Purpose To evaluate the efficacy and safety of intravitreal injection of conbercept for the treatment of macular edema secondary to central retinal vein occlusion (CRVO-ME). Methods Patients with CRVO were randomly divided into the treatment (conbercept injection) and control groups (sham injection) at a ratio of 2:1. The primary endpoint was the mean changes in best-corrected visual acuity (BCVA) from baseline to month 6. Results From baseline to month 6, the mean change in BCVA letters were 13.6 ± 12.1 (P < 0.0001) and − 2.2 ± 16.5 (P = 0.2188) in the treatment and control groups. From baseline to month 12, the mean change in BCVA letters were 14.4 ± 13.8 (P < 0.0001) and 3.0 ± 17.6 (P < 0.0001). The mean reduction of CRT from baseline to month 6 were 138.4 ± 99.4 µm (P < 0.0001) and 35.1 ± 98.8 µm (P = 0.0018). From baseline to month 12, the mean reduction values of CRT were 145.1 ± 105.1 µm (P < 0.0001) and 81.7 ± 107.9 µm (P < 0.0001). No new safety events were identified. Conclusions Intravitreal injection of conbercept has definite efficacy and expected controllable safety in patients with CRVO-ME, providing a more flexible strategy for conbercept in the clinical treatment of CRVO-ME. Trial Registration: ClinicalTrials.gov Identifier: NCT03223714, Date: July 21, 2017.

Purpose: To identify prognostic factors for postoperative visual acuity (VA) and metamorphopsia outcomes in patients with idiopathic epiretinal membrane (iERM) and to establish clinically meaningful cutoff values to guide surgical timing. Methods: This retrospective study analyzed 72 eyes from 66 patients who underwent pars plana vitrectomy with membrane peeling. Preoperative and 12-month postoperative best-corrected VA (BCVA), metamorphopsia score (META-score), and optical coherence tomography (OCT) biomarkers were evaluated using multivariate regression and receiver operating characteristic (ROC) curve analyses. Results: At 12 months, both BCVA and META-score significantly improved (both P < 0.001). Multivariate analysis identified preoperative BCVA (β = 0.719, P < 0.001), presence of ectopic inner foveal layer (EIFL) (P = 0.046), iERM stage (P = 0.020), and ganglion cell-inner plexiform layer (GCL-IPL) thickness (P = 0.007) as independent predictors of postoperative BCVA. The preoperative META-score was the sole predictor for postoperative metamorphopsia (β = 0.480, P < 0.001). ROC analysis identified optimal cutoffs for predicting poor outcomes: a preoperative BCVA > 0.5 LogMAR (AUC = 0.850) and a META-score > 2.74 (AUC = 0.990). Conclusion: Preoperative functional status (BCVA and META-score) are the primary determinants of surgical outcomes. Inner retinal biomarkers, particularly GCL-IPL thickness, provide independent predictive value. The established cutoffs (BCVA > 0.5 LogMAR; META-score > 2.74) offer objective, data-driven guidance for surgical decision-making and managing patient expectations.

The aim of this study was to investigate the fundus fluorescein angiography (FFA) findings in eyes initially diagnosed with idiopathic epiretinal membrane (iERM) and assess their impact on best-corrected visual acuity (BCVA). This retrospective comparative study included 136 patients (151 eyes) diagnosed with iERM and a control group of 121 healthy fellow eyes. All patients underwent FFA and optical coherence tomography (OCT). The primary outcomes summarized the characteristics of FFA and OCT in patients with iERM, and analyzed the relationship between FFA findings and visual acuity. Vascular leakage (P = 0.009) were significantly more prevalent in eyes with iERM compared to controls. Multivariate logistic regression analysis indicated that optic disc hyperfluorescence (OR 4.05; 95

AIMS:To evaluate the visual function and foveal architecture in patients with stage 3 idiopathic epiretinal membrane (iERM). METHODS:A cross-sectional observational study included 56 eyes of 52 patients with stage 3 iERM. The patients were classified into type A ectopic inner foveal layers (EIFL) and type B EIFL based on the presence of a continuous hyporeflective band. Visual function and foveal microarchitecture were assessed in enrolled eyes. Best-corrected visual acuity (BCVA), metamorphopsia scores, retinal sensitivity and optical coherence tomography (OCT)/OCT angiography features were compared between two subtypes. RESULT:The BCVA in type A EIFL and type B EIFL was 0.22 logarithm of minimal angle of resolution (logMAR) (0.15 logMAR, 0.40 logMAR) and 0.53±0.23 logMAR, respectively (p=0.002). Type B EIFL had higher average metamorphopsia scores, especially horizontal metamorphopsia scores, than type A (p=0.013, p=0.007, respectively). Type B EIFL had worse central 2° foveal sensitivity than type A (p=0.034). Type B EIFL had thicker central foveal thickness and EIFL thickness (514.08±73.80 µm vs 444.41±56.57 µm, p=0.001; 159.75±78.30 µm vs 48.44±18.37 µm, p<0.0001; respectively). The foveal avascular zone area of type B EIFL was smaller than that of type A (0.042±0.022 mm2 vs 0.077±0.039 mm2, p<0.0001). The vessel density and flow area of the superficial vascular complex in type B EIFL were larger than those in type A (both p=0.001). CONCLUSIONS:Type B EIFL demonstrated significantly worse visual function than type A EIFL, along with marked differences in foveal microstructure and microvasculature. Our study complements the current staging of iERM and helps determine the optimal timing of iERM surgery.

PurposeTo develop a novel system for quantifying metamorphopsia in patients with myopic traction maculopathy (MTM) and to explore the metamorphopsia pattern of MTM.DesignObservational, cross-sectional study.MethodsWe designed a new system.ResultsOf the 445 eyes tested, 188 (42.25%) were deemed by patients to have metamorphopsia impacting their daily lives while 257 (57.75%) were considered to have no metamorphopsia symptoms. The Amsler grid, M-CHARTS and METAVISION tests displayed sensitivities for metamorphopsia of 95.74%, 89.89% and 100%, respectively. The specificities of the Amsler grid, M-CHARTS and METAVISION tests are 100%. The metamorphopsia questionnaire and METAVISION scores were highly consistent (average intraclass correlation coefficient=0.951, p<0.001) and strongly correlated (R=0.879, p<0.001). The METAVISION score was highly correlated with the stages of MTM (R=0.837, p<0.001), whereas there was a moderate correlation between the M-CHARTS M-score and the stages of MTM (R=0.679, p<0.001).ConclusionsQuantification of metamorphopsia is important and useful for MTM management. The METAVISION is a clinically applicable and comprehensive approach for quantifying metamorphopsia, which can be used in clinical settings.

PURPOSE:To investigate the pace of visual acuity loss in myopic maculoschisis eyes with or without macular detachment and identify associated risk factors. METHODS:One thousand three hundred and thirty-four eyes of 991 patients with high myopia were reviewed. A new myopic traction maculopathy staging system classified four retinal stages and three foveal stages. To the myopic traction maculopathy eyes with normal fovea, maculoschisis with and without macular detachment was defined as Stage 3a and Stages 1a, 2a respectively. RESULTS:One hundred and ten (8.25%) eyes with maculoschisis were included, with a follow-up of 24.00 ± 17.47 months. Of them, 84 (76.36%) were Stages 1a, 2a, and 26 (23.64%) were Stage 3a. The visual acuity loss per year during the follow-up period was similar between eyes with Stages 1a, 2a and Stage 3a (3.13 ± 12.21 vs. 3.41 ± 18.42 letters, P = 0.930). Multivariate analyses revealed that vitreomacular interface factors were significantly associated with visual acuity loss during the follow-up, no matter in Stages 1a, 2a or Stage 3a ( P = 0.039 and P = 0.038, respectively). In the Stages 1a, 2a group, the percentage of eyes that lost at least 10 letters at the final visit compared with the baseline visual acuity was higher in eyes with vitreomacular interface factors than in those without vitreomacular interface factors (13 eyes, 50.00% vs. 14 eyes, 24.14%, P = 0.019). CONCLUSION:No differences were found in visual acuity loss pace between Stages 1a, 2a and Stage 3a. Surgical intervention or at least more intensive follow-up should be considered for Stages 1a, 2a eyes with vitreomacular interface factors, to promote a more favorable visual outcome.

Background To investigate different visual evoked potential (VEP) patterns in neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) and idiopathic demyelinating optic neuritis (IDON). Methods This was a longitudinal, prospective, case-control study. Eighty-four Chinese patients with acute optic neuritis were enrolled, including 26 NMOSD-ON patients and 58 IDON patients. All the patients underwent best-corrected visual acuity (BCVA) and full-field pattern reversal VEP recordings at the onset, 1 month, 3 months, and 6 months. Results Within 15′ checks, the NMOSD-ON patients had more severe VEP amplitude reduction at 6 months (2.39 ± 4.63 μV vs. 6.96 ± 8.88 μV, P = 0.034). However, the IDON patients showed more frequently normal VEP response at 3 months (24.0% vs. 4.5%, P = 0.017), and only prolonged P100 peak latency with normal amplitude (L) at 6 months (30.0% vs. 57.8%, P = 0.048). Within 60′ checks, no significant difference in VEP parameters between the two groups was found at each follow-up ( P > 0.05). Conclusions The NMOSD-ON patients showed more severe axonal damage and worse axonal recovery than the IDON patients. VEP elicited by smaller check size was more sensitive to visual pathway abnormality in NMOSD-ON.

AIM To identify the association of the vitreoretinal surgeons' experience with the time interval between pars-plana vitrectomy (PPV) and cataract extraction (CE). METHODS Eyes with prior PPV and following CE were included in this retrospective cohort study. The years of practice and the annual case volume were used to describe the surgeons' experience. Multivariable linear regression analysis was used to investigate the relationship between surgeons' experience and the time interval adjusted for the patients age, gender, intraocular tamponade, and case complexity. RESULTS Of 132 430 eyes, 1445 eyes were included in this study. In multivariable linear regression analysis, cases performed by surgeons with >20 practice years had longer time intervals compared with surgeons with <10 practice years after adjusted for other variables (β=0.329, 95%CI: 0.113 to 0.549, P=0.003). No difference in time interval was detected for comparing the lowest with the highest volume groups (β=0.089, 95%CI: -0.164 to 0.343, P=0.343). The surgeons' practice years were not directly with the volume. For complicated surgery, the higher-practice-year surgeons had longer time interval than lower-practice-year surgeons. CONCLUSION The time intervals from PPV to CE is longer in higher-practice-year surgeons. The surgeons' practice years may have a greater effect on the time interval than annual case volume in high-complexity cases. Matching the complexity of vitreoretinal diseases with the surgeons' practice year should be considered.

BACKGROUND:To assess the functional and structural outcomes of macular buckling using a silicone sponge-titanium exoplant for the treatment of foveoschisis (FS) and full-thickness macular holes (FTMHs) in highly myopic eyes.METHODS:Forty-nine consecutive patients with high myopia who underwent macular buckling for the treatment of FS and FTMHs were included. The outcomes measured included the anatomical success rate with FS resolution, retinal reattachment, MH closure, best corrected visual acuity (BCVA), axial length (AL) and complications of surgery. Moreover, the correlations between the BCVA at year three and series of factors, including age, duration of symptoms, baseline BCVA, AL, surgical type, preoperative macular status and severity of myopic maculopathy, were analysed.RESULTS:This study involved 28 patients (28 eyes) with FS and 21 patients (21 eyes) with FTMHs with macular detachment. Retinal reattachment was achieved in 100% of cases, while MH closure was achieved in 76.19% of cases. The BCVA significantly improved one year after macular buckling in the FS cases and two years after macular buckling in the FTMH cases, and it remained stable throughout the rest of the follow-up period. The mean AL decreased by 2.09 mm postoperatively. No major perioperative complications were observed, although one patient needed to explant the buckling device due to intolerable diplopia.CONCLUSION:Macular buckling with a silicone sponge-titanium exoplant may represent a safe and effective surgical option for the treatment of FS and FTMH in highly myopic eyes. Macular buckling showed a high closure rate and virtually no tendency to recur.

Purpose: To evaluate the efficacy and primary safety of treatment with artesunate in reducing ocular neovascularization in humans. Methods: Five patients with corneal, iris, and retinal neovascularization and no light perception were treated with intravitreal injections of artesunate 80 μg. Visual acuity, anterior segment photography, fundus fluorescein angiography, and optical coherence tomography were used to evaluate efficacy, while intraocular pressure (IOP) and lens opacity degree were employed to evaluate safety. The primary endpoint was attenuation of neovascularization as determined at 24 weeks, with the last posttreatment follow-up at 52 weeks. Results: Corneal and iris neovascularization, which were secondary to fundus ischemic diseases and retinal neovascularization in all 5 patients, were attenuated after 1 or 2 injections by the 52-week follow-up. Retinal neovascularization was also attenuated, and papilledema was alleviated. The average IOP fell from 25.5 mmHg to 17.66 mmHg. Conclusions: This pilot study determined that intravitreal artesunate injection is efficacious for reducing corneal, iris, and retinal neovascularization. These results indicate that this drug may be a novel alternative to the currently popular antivascular endothelial growth factor drugs used to suppress ocular neovascularization and improve visual function.

Objective To compare the efficacy and safety of macular buckling and vitrectomy for myopic traction maculopathy showing macular schisis (MS) and associated macular detachment (MD) but without full-thickness macular hole (FTMH). Design Prospective, randomized, parallel, open-label study. Methods Patients were randomly assigned to either buckling or vitrectomy group. Macular buckling and intravitreal C3F8 gas injection were performed in the buckling group. Small gauge vitrectomy, internal limiting membrane peeling (ILMP) and C3F8 gas tamponade were performed in the vitrectomy group. The patients were followed for 12 months. Main outcome measures Best-corrected visual acuity (BCVA) at 12 months. Results A total of 85 patients were randomized, 80 eyes were included (41 receiving buckling, 39 received vitrectomy), and 78 patients completed the study. There were less eyes determined as surgical failure and required a second surgery in the buckling group than vitrectomy the group (2.4% versus 18.4%, p = 0.021). After surgery, macular buckling achieved more improvement in BCVA (+21.7 versus +4.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p = 0.002). FTMH development was observed in only 1 (2.4%) eye, after removing of the implant due to recurrent conjunctival erosion, in the buckling group and 10 (26.3%) eyes (seven with-, three without MD) in the vitrectomy group (p < 0.001). More eyes developed cataracts in the vitrectomy group than did in the buckling group (28.9% versus 7.5%, p = 0.014). Macular buckling-associated strabismus (esotropia), binocular diplopia and implant exposure were observed in limited cases. Conclusions and relevance Macular buckling is superior to vitrectomy with ILM peeling plus gas injection for surgical treatment of MS and associated MD in high myopia.

OBJECTIVE:To evaluate the conversion of macular function in diabetic macular edema (DME) after vitreous surgery.METHODS:Seventeen eyes of 16 patients were assessed after pars plana vitrectomy for DME. Multifocal electroretinogram (mfERG) techniques were used to evaluate the effects of treatment on macular visual function, and retinal foveal thickness was determined by optical coherence tomography before and after vitrectomy. Patients were followed up continually for 7 months. The correlation between the change of tomographic features and visual functions were analyzed.RESULTS:During the follow-up period, the retinal function in macular areas recovered and the foveal thickness decreased gradually. While compared with preoperative values, the response of positive wave (P1) have shown decreases in implicit time and increases in amplitude since the forth and fifth postoperative month respectively (P < 0.05). While compared between each postoperative period, the P1 responses have increased significantly since the forth postoperative month. The correlation between the increase of P1 amplitude in macular area and the decrease of retinal foveal thickness was significant (r = 0.954, P < 0.001).CONCLUSIONS:Macular function get improvement gradually in DME after vitreous surgery; The restoration of macular function is coincident with the reduction of macular edema.

Beneficial effects of vitrectomy for diabetic macular edema (DME) have been demonstrated in a series of clinical trials. Vitreous surgery is useful in reducing the edema and improving visual acuity.

PURPOSE:This study aimed to assess the therapeutic effect of vitreous surgery in conjunction with photocoagulation for highly myopic retinal detachment resulting from a macular hole.METHODS:Sixty-two consecutive highly myopic patients (65 eyes) with retinal detachment from macular holes underwent vitreous surgery. Gas tamponade in conjunction with laser photocoagulation was performed in 46 eyes (44 cases, group 1); gas tamponade only was performed in 12 eyes (11 cases, group 2); and silicone oil tamponade only was performed in seven eyes (seven cases, group 3). Additional laser photocoagulation was given in group 1 if necessary. The anatomical and functional success rates were compared between the groups.RESULTS:Primary retinal reattachment was achieved in 43 eyes (93.5%) in group 1, seven eyes (58.3%) in group 2 and four eyes (57.1%) in group 3. Final visual acuity was 6/60 or more in 24 eyes (52.2%) in group 1, in six eyes (50.0%) in group 2 and in three eyes (42.9%) in group 3. The initial retinal reattachment rate was significantly higher in group 1 than in group 2 (P = 0.0075) and group 3 (P = 0.0248). The macular hole was completely closed in 18 eyes in group 1 and one eye in group 2 after 2 months or longer. A thin fibrous membrane and scar could be easily noticed beneath the macula in 15 eyes.CONCLUSION:Vitreous surgery in conjunction with laser photo-coagulation can improve the surgical success rate for highly myopic retinal detachment resulting from a macular hole.