Search

Background: Accessory mitral valve tissue (AMVT) is an extremely rare causes left ventricular outflow tract (LVOT) obstruction and is usually incidentally detected in childhood. It is often associated with other cardiac and vascular congenital malformations. Case Presentation: In this case, we present a 15-year-old girl was diagnosed with AMVT by transesophageal echocardiography, resulting in LVOT obstruction during systole. Interestingly enough, the patient’s accessory mitral valve remained undetected for years until he became symptomatic for wide ASD. Successful closure of the ASD with resection of the AMVT was performed with a transaortic approach. The patient was hemodynamically stable postoperatively. There were no abnormalities in the mitral valves and LVOT. Conclusion: It was also unusual to see AMVT with ASD instead of other frequently associated other congenital anomalies. Accessory mitral valve should be considered a rare but important cause of left ventricular outflow tract obstruction in childhood.

Maintaining object correspondence among multiple moving objects is an essential task of the perceptual system in many everyday life activities. A substantial body of research has confirmed that observers are able to track multiple target objects amongst identical distractors based only on their spatiotemporal information. However, naturalistic tasks typically involve the integration of information from more than one modality, and there is limited research investigating whether auditory and audio-visual cues improve tracking. In two experiments, we asked participants to track either five target objects or three versus five target objects amongst similarly indistinguishable distractor objects for 14 s. During the tracking interval, the target objects bounced occasionally against the boundary of a centralised orange circle. A visual cue, an auditory cue, neither or both coincided with these collisions. Following the motion interval, the participants were asked to indicate all target objects. Across both experiments and both set sizes, our results indicated that visual and auditory cues increased tracking accuracy although visual cues were more effective than auditory cues. Audio-visual cues, however, did not increase tracking performance beyond the level of purely visual cues for both high and low load conditions. We discuss the theoretical implications of our findings for multiple object tracking as well as for the principles of multisensory integration.

Background: Background: Parkinson’s disease (PD) patients who develop freezing of gait (FOG) have reduced mobility and independence. While some patients experience improvement in their FOG symptoms with dopaminergic therapies, a subset of patients have little to no response. To date, it is unknown what changes in brain structure underlie dopa-response and whether this can be measured using neuroimaging approaches. Objective: We tested the hypothesis that structural integrity of brain regions (subthalamic nucleus and globus pallidus internus, GPi) which link basal ganglia to the mesencephalic locomotor region (MLR), a region involved in automatic gait, would be associated with FOG response to dopaminergic therapy. Methods: In this observational study, thirty-six participants with PD and definite FOG were recruited to undergo diffusion kurtosis imaging (DKI) and multiple assessments of dopa responsiveness (UPDRS scores, gait times ON versus OFF medication). Results: The right GPi in participants with dopa-unresponsive FOG showed reduced fractional anisotropy, mean kurtosis (MK), and increased radial diffusivity relative to those with dopa-responsive FOG. Furthermore, using probabilistic tractography, we observed reduced MK and increased mean diffusivity along the right GPi-MLR tract in dopa-unresponsive FOG. MK in the right GPi was associated with a subjective dopa-response for FOG (r = –0.360, df = 30, p = 0.043) but not overall motor dopa-response. Conclusion: These results support structural integrity of the GPi as a correlate to dopa-response in FOG. Additionally, this study suggests DKI metrics may be a sensitive biomarker for clinical studies targeting dopaminergic circuitry and improvements in FOG behavior.

Daylight fluorescent artists’ colors have been well established as fugitive. Upon exposure to light, these vibrant colors can fade and exhibit color shifts. Artwork containing these fluorescent colorants presents complex challenges for art conservators faced with conserving these inherently problematic materials. This paper examined nine fluorescent colorants obtained from Kremer Pigmente, referred to the previous literature and research, and attempted to quantify the visual and photographic observations of fading and color changes. It provides additional information that could be useful in considering conservation documentation and treatment. Fiber optic spectroscopy using ultraviolet and visible light sources was used to measure the spectral shifts of the colorants before and after exposure to light. The fluorescent colors exhibited alterations in intensity coupled with primary peak shifts in the spectrum corresponding to the optical fading and color shifts. Multimodal imaging was executed to analyze the pigments in different regions of the spectrum before and after aging, which has not been documented before with these fluorescent colorants. Imaging in various regions of the spectrum indicated differences in absorption and reflectance between the pigments as captured by a modified camera. The results were compared to recently published research including the identification of the dyes present in the Kremer line of pigments. Multimodal imaging and fiber optic spectroscopy provided valuable information for future documentation and conservation of artworks containing these colorants. Specifically, these non-invasive techniques provide a method to document and identify the spectral changes between the aged and unaged pigment, graph and predict the direction of overall color change, and provide useful data for establishing future conservation treatment protocols.

Purpose. To observe and compare the efficacy of modified trabeculectomy (TE), Ahmed drainage valve implantation (AGV), and EX-PRESS glaucoma shunt for refractory glaucoma (RG). Methods. The study population of this retrospective study comprised 73 patients (76 eyes) who were suffering from RG and treated with modified TE, AGV, and EX-PRESS glaucoma shunt in our hospital from October 2012 to October 2020. The number of cases who underwent modified TE, AVG, and EX-PRESS glaucoma shunt was 36 (38 eyes). 19 (20 eyes), and 18 patients (18 eyes), respectively. The intraocular pressure (IOP), best-corrected visual acuity (BCVA), postoperative antiglaucoma medications, filter bubble morphology, anterior chamber depth (ACD), successful rate, and postoperative complications were recorded and statistically analyzed preoperative and 1 d, 1 w, 1 mon, 3 mon, 6 mon, and the end follow-up after operation. Results. The BCVA differed insignificantly among the three cohorts before and 6 months after surgery. Compared to preoperative BCVA, the postoperative BCVA of the three groups had no statistical significance. An obvious reduction in IOP was observed in all the three group after operation ( P < 0.05 ). An obvious decrease in antiglaucoma medications was observed after surgery in all the three groups ( P < 0.05 ). The AGV group showed deeper ACD postoperatively, while no marked difference was found in postoperative ACD in the other two groups. The total success rates in modified TE and AGV groups were slightly higher than those in the EX-PRESS group. The three groups differed insignificantly in filter bubble morphology after operation. Conclusion. Modified TE, AGV, and EX-PRESS glaucoma shunt showed equivalent efficacy for RG, which could validly reduce IOP and postoperative antiglaucoma medications. However, the success rates of modified TE and AGV were slightly higher than those of EX-PRESS glaucoma shunt in the last follow-up, and their complications were slightly less than those of the EX-PRESS glaucoma shunt.

Objective. To observe the morphological changes of corneal endothelial cells in healthy Chinese children and youngsters and analyze the sensitive and specificity of the endothelial assessments. Methods. 14,670 Chinese healthy volunteers enrolled were examined by specular microscopy, and the endothelial descriptive indexes: the central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in average cell size (CV), the percentage of regular hexagonal cells (hexagonality, HEX), cell size of minimal cell ( S min ), cell size of maximal cell ( S max ), average cell size ( S avg ), and size of standard deviation of cell area ( S sd ) as well as sex and age were analyzed. Results. The average age of this study is 17.36 ± 7.58 (4–30) years. There is no sex predominance: 7,260 male (49.5%) and 7,410 female (50.5%). The mean CCT, ECD, CV, HEX, S min / max , S avg , and S sd are 529.94 ± 31.53 (437–644) μm, 3,051.28 ± 375.49 (2,031–4,074) cells/mm2, 28.34 ± 4.36 (18–40) %, 61.21 ± 10.29 (17–89) %, ( 147.79 ± 21.94 to 678.29 ± 120.96 ) μm2, 332.74 ± 44.62 μm2, and 95.02 ± 23.17 μm2, respectively. The CCTs keep consistency. The ECD decreased rate is 1.02%/year. The curve of ECD and hexagonality expresses the same linear tender. The CCT and endothelial evaluation indexes have no sex predominant ( p > 0.05 ); the quantitative indicators: CCT, ECD, and HEX are significant negative associated with age ( p = 0.001 or p < 0.001 ); the variability indexes: the CV, S min , S max , S avg , and S sd are positive correlation ( p < 0.001 ). The coefficients of CCT, HE, and S min are -0.35, -0.59, and 1.17, respectively. Conclusions. The ECD decrease rate is 1.02%/year of the normal Chinese Han childhood to the earlier adulthood. The ages 4 to 12, 13 to 20, and 21 to 30 can be named as the childhood, puberty and adulthood from endothelial biologic identity. The HEX is the sensitivity marks for the polymorphisms while the S min is the specificity indicator CVs upon the Topcon Noncon Specular microscopy results.

Perceptual decisions depend both on the features of the incoming stimulus and on the ongoing brain activity at the moment the stimulus is received. Specifically, trial-to-trial fluctuations in cortical excitability have been linked to fluctuations in the amplitude of pre-stimulus alpha oscillations (≈8-13 Hz), which are in turn are associated with fluctuations in subjects’ tendency to report the detection of a stimulus. It is currently unknown whether alpha oscillations bias post-perceptual decision making, or even bias subjective perception itself. To answer this question, we used a contrast discrimination task in which subjects reported which of two gratings – one in each hemifield – was perceived as having a stronger contrast. Our EEG analysis showed that subjective contrast was reduced for the stimulus in the hemifield represented in the hemisphere with relatively stronger pre-stimulus alpha amplitude, reflecting reduced cortical excitability. Furthermore, the strength of this spontaneous hemispheric lateralization was strongly correlated with the magnitude of individual subjects’ biases, suggesting that the spontaneous patterns of alpha lateralization play a role in explaining the intersubject variability in contrast perception. These results indicate that spontaneous fluctuations in cortical excitability, indicted by patterns of pre-stimulus alpha amplitude, affect perceptual decisions by altering the phenomenological perception of the visual world.Significance StatementOur moment to moment perception of the world is shaped by the features of the environment surrounding us, as much as by the constantly evolving states that characterize our brain activity. Previous research showed how the ongoing electrical activity of the brain can influence whether a stimulus has accessed conscious perception. However, evidence is currently missing on whether these electrical brain states can be associated to the subjective experience of a sensory input. Here we show that local changes in patterns of electrical brain activity preceding visual stimulation can bias our phenomenological perception. Importantly, we show that the strength of these variations can help explaining the great inter-individual variability in how we perceive the visual environment surrounding us.

BACKGROUND: Ophthalmologists/Optometrists have a high incidence of neck pain. Little research has been conducted on specific equipment that predisposes these professionals to cervical discomfort. OBJECTIVE: Primary purpose: to determine if neck position is altered by slit lamp table design. Secondary purpose: to confirm the prevalence of neck pain in eye care professionals. METHODS: A survey of work-related pain was administered to 36 subjects (8 ophthalmologist, 2 optometrists, 26 technicians). The craniovertebral (CV) angle was measured in each subject in three separate positions (resting posture, best posture, slit lamp posture) between two different slit lamps/tables: slit lamp-deep and slit lamp-shallow. RESULTS: 79% of subjects reported neck pain in the last 6 months. The mean CV angle of all subjects at resting posture, best posture, and both slit lamp postures differed significantly. There was also a difference in CV angle between slit lamps. CONCLUSION: Neck pain is more prevalent in eye professionals than in the general population. The use of slit lamps promotes a forward head posture which decreases the CV angle, putting the user at risk for neck pain. By altering slit lamp table design, the CV angle of eye care professionals can be increased, reducing the risk for neck injury.

AIM: To examine neuroretinal function by using the multifocal electroretinography (mfERG) test in patients with neurofibromatosis type 1 (NF1) without optic pathway gliomas (OPGs). METHODS: This study was conducted on 35 patients (35 eyes) with NF1 and 30 healthy subjects (30 eyes) for the control group. Each subject underwent a complete ophthalmological examination including spectral domain-optical coherence tomography (SD-OCT) and mfERG. The 1.5-Tesla magnetic resonance imaging (MRI) scan of the brain was performed in NF1 patients to assess the presence of OPGs. All participants were recruited having a best corrected visual acuity (BCVA) of no less than 20/20 in each eye. The amplitude and implicit time of the P1 wave (first-order Kernel component) were evaluated on mfERG. Data analysis was carried out in the two central degrees and in the four quadrants from two to 25 degrees of visual field. RESULTS: Statistically significant results were obtained for the P1 wave amplitudes in the 4 quadrants in NF1 patients compared to healthy controls, while the reduction was not significant in the 2 central degrees between the groups. A statistically significant difference was observed among the P1 wave amplitudes as recorded in the 4 quadrants within the NF1 group, with lower amplitudes detected in the nasal quadrants. No differences in the implicit times were recorded in the 2 central degrees and in the 4 quadrants as compared between NF1 patients and controls. CONCLUSION: Impaired neuroretinal function in NF1 patients is expressed in a decreased amplitude of the P1-wave between 2 and 25 central retinal degrees on mfERG. Altered intracellular signal transduction due to abnormal neurofibromin-mediated cyclic adenosine monophosphate (cAMP) generation, can be involved. The possible use of mfERG as subclinical retinal damage indicator has a potential utility in clinical practice for the follow-up of NF1 patients.

Background. Stable angina pectoris (SAP) is one of the main types of coronary heart disease (CHD). To improve treatment outcomes, more effective biomarkers are needed. Currently, studies on the metabolic characteristics of SAP are lacking. Here, we explored the serum metabolomic profile of SAP and identified potential biomarkers and related pathways to assist the clinical diagnosis and treatment of SAP. Method. Thirty patients with SAP patients and 30 healthy controls (CON) without stenosis were selected for this study. All patients underwent coronary angiography. The metabolites of the two groups’ serum samples were investigated using UHPLC-QE-MS. Changes in serum metabolic profile were evaluated using multivariate statistical analysis and pathway analysis. Result. OPLS-DA analysis identified significant differences in the serum metabolic profiles between patients with SAP and CON. Twenty-five differential metabolites were identified between patients from SAP and CON groups, including choline, creatine, L-arginine, beta-guanidinopropionic acid, isopalmitic acid, xanthine, LysoPC (18 : 1), and LysoPC (20 : 3). Pathway analysis found that these differential metabolites were involved in energy metabolism, oxidative stress, purine metabolism, and other metabolic pathways. Conclusion. By comparing the serum metabolic profiles of SAP patients with a control group, we identified 25 potential biomarkers that could improve the clinical diagnosis and treatment of SAP.

The inability to meet the desired outcomes of anticancer treatment and decrease in treatment success of bacterial and fungal infections accelerated research in these areas. Our research group has conducted numerous studies, especially on benzimidazole ring systems' antiproliferative and antimicrobial activities. In this study, the antiproliferative activity of benzimidazole compounds was tested against A549, A498, HeLa, A375, and HepG2 cancer cell lines by MTT assay. All compounds exhibited good to potent antiproliferative activity against all tested cancer cell lines. Compounds 6-chloro-2-(4-fluorobenzyl)-1H-benzo[d] imidazole (30) and 6-chloro-2-phenethyl-1H-benzo[d]imidazole (46) were especially active against HeLa and A375 cancer cell lines with IC50 values in the range of 0.02-0.04 mu M. In contrast, compounds 6-chloro-2-((p-tolyloxy)methyl)-1H-benzo[d] imidazole (67) and 5(6)-chloro-2-((4-hydroxyphenoxy)methyl)-1H-benzimidazole (68) were active against A549 and A498 cancer cell lines with an IC50 value of 0.08 mu M. These compounds (30, 46, 67, and 68) were less toxic to normal human cells than the positive control compound methotrexate, which was screened to determine its toxicity against normal cell lines (HEK293). In the second part of the study, all compounds were tested to demonstrate their antimicrobial properties. All compounds exhibited moderate activity against all tested bacteria and fungi. However, some phenoxy methyl derivatives 5-chloro-2-((4-chlorophenoxy)methyl)-1H-benzo[d]imidazole (69) and 5,6-dichloro-2-((4-chlorophenoxy)methyl)-1H-benzo[d] imidazole and (74) were most active against Candida (

To explore the clinical value of Pentacam anterior segment analyzer in differential diagnosis of high myopia astigmatism and subclinical keratoconus in adolescents. The study included 100 teenagers with ophthalmic diseases treated at our hospital between July 2015 and August 2021, including 58 individuals with simple high myopia astigmatism (73 eyes in the simple high myopia astigmatism group) and 42 teenagers with subclinical keratoconus (51 eyes in the subclinical keratoconus group). The corneal parameters of the two groups were measured with a Pentacam anterior segment analyzer, and we compared the thinnest corneal thickness, anterior (posterior) vertex height of the thinnest point of the cornea, index of vertical asymmetry (IVA), index of height descent (IHD), and the average corneal pachymetric progression index. The receiver operating characteristic curve (ROC) was drawn to evaluate the value of various parameters and combined diagnostic factor Y in the differential diagnosis of high myopia astigmatism and subclinical keratoconus. The thinnest region of the cornea in the subclinical keratoconus group was less than that in the simple high myopia astigmatism group, while the anterior (posterior) vertex height of the thinnest point of the cornea, index of vertical asymmetry (IVA), index of height decentration (IHD), and average corneal pachymetric progression index were higher than those in the simple high myopia astigmatism group ( P < 0.05 ). For the differential diagnosis of high myopia astigmatism and subclinical keratoconus, the combined diagnostic factor Y, anterior (posterior) vertex height, IVA, IHD, and mean corneal progression index were 0.808, 0.833, 0.868, 0.847, 0.684, and 0.926 ( P < 0.05 ). The AUC of the combined diagnostic factory was the largest, which was significantly different from that of the anterior vertex height of the thinnest point of the cornea (Z = 3.280), the posterior vertex height of the thinnest point of the cornea (Z = 3.205), IVA (Z = 2.764), IHD (Z = 2.237), and the average corneal progression index (Z = 4.125) ( P < 0.05 ). Using the Pentacam anterior segment analyzer, differential diagnoses can be made for high myopia, astigmatism, and subclinical keratoconus.

Biodegradable films from gelatin (Gn) with various date by-product (DBP) concentrations (1, 2, 3 and 4 wt %) were prepared. Elaborated films were examined in terms of physical properties (thickness, density, water solubility, water content, degree of swelling, color), and antimicrobial properties (Escherichia coli and Staphylcoccus aureus). Adding the highest concentration of DBP (4%), resulted an increase in the WHC of film as compared with control film. Moreover, the incorporation of 1% DBP reduced the moisture level of Gn based composite films as compared with the control film. Furthermore, Film with 4% of DBP had the lowest solubility which reached 39.39%. Incorporation of DBP from 1 to 4% showed decrease of L- and a-values. The active Gn-DBP 1% showed less lightness as compared to Gn-DBP 3%. The incorporation of DBP into film-forming solutions led to increased opaqueness for all gelatin-based composite films. The calculated opacity value was inversely proportional to transparency. Moreover, the Active Gn-DBP 1% and 2% film presented effective antibacterial activity against bacteria such as Staphylococcus aureus and Escherichia coli. The results showed an enhancement in the biodegradability of Gn-DBP films in moist soil. The results reveal the benefits of date by-products incorporated into gelatin based films as a potential material for active food packaging.

Background. Glaucoma is one of the most frequent vision-threatening eye diseases. It is frequently associated with excessive intraocular pressure (IOP), which can cause vision loss and damaged optic nerves. The main objective of this study was to model time to blindness of glaucoma patients by using appropriate statistical models. Study Design. A Retrospective Community-Based Longitudinal Study design was applied. Materials and Procedures. The data were obtained from Ophthalmology Department of JUSH from the period of January 2016 to August 2020. The glaucoma patient’s information was extracted from the patient card and 321 samples were included in the study. To discover the factors that affect time to blindness of glaucoma patients’, researchers used the Accelerated Failure Time (AFT) model. Results. 81.3 percent of the 321 glaucoma patients were blind. Unilaterally and bilaterally blinded female and male glaucoma patients were 24.92 and 56.38%, respectively. After glaucoma disease was confirmed, the median time to the blindness of both eyes and one eye was 12 months. The multivariable log-logistic accelerated failure-time model fits the glaucoma patient’s time to blind dataset well. The result showed that the chance of blindness of glaucoma patients who have absolute stage of glaucoma, medium duration of diagnosis, long duration of diagnosis, and IOP greater than 21 mmHg were high with parameters (ϕ = 2.425, p value = 0.049, 95% CI [2.249, 2.601]), (ϕ = 1.505, p value = 0.001, 95% CI [0.228, 0.589]), (ϕ = 3.037, p value = 0.001, 95% C.I [2.850, 3.22]) and (ϕ 0.851, p value = 0.034, 95% C.I [0.702, 0.999]), respectively. Conclusion. The multivariable log-logistic accelerated failure time model evaluates the prognostic factors of time to blindness of glaucoma patients. Under this finding, duration of diagnosis, IOP, and stage of glaucoma were a key determinant factors of time to blindness of glaucoma patients’. Finally, the log-logistic accelerated failure-time model was the best-fitted parametric model based on AIC and BIC values.

Purpose. To evaluate the incidence of laser enhancement following cataract surgery and refractive lens exchange (RLE) with FineVision Micro F trifocal lens implantation (PhysIOL, Liege, Belgium). Methods. Retrospective study of patients who had undergone cataract or RLE surgery and had received a FineVision Micro F intraocular lens. Laser enhancement of residual refractive error was determined. Visual acuity (VA) assessments were performed before and after surgery: uncorrected distance VA (UCDVA), best-corrected distance VA (BCDVA), uncorrected near VA (UCNVA), plus preoperative and postoperative spherical equivalent (SE) assessments. Results. Of the 1129 eyes from 596 patients, 61 (5.4%) required laser enhancement to correct residual refractive error (by group: 30/679 eyes [4.4%] cataract; 31/450 eyes [6.9%] RLE). Eleven eyes received FemtoLASIK; 50 eyes received PRK. Mean UCDVA before laser enhancement was 0.26±0.19 logMAR and 0.24±0.14 in the FemtoLASIK and PRK groups, respectively. After laser enhancement, these were 0.04±0.05 logMAR and 0.13±0.19, respectively; BCDVA values were 0.00±0.00 logMAR in the FemtoLASIK group and 0.06±0.11 in the PRK group. Laser enhancement improved UCNVA (Jaeger) from 2-3 to 1-2 in both groups. Enhancement reduced preoperative SE of -0.39±0.99 D and -0.53±0.58 D (FemtoLASIK and PRK groups, respectively) to 0.24±0.36 D and 0.04±0.47 D. Conclusions. The FineVision Micro F trifocal lens is an effective solution for gaining increased spectacle independence. The incidence of residual refractive error requiring laser enhancement is low, and laser procedures are a safe and effective solution for improving the quality of vision and patient satisfaction. Synopsis. Laser enhancement rates and outcomes were determined following cataract / refractive lens exchange surgery that used a trifocal IOL. Enhancement was safe and effective and rates were low (5.4%).

BACKGROUND Intracranial pressure (ICP) and arterial blood pressure (ABP) are related to each other through cerebral autoregulation. Central venous pressure (CVP) is often measured to estimate cardiac filling pressures as an approximate measure for the volume status of a patient. Prior modelling efforts have formalized the functional relationship between CVP, ICP and ABP. However, these models were used to explain short segments of data during controlled experiments and have not yet been used to explain the slowly evolving ICP increase that occurs typically in patients after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE To analyze the functional relationship between ICP, ABP and CVP recorded from SAH patients in the first five days after aneurysm. METHODS Two methods were used to elucidate this relationship on the running average of the signals: First, using Spearman correlation coefficients calculated over 30 min segments Second, for each patient, linear state space models of ICP as the output and ABP and CVP as inputs were estimated. RESULTS The mean and variance of the data and the correlation coefficients between ICP-ABP and ICP-CVP vary over time as the patient progresses through their stay in the ICU. On average, after an SAH event, the models show that a) ABP is the bigger driver of changes in ICP than CVP and that increasing ABP leads to reduction in ICP and (b) increasing CVP leads to an increase in ICP. CONCLUSIONS Finding a) agrees with the hypothesis that patients with subarachnoid hemorrhage have defective autoregulation, and b) agrees with the positive correlation observed between central venous pressure and intracranial pressure in the literature.

Concomitant vitamin D deficiency (VDD) is speculated to aggravate diabetic macular edema (DME). We aimed to determine the effect of hypovitaminosis D correction on the outcome of treatment with intravitreal bevacizumab (IVB) in DME eyes.In this randomized clinical trial, 83 eyes of 83 patients with DME were recruited and divided into three groups: normal vitamin D levels + IVB administration (Group 1), vitamin D insufficient/deficient + IVB administration (Group 2), and vitamin D insufficient/deficient + IVB administration + oral vitamin D supplementation (Group 3). Participants were followed for 6 months after the intervention. Visual (corrected distance visual acuity, CDVA) and anatomical (central macular thickness, CMT) outcomes of intervention were evaluated 1, 3, and 6 months after three monthly loading doses of IVB were given. Serum vitamin D levels were measured 1 and 6 months after the third IVB administration.A total of 29, 26, and 28 eyes were enrolled in groups 1, 2, and 3, respectively. In months 1, 3, and 6, after the three basic loading doses of IVB, visual acuity and CMT improved in all three groups, but improvements (both functional and anatomical) in groups 1 and 3 in month 6 were more significant than in group 2 (mean CDVA LogMAR changes: - 0.18 ± 0.03, - 0.14 ± 0.05, and - 0.2 ± 0.06; mean CMT reductions: - 82.24 ± 11.43, - 66.62 ± 14.34, and - 86.14 ± 18.36, in groups 1, 2, and 3, respectively; p 0.001). The mean number of IVB injections during follow-up was 5.33 (range 4-7), which did not differ between the groups.Correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT. However, this beneficial effect seems to be delayed by several months.Iranian Registry of Clinical Trials (IRCT), IRCT20200407046978N1, registered on April 11, 2020, retrospectively registered ( https://en.irct.ir/trial/46999 ).

BACKGROUND: Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient’s functional independence, neurorehabilitation, and activities of daily living. Post-TBI photophobia can be difficult to treat and the majority of patients can suffer chronically up to and beyond one year after their injury. OBJECTIVES: This review evaluates the current theories of the pathophysiology of photophobia and the most-common co-morbid etiologies of light sensitivity in TBI to help guide the differential diagnosis and individualized management of post-TBI photophobia. METHODS: Primary articles were found via PubMed and Google Scholar search of key terms including “photophobia” “light sensitivity” “photosensitivity” “photo-oculodynia” “intrinsically photosensitive retinal ganglion cells” “ipRGC” and “concussion” “brain injury” “dry eye”. Due to paucity of literature papers were reviewed from 1900 to present in English. RESULTS: Recent advances in understanding the pathophysiology of photophobia in dry eye and migraine and their connection to intrinsically photosensitive retinal ganglion cells (ipRGC) have revealed complex and multifaceted trigeminovascular and trigeminoautonomic pathways underlying photophobia. Patients who suffer a TBI often have co-morbidities like dry eye and migraine that may influence the patient’s photophobia. CONCLUSION: Post-traumatic photophobia is a complex multi-disciplinary complaint that can severely impact a patient’s quality of life. Exploration of underlying etiology may allow for improved treatment and symptomatic relief for these patients beyond tinted lenses alone.

Purpose: The aim of this study was to investigate the prevalance of congenital optic disc (OD) anomalies in Turkey. Methods: The 11149 eyes of 5583 patients were screened for OD anomalies. All patients were underwent a complete ophthalmic examination including best corrected visual acuity, refraction, spherical equivalent, slit lamp biomicroscopy, intraocular pressure measurements, dilated stereoscopic fundus examination. Data analyses were performed by using SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL, United States).Results: 11149 eyes of 5583 participants were screened. Of the 5583 participants who underwent OD examination, 186 (3,3%) were found to be abnormal. 266 of 11149 (2,38%) eyes were found OD anomalies. 98 (52,7%) were female, 88 (47,3%) were male and the mean of age was 44,05±15,73 years. The prevalence of all congenital OD anomalies was found 3,3%. The tilted disc was the most common anomaly and was found at least one eye in 46 patients (75 eyes) and 0.82% of all screened patients. Peripapillary myelinated nerve fibres was the second common anomaly and was found at least one eye in 29 subjects (35 eyes) and 0,51% of all screened subjects. Peripapillary atrophy was the third common anormality, and was found in at least one eye in 24 patients (37 eyes) and 0,42% of all screened subjects.Conclusion: To our knowledge, this is the first study that the prevalences of all congenital optic disc anomalies from Turkey. The prevalence of congenital optic disc anomalies is higher than in other countries.

BACKGROUND: Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system, such as in the pupil and accommodation. OBJECTIVE: To describe the static and dynamic abnormalities in the pupillary and accommodative systems in those with C/mTBI. This includes both diagnostic and therapeutic aspects, with emphasis on objectively-based test findings, as well as their basic and clinical ramifications. METHODS: PubMed, Google Scholar, and Semantic Scholar databases were searched from 1980–2020, using key words of accommodation, pupil, vision therapy, vision rehabilitation, and objective testing, for peer-reviewed papers, as well as related textbooks in the area, in those with C/mTBI. RESULTS: For both systems, most static and dynamic response parameters were abnormal: they were typically reduced, slowed, delayed, and/or more variable. Most of the abnormal accommodative parameters could be significantly improved with vision therapy. CONCLUSIONS: For both systems, most response parameters were abnormal, which could explain their visual symptoms and related problems. For accommodation, the improvements following vision therapy suggest the presence of considerable visual system plasticity, even in older adults with chronic brain injury.

BACKGROUND: Tinted lenses have been used to manage visual discomfort and photosensitivity in patients with migraines, benign essential blepharospasm (BEB) and epilepsy. OBJECTIVES: The purpose of this review is to examine the existing clinical research regarding the use of colored filters among patients recovering from traumatic brain injuries. METHODS: A review of English articles from PubMed, Embase from embase.com, Web of Science, APA PsycINFO (OVID), Scopus, and Cochrane Central Register of Controlled Trials with publication years from date of inception to June 10, 2021 was performed. Articles were first screened by title and abstract, followed by full-text review. The search strategy resulted in 7819 results. The final analysis included seven articles which discussed the use of tinted lenses in patients post-traumatic brain injury. RESULTS: While there is a paucity of information related to the therapeutic use of tinted lenses to mitigate post-traumatic light sensitivity and migraines, patients will subjectively report improved symptoms, specifically with precision tints or FL-41. CONCLUSION: Further studies are needed to understand the mechanism of action as well as objective and subjective benefits of tinted lenses in patient post-traumatic brain injury.

Purpose. To evaluate the long-term anatomic and functional outcomes of autologous neurosensory retinal free flap transplantation (ART) for patients with refractory large macular hole (MH). Design. Retrospective interventional case series. Methods. We reviewed 9 patients who underwent ART for their refractory large MH. In this extended follow-up study, postoperative assessment including spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) were recorded at 12, 15, 18, 21, and 24 months after surgery. Results. The macular hole of all patients appeared successfully closed during the whole follow-up period. The mean logMAR BCVA improved from 1.61 ± 0.44 (preoperative) to 0.72 ± 0.30 (12 months after surgery) ( p < 0.001 ). Thereafter, the mean BCVA remained stable at each follow-up. At the mean 16.0 ± 0.8 months postoperatively, inner retinal cystic changes were observed in 4 eyes (44.4%), but these did not significantly affect vision. Conclusion. ART is a good alternative technique for closing large refractory macular holes. Although inner retinal cystic changes were observed in 4 eyes (44.4%), this phenomenon did not significantly affect visual acuity. It provides long-term good anatomical and functional results, especially in cases where insufficient ILM or lens capsule are left.

Objective. In infective endophthalmitis, once the patient’s vision is seriously damaged, the damage to children’s vision is particularly serious. The main purpose of this study is to investigate the etiology, epidemiology, treatment, and visual prognosis of children’s endophthalmitis and to conduct an in-depth analysis. Study Design. This study collected case data from the Beijing Tongren Hospital Capital Medical University in the period from January 1, 2002 to January 1, 2018. The basic conditions for inclusion in the collection range were patients who were less than or equal to 14 years old and had a history of infectious endophthalmitis. A retrospective study and analysis of etiology, epidemiology, treatment, and visual prognosis were performed. Kappa and Chi square test were used for statistical analysis. Results. A total of 232 cases were collected, with an average age of 6.33 ± 2.89 years (range 8months to 14 years). The most common etiologies were ocular trauma (93.5%) and previous ocular surgery (5.2%). Overall, 81 samples were sent to the microbiology department for direct smear and culture, from which 21 organisms were isolated. 28 cases (39.5%) were culture-positive. The most organism was Gram-positive organisms. In treatment, the proportion of PPV use combined with silicone oil filling had increased gradually in three phases, while the other treatments were almost decreased or nearly similar. The final visual result is 22 (9.5) in 20/200 or better, 65 (28.0) in CF-20/200, 38 (16.4) in hand move (HM), 27 (11.6) in light perception (LP), 21 (9.1) in no light perception (NLP), and 59 (25.4) did not match (NM). Conclusion. Penetrating ocular trauma is the most common cause of infectious endophthalmitis in children. The detection rate of microorganisms is low and helpless for the treatment. In this study, it was found that despite the aggressive treatments such as antibacterial and vitrectomy, the ultimate improvement in vision was highly undesirable.

Background: To identify the underlying genetic defect responsible for microphthalmos eyes in two three-generation Chinese families.Methods: In our study, we screened 425 potential eye disease-related genes of the proband of a three-generation Chinese family diagnosed with microphthalmos using next-generation sequencing-based target capture sequencing. Variants were filtered and analyzed to identify possible disease-causing variants before Sanger sequencing validation.Results: We enrolled two families with microphthalmos (Family 1: microphthalmos with congenital ocular coloboma and Family 2: simple microphthalmos). Two novel heterozygous mutations, PXDN c.3165C>T (p.Pro1055Pro) and PXDN c.2640C>G (p.Arg880Arg), were found in Family 1, and CRYBB2 c.481G>A (p.Gly161Arg) was found in Family 2, but none of the mutations were found in the unaffected individuals, who were phenotypically normal. Multiple orthologous sequence alignment (MSA) revealed that the CRYBB2 p.Gly161Arg mutation was a deleterious effect mutation.Conclusions: The three novel mutations found in our study extend our current understanding of the genetic basis of microphthalmos and provide early presymptomatic diagnosis and emphasize the significance of genetic diagnosis of microphthalmos.

As prodrugs series of new sartan-derived molecules were designed, synthesized, and evaluated. Most of the synthesized compounds could decrease blood pressure efficiently in spontaneously hypertensive rats. It could be ratiocinated that the original drugs could be released from the prodrugs exactly at the connecting position catalyzed by the hydrolyzation enzymes. The maximal response of mean blood pressure (MBP) lowered 70.2 ± 5.0 mmHg (compound 1) and 61.2 ± 1.0 mmHg (compound 4) at 10 mg/kg after oral administration, and the antihypertensive effect lasted beyond 24 h, which performed better than Losartan and were similar with Telmisartan. Pharmacokinetics test results of 1 were consistent with its anti-hypertension effects in vivo. The safety of new compounds was confirmed by the influence on the rats’ heart rates and other symptoms which couldn’t been observed during whole process. Thence, compounds 1 and 4 may be considered as potential antihypertension drug candidates.

Objective. To investigate the prevalence of refractive errors and risk factors for myopia in primary school students in Saybag District of Urumqi. Methods. A total of 972 primary school students in two elementary schools in Saybag District were included in this study which was conducted from June 2019 to November 2019. Uncorrected visual acuity test and noncycloplegic autorefraction were performed, and their visual acuity was analyzed. Multivariate regression analysis was performed to predict risk factors for myopia. Results. Myopia was the most frequent refractive error among primary school students aged 7-11 in Sayibake District, Urumqi City, with a prevalence rate of 60.39%, and mainly mild myopia. The proportion of myopia increased with age, and the proportion of females suffering from myopia was higher than that of males, and the proportion of students from the Han ethnic group suffering from myopia was also higher than that of the other ethnic groups. The students mainly suffered from mild myopia, and the degree of myopia was related to age and gender, regardless of ethnicity. In addition, multivariate regression analysis showed that age and gender were the influencing factors of myopia occurrence and progression Conclusion.Our study results showed a significant prevalence of myopia in pupils aged 7-11 years in Saybag District of Urumqi is affected by gender and age and not by ethnicity.

Background: Despite experimental evidence for concurrent dementia and visual impairment, there are no currently validated vision-related quality of life measures for use in this population. Objective: To establish the extent to which individuals with mild to moderate dementia self-report visual impairment and determine the efficacy of established vision-related quality of life measures for use in a dementia population. Methods: We compared vision-related quality of life in participants with mild-moderate dementia to healthy (dementia-free) older adults using two existing questionnaire measures already validated for use in older adults. These were the Visual Activities Questionnaire (VAQ) and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Results: Responses on both the VAQ and VFQ-25 revealed a significant effect of dementia on self-reported vision-related quality of life. Visual impairment in dementia was identified in the domains of color discrimination, disability glare, light/dark adaption, acuity/spatial vision, depth perception, peripheral vision, visual search, and visual processing speed. Factor analysis of the data suggested that existing vision-related quality of life measures, designed for use in older adult populations, are likely to provide a robust means of assessing vision-related quality of life in older adults with dementia. This is particularly true of the VAQ, for which one latent factor emerged for both dementia and dementia-free samples. Conclusion: Using existing measures designed for use in older adult populations, we have shown that people with dementia experience reduced vision-related quality of life.

Sjögren-Larsson syndrome (SLS) is a neurometabolic disease with a peculiar crystalline maculopathy. It is yet unclear if vascular abnormalities play a role in SLS maculopathy pathogenesis. We used optical coherence tomography angiography (OCT-A) to search for vessel abnormalities in SLS maculopathy. We performed a cross-sectional study in 4 patients (2 males, 2 females, aged 12–36 years) with various stages of SLS maculopathy. Besides OCT-A imaging, a complete ophthalmological examination and additional retinal imaging by transversal and en face spectral domain (SD) OCT were performed. OCT-A images were qualitatively assessed for vascular abnormalities, and imaging was compared to eight eyes of four healthy controls. On OCT-A, all eyes of patients with SLS showed a reduced capillary density around the fovea, and an enlarged foveal avascular zone (FAZ; SLS patients [n = 6 eyes] mean 0.70 mm2 [SD 0.18]; healthy controls [n = 8 eyes] mean 0.34 mm2 [SD 0.07], p = 0.004). In 2 patients, telangiectatic vessels were seen in the deep capillary layer. In conclusion, OCT angiography showed capillary paucity and morphological vessel abnormalities in these 4 patients with SLS.

BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

Retinal pigment epithelial (RPE) is primarily impaired in age-related macular degeneration (AMD), leading to progressive loss of photoreceptors and sometimes choroidal neovascularization (CNV). mTOR has been proposed as a promising therapeutic target, while the usage of its specific inhibitor, rapamycin, was greatly limited. To mediate the mTOR pathway in the retina by a noninvasive approach, we developed novel biomimetic nanocomplexes where rapamycin-loaded nanoparticles were coated with cell membrane derived from macrophages (termed as MRaNPs). Taking advantage of the macrophage-inherited property, intravenous injection of MRaNPs exhibited significantly enhanced accumulation in the CNV lesions, thereby increasing the local concentration of rapamycin. Consequently, MRaNPs effectively downregulated the mTOR pathway and attenuate angiogenesis in the eye. Particularly, MRaNPs also efficiently activated autophagy in the RPE, which was acknowledged to rescue RPE in response to deleterious stimuli. Overall, we design and prepare macrophage-disguised rapamycin nanocarriers and demonstrate the therapeutic advantages of employing biomimetic cell membrane materials for treatment of AMD.

Purpose To investigate the association between the presence of a cilioretinal artery (CRA) and advanced age-related macular degeneration (AMD), including the prevalence of choroidal neovascularization (CNV) and geographic atrophy (GA). Design Retrospective cross-sectional study. Methods Setting: Single center Patient population: A total of 738 patients with AMD who underwent optical coherence tomography angiography (OCTA) were included in the study. Fundus photographs were reviewed to determine the presence of the CRA. Intervention/observation procedures: In patients with a unilateral CRA, paired tests were performed between eyes with and without the CRA to compare AMD severity and prevalence of CNV and GA. Main outcomes: AMD stage, and prevalence of CNV and GA. Macular vasculature, including vessel density, perfusion density, and foveal avascular zone, examined using OCTA. Results A total of 27.8% and 8.1% of patients had a CRA in one and both eyes, respectively. A total of 174 eyes from 87 patients with a unilateral CRA were examined. Eyes with a CRA showed lower AMD stage (4-step AREDS category; P = 0.037) and a lower prevalence of CNV (23.0% vs. 41.4%; P = 0.024) than those without a CRA. The prevalence of GA and macular vessel density, perfusion density, and foveal avascular zone measured by OCTA were similar in both groups. Conclusions In the eyes with a CRA, AMD stage and prevalence of CNV were lower than those in the eyes without a CRA. However, the effect of the CRA on the macular vascular system remains unclear.

BACKGROUND: Changes in choroidal vascularity index (CVI) are associated with multiple choroid-related ocular diseases. CVI is calculated as the area/volume ratio of vessels in the choroid, which could be affected by alterations in regional signal intensities due to hypo-transmission defects (hypoTDs) caused by drusen and retinal pigment epithelium (RPE) detachments, and hyper-transmission defects (hyperTDs) caused by the absence of RPE. To develop a simulation model to verify the CVI assessments in eyes with hyper/hypoTDs and demonstrate that accurate CVIs can be achieved after attenuation correction on swept-source optical coherence tomography (SS-OCT). METHODS: A simulation model was developed on 6×6 mm macular scans from normal subjects. Signal intensity in a cylindrical region below RPE was altered to mimic hyper/hypoTDs. CVIs were compared inside and outside the simulated regions before and after attenuation correction. CVI assessments of OCT scans from patients with hyperTDs due to geographic atrophy (GA) and from patients with hypoTDs due to drusen that subsequently resolved with the disappearance of the hypoTDs were compared with and without attenuation correction. RESULTS: Ten normal eyes were recruited to generate the hyper/hypoTD simulation model. In eyes with hypoTDs, CVIs were overestimated, and in eyes with hyperTDs, the CVIs were underestimated (P

Skeleton-based human action recognition has received extensive attention due to its efficiency and robustness to complex backgrounds. Though the human skeleton can accurately capture the dynamics of human poses, it fails to recognize human actions induced by the interaction between human and objects, making it is of great importance to further explore the interaction between the human and objects for human action recognition. In this paper, we devise the multi-stream interaction networks (MSIN), to simultaneously explore the dynamics of human skeleton, objects, and the interaction between human and objects. Specifically, apart from the traditional human skeleton stream, 1) the second stream explores the dynamics of object appearance from the objects surrounding the human body joints; and 2) the third stream captures the dynamics of object position in regard to the distance between the object and different human body joints. Experimental results on three popular skeleton-based human action recognition datasets, NTU RGB+D, NTU RGB+D 120, and SYSU, demonstrate the effectiveness of the proposed method, especially for recognizing the human actions with human-object interactions.

A 63-year-old white man with hypertension, hyperlipidemia, adrenal insufficiency, and history of metastatic spindle cell melanoma previously treated with ipilimumab, presented with unilateral papillitis in the left eye. The disc edema evolved to neuroretinitis with additional MRI findings of perineuritis. Broad laboratory evaluation confirmed active B. henselae infection, and he confirmed exposure to a newly adopted kitten. His vision improved following a course of antibiotics and oral steroids with resolution of clinical findings. To the best of our knowledge, this is the first reported case of cat-scratch neuroretinitis with MRI findings of optic nerve and optic nerve sheath enhancement.

OBJECTIVE: The ocular vascular system plays an important role in preserving the visual function. Alterations in either anatomy or hemodynamics of the eye may have adverse effects on vision. Thus, an imaging approach that can monitor alterations of ocular blood flow of the deep eye vasculature ranging from capillary-level vessels to large supporting vessels would be advantageous for detection of early stage retinal and optic nerve diseases. METHODS: We propose a super-resolution ultrasound localization microscopy (ULM) technique that can assess both the microvessel and flow velocity of the deep eye with high resolution. Ultrafast plane wave imaging was acquired using an L22–14v linear array on a high frequency Verasonics Vantage system. A robust microbubble localization and tracking technique was applied to reconstruct ULM images. The experiment was first performed on pre-designed flow phantoms in vitro and then tested on a New Zealand white rabbit eye in vivo calibrated to various intraocular pressures (IOP) – 10 mmHg, 30 mmHg and 50 mmHg. RESULTS: We demonstrated that retinal/choroidal vessels, central retinal artery, posterior ciliary artery, and vortex vein were all visible at high resolution. In addition, reduction of vascular density and flow velocity were observed with elevated IOPs. CONCLUSION: These results indicate that super-resolution ULM is able to image the deep ocular tissue while maintaining high resolution that is comparable with optical coherence tomography angiography. SIGNIFICANCE: Capability to detect subtle changes of blood flow may be clinically important in detecting and monitoring eye diseases such as glaucoma.

Purpose To evaluate the effectiveness of previously applied successful accelerated cross-linking (CXL) treatment in keratoconus stabilization during and after pregnancy. Setting Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Turkey. Design Prospective, clinical study. Methods Patients who became pregnant with stable keratoconus (after having an accelerated CXL procedure) were included. Uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest astigmatism (MA), keratometry (K)1, K2, K-max, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior (AE) and posterior elevation (PE) were recorded at baseline (before CXL), before pregnancy (the last visit after CXL), during pregnancy (3rd trimester) and after pregnancy (the last visit after pregnancy). Results Study included 24 eyes of 19 patients. The mean time between CXL and conception was 12.4±5.1 months. The mean post-partum follow-up period was 27.6±13.3 months. The mean UDVA, CDVA, MA, and PE values did not show any significant differences during and after pregnancy compared to the post CXL values (p>0.05). The mean K-max flattened significantly after the CXL procedure (p=0.011), however it increased during pregnancy (p=0.037:after CXL-pregnancy) and then decreased back to the pre-pregnancy level after pregnancy (p=0.035:pregnancy-after pregnancy). The mean K1, K2, AE, CCT, and TCT remained stable during pregnancy and significantly decreased after pregnancy (p Conclusion Keratoconus appears to progress during pregnancy in corneas that have previously received successful accelerated CXL treatment. However, this progress is mostly temporary, and generally regression occurs after delivery.

Purpose To determine the prevalence and characteristics of Charles Bonnet Syndrome (CBS) and its relation to visual field loss (VFL) in patients with open-angle glaucoma (OAG). Design Prospective, cross-sectional study. Participants Adult patients (n=337) with manifest OAG with verified VFL and without significant macular disease or extraocular conditions known to cause visual hallucinations. Methods Patients attending the glaucoma outpatient department of the Skane University hospital, Malmo, Sweden, between April 1st 2018 and December 31st 2018 were consecutively evaluated for inclusion. Potentially eligible patients admitting to having complex visual hallucinations were interviewed to explore the characteristics of their hallucinatory experiences. Recent automated visual field examinations were available for all participants and swept source optical coherence tomography was performed in participants with CBS to rule out previously undiagnosed macular pathology. The correlation between potential risk factors and CBS was evaluated with logistic regression analysis. Main outcome measure Prevalence of CBS in patients with OAG. Results CBS was found in 7.1% (95% CI: 4.7% - 10.6%) of patients with OAG. Participants with CBS were more likely to have at least one eye with a visual field index (VFI) of ≤ 30% compared to those without CBS (71% vs. 34.2%; P = 0.001). Although the best-corrected visual acuity (BCVA) in the worse eye was significantly lower in participants with CBS (decimal equivalent of Snellen BCVA: 0.25 vs. 0.6, P = 0.003), 33% of these participants had a BCVA of ≥ 0.5 in the worse eye. In multivariable analysis, CBS was correlated to the VFI of the better eye (odds ratio 0.984; 95% CI: 0.969 - 0.998, P = 0.030) and the BCVA of the worse-seeing eye (odds ratio 0.210; 95% CI: 0.046 - 0.952, P = 0.043). Conclusions CBS was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, one out of three patients with CBS had a BCVA of ≥ 0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms of CBS in patients with glaucomatous VFL even when visual acuity is preserved.

Zhiqiao Hu,&ast; Hao Zhang,&ast; Jiaqi Wang, Huan Xiong, Yunxiao Liu, Yihao Zhu, Zewen Chang, Hanqing Hu, Qingchao Tang Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qingchao Tang, Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, People’s Republic of China, Tel +86-13945052628, Email 13945052628@qq.comPurpose: To develop and validate the risk nomogram to predict the likelihood of postoperative anxiety and depression in colorectal cancer (CRC) patients.Methods: A total of 602 CRC patients from the Second Affiliated Hospital of Harbin Medical University were included in the study and divided into development set and validation set with the 2:1 ratio randomly. Logistic regression model was used to determine independent factors contributing to postoperative anxiety and depression, which were subsequently applied to build the nomogram for predicting postoperative anxiety and depression. The performance of the risk nomogram was appraised by the area under the receiver operating curve (AUC), calibration curves and decision curve analyses (DCA).Results: Gender, personal status, income, adjuvant therapy, the Eastern Cooperative Oncology Group Scale (ECOG) score, comorbidity, postoperative complications and stoma status were significant indicators for postoperative anxiety and depression. The AUCs for the development and validation sets were 0.792 and 0.812 for the postoperative anxiety nomogram and 0.805 and 0.825 for the postoperative depression nomogram. Additionally, calibration curves and decision curve analyses also determined the reliable clinical importance of the proposed nomogram.Conclusion: The current study constructed the risk nomogram for postoperative anxiety and depression and could help clinicians determine high-risk patients to some extent.Keywords: nomogram, colorectal cancer, postoperative, anxiety and depression

To investigate whether penile pathologies are presented diversely in urologic textbooks and identify areas where more diverse presentation is warranted.Photographic depictions of penile pathologies in 9 urologic textbooks were assigned a Fitzpatrick skin phototype and constitutive skin color. Fitzpatrick skin phototypes ranged from I to VI, and constitutive skin colors were light, fair, medium, and dark. Fitzpatrick skin phototypes I-III were deemed nonskin of color, and IV-VI considered skin of color. Figures were classified based on pathology presented: infectious benign or sexually transmitted infection (STI), noninfectious benign, or malignant. Chi-square and odds ratios were used to compare skin color ranges across pathologic categories and determine where a figure depicting skin color would most likely be encountered.Within 116 figures meeting inclusion criteria, 15 (51.7%) infectious/STI pathologies displayed skin of color, while 10 (27.8%) noninfectious benign and 7 (13.7%) malignant pathologies displayed skin of color. Within 85 diagnostic images, 15 (51.7%) images of infections/STIs, 10 (28.6%) noninfectious benign, and 4 (19.0%) malignant pathologies presented skin of color (P0.01). Overall, images of patients with skin of color were more likely depictions of infections/STIs than any other pathology (P.001, OR = 2.26).There is a lack of depictions of malignant and noninfectious benign penile pathology on the skin of color. This may contribute to continued disparities in the diagnosis and treatment of penile pathologies.

PURPOSE To investigate the safety and efficacy of cultured human corneal endothelial cell (hCEC)-injection therapy with mature differentiated (mature) cell subpopulations (SPs) for corneal endothelial failure (CEF). DESIGN Comparative, interventional case series. METHODS This study involved 18 eyes with CEF that underwent cultured hCEC-injection therapy, categorized into two groups: 1) 11 eyes administered a relatively lower proportion (0.1 to 76.3%) of mature cell SPs [Group 1 (Gr1)], and 2) 7 eyes administered a relatively higher proportion (>90%) of mature cell SPs [Group 2 (Gr2)]. From 1-week to 3-years postoperative, corneal endothelial cell (CEC) density (CECD), central corneal thickness (CCT), and best-corrected visual acuity (BCVA) were recorded, and the CEC parameter's 'spring constant' was calculated. The proportion of mature SPs was evaluated by fluorescence-activated cell sorting analysis based on cell-surface markers. RESULTS At 3-years postoperative, corneal restoration with improved BCVA was attained in 10 of the 11 Gr1 eyes and all Gr2 eyes, the median CECD in Gr2 (3,083 cells/mm2; range, 2,182-4,417 cells/mm2) was higher than that in Gr1 (1,349 cells/mm2; range, 746-2,104 cells/mm2) (P < 0.001), and the spring constant verified the superiority of the mature cultured hCECs. From 24-weeks through 3-years postoperative, the median percentage of CECD decrease was 3.2% in Gr2 and 23.6% in Gr1 (P < 0.005). CCT recovery was prompt and constant in Gr2, while diverse in Gr1. No adverse events were observed. CONCLUSION Our findings showed that mature cell SPs for hCEC-injection therapy provide rapid recovery of CCT, better CECD, and low CECD attrition over 3 years post surgery.

Damon S Dierker,1 Scott G Hauswirth2 1Eye Surgeons of Indiana, Indianapolis, IN, USA; 2Department of Ophthalmology, Sue-Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USACorrespondence: Damon S Dierker, Eye Surgeons of Indiana, 9202 N Meridian St, #100, Indianapolis, IN, 46260, USA, Email damon.dierker@esi-in.comSignificance: Meibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy.Purpose: To compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD.Methods: This was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12.Results: Nineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects.Conclusion: This study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.Keywords: Dextenza, dexamethasone, LipiFlow, thermal pulsation therapy, meibomian gland dysfunction

Forgiveness helps repair ruptured relationships and maintain cooperation. It may most usefully serve these functions when it is preferentially directed toward better cooperators. We examined this proposal in two studies with young children. Study 1 asked whether children forgive in-group members (whom people generally expect to be more cooperative) more than out-group members. When a novel in-group member and out-group member both transgressed against the child and both showed remorse, 5-year-old children (N = 20) were more forgiving of the in-group member. In Study 2, when only the out-group transgressor was remorseful whereas the in-group transgressor was unremorseful (and did not demonstrate cooperative intent), 5-year-olds (N = 20) were more forgiving of the remorseful out-group transgressor. Children also judged the unremorseful in-group transgressor negatively and wanted her to leave their group. Together, these results reveal that from early in life, forgiveness is preferentially directed so as to maximize successful cooperation while reducing the risk of exploitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mei Li,1 Jing Xu,1,2 Yujue Wang,1 Xiaoye Du,1,2 Teng Zhang,1,2 Yu Chen1– 3 1Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200427, People’s Republic of China; 2Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of China; 3Laboratory of Clinical and Molecular Pharmacology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200427, People’s Republic of ChinaCorrespondence: Yu Chen, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, 200437, People’s Republic of China, Tel +86 21 5598 1009, Fax +86 21 5598 1009, Email chenyu@shutcm.edu.cnPurpose: Photoreceptors are specialized retinal neurons responsible for phototransduction. Loss of photoreceptors directly leads to irreversible vision impairment. Pharmacological therapies protecting against photoreceptor degeneration are clinically lacking. Oxidative stress and inflammation are common mechanisms playing important roles in the pathogenesis of photoreceptor degeneration. Astragaloside A (AS-A) is a naturally occurring antioxidant and anti-inflammatory agent with neuroprotective activities. However, the photoreceptor protective effects of AS-A remain unknown. The current study thus aims to illustrate the pharmacological potentials of AS-A in protecting against photoreceptor degeneration.Methods: BALB/c and C57/BL6J mice were exposed to bright light and DNA alkylating agent methyl methanesulfonate (MMS) to develop oxidative stress and DNA damage-mediated photoreceptor degeneration, respectively. Microstructural, morphological and functional assessments were performed to directly evaluate the photoreceptor protective effects of AS-A. Ultrastructural and molecular changes in the retina were examined to better understand the pharmacological mechanisms of AS-A in protecting against photoreceptor degeneration.Results: AS-A protected against bright light-induced photoreceptor impairment. Bright light-induced retinal oxidative stress and photoreceptor cell death were attenuated by AS-A treatment. AS-A treatment mitigated bright light-induced DNA damage, activation of poly (ADP-ribose) polymerase (PARP) and nuclear dislocation of high mobility group box 1 (HMGB1) in photoreceptors. AS-A broadly counteracted bright light-altered retinal gene expression profiles. In particular, AS-A decreased the retinal expression of genes involved in necroptosis and inflammatory responses. Bright light-induced microglial activation was also suppressed as a result of AS-A treatment. Furthermore, AS-A attenuated MMS-induced photoreceptor morphological impairment, elevated expression of pro-necroptotic and proinflammatory genes as well as microglial activation in the retina.Conclusion: The work here demonstrates for the first time that AS-A protects against photoreceptor degeneration in part through mitigating oxidative stress and DNA damage-induced necroptosis and inflammatory responses in the retina.Keywords: retinal degeneration, photooxidative stress, photoreceptor protection, programmed cell death, microglial activation

Katarzyna Ewa Nowik,1 Kamil Nowik,1 Piotr Kanclerz,2,3 Jacek Pawe&lstrok; Szaflik1 1Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), Medical University of Warsaw, Warsaw, Poland; 2Department of Ophthalmology, Hygeia Clinic, Gda&nacute;sk, Poland; 3Helsinki Retina Research Group, University of Helsinki, Helsinki, FinlandCorrespondence: Katarzyna Ewa Nowik, Tel +48 509 873 680, Email lek.katarzynaolejnik@onet.euPurpose: Extended depth of focus intraocular (EDOF) IOLs form a bridge between single- and multifocal IOL design. This study aimed to compare clinical outcomes obtained after implanting two different optical designs of EDOF IOLs: the Mini Well Ready (SIFI Medtech, Catania, Italy) and Tecnis Symfony (Abbott Laboratories, Illinois, USA).Methods: The retrospective observational study included 61 patients (122 eyes) who underwent bilateral implantation of the Mini Well Ready IOL (32 patients) or the Tecnis Symfony IOL (29 patients). The following preoperative and postoperative parameters were evaluated: spherical equivalent, anterior astigmatism, pupil size, monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), monocular and binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA). In the 6 months postoperative period, defocus curve, contrast sensitivity, photopic phenomena, and posterior capsule opacification were assessed.Results: The patients receiving the Tecnis Symfony had slightly better monocular and binocular UDVA and CDVA than with the Mini Well Ready IOL, the differences were not statistically significant. Whereas the UIVA, DCIVA, UNVA, DCNVA, UNVA and DCNVA values were higher in the Mini Well Ready group, the differences were not significant. There were no significant between-group differences regarding the defocus curve for the vast majority of tested vergences. Dysphotopsias postoperatively were assessed at 6 months.Conclusion: Patients receiving both the Mini Well Ready and Symfony IOLs had excellent visual acuity outcomes and spectacle independence.Keywords: cataract, extended depth of focus, defocus curve, intraocular lens

Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's effect on vitreomacular adhesion resolution (VMAR), MH closure, vitrectomy, and best-corrected visual acuity (BCVA) and investigated the effect of baseline covariates on outcome. We applied individual participant data meta-analyses to the entire population and to subgroups defined by MH or epiretinal membrane (ERM) presence. Safety data were pooled and tabulated. Five randomized controlled trials (1,067 participants) were included. Six months after treatment, ocriplasmin achieved higher rates of VMAR and MH closure versus control, lowered vitrectomy odds, and increased the likelihood of a ≥10-letter BCVA increase. VMAR rates were lower when ERM, broad VMA (> 1500 µm), diabetic retinopathy, or pseudophakia were present and higher in younger participants, women, and eyes with MHs. Ocriplasmin-treated participants experienced more short-term visual impairment that was not predictive of final BCVA, as well as vitreous floaters, photopsia, photophobia, eye pain, blurred vision, and dyschromatopsia. The most common serious adverse events for ocriplasmin and control, respectively, were MH progression (22.5%, 17.3%), new MH (1.5%, 3.4%) and retinal detachment (0.8%, 1.2%). Ocriplasmin promotes VMAR and MH closure. Transient visual phenomena are not uncommon.

PURPOSE To assess the relationship between best corrected visual acuity (BCVA) and central subfield optical coherence tomography (OCT) features in noninfectious uveitis (NIU)-related macular edema (ME). DESIGN Clinical cohort study from post hoc analysis of two phase 3 clinical trials' data. METHODS Correlation and longitudinal treatment analyses were performed. Of 198 patients with NIU, 134 received suprachoroidally administered CLS-TA (Clearside Biomedical, Inc. proprietary formulation of a triamcinolone acetonide injectable suspension) and 64 received sham, with 12.9% and 72% respectively receiving rescue therapy. RESULTS At baseline, mean BCVA progressively worsened with each ordinal drop in ellipsoid zone (EZ) integrity. Eyes with normal baseline EZ experienced greater 24-week change in BCVA compared to eyes with some degree of baseline EZ disruption (11.9 vs 9.4 letters, P=0.006). In contrast, eyes without central subfield cystoid spaces and/or central subfield SRF at baseline showed less improvement (5.5 letters or 9.5 letters, respectively) at 24 weeks, compared to those eyes with such OCT findings (13.7 letters, P = 0.012 or 17.2 letter, P

Purpose To assess the efficacy and safety of repeated low-level red-light (RLRL) therapy in myopia control in children. Design Multicenter, randomized, parallel-group, single-blind clinical trial. Participants A total of 264 eligible children aged 8 to 13 years with myopia of cycloplegic spherical equivalent refraction (SER) of -1.00 to -5.00D, astigmatism 2.50D, anisometropia 1.50D, best-corrected visual acuity (BCVA) > 0.0 logMAR (Snellen 1.0 or 20/20) were enrolled in July to August 2019. Follow-up was completed in September 2020. Methods Children were randomly assigned to the intervention group [RLRL treatment plus single vision spectacle (SVS)] and control group (SVS). The RLRL treatment was provided by a desktop light therapy device which emits red light of 650 nm in wavelength, at an illuminance level of approximately 1600 lux and a power of 0.29 mW for a 4-mm pupil (Class I Classification), and was administered at home under supervision of parents, 3 minutes per session, twice per day with a minimum interval of 4-hours, five days per week. Main outcome measures The primary outcome and a key secondary outcome were changes in axial length (AL) and SER measured at baseline, and 1-, 3-, 6- and 12-month follow-up visits. Participants who had at least one post-randomization follow-up visit were analyzed for treatment efficacy based on a longitudinal mixed model. Results Among 264 randomized participants, 246 (93.2%) children were included in the analysis (n = 117 in the RLRL and n = 129 in the SVS group). Adjusted 12-month axial elongation and SER progression were 0.13 mm (95% CI: 0.09 to 0.17) and -0.20 D (95% CI: -0.29 to -0.11) for RLRL treatment, 0.38 mm (95% CI: 0.34 to 0.42) and -0.79 D (95%CI, -0.88 to -0.69) for SVS. The difference in axial elongation and SER progression were 0.26 mm (95% CI: 0.20 to 0.31) and -0.59 D (95% CI: -0.72 to -0.46) between the RLRL and SVS groups. No severe adverse events (sudden vision loss by 2 lines or scotoma developed), functional visual loss indicated by BCVA, or structural damage seen on optical coherence tomography scans were observed. Conclusions RLRL therapy is a promising alternative treatment for myopia control in children with good user acceptability and no documented functional and structural damages.

PURPOSE To report the indications, outcomes, and complications regarding the Bag-in-the-lens (BIL) intraocular lens (IOL) exchanges over a period of 13 years in a tertiary ophthalmologic centre. SETTING Department of Ophthalmology of the University Hospital of Antwerp (UZA). DESIGN Observational retrospective study. PATIENTS AND METHODS Between 2003 and 2020, 12 176 patients were operated using the BIL technique. We included adult patients who underwent an intraocular BIL exchange and recorded the demographics, indications, outcomes, and complications. RESULTS Fifty-nine eyes of 59 patients who underwent a BIL exchange between 2007 and 2020 were included (0.48%). The mean age was 61.15 ±13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to the patients' risk factors e.g. preoperative corneal and refractive surgery. The mean preoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.36 ± 0.24 and 0.79 ± 0.24 respectively. The postoperative 1 month-UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19 respectively. The improvement in UDVA was statistically significant (

Background Weight changes during neoadjuvant chemotherapy (NAC) for pancreatic cancer (PDAC) are not well studied. We hypothesized that weight loss may predict poor outcomes. Methods Weight change from NAC initiation to pancreatectomy was grouped: gain (≥5%), stable, and loss (≥5%). Pathologic, postoperative, and survival outcomes were compared. Results 95 patients were included: 31.6% lost weight, 58.9% maintained weight, and 9.5% gained weight. There were no differences in chemotherapeutic regimens. Median recurrence-free survival (RFS) and overall survival (OS) were similar between patients with stable weight and those who lost weight (RFS: 9.6vs14.0months; OS: 25.8vs26.7months). Among those who gained weight, RFS (29.5months) and OS (38.4months) were greater relative to the other weight categories. On multivariable regression, weight gain was associated with improved RFS compared to loss (HR = 0.16). Conclusion Most patients maintain or lose weight during NAC, and weight loss does not predict poor outcomes. Weight gain may predict improved RFS.

Mohamed Salah El-Din Mahmoud, Ahmed Shawkat AbdelHalim, Hosny Ahmed Zein Ophthalmology Department, Faculty of Medicine, Minia University, Minia, EgyptCorrespondence: Mohamed Salah El-Din Mahmoud, Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt, Tel +20 1003321802, Email Mohamed_Zaki@mu.edu.eg; drmsalah1982@yahoo.comPurpose: To investigate the dynamic pupil and vault changes in eyes with implantable phakic contact lens (IPCL) under photopic and scotopic settings, as well as during accommodation using the anterior segment optical coherence tomography (AS-OCT).Methods: A prospective observational study included consecutive 36 eyes of myopic patients who underwent IPCL V2.0 implantation. Under photopic and scotopic light settings, as well as during accommodation, all patients were scanned using CASIA OCT (CASIA2; TOMEY, Nagoya, Japan). The pupil size, the vault (distance between the back surface of the IPCL and the anterior lens capsule), ACD-lens (distance between the posterior corneal surface and the anterior lens surface), IPCL-lens (distance between the posterior corneal surface and the anterior IPCL surface), and lens thickness (LT) were the study parameters.Results: The vault was significantly lower under photopic conditions (p-value< 0.001). The pupil size was significantly smaller in photopic conditions (p-value< 0.001). LT (p-value=0.975) and ACD-lens (p-value=0.917) were not significantly different between scotopic and photopic conditions, while the ACD-IPCL was significantly larger during photopic conditions (p-value=0.013). There were significant changes in all parameters between accommodative and non-accommodative conditions.Conclusion: The IPCL vault decreased significantly under photopic light conditions and accommodation.Keywords: IPCL, photopic light, scotopic light, lens accommodation, vault, AS-OCT