BACKGROUND:The financial burden and the uncertain response of the anti-vascular endothelial growth factor (anti-VEGF) treatment often cause hesitation among patients with neovascular age-related macular degeneration (nAMD), highlighting the need for a reliable method to predict treatment outcomes. We aimed to develop and validate a deep learning model that can predict the visual and anatomical prognosis of patients with nAMD undergoing anti-VEGF therapy. METHODS:This prospective, nationwide, multicentre study involved 18 tertiary referral hospitals from 12 provinces across China. A large dataset of patients (aged 50-85 years) with nAMD treated with anti-VEGF therapy (Conbercept, 0·5 mg/0·05 mL, Chengdu, China) under a 3+PRN regimen was established. All participants underwent comprehensive ophthalmological examinations, including best-corrected visual acuity (BCVA) assessment and optical coherence tomography (OCT) imaging at baseline, follow-up, and 4-6 weeks after treatment. Patients with other ocular diseases that could confound the diagnosis or prognosis of nAMD were excluded. A Structural-Attention Guided Therapeutic Response Predicting Model (KongMing Model) was developed based on the lesion-aware, transformer-based multitask architecture to facilitate post-single-injection (4-6 weeks after any single injection during the treatment), post-three-loading-injections (4-6 weeks after the first three consecutive injections), and 1-year-post-three doses plus pro re nata (3+PRN; 1-year after treatment) dual predictions of visual and anatomical prognoses. For the prediction of BCVA changes, model performance was evaluated with the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, average precision, and human-machine comparison. The prediction of BCVA values was evaluated with mean absolute error (MAE) and coefficient of determination (R2). The prediction of post-treatment OCT images was evaluated by the structural similarity index measure (SSIM) compared with the true post-treatment OCT images. Heatmaps and Shapley additive explanation images were used to identify features related to the prognosis of nAMD. FINDINGS:From July 1, 2020, to Dec 31, 2023, we collected 29 772 OCT images from 1226 participants after screening to form the internal dataset. From Jan 1, 2023, to May 1, 2024, we collected 3308 OCT images from 172 participants after screening to form the external dataset. In total, we included 603 (43·1%) women and 795 (56·9%) men. For the prediction of post-single-injection, post-three-loading-injections, and 1-year-post-3+PRN BCVA changes, our model achieved AUCs of 0·948 (95% CI 0·942-0·954) in the internal test and 0·941 (0·934-0·948) in the external test, also significantly outperforming ophthalmologists with different levels of experience in the human-machine comparison (all p<0·0001). For the prediction of the post-treatment BCVA values, our model had a remarkably low MAE across the three predictions (range 0·048 [0·039-0·057] to 0·058 [0·044-0·072]) and high R2 (range 0·7140-0·9012) across both internal and external tests. The model achieved an SSIM exceeding 0·57, indicating a close similarity between the predicted and true post-treatment OCT images. In all aspects, our model outperformed the convolutional neural network-based models. Heatmaps and SHAP plots precisely located the features related to the prognosis of nAMD. INTERPRETATION:The KongMing Model, developed and tested by a nationwide, multicentre dataset, showed excellent performance in predicting the post-single-injection, post-three-loading-injections, and 1-year-post-3+PRN visual and anatomical prognosis of patients with nAMD undergoing anti-VEGF therapy. It provides a robust and non-invasive method for more informed personalised treatment planning, potentially improving treatment adherence and avoiding unnecessary interventions. FUNDING:National Natural Science Foundation of China, CAMS Innovation Fund for Medical Sciences, Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, Lumitin Vision to Brightness Research Funding for the Young and middle-aged Ophthalmologists, Peking Union Medical College Hospital Talent Cultivation Program, Fundamental Research Funds for the Central Universities, Peking Union Medical College, National High-Level Hospital Clinical Research Funding, Beijing Students' Funding for Innovation and Entrepreneurship Training Program, Guangdong Basic and Applied Basic Research Foundation, Guangdong Provincial Key Laboratory.

AIMS:To evaluate the efficacy of intravitreal conbercept (IVC) combined with pars-plana vitrectomy (PPV) for severe, non-clearing vitreous haemorrhage (VH) caused by proliferative diabetic retinopathy (PDR) in real-world practice. METHODS:This prospective, observational, multicentre, cohort study enrolled 523 patients with VH due to PDR at 26 hospitals from August 2022 to June 2024. Patients were treated with preoperative IVC (3-7 days prior to PPV), intraoperative IVC (at completion of PPV) and PPV alone as control. The primary outcome was the incidence of early (7-30 days) postoperative VH (POVH). Secondary outcomes included late POVH (30-180 days), postoperative best-corrected visual acuity (BCVA) and distribution of POVH severity. RESULTS:Of 425 participants (425 eyes) finally enrolled, 406 completed 30-day-visit, and 341 completed 180-day-visit. The incidence of early POVH was 24.0% (36 of 150) in preoperative IVC versus 23.2% (33 of 142) intraoperative IVC compared with 37.6% (50 of 133) in control (p=0.0160, 0.0122). The incidence of late POVH was 11.9% (16 of 134) in preoperative IVC versus 17.5% (20 of 114) intraoperative IVC versus 17.8% (19 of 107) in control (p=0.4109, 0.4661). The early POVH was less severe in preoperative and intraoperative IVC cohorts compared with control (p=0.0067, 0.0304), while the severity of late POVH was comparable (p=0.4860, 0.8353). Mean postoperative BCVA was all improved but showed no significant intergroup differences (p>0.05). CONCLUSIONS:This study, with the largest participants to date, demonstrates that IVC administered preoperatively or intraoperatively effectively reduces early POVH incidence, rather than late POVH. Preoperative IVC may be preferable for patients with more severe baseline disease characteristics.

Objective:To evaluate the clinical efficacy and safety of shallow lamellar keratectomy combined with total conjunctival flap coverage and subsequent customized prosthetic shell fitting for the management of atrophic, silicone oil-filled eyes following severe open globe injury. Methods:This retrospective case series included 24 patients (24 eyes) with phthisical, silicone oil-dependent eyes after open globe injury repair between October 2010 and May 2020. All patients underwent shallow lamellar keratectomy to remove diseased corneal tissue, followed by total conjunctival flap coverage. A customized prosthetic shell was fitted approximately one month postoperatively after confirmed flap healing. Outcome measures included corneal symptom relief assessed by the Numeric Rating Scale (NRS), palpebral fissure height, exophthalmometry, cosmetic satisfaction rated on a 5-point scale, and postoperative complications. Results:The mean postoperative follow-up duration was 4.75 ± 2.51 years. All patients achieved complete resolution of pain and foreign body sensation (postoperative NRS=0 for all; preoperative median: 2.00 [IQR: 1.75-3.00] vs postoperative median: 0.00 [IQR: 0.00-0.00], P=0.001). Ocular protrusion increased significantly from a preoperative median of 7.00 mm (IQR: 6.00-8.00 mm) to 12.00 mm (IQR: 10.00-13.00 mm) postoperatively (P=0.001). Lid height increased from a preoperative median of 3.00 mm (IQR: 2.75-4.00 mm) to 10.00 mm (IQR: 8.00-11.25 mm) postoperatively (P=0.001). Patient satisfaction with ocular appearance improved markedly from a preoperative median of 1.00 (IQR: 1.00-1.25) to 5.00 (IQR: 4.75-5.00) postoperatively (P=0.001). Two eyes developed limbal epithelial implantation cysts, which were successfully managed without recurrence. Cranial CT revealed no silicone oil migration or sympathetic ophthalmia. Conclusion:This globe-preserving technique effectively alleviates corneal irritation and restores ocular symmetry in atrophic, silicone oil-filled eyes, offering a safe, cost-effective, and satisfactory conservative alternative to enucleation or evisceration. Further prospective studies with longer follow-up are warranted.

Background To explore the characteristics of retina microvascular changes in patients with diabetic nephropathy (DN) and its risk factors. Methods Retrospective, observational study. 145 patients with type 2 diabetic mellitus (DM) and DN were included in the study. Demographic and clinical parameters were obtained from medical records. Presence of diabetic retinopathy (DR), hard exudates (HEs) and diabetic macular edema (DME) were evaluated according to the color fundus images, optical coherence tomography (OCT) and fluorescence angiography (FFA). Results DR accounted for 61.4% in type 2 DM patients with DN, of which proliferative diabetic retinopathy (PDR) accounted for 23.6% and sight threatening DR accounted for 35.7%. DR group had significantly higher levels of low-density lipoprotein cholesterol (LDL-C) ( p = 0.004), HbA1c ( P = 0.037), Urine albumin creatine ratio (ACR) ( p < 0.001) and lower level of estimated glomerular filtration rate (eGFR) ( P = 0.013). Logistic regression analysis showed DR was significantly associated with ACR stage ( p = 0.011). Subjects with ACR stage3 had higher incidence of DR compared with subjects with ACR stage1 (OR = 24.15, 95%CI: 2.06–282.95). 138 eyes of 138 patients were analyzed for HEs and DME, of which 23.2% had HEs in posterior pole and 9.4% had DME. Visual acuity was worse in HEs group than in non-HEs group. There was significant difference in the LDL-C cholesterol level, total cholesterol (CHOL) level and ACR between HEs group and non-HEs group. Conclusions A relatively higher prevalence of DR was found in type 2 DM patients with DN. ACR stage could be recognized as a risk factor for DR in DN patients. Patients with DN needs ophthalmic examination more timely and more frequently.

AIM:To explore the efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of central retinal vein occlusion (CRVO) through optical coherence tomography angiography (OCTA).METHODS:Patients with prior treatment of a minimum of three consecutive intravitreal injections of either bevacizumab or ranibizumab, followed by injection of conbercept, were recruited. The minimal follow-up period after switching was 12mo. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), the interval of injections was reviewed. Perfusion density (PD) and vascular length density (VLD) of superficial and deep capillary plexus were acquired from OCTA images before and after switching.RESULTS:Twenty-four eyes were included. CRT significantly decreased from 460.71±153.23 µm (before switching) to 283.92±38.27 µm at the end of follow-up (P<0.001). However, BCVA gained to some extent (from 0.98±0.33 to 0.76±0.42 logMAR) but the difference was not significant (P=0.070). After switching to conbercept the injection interval extended from 5.2±2.3wk to 8.3±3.9wk (P=0.012). At the end of follow-up, PD of deep retinal layer decreased significantly compared with before switching (from 34.62%±5.27% to 33.26%±5.82%, P=0.016), similar result was found in VLD of deep retinal layer but not in PD or VLD in superficial layer.CONCLUSION:In cases of refractory macular edema secondary to CRVO, switching to conbercept improves macular thickness and extends interval of injection. Retinal microvasculature cannot improve with treatment of conbercept.

Objectives To investigate the effect of metformin on the decreased risk of developing age-related macular degeneration (AMD) in patients with type 2 diabetes mellitus (T2DM) for ≥10 years. Design A retrospective study. Participants Patients aged ≥50 with a diagnosis of T2DM no less than 10 years were included. Methods Variables predisposing to AMD were reviewed; the potential confounders related to T2DM or AMD were selected from literature records; AMD and diabetic retinopathy (DR) were diagnosed by funduscopy, optical coherence tomography and/or fluorescein angiography. The subgroup analysis was performed in early and late AMD. The protective effect of metformin was evaluated in duration-response and dose-response patterns. Results A total of 324 patients (115 metformin non-users and 209 users) were included in the final analysis. AMD was observed in 15.8% of metformin users and 45.2% of metformin non-users (p<0.0001). The ORs for any AMD, early AMD and late AMD present in patients with DR were 0.06 (0.02–0.20), 0.03 (0.00–0.20) and 0.17 (0.04–0.75). The serum high-density lipoprotein level was positively associated with the late AMD risk (p=0.0054). When analysed by the tertiles of cumulative duration, a similarly reduced risk was observed for the second (5–9 years) (OR: 0.24, 95% CI: 0.08 to 0.75) and third tertiles (≥10 years) (OR: 0.22, 95% CI: 0.09 to 0.52) compared with the first tertile (≤4 years). Conclusion Among patients with T2DM for ≥10 years, metformin users were less likely to develop any AMD and early AMD than non-users; however, the late AMD was not significantly associated with the use of metformin. Also, AMD was less prevalent in patients with DR. The prolonged metformin treatment with a high cumulative dose enhanced the protective effect against AMD. Metformin significantly reduces the AMD risk when the cumulative duration is >5 years.

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者二甲双胍治疗与糖尿病性视网膜病变(diabetic retinopathy,DR)的相关性.方法:回顾2015年9月至2020年8月在中日友好医院眼科就诊的1891例T2DM患者的临床资料,对病程≥10年的324例T2DM患者的一般资料、内科疾病史、糖尿病治疗史、眼科检查和实验室血生化指标进行回顾性病例研究.根据是否接受二甲双胍治疗分为二甲双胍治疗组与非二甲双胍治疗组,根据眼底检查结果同时结合DR临床诊断标准,将DR分为无明显DR、非增生性DR及增生性DR.采用logistic多因素回归分析判断年龄、性别、糖尿病发病年龄、糖尿病病程、高血压病程、高血脂病程、吸烟年数、体重指数、胰岛素治疗及空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、尿酸和血肌酐水平对结局变量的影响.结果:在DR的发病风险方面,二甲双胍治疗组与非二甲双胍治疗组的差异无统计学意义(P>0.05).对T2DM患者DR发生及不同分期的相关变量行单因素及多因素分析,结果显示吸烟年数、空腹血糖及肌酐均与DR发病呈正相关(均P<0.05),而年龄与DR发病呈负相关(P<0.01),糖尿病发病年龄与DR发生呈显著负相关(OR=0.95,95％CI:0.92～0.98,P=0.0003).在二甲双胍治疗的T2DM患者中,二甲双胍的疗程(OR=1.02,95％CI:0.96～1.08,P>0.05)及平均剂量(OR=1.50,95％CI:0.79～2.84,P>0.05)与DR的发生与进展均无显著相关性;女性DR发生与进展的风险较男性低(P<0.05);合并胰岛素治疗与DR发生呈明显正相关(OR=3.11,95％CI:1.59～6.07,P<0.01);吸烟年数长、糖化血红蛋白及尿酸水平高于正常范围均与DR的发生与进展呈正相关(P<0.05).在口服二甲双胍患者中,未使用胰岛素治疗组和联合使用胰岛素组的DR发病风险有显著差异(P<0.01);而未口服二甲双胍患者中,胰岛素治疗与DR发生呈正相关(OR=12.43,95％CI:3.75～41.19,P<0.0001).结论:病程10年以上T2DM患者中,二甲双胍治疗与DR发生与进展均无显著相关性.

ObjectivesTraumatic orbital apex syndrome (TOAS) is an uncommon but severe ocular complication of craniomaxillofacial fracture. The optimal surgical strategy for TOAS has not been determined. To investigate the endoscopic anatomy of the orbital apex region, propose a protocol for simultaneous endoscopic endonasal decompression of the optic canal, superior orbital fissure, and proper orbital apex (EEDCFA) for TOAS and report its use in two patients.MethodsAn endoscopic endonasal approach was utilized to dissect the orbital apex region in two silicon-injected adult cadaveric heads. The details of the procedure used for decompression of the orbital apex were determined. The effects of this procedure were determined in two patients with TOAS who underwent simultaneous decompression of the optic canal, superior orbital fissure, and proper orbital apex.ResultsThe orbital apex consisted of three portions, the contents of the optic canal superomedially; the contents of the superior orbital fissure inferolaterally; and the converging portion, or proper orbital apex, anteriorly. From an endoscopic endonasal approach, the optic nerve, superior orbital fissure, and orbital apex convergence prominences were found to form a π-shaped configuration. This π-shaped configuration was indicative of the orbital apex and was an important landmark for decompression of the orbital apex. Endonasal decompression of the orbital apex in the two patients resulted in the satisfactory recovery of extraocular mobility, with no surgical complications.ConclusionsEEDCFA is feasible, effective, and safe for patients with TOAS caused by direct compression of displaced fracture segments. The π-shaped configuration is a valuable landmark for EEDCFA.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease characterized by neuro-ophthalmic intercross and humoral immunity.Neuromyelitis optica related optic neuritis (NMO-ON) is often the initial symptom of NMOSD patients, with a high blinding rate, which brought a heavy blow to the quality of life, study, work and other aspects of patients.The discovery of aquaporin-4 immunoglobulin G (AQP4-IgG) has brought significant progress in the pathogenesis, diagnosis and treatment of NMOSD.However, AQP4-IgG is not a universal biomarker of NMOSD.The role of CD4 + T helper (Th) cell related cytokines in the pathogenesis of NMOSD has been increasingly emphasized.This paper reviewed the research results of CD4 + Th cell-related cytokines closely related to the occurrence of NMOSD in recent years, including Th17 cell-related cytokines such as interleukin-6 (IL-6), IL-17, IL-21, Th2 cell-related cytokines such as IL-4, IL-5, IL-13, IL-31, IL-33, and regulatory T cell-related cytokines, etc.to provide new insights for the pathogenesis, diagnosis and treatment strategies of NMOSD or NMO-ON.

Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.

PURPOSE:To explore the clinical features, surgical interventions and prognosis of injured eyes following explosion and to develop the risk factors for poor prognosis.METHODS:A nested case-control study. To the date of 31 December 2018, 99 explosion-related eye globes were selected from the Eye Injury Vitrectomy Study database, which is a multicenter prospective cohort study and began in 1990s. All cases selected underwent vitreoretinal surgery or enucleation and were followed up for at least 6 months. Clinically meaningful preoperative variables and outcomes were used to develop logistic regression models.RESULTS:The unfavourable outcomes were defined as silicone oil-filled eyes, phthisis bulbi, enucleation and anatomically restored eyes whose final BCVA is worse than initial vision after 6 months of follow-up. The proportion of unfavourable outcomes was 92.0%, 60.9% and 66.7% in large festive fireworks, detonator and beer bottle groups respective. The anatomic and visual outcome of injured eyes with combined injury of blast wave and projectile were worse than that of ruptured eyes (Fisher's exact = 0.041). The extrusion of iris/lens (OR = 3.20, p = 0.015), PVR-C (OR = 6.08, p = 0.036) and choroid damage (OR = 5.84, p = 0.025) is independent risk factors of unfavourable prognosis for explosion-related eye trauma.CONCLUSION:The extrusion of iris/lens, PVR-C and choroid damage is the independent risk factors for unfavourable outcomes in explosion-related eye trauma. There is a unique injury mechanism in explosion-related eye trauma.SUMMARY STATEMENT:Through the nested case-control study, the extrusion of iris/lens, PVR-C, and choroid damage are the independent risk factors for unfavorable outcomes in explosion-related eye trauma. The mechanism of open globe mixture and close globe mixture in explosion-related eye trauma need more cases and participating units to explore together in the future.

Objective:To assess the clinical application value of transhepatic arterial contrast-enhanced ultrasonography in evaluating the therapeutic effect of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods:Thirty-eight patients with 48 lesions of HCC underwent TACE at the First Medical Center of Chinese PLA General Hospital from September 2018 to February 2019. All of them underwent preoperative and postoperative transhepatic arterial contrast-enhanced ultrasonography to evaluate the therapeutic effect by observing the enhancement in tumor and drainage area. The outcomes of magnetic resonance imaging (MRI) one month after TACE were used for comparison. The results of transhepatic arterial contrast-enhanced ultrasonography and MRI were compared by the χ2 test, and the Kappa test was used to evaluate the consistency of the results of transhepatic arterial contrast-enhanced ultrasonography and MRI.Results:The enhancement in tumor immediately after TACE was not different from the result of magnetic resonance imaging (MRI) one month after TACE (P=0.289). The enhancement in tumor and drainage area immediately after TACE was not different from the outcomes of magnetic resonance imaging (MRI) one month after TACE (P=1.000). The Kappa in observing the enhancement in tumor and drainage area was higher than that in observing the enhancement in tumor (0.780 vs 0.664, P＜0.001). The specificity, sensitivity, and accuracy in observing the enhancement in both tumor and drainage area were 84.2%, 93.1%, and 89.5%, respectively, which were higher than those in observing the enhancement in tumor alone (79.3%, 89.4%, and 83.3%).Conclusion:Transhepattic arterial contrast-enhanced ultrasonography could observe the enhancement in tumor and drainage area immediately after TACE, and has high clinical value in evaluating the therapeutic effect of TACE.

Objective:To investigate the feasibility of evaluating the effect of embolization by transhepatic arterial contrast-enhanced ultrasonography immediately after transarterial chemoembolization (TACE) to predict the short-term curative effect for hepatocellular carcinoma (HCC).Methods:A total of 50 HCC lesions in 39 patients treated by TACE underwent transhepatic artery contrast-enhanced ultrasonography before and immediately after operation at the First Medical Center of Chinese PLA General Hospital from September 2018 to March 2019. According to the maximum area ratio of internal enhancement of the tumor after surgery and before surgery and the maximum covering ratio of drainage area before and after surgery, Spearman correlation analysis was used to compare MRI results within 1 to 3 months after TACE between groups.Results:The effect of embolization evaluated by immediate postoperative tumor enhancement ratio and postoperative covering ratio of drainage area was related to the short-term curative effect judged by modified response evalution criteria in solid tumors (mRECIST), and the postoperative covering ratio of drainage area had a more significant correlation (r=0.516, P＜0.001 and r=0.716, P＜0.001, respectively).Conclusion:The evaluation of embolization effect immediately after TACE by transhepatic artery contrast-enhanced ultrasonography has a high correlation with the short-term curative effect evaluated by mRECIST, which can provide a good imaging reference value for predicting the short-term curative effect after tumor operation.

There are few reports on the study of extraperitoneal robotic single-port laparoscopic radical prostatectomy in China. In this study, patients with localized prostate cancer were treated with extraperitoneal robotic single-port laparoscopic radical prostatectomy extraperitoneal robot-assisted single-port laparoscopic radical prostatectomy(EpRA-spRP)from April 2019 to June 2019.All patients performed EpRA-spRP successfully without adding additional auxiliary port. The operation time and blood loss were controllable, and hospitalization time was short. It is safe and feasible to perform EpRA-spRP for medium and low-risk prostate cancer. The short-term tumor control and functional recovery are satisfactory.However, the long-term effect needs further follow-up and observation.

Neuromyelitis optica(NMO)is an inflammatory central nervous system(CNS)astrocytic disease with high incidence, neuro-ophthalmic intercross, and humoral immune-dominated in Asian population. It has attracted much attention due to its high pathogenicity, high risk of recurrence, and poor prognosis. It is difficult for patients with NMO-associated optic neuritis(NMO-ON)to benefit from routine treatment, and they are often left with different degrees of optic nerve atrophy. One limitation of the study of NMO-ON is the deficiency of the experimental model. Therefore, the progress and application of NMO and NMO-ON experimental model are reviewed in this paper, aiming to explore the pathological mechanism and possible treatment of NMO visual impairment.

OBJECTIVE:To evaluate the ability of macular ganglion cell and inner plexiform layer (mGCIPL) and retinal nerve fiber layer (RNFL) thickness measurements by long-wavelength swept-source optical coherence tomography (SS-OCT) to assess retinal ganglion cell (RGC) damage in nonarteritic anterior ischemic optic neuropathy (NAION).METHODS:A retrospective study of 20 patients with unilateral NAION was performed. SS-OCT scanning of the macular and peripapillary areas was performed to measure the total and six-sector thicknesses of macular RNFL (mRNFL) and mGCIPL, as well as peripapillary RNFL (pRNFL) thicknesses in global and 12 clock-hour sectors. Further comparison of these thicknesses between NAION involved eyes and uninvolved counterparts was performed in 12 of the 20 patients at 4 visits. The thickness map and en face images generated by volume data of the posterior pole over a 12 × 9-mm area were used for RNFL analysis.RESULTS:Median time intervals between the visual symptom onset and first thinning occurrences of mGCIPL, mRNFL, and pRNFL were 17 days (95% Confidence Interval [CI] 14-18 days), 43 days (95% CI 32-48 days), and 70 days (95% CI 62-80 days), respectively. The thickness map indicated a significantly reduced pRNFL in the superior temporal sectors or temporal sectors after 9 weeks, and retinal damage corresponded to the superior hemisphere's mRNFL and mGCIPL. En face images showed that the RNFL thinning area gradually expanded along the retinal nerve fiber direction and progressed toward the optic nerve head.CONCLUSIONS:The patterns of RGC damage in the macular and peripapillary areas of NAION eyes can be revealed by SS-OCT. Objective measurement of SS-OCT is valuable in characterizing NAION.

Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.

Vascular endothelial growth factor(VEGF)is a key factor of the angiogenesis during embryonic period, and it is also an important mediator of the pathological neovascularization and vascular permeability in various ophthalmic diseases. With the increasing use of anti-VEGF therapy in adults, more and more clinical studies are focused on the application of anti VEGF therapy in pediatric retinal and choroidal diseases, including retinopathy of prematurity, Coats disease, familial exudative vitreoretinopathy, incontinence pigmented related retinopathy, sickle cell retinopathy, retinoblastoma and choroidal neovascularization caused by various causes. In this article, the application of anti VEGF therapy in these pediatric retinal and choroidal diseases was reviewed.

To evaluate the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique (IFT) in macular holes (MHs), especially in MHs with a macular hole index (MHI) < 0.5. This was a retrospective comparative study. Patients with idiopathic MHs who underwent either the IFT or conventional ILM peeling (CP) were investigated. The main outcomes included the MH closure rate, best corrected visual acuity (BCVA), and recovery rates of the external limiting membrane (ELM) and ellipsoid zone (EZ) at 1, 3, and 6 months postoperatively. Forty-eight eyes of 48 patients who underwent the IFT (n = 29, Group A) or CP (n = 19, Group B) were included. The mean minimal diameter was 522.00 ± 208.08 µm. The closure rate was 100.0% in Group A and 94.7% in Group B (P = 0.396). The mean BCVA and EZ and ELM recovery rates improved significantly in both groups postoperatively. No significant differences in BCVA or the EZ or ELM recovery rates were found between the two groups. Of the 39 eyes whose MHI was < 0.5, 25 underwent the IFT, and 14 underwent CP. Comparing the results of the closure rate, BCVA and recovery rates of the EZ and ELM between groups were similar to those in 48 eyes. Both the IFT and CP can achieve a high closure rate, with no significant difference in ordinary idiopathic MHs. The IFT does not seem to achieve better anatomical and functional outcomes than CP. The IFT should be used conservatively in ordinary non-refractory MH surgery.

Objective: To investigate the possible molecular mechanism of panax notoginseng in the treatment of vitreous hemorrhage (VH). Methods: The active components of Panax notoginseng were screened by TCMSP database and the corresponding targets were collected. Vh-related gene targets were derived from GeneCards and OMIM database, and the target of Panax notoginseng was mapped to disease target genes. STRING database and Cytoscape 3.7.2 software were used to construct the protein-protein interaction (PPI) network diagram and the interaction network of "Pantoginseng - active ingredient - VH-target protein", and the core action target genes were screened out. Finally, gene body (GO) biological process and metabolic pathway enrichment analysis of KEGG were performed on the potential therapeutic targets. Results: We identified 8 active components, 162 active component targets, 1387 VH-related genes and 75 candidate targets for VH. In the "Panax notoginseng - active ingredient-VH-target protein" interaction network, there are 82 nodes in total. The core target genes include AKT1, CASP3, VEGF-A, IL-6 and MMP-9. 143 major enrichment pathways were identified by GO and KEGG enrichment analysis. The key signal pathways include age-RAGE signaling pathway, fluid shear stress and atherosclerosis, etc., and the significant molecular functions include cytokine activity, receptor ligand activity, cytokine receptor binding, etc. Conclusion: The potential molecular mechanism of panax notoquinone in the treatment of VH is closely related to the biological processes of anti-angiogenesis, anti-inflammation, regulation of apoptosis and oxidative stress, and AKT1, CASP3, VEGF-A, IL-6 and MMP-9 may be the core target genes.