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AIM: To assess the long-term efficacy and safety of yttrium-aluminum garnet (YAG) laser vitreolysis for vision degrading myodesopsia (VDM) caused by posterior vitreous detachment (PVD). METHODS: This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis. The baseline demographic information, the patterns of floaters, the number of floaters, and the subjective improvement of floater sympotoms (ranging from 0 to 100%) from medical records were collected. Significant improvement was defined as a relief of floater symptoms of ≥50% at the final visit. The long-term efficacy and safety of YAG laser vitreolysis were analyzed. The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses. RESULTS: The final analysis included 221 patients with VDM. The mean age of patients was 61.08±7.74y, and the mean length of follow-up was 21.38±5.61mo. Totally 57.01% of patients experienced a significant improvement in their floater symptoms after YAG laser therapy, and none of them developed delayed retinal abnormalities such as retinal tears or detachments. Age (OR=1.049, 95%CI=1.007-1.092, P=0.021) was identified as a significant risk factor for significant improvement in VDM. CONCLUSION: YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM, and patients of advanced age are more likely to get favorable outcomes.

AIM: To access the agreement of intraocular pressure (IOP) values obtained from biomechanically corrected tonometer [Corvis ST (CST)], non-contact tonometer (NCT), and Goldmann applanation tonometer (GAT) in children with NCT measured-IOP (NCT-IOP) values of 22 mm Hg or more, and related factors. METHODS: A total of 51 eyes with NCT-IOP≥22 mm Hg in children aged 7 to 14y were examined and IOP was measured by CST, NCT, and GAT. Based on GAT measured IOP (GAT-IOP), ocular hypertension (OHT) group (≥22 mm Hg, 24 eyes) and the non-OHT group (

AIM: To assess the long-term outcomes of treating macular edema (ME) associated with central retinal vein occlusion (CRVO) with a regimen of “5+pro re nata (PRN)”. METHODS: This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO (non-iCRVO group, n=15) and ischemic CRVO (iCRVO group, n=12). The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab, followed by reinjections as needed or PRN. Retinal laser photocoagulation or intravitreal dexamethasone implants (DEX) were implemented in both groups when necessary. The best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT) were recorded at baseline, at 1, 2, 3, 4, 5, 6, and 12mo, and at the final visit. The efficacy rates of BCVA and CRT before and after treatment were calculated. The number of injections at each visit and the incidence of adverse events were also recorded. RESULTS: The patients, aged 59.4±15.1y, were followed up for 24.7±8.8mo (range: 15-42mo). After treatment, BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR (P=0.038) at the final visit in all patients. Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points, but there was no statistical significance (P=0.197 and 0.33, respectively). The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups (all P0.05). Laser treatment was applied to all eyes in the iCRVO group, while only 5 patients in the non-iCRVO group. Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch. DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group. CONCLUSION: The 5+PRN anti-vascular endothelial growth factor (VEGF) regimen is found to be safe and effective for both iCRVO and non-iCRVO, especially in the iCRVO group. The best regimen for such patients needs to be further investigated. Adjuvant laser therapy and DEX are necessary in some cases.

Diabetic macular edema(DME)and age-related macular degeneration(ARMD)are the leading causes of visual impairment and blindness worldwide, and their common pathological features are increased vascular permeability and abnormal neovascularization, in which cytokines such as vascular endothelial growth factor(VEGF)and angiopoietin-2(Ang-2)play an important role. Intravitreal injection of anti-VEGF agents significantly changed the clinical management of DME and ARMD, but limitations such as the non-responsive cases, the treatment burden and risks caused by frequent injections need to be overcome. Faricimab, a novel bispecific monoclonal antibody that simultaneously targets VEGF-A and Ang-2, can effectively reduce vascular permeability, decrease the number of neovascularization and alleviate retinal edema. Registered clinical studies have shown that Faricimab is effective in improving vision and reducing retinal edema, which is non-inferior to Aflibercept and Ranibizumab, maintains a long dosing interval, and has a high safety profile. This article reviews the latest advances in the treatment of DME and ARMD with Faricimab.

Diabetic retinopathy(DR)is the most prevalent and severe ocular complication in people with diabetes, and it is one of the leading causes of blindness in adults. In recent years, drug therapy represented by anti-vascular endothelial growth factor(VEGF)agents has become the first-line therapy in DR treatment, but it cannot reverse retinal non-perfusion areas, microaneurysms and abnormal teleangiectatic capillaries, those who cannot be treated on time are at risk of disease progression. Laser photocoagulation has been widely applied for more than 40 years, it can effectively reduce the rate of blindness by eliminating the non-perfusion areas of capillaries, and panretinal photocoagulation(PRP)has been the primary treatment for DR. With the continuing innovations in laser technology, on the basis of maintaining the curative effect, the aim of minimizing retinal damage and adverse side effects has been realized. A combination of laser photocoagulation and anti-VEGF agents can achieve complementary advantages and better efficacy. Deepening the clinical research on laser therapy and laser therapy combined with anti-VEGF agents in the treatment of DR may help to establish the personalized treatment corresponds with our national conditions. This article briefly reviews the latest application progress of laser therapy in DR treatment in the era of anti-VEGF agents.

AIM: To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children. METHODS: Databases (PubMed, EMBASE, the Cochrane Library and Web of science) were comprehensively searched from inception to April 2022. Types of studies included were randomized clinical trials (RCTs). The published languages were limited to English. Two researchers assessed the quality of included studies independently using Cochrane risk of bias tool based on the Cochrane Handbook for Systematic Reviews of Interventions. Funnel plots and Egger's test were used for detection of publication bias. Meta-analyses were conducted using STATA (version 15.0; StataCorp). RESULTS: A total of 15 RCTs involving 2268 patients were included in the study. In the atropine group, spherical equivalent progressed at a significantly lower rate [weighted mean difference (WMD)=0.39, 95% confidence interval (CI): 0.23, 0.54] than in the control group. A WMD of 0.15 mm was associated with less axial elongation (95%CI -0.19, -0.10). Different doses showed statistically significant differences (P

As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.

AIM: To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy (DR) or retinal vein occlusion (RVO). METHODS: This is a retrospective case control study. The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor (VEGF) for patients diagnosed with macular edema secondary to DR (DME) or RVO (RVO-ME) at Xijing Hospital from August 2021 to July 2022. Meanwhile, aqueous humor samples during vitrectomy from patients with idiopathic macular hole (IMH) were also collected and served as controls. The aqueous humor concentrations of VEGF, platelet-derived factor (PDGF), interleukin (IL)-6, IL-8, IL-18, tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein 1 (MCP-1) were measured with Human Premixed Multi-Analyte Kit (Luminex). The difference of the aqueous cytokines and the correlation between the two diseases were analyzed. RESULTS: A total of 40 eyes of 38 patients were enrolled in the study, including 13 eyes of 11 DME patients (DME group), 16 eyes of 16 RVO-ME patients (RVO-ME group) and 11 eyes of 11 IMH patients (control group). The VEGF, PDGF, IL-6, IL-8, and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group (all P

Floaters are entopic phenomenon created by vitreous opacities. Some researchers term it as “symptomatic vitreous turbidity”, which usually refers to primary type in clinic. With the increasing prevalence and aging of myopia worldwide, vitreous floaters are becoming increasingly prevalent in clinics but receiving less attention. Floaters can impair patients' vision and quality of life due to their discomfort and disorientation. A few patients become intolerable and express a strong desire for treatment. YAG laser vitreolysis for floaters has garnered considerable attention in recent years. Although some doctors still have concerns about its efficacy and safety, a handful of studies have found some beneficial effects in recent years. The author has gained expertise in clinical practice in recent years. In this review, we talk about what causes floaters and how to classify them. We also talk about the clinical indications, how YAG laser ablation works, and whether or not it is safe.

The alignment diagram, also known as nomogram, is a statistical prediction model used to predict the risk of events(such as diagnosis or prediction of disease development and consequences)by obtaining the influence power of each related factor on outcome variables through multivariate analysis. Nomogram turns the complex regression equation to a visualized diagram that is intuitive and easy to understand. It is convenient to be used for evaluating the patient's condition and communicating with doctors and patients. With rapid advances of medical science and technology and increasing demands of personalized medicine, nomograms has attracted more and more attention and applied extensively in clinical medicine. This short article introduces the basic concepts of nomogram and examples of its application in ophthalmology.

Eye movements refer to a series of spontaneous, controlled and purposeful movements of the eye. Based on a large number of observations on eye movement in scientific research and clinical work, eye movements are not only essential for maintaining clear vision in humans, but also an objective embodiment of brain activity, which is of great significance for the diagnosis and localization of multidisciplinary diseases. Eye tracking technology is a measurement technique that obtains information about eye movements. The use of eye tracking technology can obtain accurate and objective eye movement data, and explore the mechanism of eye movement, the development process and clinical significance of different eye movement types. In addition, eye tracking technology also has positive significance in the objective visual examination, diagnostic and treatment of ophthalmology. In this paper, we review the research progress of eye movements and eye tracking technology in the clinical application of ophthalmology, such as in the application of objective vision examination in infants, strabismus diagnosis and treatment, corneal refractive surgery and glaucoma diagnosis.

Diabetic macular edema(DME)is the main cause of vision loss in patients with diabetes. Hyperglycemia leads to disruption of the blood-retinal barrier by triggering a pro-inflammatory and pro-angiogenic cascade, leading to intraretinal or subretinal fluid accumulation in the macula. Intravitreal administration of steroids represents an alternative for DME, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, dexamethasone intravitreal implant(DEX implant; Ozurdex®)were developed. DEX implant is a novel, artificially degradable sustained-release implant, with the advantages of reasonable release profile, strong anti-inflammatory, rapid improvement of macular edema, good bioavailability and safety. DEX implant provides a new choice for the treatment of patients with DME and has been recommended by several guidelines. This article reviews the latest research progress of DEX implant in the clinical treatment of DME.

AIM: To study the effect of leech extract on the expression of vascular endothelial growth factor(VEGF)in retinoblastoma(WERI-RB-1 cells)and the related molecular mechanism.METHODS: WERI-RB-1 cells cultured in vitro were divided into control group, 0.04U/mL leech extract group and 0.08U/mL leech extract group. The control group was cultured with complete medium for 48h, and the leech extract group was cultured with 0.04 and 0.08U/mL drug-containing medium for 48h, respectively. The expression level of VEGF in conditioned medium of cell culture was detected by ELISA. The mRNA levels of hypoxia-inducible factor-1a(HIF-1a)and matrix metalloproteinase-9(MMP-9)were detected by RT-PCR. The expression levels of HIF-1a, MMP-9, phosphatidylinositol 3-kinase(PI3K)and human phosphorylated AKT(p-AKT)were detected by Western Blot.RESULTS: Compared with the control group, the expression of VEGF in the conditioned medium with the concentration of 0.04U/ mL and 0.08U/mL of leech extract was decreased(P

The concept of neurovascular unit(NVU), formalized in 2001 at a stroke conference, emphasizes the intimate relationship between the brain and its vessels, i.e., symbiotic relationship between brain cells and cerebral blood vessels in the developmental, structural and functional interdependence. The retina is a piece of brain. Several researchers have introduced the concept of NVU to the retina since 2007. The NVU in the retina includes neurons, glial cells, microvascular endothelial cells and pericytes. Dysfunctional NVU plays a critical role in diabetic retinopathy(DR). The current limited treatments for DR focus on the late-stage complications, i.e., diabetic macular edema and proliferative DR. While the further study on retinal NVU will develop efficacious therapeutic options for the early and all stages of DR.

The“14th Five-Year” National Eye Health Plan has been released and national eye health has risen as a national strategy. Cataract is the primary blinding eye disease in our country, which seriously affects the national eye health. Shaanxi Province, an old revolutionary base area in the western of China, has a relative lower socioeconomic level and about millions of people need to undergo cataract surgery. In 1996, multi-cooperation built the mobile ophthalmic operation vehicle — “Fuming No.1” to contribute the poverty alleviation initiative in Shaanxi Province. In the past 25a, “Fuming No.1” has taken the advantage of the convenience of mobile operation vehicles, implementing operations in rural, mountainous and old areas with weak medical services in Shaanxi Province. A total of more than 480 trips have been made, with a total mileage of more than 200 000 kilometers,covering 104 counties and districts in the province, and nearly 60 000 cases of cataract operations have been completed. “Fuming No.1” bring the light, relieve the pain for cataract patients and help them better fit the world. Furthermore, “Fuming No.1” also offers free operation and intraocular lens for more than 30 000 poor rural patients and reduces medical expenses by nearly 10 million yuan, which has obtained high praise and support from the patients and all walks of life. In addition, “Fuming No.1” is also a mobile training vehicle, which could improve the operation skills of ophthalmologists. In the process of teaching and training, the operations had also been completed with high quality. In view of the unbalanced economic development in our country, “Fuming No.1” will expand service projects, innovate work models, and continue to construct eye healthy in Shaanxi province, making greater contributions to consolidating the achievements of poverty alleviation.

According to epidemiological surveys, the incidence of myopia among Chinese children and adolescents has risen by over 53.6%. Myopia has emerged as the leading cause of vision loss among adolescents. The mental health of students suffers from vision impairment, which has an adverse ripple effect on their ability to learn and grow, and even their physical development. Based on the observation of significant differences in mental health between myopic people and normal people, scholars at home and abroad have used various psychological scales to evaluate the association between myopia and mental health issues, including anxiety and depression, as well as personality traits such as emotionalization and introversion. This article reviews the effect of myopia on adolescent mental health and the research progress on its research methods and prevention strategies.

Peripapillary pachychoroid syndrome(PPS)is a novel entity of pachychoroid disease spectrum(PDS)reported online in 2017. PPS eyes displayed thicker nasal versus temporal macular choroids, unlike PDS eyes with thicker temporal macular choroids. Peripapillary intraretinal and/or subretinal fluid was often overlying dilated Haller layer vessels(pachyvessels). Most PPS eyes exhibited other PDS findings including retinal pigment epithelial changes, serous pigment epithelial detachment and outer retinal atrophy. Their optic disc is usually crowded, and some eyes have disc edema and mild late fluorescence leakage. Most of the patients are elderly, and short axial length and hyperopia are common. While some patients experienced visual decline, the overall visual outcome was relatively favourable. Although anti-VEGF or photodynamic therapy were applied, the optimal management remains to be determined. Recognition of PPS is important to distinguish it from disorders with overlapping features such as posterior uveitis and neuro-ophthalmologic conditions. It has been suggested that PDS is consequences of chronic vortex vein stasis. And the hypothesis of choroidal venous overload provides with a unifying concept for pathophysiology of the diseases.

AIM: To compare the consistency and feasibility of objective ocular torsion measured with GMPE module-based optical coherence tomography(OCT)and fundus color photography(FCP).METHODS: Patients were enrolled in our strabismus clinic from December 2020 to March 2021, and the objective ocular torsion of the eyes was measured by both GMPE module-based OCT and FCP on the same day. FCP was used to measure the fovea-disc angle(FDA)manually by using the Adobe Photoshop software, while the GMPE module-based OCT software positioned automatically the macula and the center of the optic disc to measure the FDA.RESULTS: Fifty-five patients were included, the FDA measured by OCT was -6.6°±4.5° in the right eye and -8.8°±4.7° in the left eye, respectively; The FDA measured by FCP was -6.6°±4.7° in the right eye and -8.4°±4.1° in the left eye, respectively, with no statistically significant difference between the results of the two methods(Pright eye=0.90, Pleft eye=0.08). In patients with exotropia, the FDA measured by OCT was -5.8°±4.9° in the right eye and -9.1°±4.5° in the left eye, respectively, the FDA measured by FCP was -5.7°±5.0° in the right eye and -8.6°±4.3° in the left eye, respectively,(Pright eye=0.75, Pleft eye=0.15). Similarly, the patients with esotropia, the FDA measured by OCT was -9.0°±7.3° in the right eye and -11.3°±3.5° in the left eye, respectively, while the FDA measured by FCP was -10.0°±7.0° in the right and -10.1°±2.8° in the left eye(Pright eye=0.21, Pleft eye=0.10), respectively. There were no significant differences between the two methods in patients with esotropia or exotropia(P>0.05). The results of both Pearson test and Bland-Altman analysis were highly correlated(rright eye=0.93, rleft eye=0.94, P

Diabetic macular edema(DME)has become the leading cause of vision loss in patients with diabetes. Currently, intravitreal injection of anti-vascular endothelial growth factor(VEGF)therapy is the first-line treatment for DME. However, the economic burden and related complications brought by frequent injections should not be ignored. Therefore, the drugs with longer-lasting effects and longer injection intervals must be explored. Brolucizumab is a single-chain antibody fragment(scFv)with a high affinity for VEGF. Compared with other available anti-VEGFs, it has the characteristics of smaller molecular weight, higher tissue permeability and durable therapeutic effect. Clinical studies and real-world evidences showed that Brolucizumab is non-inferior to aflibercept in improving visual acuity in patients with DME. And Brolucizumab is more effective in regressing intra-retinal fluid and reducing central foveal thickness(CSFT)with longer injection interval. At the same time, Brolucizumab has a low incidence of adverse events and favourable safety after intraocular injection. This article reviews the latest progress of Brolucizumab in the treatment of DME.

The vitreous body, the largest intraocular component, plays a key role in eye development, refraction, cell barrier function, oxygen metabolism and the pathogenesis of assorted diseases. Age, refraction and systemic diseases can cause vitreous metabolic abnormalities. With the continuous development of vitrectomy techniques and equipment, vitreous injections and vitrectomies have increased over the recent decades. However, the normal oxygen tension gradient in the vitreous helps to protect the lens and anterior chamber angle from oxidative stress damage, whereas the increased vitreous oxygen tension around lens and the trabecular meshwork after vitrectomy. It may lead to postoperative nuclear cataract and increase the risk for glaucoma. As a conventional procedure, scleral buckling holds several advantages over vitrectomy in selected cases. This review raises concerns regarding the function of the vitreous and encourages conducting vitreous interventions prudently if it is possible.

Proliferative vitreoretinopathy(PVR)is a serious complication that occurs in the natural history of rhegmatogenous retinal detachment(RRD)or after retinal detachment surgery, often resulting in vision loss. Currently, there has no effective treatment. The pathological characteristics of PVR are the excessive inflammatory response and abnormal proliferation of various cells under the action of cytokines, which eventually form a layer of proliferative membrane around the retinal surface, and further lead to traction retinal detachment(TRD). In-depth studies on the pathogenesis of PVR will help to find promising molecular targets for its treatment. Recent studies have found that vascular endothelial growth factor(VEGF)and the epithelial-mesenchymal transition(EMT)of retinal pigment epithelium(RPE)cells play an important role in the pathogenesis of PVR. This article summarizes the roles of VEGF and RPE cell EMT in the pathogenesis of PVR and the interaction mechanism between them, with the aim to provide new ideas for the treatment and clinical research of PVR.

Migraine is acommon chronic neurovascular disorder, its pathophysiological mechanisms are not fully understood. There are various clinical phenotypes of migraine, among which visual migraine may present as visual aura. Retinal migraine and ophthalmoplegic migraine also belong to the category of visual migraine. Optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)can be used to detect the circulation of retinal nerve fiber layer, ganglion cell layer, optic papilla, retina and choroid qualitatively and quantitatively. Based on above two imaging findings, studies have addressed that during visual migraine pathogenesis, the transitory and recurrent constriction of the retinal and ciliary arteries, which may cause ischemic damage to the optic nerve, retina and choroid in patients with migraine, with the subsequent reduction in thickness of retinal nerve fiber layer, ganglion cell layer, and retinal microvasculature decrement. The fundus imaging examinations are helpful to improve our understanding on pathophysiological mechanisms of visual migraine, these imaging findings based on OCT and OCTA may serve as indicators to evaluate course and severity of visual migraine.

Anti-vascular endothelial growth factor(anti-VEGF)drugs have become the first choice for the treatment of intraocular neovascularization, but the inconvenience and possible complications caused by frequent intravitreal injection cannot be ignored. Therefore, it is necessary to seek new drugs with long-lasting effects, so as to reduce the number of injections. Brolucizumab, a novel small molecule anti-VEGF drug, has the advantages of stronger tissue penetration, higher drug concentration, smaller injection dose, long-lasting efficacy and longer injection interval. Registered clinical studies and real-world evidence showed that Brolucizumab is non-inferior to aflibercept in efficacy, while its ability to improve intraretinal/subretinal fluid is more significant, and it can maintain a longer dosing interval. In addition, Brolucizumab is safe and has a low incidence of serious adverse events, such as retinal vasculitis reported. Brolucizumab provides a new treatment option for neovascular age-related macular degeneration(nARMD). This article reviews the latest progress of Brolucizumab in the treatment of nARMD.

AIM: To evaluate the long-term anatomical and visual outcomes of drusenoid pigment epithelial detachment (D-PED) in intermediate age-related macular degeneration (AMD) eyes treated with 577 nm yellow subthreshold micropulse laser (SML). METHODS: In this retrospective study, 21 eyes of 16 patients with D-PED in intermediate AMD were consecutively included and assessed. All the eyes were treated with 577 nm SML in several sessions according to D-PED growth status. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) were assessed at the initial visit and after treatment. Spectral-domain optical coherence tomography (SD-OCT) was performed to evaluate the D-PED lifecycle by volumetric calculations. Regression analysis was used to determine the breakpoint, growth, and collapse rate of the D-PED lesions. The progression to advanced AMD was also documented. RESULTS: All the eyes were treated with SML for 2.9±1.0 sessions. The mean follow-up period was 25.3±12.6mo. The BCVA was stable from the baseline to final visit. All the eyes were categorized into two groups according to the anatomical changes of the D-PED lesion: the collapse group (n=6, 28.6%) and non-collapse group (n=15, 71.4%). The change in logMAR BCVA did not differ significantly between the collapse group 0.00 (-0.31, 0.85) and non-collapse group 0.00 (0.00, 0.00; P=1). Regression analysis showed that the growth rate was significantly higher in the collapse group (0.090±0.095 mm3/mo) than in the non-collapse group (0.025±0.035 mm3/mo; P

Corneal refractive surgery is a method of correcting refractive errors such as myopia, hyperopia and astigmatism through corneal surgery. Refractive regression can often be seen in clinical practice, that is, refractive errors occur again after surgery. Refractive regression and the consequent poor visual quality often trouble patients. So far, different types and methods of corneal refractive surgery have the problem of refractive regression. It is believed that refractive regression is mainly related with epithelium thickening and change of corneal biomechanics. Refractive regression could be predicted and avoided by preoperative risk factors such as preoperative conditions and operative parameters, and can also be prevented by selecting appropriate refractive surgery and using medicine. Non-operative and enhancement surgery can be used to treat refractive regression that has occurred.

[RETRACTED]The vitreous body, the largest intraocular component, plays a key role in eye development, refraction, cell barrier function, oxygen metabolism and the pathogenesis of assorted diseases. Age, refraction and systemic diseases can cause vitreous metabolic abnormalities. With the continuous development of vitrectomy techniques and equipment, vitreous injections and vitrectomies have increased over the recent decades. However, the normal oxygen tension gradient in the vitreous helps to protect the lens and anterior chamber angle from oxidative stress damage, whereas the increased vitreous oxygen tension around lens and the trabecular meshwork after vitrectomy may lead to postoperative nuclear cataract and a high incidence of open angle glaucoma. As a conventional procedure, scleral buckling holds several advantages over vitrectomy in selected cases. This review raises concerns regarding the function of the vitreous, and encourages conducting vitreous interventions prudently.

Metformin (MET), a first-line oral agent used to treat diabetes, exerts its function mainly by activating adenosine monophosphate-activated protein. The accumulation of oxidized phospholipids in the outer layer of the retina plays a key role in retinal pigment epithelium (RPE) cells death and the formation of choroidal neovascularization (CNV), which mean the development of age-related macular degeneration (AMD). Recent studies have shown that MET can regulate lipid metabolism, inhibit inflammation, and prohibit retinal cell death and CNV formation due to various pathological factors. Here, newly discovered functions of MET that may be used for the prevention and treatment of AMD were reviewed.

The incidences of open angle glaucoma (OAG) and high myopia are increasing concomitantly. Considering the aging population and concurrent rapid increase in the number of individuals with myopia, the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades. However, precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc, as well as extensive β-zone parapapillary atrophy in highly myopic eyes. Recent advances in optical coherence tomography (OCT) and OCT angiography (OCTA) technologies imply that both modalities are promising tools for the detection of highly myopic OAG. Notably, the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages (e.g. visual field defect, visual electrophysiological changes). We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.

AIM: To analyze the problems faced by teachers and undergraduates online teaching. METHODS:A self-designed questionnaire survey and result of examination comparison were used. The contents of the questionnaire include the time used before and after class, the confusion faced by online teaching and the self-evaluation of teaching effect. 63 students and all teachers were participants in the questionnaire survey. The survey is from May 2020 to June 2020.RESULTS: The average time spent by students before class of online teaching had no difference with that of offline teaching, while the average time spent by teachers for online teaching before class was significantly longer than that for offline teaching. 63% of the undergraduates considered that online teaching takes much more time to review after class. 95% of the students admitted that online teaching was easier to lose concentration because of lack of interaction with teachers, and 73% of teachers though that for online teaching they had less passionate compared to off line teaching. Regarding to the questionnaire survey, 73% of the instructors expected that the effect of online teaching would be worse than that of offline teaching. Surprisingly, 95% of the students thought that there had no significant difference in knowledge mastering between online and offline teaching after reviewing of courseware. For the future teaching model, 91% of the teachers and 79% of the students preferred the combination of watching pre-recorded video and live broadcasting. CONCLUSION: The lack of interaction is the primary issue of online teaching. Online teaching can achieve the same effect as offline teaching,whereas it needs more post-class time for students. The combination of watching pre-recorded video and live-broadcasting is the online teaching mode recommended by teachers and students.

Parafoveal exudative vascular anomalous complex(PEVAC)refers to a large, isolated aneurysmal lesion in the superficial or deep capillary plexus of the parafoveal retina demonstrated by optical coherence tomography(OCT)imaging and has been identified as a new entity. Patients are almost middle-aged and elder people, not accompanied by retinal vascular diseases, but can develop with myopic or age-related macular degeneration(ARMD). It has been defined as PEVAC-resembling lesions when associated with retinal vascular diseases, such as diabetic retinopathy(DR)or retinal vein occlusion. It is non-exudative in the early stage, but later intraretinal exudation may induce metamorphopsia or visual decline. In some cases, the lesion was unchanged or spontaneously resolved during long-term follow-up.Differentiation from type 3 retinal neovascularization(retinal angiomatous proliferation, RAP)and Type I MacTel may be required. The anti-vascular endothelial growth factor(VEGF)therapy is ineffective and micropulse laser treatment could achieve improvement in a few cases. It is speculated that the lesion is associated with degeneration of retinal microvascular pericytes.

AIM: To investigate the role of endoplasmic reticulum stress(ERS)in oxidized low-density lipoprotein(OxLDL)induced retinal pigment epithelium(RPE)cells apoptosis.METHODS: The human RPE cell line ARPE19 was cultured in low glucose DMEM medium with 10% fetal bovine serum. Experiments were divided into three groups: control group(normal cultured ARPE19), OxLDL group(with 5, 10, 25, 50, 100μg/mL of OxLDL), and LDL group(with 5, 10, 25, 50, 100μg/mL of OxLDL)and cultured 24h. The CCK8 kit(Cell Counting Kit-8)was used to detect cell activity, the flow cytometry was used to detect the percentage of apoptosis and the Western blotting was used to detect the expression of ERS-related proteins and apoptosis-related enzymes. The confocal microscope was used to observe the phagocytosis of Dil-labeled OxLDL(Dil-OxLDL)in RPE cells.RESULTS: The results of CCK8 showed that when compared with control group, with cell viability of(100±5.637)%, different concentrations(5, 10, 25, 50, 100 μg/mL)of OxLDL could change cell viability significantly(F=41.20, PP>0.05), and the cell viability changes were(97.55±6.217)%,(99.640±3.586)%,(90.495±2.786)%,(83.552±9.171)% and(90.910±1.429)% respectively. Flow cytometry results showed that OxLDL with concentrations higher than 25μg/mL could induce apoptosis apparently. The apoptosis rates of the blank group, the OxLDL(25μg/mL)group, and the LDL(25μg/mL)group were(5.271±0.519)%,(41.23±1.686)% and(13.07±2.579)% respectively, and the differences among them were statistically significant(F=329.8, PF=50.53, PF=55.60, PF=38.22, PF=53.94, PF=20.01, PP>0.05).CONCLUSION: ERS is involved in the apoptosis of RPE cells induced by OxLDL, and regulating ERS may achieve the purpose of inhibiting RPE cell apoptosis and thus treating RPE apoptosis-related diseases.

AIM: To investigate whether intravitreal injection of oxidized low-density lipoprotein (OxLDL) can promote laser-induced choroidal neovascularization (CNV) formation in mice and the mechanism involved, thereby to develop a better animal model. METHODS: C57BL6/J mice were randomized into three groups. Immediately after CNV induction with 532 nm laser photocoagulation, 1.0 μL of OxLDL [100 μg/mL in phosphate-buffered saline (PBS)] was intravitreally injected, whereas PBS and the same volume low-density lipoprotein (LDL; 100 μg/mL in PBS) were injected into the vitreous as controls. Angiogenic and inflammatory cytokines were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting (WB) after 5d, and CNV severity was analyzed by choroid flat mount and immunofluorescence staining after 1wk. In vitro, retinal pigment epithelial (RPE) cell line (ARPE19) were treated with OxLDL (LDL as control) for 8h. Angiogenic and inflammatory cytokine levels were measured. A specific inhibitor of lectin-like oxidized low-density lipoprotein receptor 1 (LOX1) was used to evaluate the role of LOX1 in this process. RESULTS: At 7d after intravitreal injection of 1 μL (100 μg/mL) OxLDL, T15-labeled OxLDL was mainly deposited around the CNV area, and the F4/80-labeled macrophages, the CD31-labeled vascular endothelial cells number and CNV area were increased. Meanwhile, WB and qRT-PCR results showed that vascular endothelial growth factor (VEGF), CC chemokine receptor 2 (CCR2), interleukin-6 (IL-6), IL-1β, and matrix metalloproteinase 9 (MMP9) expressions were increased, which was supported by in vitro experiments in RPE cells. LOX1 inhibitors significantly reduced expressions of inflammatory factors IL-1β and VEGF. CONCLUSION: A modified laser-induced CNV animal model is established with intravitreal injection of 1 μL (100 μg/mL) of OxLDL at 7d, which at least partially through LOX1. This animal model can be used as a simple model for studying the role of OxLDL in age-related macular degeneration.

AIM: To investigate the role of bone marrow mesenchymal stem cells(BMSCs)under hypoxia on vascular endothelial cell migration and lumen formation.METHODS: Three kinds of conditioned media(CM)were prepared which including control group(vascular endothelial cells conditioned medium, VCM), normoxic BMSCs-CM group(NCM), and hypoxic BMSCs-CM group(HCM). Then the migration and lumen formation of human umbilical vein endothelial cells(HUVECs)and monkey choroid-retinal vascular endothelial cells(RF/6A)were detected after cultured with the above three kinds of CM respectively for 6-24h.RESULTS: The numbers of cells migration and the tubes formation(including the total length of the tubes and the numbers of branches)in the hypoxic group(HCM)were increased significantly compared with the control group and the normoxic group(PF=153.3, PF=121.5, PF=81.7, PCONCLUSION: BMSCs can promote the migration and lumen formation of vascular endothelial cells under hypoxia. This mechanism may play a role in retinal neovascularization.

At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens (IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.

AIM: To compare the efficacy and safety of 577nm subthreshold micropulse laser(SML)and photodynamic therapy(PDT)in patients with chronic central serous chorioretinopathy(cCSC).METHODS: Thirty patients(30 eyes)with cCSC were treated in our hospital from February 2015 to April 2018. And 15 patients(15 eyes)were treated with SML(577 nm)while the others were treated by PDT. The BCVA and CMT as well as complications were observed at 1, 3, 6mo after treatment.RESULTS: At 1mo after treatment, BCVA was increased to 0.37±0.13 in SML group and 0.20±0.11 in PDT group(t=-3.93, Pt=-6.41, PP>0.05). During the follow-up period, there were no obvious complications or recurrence observed.CONCLUSION: Both SML(577nm)and PDT were effective and safe in the treatment of cCSC, but the theraputic effects of PDT was slightly quicker than SML. Further, with the prolongation of recovery time, the curative effects of these treatments were similar. Additionally, SML(577nm)costs was much cheaper than PDT and had no risk of injury or allergy for patients, and patients with cCSC could also be treated repeatedly using it.

AIM: To evaluate the value of ultra-wide field (UWF) imaging in the management of traumatic retinopathy under the condition of corneal scar or fixed small pupil after complicated ocular trauma. METHODS: Twenty-eight patients (28 eyes) with complicated ocular trauma were enrolled in the study from June 2016 to May 2017, including 19 males and 9 females with age ranged from 11 to 64 (43.42±12.62)y. All patients were treated with secondary vitrectomy after emergency operation for wound repair of open ocular trauma. Direct ophthalmoscopy and 45-degree fundus photography were taken at each time point of follow up for comparison of findings with UWF images. Routine eye examination including visual acuity, intraocular pressure, slit lamp examination were performed and analyzed as well. RESULTS: Among the 28 traumatized eyes, the positive rate for identification of traumatic retinopathed was 32.1% (9 cases), 14.9% (5 cases), and 85.7% (24 cases) with direct ophthalmoscopy, 45-degree fundus photography, and UWF imaging, respectively. The detective rate of UWF imaging under the condition of corneal scar or fixed small pupil was statistically greater than that of 45-degree fundus photography and direct ophthalmoscopy (Bonferroni correction, P

AIM: To evaluate the accuracy of B-mode ultrasonography in the measurement of different kinds of posterior segment intraocular foreign body(IOFB).METHODS: IOFBs from a total of 13 eyes collected in our hospital from January 2016 to December 2016 were analyzed retrospectively. Immediately after IOFBs being taken out, their actual sizes were measured with a ruler. The difference between the pre-operative B-ultrasound measurements and the actual size were compared, and the correlation coefficient was calculated(B-ultrasound measurement/actual size). In order to exclude the possibility that any damage to the IOFB during an operation may interfere with the actual size measurement, different kinds of 5mm long objects(metal, glass and wood)were put into a water sac which was about 20mm-30mm in diameter to mimic IOFB in the eyes respectively. Same measurements for each kind of objects were then preformed and repeated for 4 times. RESULTS:All the 13 cases of IOFBs, including 12 cases of magnetic metal and one case of glass were removed intact via vitrectomy. Of all metal IOFBs, the average axle length by B-mode ultrasound and the average actual axle length were 3.65±1.30mm and 2.45±0.94mm respectively. All measurements were larger than actual sizes(P=0.016). The average correlation coefficient was 1.49. For the water sac experiment, the average measured values of metal, glass and wood objects were 6.76±0.15mm, 6.55±0.04mm and 6.02±0.07mm, and the average correlation coefficient were 1.35, 1.31 and 1.20 respectively. CONCLUSION:The measured size is larger than the actual size when B-mode ultrasonographic scan is used to evaluate the posterior segment IOFB, especially for metal and glass objects. Therefore, it is necessary to take into consideration when making incisions for operational IOFB removal.

AIM:To explore clinical characteristics of supracho-roidal hemorrhage(SCH)complicated by intraocular surgery and to observe visual prognosis. METHODS:A total of 13 eyes(13 cases)with SCH related to intraocular surgery from June 2005 to June 2015 were included and respectively studied. The age of our cases ranged from 22 to 76. Of all, 4 eyes(31%)were concomitant with hypertension, 6 eyes(46%)with high myopia and 6 eyes(46%)with oculi hypertonia, respectively. Intraoperative expulsive SCH occurred in 8 eyes, while postoperative delayed SCH in 5 eyes. The most SCH(7 eyes)happened during the surgery of removing silicone oil, 4 eyes with SCH were related to extracapsular cataract extraction(ECCE), 1 SCH eye was complicated by ECCE combined with trabeculectomy and 1 SCH eye by lensectomy and vitrectomy. As for treatment, 5 eyes took medication alone, 4 eyes were performed drainage sclerotomy and gas tamponade, while the other 4 eyes were accomplished vitrectomy with adjunctive perfluoro-carbon liquids and silicone oil tamponade. RESULTS:At the 10-month of follow-up, all eyes with SCH were resolved. Except 1 eye with no light perception owing to abandoning treatment, the sights of the other 12 eyes were between light perception and 0.4. CONCLUSION:SCH complicated by intraocular surgery was rare but with devastating outcome. Aged patients, hypertension, high myopia and oculi hypertonia may be risk factors. In addition, surgical methods in the early years were likely correlated to the occurrence of SCH. Certain sight of the patients with SCH may be maintained after positive treatment.

AIM: To evaluate the effects of foldable capsular vitreous body(FCVB)implantation on the treatment of severe ocular trauma and late silicone oil-dependent eyes due to severe ocular trauma and recurrent retinal detachment. METHODS: We retrospectively reviewed the four patients(four eyes)with FCVB implantation at our hospital since November 2017. Out of these 4 patients, 2 were males and 2 were females, with an average age of 31.5 years and an average intraocular pressure(IOP)of 5.6mmHg pre-operatively. Among those 4 eyes, 3 eyes underwent silicone oil tamponade due to severe ocular trauma and the other one was recurrent retinal detachment in silicone oil-filled eye. Standard pars plana vitrectomy(PPV)was performed, and the FCVB was triple folded and implanted in the vitreous cavity of four eyes. The retinal was assessed, as well as visual acuity, IOP, FCVB condition before and after treatment, and applied therapy. RESULTS: All of those 4 eyes underwent successfully implantation of FCVB, which remained its proper position. During 1-3mo follow-up, the mean visual acuity was no different compared with pre-operative values. However, the average IOP was 10mmHg postoperatively. In addition, no retinal detachment was found using B-scan ultrasound after FCVB implantation. Moreover, FCVB-supported fundus was stable and no complication was found. CONCLUSION: FCVB implantation is a safe and effective method for the treatment of severe ocular trauma and late silicone oil- dependent eyes. It can maintain the morphology as well as IOP of those eyes.

AIM: To investigate the findings of infrared fundus autofluorescence (IR-AF) and spectral-domain optical coherence tomography (SD-OCT) in eyes with optic disc melanocytoma (ODM). METHODS: IR-AF findings and those of other ophthalmologic imaging examinations, including short-wave autofluorescence (SW-AF), fluorescein angiography (FA), fundus color photography, and SD-OCT of 8 eyes of 8 consecutive cases with ODM were assessed. RESULTS: The ODMs in all cases (100%) presented similar IR-AF, SW-AF, and FA findings. On IR-AF images, ODMs showed outstanding hyper-AF with well-defined outline. On SW-AF images, the area of ODMs presented as hypo-AF. FA images revealed the leaking retinal telangiectasia on the surface of the ODMs. On SD-OCT images in 8 cases (100%), the ODMs were sloped with highly reflective surface, which were disorganized retina and optic nerve layers. In 7 cases (87.5%), peripapillary choroids were involved. The melanocytomas of 8 cases (100%) presented as optically empty spaces. Vitreous seeds were found in one case (12.5%). CONCLUSION: IR-AF imaging may provide a new modality to evaluate the pathologic features of ODMs, and together with SW-AF imaging, offers a new tool to study biological characteristics associated with ODMs. SD-OCT is a valuable tool in delimitating the tumor extension and providing morphological information about the adjacent retinal tissue.

Thenatural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body .

BACKGROUND: Human N-Myc downstream regulated gene2 (NDRG2), a novel gene has been cloned and shown to be related to a number of cellular processes, including proliferation, differentiation, stress, and apoptosis. NDRG2 has also been linked to age-related Alzheimer's disease. Since the role of this gene in senescence is limited, we have investigated the potential role of NDRG2 in human lens epithelial cells (HLECs), a paradigm implicated in age-related cataract. METHODOLOGY/PRINCIPAL FINDINGS: Cultured HLECs (SRA01/04) were subjected to prolonged exposure to low dose of H(2)O(2) to simulate senescence. After being exposed to 50 µM H(2)O(2) for 2 weeks, HLECs senescent-morphological changes appeared, cell viability decreased dramatically, cell proliferation reduced from 37.4% to 16.1%, and senescence-associated β-galactosidase activity increased from 0 to 90.3%. Ndrg2 protein expression was also significantly increased in these senescent cells. To induce overexpression of NDRG2, SRA01/04 cells were infected with the adenoviral vector of NDRG2. In these cells, overexpression of NDRG2 resulted in a fibroblast-like appearance and the cell viability decreased about 20%. In addition, the NDRG2-overexpression cells demonstrated 20% lower viability when exposed to 50-200 µM H(2)O(2) for acute oxidative stress. Furthermore, the expression of NDRG2 from age-related cataracts was up-regulated 2-fold at both mRNA and protein levels compared with the clear lenses. CONCLUSIONS/SIGNIFICANCE: NDRG2 is up regulated not only in the ageing process of HLECs in vitro but also in the cells from human age-related cortical cataract in vivo. Up-regulation of NDRG2 induces cell morphological changes, reduces cell viability, and especially lowers cellular resistance to oxidative stress. NDRG2-mediated affects in HLECs may associate with age-related cataract formation.