Objective: Infection by Demodex mites is a significant factor in causing blepharitis. The collected superficial eyelid tissue images currently have low resolution and strong noise. High-quality reconstruction of low-quality images is needed to assist ophthalmologists in accurately and quickly diagnosing mite infestations. Methods: We propose a novel GAN-based super-resolution reconstruction model. We utilize Residual-in Residual Dense Blocks (RRDB) as the fundamental building units and employ high-order degradation to simulate real-world degradation. Additionally, we introduce a new attention mechanism, All Attention Mechanism (AAM), which effectively captures and utilizes crucial image features, expanding the scope of utilized pixels. This significantly enhances the quality of reconstructed images. Results: Compared to existing super-resolution reconstruction models, our model demonstrates the strongest generalization ability and robustness. On the CIDMG and FMD datasets, we achieve the lowest NIQE and the highest SSIM values. Our model outperforms the SOTA SwinIR model, reducing reconstruction time by 76% and improving the image quality by 6.6% for low-noise images and 15.3% for high-noise images. Conclusion: By combining GAN with AAM, we have significantly improved the model's generalization ability, robustness, and real-time performance. Significance: This is the first time that domain generalization has been used for reconstructing superficial eyelid tissue images. The stable and fast reconstruction performance reduces the impact of noise and low resolution on image quality, significantly reducing examination time and improving diagnostic accuracy. This greatly enhances the clinical utility of confocal microscopy for eyelid demodex examination.

Background To evaluate the clinical results and rotational stability of V4c toric implantable collamer lens (TICL, STAAR Surgical Company, Monrovia, CA, USA) in patients with moderate to high myopic astigmatism. Retrospective, interventional case series was performed at Shenzhen Eye Hospital, Shenzhen, Guangdong, China. Methods This study enrolled 43 patients (72 eyes) who received TICL implantation to correct myopia and myopic astigmatism. The patients underwent visual and refractive examinations before and 1 month after surgery. Astigmatic changes were estimated using polar value analysis. The difference between the achieved axis and the intended axis at the last follow-up was taken as the rotation of the V4c TICL. Results At 1 month postoperatively, the mean safety and efficacy indices were 1.17 and 1.13, respectively. A significant reduction of 8.92±2.58 D was observed in the spherical equivalent refraction (SER), which decreased from −9.29±2.41 D preoperatively to −0.37±0.55 D postoperatively. The astigmatic error of treatment in cylinder format was calculated to 0.50±0.41 @ 15.08° relative to the preoperative stronger meridian at 1 month, postoperatively. At 1 month postoperatively, the mean absolute rotation was 8.30±10.00 degrees (median =5.46 degrees; range, 0.00–58.88 degrees). Conclusions TICL could achieve good astigmatic outcomes for correcting moderate to high myopic astigmatism. After TICL implantation, corneal astigmatism remained unchanged. To optimize postoperative astigmatic outcomes in TICL, polar value analysis can be used to build a nomogram.

Silicone implant-based augmentation rhinoplasty or mammoplasty induces capsular contracture, which has been acknowledged as a process that develops an abnormal fibrotic capsule associated with the immune response to allogeneic materials. However, the signaling pathways leading to the nasal fibrosis remain poorly investigated. We aimed to explore the molecular mechanism underlying the pathogenesis of nasal capsular contracture, with a specific research interest in the signaling pathways involved in fibrotic development at the advanced stage of contracture. By examining our recently obtained RNA sequencing data and global gene expression profiling between grade II and grade IV nasal capsular tissues, we found that both the RAP1 and JAK/STAT signaling pathways were hyperactive in the contracted capsules. This was verified on quantitative real-time PCR which demonstrated upregulation of most of the representative component signatures in these pathways. Loss-of-function assays through siRNA-mediated Rap1 silencing and/or small molecule-directed inhibition of JAK/STAT pathway in ex vivo primary nasal fibroblasts caused a series of dramatic behavioral and functional changes, including decreased cell viability, increased apoptosis, reduced secretion of proinflammatory cytokines, and synthesis of type I collagen, compared to control cells, and indicating the essential role of the RAP1 and JAK/STAT signaling pathways in nasal capsular fibrosis. Our results sheds light on targeting downstream signaling pathways for the prevention and therapy of silicone implant-induced nasal capsular contracture.

BACKGROUND:To investigate the corneal neurotropic phenomenon in patients with lattice corneal dystrophy (LCD) with in vivo laser scanning confocal microscopy (IVCM).METHODS:IVCM was performed on a total of 15 patients (28 eyes) with LCD annually at a follow-up. A collection of the data was acquired to be analyzed.RESULTS:As indicated by the analysis, the LCD patients' normal corneal stromal nerves (Grade 0) presented a decline with the prolongation of the follow-ups, corresponding to a gradual increase in grade I and II involving amyloid-wrapped nerve fibers, which demonstrated that the growing amount of amyloid deposit due to the corneal nerve invasion increased slowly over time.CONCLUSIONS:The neurotropic phenomenon could increase with its severity in the corneal lesion of the patients with LCD, and also reflect the distribution of the corneal nerves, to some extent. IVCM provides a rapid, noninvasive way to observe the corneal nerves, which can be an efficient means of better understanding the development of LCD.

目的:采用角膜激光共焦显微镜观察研究颗粒状角膜营养不良家系患者的角膜状况.方法:采用角膜激光共焦显微镜对4例(6只眼)颗粒状角膜营养不良患者的角膜进行扫描检测,对比裂隙灯及普通显微镜观察分析检查情况.结果:颗粒状角膜营养不良患者的病变角膜裂隙灯下呈现面包屑样的灰白色混浊,在苏木精-伊红(hematoxylin-eosin,HE)染色中呈现出伊红染的颗粒,沉积于基质板层之间,在共焦显微镜下则为中高反光的团块,相互融合,并取代了基质细胞.结论:颗粒状角膜营养不良患者角膜病变从裂隙灯到普通HE染色下的显微镜,乃至高倍的共焦显微镜观察到的沉积物,分布情况相吻合,印证角膜病变发展的状况,有利于了解该病变的发展情况.

目的 采用角膜激光共焦显微镜对真菌孢子致病的真菌性角膜溃疡及培养菌落进行观察,比较并总结其特点.方法 回顾性系列病例研究.11例(11只眼)角膜溃疡经取溃疡灶取材培养、菌种鉴定确诊为孢子致病的真菌性角膜溃疡患者,采用激光角膜共焦显微镜分别观察角膜溃疡灶中的真菌孢子形态和培养菌落涂片的真菌孢子形态,研究二者孢子图像的相似性,为早期诊断单纯孢子致病的真菌性角膜溃疡打下研究基础.结果 溃疡灶中的活体孢子与实验室培养出的真菌菌落涂片的孢子,在角膜激光共焦显微镜图像上,有很好的一致性.结论 孢子致病的真菌性角膜溃疡,其角膜激光共焦显微镜检查到的活体孢子图像与培养孢子的图像特点基本吻合.角膜激光共焦显微镜检查在孢子致病的真菌性角膜溃疡诊断方面上,是对角膜刮片培养、实验室检查的有力补充.

Nasal capsular contracture is a prevalent complication commonly observed after rhinoplasty. However, the mechanism underlying the pathogenesis of nasal capsular contracture is largely unclear compared to that of breast capsular contracture. This study aimed to identify the key genes implicated in nasal capsular contracture progression using RNA deep sequencing (RNA-seq). Biopsy samples were taken from Grade II to Grade IV nasal fibrous capsular tissues. The former is regarded as the relatively normal tissues and thus was set as control group, while the latter was treated as pathological group. Results from RNA-seq underwent GO enrichment and KEGG pathway analysis and subsequent verification by quantitative reverse transcriptase polymerase chain reaction and western blot assays. RNA-seq analysis showed that 3149 genes were up-regulated and 3131 genes in pathological groups compared with controls. The top 30 up-regulated genes included many chemokines (e.g., CCL18, CCL13, CCL17 and CCL8), matrix metallopeptidases (e.g., MMP9 and MMP12) and integrin proteins (e.g., ITGAM and ITGB2). GO enrichment analysis demonstrated that the up-regulated genes affected various immune functions, including immune system process, cell activation, leukocyte activation, defence response and positive regulation of immune. The down-regulated gene primary influenced muscle development and functions as well as metabolic processes. In summary, this study reveal that abnormal changes of immune functions, muscle develop and metabolic processes are probably implicated in the pathogenesis of nasal capsular contracture.

Granular corneal dystrophy (GCD) is featured by corneal deposits of transforming growth factor beta-induced gene (TGFBI) mediated by the TGF-β (transforming growth factor-β)/Smad signaling. However, the roles of c-Jun amino-terminal kinase (JNK) pathway in GCD pathogenesis remains unexplored, which was investigated in this study. JNK signaling activation and inhibition in primary corneal fibroblasts were obtained by treatments with anisomycin and SP600125, respectively. Protein abundance and phosphorylation were detected by immunoblotting. Cell viability and apoptosis were analyzed by CCK-8 and flow cytometry respectively. TGFBI deposit and autophagy progression were assessed by immunofluorescence. The results found that JNK1 expression and phosphorylation were greatly increased in corneal tissues from GCD2 patients. JNK signaling activation impaired the viability and promoted apoptosis and autophagy processes in primary corneal fibroblasts, along with Smad2/3 phosphorylation, TGFBI accumulation and Bcl-2 suppression. Autophagy related proteins, such as ATG5 (autophagy related 5), ATG12 (autophagy related 12) and LC3B (microtubule-associated protein 1 light chain 3 beta), were also increased in anisomycin or TGF-β1 treated corneal fibroblasts. However, SP600125 effectively reversed the above effect induced by TGF-β1 treatment in corneal fibroblasts, including the TGF-β-induced autophagy progression. The results suggested that JNK signaling was activated in GCD2 corneal tissues, and it mediated the TGF-β-induced TGFBI protein accumulation and apoptosis of corneal fibroblasts during GCD2 pathogenesis.

Background: To investigate the corneal neurotropic phenomenon in patients with lattice corneal dystrophy (LCD) with in vivo laser scanning confocal microscopy (IVCM). Methods: IVCM was performed on a total of 15 patients (28 eyes) with LCD annually at a follow-up. A collection of the data was acquired to be analyzed. Results: As indicated by the analysis, the LCD patients’ normal corneal stromal nerves (Grade 0) presented a decline with the prolongation of the follow-ups, corresponding to a gradual increase in grade I and II involving amyloid-wrapped nerve fibers, which demonstrated that the growing amount of amyloid deposit due to the corneal nerve invasion increased slowly over time. Conclusions: The neurotropic phenomenon could increase with its severity in the corneal lesion of the patients with LCD, and also reflect the distribution of the corneal nerves, to some extent. IVCM provides a rapid, noninvasive way to observe the corneal nerves, which can be an efficient means of better understanding the development of LCD.

AIM: To study the expressions of TGFBI and microtubule-associated protein 1 light chain 3 alpha(LC3)in granular corneal dystrophy, and the influences of lithium chloride(LiCl)on corneal stromal fibroblast cell proliferation by TGFBI. METHODS: Immunohistochemistry and Western-blot assays were used to detect the expression levels of TGFBI and LC3 in corneal dystrophy and normal corneal tissues. TGFBI overexpression vector was transfected into corneal stromal fibroblasts, and then the cells were treated with 5, 10, 20, 40mmol/L LiCl for different times(0, 1, 6, 12h), and Western-blot assay was performed to evaluate the expression levels of TGFBI and LC3, and CCK-8 assay was carried out to assess cell proliferation activity.RESULTS: TGFBI and LC3 were highly expressed in corneal tissues of patients with corneal dystrophy. TGFBI overexpression inhibited the proliferation ability of corneal stromal fibroblasts(P<0.05). LiCl inhibited the expression levels of TGFBI and LC3, and enhanced the cell proliferation activity in corneal stromal fibroblasts transfected with mutant TGFBI(P<0.05).CONCLUSION: LiCl promoted the proliferation and autophagy of corneal stromal fibroblasts, and its mechanism may be related to down regulated expressions of TGFBI and LC3.

This study evaluated whether lithium chloride (LiCl) prevents cytoplasmic accumulation of mutant-transforming growth factor β-induced protein (Mut-TGFBI) in granular corneal dystrophy (GCD) via activation of the autophagy pathway. Levels of TGFBI and microtubule-associated protein 1A/1B-light chain 3 (LC3) in 3 GCD patients and healthy controls were analyzed by immunohistochemistry (IHC) staining and Western blot. Primary corneal fibroblasts were isolated and transfected with wild type or mutant type TGFBI over-expressed vectors, and then treated with LiCl and/or autophagy inhibitor 3-methyladenine (3-MA). Then, levels of TGFBI, glycogen synthase kinase-3 (GSK-3) and LC3-I/-II were detected. Cell viability and transmission electron microscopy assay were also performed. Levels of TGFBI and LC3 were significantly increased in GCD patients. Over-expression of mutant type TGFBI inhibited cell viability and induced autophagy in corneal fibroblasts. LiCl downregulated the expression of TGFBI in mutant type TGFBI over-expressed cells in a dose- and time-dependent manner. LiCl enhanced autophagy in mutant type TGFBI over-expressed cells and recovered cell viability in those cells. However, the effects of LiCl were partly attenuated when autophagy was suppressed by 3-MA. To summarize, treatment with LiCl inhibited the expression of TGFBI and recovery the inhibitory of mutant type TGFBI in cell viability, at least part through enhancing of autophagy. These data strongly suggest that LiCl may be useful in the treatment of GCD.

In this article, the significance of anterior segment optical coherence tomography (AS-OCT) to aid the clinical diagnosis and treatment of Descemet membrane (DM) detachment after phacoemulsification combined with intraocular lens implantation was retrospectively analyzed using 26 patients (26 eyes). The location and scope of DM detachment, its causative factors and the percentage of each detachment type are considered for clinical treatments. Based on the location and scope, the detachment can be divided into three types: (1) simple, (2) symmetrical and (3) complete DM detachment. Simple detachment, confined to the area of surgical incision (detachment range <1/4 corneal area), occurred in 69.20 % of cases (18/26), in which the DM detachment in the anterior lip accounted for 42.30% (11/26) and in the posterior lip accounted for 26.90% (7/26). Symmetrical DM detachment, referring to detachment (1/4 cornea area < detached area <1/2 corneal area) that appeared symmetrically on the surgical incision and the opposite site, accounted for 19.20% (5/26). Complete DM detachment (>1/2 of the corneal area), accounted for 11.50% (3/26). Interestingly, our findings suggest that the DM detachment after phacoemulsification is closely related to the location (simple and symmetrical DM detachment) and the skillfulness (complete DM detachment) of the surgical incision. Therefore, appropriate classification of DM detachment by AS-OCT and wise selection of surgical location can better guide cataract surgery in the future.

Purpose: To report challenges in the management of a patient with keratitis caused by Candida parapsilosis. Methods: An otherwise healthy 48-year-old man developed chronic corneal ulcer following ocular trauma. Microbiologic work up using smear, culture and In Vivo Confocal Microscopy, was negative. Lamellar and penetrating keratoplasty were performed to cure the infection. Results: The patient developed recurrence of the infection after lamellar keratoplasty. The interface recurrence was seen twice despite washing with antibiotics. Microbial culture finally revealed infection of C. parapsilosis which was sensitive to fluconazole and amphotericin B. Moreover, a repeat lamellar keratoplasty was followed by another recurrence. A penetrating keratoplasty was finally performed with no recurrence of infection during 10 months of follow-up. Conclusions: Diagnosis of the corneal infection by C. parapsilosis can be challenging due to recurrence of the infection after lamellar keratoplasty. A penetrating keratoplasty may be required for cure of yeast infection after repeated recurrence of the infection. In addition, yeast infection should be considered in patients with chronic keratitis.

While Plastic Compressed (PC) collagen technique is often used to fabricate bioengineered constructs, PC collagen gels are too weak to be sutured or conveniently handled for clinical applications. To overcome this limitation, electrospun poly (lactic-co-glycolide) (PLGA) mats, which have excellent biocompatibility and mechanical properties, were combined with PC collagen to fabricate sandwich-like hybrid constructs. By laser-perforating holes with different sizes and spacings in the electrospun mats to regulate the mechanical properties and light transmittance of the hybrid constructs, we produced hybrid constructs with properties very suitable to apply in corneal tissue engineering. The maximum tensile stress of the optimal hybrid construct was 3.42 ± 0.22 MPa. The light transmittance of the hybrid construct after perforation was approximately 15-fold higher than before, and light transmittance increased gradually with increasing time. After immersing into PBS for 7 days, the transmittance of the optimal construct changed from 63 ± 2.17% to 72 ± 1.8% under 500 nm wavelength. The live/dead staining, cell proliferation assay and immunohistochemistry study of human corneal epithelial cells (HCECs) and human keratocytes (HKs) cultured on the optimal hybrid construct both demonstrated that the cells adhered, proliferated, and maintained their phenotype well on the material. In addition, after culturing for 2 weeks, the HCECs could form stratified layers. Thus, our designed construct is suitable for the construction of engineered corneal tissue.

The aim of the project is to retrospectively study the changes in bacterial pathogens in acute neonatal bacterial conjunctivitis from 2002 to 2016 in Southern China. The results may provide the guidance for drug choice for acute neonatal bacterial conjunctivitis.

BACKGROUND:Iris plays important roles in ocular physiology and disease pathogenesis. Currently it is technically challenging to noninvasively examine the human iris ultrastructure in vivo. The purpose of the current study is to reveal human iris ultrastructure in patients with synechiae by using noninvasive in vivo laser scanning confocal microscopy (LSCM).METHODS:The ultrastructure of iris in thirty one patients, each with synechiae but transparent cornea, was examined by in vivo LSCM.RESULTS:Five characteristic iris ultrastructures was revealed in patients with synechiae by in vivo LSCM, which include: 1. tree trunk-like structure; 2. tree branch/bush-like structure; 3. Fruit-like structure; 4. Epithelioid-like structure; 5. deep structure. Pigment granules can be observed as a loose structure on the top of the arborization structure. In iris-associated diseases with Tyndall's Phenomenon and keratic precipitates, the pigment particles are more likely to fall off from the arborization structure.CONCLUSIONS:The ultrastructure of iris in patients with synechiae has been visualized using in vivo LSCM. Five iris ultrastructures can be clearly observed, with some of the structures maybe disease-associated. The fall-off of the pigment particles may cause the Tyndall's Phenomenon positive. In vivo LSCM provides a non-invasive approach to observe the human iris ultrastructure under certain eye disease conditions, which sets up a foundation to visualize certain iris-associated diseases in the future.

Objective To evaluate the clinical efficacy of homologous sclera patch grafting combined with autogenous conjunctival flap covering for sterile scleral melting after ophthalmologic operation.Methods Ten eyes of 10 patients with sterile scleral melting after ophthalmologic operation who underwent homologous sclera patch grafting combined with autogenous conjunctival flap covering were retrospectively reviewed.The necrotic scleral tissue was smeared and cultured,and the serological examination was carried out.The 10 eyes were treated with FK506,rhEGF and artificial tears after the operation.Results Before the operations,no bacteria or fungi were found and there was no evidence of inflammation in the 10 cases.The rheumatoid factor was abnormally high expression in one case.8 patients presented dry eye.About at d 45,8 cases of the necrotic sclera has healed after operation.2 cases of the sclera graft began to melt at d 40 and d 48 after operation because of poor vascularization.Conclusion The immunoreaction caused by systemic immunity and operation may be the main causes of sterile scleral melting after the ophthalmologic operation.The homologous sclera patch grafting combined with autogenous conjunctival flap covering is helpful to treat the scleral melting which can preserve the eyeball integrity.

Objective To study the causes and treatment of dry eye syndrome caused by Meibomian gland dysfunction (MGD).Methods The clinical data of dry eye syndrome caused by (MGD)from 2011 to 2012 in Shenzhen Eye Hospital were retrospectively analyzed.The patients were comprehensively treated by eyelid rims cleaning,Meibomian gland massages,hot packing eyelid and topical drugs and lacrimal point plug.Results Of 60 patients,there were 38 patients cured,16 cases improved,and only 3 cases no response.The total effective rate was 95％.Conclusions Meibomian gland dysfunction is one of the main causes of dry eye.Therefore,the comprehensive treatment should be applied from the causes,So promoting Meibomian gland secretion,making Meibomian gland duct unblocked will be beneficial to the stabilization of tear film and remission of dry eye syndrome.

Objective To evaluate the effect of subconjunctival bevacizumab on experimental corneal neovascularization (NV) in rabbits at different time points.Methods The right eyes of 54 white New Zealand rabbits were chemically burned with 1mol/L NaOH and randomly divided into three groups.Eighteen eyes (group A) received subconjunctival injection of bevacizumab (2.5 mg,0.1 mL) immediately after burn.Eighteen eyes (group B) received subconjunctival injection of bevacizumab (2.5 mg,0.1 mL) 3 days after burn with subconjunctival injection of normal saline.Group C was the control group.The angiogenesis and inhibition of corneal neovascularization were detected respectively by measuring the length and area of NV under slit lamp microscopy everyday.Corneal confocal microscope was used to detect the cornea at 7 days,14 days and 28 days after corneal burn.Results The occurrence time of corneal NV was (5.9± 0.8) d,(3.5 ± 0.6) d and (3.4 ± 1.1) d in group A,B and C.Compared with the group C,the corneal NV occurrence was significantly delayed in group A and B.No significant difference in the occurrence time of corneal NV was found between group B and group C (P =0.068).The corneal NV areas of group A and group B were smaller than the group C at different time points,and the difference has statistical significance (P ＜ 0.05).The degrees of fibrous structures and scars in corneal stroma of treatment groups were slightly less than the group C.Conclusion Subconjunctival injection of bevacizumab can sufficiently decrease the number of inflammatory cells in the cornea after chemical burn,improve the microenvironment of injured corneal stroma and accelerate the cornea wound healing,which eventually inhibit the growth of corneal NV.The anti-neovascular effect of bevacizumab is better if the injection is performed at the early stage of corneal angiogenesis.