Background : This study investigated the association between photoreceptor structural restoration and visual function outcomes in patients undergoing surgery for closed macular holes (MHs). Using adaptive optics scanning laser ophthalmoscopy (AOSLO) and microperimetry, we aimed to provide a more detailed understanding of photoreceptor recovery and visual improvement in closed MHs. Methods : We conducted a retrospective observational study of 31 eyes of 28 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling to treat idiopathic MHs. Visual and structural outcomes were monitored 3 months to 2 years postoperatively: best-corrected visual acuity (BCVA), MH diameter and duration, optical coherence tomography (OCT) images, 4° retinal mean sensitivity (RMS), fixation rates, 68.2% BCEA (binary contour ellipse area) of microperimetry, and cone density as measured by AOSLO. Based on the OCT findings, the patients were categorized into two groups: type 1 (closed MH with no neurosensory defect at the fovea) and type 2 (closed MH with a foveal neurosensory defect). Results : The analysis revealed that type 1 closures resulted in significantly better photoreceptor recovery, with cone cells migrating toward the fovea and forming dense islets, consistent with the integrity of the inner segment/outer segment layer on OCT. These patients also had better postoperative BCVA and higher RMS rather than fixation improvement, aligning with the improved cone density. In contrast, type 2 closures exhibited sparse cone distribution and a prevalence of large, high-density cells, possibly indicating glial cell proliferation and exposed retinal pigment epithelium (RPE). MH size, rather than duration or preoperative BCVA, was a key determinant of type 1 closure outcomes. Conclusion : AOSLO is a valuable tool for evaluating microstructural healing in MHs and reveals that type 1 closure, characterized by cone migration, leads to greater neuroretinal repair and improved BCVA and retinal sensitivity. Meanwhile, type 2 closures, marked by less photoreceptor recovery and higher glial proliferation, correspond to poorer visual function outcomes. This study highlights the role of photoreceptor density and migration in achieving optimal visual function post-surgery for MH closure.

As a crucial element of proteolysis targeting chimeras (PROTACs), the choice of E3 ubiquitin ligase significantly influences degradation efficacy and selectivity. However, the available arsenal of E3 ligases for PROTAC development remains underexplored, severely limiting the scope of targeted protein degradation. In this study, we identify a non-inhibitory aptamer targeting ZYG11B, a substrate receptor of the Cullin 2-RING ligase complex, as an E3 warhead for targeted protein degradation. This aptamer-based PROTAC platform, termed ZATAC, is facilely produced through bioorthogonal chemistry or self-assembly and shows promise in eliminating several undruggable target proteins, including nucleolin (NCL), SRY-box transcription factor 2 (SOX2), and mutant p53-R175H, underscoring its universality and versatility. To specifically deliver ZATACs into cancer cells, we further develop DNA three-way junction-based ZATACs (3WJ-ZATACs) by integrating an additional aptamer that selectively recognizes the protein overexpressed on the surface of cancer cells. The 3WJ-ZATACs demonstrate in vivo tumor-specific distribution and achieve dual-target degradation, thereby suppressing tumor growth without causing noticeable toxicity. In summary, ZATACs represent a general, modular, and straightforward platform for targeted protein degradation, offering insights into the potential of other untapped E3 ligases.

BACKGROUND:Anti-VEGF therapies improve visual acuity and reduce central macular thickness (CMT) in neovascular age-related macular degeneration(nAMD) patients. However, In our study, 35.76 % patients do not respond adequately to the anti-VEGF treatment.. Therefore, this study aimed to investigate imaging biomarkers and forecast the influencing factors of anti-VEGF treatment response in nAMD, aiming to enhance clinical evaluation. METHODS:We retrospectively analyzed data from patients treated with anti-VEGF at Tianjin Medical University General Hospital from August 2018 to August 2023, including 165 patients with exudative AMD. We investigated their sex, age, best-corrected visual acuity (BCVA)(LogMAR), number of anti-VEGF treatments, optical coherence tomography angiography (OCTA) results. A deep learning model, the improved LUNet model was used to analyze OCTA images, focusing on retinal features including foveal avascular zone (FAZ), vessel density (VD), vessel diameter index (VDI), vessel dispersion (Vdisp) of retinal layers(deep vascular complex and deep vascular complex) to assess their relationship with treatment response. RESULTS:After 6 months of anti-VEGF treatment, the patients' BCVA improved from 0.84 ± 0.40 to 0.70 ± 0.40 (t = 2.85, P = 0.005) (corresponds to an improvement from 20/140 to 20/100 on the Snellen scale.), CMT decreased from 300.16 ± 118.92 μm to 249.53 ± 84.39 μm (t = 4.46, P < 0.001). FAZ perimeter increased from 2.68 mm (2.29, 3.50) to 3.04 mm (2.57, 3.59) (Z=-2.05, P = 0.040), VDI decreased from 6.09 ± 0.83 to 5.90 ± 0.71 (t = 2.33, P = 0.021), central VD decreased (t = 2.21, P = 0.028). Logistic regression showed the Vdisp of macular neovascularization (Vdisp-MNV) (P = 0.007, OR 1.41), Vdisp of deep vascular complex(DVC) (P = 0.006, OR 0.45), neovascular surface area (SA) (P = 0.002, OR 0.26), and pigment epithelial detachment(PED) (P = 0.009, OR 0.29) significantly affected the response to anti-VEGF treatment. There were statistical differences in the association between the base line Vdisp of DVC (b = 0.07, t = 2.50, P = 0.014), base line intraretinal fluid (IRF) (b = 0.17, t = 2.02, P = 0.045) and base line BCVA, shown with multiple linear regression analysis. CONCLUSION:This study analyzed factors affecting treatment response. Vdisp in MNV showed positive correlation with anti-VEGF treatment response; SA and PED showed negative correlation with anti-VEGF treatment response. It allowed for making personalized treatment strategy to tailor interventions based on individual risk profiles and vascular characteristics which can enhance patient outcomes.

Background: Spinal cord injury (SCI) is considered a central nervous system (CNS) disorder. Nuclear factor kappa B (NF-κB) regulates inflammatory responses in the CNS and is implicated in SCI pathogenesis. The mechanism(s) through which NF-κB contributes to the neuroinflammation observed during SCI however remains unclear. Methods: SCI rat models were created using the weight drop method and separated into Sham, SCI and SCI+NF-κB inhibitor groups (n = 6 rats per-group). We used Hematoxylin-Eosin Staining (H&E) and Nissl staining for detecting histological changes in the spinal cord. Basso-Beattie-Bresnahan (BBB) behavioral scores were utilized for assessing functional locomotion recovery. Mouse BV2 microglia were exposed to lipopolysaccharide (LPS) to mimic SCI-induced microglial inflammation in vitro. Results: Inhibition of NF-κB using JSH-23 alleviated inflammation and neuronal injury in SCI rats’ spinal cords, leading to improved locomotion recovery (p < 0.05). NF-κB inhibition reduced expression levels of CD86, interleukin-6 (IL-6), IL-1β, and inducible Nitric Oxide Synthase (iNOS), and improved expression levels of CD206, IL-4, and tissue growth factor-beta (TGF-β) in both LPS-treated microglia and SCI rats’ spinal cords (p < 0.05). Inhibition of NF-κB also effectively suppressed mitochondrial fission, evidenced by the reduced phosphorylation of dynamin-related protein 1 (DRP1) at Ser616 (p < 0.001). Conclusion: We show that inhibition of the NF-κB/DRP1 axis prevents mitochondrial fission and suppresses pro-inflammatory microglia polarization, promoting neurological recovery in SCI. Targeting the NF-κB/DRP1 axis therefore represents a novel approach for SCI.

·AIM:To observe the clinical and multimodal imaging features of retinopathy associated with novel coronavirus disease 2019(COVID-19)infection,investigate the related risk factors,and analyze the treatment and prognosis. ·METHODS:A total of 7 patients(7 eyes)with clinically confirmed COVID-19-associated retinopathy in Tianjin Medical University General Hospital from December 13,2022 to January 13,2023 were included in the study.All patients underwent color fundus photography,IR,spectral-domain optical coherence tomography(SD-OCT),fundus autofluorescein(FAF)and other ophthalmic examination and serological examination. ·RESULTS:Among the included patients,2 cases(2 eyes)of central retinal vein occlusion(CRVO)appeared differently from previous CRVO.The hemorrhagic features of CRVO were round or fusiform shape hemorrhagic spots with white centers.One of them,the von Willebrand factor antigen(vWF:Ag)level was increased to 161.8％.The other case was positive in serologic test for lupus anticoagulant.In 2 cases(2 eyes)of multiple evanescent white dot syndrome(MEWDS),FAF showed that dots of high spontaneous fluorescence were scattered in the posterior pole.The prognosis of 2 MEWDS were good after the treatment of glucocorticoids.The 3 cases(3 eyes)of acute macular neuroretinopathy(AMN)showed reddened brown lesions in the macular area,hyporeflective lesions with clear boundaries on IR,and high signal intensity in the ONL and ELM,EZ/IZ signal fracture on SD-OCT. ·CONCLUSION:COVID-19 may cause inflammatory storm,involving all layers of retinal tissues and blood vessels,leading to the occurrence of various retinal lesions.Hormone therapy may be effective and the prognosis is good in most cases.Roth spot can be seen in fundus hemorrhage of CRVO,lupus anticoagulant and increased vWF:Ag may be risk factors for CRVO after COVID-19.

目的 观察新型冠状病毒感染(COVID-19)相关急性黄斑神经视网膜病变(AMN)患眼的临床和多模式影像特征.方法 回顾性临床研究.2022年12月18～26日于天津市眼科医院检查确诊的COVID-19相关AMN患者8例16只眼纳入研究.其中,男性4例,女性4例;均为双眼发病.年龄(31.5±9.6)岁.发热至出现视力下降的时间为(3.75±1.04)d.患眼均行最佳矫正视力(BCVA)、眼压、眼底彩色照相、光相干断层扫描(OCT)检查.行红外眼底照相(IR)、OCT血管成像(OCTA)、荧光素眼底血管造影(FFA)检查分别为14、6、4只眼.BCVA采用国际标准对数视力表,统计时转换为最小分辨角对数(logMAR)视力.观察分析患者临床特征和IR、OCT、OCTA影像特征.结果 患眼logMAR BCVA 4.21±0.74;眼压(14.87±1.50)mmHg(1mmHg=0.133 kPa).眼底彩色照相检查,可见多个灰白色"花瓣样"病灶围绕黄斑中心凹排列2只眼;黄斑区未见明显异常14只眼.行IR检查的14只眼中,黄斑中心凹周围不规则弱反射病灶6只眼.OCT检查,所有患眼外核层和外丛状层可见强反射,其中伴椭圆体带损伤15只眼.行OCTA检查的6只眼,视网膜浅层毛细血管丛、深层毛细血管丛(DCP)血流密度降低,DCP为著;DCP的横断面像可见尖端指向中心凹的"楔形"强反射病变区2只眼.行FFA检查的4只眼均未见明显异常荧光.结论 COVID-19相关AMN特征性表现为IR可见弱反射病灶;OCT表现为外核层和外丛状层可见强反射;OCTA表现为视网膜DCP血流密度降低.

Cutibacterium acnes chronic endophthalmitis is the most common cause of delayed infectious endophthalmitis after intraocular surgery and perforating injury, which has the characteristics of delayed onset, smoldering, recurrence and phacophagia. C. acnes is an anaerobic gram-positive bacillus which is difficult to culture.Polymerase chain reaction (PCR) provide improved diagnostic results over traditional culture techniques.Hitherto, although there is no consensus on treatment strategies, treatment methods include intraocular antibiotics, pars plana vitrectomy combined with partial or total capsulectomy, intraocular lens removal/replacement, the visual outcomes are generally favorable.Since C. acnes endophthalmitis may be masqueraded as non-infectious iridocyclitis or posterior capsular opacity in the early stage, misdiagnosis and erroneous long-term treatment with corticosteroids or Nd: YAG capsulotomy may lead to deterioration of intraocular inflammation, this paper aims to review the etioloty, clinical features, laboratory tests, treatment strategies and outcomes of C. acnes endophthalmitis, which may provide reference for fellow clinicians.

髌股关节是人体最大的滑车关节,其在伸膝的力学传导及增强下肢运动能力中至关重要.髌股关节由骨软骨界面结构、韧带支持结构、肌肉动力结构等构成.这些结构协同构成了髌股关节的功能,并共同参与维持髌骨运动轨迹的稳定.单个或多个结构的异常将造成髌股关节生物力学机制的失衡,最终产生髌股关节疼痛、髌骨不稳定等疾病.本综述拟从解剖构成、生物力学两个方面对髌股关节进行阐述.

目的 评价伴有系统性疾病的白内障患者行超声乳化白内障吸除联合人工晶状体植入术的安全性、疗效和围手术期处理原则.方法 选取2018年5月至2020年5月于天津医科大学总医院眼科诊断为白内障并伴有系统性疾病且接受超声乳化白内障吸除联合人工晶状体植入术的患者401例(499眼)为研究对象,加强术前围手术期管理,术后随访至少3个月,对比观察术前及术后患者最佳矫正视力(BCVA)、眼压、角膜内皮细胞数,并分析眼部并发症与系统性疾病的关系.结果 术后3个月,BCVA较术前提高者481眼(96.39％),不变者12眼(2.40％),下降者6眼(1.20％).术前眼压为(16.64±4.76)mmHg(1 kPa=7.5 mmHg),术后3个月为(15.79±5.98)mmHg,差异具有统计学意义(t=2.710,P<0.05).术前角膜内皮细胞数为(2523.80±469.52)个·mm-2,术后3个月为(2245.56±469.94)个·mm-2,差异具有统计学意义(Z=-17.307,P<0.05).术后并发症主要包括:一过性角膜水肿168眼(33.67％)、一过性高眼压63眼(12.63％)、一过性低眼压7眼(1.40％)、前房渗出14眼(2.81％).通过分类变量分析,2型糖尿病、尿毒症与术后一过性高眼压均相关(均为P<0.05);冠心病与术后一过性低眼压相关(P<0.05);2型糖尿病、高血压、冠心病、尿毒症、系统性红斑狼疮与术后一过性角膜水肿均相关(均为P<0.05);系统性红斑狼疮与术后前房渗出相关(P<0.05).术后随访期内患者系统性疾病均稳定.结论 超声乳化白内障吸除联合人工晶状体植入术是治疗伴有系统性疾病的白内障患者安全有效的方法.术前完善全身相关检查并控制系统性疾病是安全完成手术的基础.

AIM:To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS.METHODS:This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups.RESULTS:The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2 =6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2 =0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009).CONCLUSION:Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Objective:To investigate the changes of choroid thickness in adolescents with different types of non-pathological high myopia (HM).Methods:A retrospective observational study. From January 2021 to April 2022, 179 eyes of 101 adolescents with myopia in Liaocheng Aier Eye Hospital were collected and analyzed. According to the spherical equivalent (SE) and corneal curvature, subjects were divided into mild myopia or emmetical eye group (control group), HM group, occult HM group (OHM group) and super HM group (SHM group). There were 52 eyes in 30 cases, 47 eyes in 26 cases, 42 eyes in 24 cases and 38 eyes in 21 cases, respectively. Medical optometry, intraocular pressure, optical coherence tomography (OCT), axial length (AL) and corneal curvature were measured. The macular foveal choroidal thickness was analyzed by using spectral-domain OCT. The diopter was expressed in SE. The thickness of choroid in the fovea of macular region was measured by enhanced deep imaging with frequency domain OCT. The thickness of choroid was measured in 9 regions within 1 mm, 3 mm from the fovea, including the upper, lower, nasal and temporal regions. Generalized estimating equation was used to compare the data among groups, and the least significant difference t-test was used to compare the data among groups. The correlation between AL, corneal curvature, intraocular pressure and choroidal thickness was analyzed by Pearson correlation. Results:The choroidal thickness in the foveal macula and the areas 1 mm and 3 mm away from the fovea were compared among the control group, HM group, OHM group and SHM group, the difference were significant ( χ2=76.646, 36.715, 27.660, 35.301, 24.346, 38.093, 36.275, 33.584, 36.050; P<0.05). Compared with the control group, the choroidal thickness of the fovea and the choroidal thickness in each area within 1 and 3 mm from the fovea in the HM group, the OHM group and the SHM group were significantly thinner than those in the control group, and the difference was statistically significant ( P<0.05). There were statistically significant differences in choroidal thickness in each region between the group and the SHM group, and between the OHM group and the SHM group ( P<0.05). The results of correlation analysis showed that AL was negatively correlated with choroidal thickness in various regions ( P<0.05); SE was positively correlated with choroidal thickness in various regions ( P<0.05); corneal curvature and intraocular pressure had no significant correlation with choroidal thickness in various regions ( P>0.05). Conclusions:The choroidal thickness of SHM is significantly lower than that of OHM and HM; OHM patients have lower SE. However, the choroidal thickness is significantly thinner. AL and SE are the influencing factors of choroidal thickness.

目的 探讨一种基于深度学习的视网膜毛细血管无灌注区(NPA)智能识别定量分析系统在视网膜中央静脉阻塞(CRVO)缺血分型诊断中的应用价值.方法 回顾性病例系列研究.选取2017年1月至2018年12月经山西省眼科医院门诊确诊为CRVO并行荧光素眼底血管造影(FFA)检查的343例343眼患者纳入本研究.随访并记录患者自发病起1年内是否发生新生血管并发症.应用人工智能诊断系统计算CRVO患者后极部55°视野范围NPA面积,受试者工作特征曲线(ROC)分析该NPA面积对CRVO发生新生血管并发症的诊断价值.结果 343例CRVO患眼中有26眼发生了新生血管并发症,发病率7.58％.依据NPA面积判断CRVO患者是否发生新生血管并发症的曲线下面积为0.889(95％CI:0.799～0.978,P<0.001).最佳截断值为20.997视盘面积(DA),灵敏度为0.808,26眼新生血管并发症患者中有21眼NPA值大于该值;特异度为0.946,317眼无并发症患者中有300眼NPA值小于该值.结论 基于深度学习的NPA智能识别定量分析系统可为CRVO分型诊断提供决策依据.55°视野范围后极部NPA>20 DA可作为CRVO缺血分型的阈值标准.

ObjectiveThis study aimed to investigate the prevalence of glaucoma with associated factors in the rural populations of 10 provinces in China.DesignA population-based cross-sectional study.MethodsAll participants aged 6 years or older from 10 provinces completed visual acuity testing, slit-lamp examination, ophthalmoscopy and non-contact tonometry. Glaucoma suspects underwent fundus photography, Goldmann applanation tonometry, visual field testing and gonioscopy. Glaucoma was determined according to the International Society of Geographical and Epidemiological Ophthalmology classification scheme. Associations of demographics and medical factors with glaucoma were assessed using multiple logistic regression models.ResultsFrom June 2017 to October 2018, 48 398 of 52 041 participants were included in the final analyses. The age-standardised prevalence of glaucoma was 1.7% (95% CI 1.55% to 1.78%) among the participants older than 6 years, which was 2.1% (95% CI 1.93% to 2.23%) in participants aged over 40 years. The constituent ratios of glaucoma were: 44.4% primary angle-closure glaucoma (PACG), 34.7% primary open-angle glaucoma, 2.6% congenital glaucoma and 18.3% other types of glaucoma. Increasing age, smoking, cerebral stroke, type 2 diabetes, higher education (college or more) and higher personal income were significant risk factors for PACG. The unilateral and bilateral blindness rates in the entire study population were 4.692% and 1.068%, respectively. A family history of glaucoma was a significant risk factor for the prevalence of glaucoma and blindness in at least one eye.ConclusionsRural populations have a high prevalence of glaucoma, which should be included in chronic disease management programmes in China for long-term care.

目的 探讨青少年高度近视(HM)和超高度近视(SHM)患者视网膜微血管的变化.方法 收集2021年1月至2021年11月在聊城爱尔眼科医院就诊的37例(64眼)近视青少年患者进行分析.根据平均等效球镜度(MSE)和眼轴长度(AL),将受试者分为HM组(23例41眼,-9.0 D<MSE≤-6.0 D,25 mm≤AL≤27 mm)和SHM组(14例23眼,MSE≤-9.0 D,AL>27 mm).将黄斑中心凹6 mm范围内划分为以黄斑中心凹为中心的3个同心圆,直径为1 mm的黄斑中心凹、1～3 mm的内环区、3～6 mm的外环区,应用光学相干断层扫描血流成像(OCTA)对3个区域的浅层视网膜血管长度密度(SRVD)、浅层视网膜血管灌注密度(SBPD)和直径6 mm完整图像(整体黄斑区)的SRVD和SBPD及其内环区和外环区各个象限的患者SRVD和SBPD进行分析,并对两组患者视网膜厚度和黄斑中心凹无血管区(FAZ)面积进行分析.结果 SHM组患者整体黄斑区、黄斑中心凹、内环和外环的SRVD分别为(15.63±1.91)mm-1、(4.99±3.05)mm-1、(14.09±2.71)mm-1和(16.49±1.78)mm-1,HM组患者整体黄斑区、黄斑中心凹、内环和外环的SRVD分别为(16.94±1.30)mm-1、(7.46±2.96)mm-1、(16.18±2.12)mm-1和(17.52±1.15)mm-1,两组患者间的各区域SRVD比较差异均有统计学意义(均为P<0.05);SHM组患者整体黄斑区、黄斑中心凹、内环和外环SBPD分别为(37.33±4.87)％、(11.01±7.07)％、(32.60±6.69)％和(39.50±4.92)％,HM组患者整体黄斑区、黄斑中心凹、内环和外环SBPD别为(40.57±3.26)％、(15.95±6.68)％、(37.77±5.24)％和(42.33±2.89)％,两组患者间各区域SBPD比较差异均有统计学意义(均为P<0.05);两组患者间内环和外环各象限比较,除外环区鼻侧和下方SRVD和SBPD比较差异均无统计学意义(均为P>0.05)外,其余内环区和外环区各象限SRVD和SBPD比较差异均有统计学意义(均为P<0.05).SHM组和HM组患者各区域视网膜厚度和FAZ面积比较差异均无统计学意义(均为P>0.05).结论 SHM患者黄斑区视网膜SRVD和SBPD明显低于HM患者,而视网膜厚度和FAZ保持稳定.

年龄相关性黄斑变性(age related macular degeneration,AMD)是我国社会威胁老年人群视觉健康的重要疾病之一.近年来,国内外研究均把血管内皮生长因子(vascular endothelial growth factor,VEGF)A作为湿性AMD治疗的主要靶点.实际上,VEGF-A是维持全身血管系统平衡的重要生长因子.在眼部各种细胞因子及补体的调节下,VEGF-A起到了维持视网膜色素上皮(retinal pigment epithelium,RPE)及脉络膜功能的重要作用.单纯抗VEGF治疗而不考虑维持生理剂量的VEGF水平对于湿性AMD的治疗可能弊大于利.在充分认清VEGF-A与RPE、脉络膜的相互作用关系基础上,进行深入开发,或许在未来能够进一步提升湿性甚至干性AMD的治疗效果.

视网膜撕裂孔形成原因多为患者眼部震动突然加剧，视网膜变性薄区存在的玻璃体牵引快速撕扯视网膜所致 [1]。此类型裂孔所致视网膜脱离（RD）起病急，进展迅速，且患者多为青壮年。为以最小代价获取视网膜复位及裂孔封闭，且减少手术后并发症，我们采用最小量巩膜扣带手术（SBP）联合玻璃体腔填充无菌空气治疗一组伴单个撕裂孔的孔源性RD（RRD）患者，并对其手术后视网膜复位率、视力变化及手术后并发症发生情况进行评估。现将结果报道如下。

BACKGROUND:A growing body of evidence has confirmed the association between fine particulate matter (PM2.5) and ocular diseases, but little is known on the effect of long-term PM2.5 exposure on glaucoma. METHODS:A national cross-sectional study of the Rural Epidemiology for Glaucoma was conducted in 10 provinces of China, and 33,701 adults aged 40 years or more were included. A satellite-based model at 1-km resolution level was used to estimate PM2.5 concentrations which were assigned to each participant according to geocoded home addresses. Logistic regression model was performed to investigate associations of long-term PM2.5 exposure with glaucoma and its subtypes. RESULTS:Estimated PM2.5 concentrations ranged from 28.0 to 96.4 μg/m3. For each 10 μg/m3 increment in PM2.5, the adjusted odds ratios (ORs) were 1.07 (95% CI: 1.00-1.15) and 1.14 (95% CI: 1.02-1.26) for glaucoma and primary angle-closure glaucoma (PACG), respectively. A positive but non-significant association (OR = 1.05, 95% CI: 0.92-1.18) was detected between long-term exposure to PM2.5 and odds of primary open-angle glaucoma. The middle aged residents and non-smokers were more sensitive to the adverse effects of PM2.5. CONCLUSIONS:Long-term PM2.5 exposure was associated with glaucoma and PACG in Chinese adults, which provided new insights on adverse ophthalmic effect of PM2.5.

AIM To explore whether human umbilical cord mesenchymal stem cell (hUCMSC)-derived exosomes (hUCMSC-Exos) protect rat retinal neurons in high-glucose (HG) conditions by activating the brain-derived neurotrophic factor (BDNF)-TrkB pathway. METHODS hUCMSC-Exos were collected with differential ultracentrifugation methods and observed by transmission electron microscopy. Enzyme-linked immunosorbent assays (ELISAs) was used to quantify BDNF in hUCMSC-Exos, and Western blot was used to identify surface markers of hUCMSC-Exos. Rat retinal neurons were divided into 4 groups. Furthermore, cell viability, cell apoptosis, and TrkB protein expression were measured in retinal neurons. RESULTS hUCMSCs and isolated hUCMSC-Exos were successfully cultured. All hUCMSC-Exos showed a diameter of 30 to 150 nm and had a phospholipid bimolecular membrane structure, as observed by transmission electron microscopy. ELISA showed the BDNF concentration of hUCMSCs-Exos was 2483.16±281.75. hUCMSCs-Exos effectively reduced the apoptosis of retinal neuron rate and improved neuron survival rate, meanwhile, the results of immunofluorescence verified the fluorescence intensity of TrKB in neurons increased. And all above effects were reduced by treated hUCMSCs-Exos with BDNF inhibitors. hUCMSC-Exos effectively reduced the apoptosis rate of retinal neurons by activating the BDNF-TrkB pathway in a HG environment. CONCLUSION In the HG environment, hUCMSC-Exos could carry BDNF into rat retinal neurons, inhibiting neuronal apoptosis by activating the BDNF-TrkB pathway.

Objective:To observe the changes of macular microvessels in patients with retinal vein occlusion (RVO) and macular edema (ME) after intravitreal injection of aflibercept (IVA), and analyze its correlation with best corrected visual acuity (BCVA).Methods:A retrospective case study. Thirty patients (30 eyes) with monocular RVO with ME (RVO-ME) who were diagnosed in the clinical examination of Tianjin Eye Hospital from April 2019 to February 2020 were included in the study. Among them, there were 12 males (12 eyes) and 18 females(18 eyes); the average age was 54.30±13.17 years. The average course of disease was3.43±1.97 months. Both eyes were examined by BCVA and optical coherence tomography (OCTA). The on-demand injection was adopted after the first injection in IVA treatment regimen. The macular area 6 mm×6 mm in both eyes was scanned with an OCTA instrument, and the area of the foveal avascular area (FAZ), FAZ circumference (PERIM), and out-of-roundness were measured at baseline and 1, 3, and 6 months after treatment. Index (AI), blood flow density within 300 μm width of FAZ (FD-300), foveal retinal thickness (CMT), superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) blood flow density. The paired t test was used to compare the quantitative parameters of the affected eye and the contralateral healthy eye at baseline; the changes of the quantitative parameters at baseline and 1, 3, and 6 months after treatment were analyzed by repeated measures analysis of variance. Pearson correlation analysis was used to analyze the correlation between BCVA, retinal perfusion, and macular blood supply parameters at 6 months after IVA treatment. Results:At baseline, compared with the contralateral healthy eye, the FAZ area ( t=-4.091), PERIM ( t=-5.098) and AI ( t=-9.093) of the RVO-ME eye were enlarged, and FD-300 ( t=7.237) and overall SCP and DCP blood flow density ( t=8.735, 9.897) decreased, the difference was statistically significant ( P<0.001). Six months after treatment, the BCVA of RVO-ME eyes was significantly increased, CMT decreased, FAZ area expanded, and AI decreased ( t=8.566, 16.739, -6.469, 9.719; P<0.001), the difference was statistically significant. There was no significant change in the blood flow density of FD-300 and overall SCP and DCP, and the difference was not statistically significant ( t=1.017, 1.197, 0.987; P>0.05). Compared with baseline, the FAZ area of RVO-ME eyes gradually expanded at 3 and 6 months after treatment, and the difference was statistically significant ( F=21.979, P<0.001). Correlation analysis results showed that BCVA at 6 months after treatment was positively correlated with the overall SCP and DCP blood flow density at baseline and 6 months after treatment ( r=-0.538, -0.484, -0.879, -0.854; P<0.05). There was a negative correlation with the area of FAZ 6 months after treatment ( r=0.544, P=0.001). The number of ME recurrences was negatively correlated with BCVA and overall SCP and DCP blood flow density 6 months after treatment ( r=0.604, -0.462, -0.528; P<0.05), it was positively correlated with FAZ area ( r=0.379, P=0.043). Conclusion:Within 6 months of IVA treatment in RVO-ME eyes, ME is significantly reduced and visual acuity is improved; SCP blood flow density decreases, and FAZ area expands.