The current epidemic status of diabetic retinopathy in China is unclear. A national prevalence survey of diabetic complications was conducted. 50,564 participants with gradable non-mydriatic fundus photographs were enrolled. The prevalence rates (95% confidence intervals) of diabetic retinopathy and vision-threatening diabetic retinopathy were 16.3% (15.3%–17.2%) and 3.2% (2.9%–3.5%), significantly higher in the northern than in the southern regions. The differences in prevalence between those who had not attained a given metabolic goal and those who had were more pronounced for Hemoglobin A1c than for blood pressure and low-density lipoprotein cholesterol. The participants with vision-threatening diabetic retinopathy had significantly higher proportions of visual impairment and blindness than those with non-vision-threatening diabetic retinopathy. The likelihoods of diabetic retinopathy and vision-threatening diabetic retinopathy were also associated with education levels, household income, and multiple dietary intakes. Here, we show multi-level factors associated with the presence and the severity of diabetic retinopathy.

To compare the clinical performance between trifocal and bifocal intraocular lenses in bilateral cataract and/or refractive lens exchange (RLE) surgery. A comprehensive literature search of PubMed, EMBASE, Cochrane Controlled Trials Register and Web of Science was performed through October 2016 to identify randomized, controlled trials (RCTs) and comparative cohort studies. The primary outcomes were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, spectacle independence, patient satisfaction and contrast sensitivity. The secondary outcomes were residual sphere, spherical equivalent (SE), cylinder and complications. Six RCTs and 2 cohort studies including 568 eyes (278 in the trifocal group and 290 in the bifocal group) were identified. There was a statically significant difference between the two groups in UDVA (WMD: -0.03, 95% CI: -0.05 to -0.01, P = 0.005), but the difference (0.03 log MAR) is not clinically significant. Intermediate visual acuity was better in the trifocal IOL group judging from UIVA and defocus curves. There was a statically significant difference between the two groups in residual cylinder (WMD: 0.11, 95% CI: 0.02 to 0.20, P = 0.02), and subgroup AT Lisa tri 839MP trifocal also showed significant better UNVA than bifocal IOLs (WMD: -0.13, 95% CI: -0.17 to -0.08, P<0.00001). However, no significant differences were observed in UNVA (WMD: -0.04, 95% CI: -0.11 to 0.02, P = 0.19), spectacle independence (WMD: 1.27, 95% CI: 0.89 to 18.15, P = 0.07), patient satisfaction (WMD: 4.01, 95% CI: 0.07 to 22.72, P = 0.87), residual sphere (WMD: -0.03, 95% CI: -0.18 to 0.13, P = 0.74), SE (WMD: 0.04, 95% CI: -0.09 to 0.16, P = 0.55) or complications (WMD: 2.08, 95% CI: 0.35 to 12.43, P = 0.42). Trifocal IOL technology (especially AT Lisa trifocal 839M trifocal) had a clear advantage over bifocal IOLs in intermediate visual acuity, while both trifocal IOLs and bifocal IOLs showed excellent performance in distance visual acuity. AT Lisa trifocal 839M trifocal could provide better uncorrected near visual acuity than bifocal IOLs. However, more evidence is needed to compare their spectacle independence, higher satisfaction rate, and photic phenomena.

To assess the precision and agreement of measurements of higher order aberrations (HOAs) obtained with a ray tracing aberrometer (iTrace) and a Hartmann-Shack aberrometer (Topcon KR-1 W). Prospective evaluation of the diagnostic test. Data from the right eyes of 92 normal subjects obtained using the two devices were included in this study. Two observers performed 3 consecutive scans to determine the intraobserver repeatability and interobserver reproducibility. About one week later, one observer performed an additional 3 consecutive scans to obtain the intersession reproducibility. The within-subject standard deviation (Sw), test-retest repeatability (TRT) and intraclass correlation coefficient (ICC) were used to assess the precision, while Bland-Altman plots were performed to assess the agreement. For intraobserver repeatability of the ocular, corneal and internal HOAs, Topcon KR-1 W showed a 2.77Sw of 0.079 μm or less and ICCs of 0.761 or more; and iTrace showed a 2.77Sw of 0.105 μm or less and ICCs of 0.805 or more. The ICCs of the internal HOAs of interobserver reproducibility were less than 0.75 except for spherical aberration (SA) (0.862), and interobserver reproducibility of the counterpart showed similar but lower results. For the ocular, corneal and internal HOA measurements, statistically significant differences existed between the Topcon KR-1 W and iTrace (all P < 0.05). No significant differences were observed in the ocular SA and internal coma. The ray tracing and Hartmann-Shack method aberrometers provided excellent repeatability but less reliable reproducibility in the measurement of HOAs (except for SA). The two aberrometers should not be interchangeable in clinical application because of the significant differences in HOA measurements between them.

Purpose: To determine the effect of decorin on the barrier function of human retinal pigment epithelial (RPE) cells under high glucose (HG) plus hypoxia conditions. Methods: Human RPE cells (ARPE-19) were cultured for 18 days in normal glucose (5.5 mM) or HG (25 mM) medium. In addition, to mimic the hypoxic impact which occurs in diabetic retinopathy, cells were treated with 100 µM cobalt chloride (CoCl2) during the last two days of the experiment. Decorin 100 nM was applied 1 h before the addition of CoCl2. The RPE barrier function was evaluated by measuring transepithelial electrical resistance (TER) and apical-basolateral permeability of fluorescein isothiocyanate (FITC)-dextran. The content and distribution of tight junction proteins (claudin-1, occludin and zonula occludens-1 [ZO-1]) were examined by western blot and immunofluorescence. The p38 mitogen-activated protein kinase (MAPK) phosphorylation was evaluated by western blot and small interfering RNA transfection to p38 MAPK was also performed in ARPE-19 monolayers. Results: HG + hypoxia significantly increased FITC-dextran permeability, paralleled by decreased TER. Decorin reversed both of these effects. HG + hypoxia-induced reduction and disorganization of occludin and ZO-1 were also reversed by decorin. Decorin could prevent the activation of p38 MAPK induced by hypoxia. Silence of p38 MAPK by RNA interference could also inhibit the breakdown of ARPE-19 cell monolayer induced by HG + hypoxia. Conclusion: RPE barrier disruption induced by HG plus hypoxia is prevented by decorin via suppression of p38 MAPK activation, which could present a new therapeutic strategy for inhibition of diabetic macular edema.

To assess the precision (repeatability and reproducibility) of ocular parameters measured by the Tomey OA-2000 biometer, and to compare them with those measured by the IOLMaster. In this prospective study, the right eyes of 108 healthy subjects were included. Three consecutive scans were obtained by 2 observers using the Tomey OA-2000, and in the same session one observer used the IOLMaster (version 5.4.4.0006) for the measurements. About 1 week later, 3 scans were obtained by one observer using the Tomey OA-2000. The axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometer readings, pupil diameter (PD) and corneal diameter (CD) values measured by the Tomey OA-2000 and IOLMaster were analyzed. The coefficient of variation (CoV), intraclass correlation coefficient (ICC), within subject standard deviation (Sw) and 2.77Sw were calculated to assess the repeatability and reproducibility. The paired t test and Bland-Altman plots were used to analyze the differences and agreements of parameters measured by the two devices, respectively. Intraobserver repeatability, and interobserver and intersession reproducibility of the AL, CCT, ACD, LT, Kf, Ks, Km, PD and CD values measured by the Tomey OA-2000 biometer showed a CoV of less than 1% except that for PD, and an ICC of more than 0.97 except that for PD and CD. The AL, Kf, Ks, Km and CD values measured by the Tomey OA-2000 were 0.058 ± 0.094 mm, 0.088± 0.150 diopters (D), 0.163 ± 0.170 D, 0.127 ± 0.117 D and 0.171 ± 0.217 mm lower than those measured by the IOLMaster, respectively (all Ps < 0.05). However, the ACD values from the two devices were comparable (P = 0.169). The 95% linite of agreement (LoA) of the AL, ACD, CD and all keratometer readings were no more than 0.24 mm, 0.14 mm 0.60 mm and 0.5 D, respectively. Except for the PD and CD, the ocular parameters measured by the Tomey OA-2000 were highly repeatable and reproducible. Except for the CD value, there was good agreement of ocular parameters measured by the Tomey OA-2000 and the IOLMaster in healthy eyes.

Vascular endothelial growth factor (VEGF) is one of the major regulatory molecules in diabetic retinopathy (DR). In our previous study, we demonstrated that succinate levels were elevated in the retinas of diabetic rats and that the knockdown of the succinate receptor, G-protein-coupled receptor 91 (GPR91), inhibited the release of VEGF and attenuated retinal vascular disorder in the early stages of DR. In the present study, we examined the signaling pathways involved in the GPR91-dependent release of VEGF in the retinal ganglion cell line, RGC-5. The cells were infected with a lentiviral small hairpin RNA (shRNA) expression vector targeting GPR91 (LV.shGPR91). Immunofluorescence staining revealed that GPR91 was predominantly localized in the cell bodies of the RGC-5 cells. RT-qPCR, western blot analysis and ELISA indicated that succinate exposure upregulated VEGF expression, activated the extracellular signal-regulated protein kinase (ERK)1/2, c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK) signaling pathways and led to the release of cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2). The knockdown of GPR91 inhibited ERK1/2 and JNK activity, but did not inhibit the activation of the p38 MAPK pathway. The increase in COX-2 expression and the release of PGE2 were inhibited by transduction with LV.shGPR91 and ERK1/2, JNK and COX-2 inhibitors. The expression and release of VEGF showed similar results. Cell Counting Kit-8 (CCK-8) assays revealed that the shRNA-mediated knockdown of GPR91 decreased the proliferation of RF/6A cells cultured in succinate-conditioned medium. Our data suggest that GPR91 modulates the succinate-induced release of VEGF through the MAPK/COX-2/PGE2 signaling pathway.