accuracy remains. Background To investigate the accuracy of different IOL power calculation formulas in short eyes. Design Meta-analysis. Participants Patients with the axial length of eyes less than 22 mm from previously reported studies. Methods A comprehensive search in Pubmed, EMBASE, Cochrane Data Base of Systematic Reviews and the Cochrane Central Register of Controlled Trials was conducted by October 2016. We assessed the methodological quality using a modified QUADAS-2 tool and performed analysis on weighted mean differences of mean absolute errors (MAE) among different formulas. Main outcomes measures The between-group difference of MAE was evaluated with weighted mean difference and 95% confidence intervals. Results Ten observational studies, involving 1161 eyes, were enrolled to compare six formulas: Haigis, Holladay 2, Hoffer Q, Holladay 1, SRK/T and SRK II. Among them, the Holladay 2 introduced the smallest overall MAE (0.496D) without statistical significance. The difference of MAE is statistically significant between Haigis and Hoffer Q (mean difference = -0.07D, P = 0.003), Haigis and SRK/T (mean difference = -0.07D, P = 0.009), Haigis and SRK II (mean difference = -0.41D, P = 0.01). For publication bias and small-study effect, neither funnel plot nor egger's test detected statistical finding. Conclusion and relevance The overall evidence from the studies confirmed the superiority of Haigis over Hoffer Q, SRK/T and SRK II in prediction IOL power in short eyes.

Fibrosis is a chronic process involving development and progression of multiple diseases in various organs and is responsible for almost half of all known deaths. Epithelial–mesenchymal transition (EMT) is the vital process in organ fibrosis. Lens is an elegant biological tool to investigate the fibrosis process because of its unique biological properties. Using gain- and loss-of-function assays, and different lens fibrosis models, here we demonstrated that microRNA (miR)-26a and miR-26b, members of the miR-26 family have key roles in EMT and fibrosis. They can significantly inhibit proliferation, migration, EMT of lens epithelial cells and lens fibrosis in vitro and in vivo. Interestingly, we revealed that the mechanisms of anti-EMT effects of miR-26a and -26b are via directly targeting Jagged-1 and suppressing Jagged-1/Notch signaling. Furthermore, we provided in vitro and in vivo evidence that Jagged-1/Notch signaling is activated in TGFβ2-stimulated EMT, and blockade of Notch signaling can reverse lens epithelial cells (LECs) EMT and lens fibrosis. Given the general involvement of EMT in most fibrotic diseases, cancer metastasis and recurrence, miR-26 family and Notch pathway may have therapeutic uses in treating fibrotic diseases and cancers.

AIMS To investigate whether genetic variants of CYP2C9 and VKORC1 have different effects on the dose of warfarin in 180 Han Chinese patients who were recruited from the Fu Wai Hospital. All were on maintenance treatment with stable daily warfarin doses for a period of at least 3 months. METHODS DNA was isolated and genotyped using a Warfarin dosage Prediction Kit for single nucleotide polymorphisms (SNPs) of CYP2C9 and VKORC1. RESULTS The VKORC1 and CYP2C9*3 polymorphisms are significantly associated with warfarin maintenance dosages. Patients with AG&GG genotype in VKORC1 needed higher doses than those with AA genotypes (4.55 ± 1.27 mg/ day vs. 2.90 ± 0.97 mg/day, p 0.05). The mean warfarin daily dose requirements in the genotypes of VKORC1 and CYP2C9 were not dependent on the medical indication(s) present. CONCLUSIONS Genetic variants of CYP2C9, VKORC1, and age are significant determinants of the maintenance dose of warfarin. The medical indications atrial fibrillation, valve replacement, or a combination of both are not determinants of the warfarin dose requirements.

Purpose Several methods have been reported to treat pupil deformities. However, there are some disadvantages to these methods. Here, we introduce the new technique of pupilloplasty. Methods We retrospectively collected five patients who underwent pupilloplasty by radiofrequency diathermy (RFD) in eyes with acorea or a severe pupillary fibrous membrane. The RFD tip was inserted into the anterior chamber after injection of an ophthalmic viscosurgical device (OVD). It was then used to resect the iris and fibrous membrane around the pupillary centre to restore a centred and round pupil. Results No obvious bleeding was observed during resection of the iris or fibrous membrane with the RFD technique. All cases were successfully treated, and pupil transparency was restored. Conclusion We introduced a new technique of pupilloplasty by RFD that is easily manageable, reduces bleeding, and is suitable for most types of pupillary seclusion, especially for acorea and severe pupillary fibrous membrane.

Background: Approximately 1 in 33 newborns is affected by congenital anomalies worldwide. We aimed to develop a practical model for identifying infants with a high risk of congenital cataracts (CCs), which is the leading cause of avoidable childhood blindness. Methods: This case-control study was performed in the Zhongshan Ophthalmic Center and involved 2005 subjects, including 1274 children with CCs and 731 healthy controls. The CC identification models were established based on birth conditions, family medical history, and family environmental factors using the random forest (RF) and adaptive boosting methods (trained by 1129 CC cases and 609 healthy controls), which were tested by internal 4-fold cross-validation and external validation (145 CC cases and 122 healthy controls). The models were also tested using 4 datasets with gradually reduced proportions of CC patients (bilateral cases) to validate their performance in an approximate simulation of a clinical environment with a relatively low disease prevalence. Findings: The CC identification models showed high discrimination in both the 4-fold cross validation (area under the curve (AUC)=0.91 [95% confidence interval: 0.88–0.94] in bilateral cases; 0.82 [0.77–0.89] in unilateral cases) and external validation (AUC=0.93±0.05 in bilateral cases; 0.86±0.01 in unilateral cases), and achieved stable performance in the clinical tests (AUC=0.94–0.96 in the four subgroups by RF). Furthermore, family history of CC, low parental education level, and comorbidity were identified as the top three most relevant factors to both bilateral and unilateral CC diagnosis. Interpretation: Our CC identification models can accurately discriminate CC patients from healthy children and have the potential to serve as a complementary screening procedure, especially in undeveloped and remote areas. Keywords: Congenital anomaly, Congenital cataract, Identification model, Machine learning

Purpose:The purpose of this study was to describe the clinical features and management of fibrovascular pupillary membrane.Methods:Four patients with congenital fibrovascular pupillary membrane were recruited. Comprehensively, ophthalmic examinations were performed. Peripheral iridectomy was performed to create a tunnel for blunt dissection of adhesion between the membrane and the lens capsule. Bipolar radiofrequency diathermy was then used to cut the membrane utilizing its coagulation effect.Results:All four patients received uneventful membranectomy surgeries. The follow-up duration ranged from 9 to 16 months. All patients recovered well. Visual behavior was central and steady. The natural pupil size ranged from 2 to 3 mm. No sign of visual axis obstruction, cataract formation, or intraocular pressure elevation was detected during the follow-up. No second surgery was needed for all patients.Conclusion:Fibrovascular pupillary membrane is a rare unilateral disease impairing visual acuity in children. Using the technique combining peripheral iridectomy with bipolar radiofrequency, diathermy can simplify the traditional surgery procedures and reduce the risks when removing fibrovascular pupillary membranes.

Purpose: To explore ocular cyclorotation and the source of corneal axial misalignment during femtosecond laser-assisted cataract surgery (FLACS). Methods: Forty-five sequential patients (50 eyes) who had undergone FLACS (LenSx Laser System, Alcon Inc) were recruited. We took screenshots from videos of FLACS to analyze ocular cyclorotation and the real angle between primary incision and secondary incision (RAPS). In addition, crystalline lens tilt and theoretic angle between the primary and secondary incisions (TAPS) was also calculated. Results: The mean absolute value of ocular cyclorotation was 8.03 ± 4.48 degrees (0–19.1 degrees). The crystalline lens tilt was 3.30 ± 1.44 degrees (0.93–6.44 degrees). And the mean preoperative uncorrected visual acuity was 0.89 ± 0.50 LogMAR units. Pearson bivariate correlation analysis showed significant positive correlation between ocular cyclorotation with crystalline lens tilt (r = 0.37, p = .008), and ocular cyclorotation negatively correlated with axial length (r = −0.29, p = .038). In addition, the TAPS was 89.78 ± 1.45 degrees, and the RAPS was 85.68 ± 2.04 degrees. The angle error was 4.11 ± 1.28 degrees (pConclusions: Ocular cyclorotation commonly occurred during FLACS. In addition, increased axial length was associated with less ocular cyclorotation and increased crystalline lens tilt was related to more ocular cyclorotation. Importantly, machinery systemic errors during corneal astigmatism correction by arcuate incision in FLACS should be taken into consideration.

Purpose We assess the prevalence of spectacle wear and the factors associated with compliance among aphakic infants with congenital cataracts who underwent lens extraction in South China. Methods Infants aged 3 months to 3 years were enrolled from among participants in the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH). The prevalence and potential determinants of spectacle-wearing compliance were identified from interviews with the infants' caregivers. Results Among 192 infant caregivers, the mean (SD) age of the infants was 1.89 (0.50) years, and 57% were males. Compliance was 30.9% in the 3-month- to 1-year-old age group, 78.0% in the 1- to 2-year-old age group, and 87.0% in the 2- to 3-year-old age group. The following two factors were associated with spectacle-wearing compliance: softness of the spectacles frame (β = 1.273, P = 0.002, odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.6-8.0) and communication with other caregivers regarding the spectacle-wearing experience (β = -2.955, P = 0.034, OR = 0.1, 95% CI = 0-0.8). Conclusions Compliance with spectacle wear was low during the earlier stage, but increased with time in aphakic infants. However, overall compliance should be improved. Therefore, efficient strategies aimed at improving spectacle-wearing compliance are needed. Translational relevance These findings reveal the low spectacle-wearing compliance in aphakic infants and support useful information to improve compliance.

Purpose It is a challenge to rescue ophthalmology examinations performed in children in the sedation room after initial chloral hydrate failure. Intranasal dexmedetomidine can be used in rescue sedation in children undergoing computed tomography. The present study aimed to assess the efficacy and tolerability of intranasal dexmedetomidine use in children undergoing ophthalmic examination after chloral hydrate failure. Methods Sixty uncooperative pediatric patients with cataract (aged 5–36 months; weight, 7–15 kg) presented for follow-up ophthalmic examination. Patients who experienced chloral hydrate failure were randomized to 1 of 2 groups to receive intranasal dexmedetomidine 1 or 2 μg/kg for rescue sedation. Each group contained 30 patients. The primary outcome was the rate of a successful ophthalmic examination. Secondary outcomes included sedation onset time, recovery time, duration of examination, discharge time, and adverse events, including percentage of heart rate reduction, respiratory depression, vomiting, and postsedative agitation. Findings A successful ophthalmic examination was achieved in 93.3% (28/30) of patients in the 2-μg/kg dose group and in 66.7% (20/30) of patients in the 1-μg/kg dose group ( P = 0.021). The onset time, recovery time, and discharge time did not significantly differ between the 2 groups. None of the patients required clinical intervention due to heart rate reduction, and none of the patients in either group experienced vomiting, respiratory depression, or agitation after the administration of dexmedetomidine. Implications In children undergoing ophthalmic examination, intranasal dexmedetomidine can be administered in the sedation room for rescue sedation after chloral hydrate failure, with the 2-μg/kg dose being more efficacious than the 1-μg/kg dose, as measured by success rate. ClinicalTrials.gov identifier: NCT02077712.

The purpose of this study was to analyze the demographics and distribution of corneal astigmatism before lens extraction in patients with primary angle closure disease (PACD).Preoperative partial coherence interferometry was performed in patients with PACD. The demographic and biometric data, including corneal astigmatism and keratometry (K), were recorded.The study comprised 808 cases (1001 eyes) with a mean age of 67.66±9.07 years, and the mean axial length was 22.55±0.89 mm. The mean corneal astigmatism was 1.08±0.78 diopter (D). Corneal astigmatism was between 0.25 D and 1.25 D in 66.50% of the eyes, 1.25 D or higher in 29.68% of the eyes and0.25 D in 3.82% of the eyes. The corneal astigmatism of primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG) were 1.08±0.77 D, 0.98±0.62 D, and 0.89±0.69 D, respectively. In total, 50.60% of the eyes were classified as astigmatism against the rule (ATR), 28.69% of the eyes were with the rule, and 20.71% of the eyes were oblique. ATR astigmatism increased significantly with age (P0.001). After matching, corneal astigmatism of PACD was 1.07±0.77 D, although it was statistically significantly higher than that of ARC (0.98±0.66 D, P=0.018), the 2 demonstrated no clinical difference.The results provide normative data of corneal astigmatism for PACD patients. Corneal astigmatism was mainly distributed between 0.25 D and 1.25 D. The findings largely concur with published results in age-related cataract subjects.

Sensory loss is associated with behavioural changes, but how behavioural dynamics change when a sensory modality is impaired remains unclear. Here, by recording under a designed standardized scenario, the behavioural phenotypes of 4,196 infants who experienced varying degrees of visual loss but retained high behavioural plasticity, we show that behaviours with significantly higher occurrence in visually impaired infants can be identified, and that correlations between the frequency of specific behavioural patterns and visual-impairment severity, as well as variations in behavioural dynamics with age, can be quantified. We also show that a deep-learning algorithm (a temporal segment network) trained with the full-length videos can discriminate, for an independent dataset from 400 infants, mild visual impairment from healthy behaviour (area under the curve (AUC) of 85.2%), severe visual impairment from mild impairment (AUC of 81.9%), and various ophthalmological conditions from healthy vision (with AUCs ranging from 81.6% to 93.0%). The video dataset of behavioural phenotypes in response to visual loss and the trained machine-learning algorithm should help the study of visual function and behavioural plasticity in infants.

Aim To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches. Methods In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed. Results A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 vs 0.96±0.30; P=0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; P=0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA. Conclusion It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes.

Background To investigate the distribution of the height, weight and body mass index (BMI) of children with congenital cataracts (CC) before surgical treatment. Methods This prospective study included children with CC ≤14 years of age presenting at the Zhongshan Ophthalmic Center from Jan. 2013 to Aug. 2016. The height, weight, and BMI measurements of all participating children were obtained and compared with the World Health Organization Child Growth Reference (WHO Reference), matched by age and gender. The presence of a family history of CC or complicated systemic diseases as well as parental education levels and family income were also recorded. Results In total, 595 children with CC were included. The mean age was 52.75 ± 33.99 months, and 34.29% (204/595) of them were unilateral cases. Among all of the children, 6.72% (40/595) of cases were complicated by systemic diseases. More than 1/5 (21.01%, 125/595) of the children had a family history of CC and exhibited bilateral involvement. Less than 1/4 (23.2) of the mothers were highly educated, and more than half of the families had a family income below the city average. Height, weight, and BMI measurements of most children with CC were within the normal ranges (±95% CI of the WHO Reference). Compared to the WHO Reference, both girls and boys aged 2–5 years revealed shorter heights, and the girls aged 5–14 years exhibited a shorter height, lower body weight and lower BMI. The heights of the children with CC and systemic diseases were also shorter than the WHO Reference. The children with CC who had a family history of disease had shorter heights and lower BMIs than children with CC but no family history, and the measurements of both groups were lower than the WHO Reference values. Conclusions The height, weight and BMI of most of the children with CC in this study were within the normal ranges of the WHO Reference. However, the children with CC and concomitant systemic diseases and those with a family history of CC had shorter heights and lower BMIs. This information aids in our understanding of the physical development of children with CC.

Calcium levels in the lens rise with increasing age and increased intracellular calcium accumulation is known to be a risk factor for cataract formation. Calbindin-D28K (CALB1) is an intracellular calcium buffer. It is not clear whether CALB1 levels change in response to the Ca2+ accumulation in the lens that occurs with age. The present study investigated the distribution of CALB1 in the lenses of Sprague-Dawley (SD) rats and whether this changed with age. Lenses were isolated from SD rats at 1, 6, 12 and 18 months of age. CALB1 distribution was examined using immunohistochemistry. Lens epithelial cells were counted in median sagittal plane slices from the hematoxylin and eosin-stained lens and quantified using western blot analysis. Calb1 gene expression was examined using reverse transcription-quantitative polymerase chain reaction. CALB1 was distributed in the epithelial and fiber cells of the lens. CALB1 levels declined significantly with increasing age, whilst there was no significant accompanying decrease in the number of lens cells. A similar reduction was noted in CALB1 mRNA levels. To the best of our knowledge, this is the first study to demonstrate that CALB1 expression and CALB1 protein levels in SD rat lens decrease with age. This reduction does not reflect a reduction in lens cell numbers but a genuine reduction in gene expression within these cells. Thus, CALB1 may be important in changes occurring in the lens in older age, in particular in the development of cataracts.

Purpose To assess the bacterial contamination risk in cataract surgery associated with mechanical compression of the lid margin immediately after sterilization of the ocular surface. Setting Department of Cataract, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Design Prospective randomized controlled double-masked trial. Methods Patients with age-related cataract were randomly assigned to 1 of 2 groups. In Group A (153 eyes), the lid margin was compressed and scrubbed for 360 degrees 5 times with a dry sterile cotton-tipped applicator immediately after ocular sterilization and before povidone–iodine irrigation of the conjunctival sac. Group B (153 eyes) had identical sterilization but no lid scrubbing. Samples from the lid margin, liquid in the collecting bag, and aqueous humor were collected for bacterial culture. Primary outcome measures included the rate of positive bacterial culture for the above samples. The species of bacteria isolated were recorded. Results Group A and Group B each comprised 153 eyes. The positive rate of lid margin cultures was 54.24%. The positive rate of cultures for liquid in the collecting bag was significantly higher in Group A (23.53%) than in Group B (9.80%) ( P =.001).The bacterial species cultured from the collecting bag in Group B were the same as those from the lid margin in Group A. The positive culture rate of aqueous humor in both groups was 0%. Conclusion Mechanical compression of the lid margin immediately before and during cataract surgery increased the risk for bacterial contamination of the surgical field, perhaps due to secretions from the lid margin glands. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

The perioperative period refers to the time from the determination of surgical plan until the end of surgery-related basic treatments. In contrast to adult cataract surgery, pediatric cataract surgery may produce suboptimal outcomes due to the ever-changing condition of pediatric patients, countless operative difficulties, as well as potential complications. The perioperative period of pediatric cataract surgery often lasts up to 1 month, including preoperative, intraoperative, and postoperative phases. Considering the uniqueness in terms of patient communication, anesthetic risk, eye condition, surgery-related inflammation, and postoperative prognosis, pediatric ophthalmologists should be fully aware of these perioperative characteristics and develop coping strategies accordingly, which will contribute to the success of the surgery as well as better postoperative outcomes.

There is no widely accepted classification system for pediatric cataracts. Generally speaking, cataracts are classified according to the etiology, age of onset, morphology, location, or degree of lens opacity. Since opacity may occur in any part of the lens, the morphological manifestation of pediatric cataract is diverse and complex. Based on the abundant patient resources and first-hand clinical data from the “Cataract Children’s Home” of Zhongshan Ophthalmic Center, this chapter discusses the classification and morphological manifestation of pediatric cataracts using a large number of precious slit-lamp microscopic images.

Congenital uveal abnormalities in the presence of pediatric cataracts include aniridia, iris coloboma, persistent pupillary membrane, and pupil deformation. Congenital uveal abnormalities are associated with gene mutations and are often accompanied by other ocular or systemic abnormalities. Pediatric uveitis complicated with cataract is a common acquired uveal abnormality. With concurrent uveal abnormalities, cataract surgery may be more difficult to perform, and postoperative outcomes may also be affected. This chapter will explain how to manage various uveal abnormalities during pediatric cataract surgery and also discusses the application of prosthetic iris devices in pediatric eyes, including iris diaphragm intraocular lens, artificial iris, and capsular tension ring with iris diaphragm.

The history taking and ophthalmic examination of pediatric patients with lens diseases have special requirements and methods. Doctors and nurses of pediatric ophthalmology should not only be equipped with adequate ophthalmic knowledge but also understand the physiological and psychological characteristics of pediatric patients of different ages or in different conditions. This may facilitate the design, development, or selection of the most appropriate devices or methods to perform detailed and accurate ophthalmic examinations for pediatric patients. In clinical practice, how to communicate with pediatric patients is an art. A child-friendly environment may result in better patient cooperation, and appropriate methods and devices are the key to a successful examination. This chapter discusses the psychological characteristics of pediatric patients, communication skills, as well as some practical methods and patent devices for pediatric ophthalmic examination.

Background Congenital cataracts are often complicated by anterior segment dysgenesis. This study aims to compare bilateral anterior segment parameters, macular thickness, and best-corrected visual acuity (BCVA) in pediatric cataract patients at 3 months after unilateral cataract extraction with intraocular lens implantation. Methods Fifty-three pediatric patients with uncomplicated unilateral total cataracts were included. At 3 months post-surgery, bilateral corneal thickness at the thinnest location (CTTL), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured using Pentacam. Central macular thickness (CMT) was evaluated using spectral-domain optical coherence tomography. BCVA was measured by experienced optometrists concurrently. Descriptive statistics and bivariate corrections were performed to analyze the interocular differences in bilateral anatomic parameters and their relationships with BCVA. Results For all 53 included patients (mean age 5.2 ± 2.3 years), the median BCVA was 10/40 in the operated eyes and 40/40 in the contralateral eyes, which indicates a significant interocular difference. BCVA values in the contralateral eyes were significantly correlated with patient age at surgery, but this result differed for BCVA in the operated eyes. The Pentacam analysis revealed no significant interocular differences in bilateral CTTL and ACV, but significant differences were found for ACD. Conclusions At 3 months after surgery, unilateral pediatric cataract patients exhibited no significant interocular differences in identified anatomical parameters (except for ACD), and these parameters were not significantly correlated with BCVA in bilateral eyes. Therefore, amblyopia, but not anatomical factors, might be the main cause of interocular visual functional differences in our study population. Trial registration ClinicalTrial.gov, NCT02765230, 05/05/2016, retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0371-5) contains supplementary material, which is available to authorized users.

Objective Regular follow-up is essential to successful management of childhood cataract. We sought to assess whether a mobile phone short message service (SMS) for parents of children with cataract could improve follow-up adherence and the proportion of procedures performed in timely fashion. Design Randomized, controlled trial. This trial is registered with ClinicalTrials.gov, NCT01417819. Participants We included 258 parent–child pairs involved in the Childhood Cataract Program of the Chinese Ministry of Health. Methods Participants were randomized (1:1) to a mobile phone SMS intervention or standard follow-up appointments. All participants were scheduled to attend ≥4 follow-up appointments according to the protocol. Parents in the intervention group received SMS automated reminders before scheduled appointments. The control group parents did not receive SMSs or any alternative reminder of scheduled appointments. Regular ocular examinations and analyses were performed by investigators masked to group allocation; however, study participants and the manager in charge of randomization and sending SMSs were not masked. Main Outcome Measures Number of follow-up appointments attended, additional surgeries, laser treatments, changes in eyeglasses prescription, and occurrence of secondary ocular hypertension. Results Among parent–child participants, 135 were randomly assigned to the SMS intervention and 123 to standard appointments. Attendance rates for the SMS group (first visit, 97.8%; second, 91.9%; third, 92.6%; fourth, 83%) were significantly higher than those for the control group (first visit, 87.8%; second, 69.9%; third, 56.9%; fourth, 33.3%). The increase in attendance rate for total number of follow-up visits with SMS reminders was 47.2% (relative risk [RR] for attendance, 1.47; 95% confidence interval [CI], 1.16–1.78; P = 0.003). The number needed to remind (NNR) to gain 1 additional visit by 1 child was 3 (95% CI, 1.8–4.2). A total of 247 clinical interventions were carried out in the SMS group and 134 in the control group (RR, 1.68; 95% CI, 1.37–1.99; P = 0.007). The NNR to result in 1 additional clinical intervention was 5 (95% CI, 3.5–6.5). Conclusions The SMS reminders significantly improved follow-up adherence in pediatric cataract treatment. Using readily available mobile phone resources may be an effective and economic strategy to improve management of childhood cataract in China. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

This study is to evaluate the visual outcome and identify its crucial related factors in children undergoing cataract surgery for bilateral total congenital cataract (CC). This prospective study included consecutive bilateral total cataract patients undergoing primary surgery at Zhongshan Ophthalmic Center (ZOC), Guangzhou, China from Jan 2010 to May 2014. Visual outcome was estimated by best-corrected visual acuity (BCVA) at last follow-up. Potential related factors, including gender, age at last follow-up, age at primary surgery, surgical procedure, postoperative complications (PCs), frequency of follow-up and changes in spectacles were evaluated. Eighty-eight children (176 eyes) were included in the cohort. The mean post-operative BCVA (logMAR) was 1.07 ± 0.53 at the mean follow-up duration 31.07 ± 19.36 months. Multivariable generalized estimating equations (GEEs) showed BCVA was significantly associated with PCs, age at last follow-up and age at primary surgery. Partial correlation analysis indicated age at primary surgery was positively correlated with BCVA controlling for the other factors, both for the whole age range (R = 0.415, P 6 months (R = 0.867, P

Background Ocular biometry is important for preoperative assessment in cataract and anterior segment surgery. The purpose of this study was to investigate normative ocular biometric parameters and their associations in an older Chinese population. Methods This was a cross-sectional observational study. From 2013 to 2014, we recruited inhabitants aged 50 years or older in Guangzhou, China. Among 1,117 participants in the study, data from 1,015 phakic right eyes were used for analyses. Ocular parameters including axial length (AL), anterior chamber depth (ACD), and corneal curvature (K) were measured using an IOL Master. Results The mean AL, ACD, and K were 23.48 mm [95 % confidence interval (CI), 23.40–23.55], 3.03 mm (CI, 3.01–3.05), and 44.20 mm (CI, 44.11–44.29), respectively. A mean reduction in ACD with age was observed (P = 0.002) in male subjects but not in female subjects (P = 0.558). Male subjects had significantly longer ALs (23.68 mm versus 23.23 mm, P

Axial length (AL) is a significant indicator of eyeball development, but reports on the overall status of axial development in congenital cataract (CC) patients and its relationship with patient demographics, such as age, sex, and laterality, are rare. We prospectively investigated the AL of 1,586 patients ≤18 years old and undergoing cataract surgery in China from January 2005 to December 2014. Of these 3,172 eyes, a logarithmic correlation between AL and age in CC patients was calculated, and an age of approximately 2 years was found to be a turning point in the growth rate of AL. A considerable variation was observed in CC patients of the same age. Furthermore, 2–6 years old boys had longer AL than girls. The AL of affected eye in unilateral patients was longer than that of the contralateral eye in 2–6 years age group and longer than that of eye in bilateral CC patients in all age groups. These findings indicate that the development of the length of eyeballs in CC patients is influenced by multiple factors in addition to age. A full understanding of the distribution of AL may provide a useful reference for judging the timing of surgery in CC patients.