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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.

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. 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.

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 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

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

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.

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.

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.

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.

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.

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.