Subcapsular Opacities Research Articles

Ocular effects of Rho kinase (ROCK) inhibition: a systematic review.

Topical therapies targeting Rho-associated protein kinase (ROCK) signalling, including netarsudil (Rhopressa®) and ripasudil (Glanatec®), have become widely adopted as part of standard clinical practice to lower intraocular pressure (IOP) in patients with ocular hypertension or glaucoma. Given the pleiotropic roles of ROCK signalling, ROCK inhibition has the potential to cause unintended ocular side effects beyond IOP lowering in other substructures of the eye, both beneficial and deleterious. Additional experience and observation of patients treated with this class of medications have uncovered both new side effects not reported in the initial clinical trials, as well as potential benefits that have inspired off-label uses and that have been the topic of numerous clinical studies, case series, case reports, and translational studies. Here, we performed a comprehensive systematic review and identified 170 studies describing ocular effects of ROCK inhibition. In addition to describing well-established ocular effects associated with inhibition of ROCK signalling, such asconjunctival hyperaemia, corneal verticillata, and reticular corneal epithelial oedema, we also highlight other effects, such as corneal haemorrhages, changes in corneal contour, anterior subcapsular opacities, contact dermatitis, punctal stenosis, and eyelid wound dehiscence, which have been described in case series and case reports. Finally, we evaluated studies describing potential novel applications of ROCK inhibition for treating disorders affecting the cornea, the retina, and the optic nerve, finding strong evidence in support of a beneficial effect of ROCK inhibitors on corneal oedema due to corneal endothelial cell dysfunction. The other potential applications require further research.

Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes

PurposeTo investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.MethodsThis retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from − 4.50 to -17.00 diopters (D) and cylindrical refraction from − 0.75 to -5.50 D.ResultsFifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was − 10.06 ± 2.69 D and − 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was − 2.06 ± 1.16 D and − 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.ConclusionThe Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

Retinal image quality assessment in diabetic-retinopathy screening: Real world evidence from a lower-middle income country

Objectives: Sight loss due to diabetic retinopathy (DR) is preventable by early detection and treatment. Digital retinal imaging is the most widely practiced method of screening of DR. Poor quality of images is a major hinder to implement systematic DR screening using digital retinal imaging in low- and middle-income countries with a high prevalence of lens opacities. We aimed to identify the proportion of ungradable images using hand-held retinal imaging and predictors of image gradability in a DR screening feasibility study conducted in Sri Lanka. Material and Methods: The present study is a retrospective data analysis of a validation study conducted to assess the diagnostic test accuracy of a held-held digital retinal imaging model integrated into a tertiary level medical clinic. Two selected physician graders underwent formal training to assess retinal image quality using a “four-quadrant method of assessing gradability.” The procedure was a subjective image quality assessment performed by the physician graders manually, that is, images with more than 50% of the field with poor clarity and not suitable for retinopathy grading were classified as ungradable. Two-field (Field-1: macula centered, Field-2: disc centered) non-mydriatic and mydriatic retinal images were captured (Type of camera: Zeiss-Visuscout 100®, Germany) in a consecutive sample of people with diabetes attended for routine medical care and assessed for quality and graded by two independent physician graders on-site. The reference test was a mydriatic biomicroscopic examination conducted at a separate eye clinic by an experienced specialist retinologist. Mixed model regression analysis was conducted to assess the predictors of gradability. Results: A total of 700 individuals (5508 gradability data points) were included in the study. The proportion of ungradable images in non-mydriatic imaging was 30% for Grader 1 and 24% for Grader 2 and went down to 7% and 5%, respectively, for Grader 1 and 2 after dilating the pupils using mydriatic agents. Non-mydriatic images had almost 20 times higher odds (odds ratio [OR] 19.7, 95% confidence interval [CI] 15.1–25.8) of being rated as ungradable compared to mydriatic images. With the increase of each year in age, the odds of having ungradable digital retinal images in a patient increased by 7% (OR 1.07, 95% CI 1.05–1.09). For visual acuity increase in each level of the Log-MAR scale, the odds of having ungradable images increased by 40% (OR 1.40, 95% CI 1.30–1.51). In lens opacity, 54% higher odds of ungradability were observed when present nuclear opalescence (OR 1.54, 95% CI 1.39–1.70) and posterior subcapsular opacity (OR 1.54, 95% CI 1.24–1.92). Conclusion: Non-mydriatic methods may not be suitable as a primary DR screening strategy in countries with a high prevalence of cataracts. Increasing age, poor visual acuity, and the presence of lens opacity are factors that would affect image quality. The capacity to deliver services for managing cataracts may be an important determinant in achieving effective coverage of digital surveillance of DR in low- and middle-income countries.

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

ObjectiveTo present six cases exhibiting transient anterior subcapsular vacuolar lens opacities following early postoperative Tanito microhook trabeculotomy (TMH) performed by the same surgeon.MethodsSix patients who underwent lens-sparing TMH at Meizankai Shimizu Eye Clinic from November 2021 to May 2023, and developed anterior subcapsular vacuolar lens opacities postoperatively were reviewed. Detailed records of surgeries, follow-up findings were collected and reported.ResultsIn all six cases, anterior vacuolar subcapsular lens opacities were observed on the day after surgery, gradually decreasing without affecting visual acuity or contrast sensitivity. In all cases, without any specific interventions, the opacities disappeared by 21 months postoperatively.ConclusionAnterior subcapsular cataracts, characterized by a vacuolar appearance and transient existence, should be recognized as an early complication of ab interno glaucoma surgery, possibly linked to use of distributed ophthalmic viscosurgical devices and excessive anterior chamber irrigation leading to traumatic cataracts on the lens surface.

Ten-year follow-up of posterior chamber phakic intraocular lens with central port design in patients with low and normal vault.

To assess the clinical outcomes and postoperative complications of the implantable collamer lens (ICL) with a central port throughout 10 years of follow-up in patients with low and normal vault. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Retrospective and comparative case series. This study included eyes that underwent a V4c ICL implantation with 10 years of follow-up. The eyes were divided into 2 groups according to the vault at 1 year postoperatively: vault <250 μm and between 250 μm and 800 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), vault, complications, and secondary surgeries were analyzed. 37 and 90 eyes were enrolled in the low and normal-vault groups, respectively. No differences in UDVA, CDVA, and refraction were found between the groups over 10 years of follow-up. No cases developed ICL-induced anterior subcapsular opacity over the follow-up period. 2 (5.4%) and 8 (8.9%) eyes in the low and normal-vault groups, respectively, required ICL exchange. 1 (2.8%) and 2 (2.2%) eyes in the low and normal-vault groups, respectively, required excimer laser to correct residual refractive error. The IOP remained stable throughout the 10-year follow-up. The loss in ECD from that preoperatively to 10 years postoperatively was 3.8% and 4.5% in the low and normal-vault groups, respectively ( P = .4). No pigment dispersion glaucoma or other vision-threatening complications were reported. This study shows good long-term outcomes of the V4c ICL, supporting that the central hole provides safety to the procedure and prevents the potential risk associated with low vault.

Smurf1 Modulates Smad Signaling Pathway in Fibrotic Cataract Formation.

TGF-β/BMP signaling pathway plays a significant role in fibrotic cataract. Smurf1, a ubiquitin protein ligase, regulates the TGF-β/BMP signaling pathway through the ubiquitin-proteasome system (UPS). This study aims to investigate the role of Smurf1 in the progression of fibrotic cataract and its underlying mechanism. We used a mouse model of injury-induced anterior subcapsular cataract (ASC) and administered the Smurf1 inhibitor A01 for in vivo investigations. RNA sequencing was performed to examine global gene expression changes. Protein levels were assessed by Simple Western analysis. The volume of subcapsular opacity was determined using whole-mount immunofluorescence of lens anterior capsules. Lentivirus was utilized to establish cell lines with Smurf1 knockdown or overexpression in SRA01/04. Lens epithelial cell (LEC) proliferation was evaluated by CCK8 and EdU assays. Cell cycle profile was determined by flow cytometry. LEC migration was measured using Transwell and wound healing assays. The mRNA levels of genes associated with cell proliferation, migration, epithelial-mesenchymal transition (EMT), TGF-β/BMP pathway, and UPS were upregulated in mouse ASC model. Smurf1 mRNA and protein levels were upregulated in lens capsules of patients and mice with ASC. Anterior chamber injection of A01 inhibited ASC formation and EMT. In vitro, Smurf1 knockdown reduced proliferation, migration and TGF-β2-induced EMT of LECs, concomitant with the upregulation of Smad1, Smad5, and pSmad1/5. Conversely, overexpression of Smurf1 showed opposite phenotypes. Smurf1 regulates fibrotic cataract progression by influencing LEC proliferation, migration, and EMT through the modulation of the Smad signaling pathway, offering a novel target for the fibrotic cataract treatment.

Lens Thickness in Atopic Cataract: A Case-Control Study.

To examine whether atopic cataracts are associated with thinner lenses. Department of Ophthalmology, Jikei University Hospital, Tokyo, Japan. Retrospective matched case-control study. A total of 31 eyes with atopic cataracts, 62 with non-atopic cataracts, and 31 without cataracts were analyzed. Each group was matched for age (± 4 years) and sex. The mean lens thickness (LT) was 3.76 ± 0.40, 3.94 ± 0.49, and 4.11 ± 0.40 mm in eyes with atopic cataracts, non-atopic cataracts, and normal lenses, respectively. Repeated-measures analysis of variance showed that the LT in the atopic cataract group was significantly thinner than that in the non-atopic cataract (P = 0.036) and normal lens (P < 0.001) groups. In multivariate logistic regression analysis, a thinner LT was negatively correlated with age (OR 0.91, 95% CI 0.86-0.96) and positively correlated with anterior subcapsular cataract (ASC) (OR 5.61, 95% CI 1.97-15.99). Atopy was not a significant factor. Twenty-four of the 62 eyes (38.7%) with non-atopic cataracts and 24 of the 31 eyes (77.4%) with atopic cataracts had ASC. The lenses of eyes with atopic cataracts were thinner than those of controls. Atopic cataracts frequently present with anterior subcapsular opacity, which is associated with lens thinning.

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.

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.

Lenticular hydrops in lenticonus: a new concept

A 25-year-old male patient presented with biopsy-proven Alport's syndrome with bilateral cataracts (history of unstable refractive error over past 6 years with recent-onset diminution of vision in either eye for the past 1 year; best-corrected visual acuities of 20/100 OD and 20/200 OS; (Fig. 1A, B). On optical coherence tomography the patient showed right eye lenticonus (Fig. 1C) with a communicating hyperreflectivity (fibrosed hydration track) between the anterior capsular and subcapsular opacities (Fig. 2A). The left eye showed a flatter anterior curvature with hyperreflective dots in the anterior chamber suggestive of leaked lens matter or low-grade inflammation (Fig. 1D) with volume loss in the anterior subcapsular region (Fig. 2B) and a localized area of capsular thinning (Fig. 2C). It was hypothesized that microruptures in the anterior capsule (secondary to thinning in the lenticonus) with aqueous hydration could have caused the bilateral cataract and lenticular volume loss in the left eye, thus called hydrops.

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).

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.

Artificial Intelligence for the Estimation of Visual Acuity Using Multi-Source Anterior Segment Optical Coherence Tomographic Images in Senile Cataract.

PurposeTo investigate an artificial intelligence (AI) model performance using multi-source anterior segment optical coherence tomographic (OCT) images in estimating the preoperative best-corrected visual acuity (BCVA) in patients with senile cataract.DesignRetrospective, cross-instrument validation study.SubjectsA total of 2,332 anterior segment images obtained using swept-source OCT, optical biometry for intraocular lens calculation, and a femtosecond laser platform in patients with senile cataract and postoperative BCVA ≥ 0.0 logMAR were included in the training/validation dataset. A total of 1,002 images obtained using optical biometry and another femtosecond laser platform in patients who underwent cataract surgery in 2021 were used for the test dataset.MethodsAI modeling was based on an ensemble model of Inception-v4 and ResNet. The BCVA training/validation dataset was used for model training. The model performance was evaluated using the test dataset. Analysis of absolute error (AE) was performed by comparing the difference between true preoperative BCVA and estimated preoperative BCVA, as ≥0.1 logMAR (AE≥0.1) or <0.1 logMAR (AE <0.1). AE≥0.1 was classified into underestimation and overestimation groups based on the logMAR scale.Outcome MeasurementsMean absolute error (MAE), root mean square error (RMSE), mean percentage error (MPE), and correlation coefficient between true preoperative BCVA and estimated preoperative BCVA.ResultsThe test dataset MAE, RMSE, and MPE were 0.050 ± 0.130 logMAR, 0.140 ± 0.134 logMAR, and 1.3 ± 13.9%, respectively. The correlation coefficient was 0.969 (p < 0.001). The percentage of cases with AE≥0.1 was 8.4%. The incidence of postoperative BCVA > 0.1 was 21.4% in the AE≥0.1 group, of which 88.9% were in the underestimation group. The incidence of vision-impairing disease in the underestimation group was 95.7%. Preoperative corneal astigmatism and lens thickness were higher, and nucleus cataract was more severe (p < 0.001, 0.007, and 0.024, respectively) in AE≥0.1 than that in AE <0.1. The longer the axial length and the more severe the cortical/posterior subcapsular opacity, the better the estimated BCVA than the true BCVA.ConclusionsThe AI model achieved high-level visual acuity estimation in patients with senile cataract. This quantification method encompassed both visual acuity and cataract severity of OCT image, which are the main indications for cataract surgery, showing the potential to objectively evaluate cataract severity.

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.

Anterior Subcapsular Cataract Formation With Long-term Topical Netarsudil Treatment for Glaucoma.

The purpose of this study was to describe anterior subcapsular cataract development in patients on long-term topical netarsudil use. This clinical observational study summarizes a similar cataract pattern demonstrated in a series of patients from a single physician practice and a university-based outpatient clinic during their routine clinical follow-up visits from October 2020 to August 2021. All patients have been using topical netarsudil once daily for at least 15 months. No anterior capsular changes have been observed in any patient at the time when netarsudil was initiated. Five eyes from 4 patients between the ages of 41 and 61 and 1 eye from a patient aged 84 were found to develop anterior subcapsular opacities 15 to 37 months after beginning netarsudil. These cataracts were overall small, 1 to 3 mm, round, oval or ring-shaped, central or paracentral with mild density. No other risk factors for cataract development apart from age were found in these patients. Patients on long-term netarsudil should be monitored for potential development of anterior subcapsular cataracts.

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.