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The Evaluation of Corneal Fragility After UVA/Riboflavin Crosslinking
Li, ZW;Wang, YM;Xu, YY;Jhanji, V;Zhang, CX;Mu, GY
EYE & CONTACT LENS-SCIENCE AND CLINICAL PRACTICE 2017年 43卷2期 页码:100-102
BIOMECHANICAL PROPERTIES; PROGRESSIVE KERATOCONUS; COLLAGEN; RIBOFLAVIN; SENSITIVITY; KERATITIS; LIGHT; AGE
Purpose:To evaluate the fragility of cornea after UVA/riboflavin crosslinking (CXL).Methods:Sixty New Zealand rabbits received UVA/riboflavin crosslinking treatment (wavelength 365 nm, irradiance 3.0 mW/cm(2), and total dose 5.4 J/cm(2)) on right eyes. Animals were sacrificed before and immediately after treatment (day 0), day 1, 3, 7, and 28 after treatment. A 4x10 mm corneal strip for biomechanical evaluation was harvested after sacrifice. The corneal fragility was evaluated by measurement of elongation rate, whereby the elongation rate equals elongation length/baseline length.Results:The Youngs modulus and maximal stress were 1.410.51 MPa and 5.56 +/- 1.84 MPa before CXL, and increased to 2.31 +/- 0.68 MPa (P=0.008) and 9.25 +/- 2.74 MPa (P=0.04), respectively, on day 0, then maintained a stable level within a 28 days follow-up. The elongation rate was 62.04 +/- 9.34% before CXL and decreased to 48.95%+/- 8.24% (P=0.02) on day 0, then maintained a stable level within a 28 days follow-up.Conclusions:This study showed an increase in the corneal fragility after UVA/riboflavin crosslinking along with an increase in the corneal stiffness. A long-term follow-up should be taken to evaluate the potential deleterious effect of the increasing corneal fragility after UVA/riboflavin crosslinking.
Combining corneal crosslinking and phakic toric Implantable Collamer Lenses for the treatment of keratectasia: A case report
Zhang, X;Tao, XC;Li, ZW;Zhou, WY;Ma, P;Zhang, CX;Wang, YM;Mu, GY
EXPERIMENTAL AND THERAPEUTIC MEDICINE 2016年 12卷3期 页码:1495-1498
HIGH MYOPIC ASTIGMATISM; FOLLOW-UP; KERATOCONUS; RIBOFLAVIN; MODERATE; OUTCOMES; EYES
The present study reports the use of a phakic toric Implantable Collamer Lens (ICL) that improved the refraction correction of high myopia and astigmatism in a case of keratectasia following corneal cross-linking. A 31-year-old male was diagnosed with keratectasia 12 years after laser-assisted in situ keratomileusis (LASIK). Following LASIK, the manifest refraction was -3.50-2.25x90 [0.1 logarithmic expression (LogMAR) best corrected visual acuity (BVCA)] in the right eye and -8.00-3.50x175 (0.3 LogMAR BCVA) in the left eye, with a LogMAR uncorrected distance visual acuity (UDVA) of 0.8 and a counting fingers' value of 3 ft (CF @3 ft) in the left and right eyes, respectively. Riboflavin/ultraviolet A light (UVA) corneal crosslinking (CXL) was conducted on both eyes. Seven months after cross-linking, LogMAR UDVA was 0.4, the manifest refraction was -2.75-2.50x85 and LogMAR BCVA was 0.1 in the right eye. In the left eye, LogMAR UDVA was CF @3 ft, the manifest refraction was -15.00 and LogMAR BCVA was 0.3. The corneal topography was stable 7 months after CXL. Phakic toric ICL was implanted to correct the refractive error, following which the LogMAR UDVA improved to 0.1 in the right eye and 0.3 in left eye, and visual acuity remained stable for 6 months after ICL implantation. In conclusion, combining riboflavin/UVA corneal cross-linking and phakic toric ICL implantation may be an alternative in the correction of high refractive error in patients with keratectasia.
Evaluation of corneal endothelium after UVA/riboflavin cross-linking in thin keratoconic corneas
Chen, W;Li, ZW;Zhao, XM;Xu, WW;Mu, GY
INTERNATIONAL JOURNAL OF OPHTHALMOLOGY 2016年 9卷2期 页码:321-322
A Review of Collagen Cross-Linking in Cornea and Sclera (vol 2015, 289467, 2015)
Zhang, X;Tao, XC;Zhang, J;Li, ZW;Xu, YY;Wang, YM;Zhang, CX;Mu, GY
JOURNAL OF OPHTHALMOLOGY 2016年
Performance of the Plusoptix A09 Photoscreener in Detecting Amblyopia Risk Factors in Chinese Children Attending an Eye Clinic
Yan, XR;Jiao, WZ;Li, ZW;Xu, WW;Li, FJ;Wang, LH
PLOS ONE 2015年 10卷6期 影响因子:3.057
VISION SCREENER; REFERRAL CRITERIA; REFRACTIVE ERRORS; ACCURACY; AUTOREFRACTOR; RETINOSCOPY; RETINOMAX; S08
Purpose;-;To assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening.;-;Methods;-;Pediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses.;-;Results;-;One hundred and seventy-eight children (mean age +/- SD: 6.2 +/- 2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (P-SE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CRSE) (P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J(0) and J(45) between Plusoptix A09 (P-J) and cycloplegic retinoscopy (CRJ) (P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CRSE = 0.358 + 0.776 P-SE + 0.064 P-SE(2) + 0.011 P-SE(3). Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively.;-;Conclusions;-;The Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely.
Corneal ectasia 6.5 months after small-incision lenticule extraction
Wang, YM;Cui, CB;Li, ZW;Tao, XC;Zhang, CX;Zhang, X;Mu, GY
JOURNAL OF CATARACT AND REFRACTIVE SURGERY 2015年 41卷5期 页码:1100-1106
IN-SITU KERATOMILEUSIS; MYOPIC ASTIGMATISM; LASIK; KERATECTASIA; SMILE; DIOPTERS; EYE
Our case involves a 19-year-old patient with forme fruste keratoconus. Small-incision lenticule extraction was performed, and 6.5 months after surgery, corneal ectasia was diagnosed. Preoperatively, the minimum central corneal thickness was 546 mu m in the right eye and 542 mu m in the left eye; the refractive correction was -6.75 -1.00 x 45 and -6.75 -0.75 x 140, respectively; the lenticular thickness was 137 mu m and 135 mu m, respectively. At 6.5 months, ectasia was diagnosed based on anterior and posterior surface keratometry of 38.4/39.5 diopters (D) and -6.3/-6.8 D, respectively, in the right eye and 38.6/40.8 D and -7.11-6.6 D, respectively, in the left eye. The keratometry increased gradually and the corneal thickness decreased after surgery, and these trends continued during the 13-month follow-up. This report documents corneal ectasia as a complication of small-incision lenticule extraction and highlights the importance of preoperative evaluation and the need for long-term follow-up. (C) 2015 ASCRS and ESCRS
A Review of Collagen Cross-Linking in Cornea and Sclera
Zhang, X;Tao, XC;Zhang, J;Li, ZW;Xu, YY;Wang, YM;Zhang, CX;Mu, GY
JOURNAL OF OPHTHALMOLOGY 2015年
HYPOOSMOLAR RIBOFLAVIN SOLUTION; IN-SITU KERATOMILEUSIS; INTRACORNEAL RING SEGMENTS; MOLECULAR-WEIGHT COMPOUNDS; ULTRAVIOLET-A LIGHT; BENZALKONIUM CHLORIDE; MICROBIAL KERATITIS; THIN CORNEAS; PROGRESSIVE KERATOCONUS; ACANTHAMOEBA-KERATITIS
Riboflavin/UVA cross-linking is a technique introduced in the past decades for the treatment of keratoconus, keratectasia, and infectious keratitis. Its efficacy and safety have been investigated with clinical and laboratory studies since its first clinical application by Wollensak for the treatment of keratoconus. Although its complications are encountered during clinical practice, such as infection inducing risk, minimal invasion merits a further investigation on its future application in clinical practice. Recently, collagen cross-linking in sclera shows a promising prospect. In present study, we summarized the representative studies describing the clinical and laboratory application of collagen cross-linking published in past decades and provided our opinion on the positive and negative results of cross-linking in the treatment of ophthalmic disorders.
核黄素/UVA 诱导的角膜交联术治疗晚期圆锥角膜的安全性和有效性
张春晓;李志伟;徐文文;李凤娇;陶祥臣;牟国营
山东大学耳鼻喉眼学报 2015年 29卷2期 页码:86-88页,共3页 影响因子:0.395
核黄素/UVA 角膜交联术;角膜厚度;角膜内皮计数;圆锥角膜
目的:评价角膜厚度低于400μm 的圆锥角膜患者行核黄素诱导的长波紫外线角膜交联术的安全性和有效性。方法选择角膜厚度低于400μm 的圆锥角膜患者14例18眼,表面麻醉下去除上皮,点低渗核黄素溶液使角膜基质水肿厚度达到400μm 以上,行角膜交联术,术后戴软性角膜接触镜。术前、术后记录观察最佳矫正视力、角膜顶点 K 值、角膜厚度、角膜内皮、晶体等变化。结果术后所有患者角膜上皮于1周内愈合,14眼于5 d 内愈合;角膜 Haze 于2~6周内消退;最佳矫正视力:术前为4.76±0.61,术后3个月为4.83±0.46,6个月为4.84±0.51;角膜顶点 K 值:术前为(56.29±7.33)D,3个月为(52.42±5.76)D,6个月为(48.12±6.6)D;角膜厚度:治疗前为(318±33)μm,水肿后为(447±18)μm,3个月为(381±72)μm,6个月为(354±35)μm;角膜内皮密度:术前为(3069±202)/mm2,术后3个月为(2910±213)/mm2,6个月为(2935±215)/mm2;未见晶体、视网膜并发症。结论采用低渗核黄素法行角膜交联术治疗晚期薄角膜圆锥安全、有效。
Activation of the Notch-Nox4-reactive oxygen species signaling pathway induces cell death in high glucose-treated human retinal endothelial cells
Jiao, WZ;Ji, JF;Li, FJ;Guo, JL;Zheng, YJ;Li, SB;Xu, WW
MOLECULAR MEDICINE REPORTS 2019年 19卷1期 页码:667-677
NADPH OXIDASE; DIABETIC-RETINOPATHY; GENE-EXPRESSION; GROWTH-FACTOR; RBP-J; APOPTOSIS; DAMAGE; INHIBITION; PROTECTION
Diabetic retinopathy (DR) occurs in almost all patients with diabetes and remains as one of the major causes of vision loss worldwide. Nevertheless, the molecular mechanisms underlying the pathogenesis of DR remain elusive. The present study aimed to investigate the role and association of Notch signaling and NADPH oxidase 4 (Nox4)-mediated oxidative stress in high glucose (HG)-treated retinal cells. Human retinal endothelial cells were cultured for various durations in RPMI-1640 medium containing 30 mM glucose (HG) or 30 mM mannitol (MN) as an osmotic control; apoptotic cell death and reactive oxygen species (ROS) levels were assessed, respectively. Alterations in the expression profiles of Nox and Notch proteins were evaluated using reverse transcription-quantitative polymerase chain reaction and western blot analysis. Knockdown of Nox4 and recombination signal-binding protein J (RBPj) was generated by transfection with specific small interfering (siRNA). Persistent activation of Notch signaling was induced via the overexpression of Notch intracellular domain (NICD). In the present study, time-dependent increases in ROS production and cell death were detected in HG-treated cells. Depletion of ROS by diphenyleneiodonium decreased HG-induced cell death, and suppressed increases in caspase 3 activity and B-cell lymphoma 2-associated X protein levels. In HG-treated cells, Nox4 expression was upregulated at the mRNA and protein levels, and inhibition of Nox4 by GKT137831 or knockdown of expression by siRNA Nox4 significantly reduced ROS levels and cell death. In the presence of HG, Notch1 expression levels were elevated, and increased NICD abundance was detected in whole cell lysates and nuclear fractions. Additionally, HG-induced cell death was decreased by treatment with -secretase inhibitor (GSI), but increased via the overexpression of NICD. The application of GSI or knockdown of RBPj by siRNA RBPj prevented increases in Nox4 expression within HG-treated cells. The findings of the present study demonstrated that Nox4-mediated ROS serves an important role in HG-induced retinal cell damage, in which the activation of Notch signaling may be responsible for Nox4 upregulation. Therefore, inhibition of Notch signaling or Nox4 expression may be considered as potential therapeutic targets in patients with DR.
Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis
Zhu, W;Han, YF;Cui, CX;Xu, WW;Wang, X;Dou, XX;Xu, LL;Xu, YY;Mu, GY
OPHTHALMIC RESEARCH 2018年 59卷3期 页码:135-141
PROGRESSIVE KERATOCONUS; CRETAN PROTOCOL; ULTRAVIOLET-A; LASIK; RIBOFLAVIN
Purpose: The aim of this study was to analyze the effects of corneal crosslinking (CXL) combined with phototherapeutic keratectomy (PTK) and photorefractive keratectomy (PRK) in halting the progression and improving the visual function of corneal ectasia after laser in situ keratomileusis (LASIK). Methods: PTK-PRK-CXL was performed on 14 eyes of 14 patients who developed corneal ectasia after LASIK. The visual acuity, spherical refraction and cylinder, corneal topography indices, thinnest corneal thickness (TCT), and endothelial cell count were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively. Results: The mean uncorrected visual acuity improved significantly from 0.64 +/- 0.36 logMAR preoperatively to 0.19 +/- 0.12 logMAR at 12 months of follow-up (p < 0.001), while the mean best corrected visual acuity improved from 0.21 +/- 0.14 logMAR at baseline to 0.04 +/- 0.10 logMAR at 12 months postoperatively (p < 0.001). A significant decrease was observed in Kmax and Kmean values from 52.51 +/- 6.74 and 43.55 +/- 3.37 D at baseline to 45.72 +/- 5.18 (p < 0.001) and 40.60 +/- 3.05 D (p < 0.001) at the 1-year follow-up. The mean TCT decreased significantly from 419.07 +/- 36.56 mu m before treatment to 320.93 +/- 39.78 mu m at 12 months of follow-up (p < 0.001), and there was no significant endothelial cell loss (p > 0.05) beyond 6 months after treatment. Conclusion: PTK-PRK-CXL is a promising procedure to halt the progression of post-LASIK keratectasia with significant visual quality improvement. (C) 2018 S. Karger AG, Basel
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