Abstract:AIM: To investigate whether anti-placental growth factor (PGF) can inhibit subretinal fibrosis and whether this effect is mediated by the inhibitory effect of PGF on epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells. METHODS: Subretinal fibrosis model was established in laser induced choroidal neovascularization (CNV) mice on day 21 after laser photocoagulation. Immunofluorescence staining (IFS) of cryosections and enzyme-linked immunosorbent assay (ELISA) were used to detect the expression of PGF. IFS of whole choroidal flat-mounts was used to detect the degree of subretinal fibrosis. IFS of cryosections and ELISA were used to detect the expression of EMT related indicators in subretinal fibrosis lesions. RESULTS: The expression of PGF protein in subretinal fibrosis lesions was significantly up-regulated (P<0.05), and mainly co-stained with pan-cytokeratin labeled RPE cells. Intravitreal injection of anti-PGF neutralizing antibody reduced the area of subretinal fibrosis and the ratio of fibrotic/angiogenic area significantly at the concentrations of 0.25, 0.5, 1.0, and 2.0 μg/μL (all P<0.05). The expression of E-cadherin in the local RPE cells decreased, while α-SMA increased significantly in subretinal fibrosis lesions, and the application of anti-PGF neutralizing antibody could reverse these changes (P<0.05). CONCLUSION: The expression of PGF is up-regulated in the lesion site of subretinal fibrosis and mainly expressed in RPE cells. Intravitreal injection of anti-PGF neutralizing antibody can significantly inhibit the degree of subretinal fibrosis in CNV mice, and this effect may be mediated by the inhibition of PGF on EMT of RPE cells.

Abstract:AIM: To study the braking effectiveness of artesunate on transforming growth factor (TGF)-β2 mediated epithelial-mesenchymal transition (EMT) in retinal pigment epithelium (RPE) in vitro. METHODS: The fostered ARPE-19 cells were processed with artesunate alone or combined with the TGF-β2. The CCK-8 examination was utilized to test the cell propagation. Cell migration was detected by scratch as well as the Transwell examination. The EMT characters and activation of PI3K/Akt signal channel were estimated by Western blotting and immunofluorescence. The Western blotting was utilized in order to confirm the vitreous of controls as well as patients with proliferative vitreoretinopathy (PVR) were collected and the levels of PI3K, phospho-PI3K, Akt. RESULTS: Disposal of ARPE-19 cells with artesunate (50-150 μmol/L) obviously suppressed their propagation and immigration, which dependent on the concentration and time. Artesunate suppressed the EMT which was induced by TGF-β2 in ARPE-19 cells through sustaining the expression of vimentin and α-SMA through the suppression of PI3K, phospho-PI3K, phospho-Akt and Akt. Levels of PI3K, phospho-PI3K, AKT and phospho-Akt was increased in the vitreous in PVR (P<0.05). CONCLUSION: Such findings indicate that PI3K/Akt signal channel is highly activated in vitreous of PVR. Artesuante is an operative depressor of the propagation, immigration and TGF-β2-mediated EMT of ARPE-19 cells by reduced the expression of PI3K/Akt channel.

Abstract:AIM: To describe the clinical heterogeneity of patients with novel mutations in BEST1. METHODS: All the members in the two Chinese families underwent detailed clinical evaluations including best-corrected visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination. Fundus autofluorescence, fundus fluorescein angiography, spectral-domain optical coherence tomography, electrooculography, and electroretinogram were also performed. Genomic DNA was extracted from venous blood for all the participants. The targeted next-generation sequencing of inherited retinal disease-associated genes was conducted to identify the causative mutation. RESULTS: A novel BEST1 missense mutation c.41T>C (p.Leu14Ser) was identified in Family 1. It was co-segregated with the phenotype of best vitelliform macular dystrophy (BVMD) and bioinformatics analysis confirmed it was harmful. Another novel BEST1 frameshift mutation c.345_346insGGCAAGGACG (p.Glu119Glyfs*116) and a novel USH2A missense mutation c.12560G>A, p.Arg4187His were identified in family 2 with retinitis pigmentosa (RP), which might interact and lead to the phenotype of RP. CONCLUSION: Two novel mutations in the BEST1 gene in two unrelated families with distinct phenotypes and BEST1 mutation accompanied with USH2A mutation would result in RP, which could be enormously helpful in understanding the pathogenesis of the inherited retinal disease caused by a BEST1 mutation.

Abstract:AIM: To explore the effects of laser-activated remote phosphors (LARP) on visual function in guinea pigs. METHODS: Electroretinogram (ERG) of guinea pigs were observed after LARP irradiation at different frequencies and irradiation times. We evaluated the expression of rhodopsin, β-catenin, connexin36, calretinin, and calbindin in the retina of guinea pigs and measured the density of photoreceptor cells after high-frequency LARP irradiation. RESULTS: After LARP irradiation, the ERG results showed that the amplitude of the dark-adapted 3.0 b-wave of the model eye was lower than that of the control eye after high-frequency irradiation (P<0.05). The expression of rhodopsin, β-catenin, connexin36, calretinin, and calbindin in the retina of guinea pig declined. CONCLUSION: There is frequency cumulative damage effect on the retina that relates to LARP illumination frequency. This has significance for staff visual protection policies under LARP lighting conditions.

Abstract:AIM: To observe the efficacy of simplified one-step thermokeratoplasty for the treatment of severe acute corneal hydrops in keratoconus. METHODS: In this retrospective, noncomparative clinical study, 10 patients (10 eyes) with acute hydrops in keratoconus were treated with simplified one-step thermokeratoplasty. Pain, changes in the corneal curvature, thickness, and size and morphology of the Descemet membrane breaks were detected before and after surgery. Eight patients were successfully treated using modified deep anterior lamellar keratoplasty (DALK). Graft transparency, visual acuity, and immunological rejection were evaluated for 6 to 12mo. RESULTS: Pain and corneal oedema were promptly alleviated, and the intrastromal ruptures diminished within 3 to 6wk after thermokeratoplasty. At 3 to 6wk after corneal oedema was faded, Descemet membrane breaks and intrastromal ruptures were healed. Two patients did not undergo subsequent corneal transplantation after thermokeratoplasty. Eight patients underwent DALK successfully and safely after thermokeratoplasty, without corneal perforation. Central corneal opacity faded or disappeared within 6mo. The mean best-corrected visual acuity was increased to 20/30 at 12 mo after DALK. No one was observed with any immune rejection. CONCLUSION: One-step thermokeratoplasty can successfully and efficiently accelerate the absorption of prominent corneal oedema in severe acute hydrops patients. This simple procedure with no complications can be performed in the emergency department by residents. This method can improve the safety of DALK and obtain good postoperative vision. Long-term management of acute corneal hydrops using simplified one-step thermokeratoplasty seems promising.

Abstract:AIM: To evaluate the accuracy and predictability of ray tracing-assisted intraocular lens (IOL) calculation function in Sirius internal software and further improve the accuracy by optimizing the calculation of predicted lens position (PLP). METHODS: This retrospective study recruited 52 eyes of 49 patients. All of the cases with cataract had undergone phacoemulsification combined with IOL implantation. SRK-T, Haigis formula, and Sirius ray-tracing method were all used for each eye's IOL calculation. The mean absolute value of prediction error (prediction error=predicted refraction- postoperative refraction) was defined as mean absolute prediction error (MAPE) and was determined for each method. Calculation of PLP was optimized by effective lens position (ELP). Optimized PLP was entered to Sirius internal software again to verify whether the method was improved. RESULTS: Compared with SRK-T and Haigis formulas, less accuracy was shown in Sirius ray-tracing method (P=0.001). The ELP of the IOL moved forward compared to PLP (P<0.001). The MAPE of the ELP-inputted Sirius ray-tracing method was reduced. ELP and PLP were well correlated. Taking ELP as y and PLP given by Sirius soft as x, a linear regression formula y=0.1637x+3.1741 was concluded (R²=0.1066, P=0.018). It was shown that the optimized Sirius ray-tracing method (optimized PLP entered), compared with SRK-T and Haigis formulas, worked with the same accuracy (P=0.038). CONCLUSION: The original Sirius ray tracing method is not satisfactory enough. However, in normal eyes, the optimized Sirius ray-tracing method in IOL calculation was as accurate as SRK-T and Haigis formulas.

Abstract:AIM: To assess the predictive value of baseline parameters of ultrasound biomicroscopy (UBM) for angle widening after prophylactic laser peripheral iridotomy (LPI) in patients with primary angle-closure suspect (PACS). METHODS: Angle-opening distance (AOD), trabecular iris angle (TIA), iris thickness, trabecular-ciliary process angle, and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI. Iris convexity (IC), iris insertion, angulation, and ciliary body (CB) size and position were graded. Uni- and multivariate regression analyses were used to determine factors predicting the change in AOD (ΔAOD500, calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC. RESULTS: In 94 eyes of 94 patients with PACS, LPI led to angle widening with increases in AOD500 and TIA (P<0.01). Multivariable regression analysis showed that IC (P<0.001), CB position (P=0.007) and iris insertion (P=0.049) were significantly predictive for ΔAOD500. All quadrants were categorized into extreme IC (27.8%), moderate IC (62.3%), and absent IC (9.9%) subgroups. The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants. The AOD500 increased by 55%, and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants. CONCLUSION: In PACS patients, quadrants with greater iris bowing predict substantial angle widening after LPI. Quadrants with a flatter iris, anteriorly positioned CB, and basal iris insertion are associated with less angle widening after LPI. Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.

Abstract:AIM: To evaluate the efficacy and safety of modified trabeculectomy (experimental group) and implantation of EX-PRESS drainage device (control group), combined with intravitreal conbercept injection for neovascular glaucoma (NVG). METHODS: Totally 30 patients with NVG were selected from June 2014 to June 2017, and randomly divided into experimental group and control group. All patients were underwent intravitreal conbercept (0.5 mg/0.05 mL) treatment before surgery. Modified trabeculectomy was performed in MT group, while EX-PRESS drainage device implantation was performed in EX group. The success rates, best corrected visual acuity (BCVA), intraocular pressure (IOP), filtering bleb and complications were observed and compared. RESULTS: The differences of success rate, BCVA and filtering bleb were not statistically significant 12mo after the surgery (P>0.05), however, the difference of IOP at 1d, 1wk, 1, 3, and 6mo after surgery was statistically significant (Ftime=390.64, Ptime<0.0001) between two groups. The interactions between two groups in the given time showed no significant difference (Fintergroup×time=0.181, Pintergroup×time=0.57), and also there was no significant difference in IOP between the two groups (F=3.16, P=0.09). The results of pairwise comparison at each time point showed no significant difference in IOP between 1d and 1wk, 3 and 6, 3mo and 12mo after surgery (P>0.05), while the results at other time point indicate statistical differences (P<0.05). CONCLUSION: The modified trabeculectomy and the implantation of EX-PRESS drainage device have clinical application value in reducing IOP and postoperative complications of refractory NVG.

Abstract:AIM: To investigate the effects of on ocular surface microbiota in patients who received intravitreal injections. METHODS: Samples of ocular surface microbiota were obtained from 41 eyes of 41 patients who visited the Department of Ophthalmology. Patients were separated for three groups. Group A did not receive perioperative managements or intravitreal injection. Group B1 received only once and B2 received more than twice. In operating room, the samples were collected on the ocular surface. Operating taxonomic units (OTUs) clustering and alpha/beta diversity analysis was performed. The microbial 16S rRNA from samples were analyzed using the HiSeq 2500 platform. RESULTS: Alpha diversity did not differ in each group, and beta diversity differed in the B2 group. Beta diversity showed a significant difference between Group A and B2 (P=0.048). With the perioperative managements before intravitreal injection, the composition and relative abundance were altered. Top 10 microbiota on phylum and genus level, and then microbiota notably changed at genus level were listed. Gram-negative bacteria were varied more. Furthermore, Proteus was not found in Groups A and B1, but it was appeared after the patients received perioperative management and intravitreal injections in Group B2. CONCLUSION: With the perioperative managements, the balance of microbiota on the ocular surface is destroyed, and relative composition and abundance of microbiota on the ocular surface is obviously altered. The clinical doctors should pay more attention on the consequence of perioperative managements before intravitreal injection.

Abstract:AIM: To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional (3D) visualization system. METHODS: Enucleated porcine eyes were established as an animal model for removing foreign bodies. Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system. One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group. One senior surgeon evaluated the retinal invasion by a graded injury degree. The learning curve for minimally invasive vitreoretinal surgery was described. RESULTS: Compared with the robot-assisted group, the injury degree was higher in the manual group. For the first ten surgeries, the manual and robot-assisted groups had injuries of 2.60±1.35 (4 to 0) and 1.80±1.62 (4 to 0), respectively. For the last ten surgeries, the injury degrees were 1.90±1.20 (3 to 0) and 0.80±0.42 (1 to 0). Considering the manual and robot-assisted groups together, 95%, 75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable, easier and clearer, respectively. CONCLUSION: The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.

Abstract:AIM: To compare the assessment outcomes of the characteristics of mild to moderate non-proliferative diabetic retinopathy (NPDR) established by fundus photography and fundus fluorescein angiography (FFA). METHODS: The fundus photos and FFA results of 260 patients with diabetes mellitus were reviewed. Diabetic retinopathy (DR) severity was graded based on the international classification standard. The microaneurysms, hemorrhages, and intraretinal microvascular abnormalities (IRMA) in FFA images of patients with mild to moderate NPDR were observed. The differences between the fundus photos and the FFA results were summarized, analyzed, and compared. RESULTS: The counting of intraretinal hemorrhages identified by FFA revealed that only 9 eyes (1.9%) had more than 20 intraretinal hemorrhages in all four quadrants; 15 eyes (3.1%) had more than 20 intraretinal hemorrhages in three quadrants; 26 eyes (5.4%) had over 20 intraretinal hemorrhages in two quadrants; and 37 eyes (7.7%) had more than 20 intraretinal hemorrhages in only one quadrant. Furthermore, the number of IRMAs appeared ≥4 in 17 eyes, 3 in 35 eyes, 2 in 69 eyes, and 1 in 93 eyes. CONCLUSION: FFA has higher detection accuracy of retinal angiopathy than fundus photography. FFA grading results are helpful for timely detection and proper treatment of lesions easily missed by fundus photography.

Abstract:AIM: To develop and evaluate a new fundus image optimization software based on red, green, blue channels (RGB) for the evaluation of age-related macular degeneration (AMD) in the Chinese population. METHODS: Fundus images that were diagnosed as AMD from the Shanghai Changfeng Study database were analyzed to develop a standardized optimization procedure. Image brightness, contrast, and color balance were measured. Differences between central lesion area and normal retinal area under different image brightness, contrast, and color balance were observed. The optimal optimization parameters were determined based on the visual system to avoid image distortion. A paired-sample diagnostic test was used to evaluate the enhancement software. Fundus optical coherence tomography (OCT) was used as the gold standard. Diagnostic performances were compared between original images and optimized images using McNemar's test. RESULTS: A fundus image optimization procedure was developed using 86 fundus images of 74 subjects diagnosed with AMD. By observing gray-scale images, choroid can be best displayed in red channel and retina in green channel was found. There was limited information in blue channel. Totally 104 participants were included in the paired sample diagnostic test to assess the performance of the optimization software. After the image enhancement, sensitivity increased from 74% to 88% (P=0.008), specificity decreased slightly from 88% to 84% (P=0.500), and Youden index increased by 0.11. CONCLUSION: The standardized image optimization software increases diagnostic sensitivity and may help ophthalmologists in AMD diagnosis and screening.

Abstract:AIM: To evaluate the results and complications of secondary endoresection via pars plana vitrectomy for choroidal melanoma and review the previously reported endoresection studies on the treatment of choroidal melanoma. METHODS: The medical records of 6 patients with choroidal melanoma who underwent secondary endoresection between March 2012 and March 2020 were retrospectively reviewed. The indications for secondary endoresection were progressive or recurrent tumor and severe exudative retinal detachment after previous treatment with plaque radiotherapy/Cyberknife radiosurgery/transpupillary thermotherapy (TTT). RESULTS: Before endoresection, 2 eyes had Iodine-125 plaque radiotherapy and TTT, 1 eye had Ruthenium-106 plaque radiotherapy and TTT, 1 eye had Cyberknife radiosurgery and TTT, 1 eye had Cyberknife radiosurgery, and 1 eye had TTT only. Preoperative visual acuity ranged from 20/63 to 20/1600 (Snellen) and from 0.5 to 1.9 (mean: 1.1) on the logMAR scale. The mean tumor base diameters were 9.5×8.7 mm and the mean tumor thickness was 5.4 mm. After secondary endoresection, transient vitreous hemorrhage developed in 2 (33.3%) eyes and retinal detachment in 1 (16.7%) eye. Cytopathological examination revealed epithelioid cell melanoma in 4 (66.7%) eyes and mixed cell melanoma in 1 (16.7%). Melanoma cell type was not specified in 1 (16.7%) eye. At a mean follow-up of 49.6mo (range: 16-90mo), mean visual acuity did not improve and 1 eye was enucleated due to tumor recurrence. Final visual acuity ranged from 20/63 to 20/1600 (Snellen) and from 0.5 to 1.9 (mean: 1.2) on the logMAR scale. Two patients with choroidal melanoma developed metastasis and eventually expired. CONCLUSION: Secondary endoresection seems to be an effective treatment option for globe salvage in choroidal melanoma not responsive to conventional treatment and displaying persistent exudative retinal detachment. There was no visual acuity increase among the treated eyes but globe salvage was possible in most cases in this study.

Abstract:AIM: To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane (ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis (MF). METHODS: A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF. A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP. Next, an ILM forceps was used to catch hold of the incisal edge of the ILM flap, and the action of releasing and separating was subsequently taken toward the direction of the macular fovea. Next, the ILM forceps was used to grasp the released area, and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter. Finally, the ILM was folded backwards and peeled off in the arc direction. RESULTS: At the final visit, the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 μm. The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59. CONCLUSION: The wide range of whole piece consecutive ILM peeling without preservation of the epi-fovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.

Abstract: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.

Abstract:AIM: To compare the efficacy between two different silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy (T-PRK). METHODS: In this randomized controlled trial, a total of 89 patients (178 eyes) who underwent T-PRK at the Qingdao Eye Hospital from October to December 2019 were selected. One random eye wore a Senofilcon A bandage contact lens after surgery, and the other eye a Balafilcon A bandage contact lens. Pain scores, uncorrected visual acuity (UCVA), spherical equivalent (SE), corneal epithelial healing status, epithelial thickness, bandage lenses deposits, lenses movement, and ocular surface conditions were measured and compared. RESULTS: There were no differences between the two groups in UCVA, SE, corneal epithelial healing status, corneal epithelial thickness, tear river heights and tear film rupture time at each follow-up visit. However, postoperative pain scores in the Senofilcon A group were significantly lower than those of the Balafilcon A group (Fintergroups=67.833, P<0.001; Ftime=383.773, P<0.001; Finteraction=57.344, P<0.001). The duration of pain in eyes in the Senofilcon A group was shorter than that of the Balafilcon A group (t=-3.326, P=0.001). The surface deposition scores and movement scores of Senofilcon A bandage lenses on the first and fourth days after surgery were lower than those of Balafilcon A bandage lenses (Z=-5.385, -6.782, P<0.001; Z=-8.336, -8.906, P<0.001). CONCLUSION: Both Senofilcon A and Balafilcon A bandage lenses have good efficacy after T-PRK. Senofilcon A lenses are associated with less pain and more comfort compared to Balafilcon A.

Abstract:AIM: To evaluate the ophthalmic manifestations, radiographic features, and prognosis of Chinese patients with primary orbital mesenchymal chondrosarcoma (MCS). METHODS: The study included 6 cases with primary orbital MCS treated at Tianjin Eye Hospital from January 2009 to December 2019. Patitent ophthalmic manifestations, radiographic features, diagnosis, pathology, therapeutic regimens, and prognosis were retrospectively reviewed. RESULTS: Six patitents with primary orbital MCS were identified. The mean age at the first visit was 33y (range, 25-42y). All six patients displayed manifestations of exophthalmos, diplopia, limitation of eye displacement, upper eyelid oedema, decreased visual acuity and ptosis. The mean disease history and range were 5 and 2-8mo, respectively. The tumors were located in the superonasal extraconal compartment (2/6, 33.3%), intraconal compartment (2/6, 33.3%), and bitemporal extraconal compartment (2/6, 33.3%), respectively. Radiographic features were a well-defined, orbital mass with calcification and ossification on computed tomography (CT), and marked heterogenous enhancement on dynamic magnetic resonance imaging (MRI). Five patients were treated with tumor resection and one patient received orbital exenteration. Five patients in the cohort received postoperative radiation therapy, two patients received chemotherapy, and one patient did not receive postoperative adjuvant therapy because he refused. The histopathologic classification revealed a tumour composed of a mixture of mature chondroid tissue surrounded by small, round, and undifferentiated mesenchymal cells. Immunohistochemistry revealed Bcl-2, vimetin, CD99, and S-100 were expressed were expressed. After surgeries, two patients have developed a local recurrence. The median recurrence time of 58mo (52-64mo). One patient had distant recurrence included the lungs occurred 52mo after the initial surgery. CONCLUSION: The possibilty of orbital MCS need to be considered when a painless, slowly growing orbital mass with calcification and ossification. From our experience, trimodality treatment of radiation therapy, chemotherapy and surgery maybe the best option. Orbital MCS has a high tendency for late recurrence, regular long-term follow-up after complete excision is mandatory.

Abstract:AIM: To report the changes in detection rate and characteristics of retinopathy of prematurity (ROP) in infants, during a 12-year period in Northwest China. METHODS: The medical records of infants were retrospectively collected and reviewed using an established clinical database. The detection rate and severity of ROP were compared between two consecutive periods (P1: 2008-2013, P2: 2014-2019). Gender, gestational age (GA), birth weight (BW), multiple births, delivery pattern, and postmenstrual age of the first fundus screen were analyzed in all visiting infants. RESULTS: During the 12-year study period, 7832 infants were initially included; among them, 1266 (16.16%) were diagnosed with ROP, 441 of whom (5.63%) developed severe ROP. Throughout the study period, the total number of infants being screened showed a trend of slight fluctuation after a rapid increase; however, an annual increase was observed in the number of infants diagnosed with ROP and severe ROP. The proportion of each stage at the first screening of infants with ROP was stable. The detection rate of ROP increased from 2.33% in 2008 to 16.18% in 2010, decreased to 10.73% in 2014, and then increased to 27.47% in 2019. For severe ROP, the detection rate gradually increased from 0 in 2008 to 12.49% in 2019. Among the infants with ROP, 96 (7.58%) did not meet the screening criteria set by the Chinese Medical Association in 2014 (GA<32wk, or BW<2000 g); among them, 14 (1.11%) needed treatment because of severe ROP. CONCLUSION: From 2008 to 2019, the detection rates of ROP and severe ROP in infants screened in Northwest China were 16.16% and 5.63%, respectively. The characteristics of the ROP infants were similar to those in other middle-income regions. The “tertiary prevention network of ROP” is a potentially effective screening approach.

Abstract:AIM: To estimate the prevalence of diabetic macular edema (DME) and clinically significant macular edema (CSME), and to assess their risk factors in a population with type 2 diabetic mellitus (T2DM) located in northeast China. METHODS: Patients were included from the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based study conducted in northeast China. The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of fundus photographs. The age-standardized prevalence of DME and CSME was estimated. The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis. RESULTS: A total of 292 (15.4%) and 166 (8.8%) patients were diagnosed as DME and CSME, yielding the age and sex standardized prevalence of 13.5% (95%CI: 11.9%-15.0%), and 7.1% (95%CI: 5.9%-8.3%), respectively. Female patients had a higher prevalence of DME compared to their male counterparts (15.7% vs 10.4%, P=0.03). Multivariable Logistic regression analysis showed that younger age, insulin use, proteinuria, longer duration of diabetes, and higher glycosylated hemoglobin A1c, were associated with the prevalence of DME and CSME. Patients with higher fasting plasma glucose, systolic blood pressure, and blood urea nitrogen were also found to be associated with DME. CONCLUSION: Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort, those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.

Abstract:AIM: To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery (PCS). METHODS: The PubMed and Web of Science databases were searched from inception to April 30th, 2021. We included studies that reported on the incidence of endophthalmitis following PCS. The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale. The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity. The publication bias was assessed by Egger's linear regression and Begg's rank correlation tests. RESULTS: A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis. For overall incidence of endophthalmitis after PCS, the Meta-analysis yielded a pooled estimate of 0.092% (95%CI: 0.083%-0.101%). The incidence appeared to decrease with time (before 2000: 0.097%, 95%CI: 0.060%-0.135%; 2000 to 2010: 0.089%, 95%CI: 0.076%-0.101%; after 2010: 0.063%, 95%CI: 0.050%-0.077%). Compared with typical povidone-iodine solution (0.178%, 95%CI: 0.071%-0.285%) and antibiotics subconjunctival injections (0.047%, 95%CI: 0.001%-0.095%), the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS (0.045%, 95%CI: 0.034%-0.055%, RR: 7.942, 95%CI: 4.510-13.985). CONCLUSION: Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics, the incidence of endophthalmitis following PCS shows a decreasing trend over time. The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Abstract:With the continuing progress in space exploration, a new and perplexing condition related to spaceflight ocular syndrome has emerged in the past four decades. National Aeronautics and Space Administration (NASA) has named this condition “spaceflight-associated neuro-ocular syndrome” (SANS). This article gives an overview of the current research about SANS and traditional Chinese medicine (TCM) by analyzing the existing publications on PubMed and CNKI and reports from NASA about SANS, summarizing the potential pathogenesis of SANS and physical interventions for treating SANS, and discussing the feasibility of treating SANS with TCM. Due to the unique characteristics of the space environment, it is infeasible to conduct large-scale human studies of SANS. SANS may be the result of the interaction of multiple factors, including inflammation and fluid displacement in the optic nerve sheath and cerebrospinal fluid. We should pay attention to SANS. Visual function is not only related to the health of astronauts but also closely related to space operations. TCM has antioxidative stress and antiapoptotic effects and is widely used for optic nerve diseases. TCM has great potential to prevent SANS.

Abstract:AIM: To identify current trends in anaesthesia technique for cataract surgery and make this information available to ophthalmologists. METHODS: An electronic survey was created and distributed to members of online ophthalmology forums; results were subsequently analysed in spreadsheet software. RESULTS: In total there were 71 completed surveys. The most preferred anaesthesia technique in cataract cases was topical anaesthesia with intracameral injection (n=34, 47.9%), and the least preferred techniques were retrobulbar (n=1, 1.4%) and peribulbar blocks (n=1, 1.4%). The most commonly preferred local anaesthetic was lidocaine 2% (n=41, 57.7%). CONCLUSION: Topical anaesthesia techniques with lidocaine 2% appear to be the most preferred method of anaesthesia in cataract surgery in our survey. Compared with previous literature our survey shows that topical anaesthesia is being increasingly used in cataract surgery, especially in conjunction with intracameral injection. The predominant reasons for this seem to be patient comfort and ease of technique.

Abstract:AIM: To assess the incidence of mitral valve prolapse in patients with newly diagnosed primary open angle glaucoma. METHODS: The study included 12 patients without any other comorbidities or taking any general or local medications. Each patient underwent a full ophthalmological examination with visual field assessment and optical computed tomography of the macula and optic nerve head. Carotid Doppler ultrasound was performed to exclude impaired blood flow in this region and transthoracic echocardiography with assessment of the function and morphology of the heart valves. RESULTS: In the study group, mitral valve prolapse was found in seven patients (58.3%), while mitral valve regurgitation in 11 patients (91.7%). One case of normal pressure glaucoma and four cases of juvenile glaucoma were diagnosed. There were also other risk factors for glaucoma: myopia (58.3%), migraine headaches (41.7%), a positive family history of glaucoma (16.7%). CONCLUSION: Mitral valve prolapse could be indicated as a new risk factor for glaucoma. It seems reasonable to conduct screening tests for glaucoma in patients with mitral valve prolapse in the course of echocardiography.

Abstract:AIM: To share the results of a national screening program for amblyopia in school children in the north of Jordan. METHODS: This is a prospective national screening study for amblyopia. The program rolls first and second-grade children (6 to 7 years old) in the north of Jordan. The eye examination included: best-corrected visual acuity, cover-uncover test, and cycloplegic retinoscopy. Monocular visual acuity was tested using an ETDRS visual acuity chart without correction. Moreover, children were tested with full cycloplegic refraction when the test criteria were met. Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines. In comparison, bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye. RESULTS: The prevalence of amblyopia for the total sample tested (n=17 203) was 2.78% (n=479). The most common cause of amblyopia was hypermetropia (64.45%), followed by previous ocular surgeries (15.1%), myopia (10.43%), strabismus (9.39%), and congenital cataract (0.63%). CONCLUSION: This is the first and only study, identifing modifiable risk factors in Jordanian children with amblyopia. In their first couple of years of elementary education, many Jordanian children are affected by amblyopia and pass unnoticed. A more governmental effort is needed into screening programs to improve vision in the Jordanian population.

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