Fundus fluorescein angiography (FFA) is the gold standard for diabetic retinopathy (DR) staging, yet whether angiographic phase affects deep learning performance remains unknown. Using 7508 FFA images from 863 eyes, stratified into venous, recirculation, and late phases, we developed Swin Transformer- and ConvNeXt-based DR staging models under the International five-grade and Chinese six-grade classification systems. Multiclass and binary (NPDR vs. PDR) classification tasks were evaluated. This study provides the first systematic quantification of angiographic phase effects on FFA-based DR staging. Phase-related performance was analyzed using generalized linear mixed-effects models with beta regression. ConvNeXt generally outperformed Swin Transformer, particularly in multiclass classification. Across all experimental settings, performance showed a consistent numerical decline from the venous to the late phase. Under the International five-grade system, ConvNeXt accuracy declined from 86.67% to 81.87%; however, Bonferroni-adjusted comparisons revealed no statistically significant phase-related differences (all adjusted p > 0.05), with small effect sizes (|SMD| < 0.2). Binary classification remained highly stable across phases, with accuracies exceeding 91%. Grad-CAM visualizations demonstrated progressively diffuse model attention in later phases. These findings support phase-flexible FFA acquisition for binary DR screening, whereas venous- or recirculation-phase images remain preferable for high-precision multiclass staging, guiding phase-aware AI development.

Objective:Hemophagocytic lymphohistiocytosis (HLH) associated retinopathy remains poorly characterized in terms of clinical phenotypes and pathogenesis. This retrospective study aimed to systematically define the multimodal imaging features of retinal lesions in patients with HLH and investigate its underlying pathological mechanisms to inform clinical practice. Methods:A retrospective case series analysis was conducted on 15 HLH patients with retinal lesions. Comprehensive ophthalmic evaluations, including fundoscopy and optical coherence tomography (OCT), were integrated with systemic multimodal imaging data. Results:Imaging analysis revealed characteristic retinal structural alterations, including retinal hemorrhage (26 eyes, 86.67%), outer retinal atrophy (20 eyes, 66.67%), outer retinal hyperreflective foci (7 eyes, 23.33%), ellipsoid zone disruption (17 eyes, 56.67%) and ellipsoid zone thinning (10 eyes, 33.33%). Multimodal imaging findings suggest a potential association between HLH related retinopathy and a hypoperfused ischemic state of the retina, though this requires further validation through larger scale statistical analysis. Notably, characteristic damage to the outer retinal structures was observed across HLH patients of different etiological subtypes and could manifest at any stage of the disease, including before and after interventions such as chemotherapy and hematopoietic stem cell transplantation. Discussion:The study data indicate potential involvement of HLH induced systemic cytokine storms, secondary hemoglobin reduction, and hematologic abnormalities such as thrombocytopenia in the observed retinal changes. These interpretations should be understood as hypothesis generating observations within the constraints of descriptive research methodology. Therefore, while cytokine cascade control remains a cornerstone of management, future studies should explore the potential benefit of blood component supplementation as an adjunctive therapy in HLH related retinopathy. Conclusion:These findings highlight the necessity of establishing early warning indicators for HLH associated retinopathy and conducting multicenter prospective studies to optimize evidence based diagnostic and therapeutic strategies.

This paper presents MedSegFactory, a versatile medical synthesis framework that generates high-quality paired medical images and segmentation masks across modalities and tasks. It aims to serve as an unlimited data repository, supplying image-mask pairs to enhance existing segmentation tools. The core of MedSegFactory is a dual-stream diffusion model, where one stream synthesizes medical images and the other generates corresponding segmentation masks. To ensure precise alignment between image-mask pairs, we introduce Joint Cross-Attention (JCA), enabling a collaborative denoising paradigm by dynamic cross-conditioning between streams. This bidirectional interaction allows both representations to guide each other's generation, enhancing consistency between generated pairs. MedSegFactory unlocks on-demand generation of paired medical images and segmentation masks through user-defined prompts that specify the target labels, imaging modalities, anatomical regions, and pathological conditions, facilitating scalable and high-quality data generation. This new paradigm of medical image synthesis enables seamless integration into diverse medical imaging workflows, enhancing both efficiency and accuracy. Extensive experiments show that MedSegFactory generates data of superior quality and usability, achieving competitive or state-of-the-art performance in 2D and 3D segmentation tasks while addressing data scarcity and regulatory constraints.

目的 对近 20 年高度近视黄斑裂孔性视网膜脱离相关文献进行计量学分析,探讨其研究特征、热点及趋势.方法 基于Web of Science核心合集,采用VOSviewer软件对 2001 年至 2020 年高度近视黄斑裂孔性视网膜脱离相关文献的总体特征进行关系网络构建及可视化分析.结果 本分析共有 237 篇文献,总共被引 5272 次,篇均被引 22 次.在 20 年的时间里SCI发文量呈上升趋势,2016 年达到峰值.发表论文数量最多的国家是中国,其次是日本、意大利、美国.发表论文数量最多和h指数最高的机构是日本大阪大学.发表论文数量排名前 2 位的期刊是Retina和American Journal of Ophthalmology.关键词共现分析发现,高度近视黄斑裂孔性视网膜脱离相关研究,主要集中在玻璃体切除相关手术的探索上.该领域被引用次数排名前十的文献提示不同的年限研究的侧重点有区别,2001-2011 年主要为玻璃体切割术的使用推广和内容物的填充,2011 年之后为内界膜填塞、内界膜翻瓣、内外路联合手术的探索.结论 近些年高度近视黄斑裂孔性视网膜脱离的研究主要集中在玻璃体切割手术为基础的手术方式的改进上,如何更为恰当的处理玻璃体切割手术中的内界膜是国际学者研究的热点,具有较广阔的前景.

Purpose: To quantify the structural changes in choroidal vessels and to observe choroid microstructural changes in different age and sex groups in a healthy Chinese population. Methods: Enhanced depth imaging optical coherence tomography (EDI-OCT) was employed to analyze the luminal area, stromal area, total choroidal area, subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), large choroidal vessel layer (LCVL), choriocapillaris–medium choroidal vessel layer, and LCVL/SFCT of the choroid in the subfoveal macular area within 1500 μm of the macula. We analyzed the age- and sex-related changes in the subfoveal choroidal structure. Results: A total of 1566 eyes from 1566 healthy individuals were included. The mean age of the participants was 43.62 ± 23.29 years, the mean SFCT of healthy individuals was 269.30 ± 66.43 μm, LCVL/SFCT percentage was 77.21 ± 5.84%, and the mean macular CVI was 68.39 ± 3.15%. CVI was maximum in the 0–10 years group, decreasing with age, and the lowest values occurred in the >80 years group; LCVL/SFCT was the lowest in the 0–10 years group, increasing with age and reaching a maximum in the >80 years group. CVI showed a significant negative correlation with age, and LCVL/SFCT showed a significant positive correlation with age. There was no statistically significant difference between males and females. Interrater and intrarater reliability was less variable with CVI than with SFCT. Conclusions: The choroidal vascular area and CVI decreased with age in the healthy Chinese population, of which the age-related decrease in vascular components maybe dominated by the decrease in choriocapillaris and medium choroidal vessels. Sex had no effect on CVI. The CVI of healthy populations showed better consistency and reproducibility when compared with SFCT.

BACKGROUND:The insulin-like growth factor 1 (IGF1) gene is located within the myopia-associated MYP3 interval, which suggests it may play an important role in the progression of myopia. However, the association between IGF1 SNPs and any myopia is rarely reported. METHODS:A comprehensive literature search was conducted on studies published up to July 22, 2021 in PubMed, EMBASE, CBM, COCHRANE, CNKI, WANFANG and VIP databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for single-nucleotide polymorphisms (SNPs) that have been evaluated in at least three studies. RESULTS:Nine studies involving 4596 subjects with any myopia and 4950 controls examined 25 SNPs in IGF1 gene, among which seven SNPs were included in this meta-analysis. Significant associations were not found in any genetic models between rs6214, rs12423791, rs5742632, rs10860862, rs5742629 and any myopia. Rs2162679 was suggestively associated with any myopia in the codominant model (GA vs. AA: OR = 0.87, 95% CI: 0.76-1.00) and the dominant model (GG+GA vs. AA: OR = 0.88, 95% CI = 0.78-1.00). CONCLUSION:Meta-analysis of updated data reveals that the G allele of the IGF1 rs2162679 SNP is a potential protective factor for any myopia, which is worth further researches.

Background:Intraocular lens (IOL) implantation is required after vitrectomy combined with cataract surgery in diabetic retinopathy patients. However, the question of whether an IOL should be implanted in stage I after vitrectomy or stage II during silicone oil filling has been controversial, and there has been no systematic review of this clinical issue. Methods:WanFang, SinoMed CNKI, VIP, PubMed, Embase, and Cochrane Library databases were systematically searched for relevant studies. The deadline was May 8, 2021. All studies of stage I or II IOL implantation in patients with diabetes who underwent vitrectomy were included. Revman 5.3 software was used for the meta-analysis. Results:Four studies, involving 253 eyes, were included. This study analyzed the literature with a common outcome index by meta-analysis and systematically evaluated the literature without a common outcome index. Four studies compared the efficacy and safety of the 2 sequential surgical methods in patients with diabetic retinopathy. The results of the meta-analysis showed that there was no significant difference in the efficacy and safety of stage II IOL implantation when compared with stage I IOL implantation (P > .05). One study showed that stage II cataract surgery with oil extraction resulted in better postoperative visual acuity and fewer complications than stage I cataract surgery with vitrectomy. One study showed that stage II IOL implantation during oil extraction had better postoperative visual acuity than stage I IOL implantation during vitrectomy without increasing surgical complications. Conclusion:Vitrectomy combined with stage II IOL implantation is safer and more effective than stage I in patients with diabetic retinopathy; however, more clinical studies are needed to verify this.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

报告一例陈旧性视网膜中央静脉阻塞6年后发生视网膜中央动脉阻塞的病例,讨论视网膜血管阻塞性疾病全身治疗的重要性.

In this work, we propose an AI-based method that intends to improve the conventional retinal disease treatment procedure and help ophthalmologists increase diagnosis efficiency and accuracy. The proposed method is composed of a deep neural networks-based (DNN-based) module, including a retinal disease identifier and clinical description generator, and a DNN visual explanation module. To train and validate the effectiveness of our DNN-based module, we propose a large-scale retinal disease image dataset. Also, as ground truth, we provide a retinal image dataset manually labeled by ophthalmologists to qualitatively show the proposed AI-based method is effective. With our experimental results, we show that the proposed method is quantitatively and qualitatively effective. Our method is capable of creating meaningful retinal image descriptions and visual explanations that are clinically relevant.https://github.com/Jhhuangkay/DeepOpht-Medical-Report-Generation-for-Retinal-Images-via-Deep-Models-and-Visual-Explanation.

目的 采用频域光学相干断层扫描(SD-OCT)的增强深度成像(EDI)技术分析视网膜中央动脉阻塞(CRAO)眼各项脉络膜结构相关参数的改变.方法 收集2018年10月至2019年12月在首都医科大学附属北京友谊医院眼科确诊为CRAO的21例单眼患者临床资料.选取CRVO患眼及对侧健眼各项脉络膜结构相关参数测量结果进行分析并比较,包括脉络膜总面积(total choroidal area,TCA)、脉络膜血管面积(luminal area,LA)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)及脉络膜血管指数(choroidal vascularity index,CVI).结果 CRAO患者患眼SFCT、TCA、LA和CVI分别为(210.95±36.43) μm、(1.01±0.27) mm2、(0.64±0.18) mm2、(63.52±3.11)％,对侧健眼分别为(293.33±57.99) μm、(1.40±0.24) mm2、(0.93±0.16) mm2、(66.76±3.93)％.21眼CRAO患眼与对侧健眼相比,SFCT变薄,TCA、LA、CVI下降,差异均有统计学意义(均为P＜0.05).结论 CRAO眼脉络膜的形态结构发生改变,SFCT变薄,CVI减小,提示CRAO发生时除存在视网膜缺血外还伴有脉络膜供血不足.

目的 探讨医院人群中心性浆液性脉络膜视网膜病变(CSC)的患病情况及相关危险因素.方法 以医院人群为基础的回顾性横断面研究.以2019年1～12月期间就诊患者为研究对象,对符合纳入标准的CSC及同时期对照,进行电话通知并进行随访,填写调查问卷.采用SPSS软件进行统计分析.结果 2019年1～12月期间共有23878人次就诊于医院通州院区门诊.其中45例确诊为CSC(0.19％);男37例(82.22％),女8例(17.78％);21～65岁,平均(42.3±10.1)岁;双眼患病者3例(6.67％).45例中39例患者接受调查,选择同期年龄、性别匹配的门诊就诊患者39例为对照,进行危险因素分析.使用logistic回归分析结果显示,与CSC患病呈独立相关的因素有外源性激素使用(OR=5.04,95％CI:1.11-22.89)、睡眠时间(24:00后)(OR=4.16,95％CI:1.33-13.04)、轮班工作(OR=5.74,95％CI:1.47-22.45).结论 在医院就诊人群中CSC的患病率0.19％,与其相关的独立因素有轮班工作、睡眠时间(24:00后)和外源性激素使用.

AIM: To investigate the differences of the choroidal vascularity index between type 2 diabetes with diabetic retinopathy and non-diabetes patients.METHODS: A retrospective cross-sectional study was performed at Beijing Friendship Hospital. Enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT)scans of 68 eyes of 68 type 2 diabetes who with diabetic retinopathy were compared with those of right eyes of 34 age- and gender-matched healthy controls. The choroidal images were binarized into luminal areas(LA)and stromal areas(SA). CVI was defined as the ratio of LA to total circumscribed subfoveal choroidal area. Mean choroidal thickness, mean retinal thickness and mean CVI between patients and controls were compared using t-test. RESULTS: There were no significant differences in total circumscribed subfoveal choroidal area(0.53±0.14mm2 vs 0.49±0.15mm2), LA(0.35±0.09mm2 vs 0.32±0.10mm2), SA(0.17±0.05mm2 vs 0.17±0.06mm2), or subfoveal choroidal thickness(347.9±76.9μm vs 325.9±92.9μm)between patients with DR and controls(P>0.05). However, there was a significantly lower CVI in patients with diabetes as compared to controls(64.33%±3.25% vs 67.04%±2.46%, P<0.001). The critical value was 63.59%.CONCLUSION: CVI is a kind of biological indicators which can directly reflect the changes of choroidal internal structure, and it is more stable and reliable than SFCT. For type 2 diabetic patients who with diabetic retinopathy, CVI is lower than that of healthy people.

目的:探讨帕金森病(PD)患者的快速眼动期睡眠行为障碍发生率、睡眠结构及脑电图的电生理改变.方法:选择PD患者32例.同时纳入年龄、性别匹配的健康对照组25例.应用日本光电32导9200K脑电图机,所有患者均在神经科病房长程脑电监测室完成视频多导睡眠电生理监测(V-PSG),记录脑电图、眼球运动、下颌和肢体肌电活动、心电图、经鼻气流、胸腹部呼吸运动、血氧、鼾声,同步视频监测患者的行为.使用Polysmith软件分析呼吸、运动等相关指标,并视觉评估睡眠分期.结果:PD组患者有Ⅰ期睡眠时间和比例增多、慢波睡眠比例减少的倾向,其余睡眠结构与正常组无明显差异.PD组20例患者(62.5％)呈现快速眼动期骨骼肌肌张力不消失,其中6例(18.8％)患者伴有夜间活动和言语;对照组有4例(16％)在快速眼动期骨骼肌肌张力不消失,无言语及肢体活动.2组之间睡眠行为障碍(RBD)出现率差异有统计学意义(P＜0.01).结论:PD组患者伴睡眠行为障碍(RBD)发生率较高.V-PSG监测可以提高PD患者伴RBD的诊断.

The present study aimed to compare the imaging performance of two ultra-wide-field fluorescein angiography imaging systems, namely the OptosOptomap 200Tx (Optos 200Tx) and the Heidelberg Spectralis (Spectralis). A total of 18 patients (36 eyes) underwent angiography using the two systems at the Department of Ophthalmology, Beijing Friendship Hospital (Beijing, China) between January and June 2017. The images were obtained as a single shot centered on the macula. The total area and area within each of four visualized quadrants were calculated and compared. The averages of the total and individual quadrant area captured by the Optos 200Tx were all larger than those obtained with the Spectralis (P<0.05). For pair-wise comparison, the circular area centered on the macula (radius of 10 and 15 mm) was displayed: Optos 200Tx 10 mm (295.57 mm2) < Spectralis (520.11 mm2) < Optos 200Tx 15 mm (596.45 mm2) < Optos 200Tx (804.36 mm2) (P<0.01). The differences of each of the four quadrant areas were statistically significant between the two systems (P<0.05). The mean size of the areas was in the following order: Inferior < temporal < superior < nasal for the Optos 200Tx, and inferior < temporal < nasal < superior for the Spectralis. Further comparison of the four-quadrant area indicated that the inferior quadrant of the Optos 200Tx was smaller than the other three quadrants (P<0.01) and the inferior quadrant of the Spectralis was smaller than the superior quadrant (P<0.01). The total retinal area and the retinal area of each quadrant captured by the Optos 200Tx were larger than those captured with the Spectralis. The total retinal area captured with the Optos 200Tx was able to cover the mid-peripheral area and part of the far-peripheral area of the retina, whereas the Spectralis only covered the mid-peripheral area.

目的 分析2014年1月1日至2019年12月31日眼缺血综合征(OIS)研究领域国内外文献的特征.方法 在CNKI及WOS数据库中分别筛查出2014年1月1日至2019年12月31日与OIS相关的文献,查找文献相关数据并进行分析.结果 分析35篇中文文献,总共被引41次,该领域h指数为2;48篇外文文献,总共被引115次,该领域h指数为6.发表论文数量并列最多和h指数最高的机构是首都医科大学和波兰波美拉尼亚医科大学.发表论文数量最多和h指数最高的国内期刊是中华眼科杂志;发表论文数量并列最多和h指数最高的国外期刊是Journal of Ophthalmology和Plos One.国外发表论文数量最多的国家是中国,h指数和韩国并列最高.我国国家自然科学基金对OIS领域资助最多,占国内总发文量的20.8％.国外被引用次数最多的是Hayreh,SS.的一篇关于眼部血管阻塞性疾病黑矇病的患病率及发病机制的研究,其他排名前十的文献重点讨论OIS在OCT上的表现及缺血缺氧机制等方面.结论 OIS疾病在OCT检查上的表现及缺血缺氧机制研究成为研究者关注的热点.

Objective:To observe the effect of spectral-domain OCT with different subfoveal choroidal areas on choroid vascular index (CVI) in normal healthy eyes.Methods:Retrospective clinical study. From October 2017 to May 2018, 174 eyes of 87 healthy people who visited in the Ophthalmology Department of Beijing Friendship Hospital and had no eye abnormalities were included in the study. All patients received single line scan of macular fovea by enhanced depth imaging OCT. After binary processing of the collected choroidal images, CVI as the center radius of 750, 1500, 3000 and 4500 μm were calculated. Repeated measurement analysis of variance was performed for comparison of CVI between groups.Results:The mean values of CVI in the 750, 1500, 3000 and 4500 μm groups were 0.681±0.003, 0.678±0.002, 0.677±0.002 and 0.676±0.002, respectively. The difference between the 750 μm group and the 4500 μm group was 0.005±0.002 ( P=0.009). The other pairwise comparison results showed no statistically significant difference ( P>0.05). Conclusion:The CVI is different in healthy eyes with the different distance from macular fovea.

目的:观察振腹对糖尿病前期患者的疗效及其作用机制.方法:选择2015年1月至2016年6月期间就诊于北京中医药大学东方医院的糖尿病前期患者64例,分为观察组、对照组,每组32例.对照组无特殊干预措施,观察组予振腹治疗,均干预12周,分析各组患者血糖、胰岛素及HOMA2指标变化.结果:治疗后,观察组空腹血糖(FPG)、餐后2h血糖(2hPG)及空腹胰岛素(HNS)下降值显著高于对照组(P＜0.01);孤立的空腹血糖受损(i-IFG)及孤立的葡萄糖耐量异常(i-IGT)经振腹治疗均可显著提高患者胰岛素敏感性指数(HOMA2-％S)、降低患者胰岛素抵抗指数(HOMA2-IR)(P＜0.05,P＜0.01).结论:振腹疗法可以显著降低糖尿病前期患者FPG及2hPG水平,其中对2hPG降低更为显著,其机制可能在于振腹治疗可以改善患者胰岛素抵抗水平,提高机体胰岛素敏感性.

目的 探讨眼睑肿物的临床特征、病理分型并总结眼睑缺损修复手术体会.方法 回顾性分析2012年4月至2018年12月首都医科大学附属北京友谊医院收治的446例眼睑肿物行肿物切除伴眼睑重建患者的病例资料,分析患者的临床特征、肿物位置、病理结果及手术方法.结果 446例患者中,男性199例,女性247例;平均年龄(51.96±17.11)岁.右眼232例,左眼214例;上睑182例,下睑198例,内眦部26例,外眦部21例,眉部19例.101例肿物位于睑缘,其中累及睑缘全层者52例.行病理检查者共404例,恶性12例,良性者392例.良性和恶性肿物切除后均未见复发,最长随访5年.眼睑板层切除伴直接对位缝合231例;行邻近滑行皮瓣或旋转皮瓣修补114例;101例睑缘肿物,52例累及睑缘全层,其中行眼睑全层切除直接拉拢缝合31例;行颞侧皮瓣旋转修复21例.结论 眼睑肿物的病理决定肿物生长特征,需根据各自特点术中注意手术细节.应用最简单的方法,采用邻近组织修复缺损眼睑,最大程度减少对患者外观和眼睑功能的影响是手术成功的关键.

In recent years, pachychoroid spectmm diseases have received increasing attention. With the great progress of fundus imaging diagnosis technology, the use of fluorescein fundus angiography ( FFA) , indole green angiography ( ICGA) , frequency domain optical coherence tomography ( OCT) and optical co-herence tomography angiography ( OCTA) , multimodal imaging quantitative technology that combines diag-nosis and treatment of the pachychoroid spectmm diseases, such as age-related macular degeneration ( AMD ) , polypoid choroidal vasculopathy ( PCV ) , retinal vein occlusion ( RVO ) , diabetic retinopathy ( DR) , central serous chorioretinopathy ( CSC ) , has been used in clinical work.