Diabetic retinopathy (DR) is a common ocular complication in diabetic patients, which is chronic and progressive and seriously impairs visual acuity. The rapid occurrence and progress of cataract in diabetic patients is also one of the important reasons for visual impairment in DR patients. Compared with non-diabetic patients, diabetic patients have higher risk of complications after cataract surgery. Studies have shown that anti-vascular endothelial growth factor (VEGF) therapy after cataract surgery can prevent the aggravation of diabetic macular edema in DR patients. However, due to the lack of systematic review of the clinical effect of anti-VEGF drugs in DR patients undergoing cataract surgery, the use of anti-VEGF drugs is relatively conservative in clinic. It is believed that with the deepening of research and the progress of clinical trials, the wide application of anti-VEGF drugs in clinical practice is expected to provide more accurate and effective treatment for DR patients in the future.
Objective To analysis the effect of lens opacity on the measurement of retinal vessel oxygen saturation. Methods This was a cross sectional study. Forty four eyes of 44 patients with different degrees of lens opacity were enrolled. There were 23 males and 21 females. The patients aged from 48 to 84 years, with the mean age of (71.8±10.3) years. The mean best corrected visual acuity was 0.65±0.22. The mean intraocular pressure was (14.2±4.3) mmHg (1 mmHg=0.133 kPa). The mean equivalent spherical degree was (−0.05±2.10) D. The opitical quality analysis system was applied to measure intraocular objective scattering index (OSI) caused by lens opacity. According to the OSI, the opacity of lens was divided into four groups. Patients with OSI value ＜1.0 was grouped to level 1, which indicated that the lens were basically transparent; patients with OSI value between 1.0 and 3.0 was grouped to level 2, which indicated early cataract; patients with OSI value between 3.0 and 7.0 was grouped to level 3, which indicated progressive cataract; patients with OSI value ＞7.0 was grouped to level 4, which indicated the mature stage of cataract. The retinal oximeter Oxymap T1 was used to capture the fundus images under different wavelengths. Pearson correlation analysis was used to analyze the correlation between retinal oxygen saturation and age, intraocular pressure, equivalent spherical degree and OSI. One way ANOVA was used to analyze the difference of retinal oxygen saturation among groups. Results The mean retinal arterial oxygen saturation, venous oxygen saturation and arteriovenous difference was (90.70±6.46)%, (47.34±13.51)%, (43.36±10.09)%, respectively. The correlations of retinal arterial oxygen saturation, venous oxygen saturation and arteriovenous difference with age, intraocular pressure, equivalent spherical degree was not statistically significant (all P＞0.05). The retinal arterial oxygen saturation and venous oxygen saturation was negatively correlated with OSI (r=−0.462,−0.500; P=0.002, 0.001), the arteriovenous difference and OSI was positively correlated (r=0.373, P=0.013). According to lens opacity, there were 11 eyes in level 1, 9 eyes in level 2, 14 eyes in level 3, 10 eyes in level 4. There were significant differences of retinal artery and venous oxygen saturation among different lens opacity levels (F=5.340, 4.710; P=0.003, 0.007); meanwhile, the arteriovenous difference was not significantly different (F=2.048, P=0.123). The retinal arterial oxygen saturation and venous oxygen saturation was significantly lower in the level 4 lens opacity group than any other three groups (all P＜0.05), but there was no statistically significant difference among level 1 to level 3 lens opacity group. Conclusion The effect of lens opacity of level 1 to level 3 is limited on the measurement of retinal oxygen saturation, but level 4 lens opacity will cause decrease of retinal artery and venous oxygen saturation.
Objective To compare the efficacy and safety of pars plana vitrectomy (PPV) versus scleral buckling (SB) on rhegmatogenous retinal detachment (RRD) after cataract surgery. Methods A computerized search was conducted in the Cochrane Library, Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM) combined with manually searching of related literatures. Randomized controlled trials (RCT) comparing PPV with SB for RRD after cataract surgeries were collected. Best corrected visual acuity (BVCA), reattachment rate after primary surgery, final reattachment rate and complications between the two operations were compared. Results A total of four RCTs were included in this meta analysis, including 690 eyes of 690 patients (331 eyes in the PPV group, 359 eyes in the SB group). There was no difference in reattachment rates after primary surgery between two groups ［odds ratio (OR) =1.68; 95% confidence interval (CI), 0.81-3.49; P=0.16). Final reattachment rate were in favor of PPV (OR=1.97; 95% CI,1.04 -3.73;P=0.04). There was no significant difference in the proportion of BCVA at six months (weighted mean difference=0.06; 95%CI,-0.01- 0.14; P=0.11). PPV was associated with a significantly lower frequency of diplopia/extrocular muscle dysfunction than SB (OR=6.59; 95% CI1.16 - 37.27; P=0.03), whereas other complications, such as proliferative vitreoretinopathy, macular pucker, cystoid macular edema, and choroidal detachment did not differ statistically (P＞0.05). Conclusion Compared with SB, PPV is more likely to achieve a favorable final reattachment rate for RRD after cataract surgery, and with a lower rate of diplopia/extrocular muscle dysfunction.
Objective To observe the changes in peripapillary vessel perfusion after uncomplicated phacoemulsification surgery in patients with cataract and primary open-angle glaucoma (POAG). Methods A case-control study. From November 2017 to April 2019, 17 eyes of 17 cases of POAG complicated with cataract (observation group) and 17 eyes of 17 cases of simple senile cataract (control group) were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field, optical coherence tomography angiography (OCTA) examination, and measurement of axial length (AL) and central corneal thickness (CCT). All eyes underwent conventional phacoemulsification surgery for cataract. After the operation, the same equipment and methods as before the operation were used for related inspections. The VD, the thickness of the retinal nerve fiber layer (RNFL), and the IOP were observed before the operation, at the end of the operation, and 1 d, 1 week, 1 month and 3 months after the operation, mean visual field defect (MD) changes 3 months after surgery. Data comparisons within groups used repeated measures analysis of variance; data comparisons between groups used independent samples t test. Results The average age of patients in the observation group and control group was 68.18±6.13 and 65.82±6.95 years, respectively, and the difference was not statistically significant (t=1.912, P=0.072). There was no significant difference in AL (t=1.436), CCT (t=−1.557) and phacoemulsification (t=1.602) between the two groups (P>0.05). The difference of the mean IOP was statistically significant between the two groups (t=4.139, P<0.05). Before surgery, the VD (t=−6.560) and RNFL thickness (t=−7.320) of the observation group were lower than those of the control group, and the difference was statistically significant (P＜0.05). Compared with before the operation, the VD around the disc of the eye in both groups increased at the end of the operation and at different time points after the operation. Among them, the observation group had a statistically significant difference at 1 month after the operation of the eye (F=3.108, P=0.042); the control group had no significant difference at different time points after the operation (F=1.981, P＞0.05). The results of each quadrant analysis showed that only the observation group had a statistically significant difference in the temporal side of the eye one month after surgery (F=5.414, P=0.017). After surgery, the observation group and the control group had thicker RNFL thickness around the disc of the eye, and the difference was statistically significant (F=22.670, 23.080; P=0.002, 0.001). Before the operation and 3 months after the operation, the average MD of the eyes of the observation group and the control group were 14.90±7.15, 1.12±0.93 dB and 12.10±7.70, 0.88±0.66 dB, respectively. The average MD before and 3 months after the operation was compared, and the difference was statistically significant (t=14.414, 13.225; P=0.000, 0.000). Compared with before surgery, there was no statistically significant difference in the average MD of the two groups of eyes at 3 months after surgery (t=0.938, 0.817; P=0.082, 0.103). At the end of the operation, the intraocular pressure of the observation group and the control group were 10.84±3.39 and 11.46±3.79 mm Hg (1 mm Hg=0.133 kPa), respectively; they were both lower than before the operation, and the difference was statistically significant (t=−2.211, −2.310; P＜0.05). Conclusions The thickness of VD and RNFL in eyes with POAG combined with cataract is lower than that in patients with senile cataract alone. The high perfusion pressure during conventional phacoemulsification surgery can cause a transient increase in VD, but it will not cause further damage to the visual field of POAG patients.
Objective To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract. Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration. Results A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(Plt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (Plt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, Plt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, Plt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.
Cataract combined with retinopathy can seriously affect the vision of patients. Vitrectomy combined with one-stage implantation of multi-focal intraocular lens (MIOL) has been paid more and more attention. The application of MIOL shows potential in improving the visual quality of patients, but its effect is affected by many factors, and refractive drift is a key problem to be solved. At present, the research mainly focuses on cataract patients with high myopia, and further research on other types of retinopathy is needed. In the future, multi-center, large-sample, long-term clinical studies and interdisciplinary cooperation are needed to optimize surgical and management programs to enhance the application effect of MIOL in the treatment of retinopathy and improve the quality of life of patients.
ObjectiveTo observe the clinical manifestations of a Wagner syndrome (WS) family. MethodsA retrospective clinical study. Four patients (the proband, his father, sister, and brother) and one family member (the proband's mother) from a WS family diagnosed by clinical examination in Chengdu Aidi Eye Hospital in June 2023 were included in the study. The proband's medical history was examined in detail, followed by best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), and OCT angiography (OCTA). The proband underwent full field electroretinogram (ERG) examination. The proband and his sister and brother underwent blood glucose, blood pressure, hearing, face, joint, exercise and general physical examination at the same time. Peripheral venous blood was collected from the proband and 4 other family members. The proband extracts genomic DNA samples, conducts target region capture, library construction and high-throughput sequencing after qualified quality control. The suspected pathogenic mutation sites were verified by Sanger. According to the selected mutation sites, other family members in this family were co-isolated and verified. The pathogenicity of the mutation site was analyzed using the guidelines of the American College of Medical Genetics and Genomics (ACMG). ResultsProband (Ⅱ-1) was 23 years old female. Both eyes BCVA were 0.1. The waveforms of ERG in both eyes were basically normal, and some amplitudes were reduced. Sister of the proband (Ⅱ-2) was 20 years old. Both eyes BCVA 1.0. Fundus examination showed no obvious abnormality. Brother of the proband (Ⅱ-3) was 19 years old. The left eye underwent pars plana vitrectomy combined with silicone oil filling 2 years ago due to retinal detachment and severe vitreous hyperplasia. BCVA light sensitivity, complicated cataract, and fundus opacity were observed. Right eye BCVA was 0.1. The lenses of the proband and his younger sister and brother were pointed and wedged, and the younger brother was heavier. Vitreous cavity of lens. The retina color of both eyes and the right eye of the younger brother of the protor was dark, with flaky dark areas on the side of the nose and the posterior pole, and the symmetrical retinal veil membrane hyperplasia and pulling on the periphery, showing small retinal splits. The choroidal retina showed focal and segmental symmetrically large atrophy. The optic disc was tilted. By OCT examination, the ellipsoid band was partially missing and broken, and the thickness of the choroid layer was reduced. Retinal cortical atrophy in 1 eye (younger brother of proband). By OCTA examination, the mesovascular layer of choroid was atrophied seriously and the blood density decreased. The results of laboratory and general examination of the three siblings showed no obvious abnormalities. The results of genetic testing showed that the proband, his father (Ⅱ-1), his sister and his brother carried a heterozygous mutation of the VCAN gene c.9264A>G (p.Pro3088=). According to ACMG guidelines, the pathogenicity of this variant was unknown. The mother of proband (Ⅰ-2) was wild type. ConclusionsThe abnormal manifestations of WS eyes are diverse, and both anterior and posterior segments could be involved. The pathogenicity of the heterozygous variation of VCAN gene c.9264A>G (P.RO3088 =) in this family is unknown.