BACKGROUND:This study explores the causal relationships between five major lipids, 249 circulating metabolites, and four diabetic retinopathy (DR) outcomes: overall DR, background DR, severe background DR, and proliferative DR (PDR). We aim to identify plasma proteins that mediate these causal effects, offering insights into potential therapeutic targets. METHODS:We conducted metabolome-wide Mendelian randomization (MR) analyses to assess associations between major lipids, metabolites, and DR outcomes. Multivariable MR (MVMR) and proteome-wide mediated MR (two-step MR) analyses were performed to ensure robust evaluation and identify mediating plasma proteins. RESULTS:Triglycerides were identified as a significant risk factor for DR, mediated by proteins like Dickkopf-3 (DKK3), ST6 N-acetylglucosamine transferase 6 (ST4S6), and Neogenin (NEO1). For background DR, HDL-C, specific VLDL particles, and LDL triglycerides were protective, mediated by proteins like chloride intracellular channel 5 (CLIC5), basal cell adhesion molecule (BCAM), and Ribophorin I (RPN1). Additionally, polyunsaturated fatty acids (PUFAs) and total choline were protective against PDR, mediated by Radical Fringe Gene (RFNG). CONCLUSIONS:This study identifies specific plasma proteins that mediate the effects of lipids and metabolites on DR, establishing a direct molecular link between these biomarkers and disease progression. These findings enhance our understanding of the pathophysiological mechanisms underlying DR and highlight potential targets for therapeutic intervention.

AIM:To elucidate the manifestations and associated complications observed in patients with intraocular silicone oil (SO) emulsification through multiple imaging modalities. METHODS:This single-center, observational, retrospective study included 116 patients who underwent pars plana vitrectomy (PPV) with SO injection for retinal detachment (RD), followed by subsequent SO removal at the Second Hospital of Hebei Medical University from January 2013 to January 2023. Comprehensive records of ophthalmic examinations utilizing multiple imaging techniques were maintained. RESULTS:The study comprised 56 females and 60 males, with a mean age of 52.75±13.6y. The mean follow-up duration for SO tamponade was 9.04±11.33mo (range: 1-84mo). Among the participants, 59 patients were diagnosed with SO emulsification, while 57 patients were in the SO unemulsified group. Patients with SO emulsification had a significantly prolonged SO tamponade duration (P<0.01). Multiple imaging techniques revealed notable signs of SO emulsification and its complications, such as 4 cases (3.4%) with posterior corneal SO-like keratic precipitates (KP) observed by anterior segment photography, 23 cases (19.8%) exhibiting spherical high-reflection signals in the inter-retina, retinal pigment epithelium, or choroid detected by Spectralis spectral domain optical coherence tomography (SD-OCT), 4 cases (3.4%) showing slow movement of emulsified SO droplets within retinal vessels during fluorescein angiography (FFA), plain and enhanced head magnetic resonance imaging (MRI) images of these four patients did not detect emulsified SO in the lateral ventricles, suprasellar cistern, subarachnoid space, third ventricle, fourth ventricle, or other intracranial locations. CONCLUSION:Intraocular emulsified SO can lead to damage in both anterior and posterior segment tissues, encompassing corneal degeneration, cataracts, glaucoma, retinal and choroid inflammation. Objective multiple imaging techniques such as anterior segment photography, SD-OCT, FFA, and MRI offer comprehensive evaluation and diagnosis of SO emulsification and its associated complications.

BACKGROUND:To evaluate the efficacy and safety of a linearly cross-linked sodium hyaluronic acid (HA) hydrogel used as a retinal patch in the treatment of rhegmatogenous retinal detachment (RRD). METHODS:This multicenter, randomised, parallel-controlled trial included 313 participants diagnosed with RRD classified as PVR grade A or B, excluding those with giant retinal tears (defined as tears spanning more than one quadrant). Participants were randomly assigned to either an experimental group or a control group. Following laser photocoagulation to retinal breaks, the experimental group received intraocular tamponade with a combination of linearly cross-linked sodium HA hydrogel and sterile air, whereas the control group received intraocular tamponade with perfluoropropane gas (C3F8). According to the intention-to-treat (ITT) principle, the final analysis included 155 subjects in the experimental group and 158 in the control group. The primary outcome measure was the retinal reattachment rate within 24 weeks postoperatively. RESULTS:At 24 weeks, retinal reattachment rates were 91.8% in the experimental group and 91.4% in the control group (p = 0.903), with no statistically significant differences at any follow-up time point. Additionally, there were no significant differences between the two groups regarding best-corrected visual acuity (BCVA), intraocular pressure (IOP), or postoperative complications. CONCLUSIONS:The application of linearly cross-linked sodium HA hydrogel as a retinal patch demonstrated effectiveness comparable to traditional gas tamponade in the treatment of RRD. Furthermore, this method exhibited a favourable safety profile. The technique obviates the need for postoperative prone positioning, significantly improving the patient's postoperative comfort and quality of life. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR2000037030.

Background:Myopia is associated with scleral weakness and thinness, leading to visual impairment. Currently, posterior scleral reinforcement (PSR) remains the primary treatment for this condition. However, clinical practice commonly faces challenges such as insufficient donor availability and inadequate strength of allogeneic sclera materials. Therefore, in this study, we evaluated the cytokine expression and biomechanical characteristics of two types of scleral reinforcement materials (demineralized bone matrix (DBM) and allogeneic sclera) to identify the optimal material for PSR. Methods:Seventy-two two-week-old New Zealand rabbits were utilized in this study. Each rabbit eye was assigned to either an experimental group or an untreated group (no surgical intervention), which were further divided into DBM, allogenic sclera, and control groups (surgery without implantation). Samples were analyzed during different postoperative periods including the inflammatory response period at week 2, angiogenesis period at week 4, collagen formation period at week 12, and connective tissue proliferation period at week 24. Refractive power and axial length of the experimental eyes were measured at 2, 4, 12,and 24 weeks postoperatively while implanted slices with attached sclera from the DBM and Sclera group experimental eyes were collected. The same area of sclera was obtained from the sham group for immunohistochemical analysis and western blot detection to analyze levels of bFGF (Basic Fibroblast Growth Factor), CTGF (Connective Tissue Growth Factor), TGF-β (Transforming Growth Factor β),and Collagen I along with respective elasticity modulus and ultimate strength of the implant slice taken. Results:There were no significant differences (P > .05) in axial length and refractive power between the DBM and allogenic groups before 24 weeks, while a significant difference (P < .05) was observed compared to the control group. The levels of bFGF, CTGF, and TGF-β in the DBM and sclera groups were significantly higher than those in the control group (P < .05). After 24 weeks, histological analyses revealed a strong connection between the implants and sclera with collagen formation. The elasticity modulus and ultimate strength of both DBM and scleral groups were significantly higher than those of the control group (P < .05). Furthermore, the DBM group exhibited a higher elastic modulus and ultimate strength compared to the scleral group (P < .05). The synthesis of collagen can be effectively promoted by bFGF, CTGF, and TGF-β, leading to increased elastic modulus and ultimate strength which helps prevent posterior scleral expansion, thereby controlling further axial growth delay complications occurrence. Conclusion:The cytokine expression profile along with biomechanical characteristics make DBM an ideal material for posterior scleral reinforcement due to its low antigenicity, excellent biocompatibility without obvious postoperative rejection reaction as well as its ability to closely associate with autologous sclera making it widely available from various sources.

Artificial intelligence (AI)-based diagnostic systems have been reported to improve fundus disease screening in previous studies. This multicenter prospective self-controlled clinical trial aims to evaluate the diagnostic performance of a deep learning system (DLS) in assisting junior ophthalmologists in detecting 13 major fundus diseases. A total of 1493 fundus images from 748 patients were prospectively collected from five tertiary hospitals in China. Nine junior ophthalmologists were trained and annotated the images with or without the suggestions proposed by the DLS. The diagnostic performance was evaluated among three groups: DLS-assisted junior ophthalmologist group (test group), junior ophthalmologist group (control group) and DLS group. The diagnostic consistency was 84.9% (95%CI, 83.0% ~ 86.9%), 72.9% (95%CI, 70.3% ~ 75.6%) and 85.5% (95%CI, 83.5% ~ 87.4%) in the test group, control group and DLS group, respectively. With the help of the proposed DLS, the diagnostic consistency of junior ophthalmologists improved by approximately 12% (95% CI, 9.1% ~ 14.9%) with statistical significance ( P < 0.001). For the detection of 13 diseases, the test group achieved significant higher sensitivities (72.2% ~ 100.0%) and comparable specificities (90.8% ~ 98.7%) comparing with the control group (sensitivities, 50% ~ 100%; specificities 96.7 ~ 99.8%). The DLS group presented similar performance to the test group in the detection of any fundus abnormality (sensitivity, 95.7%; specificity, 87.2%) and each of the 13 diseases (sensitivity, 83.3% ~ 100.0%; specificity, 89.0 ~ 98.0%). The proposed DLS provided a novel approach for the automatic detection of 13 major fundus diseases with high diagnostic consistency and assisted to improve the performance of junior ophthalmologists, resulting especially in reducing the risk of missed diagnoses. ClinicalTrials.gov NCT04723160

OBJECTIVES:Patients with polypoidal choroidal vasculopathy (PCV) exhibit variability in response to anti-VEGF therapy. This study aimed to analyse the aqueous humour proteomic profiles of PCV patients and provide preliminary insights for the identification of biomarkers associated with anti-VEGF drug responsiveness. METHODS:PCV patients who were treatment-naïve or untreated for more than 3 months were prospectively recruited from two hospitals in Beijing and Tianjin. Based on the relative changes in central macular thickness (ΔCMT/baseline-CMT) before and after anti-VEGF treatment, the PCV patients were divided into a good response (GR) group (≤-25%) and a poor response (PR) group (>-25%). Aqueous humour proteomics was performed by the Data-independent Acquisition-Mass Spectrometry (DIA-MS) method, and differentially expressed proteins (DEPs) analysis between the different PCV groups and the control group was conducted. Key DEPs were selected for preliminary validation in the aqueous humour using the Luminex method retrospectively. RESULTS:A total of 31 PCV patients (31 eyes) were included, 13 in the GR group and 18 in the PR group. A total of 414 DEPs were identified, including 36 significantly upregulated proteins, such as G protein regulatory factor 10 (RGS10), podocin (PODN) and epidermal growth factor (EGF), and 32 downregulated proteins, including RAB11FIP4 (Rab11 family-interacting protein 4), α-synuclein (SNCA), haemoglobin subunit δ (HBD) and interleukin 6 (IL6). Compared to the cataract control group (10 eyes), 134 proteins were significantly upregulated, and 72 were downregulated. KEGG pathway enrichment analysis revealed that the GR and PR groups differ in terms of cell communication, and cell signal transduction. Protein-protein interaction analysis revealed interactions between EGF and various DEPs. Validation of aqueous humour proteins using the Luminex method revealed that changes in the levels of EGF were associated with the anti-VEGF treatment response in PCV patients. CONCLUSIONS:PCV patients with good or poor anti-VEGF responses exhibit distinct aqueous humour proteomic profiles. Aqueous EGF may serve as a biomarker for the 'precise treatment' of PCV.

Purpose: The dysregulation of NF-kappa B signaling activity plays an important role in the pathogenesis of diabetic retinopathy (DR). This study explored the association between NEDD4L and I kappa B alpha in DR.Methods: The rat model of diabetes was established and altered retinal vascular permeability in these rats was examined through an Evans blue dye assay. A range of glucose concentrations were used to treat retinal vascular endothelial cells (RVECs). The cells viability and apoptosis were assessed through MTT and flow cytometry, while shifts in cell permeability were examined by transendothelial resistance (TEER) and FITC dextran assay. The interaction of NEDD4L and I kappa B alpha was tested by Co-IP, while mRNA and protein levels were assessed via qPCR and Western blotting, respectively.Results: High glucose suppressed proliferative activity of RVECs, and promoted apoptosis and the protein level of NEDD4L and NF-kappa B p65, but decreased I kappa B alpha. NEDD4L knockdown reversed the changes in inflammation, oxidative stress, and permeability in RVECs exposed to high glucose. Similarly, NEDD4L silencing reverted observed TEER decreases, increased monolayer permeability to FITC dextran, and ZO-1 and Claudin-5 downregulation in response to high glucose. Conversely, the impact of NEDD4L overexpression was reversed by the NF-kappa B inhibitor PDTC treatment. NEDD4L induced the ubiquitination of I kappa B alpha in an IKK-2-dependent manner. Moreover, siNEDD4L treatment alleviated the symptoms of DR through the inactivation of NF-kappa B signaling in vivo.Conclusions: NEDD4L could enhance inflammation, oxidative stress, and permeability in the retinal vascular endothelium by facilitating the ubiquitination of I kappa B alpha in an IKK-2-dependent manner. Our results support a role for NEDD4L in the pathogenesis of DR.

目的 探讨线上以问题为导向的学习(problem-based learning,PBL)教学法在留学生眼科学教学中的应用与效果.方法 选择 2013 年 8-12 月河北医科大学国际班 70 名本科留学生为对照组,2020 年 8-12 月河北医科大学国际班 65 名本科留学生为试验组.试验组采用线上PBL教学法,对照组采用传统教学模式,比较两组期末考试成绩和教学效果.结果 试验组与对照组的期末考试成绩比较,差异无统计学意义(P＞0.05).试验组自学能力、创新能力、逻辑思维能力、适应临床工作、基础知识掌握、激发学习兴趣、专业知识系统性、归纳能力评分高于对照组,差异有统计学意义(P＜0.001).结论 线上PBL教学法适合于留学生眼科学教学,教学效果更佳,有利于留学生的成长.

CLINICAL RELEVANCE:There are many methods to control the progression of myopia. However, it is currently unknown which method could better control myopia progression: 0.02% atropine eye drops, peripheral myopic defocus design spectacle lenses (PMDSL), or orthokeratology (OK). BACKGROUND:To compare the efficacy of 0.02% atropine, PMDSL, and OK to control axial length (AL) elongation in children with myopia. METHODS:This study was analysed based on a previous cohort study (0.02% atropine group) and retrospective data (PMDSL and OK group). Overall, 387 children aged 6-14 years with myopia - 1.00D to - 6.00D in the three groups were divided into four subgroups according to age and spherical equivalent refraction (SER). The primary outcome was changed in AL over 1-year. RESULTS:The mean axial elongation was 0.30 ± 0.21 mm, 0.23 ± 0.16 mm, and 0.17 ± 0.19 mm in the 0.02% atropine, PMDSL, and OK groups, respectively. Multivariate linear regression analyses showed significant differences in axial elongation among the three groups, especially in children aged 6-10, but not in children aged 10.1-14; the corresponding axial elongation was 0.35 ± 0.21 mm, 0.23 ± 0.17 mm, and 0.21 ± 0.20 mm (P < 0.05 between any two groups, except between PMDSL and OK groups at P > 0.05) and 0.22 ± 0.20 mm, 0.21 ± 0.13 mm, and 0.13 ± 0.18 mm (P < 0.05 between any two groups, except between 0.02% atropine and PMDSL groups at P > 0.05) in children with SER from - 1.00D to - 3.00D and from - 3.01D to - 6.00D, respectively. CONCLUSIONS:Within the limits of this study design and using only the current brand of PMDSL, OK appeared to be the best method, followed by PMDSL and then 0.02% atropine, for controlling AL elongation over one year. However, different effects were found in the various age and SER subgroups.

Background Several studies have shown that various concentrations of low-concentration atropine can reduce myopia progression and control axial elongation safely and efficiently in children. The aim of this study was to evaluate the effects of 0.02% and 0.01% atropine on ocular biometrics. Methods Cohort study. 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes nightly. Controls ( N = 120) wore only SV spectacles. Ocular and corneal astigmatism were calculated using Thibos vector analysis and split into J0 and J45. Results The changes in cycloplegic spherical equivalent refraction (SER) and axial length (AL) were −0.81 ± 0.52D, −0.94 ± 0.59D, and −1.33 ± 0.72D; and 0.62 ± 0.29 mm, 0.72 ± 0.31 mm, and 0.89 ± 0.35 mm in the 0.02% and 0.01% atropine and control groups, respectively (all P < 0.05). Both anterior chamber depth (ACD) and ocular astigmatism (including J0) increased, and lens power decreased in the three groups (all P < 0.05). However, there were no differences in the changes in ACD, ocular astigmatism, and lens power among the three groups (all P > 0.05). Intraocular pressure (IOP), corneal curvature, ocular astigmatism J45, and corneal astigmatism (including J0 and J45) remained stable over time in the three groups (all P > 0.05). The contributions to SER progression from the changes in AL, lens and corneal power of the three groups were similar ( P > 0.05). The contribution of AL change alone to the change in SER was 56.3%, 63.4% and 78.2% in the above corresponding three groups. Conclusions After 2 years, 0.02% and 0.01% atropine had no clinical effects on corneal and lens power, ocular and corneal astigmatism, ACD or IOP compared to the control group. 0.02% and 0.01% atropine helped to control myopia progression mainly by reducing AL elongation.

Purpose: To examine whether and how carbohydrate response element-binding protein (ChREBP) plays a role in diabetic retinopathy. Methods: Western blotting was used to detect ChREBP expression and location following high glucose stimulation of Human Retinal Microvascular Endothelial Cells (HRMECs). Flow cytometry, TUNEL staining, and western blotting were used to evaluate apoptosis following ChREBP siRNA silencing. Cell scratch, transwell migration, and tube formation assays were used to determine cell migration and angiogenesis. Diabetic models for wild-type (WT) and ChREBP knockout (ChKO) mice were developed. Retinas of WT and ChKO animals were cultivated in vitro with vascular endothelial growth factor + high glucose to assess neovascular development. Results: ChREBP gene knockdown inhibited thioredoxin-interacting protein and NOD-like receptor family pyrin domain containing protein 3 expression in HRMECs, which was caused by high glucose stimulation, reduced apoptosis, hindered migration, and tube formation, and repressed AKT/mTOR signaling pathway activation. Compared with WT mice, ChKO mice showed suppressed high glucose-induced alterations in retinal structure, alleviated retinal vascular leakage, and reduced retinal neovascularization. Conclusions: ChREBP deficiency decreased high glucose-induced apoptosis, migration, and tube formation in HRMECs as well as structural and angiogenic responses in the mouse retina; thus, it is a potential therapeutic target for diabetic retinopathy.

AIM: To study the role and mechanism of curcumol in neovascularization induced by vascular endothelial growth factor(VEGF).METHODS: Human umbilical vein endothelial cells were cultured in vitro and treated with 50ng/mL VEGF and curcumol at different concentrations. Cell proliferation was detected by CCK-8 and EdU assay, the migration ability of cells was analyzed by Transwell assay, the angiogenesis ability of endothelial cells was analyzed by tube formation assay, and the change of Akt/mTORC1 signal pathway was detected by Western blot.RESULTS: CCK-8 results showed that the OD450 value of cells in 400 and 800 μmol/L curcumol+VEGF group was significantly lower than that in VEGF group(all P&#x003C;0.01). EdU results showed that the rate of cell proliferation in 400 μmol/L curcumol+VEGF group was significantly lower than that in VEGF group(P&#x003C;0.001). Transwell assay and the formation assay results showed that the number of migratory cells in 400 μmol/L curcumol+VEGF group was decreased, and the number and length of tube branches were also reduced compared with VEGF group(all P&#x003C;0.001). Western blot results showed that curcumol significantly inhibited the expression of p-Akt and p-S6, which were downstream targets of Akt/mTORC1 pathway in cells.CONCLUSION: Curcumol can inhibit VEGF-induced cell proliferation, migration and tube formation of vein endothelial cells, and has a strong inhibitory effect on angiogenesis, which can be further studied in the treatment of ocular fundus neovascularization.

Objective. The effects of TGF-β2 on mechanical properties of sclerotic desmocytes isolated from healthy and myopic guinea pigs were investigated in order to further understand the pathogenesis of myopia. To study the effect of TGF-β2 on the mechanical properties of posterior scleral fibroblasts in experimental myopia. Methods. A lens-induced myopia (LIM) animal model was developed in 12 guinea pigs, with the opposite eye serving as a self-control (SC). Five untreated guinea pigs served as normal controls. Lenses were removed 30 days after model onset. Primary scleral fibroblasts were isolated and passaged twice and then treated with vehicle control or 1, 10, or 100 ng/mL TGF-β2. After 24 h, micropipette aspiration was used to investigate the viscoelastic properties of the cells. Results. Scleral fibroblasts from LIM exhibited significantly higher equilibrium moduli and apparent viscosities relative to SC without TGF-β2 treatment. Treatment of LIM or SC scleral fibroblasts with 1 or 10 ng/mL TGF-β2 led to significantly different (p<0.05) equilibrium moduli and apparent viscosities compared with vehicle control, whereas no significant differences were observed upon treatment with 100 ng/mL TGF-β2. LIM cells treated with 1 and 10 ng/mL TGF-β2 exhibited lower equilibrium moduli and apparent viscosities compared with similarly treated SC cells, but LIM cells and SC cells treated with 100 ng/mL TGF-β2 had similar mechanical properties. Conclusions. The addition of 1 and 10 ng/mL TGF-β2 can lower the equilibrium modulus and apparent viscosity of scleral fibroblasts in the normal eye.

PurposeTo study the topographical relationship between acute macular neuroretinopathy (AMN) lesions and the choroidal watershed zone (CWZ) or patchy choroidal filling (PCF) using multimodal imaging.MethodsLesions in patients diagnosed with AMN were clinically examined using multimodal imaging, including fundus photography, near-infrared reflectance imaging, spectral-domain optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography, OCT angiography, and microperimetry. The topographical relationship between AMN and the CWZ or PCF was evaluated.ResultsSeven eyes of six patients were included in the study. The mean age of the patients was 35.8 ± 11.7 years. The AMN lesions were collocated with the CWZ in five eyes and the PCF in one eye. Among these eyes, three had complete patterns, and three had partial patterns. Only one eye showed no topographical relationship between AMN and the CWZ or PCF.ConclusionThe colocation of AMN and CWZ/PCF suggests that the AMN lesions were within an area with a dual-watershed zone: the watershed zone between the retinal deep capillary plexus and choriocapillaris, and the choroidal watershed zone or patchy choroidal filling. This retinal area was highly vulnerable to hypoperfusion. Our results suggest a novel pathophysiological mechanism for AMN.

BACKGROUND Phakic intraocular lens（pIOL） implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia. However, it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole（MH） in a patient with a history of bilateral pIOL implantation for the correction of myopia of –12.00 diopters in both eyes 7 mo ago. The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases, MH can occur following pIOL. In this present case report, we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.

我们的老主任、恩师廖菊生教授因病医治无效，于2022年5月21日凌晨2时8分驾鹤西去，享年100岁。

To evaluate the effects of 0.02% and 0.01% atropine eye drops on ocular and corneal astigmatism over 2 years. A prospective clinic-controlled trail. The cohort study assessed 400 myopic children and divided them into three groups: 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes once nightly. Control children (n = 120) only wore SV spectacles. Spherical equivalent refractive errors (SER) and corneal curvature were measured every 4 months. The SER and corneal curvature were assessed by cycloplegic autorefraction and IOLMaster. Ocular and corneal astigmatism were calculated by Thibos vector analysis and then split into its power vector components, J0 (with-the-rule astigmatism) and J45 (oblique). After 2 years, the ocular astigmatism increased by -0.38 ± 0.29 D, -0.47 ± 0.38 D, -0.41 ± 0.35 D in the 0.02%, 0.01% atropine groups and control group, respectively (p = 0.15). The corresponding corneal astigmatism increased by -0.20 ± 0.34 D, -0.28 ± 0.35 D and -0.26 ± 0.26 D (p = 0.18). The ocular astigmatism J0 increased by 0.19 ± 0.28 D, 0.22 ± 0.36 D, 0.18 ± 0.31 D in the 0.02% atropine, 0.01% atropine and control groups, respectively (p = 0.65). The corresponding corneal astigmatism J0 increased by -0.05 ± 0.34 D, -0.11 ± 0.37 D and -0.13 ± 0.30 D (p = 0.23). There was a small but significant increase in ocular astigmatism (including J0) (all P < 0.05), but there were no changes in the ocular astigmatism J45 and corneal astigmatism (including J0 and J45) in the three groups over time (all p > 0.05). However, there were no significant differences in the changes in ocular astigmatism (including J0) among the three groups. Treatment with 0.02% and 0.01% atropine had no clinically significant effect on ocular and corneal astigmatism over 2 years. The First Affiliated Hospital of Zhengzhou University, ChiCTR-IPD-16008844 . Registered 14/07/2016.

Objective::To evaluate the effects of 0.02% and 0.01% atropine eye drops on total astigmatism and corneal astigmatism in myopic children.Methods::A prospective cohort study. The cohort study assessed 400 myopic children between June 2016 and June 2017 and divided them into three groups: 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision spectacles (SVS), with one drop of atropine applied to both eyes once nightly. The children in the control group ( n=120) only wore SVS. Spherical equivalent refractive (SE) and corneal curvature were measured every 4 months for 1 year. SE and corneal curvature were assessed by cycloplegic autorefraction and IOLMaster. Total and corneal astigmatism were calculated by standardized vector analysis and then split into its power vector components: X, Y and axes. Only the right eye was selected for data analysis. An analysis of variance test, rank sum test and Chi-square test were used for data analysis. Repeated measures analysis of variance and the generalized estimation equation GEE model were used to compare the changes in total astigmatism, corneal astigmatism and the axial changes in corneal astigmatism. Results::After 1 year, there was a small but significant increase in total astigmatism (including X), which had statistically significant differences in the 0.02% and 0.01% atropine and control groups (total astigmatism: Ftime=15.25, P=0.001; total astigmatism X: χ2time=48.07, P<0.001). Total astigmatism (including X) changed at the same rate in the 3 groups, and there were nostatistically significant differences among the groups. There was a small but significant increase in corneal astigmatism (including X), which was significantly different over time in the three groups (corneal astigmatism: Ftime=8.11, P=0.001; corneal astigmatism X: χ2time=20.79, P<0.001). Total astigmatism (including X) changed at the same rate in the 3 groups, and there was no statistically significant difference among the groups. There were no significant changes in the total and corneal astigmatism Y and their axes in the three groups over 1 year and the changes were not significantly different. Conclusion::Children with myopia who regularly instilled 0.02% or 0.01% atropine eye drops for 1 year showed no effect on total astigmatism, corneal astigmatism, or their axes after standardized vector analysis.

OBJECTIVE:The characteristics of the early changes in preclinical diabetic retinopathy (DR) are poorly known. This study aimed to analyse the changes in the structure and function of the fundus in diabetic patients without diabetic retinopathy (NDR). METHODS:This prospective study enrolled patients with type 2 diabetes and healthy controls from April to December 2020. Retinal sensitivity was measured by microperimetry. The peripapillary retinal nerve fibre layer (p-RNFL) thickness, macular retinal thickness, and retinal volume were measured by optical coherence tomography (OCT). The vessel density (VD) and perfusion density (PD) of the peripapillary area, as well as the foveal avascular zone (FAZ) area, FAZ perimeter, and FAZ circularity, were measured by optical coherence tomographic angiography (OCTA). RESULTS:A total of 71 cases (100 eyes) were enrolled in the study, including 34 cases (51 eyes) in the NDR group and 37 cases (49 eyes) in the control group. The mean retinal sensitivity was lower in the NDR group than in the control group for all sectors (all p < .001). Compared with controls, the NDR group showed thinner p-RNFL in the T sector (76.24 ± 14.29 vs. 85.47 ± 19.66 µm, p = .035). The NDR group had a thinner retina in the N2 sector (304.55 ± 16.07 vs. 312.02 ± 12.30 µm, p = .010). The PD of DCP was lower in the N2 sector in the NDR group (44.92 ± 11.77 vs. 50.27 ± 6.37%, p = .044). The VD was higher in the NDR group in RPCP-S/N/I, and the PD was higher in the RPCP-S/N (all p < .05). The frequencies of perifoveal capillary drop-out, notched or punched out borders of the superficial FAZ, and loss of smooth contour were all higher in the NDR group (all p < .05). CONCLUSION:The structure (p-RNFL thickness, VD, and PD) and function (retinal sensitivity) display some changes in diabetic patients even if they had not been found to have DR.Key messagesDecreased retinal sensitivity was observed in diabetic patients before the onset of diabetic retinopathy.Compared with the control group, we found the changes in vessel density or perfusion density in a certain area, whether in SCP, DCP, or RPCP in the NDR group.Before the onset of diabetic retinopathy, the structure and function of the retina in diabetic patients had changed.

目的 应用光学相干断层描血管成像技术(optical coherence tomog-raphy angiography,OCTA)观察无眼底病变的2型糖尿病患者的黄斑区微血管改变.方法 收集2型糖尿病患者89例入研究组,包括轻度非增殖期组(NPDR组)66例114眼,无眼底病变者(0期组)23例37眼,另收集正常39例61眼入对照组.应用OCTA对所有受试者黄斑区行3 mm×3 mm范围模式扫描,分别测量表层毛细血管丛(superficial capillary plexuses,SCP)、深层毛细血管丛(deep capillary plexuses,DCP)黄斑中心凹无血管区(foveal avascular zone,FAZ)面积以及SCP层、DCP层和脉络膜毛细血管层黄斑血流密度及血流密度百分比.结果 0期组SCP层、DCP层FAZ面积分别为(0.39±0.14)、(0.69±0.20),NPDR组分别为(0.44±0.16)、(0.80±0.32),对照组为(0.38±0.12)、(0.64±0.21),NPDR组各层FAZ面积高于对照组(t=2.89、3.66,P=0.013、0.001).0期组SCP层、DCP层和脉络膜毛细血管层黄斑血流密度分别为(1.71±0.23)、(1.80±0.26)、(3.21±0.22),NPDR组分别为(1.63±0.21)、(1.76±0.42)、(3.19±0.26),对照组分别为(1.70±0.36)、(2.09±0.34)、(3.19±0.22),0期组及NPDR组DCP层黄斑血流密度均值低于对照组(t=3.726、5.535,P<0.001).0期组SCP层、DCP层和脉络膜毛细血管层黄斑血流密度百分比分别为(14.06±2.74)、(15.33±2.95)、(35.42±6.00),NPDR组分别为(13.41±2.56)、(14.35±4.21)、(35.40±6.97),对照组分别为(13.33±3.71)、(17.98±4.24)、(35.18±6.21),0期组及NPDR组DCP层黄斑血流密度百分比均值低于对照组(t=-3.76、-5.46,P<0.05).在糖尿病患者中,病程5～10年以及≥10年的患者SCP层FAZ面积均值高于病程<5年的均值(t=-2.93、-2.41,P=0.012、0.017).结论 OCTA检查有助于发现早期糖尿病视网膜病变(diabetic retinopathy,DR).