Aim:To compare the efficacy of femtosecond laser assisted cataract surgery (FLACS) combined with pars plana vitrectomy (PPV) and conventional phacoemulsification surgery (CPS) combined with PPV in the treatment of cataract patients with fundus diseases. Methods:A retrospective analysis was conducted on 379 affected eyes from Shanghai Aier Eye Hospital from 01/02/2022 to 01/02/2025, divided into group A (n=182, 48%, FLACS+PPV) and group B (n=197, 52%, CPS+PPV), to compare surgical costs, best corrected visual acuity (BCVA), complications, and surgical time. Results:Postoperative visual acuity improved significantly in both groups (all P < 0.0001). For vitreous opacity (VO) patients, the BCVA improvement in group A (0.34±0.51) was significantly better than that in group B (0.15±0.52, P=0.03), with a shorter surgical time (45.22±8.15 vs 52.72±7.17 min, P < 0.0001) and lower complication rate (7.14% vs 11.68%). Overall, group A had a shorter surgical time (47.75±10.06 vs 59.22±11.6 min, P < 0.0001) and better postoperative BCVA (0.36±0.45 vs 0.49±0.48, P=0.0001) than group B, but higher surgical costs (21,600±9180 vs 15,399±2996 yuan, P < 0.0001). Conclusion:FLACS+PPV has excellent therapeutic effects but is expensive, while CPS+PPV has a high cost-effectiveness, and clinical selection should be based on the patient's condition.

AIM:To observe the postoperative efficacy and factors affecting refractive status following combined vitrectomy and cataract surgery for high myopia (HM) with cataract and vitreous opacities, and compare the differences in refractive status between eyes with and without posterior capsulotomy. METHOD:Retrospective case study, a total of 57 patients (81 eyes) diagnosed with HM complicated with cataracts and vitreous opacity at Shanghai Aier Eye Hospital between 01/01/2022 and 01/01/2025.were included in the study, who underwent pars plana vitrectomy (PPV) combined with cataract phacoemulsification and intraocular lens (IOL) implantation. Preoperative examinations included best corrected visual acuity (BCVA), IOL-master, and Pentacam, with IOL power calculated using the Barrett formula. Postoperative follow-up was conducted at 3 months, including BCVA and refraction assessment. Besides, compared and analyzed the refractive status of eyeballs with and without posterior capsule incision during surgery(60 eyes with posterior capsulotomy and 21 eyes with posterior capsule preservation). RESULTS:The mean axial length (AL) of patients' eyes was 29.77 ± 2.55 mm, and the mean preoperative BCVA was 0.64 ± 0.60 (LogMAR). Three months postoperatively, the mean BCVA improved to 0.40 ± 0.43 (LogMAR), showing a statistically significant improvement (P < 0.05). The mean postoperative spherical equivalent (SE) was -2.83 ± 1.57 degree (D), with an average deviation of -0.23 ± 0.55 (D) from the target refraction. The refractive deviation of all eyes was -0.23 ± 0.55D, and -0.20 ± 0.56D in the posterior capsulotomy group, which was less than -0.30 ± 0.53D in the posterior capsule preservation group compared with the target refractive deviation(p = 0.49). In addition, preoperative SE, postoperative SE, and reserved diopter were significantly correlated with postoperative refractive deviation (r = 0.37,p = 0.0007;r = 0.24,p = 0.03;r = 0.61,p < 0.0001), while age and anterior chamber depth (ACD) were respectively correlated with refractive deviation (r = 0.16,p = 0.22; r = -0.10,p = 0.39). CONCLUSION:Combined surgery for HM with cataract and vitreous opacities improves postoperative vision. The mean deviation between reserved refraction and target refraction is less than 0.5 D. Refractive deviation is significantly correlated with preoperative/postoperative SE and reserved degree, may have a positive correlation with age,and may be negatively correlated with ACD. Posterior cystectomy may also be one of the influencing factors in reducing refractive deviation.

Inherited retinal dystrophies (IRDs) represent heterogeneous genetic eye disorders frequently linked to RPE65 mutations. Voretigene neparvovec (VN, Luxturna), an AAV2-mediated gene therapy, remains the sole approved drug for biallelic RPE65-associated IRDs. This study presents 3-, 6- and 22-month follow-up findings of the first mainland Chinese patient with compound heterozygous RPE65-related Leber congenital amaurosis type 2 (LCA2) receiving sequential bilateral subretinal Luxturna injections. Binocular full-field stimulus threshold (FST) improvement was documented, and rod-dominant visual function improvement was verified via chromatic threshold difference analysis. No treatment-related adverse events were noted at the 3-month follow-up, while bilateral chorioretinal atrophic lesions, classified as treatment-emergent ocular findings with undetermined causal correlation to gene therapy, were detected at the 6-month visit, and these lesions further enlarged at the 22-month follow-up. Long-term assessment confirmed persistent improvement in dark-adapted visual function but not best-corrected visual acuity (BCVA). This single case demonstrates the favorable sustained dark-adapted rod function improvement of voretigene neparvovec in this Han Chinese patient with LCA2. Although obvious improvement in nyctalopia after early gene therapy has been observed in this patient, all FST data in this study are binocular integrated measurements that cannot be separated to evaluate individual monocular function. Further controlled cohort studies enrolling more Han Chinese participants are still required to verify whether early intervention provides more prominent and definitive relief of nyctalopia for patients carrying biallelic RPE65 variants.

Purpose: To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. Methods: Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. Results: Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 +/- 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). Conclusion: The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

Aim Utilizing a combination of micro-computed tomography (micro-CT) and anatomical techniques for the volumetric assessment of the eyeball and its constituents in Bama Miniature Pigs, New Zealand rabbits, and Sprague-Dawley(SD) rats. Method Six Bama Miniature pigs, New Zealand rabbits, and SD rats were enrolled in the study. Micro-CT and gross volumetric estimation of ocular volume were employed to acquire data on ocular volume, anterior chamber volume, lens volume, and vitreous cavity volume for each eye. Results The eyeball volume of pigs ranges from approximately 5.36 ± 0.27 to 5.55 ± 0.28 ml, the lens volume from approximately 0.33 ± 0.02 to 0.37 ± 0.06 ml, the anterior chamber volume from approximately 0.19 ± 0.05 to 0.28 ± 0.04 ml, and the vitreous volume is approximately 3.20 ± 0.18 ml. For rabbits, the eye volume, lens volume, anterior chamber volume, and vitreous volume range from approximately 3.02 ± 0.24 to 3.04 ± 0.24 ml, 0.41 ± 0.02 to 0.44 ± 0.02 ml, 0.23 ± 0.04 to 0.26 ± 0.05 ml, and 1.54 ± 0.14 ml, respectively. In SD rats, the volumes are 0.14 ± 0.02 to 0.15 ± 0.01 ml for the eyeball, 0.03 ± 0.00 to 0.03 ± 0.00 ml for the lens, 0.01 ± 0.00 to 0.01 ± 0.01 ml for the anterior chamber, and 0.04 ± 0.01 ml for the vitreous volume. Conclusion The integration of micro-CT and gross volumetric estimation of ocular volume proves effective in determining the eyeball volume in Bama Miniature Pigs, New Zealand rabbits, and SD rats. Understanding the volume distinctions within the eyeballs and their components among these experimental animals can lay the groundwork for ophthalmology-related drug research.

AimThe aim of this study was to confirm the presence of the form deprivation myopia (FDM) guinea pig eye-gut axis and investigate the relationship between serum vasoactive intestinal peptide (VIP), lipopolysaccharides (LPS), specific gut microbiota and their metabolites.Method20 specific-pathogen-free (SPF) guinea pigs were divided into the FDM and the control(Con) group. Following model induction, serum levels of VIP and LPS were quantified. A combination of 16S ribosomal ribosomal Ribonucleic Acid (rRNA) gene sequencing, non-targeted metabolomics and bioinformatics analysis were employed to identify disparities in gut microbiota and metabolites between the two groups of guinea pigs.ResultCompared to the control group, FDM guinea pigs exhibited a significant trend towards myopia, along with significantly elevated concentrations of LPS and VIP (p < 0.0001). Furthermore, Ruminococcus_albus emerged as the predominant bacterial community enriched in FDM (p<0.05), and demonstrated positive correlations with 10 metabolites, including L-Glutamic acid, Additionally,Ruminococcus_albus exhibited positive correlations with VIP and LPS levels (p<0.05).ConclusionThe findings suggest that the Ruminococcus_Albus and glutamate metabolic pathways play a significant role in myopia development, leading to concurrent alterations in serum VIP and LPS levels in FDM guinea pigs. This underscores the potential of specific gut microbiota and their metabolites as pivotal biomarkers involved in the pathogenesis of myopia.

PurposeTo determine whether pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for rhegmatogenous retinal detachment (RRD) could get better functional and anatomical outcomes.MethodsA comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the mean change of best corrected visual acuity (BCVA) from baseline and calculating the odd ratios (OR) for rates of epiretinal membrane (ERM) formation and recurrence of retinal detachment (RD).ResultsFourteen studies were selected, including 2259 eyes (825 eyes in the ILM peeling group and 1434 eyes in the non-ILM peeling group). There was no significant difference in terms of mean change in BCVA from baseline and the rate of RD recurrence (WMD = 0.02, 95% CI, -0.20 to 0.24, P = 0.86, and OR = 0.55, 95% CI, 0.24 to 1.26, P = 0.16), but ILM peeling was associated with a significantly lower frequency of postoperative ERM formation (OR = 0.13, 95% CI, 0.06 to 0.26, P<0.00001). Similar results were obtained in a sub-analysis based on macula-off RRD.ConclusionILM peeling results in similar BCVA, with same rate of RD recurrence, but lower rate of postoperative ERM development. ILM peeling could be considered in selected cases with risk factors that are likely to develop an ERM.

IntroductionDamage to retinal pigment epithelium (RPE) cells caused by oxidative stress is closely related to the pathogenesis of several blinding retinal diseases, such as age-related macular degeneration (AMD), retinitis pigmentosa, and other inherited retinal degenerative conditions. However, the mechanisms of this process are poorly understood. Hence, the goal of this study was to investigate hydrogen peroxide (H2O2)-induced oxidative damage and protective role of peroxiredoxin 6 (PRDX6) protein via EGFR/ERK signaling pathway in RPE cells. MethodsCells from a human RPE cell line (ARPE-19 cells) were treated with H2O2, and then cell viability was assessed using the methyl thiazolyl tetrazolium assay. Cell death and reactive oxygen species (ROS) were detected by flow cytometry. The levels of PRDX6, epidermal growth factor receptor (EGFR), P38 mitogen-activated protein kinase (P38MAPK), c-Jun N-terminal kinase (JNK), and extracellular signal-regulated kinase (ERK) were detected by Western blot assay. PRDX6 and EGFR were also detected via immunofluorescence staining. ResultsOur results show that H2O2 inhibited cell viability, induced cell death, and increased ROS levels in ARPE-19 cells. It was also found that H2O2 decreased the levels of PRDX6, EGFR, and phosphorylated ERK but increased the levels of phosphorylated P38MAPK and JNK. PRDX6 overexpression was found to attenuate H2O2-induced inhibition of cell viability and increased cell death and ROS production in ARPE-19 cells. PRDX6 overexpression also increased the expression of EGFR and alleviated the H2O2-induced decrease in EGFR and phosphorylated ERK. Moreover, inhibition of epidermal growth factor-induced EGFR and ERK signaling in oxidative stress was partially blocked by PRDX6 overexpression. DiscussionOur findings indicate that PRDX6 overexpression protects RPE cells from oxidative stress damage caused by decreasing ROS production and partially blocking the inhibition of the EGFR/ERK signaling pathway induced by oxidative stress. Therefore, PRDX6 shows promise as a therapeutic target for the prevention of RPE cell damage caused by oxidative stress associated with retinal diseases.

Aim: Myopia is a common chronic eye disease, this study is to investigate the effects of exogenous retinoic acid (RA) on intraocular parameters, especially choroidal thickness (CT) and retinal thickness (RT), in guinea pigs with form deprivation myopia (FDM). Methods: A total of 80 male guinea pigs were divided randomly into 4 groups: Control, FDM, FDM + RA, and FDM + Citral groups. The FDM + RA group was given 24 mg/kg RA dissolved in 0.4 mL peanut oil; the FDM + Citral group was given citral 445 mg/kg dissolved in 0.4 mL peanut oil; The other two groups were given 0.4 mL peanut oil. After 4 weeks, the refractive error (RE), axial length (AL), and intraocular pressure (IOP) of all guinea pigs were measured, and the parameters of RT and CT were obtained using enhanced depth imaging optical coherence tomography (EDI-OCT). Results: After 4 weeks, both the RE and AL in the FDM and FDM + RA groups were increased, and the RT and CT in both groups were smaller than those in the Control group (p < 0.05). Only the IOP of the right eye in the FDM + RA group increased significantly (p < 0.05). The RT of the right eye of the 4 groups was compared: Control group > FDM + Citral group > FDM group > FDM + RA group. Compared with the RT of the left eye and the right eye among the 4 groups, the RT of the right eye in the FDM and FDM + RA groups was significantly less than that in the left eye (p < 0.05). Moreover, the CT of the right eye in the Control group was greater than that in the other three groups (p < 0.0001). There was no significant difference in the CT among the FDM, FDM + RA, and FDM + Citral groups (p > 0.05). In contrast to the RT results, the CT results of the left and right eyes in the FDM + Citral group showed statistically significant differences (p < 0.05). Conclusion: RA participates in the progression of FDM as a regulatory factor. Exogenous RA can increase the RE, AL, and IOP of FDM guinea pigs, and might aggravate the retinal thinning of FDM guinea pigs. Citral can inhibit these changes, but RA might not affect the thickness of the choroid.

Background. To report the outcomes of phacoemulsification combined with vitrectomy in eyes with extreme myopia (-30 diopters or more). Case Presentation. Three patients with cataract, vitreous opacities, and extreme myopia of more than -30 diopters underwent a combined surgical procedure of cataract extraction combined with vitrectomy. Postoperative refractive correction of the three cases ranged from -1.0 D to -2.5 D spherical equivalent. There was an obvious hyperopic shift of all cases. All patients noted a significant improvement in uncorrected and best-corrected visual acuity from 0.4 to 0.8 in case 1, from CF/70 cm to 1.0 in case 2, and from 0.12 to 0.5 in the right eye and 0.15 to 0.2 in the left eye in case 3. Vitreous floaters disappeared in all cases. No complications were noted during follow-up. Conclusions. To the best of the authors’ knowledge, these represent the first reported clinical cases of combined cataract extraction+vitrectomy surgery in eyes with extreme (>-30 D) myopia. Our results support the notion that phacoemulsification combined with vitrectomy may be a good therapeutic option for cataracts and vitreous floaters in cases with extreme myopia.

Background Obtaining accurate axial length (AL) is very important for the establishment of animal models of myopia. The purpose of this study is to compare the accuracy of Quantel A-B scan, OD-1 A scan, and vernier caliper in measuring AL in Sprague Dawley (SD) rats. Methods In total, 60 5-week-old SD rats were divided into female rat group ( n = 30) and male rat group ( n = 30). Quantel A-B scan and OD-1 A scan were, respectively, used to measure the AL of both eyes of each living rat, and vernier caliper was used to measure the anterior-posterior diameter of each rat’s eyeball. Besides, the correlation between refractive error (RE) and AL measured by different instruments was evaluated, and the accuracy of the three measurement methods was compared according to gender and left/right eyes. Results There were significant differences in AL and diopter of SD rats at the same age ( p < 0.05). the AL of male rats was greater than that of female rats, while diopter (D) was the opposite; There was no significant difference in AL and D between left and right eyes in the same SD rats ( p > 0.05); There were statistical differences among the three measurement methods ( p < 0.05), AL measured by vernier caliper was the largest, followed by Quantel A-B scan, OD-1 A scan; Difference in AL between male and female was not statistically significant between the results obtained by Quantel A-B scan and vernier caliper ( p > 0.05), but there were statistically significant differences between the other two measurement methods ( p < 0.05). Conclusion Sex is the influencing factor of AL and RE. Imaging measurement can accurately measure the AL in living small rodents. Compared with OD-1 A scan, Quantel A-B scan may be more accurate.

AIM: To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients. METHODS: Two researchers independently searched PubMed, Cochrane Library, Web of Science, and other databases to screen studies comparing best-corrected vision acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. Post-treatment chorioretinal atrophy (CRA) is a secondary outcome indicator. The retrieval time limit is from the database construction to January 30, 2023. RESULTS: A total of 1072 eyes in 16 articles were included. In the RCTs, intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) were superior to PDT (MD=0.18, 95%CI: 0.02, 0.40, MD=0.18, 95%CI: 0.01, 0.42) in improving BCVA of mCNV patients (P<0.05). The relative effectiveness in improving BCVA, from high to low, appeared to be IVR, intravitreal aflibercept (IVA), IVB, LT, PDT, and sham first followed by IVA (Sham/IVA). While improving the FCT from high to low was IVA, IVR, IVB, PDT. In retrospective studies, the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA, intravitreal conbercept (IVC), IVR, IVB, IVB/IVR, PDT with IVB/IVR, PDT. The effect of improving FCT was IVA, IVR, IVC, PDT, and IVB from high to low. And in the effects of improving CRA, the IVB appeared to be higher than IVR, while the PDT was the smallest, but none of the differences in the results were statistically significant. CONCLUSION: Anti-VEGF has the best effect on long-term vision improvement in mCNV patients, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT. There is no significant difference in the improvement of visual acuity, macular edema, and CRA in mCNV patients treated with any different anti-VEGF drugs.

Background: Conbercept, as a novel vascular endothelial growth factor (VEGF) inhibitor, was approved for the treatment of neovascular age-related macular degeneration (nAMD) in China. Objective: This study aimed to compare the efficacy and safety between conbercept and ranibizumab in patients with nAMD. Methods: Several databases (PubMed, Web of Science, China National Knowledge Infrastructure, and WANFANG) were searched for the results of studies describing conbercept and ranibizumab for the treatment of nAMD. Sixteen randomized controlled trials including 1,224 eyes met our search criteria and were assessed. Results: Conbercept and ranibizumab had comparable effects on improving visual acuity at 3 months (standardized mean difference [SMD]: -0.19; 95% confidence interval [CI]: -0.46 to 0.08; p = 0.17) and 6-12 months (SMD: -0.01; 95% CI: -0.20 to 0.18; p = 0.90). At 3 months and 6-12 months, the differences in the change of central macular thickness in conbercept and ranibizumab groups were 1.06 mu m (95% CI: -3.52 to 5.64; p = 0.65) and -0.12 mu m (95% CI: -9.26 to 9.02; p = 0.98). In the short term, there was no significant difference between the 2 groups with respect to ocular adverse events (odds ratio [OR]: 0.86; 95% CI: 0.46-1.61; p = 0.63). No significant differences were observed in the recovery rate of choroidal neovascularization leakage between conbercept and ranibizumab at both 3 months (OR: 1.49; 95% CI: 0.83-2.68; p = 0.18) and 6-12 months (OR: 0.66; 95% CI: 0.18-2.43; p = 0.53). There were significant differences between conbercept and ranibizumab in terms of decreasing intraocular pressure (weighted mean difference [WMD]: -1.74; 95% CI: -2.28 to -1.20; p < 0.00001), the plasma VEGF level (WMD: -21.49; 95% CI: -26.28 to -16.70; p < 0.00001), and the C-reactive protein level (WMD: -1.16; 95% CI: -1.45 to -0.87; p < 0.00001) in the short term. Conclusion: Conbercept was similar to ranibizumab in terms of efficacy and safety for the treatment of nAMD in China. Further studies with longer term observation are needed to support this conclusion. (c) 2021 The Author(s).Published by S. Karger AG, Basel

Abstract Purpose: In order to evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs, photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients were evaluated in a mesh meta-analysis. Methods: Two researchers independently searched PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, Embase, and other databases to screen RCTs and retrospective studies comparing best-corrected visual acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. The retrieval time limit is from the database construction to November 30, 2021. ADDIS1.16.8 and R 3.5.3 software were used to conduct mesh meta-analyses of RCTs and retrospective studies, respectively. Results: A total of 601 eyes in 8 RCTs involving 6 treatment options: intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), intravitreal conbercept (IVC), intravitreal aflibercept (IVA), LT, PDT, sham first followed by IVA (Sham /IVA). The results of the mesh meta-analysis showed that: in the RCTs, IVB and IVR were superior to PDT [MD=0.18, 95%CI (0.01, 0.42)] in improving BCVA of mCNV patients, and all the therapeutic effects from high to low might be intravitreal IVA, IVB, IVR, LT, Sham/IVA, and PDT; the order of FCT thickness reduction from high to low is IVA, IVR, IVB, PDT. In addition, the results of BCVA after long-term treatment in retrospective studies showed that all the therapeutic effects from high to low might be IVA, IVC, IVB /IVR, IVB, IVR, PDT, PDT with IVB /IVR; as for the order of FCT thickness reduction from high to low is IVA, IVC, IVR, IVB, PDT. Conclusions: Anti-VEGF treatment in patients with long-term improvement in mCNV vision effect is best, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT; There was no significant difference in the improvement of visual acuity and macular edema in mCNV patients with different anti-VEGF drugs. Due to the limited number and quality of included literature, the above conclusions need to be confirmed by more large-sample and high-quality articles.

Myopic traction maculopathy (MTM) is the leading cause of visual loss in high myopia. The purpose of this study was to compare the outcomes of pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane (ILM) peeling and complete ILM peeling for MTM. A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the change of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) from baseline and calculating the odd ratios (OR) for rates of complete reattachment (CR) and postoperative macular hole (MH) formation. Ten studies were selected, including 417 eyes (172 eyes in the fovea-sparing ILM peeling group (FSIP) and 245 eyes in complete ILM peeling group (CIP)). There was no significant difference in terms of mean change in CFT from baseline and the rate of CR(WMD = 3.53, 95% CI, −25.56 to 32.63, P = 0.81, and OR = 1.41, 95% CI, 0.81 to 2.44, P = 0.22). FSIP was superior to CIP in terms of mean change of logMAR BCVA post operation (WMD = −0.09, 95% CI, −0.15 to −0.03, P = 0.003), and associated with a significantly lower frequency of postoperative MH formation (OR = 0.19, 95% CI, 0.07 to 0.50, P = 0.0008). FSIP resulted in similar anatomic outcomes compared to CIP, but resulted in better visual acuity and lower rates of postoperative MH development.

Purpose To evaluate the efficacy of intravitreal conbercept (IVC) in pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR). Methods A meta-analysis of randomized control trials (RCTs) using online databases was performed. The intraoperative outcome measures were the incidence of intraoperative bleeding and endodiathermy application, and the mean surgical time. The postoperative outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline, postoperative vitreous clear-up time and incidence of recurrent vitreous hemorrhage (VH). Results Eight RCTs were selected for meta-analysis. They included 409 eyes (215 eyes in IVC group and 194 eyes in no conbercept group). Preoperative IVC application was associated with less intraoperative bleeding and endodiathermy applications (RR = 0.34, 95% CI, 0.23–0.50, P < 0.00001, and RR = 0.26, 95% CI, 0.12–0.56, P = 0.0005) compared to no conbercept. It also shortened surgical time (WMD = −15.87, 95% CI, −22.04 to −9.69, P < 0.00001). In addition, preoperative or intraoperative IVC achieved better BCVA outcome (WMD = −0.37, 95% CI, −0.62 to −0.13, P = 0.003), shorter vitreous clear-up time postoperatively (WMD = −5.44, 95% CI, −6.31 to −4.57, P < 0.00001) and a lower rate of VH recurrence (RR = 0.45, 95% CI, 0.22–0.91, P = 0.03). Conclusion IVC is an effective adjuvant in PPV for PDR, with better intraoperative and postoperative outcomes.

Objective: To investigate the safety and efficacy of topical anesthesia combined with subconjunctival anesthesia (termed two-step anesthesia) for 23- or 25-gauge pars plana vitrectomy or other posterior segment surgery. Methods: Patients (n = 90) requiring 23-/25-gauge vitrectomy or other posterior segment surgery were randomized into 3 groups. Group 1 received peribulbar anesthesia, group 2 received retrobulbar anesthesia and group 3 received two-step anesthesia. A 5-point visual analog pain scale (VAPS) was used to measure self-report of patient pain. Complications were recorded for subsequent analysis. Results: VAPS scores for overall intraoperative pain ranged from 0 to 3 (1.07 ± 1.07) in group 1, from 0 to 2 (0.69 ± 0.93) in group 2 and from 0 to 3 (1.06 ± 0.98) in group 3. Assessment of surgeon discomfort score ranged from 0 to 2 (0.31 ± 0.66) in group 1, from 0 to 3 (0.38 ± 0.82) in group 2 and from 0 to 2 (0.47 ± 0.62) in group 3. Both scores reveal no significant difference among the 3 groups. While there were no complications noted in group 1, there was an ocular perforation in group 2. Additionally, there were no complications in group 3 related to the anesthetic technique. Conclusions: Results suggest that two-step anesthesia is a safe and effective anesthetic approach for selected patients undergoing 23- or 25-gauge pars plana vitrectomy or other posterior segment surgeries. It may offer a viable alternative to peribulbar anesthesia and retrobulbar anesthesia for carefully selected 23- or 25-gauge cannular-access ocular surgeries.

As the peroxisome proliferator - activated receptor alpha (PPARα) agonist, fenofibrate has been widely used to be a good lipid-regulating drug in the clinical application. In this study, we investigated the mechanism by which keratocytes inhibit the corneal neovascularization (CNV) through PPARα - activation. To do this, the CNV model was established by alkali burn, followed by being divided into three groups including control, fenofibrate and vehicle group. The expression of VEGFr3, MMP13 and PPARα in corneas of normal mouse and alkali-burned mouse was determined via quantitative RT- PCR (qRT-PCR) and Western blot analysis (WB). The CNV area was observed under a slit lamp microscope. The location of PPARα expression in the corneas was determined via immunohistochemistry. In cultured primary keratocytes, the effect of fenofibrate on PPARα, VEGFr3 and MMP13 expression was determined by qRT-PCR and WB. Besides, PPARα knockout (PPARα-/-) mouse CNV and keratocytes model were established to further confirm the effect of PPARα on VEGFr3 and MMP13 expression. We found that PPARα was expressed in epithelium, stroma and endothelium of the normal cornea, however, with relatively low level in the corneal stroma. Meanwhile, its expression was decreased markedly in the cornea during the stage of CNV formation. After treatment of fenofibrate, PPARα expression was promoted and the expression of VEGFr3 and MMP13 was inhibited in both CNV mice model and primary keratocytes, and CNV areas were decreased in CNV mice model. However, the results in PPARα-/- CNV and keratocytes model were opposite. Our results suggest that keratocytes could promote the expression of VEGFr3 and MMP13, and CNV formation through PPARα downregulation.