BACKGROUND: This study compares the clinical outcomes of femtosecond laser small-incision lenticule extraction (SMILE) for the correction of myopia and myopic astigmatism greater than - 10 D, and - 10 D or less respectively.
METHODS: 60 eyes/patients were equally selected into group 1 (myopia and myopic astigmatism of - 10 D or less) and group 2 (myopia and myopic astigmatism of over - 10 D), both of which were treated with SMILE. Visual and refractive outcomes, corneal higher-order aberrations, and Bowman\'s layer micro-distortions were evaluated preoperatively, 3 months, and 6 months postoperatively.
RESULTS: LogMAR corrected distance visual acuity (CDVA) of group 1 and group 2 was - 0.069 ± 0.047 and - 0.053 ± 0.073 6 months postoperatively (P = 0.48). 100% eyes in group 1 and 97% in group 2 were within 1 D of targeted correction (P = 0.45). Meanwhile, 100% eyes in group 1 and 97% in group 2 had an uncorrected distance visual acuity of 20/25 or better (P = 0.20). Changes in corneal higher-order aberrations root mean square, coma, and trefoil were similar between the two groups but spherical aberration was higher in group 2 (P < 0.01). Micro-distortions were observed in 53% in group 1 and 77% in group 2. More micro-distortions were observed in group 2 (3.40 ± 2.66) than in group 1 (2.07 ± 2.29) (P = 0.041). The total number of micro-distortions was not correlated with postoperative CDVA (P = 0.77).
CONCLUSIONS: Visual outcomes showed similar results of SMILE for myopic correction of > - 10 D and ≤ - 10 D. Refractive outcomes showed slightly under-correction in higher myopic eyes. Higher myopic treatment tends to induce more spherical aberrations. Micro-distortions had no impact in visual and refractive outcomes.

BACKGROUND: To investigate thickness changes in the corneal epithelium and Bowman\'s layer after overnight silicone hydrogel contact lens (CL) wear by using ultra-high resolution optical coherence tomography (UHROCT).
METHODS: Eleven subjects without CL wearing history were recruited for this study. An UHROCT was used to measure the thickness of the epithelium (ET), Bowman\'s layer (BT), stroma (ST), and total cornea (CCT) at the center of both eyes. A silicone hydrogel CL was inserted in the right eye of each subject, and the fellow non-CL wearing left eye served as the control. The lens was inserted at 9:30 pm and removed at 8:00 am the next morning. The subjects were evaluated at 9:00 pm (baseline), 9:30 pm (lens insertion), 10:00 pm (before sleep), 7:00 am (waking), 7:30 am, and 8:00 am (lens removal).
RESULTS: Compared to the lens insertion level, the ET of the lens-wearing eye increased by 5.73% at eye opening (P = 0.001). The ET of the non-CL wearing eye and the BT in both eyes did not change after overnight CL wear. Compared to baseline, the CCT of the lens-wearing eye increased by 2.87% upon waking (P = 0.003) and recovered 30 min later (P = 0.555). In contrast, compared to baseline, the CCT of the non-CL wearing eye did not increase upon waking (P = 0.105).
CONCLUSIONS: By using UHROCT, we found that overnight CL wear induced different swelling responses in the various sublayers of the cornea.
BACKGROUND: Retrospectively registered. Registration number: ChiCTR1800015115 . Registered 07 March 2018.

BACKGROUND: Reis-Bücklers corneal dystrophy (RBCD) was consistently reported as a corneal dystrophy only affected Bowman\'s layer and superficial corneal stroma, and superficial keratectomy was a recommendation surgery for treatment in literatures. The study reported new histopathological and ultrastructural findings in RBCD caused by the Arg124Leu mutation of transforming growth factor induced (TGFBI) gene in a four-generation Chinese pedigree.
METHODS: Subjects including eight patients and seven unaffected family members received slit-lamp biomicroscopy and photography. DNA was obtained from all subjects, and exons 4 and 11 to 14 of TGFBI gene were analyzed by polymerase chain reaction and the products were sequenced. Anterior segment optical coherence tomography (AS OCT) and in vivo confocal microscopy were conducted for ten eyes of five patients. Based on the results of AS OCT and in vivo confocal microscopy, deep anterior lamellar keratoplasty (DLKP) using cryopreserved donor cornea was applied for four eyes of four patients. Four lamellar dystrophic corneal buttons were studied by light and transmission electron microscopy, and TGFBI immunohistochemistry.
RESULTS: Eight patients had typical clinical manifestations of RBCD presenting recurrent painful corneal erosion starting in their early first decades, along with age-dependent progressive geographic corneal opacities. TGFBI sequencing revealed a heterozygous mutation, Arg124Leu in all eight patients. Anterior segment optical coherence tomography and in vivo confocal microscopy showed the dystrophic deposits involved not only in subepithelial and superficial stroma, but also in mid- or posterior stroma in four examined advanced eyes. Light microscopy showed Bowman\'s layer was absent, replaced by abnormal deposits stain bright red with Masson\'s trichrome. In superficial cornea, the deposits stacked and produced three to five continuous bands parallel to the corneal collagen lamellae. In mid- to posterior stroma, numerous granular or dot- like aggregates were heavily scattered, and most of them presented around the nuclei of stromal keratocytes. Transmission electron microscopy revealed the multiple electron-dense rod-shaped deposits aggregated and formed a characteristic pattern of three to five continuous bands in superficial cornea, which were similar to those seen under light microscopy. In mid- to posterior stroma, clusters of rod-shaped bodies were scattered extracellular or intracellular of the stromal keratocytes between the stromal lamellae suggesting the close relationship between mutated proteins and keratocyte.
CONCLUSIONS: The study offer evidences indicating DLKP is a viable treatment option for advanced RBCD to avoid recurrence, and the mutated TGFBIp in dystrophic corneas are of keratocytes origin.

Ultra-high resolution optical coherence tomography (UHR-OCT) can image the corneal epithelium and Bowman\'s layer and measurement the thicknesses. The purpose of this study was to validate the diagnostic power of vertical thickness profiles of the corneal epithelium and Bowman\'s layer imaged by UHR-OCT in the diagnosis of sub-clinical keratoconus (KC). Each eye of 37 KC patients, asymptomatic fellow eyes of 32 KC patients, and each eye of 81 normal subjects were enrolled. Vertical thickness profiles of the corneal epithelium and Bowman\'s layer were measured by UHR-OCT. Diagnostic indices were calculated from vertical thickness profiles of each layer and output values of discriminant functions based on individual indices. Receiver operating characteristic curves were determined, and the accuracy of the diagnostic indices were assessed as the area under the curves (AUC). Among all of the individual indices, the maximum ectasia index for epithelium had the highest ability to discriminate sub-clinical KC from normal corneas (AUC = 0.939). The discriminant function containing maximum ectasia indices of epithelium and Bowman\'s layer further increased the AUC value (AUC = 0.970) for sub-clinical KC diagnosis. UHR-OCT-derived thickness indices from the entire vertical thickness profiles of the corneal epithelium and Bowman\'s layer can provide valuable diagnostic references to detect sub-clinical KC.

Pterygium is a common ophthalmic disease affecting humans only. Extensive epidemiological data have demonstrated a causative effect of chronic ultraviolet (UV) radiation on pterygia. Progress has been made in determining the origin of pterygia, their nasal predilection and wing‑shaped appearance, and the roles of UV radiation in the initiation and the development of pterygia. In the present review, the current understanding of the involvement of UV radiation in the pathogenesis of pterygia is summarized. This involvement includes the alteration of limbal stem cells and fibroblasts that contribute to the initiation of pterygia and the induction of various pro‑inflammatory cytokines, growth factors and matrix metalloproteinases that promote the progression of pterygia. Further elucidation of the roles of UV radiation in the pathogenesis of pterygia may help to encourage individuals at risk of developing pterygia to take preventive measures and aid researchers in the development of novel targeted therapeutic agents to treat pterygia.

To measure the cell size and cell density in five layers of the central cornea in the widely used inbred C57BL/6 mouse strain using in vivo three-dimensional (3D) two-photon (2PH) imaging.
Corneas were scanned using a 2PH laser scanning fluorescence microscope after staining with plasma membrane stain and Hoechst 33342. Good quality 3D images were selected for the cell density and cell size analysis. Cell density was determined by counting the cell nuclei in a predefined cube of 3D images. Cell size measurements, including cell surface area, cell volume, nuclear surface area and nuclear volume, were automatically quantified using the Imaris software. The cell and nuclear surface-area-to-volume ratio (S:V ratio) and the cell nuclear-cytoplasmic ratio (N:C ratio) were calculated.
The highest cell density was observed in the basal epithelium and the lowest in the posterior stroma. The highest cell surface area was found in the anterior stroma, and the highest cell volume was observed in the superficial epithelium. The lowest cell surface area and cell volume were both found in the basal epithelium. The highest S:V ratio was observed in the basal epithelium and the lowest in the superficial epithelium. The highest cell nuclear surface area and volume were both observed in the superficial epithelium and the lowest in the basal epithelium. The highest cell nuclear S:V ratio was observed in the basal epithelium and the lowest in the superficial epithelium. The highest N:C ratio was found in the basal epithelial cells and the lowest in the posterior keratocytes.
We are the first to quantify the cell density and size parameters, including cell surface area and volume, cell nuclear surface area and volume, and the S:V ratio, in the five layers of the central cornea. These data provide important cell morphology features for the study of corneal physiology, pathology and disease in mice, particularly in C57BL/6 mice.

OBJECTIVE: To determine the impact of flap creation methods for sub-Bowman\'s keratomileusis (SBK) on central Bowman\'s layer thickness.
METHODS: SBK flaps were made by Moria microkeratome for 20 subjects and by femtosecond (FEMTO) laser for 21 subjects. Corneal sublayer thicknesses were measured by ultra-high resolution optical coherence tomography before SBK and at 1 day, 1 week, 2 weeks, and 1 month afterwards. Each subject was imaged twice on each visit. Thicknesses of central epithelium, Bowman\'s layer, flap, and total cornea were calculated using a custom-made automated image processing algorithm. The repeatability of sublayer thickness measurements was tested by the intraclass correlation coefficient (ICC) and by the coefficient of repeatability (CoR) at 1 week post-SBK.
RESULTS: ICCs of the Moria and FEMTO groups were ≥ 0.959 and ≥ 0.961 respectively for all sublayer measurements. The segmentation CoRs were less than 6.78% and 5.63% respectively. For both groups, microdistortions were present in the epithelium and Bowman\'s layer after SKB. The flap thickness of the Moria group was 9.8 μm (95% confidence interval: 4.8 - 14.8 μm) thinner than the FEMTO group one day after SBK (independent samples t-test, P < 0.05). Bowman\'s layer became thicker by 1.6 ± 1.1 μm and 1.7 ± 1.6 μm one day post-SBK for the Moria and FEMTO groups (repeated ANOVA, P < 0.05) and then remained stable. Corneal and sublayer thickness were similar between the two groups.
CONCLUSIONS: Central Bowman\'s layer thickness increased 1 day post-SBK. Flap creation by Moria microkeratome and femtosecond laser did not have significantly different impacts on Bowman\'s layer thickness following SBK.
BACKGROUND: Chinese Clinical Trial Registry (ChiCTR) NO: ChiCTR-OCH-14004525.

OBJECTIVE: To compare the outcomes of sub-Bowman keratomileusis (100-μm flap) and laser in situ keratomileusis (LASIK) (120-μm flap) using 150-kHz femtosecond laser.
METHODS: Randomized, double-masked, contralateral clinical trial.
METHODS: One hundred patients (200 eyes) with myopia or myopic astigmatism were included. Postoperative examinations were performed at week 1 and months 1, 3, 6, and 12. Main outcome measures included postoperative uncorrected (UCVA) and best-corrected distance visual acuity (BCVA); manifest refraction spherical equivalent; efficacy and safety indices; corneal thickness; and complications.
RESULTS: The mean age of patients was 33.9 ± 7.9 years. Overall, the preoperative UCVA, BCVA, and manifest refraction spherical equivalent were 1.349 ± 0.332, -0.022 ± 0.033, and -5.81 ± 1.61 diopters, respectively. No significant difference was observed in preoperative (P ≥ .226) or intraoperative parameters (P ≥ .452) between both groups, except residual stromal thickness (P < .001). The UCVA, manifest refraction spherical equivalent, and central corneal thickness stabilized by 1 week, while the thinnest corneal thickness stabilized by 3 months postoperatively. There was no significant difference between both groups for any parameter during all follow-up visits (P ≥ .132) except the 3-month safety index, which was better in the sub-Bowman keratomileusis group (P = .007). Soft opaque bubble layer was noted intraoperatively in 12 cases (7, 100-μm group; 5, 120-μm group; P = .577). No postoperative complications were observed.
CONCLUSIONS: Our study did not find any differences in the visual and refractive outcomes between femtosecond-assisted sub-Bowman keratomileusis and LASIK. Both surgeries resulted in quick visual recovery as early as 1 week postoperatively.

OBJECTIVE: To investigate thickness profile changes of the corneal epithelium and Bowman\'s layer at the vertical and horizontal meridians with overnight myopia orthokeratology (OK) lenses.
METHODS: Twenty subjects (age range: 19-33 years) wore reverse-geometry rigid gas-permeable OK lenses in both eyes for 30 days. Before lens wear and after 1, 7, and 30 days of overnight lens wear, evaluation of lens fitting, visual acuity examination, corneal topography, and ultra-high resolution optical coherence tomography (UHR-OCT) were performed. The central, midperipheral, and peripheral cornea were imaged in both the horizontal and vertical meridians. Custom software was produced to acquire the thickness profiles of the epithelium and Bowman\'s layer.
RESULTS: Unaided visual acuity and refraction were improved significantly after OK lens wear. The central corneal epithelium thinned in the horizontal and vertical meridians after one night of lens wear (P < 0.05). In the horizontal meridian, the epithelium thickened at the temporal and nasal midperipheries (P < 0.05), while the superior midperipheral epithelium thinned in the vertical meridian. There were no changes in the thickness profile of Bowman\'s layer during the study period.
CONCLUSIONS: Overnight wear of OK lenses caused the central corneal epithelium to thin in both the vertical and horizontal meridians, while the midperipheral nasal and temporal epithelium became thicker and the superior midperipheral epithelium became thinner. The thickness of the central or midperipheral Bowman\'s layer in either meridian did not change. Improved vision acuity after overnight OK lens wear can be attributed to changes in the corneal epithelium and not Bowman\'s layer.

OBJECTIVE: To characterize the thickness profile of the corneal epithelium and the Bowman\'s layer across the horizontal meridian.
METHODS: Forty-four eyes of 22 healthy subjects were investigated in this study. Ultra-high resolution anterior segment spectral domain-optical coherence tomography (SD-OCT) was used to assess the topographic thickness of the epithelium and the Bowman\'s layer across the cornea. Thicknesses at five locations, including the center, midperiphery, and periphery close to the limbus, on both the nasal and the temporal sides along the horizontal meridian, were analyzed.
RESULTS: Mean epithelial thickness at the central cornea was 52.5 ± 2.4 μm. It increased gradually from the center to the periphery (P < 0.001). There was no significant difference between the nasal side and the temporal side for epithelial thickness. The central Bowman\'s layer thickness was 17.7 ± 1.6 μm, and it remained constant from the center to the midperiphery (P > 0.05). However, thicknesses at the nasal and temporal periphery, 20.0 ± 1.9 μm and 19.8 ± 2.2 μm, respectively, were significantly greater than the central and midperipheral thicknesses (P < 0.001). Nasal and temporal thicknesses were similar on either side of the center.
CONCLUSIONS: The epithelium and the Bowman\'s layer were not evenly distributed across the horizontal meridian of the cornea. SD-OCT provided useful information about topographic thickness of the different corneal layers in vivo.