AIM: To investigate the effect of 0.01% low-concentration atropine (LA) on quantitative contrast sensitivity function (qCSF) in children with myopia. METHODS: This paired case-control study included 90 eyes of 58 children who were sex-, age-, and refraction-matched and equally divided into two groups: the 0.01% LA group had undergone 6mo use of daily 0.01% atropine and control group was naïve to LA. Routine ophthalmic examinations and qCSF test without refractive correction were performed. Two groups were compared in monocular and binocular qCSF parameters, including the area under logCSF, CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cycle per degree (cpd). RESULTS: In the monocular comparison, the CSF acuity of the LA group was significantly higher than that of the control group (7.58±5.51 vs 6.37±4.22 cpd, P<0.05). The subgroup analysis showed that in the 6-9y group, CSF acuity was significantly higher in the LA group than the control group (8.76±6.19 vs 6.54±4.25 cpd, P<0.05), and in the Female group, low refraction sphere group, and high refraction cylinder group, the CS at high spatial frequencies (12.0 and 18.0 cpd) were significantly higher in the LA group than in the control group (all P<0.05). In the binocular test, CSF acuity and CS at 12.0 cpd were significantly higher in the LA group than in the control group (10.95±7.00 vs 8.65±5.12 cpd; 0.17±0.33 vs 0.06±0.16, respectively; both P<0.05). CONCLUSION: Use of LA may result in improved CS in children with early onset myopia.

To investigate the long-term safety and efficacy of using keratorefractive lenticule extraction (KLEx)-derived corneal stromal lenticules preserved in nutrient capsules for the treatment of corneal diseases. Eye and ENT Hospital of Fudan University. Observational study. Ten eyes of 10 patients with corneal diseases (6 males, 4 females, age 38.10 ± 9.11 years, ) were treated with phototherapeutic keratectomy combined with epikeratophakia or intrastromal keratoplasty using KLEx-derived lenticules. Corneal stromal lenticules which used for transplantation was extracted from healthy myopia patients and stored in nutrient capsules at 4 °C for 28 days. Patients underwent slit-lamp microscopy, uncorrected and corrected distance visual acuity (CDVA), subjective refraction, corneal topography, and anterior segment optical coherence tomography evaluations preoperative and were followed-up at 1-week, 1-month, 3-months, and 1-year postoperatively. No complications occurred intra- or postoperatively. CDVA increased by at least two lines in seven eyes and by one line in one eye, while remaining unchanged in two eyes, by the final follow-up. There was no significant difference found in the comparison of each postoperative corneal thickness to preoperative measure. The lenticules maintained a good degree of transparency 1-year post-operatively and adhered closely to the adjacent tissue. Intraocular pressure remained stable from preoperatively to all points postoperatively. There was no significant difference in corneal endothelial cell density values between pre and all post-operative time points. KLEx-derived corneal stromal lenticules preserved in nutrient capsules for up to 28 days can be safely and effectively utilized as allografts for the treatment of corneal diseases, demonstrating favorable long-term outcomes.

Aims To identify factors contributing to rapid axial length (AL) growth in children aged 3-9 years.Methods Four thousand four hundred thirty-five children were followed from 2019 to 2022. AL and corneal curvature were measured using an IOLMaster 500, while refractometry and visual acuity were also assessed. Baseline data included demographics and parental myopia status, with annual updates on height, weight and behavioural factors. Latent class growth model was used to discover AL trajectories, whereas multiple logistic regression was used to identify determinants of rapid AL elongation.Results For all participants, baseline age and parental myopia influenced AL growth. Specifically, children aged 3-6 years exhibited faster AL elongation when engaging in persistent excessive homework time (OR, 2.86, 95% CI 1.31 to 6.95) and near-work activities (OR, 2.13, 95% CI 1.12 to 4.10). For the 7-9-year group, the risk factors of rapid AL growth included being female (OR, 2.05, 95% CI 1.45 to 2.90) and need myopia correction at baseline (OR, 3.19, 95% CI 2.02 to 5.02). Notably, actively engaging in outdoor activities had a protective effect in the 7-9-year group (OR, 0.65, 95% CI 0.43 to 0.97).Conclusions This study delineates AL growth trajectories in children aged 3-9 years and highlights distinct risk factors for rapid AL growth. These findings underscore the necessity of implementing age-specific strategies for myopia prevention and control.

Our previous survey identified a lack of knowledge of myopia among Chinese parents. This research aims to update the characteristics of parents’ knowledge, attitude, and practice in myopia control. A self-administered questionnaire was disseminated to parents of myopic children in 16 hospitals from 11 provinces in China. Comprehensive information regarding the knowledge, attitude, and practice in myopia of parents with myopic children was collected, with the underlying correlations being analyzed. A total of 1266 valid questionnaires were collected. The concern over children’s visual problems arose significantly earlier among myopic parents (P < 0.001). Axial length was recorded by 29.9

PURPOSE: To evaluate the corneal biomechanical metrics of Chinese adults with myopia and identify relevant factors of Brillouin microscopy. METHODS: In this cross-sectional study, corneal biomechanics in Chinese adults with myopia were quantified and analyzed using Brillouin microscopy and the Corvis ST (CST) (Oculus Optikger & auml;te GmbH) and analyzed. Univariate linear regression was used with potential factors including age, sex, spherical equivalent (SE), intraocular pressure (IOP), central corneal thickness (CCT), and mean keratometry (Kmean). RESULTS: The study included 87 eyes of 87 participants (mean age: 24.47 +/- 6.27 years). Central, Mean, maximum (Max), minimum (Min), standard deviation, and Max-Min Brillouin modulus (BM) values obtained from Brillouin microscopy exhibited values of 2.826 +/- 0.039, 2.827 +/- 0.027, 2.864 +/- 0.034, 2.790 +/- 0.038, 0.108 +/- 0.042, and 0.074 +/- 0.041 GPa, respectively. No significant correlations were found between BM parameters and age, sex, SE, IOP, or CCT. However, the Mean (b =-0.251, P = .019), Min (b =-0.315, P = .003), and Max-Min (b = 0.229, P = .033) BM values were significantly associated with Kmean. The Central, Mean, Min, and Max BM values negatively correlated with the Tomographic Biomechanical Index measured by CST (Spearman's r =-0.24,-0.35,-0.29, and-0.23, respectively, all P < .05). CONCLUSIONS: Brillouin microscopy accurately reflects corneal biomechanical parameters in Chinese adults with myopia, independent of IOP and CCT, with a good correlation with CST. Concurrent evaluation of the corneal curvature is imperative when employing Brillouin microscopy in clinical practice.

Purpose: To evaluate changes of hydroxyproline concentration and its influencing factors of small incision lenticule extraction (SMILE)-derived corneal stromal lenticules with different preservation methods. Methods: A total of 390 corneal stromal lenticules of 195 patients were derived from SMILE surgeries. Thirty of the lenticules were classified as the fresh (control) group, and the rest were randomly and evenly divided and stored in anhydrous glycerol, silicone oil, Optisol, and cryopreservation for 1 day, 1 week, or 1 month. A hydroxyproline assay kit (ab222941, Abcam) was used to measure the hydroxyproline concentration in each preservation method. Concentrations of MMP-2, TIMP-2, TNF alpha, TGF beta 2, and reactive oxygen species were also evaluated. Results: In the anhydrous glycerol group, the concentration of hydroxyproline decreased within 1 week (fresh: 1 d Delta = 0.229, P < 0.001*; 1 d - 1 w Delta = 0.055, P < 0.001*) while that in the silicone oil group remained stable in 1 week (1 d - 1 w Delta = -0.005, P = 0.929) and decreased significantly in 1 m (1 m - 1 w Delta = -0.041, P = 0.003*). The sequence of hydroxyproline concentration in the Optisol group was 1 m > 1 day > 1 week. Hydroxyproline concentration in the cryopreservation group decreased within 1 m. Hydroxyproline concentration was highest in the Optisol group and lowest in the anhydrous glycerol group under the same preservation time. Hydroxyproline concentration was negatively correlated with MMP-2 (r = -0.16, P = 0.421) and TIMP-2 (r = -0.56, P = 0.002*) while MMP-2 and TNF alpha (r = 0.17, P = 0.242), TIMP-2 and TGF beta 2 (r = 0.21, P = 0.207), and TNF alpha and reactive oxygen species (r = 0.52, P = 0.007*) were positively correlated. Conclusions: More collagen was retained in SMILE lenticules preserved in Optisol under the same preservation time. The mechanism of the changes of collagen in preserved SMILE-derived lenticules and oxidative stress requires additional investigation.

BACKGROUND:To establish a novel vault prediction formula after implantable collamer lens (ICL) implantation that considers both anterior and posterior chamber characteristics with multi-modal parameters. METHODS:A total of 103 and 65 eyes were included in the development and validation groups, respectively. Exploratory factor analysis was performed using data from optical coherence tomography and ultrasound biomicroscopy in the development group to synthesise summative factors with different clinical significance. Dominant original metrics with heavy loadings on significant factors (absolute value of the loading coefficient >0.5) were screened for multivariate linear regression models using a stepwise method. The newly derived formula was evaluated and compared to the NK and KS formulas in the validation group. RESULTS:Six factors (anterior chamber angle, horizontal width, lens, iris, iridociliary complex and ciliary body) were generated after dimension reduction via factor analysis. Factors 2 (horizontal width), 3 (lens), and 5 (iridociliary complex) had a significant influence on the vault. When dominant metrics on these factors were screened for further model building, ICL size, anterior chamber width, crystalline lens rise, iris curvature, and iris-ciliary process distance were retained in the final formula, with an adjusted R2 of 0.698, a median absolute error of 81.97 mm, and a root-mean-square error of 103.35 mm. CONCLUSIONS:Multiple intraocular components, including the lens, iris, and ciliary body, play important roles in vault determination. The new formula exhibits good accuracy for vault predictions and ICL size recommendations.

Background: Prealbumin is a symbol of protein nutrition and is involved in anti-inflammatory and neuron regeneration, but its association with the prognosis of ischemic stroke remains unclear. We aimed to prospectively explore the associations between serum prealbumin levels and adverse clinical outcomes after ischemic stroke in a large-scale cohort study. Methods: We measured serum prealbumin levels among 6609 ischemic stroke patients admitted at Minhang hospital. The primary outcome was composite of death and major disability (modified Rankin Scale [mRS] score >= 3) at 3 months after stroke onset, and secondary outcomes included death and the ordered 7-level categorical score of mRS. Results: During 3 months of follow-up, a total of 2118 patients developed the primary outcome. After multivariable adjustment, high prealbumin levels were associated with a decreased risk of primary outcome (odds ratio, 0.71; 95% CI, 0.59- 0.85; P-trend< 0.0001) when 2 extreme quartiles were compared. Each unit increase of log-transformed prealbumin was associated with a 42% (95% CI, 28-53%) decreased risk of primary outcome. There was a better shift in the distribution of mRS score at 3 months with higher quartiles of serum prealbumin in ischemic stroke patients (P-trend< 0.0001). Multivariable-adjusted spline regression model showed a linear relationship between prealbumin and the risk of primary outcome (P for linearity = 0.0036). Conclusion: High serum prealbumin level was independently associated with decreased risks of adverse clinical outcomes among ischemic stroke patients. Our findings suggested that prealbumin may be a valuable prognostic biomarker and indicated the importance of keeping nourished in the daily life.

Abstract Background This study assessed the agreement of ocular parameters of patients with myopia measured using Colombo intraocular lens (IOL) 2 and IOLMaster 700. Methods Eighty patients (male, 22; average age, 29.14 ± 7.36 years) with myopia (159 eyes) were included in this study in May 2023. The participants’ axial length (AXL), central corneal thickness (CCT), lens thickness (LT), white-to-white distance (WTW), front flat (K1), steep (K2), mean (Km) corneal keratometry, astigmatism (Astig), J0 vector, and J45 vector were measured using the IOLMaster 700 and Colombo IOL 2. The measurements from both devices were compared using the generalized estimating equation, correlation analysis, and Bland-Altman plots. Results With the Colombo IOL 2, lower values for K2 and J0 (odds ratio [OR] = 0.587, p = 0.033; OR = 0.779, p < 0.0001, respectively), and larger values for WTW, Astig, and J45 (OR = 1.277, OR = 1.482, OR = 1.1, all p < 0.0001) were obtained. All ocular measurements by both instruments showed positive correlations, with AXL demonstrating the strongest correlation (r = 0.9996, p < 0.0001). The intraclass correlation coefficients for AXL and CCT measured by both instruments was 0.999 and 0.988 (both p < 0.0001), and Bland-Altman plot showed 95% limits of agreement (LoA) of -0.078 to 0.11 mm and − 9.989 to 13.486 μm, respectively. The maximum absolute 95% LoA for LT, WTW, K1, K2, and J0 were relatively high, achieving 0.829 mm, 0.717 mm, 0.983 D, 0.948 D, and 0.632 D, respectively. Conclusions In young patients with myopia, CCT and AXL measurements obtained with the Colombo IOL 2 and IOLMaster 700 were comparable. However, WTW, LT, corneal refractive power, and astigmatism values could not be used interchangeably in clinical practice.

Abstract This study investigated screen-time behaviors of Chinese children and adolescents and the efficacy of artificial intelligence (AI)-based alerts in screen-time behavior correction. Data from 6,716 children and adolescents with AI-enhanced tablets that recorded behavioral and light environment data during use were analyzed. The mean daily screen time was 67.10 ± 48.26 min. The screen time of junior-high-school students exceeded 1.5 h (92.50 ± 75.06 min) and that of school-aged participants exceeded 4 h per week. Children younger than two years used tablets for more than 45 min per day. Learning accounted for more than 50% of participants’ screen time. The distance alarm was triggered 807,355 times. Some participants (31.03%, 2061/6643) used tablets for 1 h at an average distance < 50 cm. Over 70% of the participants used the tablet under an illuminance < 300 lx during the day and more than 60% under an illuminance < 100 lx at night. More than 85% of the participants’ ambient light exceeded 4,000 K color temperature at night. The screen time of school-aged participants was longer than that of preschool-aged children. The recorded illumination was insufficient and was paired with a high color temperature at night. AI can effectively remind children and adolescents to correct unhealthy behaviors during screen time.

IntroductionThe prevalence of myopia in young generations has dramatically increased over the years, especially in China. This study aims to understand Chinese parents' perspectives on myopia for further improvement of treatment compliance and informing future health planning and policy.MethodsThis was a prospective cross-sectional survey study. A self-administrated, internet-based questionnaire was distributed to 2545 parents in China. Detailed information about the demographics, the awareness of myopia, related complications, and practices of myopia prevention and control of the respondents were collected. The distribution of answers was compared among different groups of children's age, children's refractions, and parents' residential locations. Relationships between parental cognition and behavior were also analyzed.ResultsEligible responses were returned by 2500 parents. A total of 55.1% of the respondents considered myopia as a disease and more than 70% of respondents did not realize pathological changes related to myopia. Most parents thought myopia could be prevented (82.0%) and controlled (75.2%), and these parents were more likely to take measures than the parents who did not think so (P < 0.001). The most common myopia control modality was spectacles (87.0%), among which single-vision spectacles are the most used (63.7%).ConclusionsKnowledge about health risks related to myopia was lacking in Chinese parents and their practices of myopia control mainly involved single-vision glasses. Nationwide education for parents about myopia is needed to further advance outcomes of myopia prevention and control.

Abstract Purpose: To compare the long-term safety and efficacy of monovision surgery using implantable collamer lens (ICL) V4c and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in myopic patients with early presbyopia. Setting: Eye and ENT Hospital of Fudan University,shanghai, China. Design: Case series study. Methods: 48 eyes of 24 patients were included (male/female: 10/14, mean age 45.50±3.82 years). We recorded parameters including mean spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, intraocular pressure, presbyopic add power, visual acuity (VA) (logMAR) of dominant eyes (D-eye), non-dominant (nD-eye) eyes, and both eyes (Bi) at 0.4 m, 0.8 m, and 5 m, corneal wavefront aberration, and contrast sensitivity (CS) at the last follow-up (4.5 years, 54.00±9.77 months). Statistical significance was set at p<0.05. Results: All surgeries were uneventful. The safety indices of ICL V4c group and FS-LASIK group were 1.17±0.30 and 0.98±0.20 (p<0.05), and the efficacy indices were 0.79±0.07 and 0.52±0.07 (p<0.05) respectively. The binocular VA (logMAR) of ICL V4c group and FS-LASIK group at 5.0 m were: 0.02±0.11, 0.18±0.30; 0.8 m: 0.09±0.12, -0.01±0.11; 0.4 m: -0.02±0.06, -0.03±0.08, (p>0.05 at three distances). Compared with ICL V4c group, lower CS was observed at 1.0 cpd in the FS-LASIK group (1.07±0.31 vs. 0.80±0.51, p=0.043). Conclusions: Implantable collamer lens V4c and FS-LASIK are safe and practicable for correction of myopes with presbyopia. Compared with the FS-LASIK group, the ICL V4c group showed superior CS in nD-eyes in low spatial frequency.

To investigate the morphological changes of concave iris in myopic patients after EVO implantable collamer lens (ICL) implantation. EVO ICL candidates with posterior bowing iris were observed using ultrasound biometric microscopy (UBM) in this prospective nonrandomized observational study. Forty patients were enrolled, with 20 patients in the concave iris group and the other 20 patients in the control group. None of the patients underwent laser peripheral iridotomy. All patients received preoperative and postoperative examinations, which included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), subjective manifest refraction and intraocular pressure. UBM was used to observe iris curvature (IC), irido-corneal angle (ICA), posterior chamber angle (PCA), iris-lens contact distance (ILCD), iris-zonule distance (IZD) and ciliary process length (CPL). Anterior chamber angle pigment was observed by gonioscopy. The preoperative and postoperative data were analyzed using SPSS. The average follow-up period was 13.3 ± 5.3 months. The mean efficacy indices were 1.10 ± 0.13 and 1.07 ± 0.11 (P = 0.58), and the safety indices were 1.19 ± 0.09 and 1.18 ± 0.17 in the control group and the concave iris group (P = 0.93), respectively. The IOP postoperatively were 14.13 ± 2.02 mmHg and 14.69 ± 1.59 mmHg in control and concave iris groups (P = 0.37). Preoperatively, the concave iris group was presented with greater IC (P < 0.0001), longer ILCD (P < 0.0001), wider ICA (P = 0.004), narrower PCA (P = 0.01), and shorter IZD (P = 0.03) than the control group. In the concave iris group, IC, ILCD and ICA were significantly decreased after ICL implantation (P < 0.0001), while PCA and IZD were significantly increased (P = 0.03 and P = 0.04, respectively). Postoperative IC, ILCD, ICA, PCA and IZD were not statistically different between groups (P > 0.05). There was no significant difference in pigment deposition grades between the two groups (P = 0.37). After EVO ICL implantation, the morphology of concave iris was significantly improved, which may reduce the risk of intraocular pigment dissemination caused by iris concavity. The concave iris has no impact on the safety of EVO ICL surgery during the follow-up.

PurposeTo evaluate the anterior segment in children with an R124L mutation corneal dystrophy (CD) using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM).MethodsWe investigated a family with prevalent CD and an R124L mutation; 59 individuals (14 patients; 6 male and 8 female, aged 2–69 years, 6 children, 2:4 male: female ratio) from four generations were included. We observed corneal lesions through ophthalmologic examinations, AS-OCT, and IVCM. The mean follow-up was 4.60 ± 3.91 years.ResultsThe mean age for childhood CD onset was 0.90 ± 0.61 years. An Avelino DNA test revealed a heterozygous R124L mutation. Clinical manifestations included recurrent photophobia, tearing, and a foreign body sensation. Recurrence frequency decreased with age. Slit lamp microscopy revealed a rough corneal epithelium. The anterior matrix under the corneal epithelium and the anterior elastic layer were scattered with gray and white opacity. From onset to follow-up, the children’s visual acuity decreased from 0.34 ± 0.12 to 0.55 ± 0.17 LogMAR units. AS-OCT showed uneven corneal epithelial thickness. The Bowman’s layer was replaced by abnormal substances in the anterior segment. Corneal deposits became increasingly thicker; the average thickness at the last follow-up was 102.78 ± 10.13 μm. IVCM revealed uneven and reflective signals in the corneal upper cortex and subepithelium, with unclear boundaries and a loss of normal cell morphology.ConclusionWe report an early age of onset in a family with prevalent CD due to R124L mutations. AS-OCT is a convenient, quick, and non-contact tool for screening and monitoring the pathological process of CD.

Stroke is an acute cerebrovascular disease caused by a local cerebral blood circulation disorder, and is the second leading cause of global human death. According to China Stroke Statistics 2019, ischemic stroke accounted for 81.8% of all stroke cases. The most effective medical treatments for acute ischemic stroke (AIS) are to offer intravenous thrombolysis (within 4.5 hours) and mechanical thrombectomy (within 6 hours) during the ultra-early period of time following the onset.

1Life after Stroke Centre, Stroke Action Nigeria, Onitsha, Nigeria 2Department of Nursing Science, Nnamdi Azikiwe University, Awka, Nigeria 3Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Nsukka, Nigeria 4Department of Neurology, Minhang Hosptial, Fudan University, Shanghai, China 5Department of Anaesthesiology and Critical Care, Perelman School of Medicine at the University of Philadelphia, Philadelphia, Pennsylvania, USA 6Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Objective: To study and analyze the clinical effect of electroacupuncture at Baihui and Neiguan Points on cognitive function recovery of elderly patients after general anesthesia. Methods: The subjects were 80 elderly patients who received general anesthesia from January 2019 to February 2021. According to different anesthesia methods, they were divided into research group (electroacupuncture at Baihui and Neiguan combined with conventional drug anesthesia) and control group (simple drug anesthesia). The postoperative cognitive function recovery of the two groups was observed and compared. Results: Compared with the control group, the MMSE score and POCD incidence of research group were significantly better. There was significant difference between the two groups (P < 0.05). Conclusion: Conclusion electroacupuncture at Baihui and Neiguan combined with conventional drug anesthesia can promote the recovery of cognitive function and prevent cognitive dysfunction in elderly patients under general anesthesia.

本文针对卒中院前急救体系的最新研究进展进行了综述,内容包括卒中院前急救流程中患者识别、院前急救人员识别、现场处理、急诊转运及院前院内衔接等各个环节的研究进展.同时,展望了我国卒中院前急救体系的未来发展,提出争取政府支持、整合资源、结合高新科技促进体系建设的建议,以期为我国卒中院前急救体系的相关研究和发展提供参考.