Background: Patients developing cataracts after implantable Collamer lens (ICL) implantation represent a unique population requiring careful intraocular lens (IOL) selection. This study compared clinical outcomes between monofocal IOL (SIOL) and multifocal IOL (MIOL) implantation after ICL removal combined with cataract surgery. Methods: This prospective case series included 70 eyes from 70 patients who underwent ICL removal combined with femtosecond laser-assisted cataract surgery (FLACS). The MIOL group (31 eyes) received ZEISS AT LISA tri 839MP trifocal IOL targeting emmetropia, while the SIOL group (39 eyes) received ZEISS CT ASPHINA 409MP monofocal IOL with intentional myopic target of -2.00D to -3.00D. Comprehensive ophthalmic examinations were performed preoperatively and at 1 month postoperatively, including visual acuity, defocus curve, objective visual quality parameters, and patient questionnaires. Results: The MIOL group achieved significantly better uncorrected distance visual acuity (UDVA) (0.02±0.04 LogMAR) compared to the SIOL group (0.35±0.15 LogMAR) (P<0.001), as expected due to the intentional myopic target. However, corrected distance visual acuity (CDVA) showed no significant difference between groups (0.00±0.02 vs 0.01±0.03 LogMAR, P=0.562). The MIOL group demonstrated a distinct "defocus plateau" from 0D to -3D. Postoperative MTF-10 was 0.31±0.12 in the MIOL group and 0.35±0.14 in the SIOL group (P=0.042). Postoperative MTF-30 was 0.12±0.05 and 0.15±0.06, respectively (P=0.038). Postoperative Strehl ratio was 0.09±0.07 and 0.11±0.04, respectively. The MIOL group showed higher spectacle independence rates. Conclusions: MIOL implantation provides excellent uncorrected distance vision and full-range vision with high spectacle independence. SIOL implantation with myopic target results in poorer uncorrected distance vision but comparable corrected distance vision and superior optical quality. Both IOL types have distinct advantages, and selection should be individualized.

PURPOSE:To compare postoperative visual outcomes between bilateral multifocal intraocular lens (IOL) implantation and mix-and-match strategies. METHODS:This prospective multicenter observational study enrolled 156 patients (312 eyes) who underwent uneventful cataract surgery with IOL implantation in both eyes. Patients were divided into five groups based on binocular IOL strategy: mix-and-match of monofocal and bifocal IOLs (MB group), bilateral bifocal IOLs (BB group), monofocal and trifocal IOLs (MT group), bifocal and trifocal IOLs (BT group), and bilateral trifocal IOLs (TT group). Binocular visual outcomes, including visual acuity, defocus curves, contrast sensitivity, stereoacuity, and subjective visual quality measures such as Visual Function Index 14 scores, spectacle independence, and patient satisfaction were assessed at 6 months after surgery. RESULTS:All patients showed significant improvement in binocular visual acuity after surgery. Binocular distance visual acuity, contrast sensitivity, Visual Function Index 14 scores, spectacle independence, and satisfaction were comparable between the MB and BB groups and among the MT, BT, and TT groups. BB yielded slightly better binocular near visual acuity than MB. TT achieved mildly superior intermediate and near visual acuity than MT. Near stereoacuity was significantly better for BB than MB and for BT than MT. TT showed superior intermediate and near stereoacuity than MT. Patients who had MT and BT were more likely to report difficulty with distance perception than those who had TT. Photic disturbances were relatively more common in the BB and TT groups compared to the mix-and-match groups. CONCLUSIONS:The mix-and-match strategy provided comparable binocular distance visual acuity, contrast sensitivity, and subjective visual quality to bilateral multifocal IOL implantation. Intermediate and near visual acuity and stereoacuity may be compromised in monofocal-multifocal combinations.

PURPOSE:As the prevalence of high myopia increases around the world, the incidence of highly myopic cataract (HMC) would increase and present clinicians with unique management challenges. This modified Delphi consensus study aimed to establish practical recommendations for HMC diagnosis and treatment, addressing key controversies in preoperative evaluation, surgical considerations, and postoperative care. METHODS:An international panel of 30 cataract experts from 14 countries/territories participated in this two-round e-Delphi study. Consensus was defined as ≥ 75% agreement on 5-point Likert-scale statements covering disease characterization, preoperative evaluation, intraoperative precautions, and postoperative care. RESULTS:A formal consensus was reached by a broad majority of the panel (86.67%) to endorse HMC as a separate disease category, typically manifesting 10-20 years earlier than age-related cataracts. Key consensus included: use of combined IOL formula calculations (96.67% agreement), preference for hydrophobic acrylic intraocular lens (96.67%), and mandatory 3-month postoperative retinal exams (96.67%). Controversies persisted regarding immediate sequential bilateral surgery, prophylactic routine implantation of a capsular tension ring, and postoperative steroid regime. CONCLUSIONS:We present commonly agreed recommendations for the clinical management of HMC, which include tailored surgical approaches and vigilant postoperative monitoring to address this growing public health challenge.

PURPOSE:To evaluate the visual performance and optical quality of a trifocal intraocular lens (IOL) in patients with high myopic cataracts. METHODS:This is a prospective, multicenter, non-randomized cohort study. Patients scheduled for cataract surgery with binocular AcrySof IQ® PanOptix® TFNT00 IOL implantation were enrolled. Participants with axial length (AL) ≥ 26 mm were assigned to the high myopia group, while age- and sex-matched patients with AL < 26 mm in the control group. Key outcomes measured included uncorrected distance visual acuity (UDVA), intermediate and near visual acuity (UIVA, UNVA), best-corrected distance visual acuity, defocus curve, contrast sensitivity, visual quality (objective and subjective), and reading ability. RESULTS:58 eyes from 29 patients in the high myopia group and 56 eyes from 28 patients in the control group were included. Both groups showed significant improvements in visual acuity postoperatively although the UIVA and UNVA of patients with high myopia were significantly worse than those in the control group after 1 month, 3 months, and 1 year (both P < .05). The high myopia group had lower mean visual function-index scores for near-range activities and fewer photic phenomena (halo) than the control group (all P < .05). Preferred reading distance and speed did not differ significantly between the groups. CONCLUSIONS:Trifocal IOL implantation improved visual acuity in both groups. However, patients with high myopia experienced significantly poorer intermediate/near vision outcomes and also less complains about photic phenomena than controls. These findings support cautious patient selection and preoperative counseling for this population.

Purpose: To elucidate the impact of mild PCO on the visual outcomes in patients with hydrophilic trifocal IOLs, and to identify objective indicators that can assist in determining the need for Nd:YAG laser capsulotomy. Methods: This is a prospective observational study. 189 patients implanted trifocal IOL who underwent Nd:YAG laser posterior capsulotomy were recruited. Patients were classified into four grades according to PCO morphology. The distance, intermediate, and near visual acuity (VA), dysfunction lens index (DLI), contrast sensitivity (CS) and visual function (VF-14) scores were measured before and 1 month after Nd:YAG laser capsulotomy. Results: Before Nd:YAG laser capsulotomy, a significant correlation was observed between PCO grading and uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) visual acuity, corrected distance VA (CDVA), DLI, and VF-14 scores (All P < 0.001). However, in patients with PCO grade 1 (mild), post-capsulotomy UNVA, DLI, medium and high spatial frequency CS under photopic condition and VF-14 scores were significantly improved compared with pre-capsulotomy values (all P < 0.05). The area under the receiver operating characteristic curve for DLI was 0.830 (P < 0.001), with a corresponding cut-off value of 7.225, indicating its usefulness in assessing the need for Nd:YAG laser capsulotomy in cases of mild PCO. Conclusions: Mild PCO initially impairs near visual acuity in patients with trifocal IOLs and concurrently diminishes both subjective and objective of visual quality. The DLI can serve as an auxiliary diagnostic indicator to assess whether patients with mild PCO may benefit from Nd:YAG laser capsulotomy.

Background:Surgical decision-making for highly myopic cataracts requires a high level of expertise. We, therefore, aimed to develop a preliminary artificial intelligence (AI) model for surgical decision-making in highly myopic cataracts, based on previous deep learning models. Materials and methods:We first established a highly myopic cataract decision-making AI model by integrating cataract grading and postoperative visual acuity prediction models of highly myopic eyes, which we had developed previously, with surgical decision logic. The outcomes of surgical decision-making were classified into four categories: surgery not advised, cataract surgery recommended, retinal surgery recommended, and combined cataract-retinal surgery recommended. The gold standard for surgical decision is defined as the decision jointly made by two professional ophthalmologists together (X.Z. and Y.W.). If the decision-makings regarding highly myopic cataract surgery were not fully consistent, a final judgment was made by a third expert (Y.L.). Subsequently, we evaluated the accuracy of AI model's surgical decision-making against the gold standard and doctors at different levels, using both internal (107 highly myopic eyes from Eye and ENT Hospital, Fudan University) and external (55 highly myopic eyes from Wuhan Aier Eye Hospital) test datasets. Results:In the internal and external datasets, according to the Lens Opacities Classification System (LOCS) III international standards for cataract grading, 99.07% and 87.27% of automatic nuclear grading, along with 88.79% and 61.82% of automatic cortical grading, respectively, had an absolute prediction error of ≤1.0 compared with the gold standard. The mean postoperative visual acuity prediction error was 0.1560 and 0.3057 logMAR in the internal and external datasets, respectively. Finally, the consistency of the AI model's surgical decisions with the gold standard for highly myopic cataract patients in the internal and external datasets was 96.26% and 81.82%, respectively. AI demonstrated substantial agreement with the gold standard (Kappa value = 0.811 and 0.556 in the internal and external datasets, respectively). Conclusion:The AI decision-making model for highly myopic cataracts, based on two deep learning models, demonstrated good performance and may assist doctors in complex surgical decision-making for highly myopic cataracts.

This prospective, non-randomized, comparative study aimed to compare the visual outcomes and patient satisfaction after implantations of three presbyopia-correcting intraocular lenses (IOLs) after myopic refractive surgery. It was conducted from January 2020 to December 2021 in Shanghai Heping Eye Hospital. Patients were divided into three groups based on the type of IOL implanted. The visual acuity, refractive stability, high-order aberrations, objective visual quality, spectacle independence, and visual function index 14 questionnaire scores of the three groups were compared. This study included 78 eyes of 39 patients: 26 eyes with 839MP, 26 eyes with MF30, and 26 eyes with ZXR00. Uncorrected distance visual acuity improved significantly for all three groups. For a pupil diameter of 4.0 mm, the spherical aberrations of the three groups were 0.33 ± 0.16 μ, 0.50 ± 0.08 μ, and 0.39 ± 0.10 μ, respectively. The spectacle independence for distance vision was over 90% in each group; for near vision, it was only 25% for the ZXR00 group. All three types of presbyopia-correcting IOLs improved visual quality in post-LASIK or PRK patients. However, the high incidence of photic phenomena after presbyopia-correcting IOL implantation in patients who have undergone myopic LASIK should not be neglected.

To investigate the spatial and morphologic features of lenses with different axial length (ALs) in cataract patients using swept-source optical coherence tomography (SS-OCT). Totally 105 eyes of 105 patients scheduled to have cataract surgery were included. Eyes were divided into the control (AL < 24.5 mm), moderate myopia (MM, 24.5 ≤ AL < 26 mm) and high myopia (HM, AL ≥ 26 mm) groups. Spatial features including lens vault (LV) and iris-to-lens distance (ILD), and morphologic features including radii of curvature of anterior and posterior surface (Ra, Rp), lens diameter (LD) and lens thickness (LT) were measured in eight directions by SS-OCT. Spatially, the HM group had larger LV and ILD than the control group (both P < .05). LV and ILD were negatively correlated with AL, respectively (LV: r = -.484, P < .0001; ILD: r = -.656, P < .0001). Morphologically, both MM and HM groups had greater Ra and Rp than the control group. Ra was positively correlated with AL (r = .622, P < .0001), while the relationship between Rp and AL was non-linear. Moreover, the MM and HM groups had larger LD than the control group (both P < .001). Anterior LT was thinner in the HM than in the MM group (P = .026), while posterior LT between these two groups was similar. When compared in eight directions, similar trends were seen in Ra, Rp and LD, and the HM group showed a greater difference in Ra between horizontal and vertical directions. This SS-OCT-based study showed that longer axial length is associated with a flatter lens, which was mainly attributed to the increase of Ra and LD. Longitudinal studies would be necessary to establish a causal relationship and temporal progression.

To analyze and compare the visual performance and patient satisfaction following the implantation of toric multifocal intraocular lenses (TMIOLs) in adult patients with different types of developmental cataracts (DC) accompanied by corneal astigmatism (CA). This is a prospective observational cohort study. Patients diagnosed with DC aged 18–30 years were divided into three groups according to the anatomic location of the lens opacity: cortical, nuclear, and posterior subcapsular (PSC) groups, and implanted with TMIOLs. Visual acuity (VA), postoperative refractive astigmatism (RA), intraocular lens (IOL) rotation, high-order aberrations (HOAs), modulation transfer function (MTF) curve, and Strehl ratio were compared. The functional vision and incidence of photic phenomena were surveyed using questionnaires. Fifty-five eyes of 37 patients were enrolled and completed a 1-year follow-up. The mean CA was 2.06 ± 0.79 D preoperatively, and the mean RA was 0.29 ± 0.30 D 3-month postoperatively. The IOL rotation was 2.48° ± 1.89°, with no deviation > 10°. At 12 months, mean uncorrected distance VA improved from 0.93 ± 0.41 preoperatively to 0.08 ± 0.08 logarithm of the minimum angle of resolution (logMAR), mean uncorrected near VA increased from 0.45 ± 0.30 preoperatively to 0.12 ± 0.11 logMAR, and mean uncorrected intermediate VA was 0.14 ± 0.08 logMAR. The cortical and nuclear groups displayed better improvements in uncorrected near and intermediate VA than that in the PSC group. Similar results were observed in the 3-month defocus curves, HOAs, MTF curve, halo incidence, and near vision satisfaction. In adult patients with DC accompanied by CA, TMIOLs implantation achieved good postoperative visual outcomes and significantly reduced glasses dependency. Patients with cortical or nuclear lens opacity showed better whole-course VA and quality of vision, while patients with PSC opacity showed unsatisfactory near vision and suffered more photic phenomena.

& BULL; PURPOSE: To compare the postoperative visual out-comes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts. & BULL; DESIGN: Prospective, multicenter, randomized con -trolled trial. & BULL; METHODS: Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n = 27) or the 839 MP (n = 28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncor-rected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vi-sion and incidence of photic phenomena were surveyed using questionnaires. & BULL; RESULTS: Visual acuity at all ranges of vision was sig-nificantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group ( P = .013). Reading abil-ity at 40 and 60 cm was similar in both groups ( P > .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function In-dex 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group.& BULL; CONCLUSION: Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained im-peded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in in-termediate activities, with a lower photic phenom-ena incidence. (Am J Ophthalmol 2023;254: 1-10. & COPY; 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))

Introduction Astigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism. Methods This prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups. Results In total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at −1.50 and − 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups. Discussion Both FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

PurposeThe aim of this study was to evaluate the effect of residual astigmatism on postoperative visual outcomes after trifocal intraocular lens implantation.MethodsIn this prospective observational study, we divided 156 eyes into two groups according to postoperative astigmatism measured by subjective optometry and followed them up for 3 months. Visual acuity, modulation transfer function (MTF) curves, Strehl ratio (SR), Visual Function Index-14 scores, and photic phenomena were compared.ResultsLinear regression analysis revealed a weak correlation between residual astigmatism and uncorrected distance visual acuity (UDVA) (r = 0.190, P = 0.016) at 3 months and a significant between-group difference at 1- and 3-month postoperative UDVA (P = 0.038, P = 0.018, respectively). MTF curve values and SR (MTF-10 total, MTF-10 cornea, MTF-30 total, MTF-30 cornea, SR Total, and SR cornea) were significantly worse (P < 0.001), and the Visual Function Index-14 scores were lower in the 0.5 < astigmatism ≤ 1.25 D group (P < 0.05) than in the astigmatism ≤ 0.5 D group. No significant differences were found in the frequency, severity, and bothersomeness of photic phenomena (P > 0.05).ConclusionPostoperative residual astigmatism affects the UDVA of the trifocal intraocular lens-implanted eyes. Although we found no significant differences in uncorrected intermediate and near visual acuity, both objective and subjective visual quality were affected, suggesting the need for surgical planning when the anticipated postoperative astigmatism is >0.5 D.

Purpose. To investigate the benefits of multifocal lens in patients with high myopic cataract and compare the clinical effects between AT LISA tri 839MP and MPlus LS-313 MF30 intraocular lenses (IOLs) in high myopic eyes. Methods. This retrospective cohort study analyzed 60 eyes with axial length >26 mm in 40 patients. Thirty eyes were implanted with MF30, and the remaining 30 eyes were implanted with 839MP. Postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA), defocus curve, modulation transfer function (MTF) curve, Strehl ratio (SR), and complications were compared between the two groups. Results. All vision outcomes were significantly improved in both groups ( p < 0.05 ). There was no significant between-group difference in UDVA at 1 and 3 months postoperatively ( p > 0.05 ). However, UIVA and UNVA were significantly better in the 839MP group ( p < 0.05 ). The VF-14 score, especially for near vision quality, was significantly higher in the MF30 group (2.2 ± 0.9 vs. 0.8 ± 0.7; p ≤ 0.001 ). The SR of both groups significantly increased postoperatively ( p < 0.05 ). All the 3-month MTF curve values (MTF 10 total, MTF 10 internal, MTF 30 total, and MTF 30 internal) were significantly better in the 839MP group ( p < 0.05 ). Meanwhile, all the high-order aberration values (coma, spherical aberration, and trefoil) were significantly greater in the MF30 group ( p < 0.05 ). Conclusion. Multifocal IOL implantation achieves good quality of distance, intermediate, and near vision in patients with high myopia, improving their quality of life. Both 839MP and MF30 IOLs can provide good distance vision, but 839MP performs better in near and intermediate vision. However, for some patients with an extra-long optic axis, MF30 may be a good choice because of its wider range of degrees.

Objectives To investigate the relationship between serum lipids and pterygium in a large-scale rural population aged 40 years or older from Southern China. Study design The Dongguan Eye Study was a cross-sectional population-based study from September 2011 to February 2012. Setting The area was set in the rural area of Dongguan, Southern China. Participants Adult rural population aged 40 or older. Methods Participants underwent physical, haematological and ophthalmic examinations. Primary and secondary outcome measures The frequency and risk factors of pterygium. Results A total of 11 357 participants were eligible for inclusion and 8952 (78.8%) participants were enrolled for the systemic and ophthalmic examinations. The prevalence of pterygium was 17.3% after adjusting the sex and age distribution, 22.0% in participants with hypercholesterolaemia (total cholesterol ≥6.22 mmol/L (240 mg/dL)) and 21.8% in those with low-density lipoprotein-cholesterol (LDL-C) ≥4.14 mmol/L (160 mg/dL), respectively. After adjusting for multiple confounding factors, higher level of high-density lipoprotein-cholesterol (HDL-C) (OR: 1.23, 95% CI: 1.06 to 1.41) and LDL-C (OR: 1.13, 95% CI: 1.06 to 1.20) were positively associated with the risk of pterygium. The ORs for HDL-C or LDL-C with pterygium were significantly greater in participants aged 40–49 years than those aged 50 years or above (P for interaction <0.001). Furthermore, increased HDL-C showed greater association with pterygium in normal body mass index (BMI) group compared with overweight group (P for interaction=0.002). Conclusion Increased HDL-C and LDL-C are risk factors of pterygium, especially in people <50 years or those with normal BMI level. Strict control of HDL-C and LDL-C may be a new prevention method in reducing the risk of pterygium.

Background Due to complicated and variable fundus status of highly myopic eyes, their visual benefit from cataract surgery remains hard to be determined preoperatively. We therefore aimed to develop an optical coherence tomography (OCT)-based deep learning algorithms to predict the postoperative visual acuity of highly myopic eyes after cataract surgery. Materials and Methods The internal dataset consisted of 1,415 highly myopic eyes having cataract surgeries in our hospital. Another external dataset consisted of 161 highly myopic eyes from Heping Eye Hospital. Preoperative macular OCT images were set as the only feature. The best corrected visual acuity (BCVA) at 4 weeks after surgery was set as the ground truth. Five different deep learning algorithms, namely ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Inception-v3, were used to develop the model aiming at predicting the postoperative BCVA, and an ensemble learning was further developed. The model was further evaluated in the internal and external test datasets. Results The ensemble learning showed the lowest mean absolute error (MAE) of 0.1566 logMAR and the lowest root mean square error (RMSE) of 0.2433 logMAR in the validation dataset. Promising outcomes in the internal and external test datasets were revealed with MAEs of 0.1524 and 0.1602 logMAR and RMSEs of 0.2612 and 0.2020 logMAR, respectively. Considerable sensitivity and precision were achieved in the BCVA < 0.30 logMAR group, with 90.32 and 75.34% in the internal test dataset and 81.75 and 89.60% in the external test dataset, respectively. The percentages of the prediction errors within ± 0.30 logMAR were 89.01% in the internal and 88.82% in the external test dataset. Conclusion Promising prediction outcomes of postoperative BCVA were achieved by the novel OCT-trained deep learning model, which will be helpful for the surgical planning of highly myopic cataract patients.

Purpose: To development and validation of machine learning-based classifiers based on simple non-ocular metrics for detecting referable diabetic retinopathy (RDR) in a large-scale Chinese population–based survey.Methods: The 1,418 patients with diabetes mellitus from 8,952 rural residents screened in the population-based Dongguan Eye Study were used for model development and validation. Eight algorithms [extreme gradient boosting (XGBoost), random forest, naïve Bayes, k-nearest neighbor (KNN), AdaBoost, Light GBM, artificial neural network (ANN), and logistic regression] were used for modeling to detect RDR in individuals with diabetes. The area under the receiver operating characteristic curve (AUC) and their 95% confidential interval (95% CI) were estimated using five-fold cross-validation as well as an 80:20 ratio of training and validation.Results: The 10 most important features in machine learning models were duration of diabetes, HbA1c, systolic blood pressure, triglyceride, body mass index, serum creatine, age, educational level, duration of hypertension, and income level. Based on these top 10 variables, the XGBoost model achieved the best discriminative performance, with an AUC of 0.816 (95%CI: 0.812, 0.820). The AUCs for logistic regression, AdaBoost, naïve Bayes, and Random forest were 0.766 (95%CI: 0.756, 0.776), 0.754 (95%CI: 0.744, 0.764), 0.753 (95%CI: 0.743, 0.763), and 0.705 (95%CI: 0.697, 0.713), respectively.Conclusions: A machine learning–based classifier that used 10 easily obtained non-ocular variables was able to effectively detect RDR patients. The importance scores of the variables provide insight to prevent the occurrence of RDR. Screening RDR with machine learning provides a useful complementary tool for clinical practice in resource-poor areas with limited ophthalmic infrastructure.

Diabetic retinopathy (DR) is a major cause of visual deficits and blindness in the working-age population and inflammatory response is a key event during DR. In this study, we investigated the anti-inflammatory properties of small extracellular vesicles (sEVs) derived from human umbilical cord mesenchymal stem cells (hUCMSCs) in a diabetic rat model and human retinal microvascular endothelial cells. After development of DR in rats subjected to diabetes induction with streptozotocin (STZ), the DR rats were treated with different concentrations of hUCMSC-sEVs. Our results showed that the treatment of the retinas of DR rats with hUCMSC-sEVs not only reduced the level of vascular leakage in the retinas of rats but also decreased the retinal thickness as well as the associated inflammation. Further, our in vitro evidences suggest that hUCMSC-sEVs repress high glucose (HG)-induced cell inflammation and apoptosis. Subsequently, we analyzed the differentially expressed microRNAs (miRNAs) in the hUCMSC-sEVs by microarray and performed in silico studies to predict the target mRNA of miR-18b. Our findings also revealed that the expression of miR-18b was significantly elevated in the retina of diabetic rats after sEV treatment. In addition, miR-18b was found to target mitogen-activated protein kinase kinase kinase 1 (MAP3K1), thereby inhibiting NF-κB p65 phosphorylation to alleviate DR. Overall, this study highlights the potential of hUCMSCs-sEVs as biomaterials for anti-inflammatory and anti-apoptotic effects in DR by transferring miR-18b.

Objective:To evaluate the effect of femtosecond laser-assisted relaxing arcuate keratotomy in cataract surgery for coma correction on improving postoperative visual quality.Methods:This was a prospective case-control study. A total of 60 eyes of 51 cases with cataract from Jan. to Dec. 2018 in Shanghai Heping Eye Hospital were collected in the study. All cases were randomly divided into two groups, the trial group with 30 eyes and the control group with 30 eyes. The trial group received femtosecond laser assisted phaco & relaxing arcuate keratotomy. The control group underwent conventional femtosecond laser assisted phaco. Corneal astigmatism and 3mm coma under the pupils were scanned through iTrace at 3 months after surgery. The modulation transfer function (MTF) values and Strehl rate (SR) of the full eye were concluded. Total high-order aberration of the whole eye at 3mm and 6mm were measured in the meantime. The follow-up time was 3 months after surgery.Results:Corneal coma and astigmatism after surgery decreased in the trial group ( t=15.50, P<0.05). Visual quality analysis of patients after cataract surgery: there were significant differences between the trial group and the control group in corneal astigmatism [(0.277±0.100) D, (1.257±0.246) D], coma 0.046±0.026, 0.181±0.060, MTF (0.381±0.096, 0.248±0.105) and SR (0.100±0.023, 0.067± 0.023) values after cataract surgery( P<0.05). The difference in HOA in the examination of 6mm under the pupils was statistically significant ( P<0.05). Conclusion:Femtosecond laser-assisted relaxing arcurate keratotomy for coma correction can improve the visual quality significantly after cataractsurgery.

AIM: To investigate the clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma and its surgical treatment. METHODS: It was a retrospective case series study. The general clinical data and related ocular manifestations in 15 patients(26 eyes)with Axenfeld-Rieger syndrome associated with secondary glaucoma in our hospital from January 2003 to January 2016 were collected and analyzed retrospectively. RESULTS: Age of the patients ranged from 3-month to 43 years old, and the median age was 11 years old. There were of all 11 patients(73%)had bilateral glaucoma and 4(27%)had unilateral glaucoma. In the aspect of clinical features, hypoplasia or deficiency of the iris was found in 20 eyes(77%), peripheral iridocorneal adhesions was found in 17 eyes(65%)in various extent, and pupil distortion or multiple-pupil was found in 14 eyes(54%); Also posterior embryotoxon was found in 14 eyes(54%)as well; And 11 eyes(42%)had anomalies in corneal size. That root of iris is located at a more anterior position than that of a normal eye was found in all affected eyes by gonioscopy, coupled with different extent of angle synechiae-closure. According to the data, in 15 patients only two had a family history of ARS, while 5 had systematic abnormalities, eyes excepted, in dental, maxillary, cardiovascular, et al. Anti-glaucoma surgeries including trabeculotomy, trabeculectomy, glaucoma valve implantation were performed in 20 eyes. Nine patients(11 eyes)were followed up for 59mo on average. Intraocular pressure was significantly lower than pre-operation(t=2.4185, P=0.0362), and intraocular pressure in 7 followed-up eyes was controlled ≤21mmHg. The long-term success rate of surgery was 64%. CONCLUSION: The clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma were diverse. The patients might concomitant with other systematic dysplasia. Although it was tough to treat, surgery for glaucoma could reduce the intraocular pressure effectively.

目的 研究SRK/T、Haigis、Olsen三种人工晶状体计算公式术后屈光状态预估的稳定性与角膜屈光度数的关系,并比较3种公式预测高度近视合并白内障患者术后屈光状态的准确性,为临床上高度近视合并白内障患者人工晶状体公式的选择提供依据.方法 收集2016年10月10日至2019年8月20日于广州中医药大学第一附属医院住院的68例104眼符合高度近视合并白内障患者资料,根据角膜屈光度数将病例分为3组,计算3种公式不同角膜屈光度数的预测屈光度与术后实际屈光度的绝对差值,分析3种公式在不同角膜屈光度数亚组的区别,并比较3种公式的准确性.结果 3组组间的比较差异均无统计学意义(P>0.05);K≤43.00 D范围内,SRK/T、Haigis与Olsen公式两两比较差异都有统计学意义(P<0.05);在43.00 D<K≤45.00 D范围内,SRK/T与Olsen公式、Haigis与Olsen公式比较差异有统计学意义(P<0.05);当K>45.00 D时,仅SRK/T与Olsen公式比较具有统计学意义(P<0.05),在全部K值范围进行比较时,3种公式两两比较有统计学意义(P<0.05).结论 3种公式受角膜屈光度数影响都较小,各组间未见明显差别,在术后屈光状态的预测方面,Olsen公式预测准确性优于SRK/T、Haigis公式,而SRK/T公式预测准确性最差.临床上高度近视合并白内障患者,人工晶状体计算公式应以Olsen公式计算结果为准.