Xin Tang

Prevalence of Corneal Astigmatism in Patients before Cataract Surgery in Northern China

Purpose. To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates in a teaching hospital in northern China. Methods. From May 1, 2012, to April 30, 2013, partial coherence interferometry (IOLMaster) measurements of all qualified cataract surgery candidates were retrospectively collected and analyzed. Results. The study evaluated 12,449 eyes from 6,908 patients with a mean age of 69.80 ± 11.15 (SD) years. The corneal astigmatism was 0.5 diopters (D) or less in 20.76% of eyes, 1.0 D or more in 47.27% of eyes, 2.0 D or more in 13.16% of eyes, and 3.0 D or more in 3.75% of eyes. With-the-rule astigmatism was found in 30.36% of eyes, while against-the-rule was found in 52.41% of eyes. The percentage of against-the-rule astigmatism increased with age. Conclusion. Our study showed that almost one-half of preoperative eyes (47.27%) in northern China have a corneal astigmatism of 1.0 D or more, indicating that more surgical techniques or toric IOLs are needed to achieve better visual rehabilitation.

Correlation of Macular Choroidal Thickness with Concentrations of Aqueous Vascular Endothelial Growth Factor in High Myopia

Abstract Purpose: To investigate the association of both aqueous and serum vascular endothelial growth factor (VEGF) levels and macular choroidal thickness in high myopia. Materials and methods: VEGF concentrations were measured in aqueous and serum samples via enzyme-linked immunosorbent assay (ELISA) and compared between high myopia (n = 36 eyes, 36 patients) and normal control (n = 42 eyes, 42 patients) eyes. Macular choroidal thickness, the distance from the retinal pigment epithelium (RPE) to the scleral interface, was determined via enhanced depth-imaging optical coherence tomography (EDI-OCT). Axial length was measured using the intraocular (IOL) lens Master. Results: Aqueous levels of VEGF from high myopia patients were significantly lower compared with those from control persons (61.4 ± 27.6 versus 122.6 ± 52.4 pg/ml; p < 0.001), respectively. Macular choroidal thickness of high myopia patients was significantly lower compared with that of control persons (111.1 ± 45.0 versus 230.6 ± 81.8 μm; p < 0.001), respectively. Aqueous levels of VEGF were significantly associated with both macular choroidal thickness (R2 = 0.641; p < 0.001) and axial length (R2 = 0.679; p < 0.001) in high myopia patients. In addition, there was a significantly negative correlation between macular choroidal thickness and axial length (R2 = 0.69; p < 0.001). However, no correlation between serum VEGF and either macular choroidal thickness or axial length was detected in high myopia patients (R2 = 0.009; p = 0.59; R2 = 0.00002; p = 0.981). Conclusions: Macular choroidal thickness was significantly correlated with aqueous, but not serum, levels of VEGF in highly myopic eyes. Macular choroidal thickness may be of predictive value for identifying aqueous VEGF levels in high myopia patients and may, thus, be a useful prognostic modality.

Human corneal epithelial cells produce antimicrobial peptides LL-37 and β-defensins in response to heat-killed Candida albicans.

Aims: To explore the innate response of human corneal epithelial cells (HCECs) exposed to fungus by producing antimicrobial peptides LL-37 and β-defensins. Methods: Primary HCECs were treated with heat-killed Candida albicans (HKCA) at different doses (103-106 cells/ml) for 2-48 h. The cells were subjected to total RNA extraction, reverse transcription and quantitative real-time PCR for mRNA expression. Cells treated for 48 h were used for immunofluorescent staining and ELISA. Results: Human LL-37 and β-defensins (hBDs) 1-4 were detected in normal HCECs. The mRNA expression of LL-37, hBD2, and hBD3 was dose-dependently induced by HKCA with their peak levels at 4 h. HKCA (106 cells/ml) stimulated the mRNA of LL-37, hBD2, and hBD3 4.33 ± 1.81, 3.75 ± 1.31, and 4.91 ± 1.09 fold, respectively, in HCECs. The stimulated production of LL-37, hBD2, and hBD3 by HKCA was confirmed at protein levels by immunofluorescent staining and ELISA. The protein production of LL-37, hBD2, and hBD3 significantly increased to 109.1 ± 18.2 pg/ml, 4.33 ± 1.67 ng/ml, and 296.9 ± 81.8 pg/ml, respectively, in culture medium of HCECs exposed to HKCA (106 cells/ml) compared to untreated HCECs. Conclusions: HCECs produce antimicrobial peptides, LL-37, hBD2 and hBD3, in response to stimulation of HKCA, which suggests a novel innate immune mechanism of the ocular surface in defense against fungal invasion.

Comparison of the Retinal Straylight in Pseudophakic Eyes with PMMA, Hydrophobic Acrylic, and Hydrophilic Acrylic Spherical Intraocular Lens

Purpose. To investigate the intraocular straylight value after cataract surgery. Methods. In this study, 76 eyes from 62 patients were subdivided into three groups. A hydrophobic acrylic, a hydrophilic acrylic, and a PMMA IOL were respectively, implanted in 24 eyes, 28 eyes, and 24 eyes. Straylight was measured using C-Quant at 1 week and 1 month postoperatively in natural and dilated pupils. Results. The hydrophilic acrylic IOLs showed significantly lower straylight values than those of the hydrophobic acrylic IOLs in dilated pupils at 1 week and 1 month after surgery (P < 0.05). However, the straylight values of the hydrophilic acrylic IOLs were the lowest among the three IOL groups. No significant difference was observed in straylight between 1 week and 1 month postoperatively in each group with natural and dilated pupils (P > 0.05). Moreover, no significant difference was found in straylight between natural and dilated pupils in each group at 1 week and 1 month postoperatively (P > 0.05). Conclusions. Although the hydrophobic acrylic IOL induced more intraocular straylight, straylight differences among the 3 IOLs were minimal. Pupil size showed no effect on intraocular straylight; the intraocular straylight was stable 1 week after surgery.

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients. METHODS This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE). RESULTS The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3. CONCLUSION Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Implication of Smad2 and Smad3 in Transforming Growth Factor-β-induced Posterior Capsular Opacification of Human Lens Epithelial Cells

Abstract Purpose: Transforming growth factor-β2 (TGF-β2) is a potent inducer of posterior capsular opacification (PCO), a critical Smad-dependent event. This study was conducted to investigate the contributions of Smad2 and Smad3 to PCO development based on selective over-expression of either Smad2 or Smad3. Methods: We selectively activated the TGF-β/Smad pathway in cell lines transfected with expression plasmids containing Smad2 or Smad3. These cell lines were then analyzed to determine the individual contributions of Smad2 and Smad3 to TGF-β2 treatment response in an in vitro culture of HLE B-3 cells. The effects of Smad2 and Smad3 on cell viability were assessed by MTT and flow cytometry assay. A transwell assay was used to observe the role of Smad2 and Smad3 in the migration of HLE B-3 cells. Western blotting, real-time PCR, and immunocytofluorescence staining were performed to detect the accumulation of ECM proteins and EMT in response to selective Smad2 or Smad3 activation. The presence of soluble collagen I, and fibronectin in the culture medium supernatant were detected by ELISA. Results: Selective Smad3 activation via gene transfection enhanced TGF-β2-responsive growth inhibition and apoptosis. Transwell assay results showed that TGF-β2-induced cell migration was Smad2 dependent and Smad3 independent. Analysis by Western blot, RT-PCR and ELISA demonstrated that the determinant factor in ECM secretion was Smad3 signaling rather than Smad2 signaling. Western blot and RT-PCR showed that the loss of E-Cadherin and acquisition of α-SMA, the hallmark of epithelial-mesenchymal transition (EMT), were both reliant on Smad2 signaling. Immunocytofluorescence staining confirmed the role of Smad2 in the accumulation of α-SMA. Conclusions: Smad2 and Smad3 are both necessary for the formation of PCO. The discovery of additional TGF-β2/Smad signaling mechanisms may provide potential therapeutic targets to help combat PCO.

Association between Genetic Polymorphisms of the Beta Adrenergic Receptor and Diurnal Intraocular Pressure in Chinese Volunteers and Glaucoma Patients.

ABSTRACT Purpose: To evaluate the relationship between genetic polymorphisms of the beta adrenergic receptor (ADR) and diurnal intraocular pressure (IOP) in Chinese healthy volunteers, normal tension glaucoma (NTG) patients, and primary open-angle glaucoma (POAG) patients. Methods: Fifty healthy volunteers (control group), 55 untreated NTG patients, and 55 untreated POAG patients were recruited. IOP of both eyes was measured at 3-hour intervals from 0600 to 2400 hours. For control group, IOP data from the eye with better mean deviation (MD) of visual field was used for statistical analysis. For glaucoma patients, IOP data from the eye with a greater visual field defect was used for statistical analysis. Genetic polymorphisms of ADR were determined by direct DNA sequencing. The relationship between IOP and genetic polymorphisms was statistically analyzed. Results: R16G (A/G), L84L (G/A), and R175R (C/A) in β2-ADR showed significantly different allele in the three groups (p = 0.005, p = 0.045, and p = 0.045, respectively). For the POAG group, C/C of R389G (C/G) in β1-ADR had a significantly lower diurnal mean IOP (p < 0.001), peak IOP (p = 0.010), trough IOP (p < 0.001), and larger IOP range (p = 0.047) than G carriers; C/C of R389G (C/G) in β1-ADR and G carriers had parallel diurnal IOP curves but significantly different diurnal IOP levels (p = 0.001); C/C of Q27E (C/G) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.045) than G carriers; G/G of L84L (G/A) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.044) than A carriers; C/C of R175R (C/A) in β2-ADR had a significantly higher diurnal mean IOP (p = 0.044) than A carriers; T/T of W64R (T/C) in β3-ADR had a significantly smaller IOP range (p = 0.001) than C carriers. Conclusion: Certain polymorphisms of β2-ADR showed significantly different genotype frequencies in healthy volunteers untreated NTG patients, and POAG patients. Polymorphisms of the β-ADR gene may alter the untreated IOP level of POAG patients.

Short-term reproducibility of intraocular pressure and ocular perfusion pressure measurements in Chinese volunteers and glaucoma patients

BackgroundTo evaluate the short-term reproducibility of diurnal intraocular pressure (IOP) and ocular perfusion pressure (OPP) measurements in normal volunteers, untreated normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients.MethodsFifty-four healthy volunteers (control group), 67 NTG patients and 54 POAG patients were recruited. The IOPs of both eyes were measured with a Goldmann applanation tonometer at 3-h intervals over 2 consecutive days. Blood pressure (BP) measurements were collected at the same times. The mean IOP/OPP, peak IOP/OPP, trough IOP/OPP and IOP/OPP fluctuations on each day were also calculated. The intraclass correlation coefficients (ICCs) were used to evaluate the reproducibilities.ResultsIn the control group, the ICCs of mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.921, 0.889, 0.888, and 0.661, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuations were 0.962, 0.918, 0.953, and 0.680, respectively. In the NTG group, the ICCs of the mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.862, 0.741, 0.798, and 0.290, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuations were 0.947, 0.828, 0.927, and −0.008, respectively. In the POAG group, the ICCs of the mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.857, 0.666, 0.808, and 0.546, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuation were 0.934, 0.842, 0.910, and 0.093, respectively.ConclusionThe IOP measurements within a single day were not highly reproducible in the short-term. The normal volunteers exhibited better IOP and OPP reproducibilities than the glaucoma patients. The IOP and OPP fluctuations could not be accurately evaluated based on the IOP or OPP measurements within a single day.

Application of 25 MHz B-Scan Ultrasonography to Determine the Integrity of the Posterior Capsule in Posterior Polar Cataract

Purpose To report the application of 25 MHz B-scan ultrasonography (MHzB) to determine the integrity of the posterior capsule (PC) in posterior polar cataract (PPC). Methods Patients with whom PPC was clinically diagnosed using slit lamp microscopy who underwent 25 MHzB before phacoemulsification were retrospectively reviewed. The status of the PC was determined by 25 MHzB before phacoemulsification and confirmed during cataract surgery. Results In total, 21 eyes in 14 clinically diagnosed PPC patients were enrolled in this study. Out of 25 MHzB images, 19 PCs were found to be intact, while 2 showed dehiscence before cataract surgery. During phacoemulsification, 17 PCs were observed to be intact, while 4 PCs showed posterior capsule rupture (PCR). These 4 PCR cases included the above 2 eyes, in which preexisting dehiscence was detected by 25 MHzB. The other 2 PCR cases showed high reflectivity between high echoes in posterior opacities and the PC, indicating synechia between the PPC and PC. Conclusion This is the first report to show that 25 MHzB can be used to clearly visualize the status of the PC in PPC. These results, in turn, could be used to select the appropriate treatment and to thereby avoid further complications during PPC surgery.

Role of Smad3 signaling in the epithelial‑mesenchymal transition of the lens epithelium following injury

Transforming growth factor-β (TGF-β) is important in the development of posterior capsule opacification (PCO), and inhibition of the TGF-β pathway may represent a novel method of treating PCO. Drosophila protein, mothers against decapentaplegic homolog 3 (Smad3) is a phosphorylated receptor-activated Smad required for the transmission of TGF-β signals. Smad3 knockout (KO) disturbs the activation of TGF-β signaling, thus inhibiting the onset of PCO. In the present study, lens epithelial cell (LEC) damage induced by extracapsular cataract extraction was simulated by puncture of the anterior capsule using a 26-gauge hypodermic needle. The effect of Smad3 in the trauma-induced epithelial-mesenchymal transition (EMT) of the lens epithelium in Smad3-KO and wild-type (WT) mice was then observed. The expression levels of EMT markers and extracellular matrix components were measured in the two groups by reverse transcription-quantitative polymerase chain reaction analysis, western blot analysis and immunofluorescence staining. Apoptosis was also detected in the punctured anterior capsule. The Smad3-KO mice exhibited lower expression levels of α-smooth muscle actin, lumican, osteopontin, fibronectin and collagen, compared with the WT mice. Additionally, the Smad3-KO mice exhibited a higher percentage of apoptotic cells than the WT mice. Smad3 signaling was associated with the induction of trauma-induced EMT, and Smad3 KO interfered with TGF-β signaling pathway activation, but did not completely inhibit the trauma-induced EMT in LECs. Therefore, Smad3 may be a target in the treatment of PCO and other fibrosis-related diseases.