BACKGROUND An in vitro injury model mimicking a corneal surface injury was optimised using human corneal epithelial cells(hCEC).AIM To investigate whether corneal-stroma derived stem cells(CSSC) seeded on an amniotic ...BACKGROUND An in vitro injury model mimicking a corneal surface injury was optimised using human corneal epithelial cells(hCEC).AIM To investigate whether corneal-stroma derived stem cells(CSSC) seeded on an amniotic membrane(AM) construct manifests an anti-inflammatory, healing response.METHODS Treatment of hCEC with ethanol and pro-inflammatory cytokines were compared in terms of viability loss, cytotoxicity, and pro-inflammatory cytokine release, in order to generate the in vitro injury. This resulted in an optimal injury of 20%(v/v) ethanol for 30 s with 1 ng/mL interleukin-1(IL-1) beta. Co-culture experiments were performed with CSSC alone and with CSSC-AM constructs.The effect of injury and co-culture on viability, cytotoxicity, IL-6 and IL-8 production, and IL1 B, TNF, IL6, and CXCL8 mRNA expression were assessed.RESULTS Co-culture with CSSC inhibited loss of hCEC viability caused by injury. Enzyme linked immunosorbent assay and polymerase chain reaction showed a significant reduction in the production of IL-6 and IL-8 pro-inflammatory cytokines, and reduction in pro-inflammatory cytokine mRNA expression during co-culture with CSSC alone and with the AM construct. These results confirmed the therapeutic potential of the CSSC and the possible use of AM as a cell carrier for application to the ocular surface.CONCLUSION CSSC were shown to have a potentially therapeutic anti-inflammatory effectwhen treating injured hCEC, demonstrating an important role in corneal regeneration and wound healing, leading to an improved knowledge of their potential use for research and therapeutic purposes.展开更多
Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This was a prospective interventional case ...Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4=excellent-poor).Weighted Cohen’s kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6months(1.0±0.0)and 12months(1.0±0.0)postoperatively.At final follow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(κ=0.86-0.95)and inter-rater reliability(κ=0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathin CAG.展开更多
The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular deg...The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of prematurity.Cataract management is another feld that can beneft from greater AI application.Cataract is the leading cause of reversible visual impairment with a rising global clinical burden.Improved diagnosis,monitoring,and surgical management are necessary to address this challenge.In addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 pandemic.AI on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical barriers.First,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs.This utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts appropriately.Second,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional formulas.Third,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical procedures.Fourth,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser capsulotomy.These advances in AI could transform cataract management and enable delivery of efcient ophthalmic services.The key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of end-users.展开更多
Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case ...Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4:excellent-poor).Weighted Cohen's kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6 months(1.0±0.0)and 12 months(1.0±0.0)postoperatively.At final fllow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(k:0.86-0.95)and inter-rater reliability(k:0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathinCAG.Trial registration:ClinicalTrials.gov,NCT02866968.Registered in July 2016.展开更多
文摘BACKGROUND An in vitro injury model mimicking a corneal surface injury was optimised using human corneal epithelial cells(hCEC).AIM To investigate whether corneal-stroma derived stem cells(CSSC) seeded on an amniotic membrane(AM) construct manifests an anti-inflammatory, healing response.METHODS Treatment of hCEC with ethanol and pro-inflammatory cytokines were compared in terms of viability loss, cytotoxicity, and pro-inflammatory cytokine release, in order to generate the in vitro injury. This resulted in an optimal injury of 20%(v/v) ethanol for 30 s with 1 ng/mL interleukin-1(IL-1) beta. Co-culture experiments were performed with CSSC alone and with CSSC-AM constructs.The effect of injury and co-culture on viability, cytotoxicity, IL-6 and IL-8 production, and IL1 B, TNF, IL6, and CXCL8 mRNA expression were assessed.RESULTS Co-culture with CSSC inhibited loss of hCEC viability caused by injury. Enzyme linked immunosorbent assay and polymerase chain reaction showed a significant reduction in the production of IL-6 and IL-8 pro-inflammatory cytokines, and reduction in pro-inflammatory cytokine mRNA expression during co-culture with CSSC alone and with the AM construct. These results confirmed the therapeutic potential of the CSSC and the possible use of AM as a cell carrier for application to the ocular surface.CONCLUSION CSSC were shown to have a potentially therapeutic anti-inflammatory effectwhen treating injured hCEC, demonstrating an important role in corneal regeneration and wound healing, leading to an improved knowledge of their potential use for research and therapeutic purposes.
文摘Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4=excellent-poor).Weighted Cohen’s kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6months(1.0±0.0)and 12months(1.0±0.0)postoperatively.At final follow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(κ=0.86-0.95)and inter-rater reliability(κ=0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathin CAG.
文摘The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of prematurity.Cataract management is another feld that can beneft from greater AI application.Cataract is the leading cause of reversible visual impairment with a rising global clinical burden.Improved diagnosis,monitoring,and surgical management are necessary to address this challenge.In addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 pandemic.AI on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical barriers.First,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs.This utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts appropriately.Second,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional formulas.Third,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical procedures.Fourth,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser capsulotomy.These advances in AI could transform cataract management and enable delivery of efcient ophthalmic services.The key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of end-users.
文摘Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4:excellent-poor).Weighted Cohen's kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6 months(1.0±0.0)and 12 months(1.0±0.0)postoperatively.At final fllow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(k:0.86-0.95)and inter-rater reliability(k:0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathinCAG.Trial registration:ClinicalTrials.gov,NCT02866968.Registered in July 2016.
