PURPOSE. Glaucoma is the leading cause of irreversible blindness worldwide and encompasses a group of diseases characterized by optic nerve atrophy and visual field defects. Acute intraocular pressure (IOP) elevation is a key driver of retinal inflammation and optic nerve damage, often accompanied by microglial activation and dysregulated ferroptosis pathways. Vitamin K1, a fat-soluble vitamin, possesses anti-inflammatory and antioxidant properties, and has the potential to regulate ferroptosis. However, its mechanisms in alleviating retinal inflammation following acute IOP elevation remain unclear. METHODS. In vivo, we established a mouse model of acute ocular hypertension to evaluate the protective effects of vitamin K1 on the retina and visual function. Transcriptome sequencing was used to explore the underlying mechanisms by which vitamin K1 exerts its effects. Immunofluorescence and Western blot were used to assess retinal inflammation and observe ferroptosis in microglia. In vitro, we developed a BV2 cell OGDR model to investigate the regulatory effects of vitamin K1 on iron metabolism and inflammation in microglia. RESULTS. Our findings demonstrated that acute IOP elevation led to microglial activation, along with iron overload and ferroptosis in microglia. Further analyses revealed that microglial ferroptosis was accompanied by an upregulation of inflammatory cytokine gene expression and protein levels. Vitamin K1 intervention, however, inhibited microglial ferroptosis, alleviated retinal inflammation, minimized retinal ganglion cell (RGC) loss, and protected visual function. CONCLUSIONS. In conclusion, this study demonstrates that vitamin K1 exerts a protective effect by modulating microglial ferroptosis, thereby alleviating acute ocular hypertension-induced retinal inflammation.

Purpose:To investigate changes in anterior scleral thickness (AST) in patients with Posner-Schlossman Syndrome (PSS). Methods:Sixty-two patients with PSS were enrolled. AST was measured using swept-source optical coherence tomography at 0 mm (AST0), 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) from the scleral spur. Results:AST0, AST1, AST2, and AST3 were significantly reduced in PSS-affected eyes compared with that in fellow eyes. Furthermore, we divided patients into two subgroups based on the course of PSS: the short-term (PSS course < 1 year) subgroup and the long-term (PSS course ⩾ 1 year) subgroup. In the short-term subgroup, no significant differences in AST parameters (AST0, AST1, AST2, and AST3) were observed in PSS-affected and fellow eyes, while in the long-term subgroup, all the AST parameters (AST0, AST1, AST2, and AST3) were significantly reduced in PSS-affected eyes compared with that in fellow eyes. Conclusions:PSS-affected eyes demonstrated significantly reduced AST compared with that in fellow eyes. Moreover, a significant reduction of the AST was observed in long-term PSS-affected eyes, but not in short-term PSS-affected eyes. This indicates that changes in AST in PSS are time-dependent and progressive. Significant reduction of the AST is observed only after a certain period of time.

Neuroinflammation, characterized by microglial activation and the release of multiple inflammatory mediators, is a key factor in acute glaucomatous injury leading to retinal ganglion cell (RGC) death and ultimately irreversible vision loss. Irisin, a novel exercise-induced myokine, has demonstrated anti-inflammatory activity in ischemia/reperfusion injuries across multiple organs and has displayed a significant neuroprotective role in experimental stroke disease models. This study examined the protective impact of irisin and investigated its potential mechanism involved in this process utilizing an acute ocular hypertension (AOH)-induced retinal injury model in mice and a microglia inflammation model induced by lipopolysaccharide (LPS). There was a transient downregulation of irisin in the retina after AOH injury, with parallel emergence of retinal neuroinflammation and RGC death. Irisin attenuated retinal and optic nerve damage and promotes the phenotypic conversion of microglia from M1 to M2. Mechanistically, irisin significantly upregulated the expression of integrin alpha VI35, pAMPK, and autophagy-related markers. Integrin alpha VI35 was highly expressed on microglia but hardly expressed on RGC. The integrin alpha VI35 inhibitor cilengitide, the AMPK inhibitor dorsomorphin, and the autophagy inhibitor 3Methyladenine (3 -MA) blocked the neuroprotective effects of irisin. Our results suggest irisin attenuates acute glaucoma-induced neuroinflammation and RGC death by activating integrin alpha VI35/AMPK in microglia and promoting autophagy. It should be considered a potential neuroprotective therapy for acute glaucoma.

Neuroinflammation, characterized by microglial activation and the release of multiple inflammatory mediators, is a key factor in acute glaucomatous injury leading to retinal ganglion cell (RGC) death and ultimately irreversible vision loss. Irisin, a novel exercise-induced myokine, has demonstrated anti-inflammatory activity in ischemia/reperfusion injuries across multiple organs and has displayed a significant neuroprotective role in experimental stroke disease models. This study examined the protective impact of irisin and investigated its potential mechanism involved in this process utilizing an acute ocular hypertension (AOH)-induced retinal injury model in mice and a microglia inflammation model induced by lipopolysaccharide (LPS). There was a transient downregulation of irisin in the retina after AOH injury, with parallel emergence of retinal neuroinflammation and RGC death. Irisin attenuated retinal and optic nerve damage and promotes the phenotypic conversion of microglia from M1 to M2. Mechanistically, irisin significantly upregulated the expression of integrin αVβ5, p-AMPK, and autophagy-related markers. Integrin αVβ5 was highly expressed on microglia but hardly expressed on RGC. The integrin αVβ5 inhibitor cilengitide, the AMPK inhibitor dorsomorphin, and the autophagy inhibitor 3-Methyladenine (3-MA) blocked the neuroprotective effects of irisin. Our results suggest irisin attenuates acute glaucoma-induced neuroinflammation and RGC death by activating integrin αVβ5/AMPK in microglia and promoting autophagy. It should be considered a potential neuroprotective therapy for acute glaucoma.

AIM: To preliminarily assess the efficacy and safety of PAUL glaucoma implant in glaucoma management.METHODS: Clinical data of 10 glaucoma patients(10 eyes)who treated with Paul's glaucoma implant from March 2022 to January 2023 were retrospectively analyzed. A follow-up of 12 mo was performed to observe changes in visual acuity, intraocular pressure, and number of anti-glaucoma medications before and after surgery.RESULTS: Included patients had no significant change in visual acuity from preoperative to last follow-up; preoperative intraocular pressure was 19-60(median 28)mmHg, and it was 10-18(median 14)mmHg at last follow-up. All patients required two to four antiglaucoma medications preoperatively, and only 1 case needed medications at final follow-up. Four patients had a significant decrease in corneal endothelial cell density compared with the preoperative period, and no corneal-related complications occurred. At final follow-up, all 10 patients met surgical success criteria.CONCLUSION: PAUL glaucoma implant has significant IOP lowering efficacy and that corneal endothelial cell damage may be a pitfall of its presence.

Précis: Lower response of aqueous outflow pathway structures after pilocarpine could be observed in primary open angle glaucoma (POAG) patients, which is likely to be helpful for understanding intraocular pressure (IOP) evaluation in glaucoma. Purpose: To evaluate the morphologic changes in the trabecular meshwork (TM), Schlemm canal (SC), scleral spur (SS), and ciliary muscle after miosis in patients with POAG and healthy individuals. Methods: A total of 30 patients with POAG and 26 healthy controls were recruited. All participants underwent complete ophthalmologic examinations, including IOP and swept-source optical coherence tomography (OCT), before and 1 hour after the local administration of pilocarpine (2%). OCT measurements included TM thickness and width, SC diameter and area, SS length, ciliary muscle thickness, and ciliary muscle angle (CMA). Results: Pilocarpine administration induced a decline in IOP (15.6±2.3–14.6±2.2 mm Hg), decrease in nasal SS length (196.31±47.75–171.52±33.93 μm), decrease in TM thickness (90.18±16.43–83.02±13.74 μm), and increase in SC diameter (134.84±32.28–162.08±48.67 μm) and SC area (3851.37±1455.07–4801.39±1762.37 μm 2 ) among healthy controls. In contrast, no significant changes in IOP and OCT measurements were found in patients with POAG. At baseline, CMA was independently correlated with IOP in normal eyes. After miosis, the change in TM thickness was independently correlated with changes in IOP in normal eyes; in eyes with POAG, changes in SS length and CMA were independently associated with changes in IOP. Conclusions: Topical pilocarpine-induced morphologic changes to outflow pathway structures in healthy individuals without significant changes in POAG. The lower response observed in patients with glaucoma may be relevant to understanding IOP changes.

Introduction: The aim of this study was to investigate and compare the anterior segment biometrics in high myopia and control groups. Methods: Thirty-four eyes of 34 high myopia patients and 42 eyes of 42 control subjects were included. Schlemm’s canal (SC) area, trabecular meshwork (TM) thickness and length, scleral spur (SS) length, and anterior scleral thickness (AST) were measured using swept-source optical coherence tomography. Associations between SC area, TM thickness, TM length, SS length, and AST were also estimated. Results: SC area, TM thickness, and SS length were significantly associated with AST0 (AST at 0 mm from SS) in both high myopia and control groups. AST0 (702.61 ± 78.05 vs. 729.12 ± 95.87 μm, p = 0.085) and SS length (206.25 ± 52.25 vs. 212.09 ± 51.86 μm, p = 0.556) were not significantly different between high myopia and control groups, whereas SC area (6,622.68 ± 1,130.06 vs. 6,105.85 ± 1,297.84 μm2, p = 0.015) was significantly greater and TM thickness (96.15 ± 34.40 vs. 107.93 ± 29.97 μm, p = 0.048) was significantly thinner in high myopia group than in control group. Conclusion: SC area and TM thickness were significantly associated with AST0, while AST0 and SS length were not significantly different between high myopia and control groups. The changes in SC and TM dimensions in high myopia eyes might be caused by factors other than AST0 and SS length.

Purpose To investigate the effect of endothelin-1 (ET-1) in excessive accumulation of extracellular matrix (ECM) of the trabecular meshwork (TM) and its role in intraocular pressure (IOP) regulation. Methods Cultured human TM cells (HTMCs) were treated with ET-1, ET-1 + ETA receptor (ETAR) antagonist BQ123, ET-1 + ETB receptor (ETBR) antagonist BQ788. The expressions of fibronectin (FN) and collagen type IV (Col IV) were evaluated by western blotting and immunofluorescence. A time course effect of ET-1 on the transcription level of connective tissue growth factor (CTGF) was investigated by qRT-PCR. Next, the transcription level of CTGF was downregulated by using antisense oligodeoxynucleotide sequence. Then HTMCs were treated with ET-1, and the expression levels of FN and Col IV were evaluated by western blotting. In addition, by using an ex-vivo model of cultured anterior eye segment, we explored the effect of ET-1 on IOP changes and the expressions of FN and Col IV. Results In cultured HTMCs, the expressions of FN and Col IV were significantly increased after ET-1 treatment, which were blocked by the pretreatment of ETAR antagonist BQ123, rather than ETBR antagonist BQ788. Besides, the CTGF mRNA level increased significantly and reached a peak after 48 h of ET-1 treatment. However, the effect of ET-1 on increasing the expressions of FN and Col IV in HTMCs could be inhibited by the downregulation of CTGF. In an ex-vivo model, IOP increased significantly after ET-1 administration, which could be blocked by BQ123 but not by BQ788. Furthermore, elevated expressions of FN and Col IV in TM were observed after ET-1 perfusion, and could be inhibited by BQ123 pretreatment. Conclusion Excessive ET-1 in aqueous humor could lead to the abnormal accumulation of FN and Col IV in TM via the ETA-CTGF pathway, thereby increasing IOP.

AIM:To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA).METHODS:In this cross-sectional comparative study, 30 healthy participants were enrolled. Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA before and after water loading. The area, height, width, location depth and blood flow of the aqueous vein and conjunctival vein were measured by Image J software.RESULTS:In the static state, the area of the aqueous vein was 8166.7±3272.7 µm2, which was smaller than that of the conjunctival vein (13 690±7457 µm2, P<0.001). The mean blood flow density of the aqueous vein was 35.3%±12.6%, which was significantly less than that of the conjunctival vein (51.5%±10.6%, P<0.001). After water loading, the area of the aqueous vein decreased significantly from 8725.8±779.4 µm2 (baseline) to 7005.2±566.2 µm2 at 45min but rose to 7863.0±703.2 µm2 at 60min (P=0.032). The blood flow density of the aqueous vein decreased significantly from 41.2%±4.5% (baseline) to 35.4%±3.2% at 30min but returned to 45.6%±3.6% at 60min (P=0.021).CONCLUSION:The structure and blood flow density of the aqueous vein can be effectively evaluated by OCT and OCTA. These may become biological indicators to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.

In the proposed network, the features were first extracted from the gonioscopically obtained anterior segment photographs using the densely-connected high-resolution network. Then the useful information is further strengthened using the hybrid attention module to improve the classification accuracy. Between October 30, 2020, and January 30, 2021, a total of 146 participants underwent glaucoma screening. One thousand seven hundred eighty original images of the ACA were obtained with the gonioscope and slit lamp microscope. After data augmentation, 4457 images are used for the training and validation of the HahrNet, and 497 images are used to evaluate our algorithm. Experimental results demonstrate that the proposed HahrNet exhibits a good performance of 96.2% accuracy, 99.0% specificity, 96.4% sensitivity, and 0.996 area under the curve (AUC) in classifying the ACA test dataset. Compared with several deep learning-based classification methods and nine human readers of different levels, the HahrNet achieves better or more competitive performance in terms of accuracy, specificity, and sensitivity. Indeed, the proposed ACA classification method will provide an automatic and accurate technology for the grading of glaucoma.

Purpose The purpose of this study was to investigate trabecular meshwork (TM) and Schlemm's canal (SC) morphology in Posner-Schlossman syndrome (PSS). Methods Forty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography. Results TM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm2 vs. 5445.69 ± 1368.89 µm2, P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm2 vs. 5476.40 ± 1390.15 µm2, P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05). Conclusions TM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.

Purpose: To investigate iris atrophy in Posner–Schlossman syndrome (PSS). Methods: Sixty-one patients with PSS were included. Using swept-source optical coherence tomography, the thickness of anterior border layer (A), middle stromal layer (M), and the posterior pigmented epithelial layer (P) of iris were measured at 500 μm, 1000 μm, 1500 μm, 2000 μm, and 2500 μm from the pupillary edge in both PSS-affected and fellow eyes. The relationships between iris thickness and corneal endothelium density, cup-to-disc (C/D) ratio, and retinal nerve fiber layer (RNFL) thickness were also estimated in PSS-affected eyes. Results: Iris thickness parameters, including M500, M1000, A1500, A2000, P2000, and P2500, were significantly thinner in PSS-affected eyes than in fellow eyes (all p < 0.05). Moreover, M500 and M1000 were significantly associated with corneal endothelium density (p = 0.047 and 0.018, respectively), and M500 was significantly associated with C/D ratio (p = 0.001) and RNFL thickness (p = 0.037) in PSS-affected eyes. Conclusions: Iris showed significant thinning and atrophy in PSS-affected eyes, and iris stromal thickness close to the pupillary edge could be a novel clinical predictor of the changes in corneal endothelium, C/D ratio, and RNFL thickness in PSS.

AIM:To observe the changes in Schlemm's canal (SC), trabecular meshwork (TM), and anterior chamber relevant parameters after small incision lenticule extraction (SMILE) of myopia patients. METHODS:A total of 58 eyes from 30 patients who underwent SMILE were divided into a low and moderate myopia group (group A, 32 eyes) and a high myopia group (group B, 26 eyes). The diameter and area of the SC, the width and thickness of TM obtained by CIRRUS HD-OCT5000, and the related anterior chamber parameters obtained by Pentacam anterior segment analysis system, accommodation amplitude (AMP) were observed pre- and postoperatively. The preoperative intraocular pressure (IOP) and postoperative correction of intraocular pressure (IOPcc) were measured. RESULTS:The diameter and area of the SC in the two groups were significantly increased postoperatively (all P<0.01). The TM width of the patients in the two groups were increased at 1mo after surgery (both P<0.01), but the TM thickness did not change (P>0.05). The corneal curvature, central anterior chamber depth, and anterior chamber volume decreased after SMILE surgery (all P<0.01). There was a weak negative correlation between the SC area change and AMP change in group A (r=-0.362, P<0.01). The postoperative IOP decreased after correction by Shah formula (P<0.05). CONCLUSION:SC and TM in myopia patients change in the early postoperative stage of SMILE and the IOP is decline.

Purpose To investigate the anterior scleral thickness (AST) and its associations with Schlemm’s canal (SC) area, trabecular meshwork (TM) thickness and length, and scleral spur (SS) length in healthy and primary open-angle glaucoma (POAG) groups. Methods Thirty-five eyes of 35 healthy subjects and 23 eyes of 23 patients with POAG were included. The AST, SC area, TM thickness and length, and SS length were measured using swept-source optical coherence tomography. AST was measured at 0 mm (AST0), 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) from SS. Associations between AST and SC area, TM thickness and length, and SS length were also estimated. Results AST0 (728.84 ± 99.33 vs. 657.39 ± 67.02 μm, p < 0.001), AST1 (537.79 ± 79.55 vs. 506.83 ± 57.37 μm, p = 0.038), AST3 (571.09 ± 79.15 vs. 532.13 ± 59.84 μm, p = 0.009), SC area (6304.26 ± 1238.72 vs. 4755.64 ± 1122.71 μm 2 , p < 0.001), TM thickness (107.21 ± 31.26 vs. 94.51 ± 24.18 μm, p = 0.035), TM length (736.20 ± 141.85 vs. 656.43 ± 127.03 μm, p = 0.004), and SS length (219.89 ± 50.29 vs. 174.54 ± 35.58 μm, p < 0.001) were significantly greater in healthy group than in POAG group. In addition, SC area, TM thickness, and SS length were significantly and positively associated with AST0 in the healthy group, whereas no similar associations were observed in the POAG group. Conclusions Compared with the healthy group, AST was significantly thinner in the POAG group, which also had smaller SC and TM dimensions. Moreover, the SC area, TM thickness, and SS length were significantly and positively associated with AST in the healthy group. Thus, AST might play an important role in maintaining TM and SC morphology and further in the pathogenesis of POAG.

Abstract PURPOSE. To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA). METHODS. In this cross-sectional comparative study, 30 healthy participants were enrolled. Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA during the static state and after water loading. The area, height, width, depth and blood flow of the aqueous vein and conjunctival vein were measured by ImageJ software. RESULTS. In the static state, the area of the aqueous vein was 8166.7 ± 3272.7µm2, which was smaller than that of the conjunctival vein (13690 ± 7457 µm2). The mean vessel density of the aqueous vein was 35.3 ± 12.6%, which was significantly less than that of the conjunctival vein (51.5 ± 10.6%). After water loading, the area of the aqueous vein decreased significantly from 8725.8 ± 779.4 µm2 (baseline) to 7005.2 ± 566.2 µm2 after 45 min but returned to 7863.0 ± 703.2 µm2 after 60 min. The vessel density of the aqueous vein decreased significantly from 41.2 ± 4.5% (baseline) to 35.4 ± 3.2% after 30 min but returned to 45.6 ± 3.6% after 60 min. CONCLUSIONS. The structure and vessel density of the aqueous vein can be effectively evaluated by OCT and OCTA, which might provide a biological indicator to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.

AIM: To observe the dynamic changes of lens parameters of adolescents with hyperopia and myopia, analyze the difference to investigate the characteristics of lens changes under different accommodation stimuli.METHODS: A random selection of 50 cases(86 eyes)of adolescents with refractive errors aged 7-15 years old who visited our clinic from January to October 2019 were divided into in myopia group(29 cases, 46 eyes, mean equivalent spherical lens was -2.17±1.41D)and hyperopia group(21 cases, 40 eyes, mean equivalent spherical lens was 1.92±1.49D). The axial length(AL)was measured by optical biometer(IOL Master). By using anterior swept source optical coherence tomography(SS-OCT), the dynamic changes of lens parameters including lens thickness(LT), anterior crystalline lens radius of curvature(ALRC)and posterior crystalline lens radius of curvature(PLRC)were observed under different accommodation stimuli(0, -3, -6D).RESULTS: In the state of relaxed accommodation(0D), the LT of the myopia group was significantly lower than that of the hyperopia group, both ALRC and PLRC were greater than those of the hyperopia group(all P<0.01). The AL of the hyperopia group was significantly shorter than that of the myopia group(22.49±1.12mm vs 24.48±0.82mm, P<0.01). With the increase of the accommodation stimulus amplitudes(-3, -6D), the LT of the two groups increased significantly, the ALRC and PLRC both decreased significantly(all P<0.01). Under the condition of -3D and -6D, the change rate of ALRC was higher than that of PLRC in both groups(P<0.01). However, the change rate of LT and PLRC were not significantly different between the two groups(P>0.05). Furthermore, the change rate of ALRC in the hyperopia group was significantly higher than that of the myopia group when the -6D accommodation was completed(P<0.05).CONCLUSION: During accommodation stimulation, the thickness of the lens in adolescents with refractive errors increased, the shape of the lens became convex, and the degree of change of the anterior surface was significantly greater than that of the posterior surface.

Purpose To investigate the iris thickness (IT) of patients with primary open-angle glaucoma (POAG) and older adults using anterior segment swept-source optical coherence tomography (SS-OCT). Methods In this comparative cross-sectional study, 154 participants were enrolled, including 40 patients with POAG and 114 healthy individuals. Nasal-angle SS-OCT images were analysed using callipers to measure the thickness of the iris, including the anterior border layer, stromal, and pigmented epithelial layer, at 1 and 2 mm from the pupil edge. The relationship between IT and glaucoma severity was analysed, and receiver operating characteristic curves were constructed to assess the ability of each IT parameter to distinguish patients with glaucoma from healthy controls. Results The IT parameters and iris area were lower in the POAG group than in the age-matched control group (p < 0.05). In the POAG group, the thickness of the pigmented epithelial layer at 1 and 2 mm was significantly correlated with the severity of glaucoma (p < 0.05). Iris area, with a cut-off of 1.43 mm(,)(2) exhibited the highest sensitivity (85%) and specificity (64.81%; area under the curve = 0.783) for distinguishing patients with POAG from healthy controls. Older adults tended to have the thinnest IT, children had the smallest iris area (p < 0.05). Conclusions In patients with POAG, the severity of iris atrophy was associated with glaucoma severity. The results of IT measurements by SS-OCT may help in the clinical evaluation of POAG.

To quantitatively analyze changes in the inner components of the human crystalline lens during accommodation in adults. Eyes of 23 subjects were sequentially examined using CASIA2 Optical Coherence Tomography under 0D, − 3D and − 6D accommodation states. The anterior chamber depth (ACD), anterior and posterior crystalline lens radius of the curvature (ALRC and PLRC) were obtained using built-in software. The lens thickness (LT), lenticular nucleus thickness (NT), anterior cortex thickness (ACT), posterior cortex thickness (PCT), anterior and posterior lenticular nucleus radius of the curvature (ANRC and PNRC), anterior and posterior lenticular nucleus vertex (ANV and PNV) were quantified manually with the Image-pro plus software. During accommodation, the ACD became significantly shallower and LT significantly increased. For changes in the lens, the ALRC decreased by an average magnitude (related to accommodative stimuli) 0.44 mm/D, and PLRC decreased 0.09 mm/D. There was no difference for the ACT and PCT in different accommodation states. For lenticular nucleus response, NT increased on average by 30 μm/D. Both the ANRC and PNRC decreased on average by 212 μm/D and 115 μm/D respectively. The ANV moved forward on average by 0.07 mm under − 3D accommodative stimuli and 0.16 mm for − 6D. However, there was no statistically significant difference between different accommodation states in the PNV movement. Under accommodation stimulation, lens thickness changed mainly due to the lenticular nucleus, but not the cortex. For the lenticular nucleus, both the ANRC and PNRC decreased and ANRC changed the most. The anterior surface of the nucleus moved forward while the posterior surface of the nucleus moved backward but only slightly.

AIM: To evaluate the ocular outcomes and to elucidate possible mechanisms underlying intraocular pressure (IOP) change following the head-down tilt (HDT) test. METHODS: The study included 21 participants at the Department of Ophthalmology of Tongji Hospital. Subjects received the test of I-care tonometry, enhanced depth imaging optical coherence tomography and heart rate variability (HRV) analysis before and after 15min HDT test. The lumen area of Schlemm's canal (SCAR), IOP, HRV were calculated. RESULTS: IOP increased significantly after 20° head down position from 14.0±3.0 to 17.0±3.3 mm Hg (P<0.001). SCAR decreased from 13449.0±5454.9 μm2 at sitting condition to 9576.6±4130.9 μm2 post 15min HDT test. High frequency (HF) indices increased significantly from 1462±865 Hz at baseline to 2128±824 Hz. Heart rate (HR) decreased significantly from 76±11.48 to 70±11.52 bpm after the HDT. The linear regression analysis showed that the difference of HF and SCAR significantly correlated with each other during the HDT (R2=20%, P=0.04). CONCLUSION: These outcomes perform the first evidence of the activation of autonomic nervous system of HDT may cause the collapse of Schlemm's canal lumen, which in turn leading to the increased IOP.

在"互联网+"融合创新,培育新兴业态的背景下,互联网医疗已成为必然的发展趋势.以"云"门诊的建设和应用体会为切入点,分析其"三层四端点"的架构和实施路径;阐明其在突破时空限制,提升医疗服务质量,尤其在疫情防控期间发挥的重要作用;进一步探讨"云"门诊的应用和存在的挑战,以期推进我国互联网医疗事业的发展.