Aim or purpose: To compare the survival rate, complication rate, marginal bone resorption, and facial bone thickness between narrow diameter implants and conventional diameter implants combined with GBR in the anterior areas Materials and methods: Fifteen patients with single anterior tooth lost and alveolar ridge widths of 6-6.6mm were selected. 8 sites were implanted with 3.0mm diameter implants, and 7 sites were implanted with 3.6mm diameter implants combined with GBR. Facial bone thickness and marginal bone levels were measured at T1(post-operation) and T2(secondary operation) using CBCT and analyzed. Implant stability was measured at T2. Complications were recorded from T1 to T2. Results: At T2, the survival rate of implants in both groups was 100% with no complications. The facial bone thickness of the conventional diameter implants was significantly greater at the middle and apical parts compared to the narrow diameter implants (P<0.05), with no significant difference at the neck; facial bone resorption was significantly higher at the neck and apical parts compared to the narrow diameter implants (P<0.05), with no significant difference at the middle part. There was no significant difference in marginal bone resorption between the two groups. Conclusions: There was no difference in implant survival rates or complications between the two groups. There were no significant differences in facial bone thickness and marginal bone resorption between the two surgical approaches, indicating that the use of narrow diameter implants alone can achieve clinical and radiological outcomes comparable to those of conventional diameter implants combined with GBR.

PURPOSE:To evaluate the clinical and retinal imaging features of Chinese patients with acute macular neuroretinopathy (AMN) associated with COVID-19. DESIGN:A prospective observational study. METHODS:Retinal imaging, including color fundus photography, near-infrared imaging (NIR), swept-source optical coherence tomography (SS-OCT), optical coherence tomography angiography (OCTA), and Humphrey perimetry, were conducted for each case. RESULTS:All cases were included within the first three months following the pandemic outbreak. A total of 12 male patients (36.36 %) and 21 female patients (63.64 %) were prospectively recruited, and 29 cases (87.88 %) were bilaterally affected. The median interval between the onset of fever and the appearance of ocular symptoms was two days (range, 0.5-5.0 days). Apart from the outer retinal changes typical of AMN, changes in the inner retinal layers were observed, including intraretinal hemorrhage (8.06 %), cotton wool spots (9.68 %), and paracentral acute middle maculopathy (PAMM) (8.06 %). Smaller retinal inner nuclear layer hyperreflective speckles (RIHS) (41.94 %) were identified as a distinguishing feature from typical PAMM. Voids of vessel signals were found in the superficial (11.54 %), intermediate (82.69 %), and deep capillary plexus (98.08 %), and in the choriocapillaris (19.23 %) on OCTA. Humphrey perimetry illustrated central, paracentral, and peripheral scotomas. The occult lesions associated with AMN, PAMM, and some of the RIHS illustrated by OCT were visualized topographically and further confirmed by OCTA as perfusion defects. CONCLUSION:An increase in AMN cases correlated with the SARS-CoV-2 outbreak. Additional features, including widespread inner retinal perfusion deficits, were observed and may serve as potential biomarkers for systemic microcirculation dysregulation in COVID-19.

Abnormalities in lipid metabolism have been proposed in Bietti’s crystalline dystrophy (BCD). We aim to characterize the lipid profiles in a case-control study. All participants were genetically confirmed by CYP4V2 gene sequencing and underwent chorioretinopathy evaluation by calculating the percentages of AF atrophy (PAFA). Fasting blood samples of BCD patients and controls were collected, and plasma was analyzed for routine lipid profiles. Targeted lipidomic evaluation includes long chain polyunsaturated fatty acids (LCPUFA) and associated eicosanoid metabolites. Routine lipids profiles showed elevated plasma levels of triglyceride (P = 0.043) and low-density lipoprotein cholesterol (P = 0.024) in BCD patients. Lipidomic analysis showed significantly decreased levels of ω-3 LCPUFA including docosahexaenoic acid (DHA, 22:6, P = 0.00068) and eicosapentaenoic acid (EPA, 20:5, P = 0.0016), as well as ω-6 LCPUFA arachidonic acid (ARA, 20:4, P < 0.0001) in BCD patients. Eicosanoid metabolites, either derived from ω-3 and/ or ω-6 LCPUFAs via cyclooxygenase (COX) or lipoxygenase (LOX) pathways, including 5-HEPE, 12-HEPE, 13-HDHA, 15-HETE, 12-HETE, 5-HETE, 6k-PGF1a, PGE2, PGJ2, and TXB2, exhibited significant differences (P < 0.0001) between BCD patients and controls. Genotypes of CYP4V2, specifically the biallelic null mutations, were observed to correlate with more remarkably reduced levels of oxylipins, involving major LOX pathway metabolites including 5-HETE, 5-HEPE, 12-HEPE and LTB4. BCD patients demonstrated significant decreases in plasma levels of ω-3 and ω-6 LCPUFA (DHA, EPA, and ARA), as well as their downstream metabolites via the COX and LOX pathways, suggesting that these might be implicated in BCD pathogenesis and could serve as biomarkers and therapeutic targets of the disease. What is known What is new

Purpose: To delineate the genotype and phenotype of RH in a Chinese cohort. Methods: A group of 51 Chinese probands with RH across 76 eyes was assembled and underwent complete retinal imaging examinations. Sanger sequencing and universal primer quantitative fluorescent multiplex–polymerase chain reaction (UPQFM-PCR) were employed for mutation detection in the coding region of the Von Hippel–Lindal (VHL) gene. For frequency calculation, our series was combined with three large cohorts of East Asian descent through a literature review. Results: The Von Hippel–Lindal (VHL) syndrome was excluded in fifteen patients (median age: 32.00 years) with unilateral solitary RH. Thirty-six patients of younger ages (median: 22.00 years, p = 0.008, Mann–Whitney test) conformed to the diagnostic criteria of the VHL syndrome, and thirty-four patients were genetically confirmed. There were four novel variants identified in the VHL gene. Codons 167, 161 and 86 exhibited a mutation occurrence of more than 5% after pooling with literature data, and the large genomic deletion demonstrated a frequency of 17.65%. The RHs were classified as “extrapapillary”, “juxtapapillary” and “mixed” types in 53, 7 and 5 eyes, respectively. Almost all extrapapillary RH lesions were found in the peripheral retina. Hemangioblastomas in the central nervous system (CNS) were observed in 25 out of 31 kindreds (80.65%) with full systemic evaluation data. Conclusions: VHL-associated RH might exhibit earlier onset than non-VHL RH. Large genomic deletions were observed at a notably high frequency in the Chinese series with VHL-associated RH, which might be associated with East Asian ethnicity background. RH could potentially serve as an early indicator of CNS hemangioblastoma.

Purpose: To investigate the effects of anterior chamber pigment dispersion on ocular immune privilege and the possible mechanisms involved in a DBA/2J mouse model of pigmentary glaucoma. Methods: DBA/2J mice were utilized as a pigment dispersion model, and age-matched C57BL/6J mice were used as the control group in this study. Proteins in the aqueous humor (AH) and serum were quantified using the bicinchoninic acid assay. Immune cells in the AH were detected using hematoxylin and eosin staining and immunocytochemistry. The expression of TGF-β2 in the AH and cytokine levels (IL-10, IFN-γ) in serum were measured using ELISA. Anterior chamber-associated immune deviation (ACAID) was induced in DBA/2J mice by injecting antigens into the anterior chamber. Delayed-type hypersensitivity (DTH) assays were used to assess the induction of ACAID. In DBA/2J mice, before and after pigment dispersion, following anterior chamber injection of pigment particles, and after ACAID modeling, the expression of regulatory T cells (Tregs) was detected using flow cytometry. Results: Compared to C57BL/6J mice, the protein concentration, immune cell count, and TGF-β2 levels in the AH were elevated in DBA/2J mice. Protein concentration and IL-10 levels in serum were increased, while IFN-γ levels were decreased in DBA/2J. Additionally, the expression of Treg cells in the spleen of DBA/2J mice was significantly increased after pigment dispersion and anterior chamber injection of pigment particles. At 3 and 6 months, DTH responses in DBA/2J mice were not inhibited, thus preventing ACAID induction. However, the opposite was observed at 9 months in DBA/2J mice. Furthermore, the ACAID group exhibited an augmented expression of Treg cells. Conclusions: Dispersion of pigment particles in the anterior chamber of the eye enhances the state of ocular immune privilege by influencing the immunosuppressive microenvironment and inducing more Treg cells to reestablish ACAID.

PURPOSE:To qualitatively and quantitatively characterise the genotypes and phenotypes of Bietti's crystalline dystrophy (BCD) in a cohort of patients. DESIGN:Cross-sectional and observational study. METHODS:Clinically confirmed BCD patients were recruited for genotyping and phenotyping. Multiple retinal imaging modalities were employed. Atrophy in the fovea was adopted as major consideration for staging strategy, while percentage area of autofluorescence (AF) atrophy (PAFA) in the macula was determined for quantitation. RESULTS:In 74 clinically diagnosed BCD patients, c.802-8_810del17insGC was shown the predominant variant of the CYP4V2 gene (allele frequency 55.4%). Sixty-two cases (123 eyes) with full imaging data were classified according to a modified criterion into stages 1 (n=8, 6.50%), 2A (n=9, 7.32%), 2B (n=17, 13.82%), 3A (n=30, 24.39%) and 3B (n=59, 47.97%). The eyes of the stage 2B were particularly deemed 'high risk' due to atrophy near fovea, while in stage 3A, though with remarkable foveal atrophy, preserved retinal pigment epithelium/photoreceptor islands near the fovea were found in 14 eyes. A tendency of increase in PAFA with age was found (rs=0.31, p=0.014). Significant PAFA increase was shown through stages 1 to 3B, and best-corrected visual acuity (BCVA, Logarithm of the Minimum Angle of Resolution) was shown to moderately correlate with PAFA (rs=0.56, p<0.001). CONCLUSION:The PAFA might be an efficient biomarker for BCD severities correlating with BCVA. The highly heterogeneous chorioretinopathy and BCVA of BCD cases appear to be associated with disease stages, progression types and patients' ages. Foveal involvement should be of a major concern for consideration of potential therapeutic intervention.

PURPOSE:This study aimed to evaluate the clinical and genetic characteristics of eight members from a Chinese Han family who displayed autosomal recessive bestrophinopathy (ARB)-like retinal changes in autosomal dominant (AD) inheritance pattern. METHODS:Clinical investigations included slit-lamp, tonometry, fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, electrooculography, and ultrasound biomicroscopy. Ocular axial length measurements were collected retrospectively. The targeted exome sequencing (TES) was applied for the genetic analysis of the proband. PCR-based Sanger sequencing was performed on the family for validation and co-segregation analysis. RESULTS:Eight members in the three-generation pedigree complained about vision loss and seven of them had detailed clinical assessments, demonstrating ocular phenotypes including extramacular and vascular arcades subretinal deposits and Arden ratio decline on electrooculography that resembled ARB. Bilateral anterior chamber structure abnormalities were observed in seven cases and three patients were diagnosed with angle-closure glaucoma. Despite clinical phenotypes supporting ARB, there was only a single heterozygous mutation of c.227T > C (p.Ile76Thr) in the BEST1 gene detected in all eight patients, which showcased AD inheritance. CONCLUSIONS:An ARB-like phenotype could be caused by a heterozygous mutation of the BEST1 gene and inherited in an AD fashion.

Posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE) is a challenging clinical dilemma. A retrospective single-center study was performed to investigate the clinical features, risk factors, outcomes, and clinical determinants of the prognosis of PRES in SLE. A retrospective study was performed from January 2015 to December 2020. 19 episodes of lupus PRES and 19 episodes of non-lupus PRES were identified. 38 cases of patients presenting with neuropsychiatric lupus (NPSLE) hospitalized during the same period were selected as controls. Survival status was acquired via outpatient and telephone follow-up in December 2022. The clinical neurological presentation of PRES in lupus patients was similar to that of the non-SLE-related PRES and NPSLE populations. Nephritis-induced hypertension is the predominant trigger of PRES in SLE. Disease flare and renal failure-triggered PRES were identified in half of the patients with SLE. The mortality rate of lupus-related PRES during the 2‑year follow-up was 15.8

Abstract Background: Scleral buckling surgery is still the preferred treatment option for some cases. However, there are still some deficiencies in its illuminating system and surgical procedures, especially for cases of children or adolescents with sticky vitreous accompanied by amount of subretinal fluid accumulation or large retinal tears, as well as cases with intraocular lens implantation or cases where the pupil should not be dilated during surgery. This study aimed to evaluate the modified surgical technique and outcomes of wide-angled endoillumination-assisted scleral buckling (SB) with intraocular irrigation during the procedure of subretinal fluid drainage for rhegmatogenous retinal detachment(RRDs). Methods : A series of 9 eyes of 9 consecutive patients with RRD who underwent the modified SB were included in this study. SB was performed under the wild-field noncontact lens attachend to lumera microcopewith a 25-gauge endoillumination probe. Intraocular irrigation was performed under an supranormal intraocular pressure to facilitates the external drainage of subretinal fluid under the direct visualization until complete retinal reattachment. Results : 8 patients underwent successful primary retinal detachment repair without any intraoperative or post-operative complications. In the other case, although the retina was reattached after the first operation, the retinal hole valve was further pulled due to the vitreous continuous contraction. One month after the operation, the retinal hole opened again, and retinal detachment progressed. Vitrectomy was performed. Conclusions : Wide-angled endoillumination and intraocular irrigation assisted scleral buckling surgery for RRDs, can provide good anatomical and functional outcomes with great advantages and low complication rate.

Purpose: To characterize the clinical features of macular neovascularization (MNV) secondary to Bietti crystalline dystrophy. Methods: The imaging data of 157 eyes in 79 patients with Bietti crystalline dystrophy were retrospectively reviewed. 12 individuals (19 eyes) were found to have MNVs. Multimodal retinal imaging was used to evaluate the features of MNVs and the primary chorioretinopathy. Results: The MNV lesions were shown as typical type 2 MNVs with subretinal hyperreflective material (SHRM), and usually detected along the borders of the retinal pigment epithelium/choriocapillaris dropout. The active MNVs were noted in earlier stages of Bietti crystalline dystrophy, while the activity was observed to be reduced in advanced cases. On spectral domain optical coherence tomography, the outer retinal structures were demonstrated to be partially preserved above the SHRMs compared with the extensive atrophy contiguously. Fibrotic scaring of the MNVs was commonly observed and arteriolarization was usually shown within the scars. Conclusion: MNV was demonstrated to be a common complication secondary to Bietti crystalline dystrophy. The lesions were typical type 2 MNV of varied activities possibly associated with the degrees of the primary degeneration. Choriocapillaris hypoperfusion may participate in MNV development.

Objective To develop a few-shot learning (FSL) approach for classifying optical coherence tomography (OCT) images in patients with inherited retinal disorders (IRDs).Methods In this study, an FSL model based on a student-teacher learning framework was designed to classify images. 2,317 images from 189 participants were included. Of these, 1,126 images revealed IRDs, 533 were normal samples, and 658 were control samples.Results The FSL model achieved a total accuracy of 0.974-0.983, total sensitivity of 0.934-0.957, total specificity of 0.984-0.990, and total F1 score of 0.935-0.957, which were superior to the total accuracy of the baseline model of 0.943-0.954, total sensitivity of 0.866-0.886, total specificity of 0.962-0.971, and total F1 score of 0.859-0.885. The performance of most subclassifications also exhibited advantages. Moreover, the FSL model had a higher area under curves (AUC) of the receiver operating characteristic (ROC) curves in most subclassifications.Conclusion This study demonstrates the effective use of the FSL model for the classification of OCT images from patients with IRDs, normal, and control participants with a smaller volume of data. The general principle and similar network architectures can also be applied to other retinal diseases with a low prevalence.

患者女性,47岁.因左眼突发无痛性视力下降10 d,于2020年9月20日就诊于首都医科大学附属北京同仁医院眼底病科.否认头痛、乏力、恶心等症状.无发热史,肌痛、远端关节痛.眼部检查:视力:右眼0. 8 ,左眼光感,矫正不提高,光定位不准;眼压:右眼 18 mmHg (1 mmHg =0. 133 kPa),左眼19 mmHg.双眼结膜无充血,角膜清,前房中深,左眼瞳孔轻度散大,直径约为4 mm,相对性传入性瞳孔障碍(relative afferent pupillary defect,RAPD)(±),双眼晶状体轻度混浊,余前节(-).散瞳查眼底:右眼眼底未见明显异常,左眼视乳头水肿,边界不清,表面可见少量线状出血(图1).外院自动量化视野检查显示与生理盲点相连的弓形暗点短期内迅速发展至全视野缺损.全身检查:红细胞沉降率(ESR)和C反应蛋白未见明显异常,血压100/60 mmHg.眼部辅助检查:相干光层析成像术(optical coherence tomo-graphy,OCT)示:左眼视盘反射隆起增厚,上下方显著,增厚以视神经纤维层为主,视盘前可见增生膜(图2).既往史:曾于当地医院行糖皮质激素冲击治疗(具体不详),患者自述视力未见明显改善.

Objective:To explore the effect of traditional Chinese medicine soothing and fixed pillow in patients after endothelial keratoplasty with anterior chamber gas injection.Methods:From October 2020 to May 2022, convenience sampling was used to select 60 patients who underwent endothelial keratoplasty in the Ophthalmology Ward of Beijing Tongren Hospital as the research object. The patients were divided into the intervention group and the control group by random number table method, 30 cases in each group. The control group was given routine perioperative nursing, while the intervention group was given the traditional Chinese medicine soothing and fixed pillow on the basis of the nursing of the control group. The General Information Questionnaire, General Comfort Questionnaire (GCQ) and Postural Compliance Questionnaire were used to evaluate the patients.Results:The total score and the scores of each dimension of GCQ in the intervention group were higher than those in the control group, on the day after operation, the first day after operation, and the second day after operation, the accumulative daily supine time were longer than those in the control group, and all the differences were statistically significant ( P<0.05) . Conclusions:The traditional Chinese medicine soothing and fixed pillow can improve the comfort of patients with endothelial keratoplasty in continuous supine position after operation, prolong the supine time after operation, and improve the compliance of postoperative position of patients with endothelial keratoplasty.

Objective We wanted to investigate the radial peripapillary capillary (RPC) network in patients with Bietti crystalline dystrophy (BCD). Methods We compared RPC densities in the disk and different peripapillary regions, obtained using optical coherence tomography angiography in 22 patients with BCD (37 eyes) and 22 healthy subjects (37 eyes). The BCD group was then divided into Stage 2 and Stage 3 subgroups based on Yuzawa staging, comparing the RPC densities of the two. Results The disk area RPC density was 38.8％ ± 6.3％ in the BCD group and 49.2％ ± 6.1％ in the control group (P < 0.001), and peripapillary region RPC density was significantly lower in the BCD group than in the control group (49.1％ ± 4.7％ and 54.1％ ± 3.0％, respectively, P < 0.001). There were no significant RPC density differences between the tempo quadrant and inside disk of Stages 2 and 3 subgroups; the other areas showed a significantly lower RPC density in Stage 3 than in Stage 2 BCD. Conclusion The BCD group RPC density was significantly lower than the control group. The reduction of RPC density in the tempo quadrant occurred mainly in the Stage 1 BCD. In contrast, the reduction of RPC density in superior, inferior, and nasal quadrants occurred mainly in Stage 2.

目的 探索医疗失效模式与效应分析在居家腹膜透析(腹透)患者管理的应用价值.方法 选取2020年1-6月该院腹透中心管理的居家规律腹透3个月及以上、年龄18～75岁患者68例作为研究对象,应用医疗失效模式与效应分析(HFMEA)对患者的管理进行风险评估,制订具体改进措施,比较该管理模式实施前后风险优先指数(RPN)值,以及患者居家腹透相关理论知识、腹透操作与外出口换药操作考核结果等.结果 应用HFMEA进行居家腹透患者管理后水肿、饮食与出入量不平衡、腹膜炎、心力衰竭、运动量不足等主要失效模式的RPN值明显下降,差异均有统计学意义(t=26.159、19.490、9.752、4.813、6.062,P<0.05);患者理论知识、透析操作与外出口换药操作考核成绩均明显提升,差异均有统计学意义(t=5.976、2.820、3.886,P<0.05).结论 应用HFMEA模式对居家腹透患者进行管理,对解决患者居家腹透相关问题、提高患者理论知识与操作能力是有效、可行的.

Bietti crystalline corneo-retinal dystrophy (BCD) is an autosomal recessive inherited retinal dystrophy characterized by multiple shimmering yellow-white deposits in the posterior pole of the retina in association with atrophy of the retinal pigment epithelium (RPE), pigment clumps, and choroidal atrophy and sclerosis. Blindness and severe visual damage are common in late-stage BCD patients. We generated a Cyp4v3 knockout mouse model to investigate the pathogenesis of BCD. This model exhibits decreased RPE numbers and signs of inflammation response in the retina. Rod photoreceptors were vulnerable to light-induced injury, showing increased deposits through fundoscopy, a decrease in thickness and a loss of cells in the ONL, and the degeneration of rod photoreceptors. These results suggest that an inflammatory response might be an integral part of the pathophysiology of BCD, suggesting that it might be reasonable for BCD patients to avoid strong light, and the results provide a useful model for evaluating the effects of therapeutic approaches.