Posterior Subcapsular Opacities Research Articles

Prevalence of common and rare ophthalmic findings in adults attending a medical survey institute

PurposeTo examine the ophthalmic data from a large database of people attending a general medical survey institute, and to investigate ophthalmic findings of the eye and its adnexa, including differences in age and sex.MethodsRetrospective analysis including medical data of all consecutive individuals whose ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects examined at a single general medical survey institute.ResultsData were derived from 184,589 visits of 3676 patients (mean age 52 years, 68% males). The prevalence of the following eye pathologies were extracted. Eyelids: blepharitis (n = 4885, 13.3%), dermatochalasis (n = 4666, 12.7%), ptosis (n = 677, 1.8%), ectropion (n = 73, 0.2%), and xanthelasma (n = 160, 0.4%). Anterior segment: pinguecula (n = 3368, 9.2%), pterygium (n = 852, 2.3%), and cataract or pseudophakia (n = 9381, 27.1%). Cataract type (percentage of all phakic patients): nuclear sclerosis (n = 8908, 24.2%), posterior subcapsular (n = 846, 2.3%), and capsular anterior (n = 781, 2.1%). Pseudophakia was recorded for 697 patients (4.6%), and posterior subcapsular opacification for 229 (0.6%) patients. Optic nerve head (ONH): peripapillary atrophy (n = 4947, 13.5%), tilted disc (n = 3344, 9.1%), temporal slope (n = 410, 1.1%), ONH notch (n = 61, 0.2%), myelinated nerve fiber layer (n = 94, 0.3%), ONH drusen (n = 37, 0.1%), optic pit (n = 3, 0.0%), and ON coloboma (n = 4, 0.0%). Most pathologies were more common in males except for ONH, and most pathologies demonstrated a higher prevalence with increasing age.ConclusionsNormal ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects seen at a single medical survey institute.

Aquaporins contribute to vacuoles formation in Nile grass type II diabetic rats.

Regulation of ion and water microcirculation within the lens is tightly controlled through aquaporin channels and connexin junctions. However, cataracts can occur when the lens becomes cloudy. Various factors can induce cataracts, including diabetes which is a well-known cause. The most common phenotype of diabetic cataracts is a cortical and/or posterior subcapsular opacity. In addition to the three main types and two subtypes of cataracts, a vacuole formation is frequently observed; however, their origin remains unclear. In this study, we focused on the aquaporins and connexins involved in diabetes-induced cataracts and vacuoles in Nile grass type II diabetes. The results showed that the expression of aquaporin 0 and aquaporin 5 increased, and that of connexin 43 decreased in diabetic rat lenses. Additionally, aquaporin 0 and 5 were strongly localized in peripheral of vacuoles, suggesting that aquaporins are involved in vacuoles formation. Transillumination photography revealed large vacuoles at the tip of the Y-suture in the anterior capsule of the diabetic lens, and several small vacuoles were observed in the posterior capsule. Within the vacuoles, cytoplasmic degradation and aggregation of fibrous material were observed. Our findings suggest that aquaporins are potential candidate proteins for preventing vacuole formation.

Comparison of visual outcomes in adult patients with different types of developmental cataracts after toric multifocal intraocular lenses implantation

Purpose 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).Methods 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.Results 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.ConclusionIn 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.

Distinct gene expression profiles underlie morphological and etiological differences in pediatric cataracts.

Pediatric cataract is a major cause of preventable childhood blindness worldwide. Although genetic mutations or infections have been described in patients, the mechanistic basis of human cataract development remains poorly understood. Therefore, gene expression of structural, developmental, profibrotic, and transcription factors in phenotypically and etiologically distinct forms of pediatric cataracts were evaluated. This cross-sectional study included 89 pediatric cataract subjects subtyped into 1) prenatal infectious (cytomegalovirus, rubella, and combined cytomegalovirus with rubella infection), 2) prenatal non-infectious, 3) posterior capsular anomalies, 4) postnatal, 5) traumatic, and 6) secondary, and compared to clear, non-cataractous material of eyes with the subluxated lenses. Expression of lens structure-related genes (Aqp-0, HspA4/Hsp70, CrygC), transcription factors (Tdrd7, FoxE3, Maf, Pitx 3) and profibrotic genes (Tgfβ, Bmp7, αSmA, vimentin) in surgically extracted cataract lens material were studied and correlated clinically. In cataract material, the lens-related gene expression profiles were uniquely associated with phenotype/etiology of different cataracts. Postnatal cataracts showed a significantly altered FoxE3 expression. Low levels of Tdrd7 expression correlated with posterior subcapsular opacity, whereas CrygC correlated significantly with anterior capsular ruptures. The expression of Aqp0 and Maf was elevated in infectious cataracts, particularly in CMV infections, compared to other cataract subtypes. Tgfβ showed significantly low expression in various cataract subtypes, whereas vimentin had elevated gene expression in infectious and prenatal cataracts. A significant association between lens gene expression patterns in phenotypically and etiologically distinct subtypes of pediatric cataracts suggests regulatory mechanisms in cataractogenesis. The data reveal that cataract formation and presentation is a consequence of altered expression of a complex network of genes.

Correlation Between Lens Density Measured by Swept-Source Optical Coherence Tomography and Phacodynamic Parameters of Centurion Phacoemulsification

Purpose To evaluate the correlation between lens density measured by IOL-Master 700 based on swept-source optical coherence tomography (SS-OCT) technology and the phacodynamic parameters of Centurion phacoemulsification in cataract surgery. Methods This prospective study included 66 patients (83 eyes) with age-related cataracts. Using the Lens Opacities Classification System III (LOCS III), the lens nuclear color (NC), lens nuclear opalescence (NO), cortical (C), and posterior subcapsular (P) opacities were obtained. Six meridian orientations of IOL-Master 700 images were captured, and the lens and nuclear regions were analyzed using ImageJ to generate the average lens nucleus density (AND) and average lens density (ALD). Phacodynamic parameters were recorded. The correlation between lens density and the phacodynamic parameters was analyzed. According to the AND, patients were divided into four groups (soft, medium-hard, hard, and extremely hard nucleus), and the phacodynamic parameters were compared among groups. Results The correlation between the AND obtained by LOCS III grading and SS-OCT-based cataract quantification system score (NC and NO) was statistically significant (r NC = 0.795, r NO=0.794, both p = .000). AND correlated significantly with cumulative dissipated energy (CDE, r = 0.545, p = .000), total ultrasound time (TUST, r = 0.354, p = .001), and total torsional ultrasound time (TTUT, r = 0.314, p = .004). Among the four groups divided by AND, the difference in CDE (P 13 = 0.002, P 14 < 0.001, P 24 = 0.002) was statistically significant. Conclusion AND measured by IOL-Master 700, SS-OCT correlated significantly with LOCS III classification and phacodynamic parameters of the Centurion system, especially with CDE, TUST, and TTUT. AND can be used as an indicator for quantitative evaluation and help inform the surgical plan.

Prevalence and patterns of refractive error among adults in Sagamu, South-West Nigeria

Background: The study was part of community-based research towards strengthening the provision of optical services within a local governmental area in Nigeria.Aim: To describe the prevalence of refractive errors in the southwestern Nigerian adult population.Setting: Adults of age 30 years and above who were regular residents of the local governmental area.Methods: A multistage stratified random cluster sampling method was used to select the subjects. The sampling unit was the different households. A random sample of them were refracted and then refractive errors were analysed. Analyses excluded participants with history of cataract surgery. Associations with myopia (−0.50 dioptres [D] or more) and hyperopia (≥ 0.50 D) were evaluated in logistic regression analyses.Results: The prevalence of refractive error in the study sample was 33.8% (95% confidence level [CI]: 27.1–34.4) using study participants with 6/9 presenting visual acuity but improvement by at least a line with pin hole. The prevalence of hyperopia was 46.9% and higher in women (51.8%), while that of myopia was 21.9% but higher in men (25.0%). The prevalence of hyperopia increased from 29% for 40–49 years of age to 65% for 50–59 years of age and tended to decline thereafter. Prevalence of myopia decreased from 17% in persons 40–49 years of age to 11% in those 50–59 years of age but increased after 60 years of age. A higher prevalence of myopia was positively associated (p  0.05) with lifetime occupations requiring near work, nuclear opacities, posterior subcapsular opacities and glaucoma. Factors associated with hyperopia were the same as for myopia, except for occupation, and in the opposite direction.Conclusion: The high prevalence of refractive errors strongly supports the need for an affordable and accessible optical service in the local government.

Impact of lens opacity and axial length on concomitant screening of maculopathy by swept-source optical coherence tomography-based optical biometer

BackgroundPreoperative evaluation of macular disorders is crucial to predict postoperative visual outcomes among patients with cataract. The swept-source optical coherence tomography (SS-OCT) based optical biometer was proved to be useful in screening macular pathology, while the impact of lens opacities and axial lengths on macular disease screening using SS-OCT based optical biometer remained unknown. This study aimed to evaluate the influence of lens opacities and axial lengths on foveal image quality detected by SS-OCT-based optical biometer, as well as sensitivity and specificity for the detection of macular diseases.MethodsThis was a diagnostic accuracy study that retrospectively included patients who underwent preoperative cataract examinations at our hospital between November 2020 and June 2021. All patients underwent SS-OCT based optical biometer and spectral-domain OCT (SD-OCT). The SD-OCT was the golden standard for diagnosing macular diseases. Sensitivity, specificity, and receiver operating characteristic (ROC) were calculated to evaluate the value of foveal SS-OCT scans for the detection of macular disease.ResultsOf the 224 eyes enrolled in the study, 82 eyes were diagnosed with macular disease by SD-OCT. The foveal image was almost indistinguishable due to poor quality when the mean grayscale of the image was less than 40. The posterior subcapsular opacity score and the axial length were significantly correlated with the gray density of the foveal image (r=−0.70, P<0.0001 and r=−0.40, P<0.0001). After excluding cases with indistinguishable foveal images (subcapsular opacities score ≥3.5, axial length ≥28.9 mm), the SS-OCT yielded 68% (95% confidence interval, 0.54–0.79) sensitivity and 87% (95% confidence interval, 0.78–0.92) specificity in 136 eyes.ConclusionsRoutine SS-OCT based biometric measurement for the evaluation of macular pathology simultaneously prior to cataract surgery is suggested except for patients with advanced cataract (posterior subcapsular opacities score ≥3.5) and long axial length (≥28.9 mm).

Study of Low-Dose Radiation Workers Ionizing Radiation Sensitivity Index and Radiation Dose-Effect Relationship.

In the present study, we analyzed radiation injuries to Chinese workers exposed to low-dose radiation. We discuss the relationships between dose and injury. This study randomly selected 976 radiation workers who underwent occupational health monitoring. The radiation workers were divided into 5 different types of work: radiation diagnosis, radiation therapy, interventional therapy, nuclear medicine, and industrial inspection. This research was approved by the Bioethics Committee at the Gansu Provincial Center for Disease Control and Prevention. The average annual cumulative dose to interventional radiation workers was the highest, i.e., 0.86 mSv. The detection rate of lens opacity was 37%, but 99.70% of lens opacities occurred in the peripheral cortex. Posterior subcapsular opacification was detected less than 1.00% of the time. The rate of chromosomal aberrations was highest for radiological workers with more than 20 years of service. Annual cumulative dose reached 2.04 mSv, and the monitoring dose for 3 months was as high as 1.62 mSv. Dicentric chromosomes were also detected. The manual packaging and drug delivery nuclear medicine staffs totaled 14 individuals. 131 131 was detected in the thyroids of 4 workers (28.57%). The detection rate of thyroid 131 I was higher in the hand-packed and administered group than in the automatic administration group. Radiation workers exposed to low doses of radiation can sustain injuries. Interventional radiology workers receive the highest doses and sustain the most significant effects. This study suggests that chromosome aberration analysis is an important index in occupational health monitoring of radiological workers. Monitoring of internal radiation exposure cannot be ignored for nuclear medicine staff.

Eye lens opacities and cataracts among physicians and healthcare workers occupationally exposed to radiation: A systematic review and meta-analysis.

To evaluate the risk of developing eye lens opacities and cataracts among physicians and healthcare workers occupationally exposed to radiation. Our literature search captured articles published in Embase, Web of Science, PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar databases until September 2021. Then, we retrieved articles reporting cataracts and eye lens opacities induced by radiation exposure among healthcare professionals. The outcomes of interest were cataracts, nuclear opacity, cortical opacity, posterior subcapsular opacity, and any lens opacity. Of the 4123 articles identified, 15 studies met the inclusion criteria. Healthcare workers exposed to radiation had a significantly greater risk of posterior subcapsular cataracts (PSCs), cataracts, and any lens opacities than those of the non-exposed participants (p<0.05). The cortical opacity was not significantly different between the exposed and non-exposed participants (p>0.05). Radiation was not determined to be a risk factor for nuclear opacity as it was significantly greater in the control group than the exposed participants. Subgroup analysis revealed that nurses had the highest risk for PSCs (risk ratio = 4.00), followed by interventional cardiologists (risk ratio = 3.85). The risk of posterior subcapsular opacities and cataracts is significantly higher in healthcare workers with occupational radiation exposure than in non-exposed workers, highlighting the necessity to enhance and promote the wearing of protective measures with high safety levels.

Deep Learning-Based Cataract Detection and Grading from Slit-Lamp and Retro-Illumination Photographs: Model Development and Validation Study.

PurposeTo develop and validate an automated deep learning (DL)-based artificial intelligence (AI) platform for diagnosing and grading cataracts using slit-lamp and retroillumination lens photographs based on the Lens Opacities Classification System (LOCS) III.DesignCross-sectional study in which a convolutional neural network was trained and tested using photographs of slit-lamp and retroillumination lens photographs.ParticipantsOne thousand three hundred thirty-five slit-lamp images and 637 retroillumination lens images from 596 patients.MethodsSlit-lamp and retroillumination lens photographs were graded by 2 trained graders using LOCS III. Image datasets were labeled and divided into training, validation, and test datasets. We trained and validated AI platforms with 4 key strategies in the AI domain: (1) region detection network for redundant information inside data, (2) data augmentation and transfer learning for the small dataset size problem, (3) generalized cross-entropy loss for dataset bias, and (4) class balanced loss for class imbalance problems. The performance of the AI platform was reinforced with an ensemble of 3 AI algorithms: ResNet18, WideResNet50-2, and ResNext50.Main Outcome MeasuresDiagnostic and LOCS III-based grading prediction performance of AI platforms.ResultsThe AI platform showed robust diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.9992 [95% confidence interval (CI), 0.9986–0.9998] and 0.9994 [95% CI, 0.9989–0.9998]; accuracy, 98.82% [95% CI, 97.7%–99.9%] and 98.51% [95% CI, 97.4%–99.6%]) and LOCS III-based grading prediction performance (AUC, 0.9567 [95% CI, 0.9501–0.9633] and 0.9650 [95% CI, 0.9509–0.9792]; accuracy, 91.22% [95% CI, 89.4%–93.0%] and 90.26% [95% CI, 88.6%–91.9%]) for nuclear opalescence (NO) and nuclear color (NC) using slit-lamp photographs, respectively. For cortical opacity (CO) and posterior subcapsular opacity (PSC), the system achieved high diagnostic performance (AUC, 0.9680 [95% CI, 0.9579–0.9781] and 0.9465 [95% CI, 0.9348–0.9582]; accuracy, 96.21% [95% CI, 94.4%–98.0%] and 92.17% [95% CI, 88.6%–95.8%]) and good LOCS III-based grading prediction performance (AUC, 0.9044 [95% CI, 0.8958–0.9129] and 0.9174 [95% CI, 0.9055–0.9295]; accuracy, 91.33% [95% CI, 89.7%–93.0%] and 87.89% [95% CI, 85.6%–90.2%]) using retroillumination images.ConclusionsOur DL-based AI platform successfully yielded accurate and precise detection and grading of NO and NC in 7-level classification and CO and PSC in 6-level classification, overcoming the limitations of medical databases such as few training data or biased label distribution.

A Review on Association Between Diabetes Mellitus and Cataract Formation

Major cause of blindness among diabetic patients is cataract both in developed and developing countries. Diabetic ocular complications are most common in both type-1 and type-2 diabetes, considering the fifth most common cause of legal blindness. This review aims to systematically evaluate the studies on occurrence of cataract formation among diabetic patients, types of cataract and its mechanisms of pathogenesis. According to WHO, cataract is 33% of all type of visual impairment. Prevalence of cataract increased with increasing age in both younger and older onset diabetic persons. Females had higher rates than males. The pathogenesis of diabetic cataract development is still not fully understood. Population-based studies have greatly increased our knowledge concerning the association between diabetes and cataract formation and have defined risk factors for the development of cataract. Simply diabetic cataracts are characterized by cortical or posterior sub-capsular opacities. Aldose reductase and polyol are responsible for diabetes ocular complications. Mechanisms of diabetic cataractogenesis have been studied in less detail than those of other diabetic complications. Both animal and human studies support important contribution of increased aldose reductase activity. Several clinical studies investigated the role of phacoemulsification surgery and its post-surgery complications. Researchers are trying to develop aldose reductase inhibitors and antioxidants, may be effective treatment to prevent or cure diabetes cataract.

ATM and TP53 Polymorphisms Modified Susceptibility to Radiation-Induced Lens Opacity in Natural High Background Radiation Area, China

Purpose: A population-based case-control study was conducted in Yangjiang and Enping areas in South China to assess whether the risk of lens opacity induced by natural high background radiation exposure is modulated by polymorphisms of ATM and TP53. Materials and methods: A total of 133 cases who were diagnosed with cortical and posterior subcapsular (PSC) opacity were recruited, and 419 healthy controls were selected through counter-matching in terms of radiation status. Genomic DNA from all the participants was genotyped with the Illumina platform for four single nucleotide polymorphisms of ATM (rs189037, rs373759, and rs4585) and TP53 (rs1042522). The cumulative lens dose received during the entire life was estimated based on annual indoor and outdoor radiation doses and gender- and age-specific occupancy factors. Non-conditional logistic regression was performed to calculate odds ratio (OR) and 95% confidence intervals (95% CI). Results: ATM rs189037 and TP53 rs1042522 were significantly related to cortical and PSC opacity. The risk of opacity was higher when individuals carried the A allele of ATM rs189037 and C allele of TP53 rs1042522, compared with GG genotype. ATM rs189037 A allele carriers (AG/AA) and TP53 rs1042522 C allele carriers (CG/CC) combined with a cumulative lens dose of 100 mGy or higher showed statistically significant opacity risks (OR =5.51, 95% CI: 1.47–20.66; OR =2.69, 95% CI: 1.10–6.60). Conclusion: The A allele of ATM rs189037 and C allele of TP53 rs1042522 increase the risk of lens opacity induced by radiation. These polymorphisms in ATM and TP53 might modify the risk of cortical and PSC opacity induced by chronic and prolonged low-dose radiation.

Effect of Phacoemulsification and Intraocular Lens Implantation on High Myopia with Cataract

Objective:To observe the clinical effect of phacoemulsification and intraocular lens implantation for high myopia with cataract. Results: To analyze 144 cases (152 eyes) of high myopia with cataract, male 78 cases (84 eyes), female 66 cases (68 eyes); age between 45~81 years old, average 65.26 years old; Axis oculi length 6.47~34.04mm, average 29.82mm. Nuclear lens opacities 86 eyes, Posterior subcapsular opacity 38 eyes, Cortical opacity 28 eyes; Nuclear hardness grading standards by Emery, 42 eyes nuclear grade Ⅱ, 72eyes nuclear grade Ⅲ, 34 eyes nuclear grade Ⅳ, 4 eyes nuclear grade V; Before the surgery, corrects defects of vision ≤0.1 in 120 eyes(79%), 0.1～0.2 in 32 eyes(21%), All patients under the topical anesthesia received the phacoemulsification and intraocular lens implantation. Results: After operation all the patients’ vision 0.5 in 78 eyes(51%), 0.2～0.4 in 56 eyes(37%), 0.1 in 18 eyes(12%), Compared with before operation, the enhancement of vision has a statistics significance(P0.01). Intraoperative, posterior capsule rupture is 2 cases(1.3%); No one has high intraocular pressure after operation, Cornea dropsy is 32 eyes(21%), after 3~7 d anti-SARS, just right for the illness treatments, cornea dropsy abates. After 3~6 months, no one has after-cataract in all patients. Conclusion: This is an effective treatment of phacoemulsification and intraocular lens implantation for high myopia with cataract and may improve the patients’ vision obviously and their quality of life.

Lipemic aqueous humor and suspected xanthomas associated with primary hypertriglyceridemia in a cat

AbstractA 1‐year‐old, male neutered, European Shorthair cat presented for bilateral lipemic aqueous humour and mildly increased intraocular pressure in the left eye. Laboratory evaluations showed hypertriglyceridemia and elevation of alpha‐1‐globulins and serum amyloid‐A. The initial treatment plan consisted of topical flurbiprofen, tobramycin‐dexamethasone, dorzolamide and low‐fat diet. Lipemic aqueous resolved within 72 hours without recurrence. Presumed lipemic droplets were observed in the vitreous. Two months after the initial diagnosis the cat returned with dermatological changes, consisting of pale pink papules and erosions on the neck and ear pinna with pruritus. Cytology of these lesions was consistent with cutaneous xanthoma. A primary familial hypertriglyceridemia was confirmed by exclusion on the basis of normal abdominal ultrasound, urine test and repeated blood work after the change of the diet. The xanthomas resolved two weeks after further restriction of the diet. At 74‐weeks after initial presentation posterior subcapsular lenticular opacities appeared in both eyes.

Influence of lens opacities and cataract severity on quantitative fundus autofluorescence as a secondary outcome of a randomized clinical trial

The aim of this study is to investigate the impact of age-related lens opacities and advanced cataract, quantified by LOCS III grading, on quantitative autofluorescence (qAF) measurements in patients before and after cataract surgery. Images from a randomized controlled trial evaluating the impact of femtosecond-laser assisted cataract surgery (FLACS) on retinal thickness were analyzed post-hoc. One-hundred and twenty eyes from 60 consecutive patients with age-related cataract were included and assessed with qAF and optical coherence tomography (OCT) before, 1, 3 and 6 weeks after cataract surgery (randomized 1:1 to FLACS or phacoemulsification). LOCS III grading was performed before surgery. Pre- to post-surgical qAF values, as well as the impact of LOCS III gradings, surgery technique, gender, axial length and age on post-surgery qAF values was investigated using generalized linear mixed models. For this analysis, 106 eyes from 53 patients were usable. No difference in qAF was found between FLACS and phacoemulsification (p > 0.05) and results were pooled for the total cohort. Mean pre-surgical qAF was 89.45 ± 44.9 qAF units, with a significant mean increase of 178.4–191.6% after surgery (p < 0.001). No significant difference was found between the three follow-up visits after surgery (p > 0.05). Higher LOCS III cortical opacity quantifications were associated with a significantly greater increase in qAF after surgery (estimate: 98.56, p = 0.006) and nuclear opacities showed a trend toward an increased change (estimate: 48.8, p = 0.095). Considerable interactions were identified between baseline qAF and cortical opacities, nuclear opacities and posterior subcapsular opacities, as well as nuclear opacities and cortical opacities (p = 0.012, p = 0.064 and p = 0.069, respectively). Quantitative autofluorescence signals are significantly reconstituted after cataract surgery and LOCS III gradings are well associated with post-surgical qAF values. Careful consideration of age-related lens opacities is vital for the correct interpretation of qAF, especially in retinal diseases affecting the elderly.ClinicalTrials.gov Identifier: NCT03465124.

Clinical Characteristics of Presenile Cataract: Change over 10 Years in Southern Taiwan.

Purpose The purpose of this study is to investigate the clinical characteristics of presenile cataract and compare that to ten years ago in southern Taiwan. Methods The subjects who received cataract surgeries aged 30 to 54 years were recruited in Kaohsiung Chang Gung Memorial Hospital during September 2015 and August 2016. Patients with uveitis or those who received combined cataract surgeries were excluded. Retrospective chart review was performed in this study. Results A total number of 2439 cataract surgeries were performed, and 302 (12.38%) eyes were having presenile cataract. Mean age was 47.55 ± 5.64 years old, and mean axial length was 26.00 ± 2.89 mm. Among 302 presenile cataract eyes, the leading cause was high myopia (defined as mean axial length ≥ 26 mm, 47.02%), followed by diabetes mellitus (26.82%). In types of lens opacity analysis, 67.55% of the patients were nuclear sclerosis dominant. Compared to the previous study 10 years ago, the leading cause of presenile cataract changed from idiopathy to high myopia, whereas the lens opacity types changed from posterior subcapsular opacity dominant to nuclear sclerosis dominant. Conclusions High myopia has become the most important clinical characteristic associated with presenile cataract in a myopia epidemic area, and the most common type of lens opacity was nuclear sclerosis. With the increasing prevalence of high myopia, we should pay more attention to the management of presenile cataracts in high myopes to avoid complications.

Deep Learning-Based Cataract Detection and Grading from Slit-Lamp and Retro-Illumination Photographs: Model Development and Validation Study

Backgroud: Accurate detection and grading of cataract is pivotal in providing personalized precision treatment strategies for preventing visual loss. We develop and validate an automated deep learning (DL)-based artificial intelligence (AI) platform for diagnosing and grading cataracts, using slit-lamp and retro-illumination lens photographs based on the Lens Opacities Classification System-Ⅲ (LOCS-Ⅲ). Methods: Slit-lamp and retro-illumination lens photographs were graded by two trained graders using LOCS-III. Image datasets were labeled and divided into training, validation, and test datasets. We trained and validated AI platforms with four key strategies in the AI domain: (1) region detection network for redundant information inside data, (2) data augmentation and transfer learning for the small dataset size problem, (3) generalized cross entropy loss for dataset bias, and (4) class balanced loss for class imbalance problems. The performance of the AI platform was reinforced with an ensemble of three AI algorithms (ResNet18, WideResNet50-2, and ResNext50). Finding: The AI platform showed robust diagnostic performance (AUC of 0.9992 [0.9986-0.9998], 0.9994 [0.9989-0.9998]; accuracy of 98.82% [97.7-99.9], 98.51% [97.4-99.6]) and grading prediction performance (AUC of 0.9567 [0.9501-0.9633], 0.9650 [0.9509-0.9792]; accuracy of 91.22% [89.4-93.0], 90.26% [88.6-91.9]) for nuclear opalescence (NO) and nuclear color (NC) using slit-lamp photographs. For cortical opacity (CO) and posterior subcapsular opacity (PSC), the system achieved high diagnostic performance (AUC of 0.9680 [0.9579-0.9781], 0.9465 [0.9348-0.9582]; accuracy of 96.21% [94.4-98.0], 92.17% [88.6-95.8]) and good grading prediction performance (AUC of 0.9044 [0.8958-0.9129], 0.9174 [0.9055-0.9295]; accuracy of 91.33% [89.7-93.0], 87.89% [85.6-90.2]) using retro-illumination images. Interpretation: Our DL-based AI platform successfully yielded accurate and precise detection and grading of NO and NC in seven-level classification and CO and PSC in six-level classification, overcoming the limitations of medical databases such as small training data or biased label distribution. Funding: This work was supported by the National Research Foundation of Korea grant funded by the Korean government's Ministry of Education (NRF-2021R1C1C1007795; Seoul, Korea), which was received by D.H.L. Declaration of Interest: The authors declare no conflict of interest Ethical Approval: The study was approved by the Samsung Medical Center Institutional Review Board (IRB file number 2020-08-035)

Clinicopathological correlations and surgical outcomes in a case of electric cataract

Accidental high voltage electric current can cause potentially life-threatening and blinding injuries. A young man presented with reduced vision in both his eyes for the previous 3 months. He had posterior subcapsular opacities in both eyes (more in the left eye). He did not give any significant history of trauma or use of steroids. He had a well-healed scar on the forehead, and on the inquiry about the scar, he revealed a history of electrocution 1 year before. He was diagnosed as a case of electric cataract and underwent phacoemulsification and foldable intraocular lens implantation with excellent visual outcome in the left eye. On histopathology of anterior capsule, focal areas of calcification were noted, which is to the authors' knowledge, a new finding, unreported earlier.

Retinitis pigmentosa with bilateral irido-fundal coloboma

A 40-year-old male, presented with gradual painless progressive loss of vision in both the eyes more in right since 1 year. Born out of consanguineous marriage, he gave a history of night blindness since childhood. The best-corrected visual acuity was 20/200 and 20/40 in right and left eye, respectively. Refraction showed an axial myopia of -9.00 DS/-1.50 DC at 100 degree in the right eye. The left eye showed refraction of +1.00 DC at 170 degree. Intraocular pressure with noncontact tonometer was 15 and 16 mm of Hg. Axial length was found to be 24.93 mm and 23.60 mm in right and left eye, respectively. Vertical and horizontal corneal diameters were 11 mm in both eyes. Keratometry values in the right eye were K vertical 43.55D, K horizontal 44.06D and in the left eye were K vertical 43.05D, K horizontal 43.49D. Slit-lamp examination revealed a clear cornea and normal anterior chamber depth. Inferonasal iris coloboma was noted in both eyes [Fig. 1]. The lens showed nuclear sclerosis grade 2 with posterior subcapsular opacification in right and nuclear sclerosis grade 2 in the left eye according to the Lens Opacities Classification System II (LOCS II) The posterior segment showed a normal-looking disc with minimal arteriolar attenuation, boney spicules distributed from the mid periphery throughout the retina in both eyes. Chorio-retinal coloboma was type 3 (separated from the optic disc by a clear area of the retina) in the right eye [Fig. 2] and type 7 (extreme peripheral coloboma) in the left eye [Fig. 3] according to Ida Manns classification. B scan ultrasonography showed an excavated lesion in the inferior aspect suggestive of fundus coloboma in the right eye. In the left eye the coloboma was not well demarcated on B scan ultrasonography.Figure 1: Anterior segment photographs with diffuse illumination (a) Right eye showing inferonasal iris coloboma with cataractous lens. (b) Left eye showing inferonasal iris colobomaFigure 2: (a) Fundus photograph of right eye showing coloboma in the inferior quadrant sparing disc and macula with bony spicules in the mid periphery. (b) Fundus photograph right eye, superonasal quadrant showing bony spicules in the mid peripheryFigure 3: (a) Fundus photograph of left eye depicting bony spicules in mid periphery and extreme peripheral coloboma inferiorly. (b) Peripheral coloboma with bony spicules in inferior quadrantPhacoemulsification with intraocular lens implantation under topical anesthesia was done in the right eye. Postoperatively at the end of 1 month best-corrected visual acuity was 20/30 in the right eye with a refraction of -0.75 DC at 80 degrees and near vision of N6 with + 3.00 DS. Discussion Retinitis pigmentosa is most commonly associated with posterior subcapsular cataract 53%[1] glaucoma 2.3%[2] myopia, keratoconus, vitreous detachment, and optic disc drusen. Association of macular colobomas with retinitis pigmentosa, especially autosomal dominant RP and Ushers syndrome has been extensively reported in the literature. In 2004, phenotypically different RP with macular coloboma was reported by Parmeggiani in 3 adult siblings[3], which was stated as an autosomal dominant feature. The association of iris and fundal coloboma with RP has been rarely reported in the literature. Kelly et al.[4] described the incidence, ocular findings, and systemic associations of coloboma in a population-based cohort study in the United States, reported one case with unilateral coloboma in association with RP. Population-based studies in India are scanty. Pallavi Agrawal et al.[5] reported a similar case of unilateral coloboma from a case in Mumbai, India in 2013. Bilateral Irido-fundal coloboma and RP can be separate entities occurring together in this case, or it could be a rare association. Similar cases/case series need to be reported to come to a conclusive result. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Risk of cataract in health care workers exposed to ionizing radiation: A systematic review

Background:The eye is an important sensory organ occupationally exposed to ionizing radiation (IR) in healthcare workers (HCWs) engaged in medical imaging (MI). New evidence highlights the possible induction of cataract at IR exposure levels to be much lower than expected in the past.Objective:Conduct an updated review on the current evidence on cataract risk in healthcare workers exposed to IR.Methods:Published scientific studies on cataract risk in IR exposed healthcare workers were collected through a systematic search of two biomedical databases (MEDLINE and Scopus). Data from included studies was extracted and summarized. Study quality was also assessed.Results:All 21 eligible studies reported an increased prevalence of cataract, especially posterior subcapsular cataract, in IR exposed HCWs with a higher prevalence in interventional cardiology staff.Discussion:Our review synthesizes the latest evidence to support the hypothesis of a significantly increased risk of occupational cataract in healthcare workers operating MI and exposed to IR, especially in interventional cardiologists. Data also support a dose-response relationship between IR exposure and the prevalence of opacities, especially posterior subcapsular opacities.Conclusions:Findings highlight the need for effective control measures including appropriate training, adherence to protective procedures, and a constant use of shields and eye personal protective equipment in healthcare workers with optical exposure to IR. Periodic health surveillance programs, possibly including lens evaluation, are also important to monitor cataract risk in these MI operators.