Yu Du

Traumatic Cataract in Children in Eastern China: Shanghai Pediatric Cataract Study

Traumatic cataract is a main cause of visual impairment in pediatric populations and is preventable. Awareness of the causes and consequences of pediatric eye trauma play roles in health education and prevention of blindness. We conducted a retrospective chart review based on 5-year clinical data of pediatric traumatic cataract cases treated at the Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China. Clinical features including demographic data, injury mechanism, and causative agents were analyzed. A total of 321 eyes of 321 children (male, 74.1%) were included. Penetrating injury accounted for 76.6% of all injuries; 65% of children with such injuries underwent their first surgery on the day of injury. The average age at injury was 6.3 ± 3.7 years, while the peak age was from two to eight years. The main causes of ocular injury were sharp metal objects, toys, and wooden sticks. The causative agent changed with increasing age; however, scissors were the leading cause within almost all age groups. Cataract surgery significantly improved visual acuity in children with traumatic cataract. These findings add information regarding the characterization of pediatric traumatic cataract in China and can help guide safety education and preventative measures.

DNA hypermethylation-mediated downregulation of antioxidant genes contributes to the early onset of cataracts in highly myopic eyes

High myopia is recognized as a risk factor for earlier onset of nuclear cataracts. One possible explanation for this is that lenses in highly myopic eyes are exposed to higher levels of oxygen than normal eyes owing to earlier vitreous liquefaction and, hence, are subjected to oxidative insults. Here, we first compared the methylation levels of six essential antioxidant genes (GSTP1, NRF2, OGG1, TXN, TXNRD1 and TXNRD2) between highly myopic cataract (HMC) and age-related cataract (ARC) lens epithelial samples via Sequenom MassARRAY. We found that specific CpG units in the promoters of GSTP1 and TXNRD2 were hypermethylated and that the expression levels of these two genes were lower in the HMC group than in the ARC group. A luciferase reporter assay confirmed the significance of differentially methylated fragments in the activation of transcription. The importance of GSTP1 and TXNRD2 in antioxidant capacity was confirmed by overexpression or knockdown experiments on cultured lens epithelial cells (LECs). In addition, the expression of DNA methyl transferase 1 (DNMT1) was higher in the lens epithelium of HMC patients than that of ARC patients, and the expression of GSTP1 and TXNRD2 was upregulated by use of a DNMT inhibitor in cultured LECs. Finally, we mimicked the intraocular environment of highly myopic eyes by treating LECs with hydrogen peroxide (H2O2) and observed both alterations in the methylation status of the GSTP1 and TXNRD2 promoters and time-dependent altered expression levels. Therefore, we propose that in an environment with high oxygen, in which lenses in highly myopic eyes are immersed, there exists a vicious cycle composed of increased oxidative stress and decreased enzymatic antioxidants via the hypermethylation of antioxidant genes.

Effects of Pranoprofen on Aqueous Humor Monocyte Chemoattractant Protein-1 Level and Pain Relief During Second-Eye Cataract Surgery

The aim of our present study is to evaluate the efficacy of pranoprofen eye drops as pain relief during sequential second-eye cataract surgery and to investigate the possible mechanism. Seventy-six patients scheduled for bilateral sequential cataract surgery were randomly assigned to two groups: (1) treatment group (administered pranoprofen eye drops), or (2) control group (administered artificial tears). Preoperative anxiety and intraoperative pain were assessed. Monocyte chemoattractant protein 1 (MCP-1) in the aqueous humor was measured with a suspension cytokine array. An extracapsular lens extraction model was established in the Wistar rat and the MCP-1 concentrations were measured with an enzyme-linked immunosorbent assay. We found that in the control group, the pain scores were significantly higher during second-eye surgery than during first-eye surgery (both scores P < 0.001). In the treatment group, there was no significant difference in the pain scores during first-eye and second-eye surgery (both scores P > 0.1). The pain during second-eye surgery was significantly lower in the treatment group than in the control group (both scores P < 0.01). And in the 1-week and 6-week interval subgroups, the pain scores during second-eye surgery were significantly lower in the treatment group than the control group (P = 0.047 and P = 0.035, respectively). While the second-eye MCP-1 level was significantly lower after a 1-week interval in the treatment group than in the control group (P = 0.012), but did not differ significantly after a 6-week interval (P > 0.1). A parallel trend in the MCP-1 concentration was detected in the rat model. In conclusion, the preoperative administration of pranoprofen eye drops reduced the perceived pain during second-eye cataract surgery, especially when performed after 1-week and 6-week intervals between the first-eye and second-eye surgery. MCP-1, a pain-related cytokine, was associated with the pain-relief mechanism of pranoprofen when second-eye surgery was performed 1 week after second-eye surgery.

Comparison of long-term decentration and tilt in two types of multifocal intraocular lenses with OPD-Scan III aberrometer

PurposeTo compare the long-term decentration and tilt in two multifocal intraocular lenses (MfIOLs) with an OPD-Scan III aberrometer.MethodsEighty cataract patients who underwent uneventful MfIOL implantation (42 with AcrySof® IQ ReSTOR® SN6AD1 and 38 with AMO Tecnis® ZMB00) were enrolled. At 1 year after surgery, a postoperative visual acuity evaluation included the measurement of uncorrected distance visual acuity, corrected distance visual acuity, distance-corrected near visual acuity, and distance-corrected intermediate visual acuity. OPD-Scan III aberrometer was used to collect the decentration, tilt, and high-order aberration (HOA) data. Significance was tested with Student’s t test, Mann–Whitney U test, paired t test, and χ2 testResultsThe average intraocular tilt was lower in the SN6AD1 group than in the ZMB00 group, whereas the average decentration of the two groups did not differ significantly. The mean total ocular HOAs, ocular trefoil, total internal HOAs, and spherical aberrations were significantly lower in the SN6AD1 group than in the ZMB00 group. In both the SN6AD1 and ZMB00 groups, the intraocular tilt was directly proportional to the total ocular HOAs, coma, and spherical aberration. However, there was no significant correlation between decentration and any type of HOA in SN6AD1 group, whereas decentration correlated positively with total ocular HOAs, coma, and spherical aberration in ZMB00 group.ConclusionBoth MfIOLs significantly improve the visual acuity of the patients. However, tilt was lower in the SN6AD1 group than in the ZMB00 group 1 year after surgery, which provide fewer HOAs and better visual quality.

Clinical Features of Congenital and Developmental Cataract in East China: A Five-year Retrospective Review

Congenital/developmental cataract is a significant cause of blindness in children worldwide. Full knowledge of clinical features is essential for early diagnosis and proper treatment to prevent irreversible visual impairment. We conducted a retrospective chart review on 520 congenital/developmental cataract cases based on a five-year clinical data from Eye and ENT Hospital of Fudan University, Shanghai, China. Clinical features including age at the surgery, chief complaints, interval between initial identification of cataract-related manifestations and surgery, etc. were summarized. 56.3% of children were bilateral. The age at surgery ranged from 0.25 to 17.4 years, only 9.2% receiving surgery below 1 year. Interval between initial identification of manifestations and surgery ranged from 2 days to 17 years. Concomitant congenital abnormalities were present in 67 patients, with persistent hyperplastic primary vitreous and congenital heart disease as the most frequent ocular and systemic disorders. Strabismus and nystagmus were seen in 20.6% and 11.9% of patients. In bilateral cataract patients with strabismus, axial lengths of esotropia-affected eyes were statistically shorter than exotropia-affected eyes. These findings provide information on characteristics of congenital/developmental cataract in China and may assist in achievement of comprehensive treating strategies in these cases.

Racemization at the Asp 58 residue in αA‐crystallin from the lens of high myopic cataract patients

Post‐translational modifications in lens proteins are key causal factors in cataract. As the most abundant post‐translational modification in the lens, racemization may be closely related to the pathogenesis of cataract. Racemization of αA‐crystallin, a crucial structural and heat shock protein in the human lens, could significantly influence its structure and function. In previous studies, elevated racemization from l‐Asp 58 to d‐isoAsp58 in αA‐crystallin has been found in age‐related cataract (ARC) lenses compared to normal aged human lenses. However, the role of racemization in high myopic cataract (HMC), which is characterized by an early onset of nuclear cataract, remains unknown. In the current study, apparently different from ARC, significantly increased racemization from l‐Asp 58 to d‐Asp 58 in αA‐crystallin was identified in HMC lenses. The average racemization rates for each Asp isoform were calculated in ARC and HMC group. In ARC patients, the conversion of l‐Asp 58 to d‐isoAsp 58, up to 31.89%, accounted for the main proportion in racemization, which was in accordance with the previous studies. However, in HMC lenses, the conversion of l‐Asp 58 to d‐Asp 58, as high as 35.44%, accounted for the largest proportion of racemization in αA‐crystallin. The different trend in the conversion of αA‐crystallin by racemization, especially the elevated level of d‐Asp 58 in HMC lenses, might prompt early cataractogenesis and a possible explanation of distinct phenotypes of cataract in HMC.

Type II Peter’s anomaly with histopathological proof: a case report

BackgroundPeter’s anomaly is a rare congenital anterior segment dysgenesis with poor visual results. This case report describes a case of bilateral Type II Peter’s anomaly with notable clinical and histopathological features.Case presentationA 7-year-old boy was admitted to our center with complaints of bilateral central opacification, photophobia and severe reduced vision since birth. He underwent phacoemulsification, intraocular lens (IOL) implantation and anterior vitrectomy on the right eye in another medical institution two years ago. Slit lamp examination revealed bilateral central corneal opacity, few strands of peripheral iris, irregular pupils and cloudy lens with central adhesion to posterior corneal surface in the left eye. Additionally, a history of premature birth and mental retardation was also noted. The patient was diagnosed with Peter’s anomaly in the left eye, pseudophakia in the right eye and bilateral amblyopia. Similar surgery to the right one was performed on the left eye. A vesicle-like structure was found in the anterior chamber intraoperatively, which was composed mainly of immature lens and some corneal stroma as revealed by postoperative histopathological examinations.ConclusionsThe exact mechanism of Peter’s anomaly is not completely understood, however, the notable histopathological features of tissue obtained from the present case may provide evidence to the hypothesis of developmental anomalies.