This study aimeṭo characterize vitreous proteomic changes in idiopathic macular hole (IMH) and to investigate molecular distinctions from epiretinal membrane (ERM). A prospective study analyzing proteomics was conducted on undiluted vitreous samples from 10 IMH patients and 10 ERM controls of similar age. Label-free quantitative mass spectrometry integrating data-independent acquisition (DIA) workflows was used to identify differentially expressed proteins (DEPs). Bioinformatic analyses included Gene Ontology (GO) and KEGG pathway enrichment. Selected candidate proteins were validated by enzyme-linked immunosorbent assay (ELISA). A total of 826 vitreous proteins were quantified via DIA, with 19 showing differential expression (FDR-adjusted p < 0.05). Enrichment analyses suggested associations with extracellular matrix organization, cell adhesion, and signaling pathways related to glial activation and tissue remodeling. ELISA validation confirmed significantly reduced vitreous levels of VASN (p = 0.0024) and TNC (p = 0.0005) in IMH compared with ERM, whereas LAMC1 showed no significant difference (p = 0.43). Comparative vitreous proteomics identified consistent downregulation of VASN and TNC in IMH. These findings suggest that alterations in the vitreous microenvironment may be associated with dysregulated extracellular matrix and tissue remodeling processes in IMH. Further functional and larger scale studies are required to clarify their mechanistic and clinical relevance.

PurposeTo report a rare case of ulcerative colitis (UC)-associated bilateral panuveitis presenting with serous ciliary body detachment and choroidal detachment.Case descriptionA 51-year-old Asian woman with a history of UC presented with a 10-day history of bilateral blurred vision, ocular pain, redness, and photophobia. At presentation, her best-corrected visual acuity (BCVA) was 20/60 in the right eye and 20/100 in the left eye, with normal intraocular pressure. Slit-lamp examination showed signs of anterior uveitis. Fundus examination revealed bilateral optic disk edema and peripheral choroidal detachment in the left eye. Indocyanine green angiography showed multiple patchy hypofluorescent lesions in the posterior pole. Optical coherence tomography confirmed choroidal thickening and disk swelling, and ultrasound biomicroscopy demonstrated bilateral serous ciliary body detachment. After excluding other systemic and ocular etiologies, a diagnosis of bilateral UC-associated panuveitis was made. The patient received topical steroids, retrobulbar injection of triamcinolone acetonide in the left eye and oral prednisone initiated at 60 mg/day and tapered gradually. Her BCVA improved to 20/20 in the right eye and 20/30 in the left eye after 9 months follow-up.ConclusionUC-associated uveitis can manifest as bilateral panuveitis with ciliary body and choroidal detachment. Prompt diagnosis and immediate initiation of systemic corticosteroid therapy are critical for achieving optimal anatomical restoration and visual prognosis.

Abstract Lupus retinopathy (LR) is one of the most frequent and serious ocular complications of systemic lupus erythematosus (SLE), because it may cause irreversible visual impairment. The aim of this study was to evaluate the association between serum anti-retinal antibodies levels of SLE patients and the incidence of LR. Levels of serum anti-α-enolase antibody (Ab), anti-arrestin Ab, anti-recoverin Ab and anti-IRBP3 Ab were detected in 89 SLE patients (divided into LR group and non-LR group) and 81 healthy controls by enzyme-linked immunosorbent assay (ELISA). The correlation between these four anti-retinal Ab, SLE activity and the incidence of LR was evaluated. LR group had a higher SLE disease activity index (average SLEDAI score, 18 (7) versus 9 (5), P < 0.001), higher frequency of pleurisy (40% versus 20.4%, P = 0.044) and lower level of hemoglobin (102.343 ± 23.157 versus 112.759 ± 19.678, P = 0.025) comparing to non-LR group. LR group had higher levels of anti-α-enolase than non-LR group (P = 0.033) and control group (P < 0.0001). The levels of anti-recoverin in LR group was higher than non-LR group (P = 0.036) and control group (P < 0.0001), while the difference was not significant between non-LR group and control group (P = 0.109). Using combination of anti-α-enolase Ab and anti-recoverin Ab to diagnose LR in SLE patients is more effective (with area under the receiver operating characteristic curve (AUC): 72.68%) than use anti-α-enolase Ab (AUC: 65.65%) or anti-recoverin (AUC: 61.96%) only. Our results suggested that anti-α-enolase and anti-recoverin may be used as potential biomarkers of lupus retinopathy in SLE patients.

Biological age estimators quantify aging-related variation but provide limited insight into organ-specific aging processes. The retina enables non-invasive visualization of microvascular and neural structures and has emerged as a promising modality for biological age prediction. However, existing retinal aging models typically produce unidimensional age estimates with limited interpretability. Here we develop a deep learning framework based on a large-scale vision foundation model to estimate retinal biological age from fundus images and to characterize the physiological heterogeneity underlying retinal aging. Using a reference cohort of 56,019 relatively healthy individuals, the model achieved a Mean Absolute Error of 2.48 years in age prediction. Analysis of age deviations in a real-world clinical cohort (n = 46,369) revealed non-linear associations with cardiometabolic risk and population heterogeneity in aging patterns. Integrating multidimensional physiological profiling, feature attribution and unsupervised analysis, we identified distinct retinal aging signatures associated with systemic inflammation and hemodynamic variation. To further characterize age-related deviations, we introduced a residual learning framework that decomposes retinal aging signals into a normative age-related component and additional components associated with physiological variation, achieving a Mean Absolute Error of 1.80 years on the independent healthy test set. This approach provides an interpretable representation of retinal aging and a framework for studying organ-level aging processes and their relationship to systemic health using large-scale imaging data. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Natural Science Foundation of China (NSFC) Excellent Young Scientists Fund (Overseas). The funding source had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Peking University People's Hospital gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data referred to in this study are available upon reasonable request to the corresponding author, subject to approval by the Institutional Review Board of Peking University People's Hospital and compliance with relevant data protection regulations. Due to the sensitive nature of clinical patient data and privacy protection requirements, individual-level data cannot be made publicly available.

Background: Senior-Loken syndrome (SLS) is a rare autosomal recessive ciliopathy classically defined by the concurrence of nephronophthisis, frequently progressing to end-stage renal disease (ESRD), and retinal dystrophy, most commonly presenting as retinitis pigmentosa (RP). Given its phenotypic overlap with other renal-retinal syndromes, establishing a definitive diagnosis necessitates integrated clinical evaluation and molecular confirmation. Case Presentation: A 28-year-old Chinese female presented with a two-month history of binocular floaters. Her medical history was significant for ESRD of five years' duration, managed with maintenance hemodialysis. Ophthalmic assessment revealed retinal pigment mottling along the inferior temporal arcades and generalized arterial attenuation. Spectral-domain optical coherence tomography demonstrated outer retinal thinning with loss of the ellipsoid zone at corresponding locations. Perimetry confirmed visual field constriction, and full-field electroretinography showed severely reduced rod- and cone-mediated responses. Genetic testing was performed and a pathogenic variant in the NPHP1 gene was identified. Segregation studies confirmed both parents as heterozygous carriers, consistent with autosomal recessive inheritance. Collectively, these findings established a diagnosis of SLS. Conclusions: This case reinforces that SLS should be considered in the differential diagnosis of any young patient exhibiting RP alongside chronic kidney disease, particularly in the setting of early-onset ESRD. It also illustrates the essential role of a coordinated, multidisciplinary approach-encompassing nephrology, ophthalmology, and genetics-in diagnosing complex ciliopathies. Genetic confirmation not only validates the clinical diagnosis but also provides a foundation for family counseling, prognostic stratification, and future eligibility for gene-specific therapeutic trials.

Background: To analyze the association between central serous chorioretinopathy (CSCR) and single-nucleotide polymorphisms in the complement factor H (CFH) gene in patients of Chinese descent.Methods: 437 CSCR patients and 510 controls were enrolled from the Department of Ophthalmology, People's Hospital of Peking University. We genotyped each patient for six single-nucleotide polymorphism (SNP) markers in CFH (rs800292, rs1061170, rs3753396, rs2284664, rs1329428, and rs1065489), and assessed each SNP's associations with CSCR. We also performed a meta-analysis of CFH SNPs associations with CSCR.Results: In our Chinese population sample, two CFH SNPs—rs800292 and rs1065489—were significantly associated with CSCR. We found that rs800292 had the strongest association, and rs1065489 had the second strongest association. From a meta-analysis of all existing case-control studies on CFH SNPs and CSCR, we also found significant associations between CFH SNPs rs1329428, rs1065489, rs2284664, and rs800292, and CSCR.Conclusions: Our results show a significant association between CSCR and two SNPs in the CFH gene, rs800292 and rs1065489, in a Chinese population. These findings suggest a role for CFH in CSCR pathogenesis. Further investigation into how CFH contributes to CSCR will improve our understanding of CSCR, and of CFH as a potential therapeutic target.

The HELLP syndrome is a serious complication in pregnancy, characterized by haemolysis, elevated liver enzymes and low platelet count. We report a patient who was unaware of pregnancy presenting initially with bilateral visual loss and exudative retinal detachment and was diagnosed with HELLP syndrome during work-up. A female patient, unaware of her pregnancy, presented with painless, severe bilateral vision loss and exudative retinal detachment. Multimodal imaging of her fundus revealed hypertensive choroidopathy and retinopathy. During systemic work-up, she was found to be 26 weeks pregnant and was diagnosed with HELLP syndrome based on laboratory abnormalities. Her vision fully recovered within 4 months following urgent pregnancy termination and blood pressure control. This case highlights the importance of obtaining a thorough medical history and considering pregnancy-related complications in the differential diagnosis for reproductive-age women with acute vision loss. Prompt diagnosis and treatment of this condition are essential for the recovery of patients’ visual outcome.

This study compared the effectiveness of different ultrawide field fundus imaging systems (Clarus™ 500 and Optos®) in diagnosing diabetic retinopathy (DR). This was a prospective, multicentre study. Retinal photographs were captured at four eye centres utilizing both the Clarus™ 500 and Optos® imaging systems. The image quality and the effective retinal area were compared. Then the consistency in diagnosing the severity of DR by two distinct imaging systems was compared according to three separate grading criteria (the International Council of Ophthalmology, the Early Treatment Diabetic Retinopathy Study [ETDRS] grading diagnostic criteria, and the Chinese Clinical Diagnosis and Treatment Guidelines for Diabetic Retinopathy [2014]) were analysed. A total of 113 patients, 201 eyes and 402 images were included in this study. 39 images were excluded due to the poor image quality and 363 images were finally analyzed. The Clarus™ imaging system demonstrated better image quality than the Optos® imaging system (κ = 0.195). The mean effective retinal area was 490.03 ± 112.33 Disc area(DA) in the Clarus™ group and 410.41 ± 92.12 DA in the Optos® group (P = 0.000). The κ values were 0.812 for ETDRS DR severity, 0.787 for ICO DR severity, and 0.790 for the Chinese guidelines, indicating substantial agreement between the two imaging systems. However, Clarus™ indicated higher DR severity than the Optos® imaging system, with a higher detection rate of intraretinal microvascular abnormalities (IRMAs) and neovascularization. Clarus™ and Optos® exhibit strong concordance in the identification of DR. Clarus™ offers better image quality and IRMA recognition than Optos® and better identifies patients who need treatment.

PURPOSE:To evaluate and contrast the effectiveness and safety of two conbercept treatment protocols-a three-dose treat-and-extend (3+T&E) regimen and a three-dose pro re nata (3+PRN) regimen-in Chinese patients diagnosed with neovascular age-related macular degeneration (nAMD). METHODS:Eligible patients, who had not undergone anti-VEGF intraocular injections within 3 months prior to enrollment, were randomly assigned to either the 3+T&E or 3+PRN regimen. The 3+T&E group received at least three monthly injections, with subsequent visit intervals extended based on disease activity assessment. The primary endpoint was the mean change in best-corrected visual acuity (BCVA) from baseline to week 48, using a predefined noninferiority threshold. RESULTS:Among 501 participants (249 in 3+T&E, 252 in 3+PRN), approximately half had prior anti-VEGF treatment. At 48 weeks, both regimens showed significant BCVA improvements (+9.9 for 3+PRN, +8.6 for 3+T&E; p = .208), with comparable rates of ≥15-letter gains (32.12% for 3+PRN, 30.77% for 3+T&E; p = .827). The 3+PRN group received fewer injections (mean 6.4 vs. 6.9 in 3+T&E; p = .028) but had shorter intervals between injections (6.93 weeks vs. 7.46 weeks in 3+T&E; p = .010). Drug-related adverse events occurred in 5% of patients, with ocular events evenly distributed and minimal cardiovascular events reported. CONCLUSION:Both 3+T&E and 3+PRN conbercept regimens effectively improved visual and anatomical outcomes in Chinese nAMD patients. The 3+T&E regimen was noninferior to 3+PRN in improving BCVA from baseline to week 48. The 3+T&E regimen enabled longer injection intervals while 3+PRN regimen with less injections is more cost-effective while maintaining a comparable safety profile. Treatment plan tailored to an individual patient's situation appears necessary.

A post hoc analysis of the STAR study, which was a 48-week, phase IV, multicenter randomized controlled multicenter clinical trial was performed. This study aims to identify the baseline factors associated with visual and anatomic changes over 48 weeks in the treatment of active polypoidal choroidal vasculopathy (PCV) with conbercept. In the STAR study, 249 participants were randomized to either the 3 + Q12W (3 monthly injections followed by injections every 12 weeks) or 3 + TAE (3 monthly injections followed by treat and extend regimen) group. The association of 27 baseline factors with three outcomes—changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and maximum retinal thickness (MRT) from baseline to 48 weeks—was investigated using univariate regression analysis followed by multivariate linear regression analysis. The final multivariate model indicated that worse baseline BCVA (P < 0.01), CRT ≤ 400 μm (P < 0.01), fewer polypoidal lesions (P < 0.01), and younger age at baseline (P = 0.04) were associated with greater BCVA gain at week 48. Higher CRT and MRT at baseline were associated with a greater reduction in CRT and MRT at week 48, separately (P < 0.01 and P < 0.01, respectively). Smaller pigment epithelial detachment (PED) volume at baseline was associated with greater reductions in CRT and MRT at week 48 (both P < 0.01). Eyes with relatively good BCVA (> 73 letters) at baseline exhibited lower reductions in CRT and MRT at week 48 (P < 0.01 and P = 0.02, respectively). At week 48, eyes with hemorrhagic PEDs showed greater reductions in CRT and MRT than those with fibrovascular PEDs (P = 0.02 and P = 0.03, respectively). Furthermore, eyes with shallow irregular or sharp-peaked PEDs exhibited greater reductions in CRT (both P < 0.01) and MRT (P = 0.01 and P < 0.01, respectively) than those with multilobular PEDs from baseline to week 48. In Chinese patients with PCV receiving intravitreal injections of conbercept, baseline characteristics, including age, BCVA, CRT, MRT, number of polypoidal lesions, PED volume, and PED types and morphology, served as predictors of visual and anatomical changes over 48 weeks.

Purpose:To evaluate the impact of choroidal detachment on short-term surgical outcomes in highly myopic macular hole retinal detachment (MHRD) and to discern the risk factors associated with macular hole (MH) closure. Methods:A retrospective analysis was carried out on 104 highly myopic MHRD eyes that underwent vitrectomy and intraocular tamponade. Patients were stratified according to the presence or absence of preoperative choroidal detachment. Demographic data, preoperative ocular parameters, and postoperative outcomes were compared. Logistic regression analysis was employed to identify risk factors for MH closure. Results:No significant differences were observed in age or disease duration between groups. Preoperative visual acuity was inferior in the choroidal detachment group (2.19 ± 0.70 LogMAR vs. 1.78 ± 0.60 LogMAR, p = 0.013), and preoperative intraocular pressure (IOP) was significantly lower (9.05 ± 3.73 mmHg vs. 13.18 ± 4.15 mmHg, p < 0.001). Postoperatively, the choroidal detachment group demonstrated worse vision outcome (1.52 ± 0.49 LogMAR vs. 1.22 ± 0.38 LogMAR, p = 0.004) and a substantially higher rate of rescue therapy (28.6% vs. 3.6%, p = 0.002). The rate of MH closure was comparable between groups (41.0% vs. 42.9%, p = 1.000). Logistic regression identified advanced age (β = 0.099, p = 0.001) and lower preoperative IOP (β = -0.132, p = 0.031) as favorable factors for MH closure. Conclusion:Choroidal detachment exerts an adverse impact on postoperative visual acuity and is associated with a significantly higher rate of rescue surgical intervention. Younger age and higher preoperative intraocular pressure (IOP) may impede MH closure.

This study retrospectively analyzed medical records of 354 epiretinal membrane (ERM) eyes of 339 patients with 6-month postoperative follow-up to investigate the correlation between ectopic foveal inner layer (EIFL) and the EIFL-based ERM staging system with the anatomical and functional prognosis post pars plana vitrectomy (PPV) combined with cataract surgery. Our results showed preoperative ERM stage (tau-b = 0.196, P < 0.001), disorganization of the retinal inner layers (DRIL) severity (tau-b = 0.248, P < 0.001), central foveal thickness (CFT) (R = 0.387, P < 0.001) and EIFL thickness (R = 0.315, P < 0.001) were positively correlated with logMAR best corrected visual acuity (BCVA) at 6-month follow-up. Preoperative ERM stage (tau-b = 0.285, P < 0.001) and DRIL severity (tau-b = 0.239, P < 0.001) were positively correlated with CFT at 6-month follow-up. No significant correlation was found between ERM staging (P = 0.054) with macular edema (ME) resolution at 6 months. More advanced ERM stage (R = 0.494, P < 0.001) and DRIL severity (R = 0.379, P = 0.005) were significantly correlated with persistent newly onset ME at 6 months. Our findings showed that ERM staging based on EIFL could be a simple and intuitive way to predict the short-term functional and anatomical outcomes post-PPV.

To report the outcome of adjunctive intravitreal dexamethasone (Ozurdex) implantation in patients with proliferative diabetic retinopathy (PDR) and retinal detachment (RD) undergoing vitrectomy and silicone oil (SO) tamponade. A one-year, single-center, prospective, randomized controlled clinical trial. A total of 30 people (34 eyes) with PDR and RD who need vitrectomy and silicone oil tamponade were randomly assigned as 1:1 to study group and control group. Eyes in study group were injected with Ozurdex after vitrectomy and just before silicone oil tamponade. Primary outcome was the changes of epiretinal proliferative membranes area from 1 month to 12 months after the first operation. Anatomical and functional outcomes were also assessed during follow-up. There was no significant difference in baseline characteristics between the two groups. The incidence of preretinal proliferation progression from 1-month to 12-months follow-up in the study group was significantly lower than that in the control group (23.5

PURPOSE:This study aims to evaluate the efficacy and safety of intravenous tocilizumab (TCZ) in the treatment of Graves' ophthalmopathy (GO). METHODS:A comprehensive search was conducted across the Web of Science, PubMed, Embase, Cochrane Library, World Health Organization International Clinical Trials Registry Platform, and https://ClinicalTrials.gov databases from inception to April 2024. Randomized controlled trials (RCTs) and cohort studies that utilized intravenous TCZ for treating GO were included. RESULTS:Twelve studies encompassing 219 patients with active, steroid-resistant GO were analyzed. The meta-analysis demonstrated significant improvements in Clinical Activity Score (CAS) response (effect size [ES] = 0.98, 95% confidence interval [CI]: 0.93-1.00), proptosis response (ES = 0.50, 95% CI: 0.27-0.73), and diplopia response (ES = 0.48, 95% CI: 0.24-0.74). The ES for adverse events was 0.27 (95% CI: 0.22-0.33), with only three severe cases necessitating treatment discontinuation, and a low reactivation rate (ES = 0.01, 95% CI: 0.00-0.04). TCZ treatment led to a mean CAS reduction of 4.60 points (95% CI: 3.88-5.32) across 10 studies, a mean proptosis reduction of 2.04 mm (95% CI: 1.42-2.65) across 7 studies, and a mean decrease in thyroid-stimulating hormone receptor antibodies (TRAb) levels of 10.62 IU (95% CI: 4.67-10.62) across 5 studies. CONCLUSIONS:This meta-analysis provides robust evidence supporting the efficacy and safety of intravenous TCZ in patients with GO who are resistant to glucocorticoid therapy. The results highlight TCZ's comparable efficacy to glucocorticoids and suggest that TCZ could significantly expand clinical management options for GO. In the future, more high-quality, large-scale RCTs are still needed to confirm these findings.

Background Wolfram-like syndrome (WFLS) is an autosomal dominant inherited disease characterized by a single heterozygous pathogenic variant in the WFS1 gene. Its clinical presentation is similar to autosomal recessive Wolfram syndrome. Case presentation We reported a case of a 10-year-old boy and his family members who initially experienced hearing impairment (HI), followed by optic atrophy. Genetic testing revealed the presence of a WFS1 variant (chr4-6302385 exon8 NM_006005.3: c.2590G > A, p. Glu864Lys). Conclusion Wolfram-like syndrome, a rare neurodegenerative genetic disorder, manifested as deafness, optic atrophy, and diabetes mellitus. There hasn't been a definite treatment yet. Early identification of the variant in the WFS1 gene is beneficial for genetic counseling.

To quantitatively analyze the number and density of macrophage-like cells (MLCs) at the vitreoretinal interface at macular region in diabetic retinopathy (DR) with and without diabetic macular edema (DME). This cross-sectional study involved 240 eyes of 146 treatment-naïve DR patients, including 151 eyes with DME. The number and density of MLCs were analyzed quantitatively using optical coherence tomography angiography (OCTA) and were compared between DME and non-DME eyes as well as proliferative DR (PDR) and non-PDR (NPDR) eyes. Correlation between MLCs density and vessel density of macular superficial capillary plexus (SCP) at macular region was evaluated. The number and density of macular MLCs were both elevated in DME group compared to non-DME group (all p < 0.001). The morphology of MLCs in DME eyes appeared larger and fuller. NPDR eyes had higher number and density of MLCs (p = 0.027 and 0.026), greater central macular thickness (CMT) (p = 0.002) and vessel density than PDR eyes in non-DME group but comparable to PDR eyes in DME group. The number and density of MLCs at macular region were significantly higher with larger and fuller morphology in DR patients with DME than those without DME. PDR eyes had fewer MLCs than NPDR eyes for DR eyes without DME.

Purpose: This study aimed to determine the efficacy of the dexamethasone (DEX) intravitreal implant for the regression of macular edema and the improvement of best-corrected visual acuity (BCVA) after the removal of idiopathic epiretinal membrane (ERM). Methods: This prospective randomized controlled trial recruited 81 patients with idiopathic ERM. These patients all underwent 25-gauge pars plana vitrectomy combined with ERM and internal limiting membrane peeling surgery. Among them, 41 eyes in the DEX group received additional DEX implants and 40 in the non-DEX group did not. Outcomes including central retinal thickness (CRT), BCVA, and intraocular pressure were measured 1 and 3 months after surgery. Results: The DEX group had thinner CRTs compared to the non-DEX group at 1 month postoperatively (p <0.05), but did not differ significantly at the 1-week and 3-month follow-up visits (p = 0.109 and p = 0.417, respectively). There were no statistical differences with respect to BCVA (p = 0.499, 0.309, 0.246, and 0.517, respectively) and intraocular pressure (p = 0.556, 0.639, 0.741, and 0.517, respectively) between the two groups at each point of follow-up visits. Conclusion: DEX accelerated the reduction of CRT at 1 month after surgery. However, no evidence of further anatomical (CRT) or functional (BCVA) benefits using DEX was observed at 3 months. Clinical Trial Registration: https://clinicaltrials.gov/, identifier NCT05416827.

This study aimed to compare the anatomic and functional results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy (CSC). One hundred and thirty-one eyes of 131 patients with acute central serous chorioretinopathy (CSC) were recruited, and randomly assigned to the OCTA-guided group and ICGA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month, 3 months, and 6 months. The secondary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), choroidal capillary flow deficit density at each scheduled visit, and recurrence rate of SRF at 3 months and 6 months. There were 110 eyes that finished the follow-up, with 56 eyes in the OCTA-guided group and 54 eyes in the ICGA guided group. OCTA-guided PDT was demonstrated to be noninferior to ICGA-guided PDT for SRF resolution rate at 1 months and 6 months (P = 0.021 and P = 0.037), but not at 3 months for acute CSC (P = 0.247). The average CRT of the ICGA-guided group was significantly lower than that of the OCTA-guided group at 3-month visit (P = 0.046), but no significant difference was found between them at the 1-month and 6-month visits (P = 0.891 and 0.527). There was no significant difference between the two groups for BCVA (P = 0.359, 0.700, and 0.143, respectively) and the deficit area on CC (P = 0.537, 0.744,and 0.604, respectively) at 1, 3, and 6 months. OCTA may replace ICGA to guide PDT for the treatment of acute CSC and their follow-up.

目的 观察光相干断层扫描血管成像(OCTA)引导半剂量光动力疗法(PDT)治疗急性中心性浆液性脉络膜视网膜病变(CSC)的疗效.方法 前瞻性随机对照试验.2019年4月至2020年4月于北京大学人民医院眼科中心检查确诊的急性CSC患者72例72只眼纳入研究.将患眼随机分为OCTA、吲哚青绿血管造影(ICGA)组,分别为31例31只眼、33例33只眼.患眼均行最佳矫正视力(BCVA)、眼底彩色照相、OCTA、ICGA检查.采用国际标准视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力.OCTA组将脉络膜毛细血管层粗颗粒强反射区定为治疗区;ICGA组将与荧光素眼底血管造影渗漏点附近对应的脉络膜高灌注区定为治疗区.根据彩色眼底像中勾画的治疗区域对患眼进行半剂量PDT治疗.对比观察两组患眼治疗后1、3、6个月视网膜下液(SRF)完全吸收率、BCVA、中心凹视网膜厚度(CRT)变化情况以及治疗后3、6个月SRF复发率.两组间连续变量比较采用t检验或Wilcoxon秩和检验;分类变量比较采用x2检验.结果 治疗后 1、3、6个月,OCTA组、ICGA组SRF完全吸收率分别为74.2％(23/31)、63.6％(21/33),87.1％(27/31)、84.8％(28/33),96.8％(30/31)、91.9％(31/33);OCTA组治疗后不同时间SRF完全吸收率非劣效于ICGA组[95％可信区间(CI)-11.9％～33.1％,P=0.402;95％CI-14.7％～19.3％,P=0.107;95％CI-6.3％～16.1％,P=0.226].治疗后3、6个月,两组患眼SRF复发率比较,差异无统计学意义(x2=0.009、0.047,P=0.925、0.828);治疗后6个月,CRT比较,差异有统计学意义(t-=2.017,P=0.047);治疗后 1、3、6个月,logMARBCVA比较,差异无统计学意义(t=0.529、0.762、1.017,P=0.581、0.403、0.243).结论 随访6个月时间内,OCTA引导下的半剂量PDT治疗急性CSC患者,其SRF完全吸收率不劣于ICGA引导下的PDT.

Background: This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. Results: Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. Conclusions: AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.