PURPOSE:To explore the relationship between retinal hemorrhage in the green and red channels on ultra-widefield fundus images and the nonperfusion area (NPA) on ultra-widefield fundus fluorescein angiography in patients with acute branch retinal vein occlusion (BRVO). METHODS:This was a retrospective cross-sectional study with 96 patients, including 46 with ischemic BRVO and 50 with nonischemic BRVO. Correlation analysis between green channel hemorrhage (GCH), red channel hemorrhage (RCH), and NPA was performed. Panretina was divided into posterior and peripheral areas. RESULTS:Ischemic BRVO showed significantly higher GCH% and RCH% than nonischemic BRVO in the peripheral regions (both P < 0.001), whereas no significant differences were observed in the panretinal and posterior areas (all P > 0.05). Significant correlations were found between NPA% in the panretinal and peripheral areas and the corresponding GCH% and RCH% (all P < 0.01). However, no significant correlation was observed between posterior NPA% and posterior GCH% or RCH% (both P > 0.05). In addition, peripheral GCH% and RCH% were related to panretinal NPA% (r = 0.506, P < 0.001; r = 0.558, P < 0.001). CONCLUSION:Retinal hemorrhage on ultra-widefield fundus image was significantly associated with NPA, providing insights for assessing retinal perfusion status in acute BRVO patients.

Purpose To explore short-term changes in corneal astigmatism after combined silicone oil removal and cataract (SORC) surgery. Methods We enrolled 89 patients (43 men and 46 women). Zeiss IOLMaster was used to measure corneal astigmatism status and axial length on the day before and after the SORC surgery. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded. The results were compared to the outcomes at 3 days, 1 week, and 1 month postoperatively. Results Compared to baseline, K1 decreased significantly at 3 days postoperatively (P = 0.016), 1 week (P = 0.009), and 1 month (P = 0.035), while K2 increased significantly at 3 days postoperatively (P = 0.002), 1 week (P < 0.001), and 1 month (P = 0.001), as well as corneal astigmatism (all P < 0.001). Compared to that at the baseline, BCVA significantly improved at 3 days, 1 week, and 1 month postoperatively (all P < 0.001). Meanwhile, IOP decreased significantly at 3 days postoperatively (P < 0.001), 1 week (P = 0.005), and 1 month (P = 0.007). Similarly, axial length decreased at all follow-up time points (all P < 0.001). Conclusion Corneal astigmatism increased in the short term after the SORC operation but gradually decreased at 1 month postoperatively. BCVA improved steadily, and SORC was widely used in the clinic.

BackgroundAutoimmunity and inflammation are the main characteristics of rheumatic diseases and have both been found to be related to glaucoma. However, it remains unclear whether rheumatic diseases increase the risk of glaucoma. Here, we performed a Mendelian randomization (MR) analysis to investigate the causal effects of six common rheumatic diseases on glaucoma.MethodsSix rheumatic diseases were included: ankylosing spondylitis (AS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sicca syndrome/Sjögren’s sydrome (SS), dermatomyositis (DM), and gout. Glaucoma included primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Genetic variants associated with these rheumatic diseases and glaucoma were extracted from the genome-wide association studies and FinnGen8 database, respectively. First, a two-sample MR was used to investigate the potential causal association. Then, a multivariable MR was conducted to further verify the results. Inverse-variance weighted MR analysis was used as the main method, together with several sensitivity analyses.ResultsTwo-sample MR suggests that AS is related to a higher risk of both POAG [odds ratio (OR): 1.28, 95% confidence interval (CI) 1.13–1.44; p = 1.1 × 10−4] and PACG (OR: 1.55, 95% CI: 1.09–2.09, p = 1.4 × 10−2). Multivariable MR shows a similar trend of the effect of AS on POAG (OR: 1.52, 95% CI: 1.22–1.90, p = 1.9 × 10−4) and PACG (OR: 2.05, 95% CI: 1.06–3.95, p = 3.2 × 10−2). No significant association was observed between the other five rheumatic diseases and glaucoma.ConclusionsAS is related to an increased risk of POAG and PACG. We stress the importance of glaucoma screening for AS patients.

BackgroundCortisol plays a role in the pathogenesis of central serous chorioretinopathy (CSC). CSC patients have abnormal time-dependent changes in cortisol levels. Here we report a rare case of a patient with central serous chorioretinopathy whose pigment epithelial detachment (PED) exhibited time-dependent recurrence and resolution.Case presentationA 47-year-old man presented in 2016 for vision loss in the left eye related to recurrent CSC. During follow-up, his PED was observed to resolve spontaneously while he was still in our clinic and recurred the next morning. Such time-dependent changes of the PED were observed in several next follow-ups without any intervention. After excluding possible external factors, the abnormal diurnal variation of cortisol was considered as the internal factor affecting PED.ConclusionsThis is the first article that described the spontaneous time-dependent recurrence and resolution of PED without external interference, where endogenous cortisol may be responsible. Interventions against the abnormal cortisol level might be a potential treatment strategy for CSC. More research is urged to explore the impact of the diurnal change in cortisol levels on eyes with CSC.

PURPOSE:To present and compare the clinical features and multimodal imaging (MMI) findings of the primary form of multiple evanescent white dot syndrome (MEWDS) and MEWDS secondary to multifocal choroiditis/punctate inner choroidopathy (MFC/PIC).METHODS:A prospective case series. Thirty eyes of 30 MEWDS patients were included and divided into the primary MEWDS group and MEWDS secondary to MFC/PIC group. Demographic, epidemiologic, and clinical characteristics and MEWDS-related MMI findings of the two groups were compared.RESULTS:Seventeen eyes from 17 patients with primary MEWDS and 13 eyes from 13 patients with MEWDS secondary to MFC/PIC were evaluated. Patients with MEWDS secondary to MFC/PIC tended to have a higher degree of myopia than those with primary MEWDS. No other significant differences in demographic, epidemiologic, and clinical characteristics and MMI findings were found between the two groups.CONCLUSION:"MEWDS-like reaction" hypothesis seems to be correct for MEWDS secondary to MFC/PIC, and the authors highlight the importance of MMI examinations in MEWDS. Further research is needed to confirm whether the hypothesis is applicable to other forms of secondary MEWDS.

目的:研究长春胺对非动脉炎性前部缺血性视神经病变(NAION)大鼠模型的潜在神经保护作用.方法:90只SD大鼠随机分为正常组、单纯模型组、造模羧甲基纤维素钠灌胃组(NaCMC)组、长春胺组、造模PI3K抑制剂LY294002玻璃体腔注射(IVT LY)+长春胺组、造模DMSO玻璃体腔注射(IVT DMSO)+长春胺组.对各组进行眼底照相,眼底荧光血管造影,血清一氧化氮(N0)浓度检测,HE染色观察视网膜形态,甲苯胺蓝染色观察视神经轴突形态,免疫荧光染色计数视网膜神经节细胞(RGCs),实时定量PCR检测p-AKT、eNOS含量.结果:rNAION大鼠(rNAION)造模成功后第1天即可见大鼠视盘水肿,边界模糊.造模后第28天,长春胺组的NO浓度显著高于正常对照组、单纯模型组及NaCMC组.与单纯模型组相比,长春胺组RGCs数量明显增加(P＜0.05),p-AKT、eNOS含量明显增加(P＜0.05).IVT LY+长春胺组RGCs数量及p-AKT、eNOS含量较长春胺组明显减少(P＜0.05).结论:长春胺可能通过PI3K/AKT/eNOS信号通路发挥视神经保护作用,有望成为NAION的有效治疗药物.

To design and evaluate a deep learning model based on ultra-widefield images (UWFIs) that can detect several common fundus diseases. Based on 4574 UWFIs, a deep learning model was trained and validated that can identify normal fundus and eight common fundus diseases, namely referable diabetic retinopathy, retinal vein occlusion, pathologic myopia, retinal detachment, retinitis pigmentosa, age-related macular degeneration, vitreous opacity, and optic neuropathy. The model was tested on three test sets with data volumes of 465, 979, and 525. The performance of the three deep learning networks, EfficientNet-B7, DenseNet, and ResNet-101, was evaluated on the internal test set. Additionally, we compared the performance of the deep learning model with that of doctors in a tertiary referral hospital. Compared to the other two deep learning models, EfficientNet-B7 achieved the best performance. The area under the receiver operating characteristic curves of the EfficientNet-B7 model on the internal test set, external test set A and external test set B were 0.9708 (0.8772, 0.9849) to 1.0000 (1.0000, 1.0000), 0.9683 (0.8829, 0.9770) to 1.0000 (0.9975, 1.0000), and 0.8919 (0.7150, 0.9055) to 0.9977 (0.9165, 1.0000), respectively. On a data set of 100 images, the total accuracy of the deep learning model was 93.00

Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA).Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4 mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively).Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023).Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.

Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by the progressive and irreversible death of retinal ganglion cells (RGCs) which is caused by the insufficient blood supply to the optic nerve (ON) head. At present, hormone therapy is used to reduce optic edema, followed by nerve nutrition therapy to protect the ON. However, no surgical or medical therapy has proven to be beneficial consistently in treating NAION. Vincamine is an alkaloid extracted from the Apocynaceae Vinca plant. Vincamine and its derivatives acting as cerebral vasodilators can easily cross the blood-brain barrier, improve the metabolism of ischemic tissue and protect the neuron. In this study, we aimed to investigate the potential neuroprotection of Vincamine in the photodynamic induced rat model of NAION (rAION), to evaluate its effects and possible mechanisms. We found that Vincamine can rescue RGC death and reduce the number of apoptotic cells. The protection of Vincamine might play through the PI3K/Akt/eNOS signaling pathway. Therefore, Vincamine can be an effective therapy method for NAION.

Purpose: To assess the efficacy and safety of pars plana vitrectomy (PPV) as a treatment for intraocular retinoblastoma (RB) patients. Methods: Twenty-eight RB patients who had PPV were recruited in this retrospective case study, using the digital wide-angle retinal imaging device to record and assess disease condition. Results: The mean value of follow-up time was 79.4 months from diagnosis and 73.1 months from PPV. Up to the end of the follow-up time after PPV, the 5-year survival rate was 96.4%. Ultimately, 35.7% patients underwent enucleation of the eyeball. Among patients with salvaged eyes, 50% had no light perception vision. During the postoperative follow-up time, 14.3% of patients required no further antitumor treatment, and the remaining patients still need to continue to receive systemic or local antitumor treatment, such as chemotherapy, arterial interventional therapy, laser treatment, cryotherapy, and so on. The complication after PPV include cataracts (46.4%), iris adhesion (7.1%), emulsification of the silicone oil (17.9%), band degeneration of the cornea (10.7%), glaucoma (3.6%), and retinal neovascularization (3.6%). Conclusion: According to our observations, we recommend that the utmost care should be taken when considering PPV for the treatment of activated RB. When weighing the risk of tumor recurrence and metastasis, PPV is not suitable for routine treatment. It is necessary to fully grasp the operative indications and strictly observe operation specifications, which includes close postoperative follow-up.

Many patients with wet age-related macular degeneration do not respond well to anti- vascular endothelial growth factor A (VEGFA) therapy for choroidal neovascularization (CNV), and the efficacy of anti-VEGFA decreases over time. We investigated the hypothesis that fibrotic changes, in particular via endothelial-to-mesenchymal transition (EndoMT), play a role in CNV and alter the therapeutic effects of VEGFA pathway blockage. Induction of EndoMT of primary human retinal endothelial cells led to a significantly reduced response to VEGFA at the level of gene expression, cellular proliferation, migration, and tube formation. Suppression of EndoMT restored cell responsiveness to VEGFA. In a mouse model of spontaneous CNV, fibrotic changes and EndoMT persisted as the CNV lesions became more established over time. VEGFA receptor-2 (VEGFR2) antagonism further induced fibrosis and EndoMT in the CNV. The combination of VEGFR2 antagonism and fibrosis/EndoMT inhibition was more effective than either individual treatment in reducing CNV. Our data indicate that fibrosis and EndoMT are involved in the progression of CNV, are exacerbated by VEGFR2 inhibition, and could provide an explanation for the reduced efficacy of anti-VEGFA treatment over time.

Purpose: To analyze the use of optical coherence tomography angiography (OCTA) in order to observe the changes in chronic central serous chorioretinopathy (CCSC) after half-dose photodynamic therapy (PDT). Methods: This is a retrospective study evaluating an imaging technique in a cohort of patients. Fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA) (Heidelberg Spectralis, Heidelberg, Germany), OCT, and OCTA with the split-spectrum amplitude-decorrelation angiography algorithm (XR Optovue, Fremont, CA, USA) were performed prior to half-dose PDT. OCT and OCTA were conducted at week 1, month 1, month 2, and month 3 after half-dose PDT. Results: A total of 33 eyes of 28 patients were enrolled in the study. At the baseline assessment, the patient pool had a mean best-correct visual acuity of logMAR 0.29 ± 0.34 and the mean choroidal thickness was 407.45 ± 77.98 µm. At month 3 after PDT, the patient pool had a mean best-correct visual acuity of logMAR 0.1 ± 0.17 and the mean choroidal thickness was 355.48 ± 67.90 µm. Abnormal flow in the choriocapillary, which corresponded to the initial examinations using OCTA, was observed in all 33 eyes (100%). The images show an irregular high pixel values interval from low pixel values. At week 1 after half-dose PDT, 25 eyes (75.8%) resembled the baseline images of the choriocapillary layer of OCTA. Areas of nonperfusion in the choriocapillary were observed in 5 eyes (15.2%), and vessel-like material in the choriocapillary was observed in 3 eyes (9.0%). At month 3 after PDT, the choriocapillary layer of OCTA was shown to return to normal in 32 eyes (97%). Conclusions: We have detected choriocapillary changes in patients diagnosed with CCSC following half-dose PDT by using noninvasive OCTA. These findings provide new evidence in support of the previously proposed hypothesis on the effect of PDT and suggest that OCTA may become a useful tool in the follow-up of CCSC.

Objective:To observe the image characteristics of patients with wet age-related macular degeneration (wet-AMD) before and after anti-VEGF threapy with optical coherence tomography angiography (OCTA).Methods:After a comprehensive examination of the affected eyes,including measuring the best corrected visual acuity(BCVA) with early treatment of diabetic retinopathy (ETDRS) visual acuity chart,slit lamp examination,non-contact tonometer,ophthalmoscope,fundus color photography,fundus fluorescein angiograph (FFA),optical coherence tomography(OCT) and OCTA,28 eyes of 28 patients with CNV secondary to wet-AMD referred to the department of ophthalmology in our hospital from January to June 2015 were included in this study.Patients were aged from 54 to 82 years,with the mean of (68.19±8.41) years.After intravitreal anti-VEGF therapy,BCVA,slit lamp examination,non-contact tonometer,ophthalmoscope,fundus color photography,OCT and OCTA were assessed monthly for 3 to 6 months,FFA were examed at the last follow-up.The FFA,OCT and OCTA image features of the first and last follow-up were analyzed.Results:At the first follow-up,28 eyes with active subfoveal or juxtafoveal CNV were confirmed by fluorescein dye leakage in FFA,high signal mass were found in all these affected eyes with OCT cross line scan,13 eyes had subretinal fluid,intraretinal fluid,or sub-RPE fluid.In all these eyes,OCTA showed there was no obvious abnormality in the superficial and deep retinal capillaries.It seemed that CNV lesions did not destroy these two layers.But all the 28 eyes found abnormal blood flow signals in the outer retina (originally avascular region) and choroid capillary layer.Nine eyes were observed with clear blood vessel structures of CNV,5 of them were found with large diameter of the trunk vessels and anastomotic connections at the outer border of the neovascularization.After anti-VEGF treatment,lesions dye leakage in FFA of 11 eyes were reduced,and there were no obvious changes in the rest 17 eyes.OCT scan showed that lesions were smaller in 12 eyes,and they were stable in the other 16 eyes.OCTA showed 15 eyes with reduced abnormal blood flow signals,while the other 13 eyes had no obvious changes.Because it can clearly display the vascular structure of CNV,OCTA is more sensitive compared with FFA and OCT in the diagnosis of vascular eye disease.Conclusion:OCTA can observe the retinal and choroidal capillaries from the superficial to the deep without dye injection.It can show CNV vascular structure more clearly.It is a powerful tool for diagnosing and monitoring CNV diseases such as wet-AMD.