Tzu-Hsun Tsai

Background and Objectives: Autologous fat transplantation using fat alone can lead to postoperative complications. Laminin–alginate beads have been investigated as carriers for adipose mesenchymal stem cells (ASCs), with the potential to modulate cell release kinetics, influence macrophage responses, and thereby affect the maintenance of graft volume. We hypothesized that encapsulating ASCs in laminin–alginate beads would allow gradual ASC release into the transplantation site and influence the macrophage-related microenvironment during fat graft maturation. Materials and Methods: ASCs were isolated from two female enhanced green fluorescent protein (eGFP) transgenic rats. For SC (ASC + fat) grafts, ASCs were freely mixed with 1 mL of mature adipose tissue. For bead-encapsulated cell (BEC) (laminin–alginate + ASC + fat) grafts, ASCs were first encapsulated in laminin–alginate beads and subsequently mixed with 1 mL of fat tissue. The fat graft was subcutaneously injected into the backs of the rats, which were subsequently euthanized at weeks 4, 6, and 8. The grafts were then harvested for histological and immunofluorescence analyses. Results: The histological analysis indicated that the number of eGFP-ASCs in the BEC grafts gradually increased between weeks 4 and 8, whereas that in the SC grafts decreased over the same period. The BEC grafts also exhibited a numerically higher degree of M2 macrophage infiltration. Conclusions: Laminin–alginate bead encapsulation was associated with prolonged persistence of eGFP-ASCs within the graft area. Although the macrophage-related findings were not statistically significant, they suggest a potential interaction between gradual ASC release and the local graft microenvironment.

BACKGROUND: Despite contemporary management, the incidence of diabetic retinopathy in adolescents during the first 2–5 years of T1DM remains unchanged, underscoring the need to better understand early retinal changes. In this study, we investigated early retinal changes in children with T1DM using optical coherence tomography angiography (OCTA). Incorporating a literature review of retinal changes in other age groups, we propose a model sequence of retinal changes in patients with T1DM. METHODS: In this prospective case-control study, conducted at National Taiwan University Hospital (NTUH) from 2021 to 2023, we prospectively recruited children with T1DM from a paediatric endocrinology clinic and control children undergoing routine eye examinations at the Department of Ophthalmology. All patients and controls underwent comprehensive ophthalmological examinations and OCTA. RESULTS: In the T1DM group, the average age at diagnosis was 7.39 ± 4.29 years, average diabetes duration was 5.0 ± 3.19 years, and average glycosylated haemoglobin level was 7.41 ± 0.92%. In the control group, the mean age was10.8 ± 4.31 years, ranging from 5 to 20 years old, and that of DM group was 12.27 ± 4.32 years (p=0.08). The T1DM group showed significant decreases in macular vessel density, particularly in the superficial and deep vascular plexuses. Full retinal thickness was greater in the perifoveal annulus in the T1DM group. Prepubertal onset of T1DM negatively impacted the superficial capillary plexus in both the parafoveal and perifoveal areas. Other DM factors did not significantly correlate with vascular parameters. CONCLUSIONS: Using OCTA, we detected early, clinically inapparent microvascular reductions in vessel density in children with T1DM, while retinal layer thickness remained preserved. These findings, along with previous literature, infer that microvascular alterations detectable by OCTA, structural changes on OCT may occur sequentially and prior to clinically visible structural changes.

Introduction Topical atropine is widely used for myopia control in children, with proven efficacy in slowing myopia progression. However, concerns remain regarding its potential effects on intraocular pressure (IOP), particularly with long-term use. This study aimed to evaluate the longitudinal effects of topical atropine on IOP in children with myopia. Methods This retrospective, longitudinal study enrolled children using 0.125% atropine to control myopia progression and atropine non-users. IOP was measured repeatedly before and during treatment. RTVue optical coherence tomography (OCT) measured retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness. Multilevel models assessed IOP changes by adjusting age, sex, spherical equivalent, central corneal thickness, and baseline IOP. Results A total of 188 patients (376 eyes) in the atropine group and 188 patients (376 eyes) in the control group were included. There were 86 boys (46%) aged 8.0 ± 2.5 years. Patients in the atropine group were more myopic (−1.17 ± 1.40 versus 0.73 ± 1.83 D, P < 0.001). The central corneal thickness and baseline IOP (atropine: 17.6 ± 3.0 mmHg; control: 17.2 ± 3.6 mmHg) were similar. Over a follow-up of 18.6 months (atropine, 19.3 months; control, 18.0 months), the final IOP was higher in the atropine group (18.3 ± 3.6 versus 16.7 ± 3.2 mmHg, P < 0.001). In the multivariable multilevel models, atropine was associated with an additional 0.51-mmHg increase (95% confidence interval [CI] 0.36–0.67, P = 0.001) in IOP per year when adjusted for sex, age, central corneal thickness, spherical equivalent, and baseline IOP. RNFL (104.0 ± 8.8 versus 102.6 ± 7.5 µm, P = 0.475) and GCC thickness (98.1 ± 5.6 versus 96.7 ± 5.8 µm, P = 0.270) showed no significant differences between groups. Conclusions Atropine use for myopia control in children was associated with a modest IOP increase without apparent impact on RNFL. Regular IOP monitoring is advisable.

Purpose: The prevention and control of myopia are crucial public health issues. Therefore, this study aimed to construct reference percentile curves of age‐specific axial length based on population‐based sampling data of Taiwanese children and assess their role in the progression of myopia using a cohort of children undergoing orthokeratology. Methods: Data from 2997 representative samples of schoolchildren aged 6–18 years from a recent myopia survey in Taiwan between 2016 and 2017 were analysed for axial length distribution. Additionally, data from a cohort of 35 children with myopia treated with orthokeratology (mean follow‐up period: 36.1 ± 14.6 months) were retrospectively collected. The ability to estimate myopia progression based on percentile change rate was compared with that of axial elongation rate through model comparisons involving linear and linear mixed‐effect models. Results: Percentile curves of the children's age‐specific axial length were modelled and served as a population‐based reference in Taiwan. The percentile change rate in the cohort of orthokeratology users showed a higher correlation (ρ = 0.64) with the myopia progression rate compared to the axial length elongation rate (ρ = 0.57). The baseline spherical equivalent and percentile change rate demonstrated the most effective performance in estimating myopia progression among all parameters. Conclusions: Population‐based reference percentile curves were established for age‐specific axial length in Taiwanese schoolchildren, which can serve as valuable indicators for assessing individual health and monitoring vision trends within the population.

To quantitate the levels of various ceramide species in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate the role of vitreal ceramides in the pathogenesis of PDR. A case control study. We collected vitreous samples from 25 type 2 diabetes patients with PDR and 25 age- and sex-matched nondiabetic controls undergoing vitrectomy. The levels of ceramide species (C16:0, 18:0, 20:0, 22:0, 24:1, and 24:0) were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry with positive electrospray ionization mode. The correlation of baseline characteristics, blood test data, and clinical manifestation of PDR were analyzed with vitreal ceramides levels. The total level of ceramides was substantially higher in the PDR group than the control group (18.626 ± 19.264 versus 3.524 ± 2.456 pmol/mg protein; P < 0.001). Among ceramides of various acyl chain lengths, the increases of very-long-chain (VLC) ceramides (C22-C24) were more drastic than those of long-chain ceramides (C16-C20). In the PDR group, VLC ceramide species accounted for 76.1%, whereas in the control group, C16 ceramide predominated at 40.5%. Based on the multivariate linear regression analysis, diagnosis of diabetes (β = 14.5751; P = 0.0327) and lower body mass index (β = -2.1396; P = 0.0173) were significantly associated with higher level of VLC ceramides. Intravitreal injection of anti-VEGF leads to insignificant reduction of VLC ceramides (P = 0.068). Vitreal ceramide levels were elevated in diabetic subjects, especially the VLC species, which may contribute to the pathogenesis of diabetic retinopathy.

Introduction This study investigated the effects of automatic dual rotational Risley prisms (ADRRPs), a mobile phone application-operated device, on vergence abilities in young adults. Methods Fifty-six participants aged 20–24 performed vergence exercises. The test group used prisms with power changes from 30Δ base-out to 10Δ base-in, while the control group used plano lenses for 10 min. Ophthalmic examinations included lateral heterophoria, near point of convergence (NPC), vergence facility (VF), negative fusional vergence (NFV), and positive fusional vergence (PFV), all measured before and after the vergence exercises. Pre- and post-test results were analyzed using a paired sample t test. Additionally, three cases with convergence insufficiency (CI) performed similar exercises for 12 weeks. Results Participants were divided into the test group (n = 39; age 21.82 ± 1.10 years) and control group (n = 17; age 20.53 ± 0.51 years). In the test group, NPC improved from 6.11 ± 2.52 cm to 5.77 ± 2.30 cm (p = 0.023). VF increased from 13.75 ± 4.10 cpm to 16.50 ± 4.42 cpm (p = 0.007). PFV at 6 m and 0.4 m increased from 19.49 ± 6.77∆ to 22.19 ± 6.64∆ (p < 0.001) and 20.51 ± 7.05∆ to 22.69 ± 6.44∆ (p = 0.012), respectively. After 12 weeks, convergence insufficiency symptom survey scores for cases with CI decreased significantly, with NPC improving from 7.0 to 0 cm, 6.0 to 5.8 cm, and 6.0 to 4.7 cm. PFV increased from 10 to 25∆, 20 to 30∆, and 25 to 50∆. Conclusion This preliminary study showed the effect of ADRRPs on improving vergence abilities. Further studies are needed to investigate the long-term sustainability and effects in a larger population of individuals with CI of this approach.

Introduction To evaluate the efficacy and safety of myopia control using a multifocal soft contact lens designed with high peripheral add power in schoolchildren. Methods This 1-year multi-center, prospective, randomized, double-blind, controlled study enrolled myopic schoolchildren aged 6–15 years with refractive errors between − 1.0 D and − 10.0 D. Each participant was randomly allocated to wear a daily disposable multifocal soft contact lens as the treatment in one eye and a single-vision soft contact lens as the control in the other eye. The primary endpoints were changes in the cycloplegic spherical equivalent (SE) and axial length at 1 year. Results Fifty-two of the 59 participants (88.1%) completed the study protocol. The mean change in SE was − 0.73 ± 0.40 D in the treatment group. and − 0.85 ± 0.51 D in the control group (mean difference: − 0.12 ± 0.34 D, p = 0.012). The mean change in axial length was 0.25 ± 0.14 mm in the treatment group, and 0.33 ± 0.17 mm in the control group (mean difference: 0.08 ± 0.10 mm, p < 0.001). The treatment was well tolerated, and no serious adverse events were observed. Conclusions Treatment with multifocal soft contact lenses with high peripheral add power was effective in controlling the progression of myopia and axial length elongation in myopic schoolchildren.

Introduction This study evaluated novel automatic dual rotational Risley prisms (ADRRPs) as a vergence exercise tool for patients with myopia to improve accommodative lag and accommodative facility. Methods Participants with myopia aged 20–24 years were recruited. After vergence exercises with prisms (treatment group) or plano lenses (control group) using ADRRPs for 10 min, measurements were taken using an open-field autorefractor (Grand Seiko WAM-5500) at viewing distances of 0.4 m and 6.0 m. We measured accommodative facility using a ± 2.00 D accommodative flipper. Results A total of 56 participants (treatment group, 39; control group, 17) performed vergence exercises using ADRRPs. Participants in the treatment group showed improvements in accommodative lag at a 0.4 m viewing distance, with measurements of 0.57 D (right eye; OD) and 0.53 D (left eye; OS) and 0.21 D (OD) and 0.27 D (OS) before and after the exercises, respectively (p < 0.001). Over-refractions using an open-field autorefractor with spherical equivalent contact lenses at a 6.0 m viewing distance were − 0.01 ± 0.30 D (OD) and 0.03 ± 0.34 D (OS) and 0.15 ± 0.32 D (OD) and 0.19 ± 0.28 D (OS) before and after the exercises, respectively (difference + 0.16 D; p < 0.001). Accommodative facility values before and after exercises were 14.88 ± 3.36 and 15.59 ± 3.60 cpm, respectively (p < 0.01). No significant differences in accommodative lag, relaxation, and accommodative facility before and after exercise were observed in the control group. Conclusions Using ADRRPs in vergence exercises can improve accommodative lag, accommodative facility, and accommodative relaxation in adults with myopia. Further research to evaluate persistent and long-term effects is needed.