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To develop a model for predicting postoperative axial length (AL) in children undergoing cataract surgery younger than 2 years of age.The Eye Hospital of Wenzhou Medical University, Hangzhou, China DESIGN: Retrospective study.Children were included only if AL data were available before surgery and at least 1 year after surgery. Eyes were divided into pseudophakic, aphakic, and unaffected eye groups. Variables that could influence axial growth were analyzed and a multivariable generalized estimating equation regression model was developed to predict postoperative AL.333 eyes from 190 patients were included. We observed a logarithmic linear correlation between age and AL in the unaffected eye group, AL = (2.7924 × log of age in months) + 17.607, RThe assessment of AL is one of the most important parts of successful postoperative management in congenital cataract patients. This study established an AL estimate formula for children aged ≤ 2 years with congenital cataract who underwent cataract surgery. This model theoretically could be used to predict individual future AL for child undergoing cataract surgery.

PURPOSE To investigate the age-related tilt and decentration of crystalline lenses using a swept-source optical coherence tomography biometer (SS-OCT) (CASIA2, Tomey Corp.). SETTING Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China. DESIGN Cross-sectional study. METHODS The direction and magnitude of the crystalline lens were evaluated in 230 participants with ages ranging from 7 to 90 years using SS-OCT. The participants were divided into 4 age groups, and the differences among the groups were analyzed. Multiple linear regression was used to investigate the main factors influencing crystalline lens tilt and decentration. RESULTS The natural crystalline lens tilted toward the inferotemporal direction with a mean magnitude of 4.3 ± 1.5 degrees (range 0.7 to 8.95 degrees). The mean decentration toward the superotemporal direction was 0.17 ± 0.12 mm (range 0.03 to 1.15 mm). There was mirror symmetry between the right and left eyes. There were statistically significant differences in the crystalline lens tilt and decentration among the age groups. Multiple linear regression showed that changes in crystalline lens tilt depended on angle α (P < .01) and anterior chamber depth (ACD; P = .008), whereas crystalline lens decentration depended on angle κ (P = .003), age (P < .01), and angle α (P = .002). CONCLUSIONS Although there was a statistically significant difference in crystalline lens tilt and decentration among age groups, the variation in the crystalline lens position was partially affected by age. The crystalline lens tilt was greater in eyes with wider angle α and shallower ACD, whereas crystalline lens decentration was greater in younger eyes with wider angles κ and α.

The crystalline lens revealed steepening anterior surface and increasing equatorial diameter with age. Cycloplegia caused significant changes on the anterior surface, and this effect weakened with age., Purpose: To evaluate the effect of age and cycloplegia on the morphology of the crystalline lens using a swept-source optical coherence tomography (SS-OCT) system. Setting: Hospital. Design: Prospective cross-sectional study. Methods: The parameters including anterior chamber depth (ACD), the radii of curvature of the anterior and posterior surface of the crystalline lens (ALR and PLR), lens thickness (LT), lens equatorial diameter (LED), and lens vault (LV) were quantified by the SS-OCT before and after cycloplegia. The paired t test was used to compare the parameters before and after cycloplegia. A multivariate linear regression model was built to analyze the association between the parameters/cycloplegia-induced changes and age, while adjusting for the effect of axial length, refractive status, and sex. Results: 76 individuals (age range, 18 to 86 years) were recruited. The ALR and ACD were negatively correlated with age (P ≤ .002), and the LT, LV, and LED were positively correlated with age (P ≤ .004). In participants younger than 60 years, the ALR and ACD significantly increased, whereas the LV and LT significantly decreased after cycloplegia (all P < .001). With aging, cycloplegia-induced differences of ALR (P = .001) and ACD (P = .014) significantly decreased, and of LT (P < .001), LT (P < .001), and LV (P = .001) significantly increased. Conclusions: The crystalline lens morphology measured by the SS-OCT revealed steepening anterior surface and increasing equatorial diameter with age. Cycloplegia caused a significant change of anterior surface morphology in participants younger than 60 years, and this effect diminished with age.

Background To compare the quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy (TPRK) and off-flap epipolis-laser in situ keratomileusis (Epi-LASIK) in moderate to high myopia. Methods In this prospective self-control study, we included patients with moderate to high myopia who were randomized to undergo TPRK in one eye and Epi-LASIK in the other eye. Twelve-month follow-up results for visual acuity, refraction, ocular high-order aberrations, contrast sensitivity, postoperative pain, epithelial healing, and haze grade were assessed. Results A total of 64 eyes (32 patients) were enrolled in the study. More eyes completed re-epithelialization in the TPRK group than in the Off-flap Epi-LASIK group 3–4 days postoperatively, while all eyes completed re-epithelialization by 7 days. More eyes achieved a visual acuity (both UDVA and CDVA) of better than 20/20 in the TPRK group than in the Off-flap Epi-LASIK group. The ±0.50 D predictability for correction of the spherical equivalent (SE) was higher in the eyes of the TPRK group (91%) than in those of the off-flap Epi-LASIK group (80%) 12 months after surgery. No significant differences in ocular aberrations, including coma, spherical, and trefoil, were found between the two groups at 12 months. There were also no significant differences in visual acuity, contrast sensitivity, pain, and haze grading between the two groups. Conclusions Both TPRK and off-flap Epi-LASIK are safe, effective, and predictable treatments for moderate to high myopia with comparable surgical outcomes. Trial registration This study was retrospectively registered on ClinicalTrial.gov (NCT05060094, 17/09/2021).

To evaluate the early changes in retinal microcirculation after uncomplicated cataract surgery using an active-fluidics system. Patients underwent uncomplicated cataract surgery for both eyes were enrolled. The two eyes of the patients were randomly assigned to two groups, the active-fluidics group and the gravity-fluidics group. One eye using an active-fluidics system, and the other using a gravity-fluidics system. Optical coherence tomography angiography (OCTA) was performed at 1 day, 7 days, 30 days, and 90 days after surgery. Fifty eyes (25 patients) were included in the final analysis. A significantly lower cumulative dissipated energy (CDE), estimated fluid usage (EFU), and total aspiration time (TAT) were observed in the active-fluidics group (all P

Purpose: The aim of the study was to compare the accuracy of refractive outcomes in children undergoing secondary in-the-bag or cilliary sulcus intraocular lens (IOL) implantation, using aphakic refraction (AR)-based formulae (Hug and Khan) and biometry-based formulae (Holladay 1, Hoffer Q, SRK/T, and SRK II). Methods: In this retrospective study, a total of 65 eyes of 44 patients who underwent secondary in-the-bag or cilliary sulcus IOL implantation were included and divided into 2 groups: 39 eyes of the in-the-bag IOL group and the other 26 eyes of the sulcus-implanted IOL group. Holladay 1, Hoffer Q, SRK/T, and SRK II formulae were employed depending on the biometric data, while Hug and Khan formulae were used based on preoperative AR. The prediction error (PE) and the absolute value of predicted error (APE) were compared between the 2 groups and formulae. Results: In the in-the-bag IOL group, nonsignificant differences of APE were found among the 6 formulae, while the Holladay 1, Hoffer Q, SRK/T, and SRK II all demonstrated a significant hyperopic shift of median PE value compared to the Hug formula (p < 0.05, all), and Holladay 1 and SRK II also showed a significant hyperopic shift of PE compared to the Khan formula (p < 0.05, both). Higher percentages of eyes with PE p < 0.05, all), and the SRK II had a significantly smaller median value of APE than the Hug formula (p < 0.05), while Holladay 1 had the lowest value of APE. Higher percentages of eyes within PE p < 0.05, all). In the eyes of with in-the-bag implanted IOL, the Hug and Khan formulae had significantly smaller APE values when compared with the eyes with sulcus-implanted IOL (p < 0.05, both). Conclusions: Whether IOL was in the bag or implanted in the sulcus, almost all the formulae showed hyperopic shift, SRK/T showed the best accuracy. Biometry-based formulae were superior to AR-based formulae in accuracy of IOL power calculation, especially when IOL was implanted in the sulcus. In-the-bag IOL implantation should always be with higher priorities, especially when using AR-based formulae in IOL power calculation.

PURPOSE To explore the macular thickness changes after lens removal combined with anterior vitrectomy for pediatric cataract surgery. SETTING The Eye Hospital of Wenzhou Medical University, Zhejiang, China. DESIGN Prospective study. METHODS Thirty children (40 eyes) aged between 3 years and 9 years with pediatric cataracts, including 20 children (20 eyes) with unilateral cataracts and 10 children (20 eyes) with bilateral cataracts, were enrolled. Spectral-domain optical coherence tomography was used to obtain macular images. Central subfield thickness (CST) and retinal thickness in the Early Treatment Diabetic Retinopathy Study subfields (inner 1.0 to 3.0 mm annulus and outer 3.0 to 6.0 mm annulus) were recorded preoperatively as well as at 1, 3, 6, and 12 months postoperatively. RESULTS Forty eyes of 30 children were included. Retinal thickness in every subfield significantly thickened at 3 months postoperatively (all P < .05). CST significantly thickened compared with preoperative levels (228.03 ± 18.58 vs 240.35 ± 17.41, P = .005) at 3 months postoperatively; macular thickness gradually decreased in the following months. At 6 months postoperatively, retinal thickness in inner nasal, inferior, temporal, and outer nasal subfields remained significantly thicker compared with preoperative levels (P = .048, P = .036, P = .029, and P = .017, respectively). At 12 months, the retinal thickness in all subfields reached the preoperative level. CONCLUSIONS The influence on macular thickness lasted until 12 months after pediatric cataract surgery. The inner macular thickness increased for a longer time than the outer macular thickness postoperatively.

Purpose. This study aims to compare the accuracy of five intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, and Holladay 2) for pediatric eyes in children of different ages. Methods. In this prospective study, patients who received cataract surgery and IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of 5 formulas at 1 month postoperatively and performed subgroup analysis with the patients divided into three groups according to their ages at the time of surgery as follows: group 1 (age ≤ 2 years, 35 eyes), group 2 (2 years 5 years, 29 eyes). Results. 75 patients (102 eyes) were enrolled in this study. The Haigis formula got the smallest PE among all formulas in all three groups. With regard to APE, there were no statistical differences among the formulas except group 2, with the SRK/T formula a little smaller, the Holladay 2 formula a little larger in group 1, and the Haigis formula a little smaller in group 3. In group 2, the Haigis formula had the lowest APE (0.87 ± 0.61 D), while the Holladay 2 formula had the largest (1.71 ± 1.20 D, p<0.001), followed by the Holladay 1 formula (1.51 ± 1.07 D, p=0.002). On comparing the percentage of APE within 0.5 D and 1.0 D obtained with 5 formulas in each group, there were no statistical differences. The SRK/T formula and the Holladay 1 formula showed the highest percentage (40.00% and 60.00%) in group 1. While the Haigis formula got the highest percentage in less than 0.5 D (34.21%) and less than 1 D (60.53%) in group 2. In group 3, the Holladay 2 formula and the Haigis formula got the highest percentage less than 0.5 D (58.62%) and less than 1 D (79.31%). The multiple linear regression indicated that the age at the time of surgery was a significant factor affecting the accuracy of APE; after removing the age, AL was the only factor that affected the accuracy of APE. Conclusion. The SRK/T and the Holladay 1 formulas were relatively accurate in patients younger than 2 years old, while the Haigis formula performed better in patients older than 2.

Background Type 2 Peters anomaly is a rare anterior segment disorder characterized by central corneal leukoma with keratolenticular adhesion and cataract. Performing cataract surgery without corneal tissue transplantation in patients of type 2 Peters anomaly is extremely rare and challenging. We present a case of type 2 Peters anomaly treated by peeling off the adhesion without penetrating keratoplasty (PKP), in which restoration of corneal transparency is observed. Case presentation An 11-month-old female infant of type 2 Peters anomaly presented with bilateral corneal opacity with distinct demarcation, keratolenticular adhesion and cataract, which was first noted at the age of 3 months. By peeling off the adhesion from corneal endothelium combined with lensectomy and vitrectomy, there was a gradual reduction in corneal opacity and improvement in visual acuity after surgery over a 2-year period. Her visual acuity had improved from light perception preoperatively to 20/50 at the latest follow-up. No sight-threatening postoperative complications were noted. Conclusion It is safe and effective to peel off the keratolenticular adhesion in patients of type 2 Peters anomaly presented with distinctly demarcated corneal opacity.

Purpose: To evaluate the morphology changes of meibomian glands (MGs) after cataract surgery.Setting: Hangzhou Branch of the Eye Hospital of Wenzhou Medical University, Zhejiang, China.Methods: In this contra-lateral eye study, 40 patients received unilateral cataract surgery for age-related cataract. All the patients underwent the evaluation of non-invasive break-up time (NIBUT) and lower tear meniscus height (TMH) before the surgery and 6 months post-operatively. The MGs were evaluated via ImageJ and Meibomian Gland Bio-image Analyzer. MG dropout, length, width, area, gland diameter deformation index (DI), and gland signal index (SI) were recorded.Results: MG length, width, area, DI, and SI were significantly decreased after cataract surgery in the study group (operated eyes, P < 0.001, P = 0.003, P < 0.001, P = 0.001, and P < 0.001, respectively) and showed no significant changes in the control group (non-operated eyes) (all P > 0.05). MG loss increased more in the study group (P = 0.030), and the changes in TMH and NIBUT were not significantly different between the two eyes (both P > 0.05).Conclusion: Cataract surgery aggravated meibomian gland morphology, such as MG loss, MG length, width, area, and SI, and produced no change in NIBUT and TMH at 6 months post-operatively.

Purpose: To evaluate the effects of age on the morphologies of the crystalline lens, ciliary muscle (CM), Schlemm’s canal (SC), and trabecular meshwork (TM) using swept-source optical coherence tomography (SS-OCT).Methods: Images of the crystalline lens and iridocorneal angle were obtained in healthy participants’ eyes using SS-OCT. Morphological parameters of the crystalline lens, CM, and TM/SC were measured, and the relationship between these parameters and age was evaluated.Results: A total of 62 healthy participants were enrolled, with an age range of 7–79 years. With adjustments for the effects of axial length and sex, both the nasal and temporal SC cross-sectional areas (CSA) and the cross-sectional area of the CM (CMA), distance from the scleral spur to the inner apex of the ciliary muscle (IA-SS), and nasal SC volume were negatively correlated with age (P ≤ 0.041). Meanwhile, the lens thickness (LT) (P < 0.001) and lens vault (LV) (P < 0.001) were positively correlated with age, and the radius of the curvature of the anterior lens (ALR) was negatively correlated with age (P < 0.001).Conclusion: Increasing age was associated with a thicker crystalline lens, a steeper anterior lens curvature, an anteriorly located and smaller CM, and a narrower SC.Clinical Trial Registration:https://register.clinicaltrials.gov/prs/app/action/Select Protocol?sid=S000A3JZ&selectaction=Edit&uid=U00019K7&ts=4&cx=-c5xxp8, identifier [NCT04576884].

Background This study aimed to identify the incidence of and risk factors for postoperative glaucoma-related adverse events at various time points after congenital cataract surgery. Methods This retrospective cohort study enrolled 259 eyes from 174 patients (surgical age ≤ 7 years) who underwent congenital cataract surgery. All surgical procedures were conducted at the Eye Hospital of Wenzhou Medical University between May 2011 and March 2019. Patients were classified into group 1 [primary intraocular lens (IOL) implantation, N = 111 eyes], group 2 (secondary IOL implantation, N = 85 eyes), and group 3 (no IOL implantation, N = 63 eyes). We recorded demographic factors and incidence and risk factors for glaucoma-related adverse events. Results Glaucoma-related adverse events occurred in 21 (8.1%) eyes, whereas 27 (10.4%) eyes developed steroid-induced ocular hypertension. The percentage of glaucoma-related adverse events was 0%, 1.2%, 1.2%, 1.6%, 4.0%, and 8.9% at 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery, respectively. Sixteen (18.8%), five (7.9%), and zero eyes developed glaucoma-related adverse events in groups 2, 3, and 1, respectively. Family history of congenital cataract [hazard ratio (HR), 50.463; 95% confidence interval (CI), 7.051–361.139; P P = 0.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558–9.804; P = 0.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344–10.417; P = 0.012] were identified as predictors of postoperative glaucoma-related adverse events. Conclusions Family history of congenital cataract, thicker preoperative CCT, smaller preoperative HCD, and thinner preoperative LT are the main risk factors of postoperative glaucoma-related adverse events. Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic.

Introduction: The macular morphologic and microvascular changes in children with pseudophakia after pediatric cataract surgery remain unknown. The aim of this study was to analyze macular morphologic and microvascular remodeling in children with pseudophakia after pediatric cataract surgery using optical coherence tomography angiography (OCTA). Methods: Consecutive cases between December 1, 2018, and November 31, 2020 were recruited. Sixty-one participants (31 pseudophakic children and 30 healthy controls) met the inclusion criteria and were included for final analysis. OCTA was used to measure macular vascular density, the foveal avascular zone (FAZ), and macular thickness. The parameters were compared between pseudophakic and healthy eyes using binary logistic regression, with adjustment for the effect of refractive error, age, and axial length. Results: Compared with normal eyes, a significantly reduced area of the FAZ (p = 0.042), increased superficial foveal vascular density (p = 0.033), and increased inner and outer foveal thickness (p = 0.034 and 0.029, respectively) were noted in pseudophakic eyes. The deep parafoveal vascular density was generally lower in eyes with cataracts (p ≤ 0.044). The inner foveal thickness was positively correlated with the superficial foveal vascular density (r = 0.889, p < 0.001) and negatively correlated with the area of the FAZ (r = −0.903, p < 0.001). The outer foveal thickness was positively correlated with the deep foveal vascular density (r = 0.399, p = 0.002). Conclusions: Morphological and microvascular remodeling in children with previous pediatric cataract indicates foveal underdevelopment. The underlying mechanism requires further investigation.

Purpose: To study the correlations between subjective and objective cataract metrics with dysfunctional lens index. To investigate the potential of the DLI as a novel surgery decision-maker. Methods: In this prospective, cross-sectional study, we measured the dysfunctional lens index (DLI), Lens Opacities Classification System III nuclear opalescence (LOCS III NO) grading, preoperative corrected distance visual acuity (CDVA), objective scatter index (OSI) and Scheimpflug-based average lens density (ALD) in eyes with nuclear cataract. Eyes were classified as Surgical and Non-Surgical groups. Correlations among the DLI, OSI, ALD, LOCS III NO grading, and preoperative CDVA were analyzed. The receiver operating characteristic (ROC) curve analysis was performed for DLI, OSI, and CDVA to determine optimal cut-off values to separate between surgical and non-surgical cataracts. Results: The DLI showed the strongest correlation with the OSI (r= -0.712, P< .001), followed by LOCS III NO score (r= -0.661, P< .001), ALD (r= -0.596, P< .001) and preoperative CDVA (r= 0.563, P< .001). The area under ROC curves (AUCs) of the DLI, OSI and preoperative CDVA curve were 0.972, 0.912 and 0.844 (All P< .001), respectively. The DLI cut-off value of 5.7 implied higher levels of sensitivity (91.67%) and specificity (91.84%) than the OSI cut-off value of 2.9 and the CDVA cut-off value of 0.55 (sensitivity of 89.58% and 71.92%; specificity of 81.63% and 85.71%, respectively). Conclusion: The surgery criterion of DLI ≤ 5.7 behaved better than the surgery criterions of OSI ≥ 2.9 and preoperative CDVA ≤ 0.55 in discrimination between surgical and non-surgical nuclear cataracts.

A novel method based on surface-enhanced Raman scattering (SERS) was developed to estimate the reducing capacity of phenolic acids by using self-assembled three-dimensionally (3D) ordered gold nanoparticles (GNPs) precursor composite (SiO2/GNPs) arrays as nanoprobes. In the present work, the 3D ordered SiO2/GNPs arrays immersed in the growth solution containing different phenolic acids, the SiO2/GNPs were enlarged to varying degrees. Phenolic acids with one or more phenolic hydroxyl groups served as reductants for the growth of GNPs. The enlargement conditions varied with the different reducing capacity of phenolic acids, exhibiting specific morphologies differ from the complete gold nanoshells (GNSs). Consequently, the UV–vis spectra and SERS spectra for the phenolic acid-treated SiO2/GNPs arrays were gradually changed. The change of the intensities of the SERS spectra correlated well with phenolic acids concentration which indicated that this SiO2/GNPs array is a suitable SERS nanoprobe for phenolic acids. Results showed that the higher reducing capacity of phenolic acid, the stronger SERS of the enlarged GNSs. Thus, the SERS results could be used to evaluate the antioxidant capacity of phenolic acids by utilizing 3D ordered SiO2/GNPs arrays as nanoprobes. The results also indicated that the reducing capacity of these three phenolic acids was in the order gallic acid > syringic acid > vanillic acid. The detection ranges of vanillic acid, syringic acid and gallic acid were 10–250 µM, 10–110 µM and 5–55 µM, respectively.

Purpose: To evaluate the agreement between anew UBM and an SS-OCT. Methods: The scans of the right eye of each volunteer were obtained using the two devices. Data were fitted and recorded including...

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P

Purpose. To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes. Methods. This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded. Results. The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P>0.05). Conclusions. PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov.

PurposeTo quantitate lens nuclear opacity using long-range swept-source optical coherence tomography (SS-OCT) images and to evaluate the correlation of this method to Lens Opacities Classification System III (LOCS III) and a Scheimpflug imaging-based grading system (Pentacam Nuclear Stage function; PNS).MethodsThis study enrolled 120 participants (120 eyes) with age-related nuclear cataracts. The best-corrected visual acuity (BCVA), LOCS III nuclear opalescence (NO) and nuclear colour (NC) were obtained. The nuclear density measured using PNS function (NDPNS) was recorded. Three successive series of long-range SS-OCT images were captured, and the nuclear region was analysed using ImageJ (NIH, Bethesda, Maryland, USA) to generate SS-OCT image-based nuclear density (NDSS-OCT). The repeatability of NDSS-OCTmeasurement was evaluated using within-subject coefficient of variation (CVw) and intraclass correlation coefficient (ICC). Correlations of NDSS-OCTwith NO and NC, BCVA and NDPNSwere analysed. According to the integrity of nucleus imaged by Pentacam, patients were divided into two groups, and the parameters were compared between groups.ResultsThe CVwand ICC for NDSS-OCTmeasurement were 1.5 % and 0.994, respectively. The NDSS-OCTsignificantly correlated with NO (r=0.831), NC (r=0.873), BCVA (r=0.655) and NDPNS(r=0.891). The NDSS-OCT, NO and NC, and BCVA were significantly different between the two groups.ConclusionLens nuclear opacity quantitation using long-range SS-OCT images was repeatable and correlated well with LOCS III and PNS function. The Scheimpflug principle had a limitation in imaging dense nucleus. Long-range SS-OCT seems more promising for objectively and quantitatively assessing lens nuclear opacity.

Background Complete nuclear disassembly of superhard cataracts cannot always be achieved by phaco chop, which is considered one of the best techniques for dealing with hard cataracts. We present a phaco chop-progressive cracking technique to divide superhard cataracts completely. Case presentation We presented a case of cataract with over Grade V nucleus sclerosis and very low density of corneal endothelial cell (812 cells/mm2). By performing the cataract surgery with our phaco chop-progressive cracking technique, the corneal endothelial cells were well protected and the patient’s visual acuity was markedly improved from finger counting at 40 cm to 20/200 the day after surgery without obvious corneal edema. Conclusions Although an initial learning curve was needed, this phaco chop-progressive cracking technique could be of particular benefit to the superhard cataract, especially in patients with low density of corneal endothelial cells.

Accurate intraocular lens (IOL) power calculation is always a challenge in ophthalmology, and unoptimized process may lead to inaccurate refractive outcomes. Quality control circle (QCC) has shown its success in many fields as a process management tool. However, its efficacy in ophthalmology remains unclear. Here we utilized the QCC method to optimize the process and evaluate its efficacy in improving the accuracy of IOL power calculation. After the QCC application, the percentage of eyes with achieved refractive outcomes within 0.5 diopter significantly increased from 63.2% to 80.8% calculated by Haigis formula and 59.2% to 75.8% by SRK/T formula in patients with normal axial length (AL) (22 mm ≤ AL < 26 mm). Although there were no statistically significant differences in patients with long AL by the two formulas (p = 0.886 and 0.726), we achieved an accuracy of 75% with the application of the PhacoOptics software, which was significantly higher than that using the other two formulas (p

A novel metal-free photocatalyst with post-illumination catalytic memory was fabricated by the graphitic carbon nitride (g-C3N4), carbon nanotubes (CNTs), and graphene (Gr), in which g-C3N4 acts as an efficient photocatalyst and the CNTs and Gr act as supercapacitors. The removal of phenol was achieved in the dark by post-illumination catalytic memory because the photocatalyst could store a portion of its photoactivity via photogenerated electrons in the CNTs and Gr under visible-light illumination and then release the electrons again in the dark. Therefore, this metal-free photocatalyst is capable of operation in the dark for a broad range of applications.

We present the case of a 56-year-old woman with Marfan syndrome and more than +4.0 diopters of corneal astigmatism. In the left eye, a capsular tension ring was used to extend the capsule and a capsule hook was used to prevent zonular dehiscence, capsular bag collapse, and vitreous prolapse. Phacoemulsification was performed using low parameters to keep the capsular bag stable during the surgery and protect the zonular fibers. During the 3-year follow-up, the toric intraocular lens remained stable in the capsular bag and the patient achieved excellent visual acuity and stable refractive results after surgery.

Objective: To evaluate the morphology of iridocorneal angle and anterior segment in eyes of children with cataract. Methods: In this prospective cross-sectional study, we included eyes of children with bilateral cataract as well as unilateral cataract and fellow eyes. The iridocorneal angle was evaluated using gonioscopy. We compared the preoperative structures of iridocorneal angle and anterior segment between cataractous eyes and fellow eyes. The grading of iridocorneal angle and anatomical changes were analyzed. Results: We finally recruited 55 eyes of 55 children with bilateral cataract and 41 cataractous eyes and 33 fellow eyes of 41 children with unilateral cataract. The fellow eyes were used as a control group. The iridocorneal angle was open in eyes with pediatric cataract when compared to control eyes. The eyes with cataract exhibited more pigments on the trabecular meshwork than control eyes did (unilateral cataract vs. control, p = 0.013; bilateral cataract vs. control, p = 0.002). The eyes with cataract exhibited a smaller cornea than control eyes (unilateral cataract vs. control, p = 0.031; bilateral cataract vs. control, p < 0.001). Conclusions: The iridocorneal angle is open in the eyes of children with cataract. Eyes with increased pigments on the trabecular meshwork need to be carefully monitored and surgeons should to be on the alert for postoperative glaucoma.

To compare the accuracy of the eight formulas for intraocular lens (IOL) power calculation in pediatric cataract patients.A retrospective study. A total of 68 eyes (68 patients) that underwent uneventful cataract surgery and posterior chamber IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of the 8 formulas at 1 month postoperatively and performed subgroup analysis according to age or axial length (AL).The mean age at surgery was 34.07 ± 24.60 months and mean AL was 21.12 ± 1.42 mm. The mean prediction errors (PE) of eight formulas for all patients were as follows: SRK II (- 0.66), SRK/T (- 0.44), Holladay 1 (- 0.36), Hoffer Q (- 0.09), Olsen (0.71), Barrett (0.37), Holladay 2 (- 0.70), and Haigis (0.50). There was significant difference among the 8 formulas (p 0.0001), while no significant difference of absolute PE was found among the 8 formulas in all patients (p = 0.053). Moreover, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formula was relatively accurate in 34% and 39% of eyes, respectively. While in patients older than 2 or with AL 21 mm, Barrett and Haigis formulas were better (58% and 47% for Barrett, 52% and 53% for Haigis).Overall, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formulas were relatively accurate, while Barrett and Haigis formulas were better in patients older than 2 or with AL 21 mm.

Background: To assess the changes of anterior chamber angle in patients with shallow anterior chamber and normal anterior chamber after phacoemulsification and intraocular lens implantation (IOL) using anterior segment swept-source optical coherence tomography (AS-SS-OCT). Methods: This was a prospective case control study; 60 eyes of 60 patients who scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were classified into two groups: shallow anterior chamber group with narrow angle (SAC group, 30 eyes)；and normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), Iris volume (IV), lens vault (LV) , angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3 months after surgery. Differences between the two groups were compared. Results: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, IOP and IV between the SAC group and the NAC group before operation, except for the LV (p = 0.000). All angle parameters including ACD, ACV, AOD, ARA, TISA and TIA in both groups at 3 months post-surgery were significantly different from the preoperative values (p

The phosphorylation of histone H3 at serine 10 (p-H3S10) has been shown to be closely correlated with mitotic chromosome condensation. We previously reported that intracellular silver nanoparticles (AgNPs) release Ag ions that alter actin filament dynamics, leading to the activation of Aurora kinases and the formation of p-H3S10 through a mechanism clearly different from that occurring during mitosis. In the present study, we examined other mechanisms underlying the induction of p-H3S10 formation by AgNPs. We observed that the early formation of p-H3S10 induced by AgNPs occurred via the activation of mitogen-activated protein kinase (MAPK) pathways, specifically the Jun N-terminal protein kinase (JNK) and extracellular signal-regulated kinase (ERK) pathways. The late AgNP-induced p-H3S10 formation occurred via the activation of the entire MAPK cascade. On the other hand, p-H3S10 formation was not due to DNA damage induced by AgNPs, or the activation of the kinases ataxia telangiectasia-mutated (ATM) and ATM-Rad3-related (ATR). Several studies have compared the mechanism of AgNP toxicity to a Trojan horse-type molecular pathway. We observed different effects of AgNO3 (Ag+) and AgNPs on cells, and only the JNK inhibitor suppressed the temporary AgNO3-induced formation of p-H3S10. These results strongly indicate that AgNP-induced p-H3S10 formation does not rely solely on one signaling pathway, but rather may involve two or more pathways.

Objective. To investigate the feasibility and safety of higher-dose dexmedetomidine in ophthalmological outpatient examination of children with cataract. Methods. 100 cases of children were recruited in the study and randomly equally divided into two groups. One group was given 2 μg/kg intranasal dexmedetomidine anesthesia, while the other group was under 3 μg/kg. The dosage of dexmedetomidine was calculated by the same anesthesiologist according to the weight of patient. After sufficient sedation, the same ophthalmologist performed ocular examinations manually, including intraocular pressure, keratometry, axial length, and corneal thickness and recorded the ocular position score during intraocular pressure measurement and corneal thickness measurement. Other variables were sedation onset time, recovery time, vital signs, and side effects. Results. In intraocular pressure measurement, only one case in the 2 μg/kg group did not complete the examination, while all cases in the 3 μg/kg group completed the examination and the difference of the success rate between the two groups was nonsignificant (P>0.05). The success rates of the 3 μg/kg group in corneal curvature, axial length, and corneal thickness examination were 96%, 92%, and 86%, respectively, which were significantly higher than those of the 2 μg/kg group (22%, 18%, and 4%). The average onset time of sedation in the 3 μg/kg group was 15.42 ± 2.09 minutes, which was significantly shorter than that in the 2 μg/kg group (19.52 ± 2.43 minutes, P<0.001). The average time of completing all examinations in the 3 μg/kg group was 18.36 ± 4.01 minutes, which was significantly shorter than that in the 2 μg/kg group (22.62 ± 4.13 min, P<0.001). The recovery time of group 3 μg/kg was 90.62 ± 27.80 min, which was significantly longer than that of group 2 μg/kg (49.20 ± 15.50 min). Vital signs such as pulse, blood pressure, oxygen saturation, and heart rate kept in normal range throughout the tests, and no obvious side effects were observed. Conclusion. 3 μg/kg intranasal dexmedetomidine had a higher sedation success rate and quality than 2 μg/kg did in pediatric ocular examinations, without any obvious side effects.

For the applications where a single capacitor is incapable to meet the needs, different types, behaviors and specifications of capacitors can be packaged as a capacitor bank to fulfill the requirements of the systems. Even though some commercial capacitor bank products have already existed in the market, most of them are the experienced based design which uses same capacitors connected in parallel or series to fulfill the capacitance and voltage rating requirements, so that the volume, cost, reliability and other performance factors are not optimized. To the best knowledge, no quantitative design for capacitor banks is available by considering all the design phases. This paper proposes a design method for capacitor banks with multiple design constraints. Considering the multi-physics aspects, the performance factors (e.g., lifetime, efficiency, cost and volume) of the capacitors are modeled. By optimizing the capacitor bank configurations (e.g. hybrid capacitance ratio of types, and the capacitance and numbers for individual capacitor), the solutions which fulfill the requirements of applications are identified. To verify the accuracy of the proposed method, a capacitor bank for the DC link of a 5.5 kW PV inverter is optimized and demonstrated.

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.

A three-dimensional (3D) photocatalyst was synthesized through the self-assembly of graphitic carbon nitride (g-C3N4), TiO2, graphene (Gr), and carbon nanotubes (CNTs), in which both Gr and CNTs act as electron mediators, to form an all-solid-state g-C3N4/Gr-CNTs/TiO2 Z-scheme photocatalytic system. In this Z-scheme photocatalyst, the highly interconnected CNTs not only can effectively promote the transfer of photogenerated charge carriers, but also built a 3D open frame network to harvest more incident light and provide more specific surface area for photoreactions. Benefiting from the 3D nanostructure and Z-scheme system, phenol removal over g-C3N4/Gr-CNTs/TiO2 reached up to 90% within 120 min using a high-pressure Xe short-arc lamp as light source, which was much higher than that achieved over pure g-C3N4. The 3D Z-scheme photocatalyst fabricated in this study may be an attractive material for many environmental and energy-related applications.

Purpose. To evaluate the effect of anterior capsule polishing in patients with high myopia after cataract surgery. Setting. The Eye Hospital of Wenzhou Medical University, Zhejiang, China. Design. Prospective study. Methods. High myopic patients with a bilateral cataract who underwent phacoemulsification with 360° anterior capsular polishing in one eye and without polishing in the contralateral eye were recruited. The following parameters were recorded at 1, 3, and 6 months postoperatively, including the area and diameter of the anterior capsule opening (area and D), IOL tilt and decentration, refraction, and postoperative aqueous depth (PAD). Results. Paired samples of 38 eyes of 19 patients were enrolled. The area decreased significantly in both the polished group and unpolished group, whereas the diameter reduced more in the unpolished group. The IOL tilt and decentration at 3-month and 6-month follow-up showed significant differences between two groups. In the unpolished group, the IOL decentration firstly appeared between one-month to three-month visit, while the refraction error, PAD, and IOL tilt were significantly different between the three-month and six-month visits. Conclusion. 360° anterior capsule polishing can effectively reduce the extent of the anterior capsule contraction and increase the stability of IOL. The study was registered at http://www.clinicaltrials.gov, and the clinical trial accession number is NCT 03142269.

To describe the diagnostic signs and biometric characteristics of preexisting posterior capsule defects in congenital cataract.Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Retrospective case series.Eyes with congenital cataract were reviewed and divided into a preexisting posterior capsule defect group (study group) and a control group with intact posterior capsules. Diagnostic signs were summarized on agreement of 3 ophthalmologists after they reviewed surgical videos. The biometric parameters, including central corneal thickness, anterior chamber depth, lens thickness, vitreous chamber depth, axial length, mean keratometry, corneal astigmatism, corneal diameter, and intraocular pressure, were compared between groups. The predictors of preexisting posterior capsule defect were determined using univariate and multivariate analyses.The study comprised 81 eyes (53 patients). The diagnostic signs of preexisting posterior capsule defect included posterior capsule plaque with a well-demarcated margin, gray granules and vacuoles, and heterogeneous nuclear opacity (more dense in the posterior). The lens was significantly thinner in the study group than in the control group (P .001). The corneal diameter was significantly smaller in the study group (P = .015 horizontal and P = .005 vertical). Multivariate analysis identified lens thickness as an independent predictor (odds ratio, 0.731; 95% confidence interval, 0.621-0.860; P .001).For preexisting posterior capsule defect, lens thickness was a valuable predictor and the presence of characteristic morphology was an important indicator. The cornea configuration suggests the need for further study of the role of genetic mutation.

Purpose. To investigate the clinical efficacy and safety of combined phacoemulsification with goniosynechialysis (GSL) under an ophthalmic endoscope for chronic primary angle-closure glaucoma and coexisting cataract. Methods. This is a retrospective study. The intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Other measurements included supraciliochoroidal fluid measured by anterior segment optical coherence tomography, corneal endothelial cell density (ECD), and peripheral anterior synechia (PAS). All patients were followed for more than a year. Results. Thirty-eight eyes of 31 patients were included. The mean follow-up duration was 16.3 ± 3.9 months. The IOP decreased from 22.2 ± 9.3 mmHg at baseline to 15.4 ± 4.2 mmHg at the last follow-up (P<0.001). The mean number of glaucoma medications (0.1 ± 0.6) at the last follow-up was significantly lower than the preoperative number (2.3 ± 1.1) (P<0.001). All patients achieved improved or stable visual acuity after surgery. All patients achieved a complete opened angle after GSL. The postoperative complications included hyphema (7.9%), exudation (5.3%), transiently elevated IOP (55.3%), and supraciliochoroidal fluid (40%). Conclusions. Combined phacoemulsification and GSL under an endoscope can completely reopen PAS and is an effective and safe method for patients with chronic primary angle-closure glaucoma and coexisting cataract.

A new type of Au/TiO2/reduced graphene oxide (RGO) nanocomposite was fabricated by the hydrothermal synthesis of TiO2 on graphene oxide followed by the photodeposition of Au nanoparticles. Transmission electron microscopy images showed that Au nanoparticles were loaded onto the surface of both TiO2 and RGO. Au/TiO2/RGO had a better photocatalytic activity than Au/ TiO2 for the degradation of phenol. Electrochemical measurements indicated that Au/TiO2/RGO had an improved charge transfer capability. Meanwhile, chemiluminescent analysis and electron spin resonance spectroscopy revealed that Au/TiO2/RGO displayed high production of hydrogen peroxide and hydroxyl radicals in the photocatalytic process. This high photocatalytic performance was achieved via the addition of RGO in Au/TiO2/RGO, where RGO served not only as a catalyst support to provide more sites for the deposition of Au nanoparticles but also as a collector to accept electrons from TiO2 to effectively reduce photogenerated charge recombination.

Photocatalytic membranes that driven by visible light are highly desired for water treatment. Here g-C3N4 quantum dots (QDs) assembled into TiO2 nanotube array (TNA) membranes were fabricated for the first time as a visible-light-driven g-C3N4/TNA membrane. Benefiting from the synergistic effect of membrane filtration and photocatalysis, more than 60% of rhodamine B could be removed from water under visible light irradiation. Meanwhile, the g-C3N4/TNA membrane presented an enhanced anti-fouling ability during filtering water containing Escherichia coli under visible light irradiation, and a permeate flux of 2 times higher than that of filtration alone was obtained by integrated process. This study offers a promising strategy for the potential application of the visible-light-driven membranes in water treatment.