Volume 58 · Issue 12 · 2022

Rhegmatogenous retinal detachment (RRD) is a retinal vitreous disease, with increasing incidence in recent years. Pars plana vitrectomy is one of the most common treatments for RRD. To prevent re-detachment after the primary surgery and guarantee the visual outcome of the patients, we highlight the techniques for RRD during the PPV, including the surgical skills to manipulate the breaks, peripheral retina and vitreous base, meanwhile, empathized on the posterior vitreous detachment and posterior vitreous cortex. The aim is to increase the rate of anatomical re-attachment and to improve visual function.

The eye is considered as the best targeted organ for gene therapy, which has become a hot field of ophthalmic clinical trials in recent years. Since the risk of gene therapy is usually high, it is important to standardize the ethical review of related clinical research, so as to better protect the rights of patients and promote the innovative research. Thus, after several rounds of discussion, the experts from Chinese Vitreo-Retina Society of Chinese Medical Association and Fundus Disease Committee of Chinese Ophthalmologist Association have proposed the formal ethical review guidelines (International Practice Guideline Registration Number: IPGRP-2022CN347), which would play a role in standardizing clinical practice with gene therapy.

For vitreous or retinal choroidal diseases of unknown origin, diagnostic vitrectomy can be performed for auxiliary diagnosis. With the development of laboratory testing technology and minimally invasive vitrectomy in recent years, diagnostic vitrectomy for biopsy has been widely used in clinical practice. To standardize the clinical application of diagnostic vitrectomy for biopsy, the Ocular Oncology Committee of China Anti-Cancer Association, Ophthalmological Society of China Medicine Education Association has organized relevant experts and developed this consensus after repeated discussions on the role of diagnostic vitrectomy for biopsy, the key points of operation, specimen delivery, test selection, and complications.

To study the characteristics and significance of changes in the thickness of the outer retinal layer (ORL) outside the macula in patients with reticular macular disease (RMD).

A cross-sectional study was conducted. The clinical data of patients who visited the Department of Ophthalmology of the First Affiliated Hospital of Guangzhou Medical University from February to September 2019 were retrospectively collected. Thirty-one patients with at least one eye (54 eyes in total) diagnosed with early/mid-stage age-related macular degeneration (AMD) were consecutively included in the AMD group, and 33 patients with at least one eye (64 eyes in total) showing subretinal wart-like deposits on optical coherence tomography images were consecutively included in the RMD group. Thirty-two volunteers aged between 50 to 90 years with a normal fundus in both eyes (64 eyes in total) were consecutively included in the healthy control (HC) group. Frequency domain optical coherence tomography was applied to examine and analyze the thickness features of the ORL, inner retinal layer and choroid at the macular fovea (F), 2 mm of the temporal edge (T), the nasal edge (N), the superior edge (S) and inferior edge (I) of the macular fovea in each group. The correlations of the thickness of ORL with the choroidal thickness and the blood flow density of the choriocapillaris layer in patients with RMD were also analyzed.

The thickness of ORL at the F, T, S and I sites in the RMD group was significantly thinner than that in the AMD and HC groups. The difference was most obvious at the F site [(90.27±8.93), (98.04±11.7) and (97.19±7.02)μm] in the RMD, AMD and HC groups, respectively; all P<0.01). In the logistic regression model with independent variables of the ORL thickness at the macular F site, gender and age, there was a significant association between the thickness of ORL at the F site and the incidence of RMD (odds ratio=0.926, P<0.05). The ORL and choroid in the eyes of patients with RMD were significantly thinner at the F site [(90.27±8.93) and (163.21±72.43) μm, respectively; both P<0.01] compared with the AMD [(98.04±11.7) and (235.34±64.15) μm, respectively] and HC [(97.19±7.02) and (240.08±62.27) μm, respectively] groups. However, the ORL and choroidal thickness did not show significant and strong linear correlations at multiple sites. In contrast, there was a significant linear correlation between the blood flow density of the choriocapillaris layer and the thickness of ORL at the F, T and S sites in patients with RMD (r=0.487, 0.722, 0.467, respectively; all P<0.05).

The thickness of ORL outside the macula of eyes with RMD is thinner than that of healthy eyes and eyes with early/mid-stage AMD. The thinning of ORL outside the macula is related to the decrease in the blood flow density of the choriocapillaris layer in patients with RMD.

To evaluate the relationship between lesion features of cytomegalovirus (CMV) retinitis, including lesion size and degree of opacity of lesion borders, and aqueous CMV-DNA load in patients after allogeneic hematopoietic stem cell transplantation.

It was a retrospective case series study. Data of patients diagnosed as CMV retinitis after allogeneic hematopoietic stem cell transplantation at the Department of Ophthalmology, Peking University Third Hospital from January 2018 to October 2020 were reviewed. Lesion size was detected by ultra-wide-field fundus image and measured by ImageJ, an image processing and analysis software. Opacity of lesion borders was evaluated by a masked reader. The CMV retinitis lesions were divided into 3 types according to the opacity degree of the border of the lesions: suspected active lesion mildly to moderately opacified lesion and severely opacified lesion. All eyes were diagnosed as active cytomegalovirus retinitis. CMV-DNA in aqueous humor was detected at the first visit and at the end of the induction period of antiviral drugs. CMV-DNA load was quantitatively detected by polymerase chain reaction after 100 μl of aqueous humor was extracted, and were converted to common logarithmic representations. Pearson correlation analysis was used to analyze the correlation between lesion area, opacity degree of lesion border and aqueous humor CMV-DNA load.

A total of 71 eyes from 46 patients were included and 26 was male and 20 was female. The age of the patients was 27(13, 33)years. The active lesion size of CMV retinitis was 40(12, 65) disc areas. Eight eyes (11.3%) had a suspected active lesion, 51 eyes (71.8%) had a mildly to moderately opacified lesion border, and 12 eyes (16.9%) had a severely opacified border. At the first visit, 67 eyes (94.4%) were CMV-positive, and the CMV-DNA load was 2.04×10⁴ (6.24× 10², 1.48 ×10⁵) copies/ml. After 2 weeks of induction therapy, the viral load was 2.47×10² (1.08× 10, 6.87 ×10³) copies/ml. The correlation analysis showed that the CMV-DNA load in aqueous humor was significantly correlated with the lesion border opacity both at presentation and 2 weeks after intravitreal antiviral treatment (r=0.765, P<0.001; r=0.761, P<0.001), but was not related with the size of active fundus lesions (r=0.209, P=0.095; r=0.220, P=0.078).

Degrees of lesion border opacity can reflect levels of aqueous viral load of CMV retinitis in patients after allogeneic hematopoietic stem cell transplantation and can become a useful measurement for investigation of CMV retinitis activity.

To analyze the characteristics of full-field stimulus thresholds (FST) in patients with middle-and late-stage inherited retinal dystrophy (IRD), and to explore the feasibility of the FST test in evaluating the retinal function for IRD patients.

It was a retrospective case series study. Twenty-eight patients with IRD whose full-field electroretinogram (ERG) results showed no electrical activity (20 patients) or a serious decrease in electrical activity (8 patients) were enrolled, including 17 males and 11 females, with a median age of 32 years. Ten normal controls were also enrolled. All eyes had a measurement of best corrected visual acuity (BCVA) and an ERG test. FST stimulated by red, blue and white lights were examined with an electrophysiological instrument. The decimal value of BCVA was converted to logarithm of the minimum angle of resolution. Data of the better eye of each participant were used for statistical analysis. Independent sample t-test was used to analyze the difference in FST among patients. Linear regression was used to analyze the correlation between FST, visual acuity and ERG amplitudes.

The BCVA of all eyes was 0.7±0.6. Under the stimulation of red, blue and white lights, the FST were(-27.0±7.1), (-47.4±12.2) and(-41.7±11.5) dB in the 8 eyes with decreased electrical activity, (-16.3±7.0), (-27.2±13.7) and(-23.5±12.5) dB in the 20 eyes with no electrical activity, and(-39.9±4.0), (-65.8±4.0) and(-58.5±3.4) dB in the 10 control eyes, respectively. The FST of IRD patients were higher than the normal controls. The FST with red, blue and white lasers in eyes with no electrical activity were higher than those with severely reduced electrical activity (t=-3.472, -3.506, -3.433; all P=0.002). The BCVA was not correlated with the FST under the red, blue and white light stimulation in eyes with a serious reduction in electrical activity (r=0.134, 0.011, 0.010; P=0.055, 0.601, 0.611). There was a linear correlation between the red light stimulus FST and the b-wave amplitude of flicker ERG response (r=-0.591, P=0.026), but there was no significant correlation between other amplitudes and FST.

The FST test is a supplementary method to evaluate the retinal function of patients with middle-and late-stage IRD. It can quantitatively reflect the function of rod and cone cell system. As the retinal function of IRD patients decreases, the FST gradually increase.

To investigate the effect and comfort of using a distant-image screen for reading and learning.

It was a prospective cross-over study. Thirty-nine volunteers, including 13 males and 26 females, aged (26.4±4.5) years (20 to 37 years), were recruited from Beijing Tongren Hospital Affiliated to Capital Medical University in July 2021. The volunteers read the digital correction table printed on paper and displayed on a distant-image screen in a random order and rest in an interval of 2 hours. Reading speed, efficiency and accuracy of using the two devices were recorded, and the changes of logMAR vision, diopter, flicker fusion frequency and visual fatigue score after reading were calculated. Comparison of the quantitative data was performed using the paired t-test.

The speed, accuracy and efficiency were (41.2±11.6) digit groups/min, 80.7%±13.3% and (32.4±7.4) digit groups/min in reading on paper, (41.7±11.1) digit groups/min, 76.4%±12.6% and (31.1±6.4) digit groups/min in reading from screen, respectively. There was no significant difference in reading speed (t=-0.462, P=0.648) and reading efficiency (t=1.954, P=0.058), but there was significant difference in reading accuracy (t= 2.226, P=0.032). The logMAR visual acuity of right eye and left eye decreased by 0.014±0.032 and 0.013±0.050 after reading on paper, but increased by 0.007±0.033 and 0.007±0.036 after reading from screen, respectively. The difference was significant (right eye, t=2.592, P=0.013; left eye, t =2.154, P=0.038). The myopia degree of right eye and left eye increased by (0.07±0.29) D and (0.06±0.24) D after reading on paper, and increased by (0.01±0.29) D and (0.02±0.28) D after reading from screen, respectively. The flicker fusion frequency decreased by (0.1±1.0) Hz after reading on paper, but increased by (0.3±1.2) Hz after reading from screen. There was no significant difference (P>0.05). The subjective scale score of visual fatigue increased in both groups, with no statistically significant difference (t=1.165, P=0.251).

The use of a distant-image screen for reading and learning does not affect the reading efficiency or increase the visual fatigue, and can avoid the decline of visual acuity caused by near viewing compared with using the printed matter.

To explore the characteristics of visual function and eye diseases in children with autism spectrum disorder (ASD) and mental retardation.

It was a cross-sectional study. Two hundred and ninety-two cases (584 eyes) of children with ASD combined with mental retardation from 7 special education schools in Chaoyang District of Beijing, including 235 males (80.48%) and 57 females (19.52%); The age ranged from 2 to 18 years old. Subjective far and near vision, near stereoacuity, objective vision, diopter, anterior segment and fundus were examined. In addition, 300 students with normal intelligence level, aged 2 to 18 years, were included as controls. LogMAR was used to record vision examination. Subjective, objective vision and diopter were examined. Mann Whitney U test or Kruskal Wallis H test was used for the data of children with different genders, different age.

Among 584 eyes of children with ASD and mental retardation, 272 eyes (47.22%) were ametropia, 260 eyes (45.14%) were astigmatism, 29 eyes (5.03%) were hyperopia, 10 eyes (1.74%) were myopia, and 47 eyes (8.16%) were amblyopia risk factors. Among 292 children, there were 20 cases of strabismus (6.85%), 3 cases of color weakness (1.03%), and 4 cases of external eye abnormalities (1.37%). Two hundred and eleven children completed near stereopsis examination, of which 54 (25.59%) were within 100″ and 157 (74.41%) were within 200″ to 900″. Two hundred and seventy-two eyes with ametropia, 157 eyes (57.72%) needed correction but did not. The median and quartile of subjective and objective logMAR visual acuity were 0.22(0.10, 0.35), 0.10(0.00, 0.22), respectively; There were no significant differences in far visual acuity, near visual acuity, objective visual acuity, diopter, and near stereoacuity between different genders of ASD children with mild or moderate mental retardation (all P>0.05); There was a statistically significant difference in ASD children with mild mental retardation at different age rangs (H=21.453, P<0.001). There was a statistically significant difference in subjective tests such as far visual acuity and near visual acuity, for children with moderate mental retardation (Z=-3.508, -4.503; P<0.001). There was no statistically significant difference in objective visual acuity, diopter and near stereo acuity(all P>0.05). There are 300 healthy children as the control group, with LogMar′s subjective far vision is 0.10(0.00, 0.22), and the objective vision is 0.00(0.00, 0.10), diopter 0.25 (-0.25, 0.50) D. Compared with healthy children, ASD children with mental retardation had a significant difference in subjective far vision and objective vision (Z=-8.527, -10.393; P<0.001). There was no significant difference in diopter (Z=-1.274, P=0.203).

The subjective and objective visual acuity of children with ASD combined with mental retardation was lower than that of healthy children. The prevalence and uncorrected rate of refractive errors, strabismus, amblyopia and other eye diseases were significantly higher than those of healthy children. Their refractive errors were mainly astigmatism, and the rates of correction and treatment were low.

A 35-year-old male patient presented to the hospital with binocular blurred vision for 2 weeks. The visual acuity of both eyes was 0.8. Fundus examination showed multiple yellow-white punctate lesions in the posterior pole of both eyes. OCT showed cystoid edema and submacular edema, thickening of ellipsoid zone and enhancement of reflex in macular region. Fundus autofluorescence showed strong autofluorescence at the lesion site. Fundus fluorescein angiography showed no fluorescence leakage in the lesion area. The patient was diagnosed with acute exudative polymorphous vitelliform maculopathy based on medical history, ocular multimodal examination and general examination. The patient was not given special treatment, but one week later, the lesion was fused and expanded, and the macular edema was worse than before.

A 12-year-old boy presented to the hospital because of poor vision for half a year. Examination revealed nystagmus in both eyes. Examination of the anterior segment of both eyes showed no obvious abnormalities, and the vitreous bodies of both eyes were concentrated and agglutinated. Fundus showed clear boundary of optic disc, pale white, leopard striated retina, and characteristic atrophy of pigment epithelium, choroid, and macular atrophy. Knobloch syndrome was confirmed by multimodal imaging and genetic testing.

The first patient complained of red eye, photophobia, and difficulty in eye-opening of the right eye for 5 months. The second patient complained of grinding pain and difficulty in eye-opening of the left eye for 1 week. The third patient complained of repeated red eye and blurred vision in the left eye for half a year. After detailed examination, a blue suture thread approximately 2 mm in length with a knot was found in the mucosal fold of the first patient, a bee sting was embedded in the middle of the meibomian gland duct in the upper eyelid of the second patient, a glassy foreign body was found in the chamber angle at the 6 o′clock position of the third patient. The corneal and ocular surface injury gradually healed with no recurrence after the timely removal of the occult foreign bodies.

Solitary fibrous tumor (SFT) is an uncommon spindle cell tumor that occurs mainly in the pleura, but also in other parts of the body. Intraocular SFT is very rare. This paper reports 2 cases of choroidal SFT which were diagnosed by clinical, imaging, histopathological and immunohistochemical staining. The patient remained asymptomatic with no sign of recurrence and metastasis after operation.

Patient 1 was a 44-year-old female with a progressively enlarging orbital mass on the right side for 2 years, while patient 2 was a 25-year-old female who complained of protrusion of the right eye for 2 months. Both patients presented with exophthalmos and a palpable infraorbital mass without vision loss. Magnetic resonance imaging examination showed a well circumscribed circular orbital lesion, with hypointensity on T1 weighted image and heterogeneous hyperintensity on T2 weighted image, which could be significantly enhanced, in either eye. Both eyes were diagnosed as begin orbital tumor and received resection under general anesthesia. Intraoperatively, the distal end of the tumors was found to transmigrate to normal nerves and insert into the inferior oblique muscle. Combined with the pathological diagnosis of schwannoma and postoperative occurrence of mydriasis and inferior oblique muscle paralysis in both patients, it was confirmed that the two lesions were schwannomas originating from the branch of the inferior oblique muscle innervated by the oculomotor nerve.

A 71-year-old man presented with a history of persistent redness and swelling in the left eye accompanied by an enlarging mass in the conjunctiva. He denied any history of trauma. Local anti-inflammatory treatment was ineffective. Slit lamp examination demonstrated a tough and immobile grayish broad basal mass at the corneal limbus and bulbar conjunctiva and a local bulge of 3 mm × 2 mm at the medial and lateral side of the upper palpebral conjunctiva near the eyelid margin. The excisional biopsy showed granulomatous inflammation with irregular and atypical squamous epithelial hyperplasia. Histopathology and immunohistochemical staining revealed a fungal infection. The secretion smear examination was performed to clarify the pathogen as Candida albicans, and chronic fungal maxillary sinusitis was found through imaging tests. Thus a diagnosis of conjunctival candidiasis was made. The conjunctival mass subsided after systemic and local antifungal therapy.

The number of people suffering from age-related macular degeneration (AMD) in China is increasing year by year, so it is particularly necessary to find a feasible approach to prevent AMD. Related studies have shown that the preventive effect of exercise on AMD may be associated with the change of factors affecting neovascularization, inhibiting systemic inflammatory response, reducing oxidative stress and affecting microvascular endothelial function. However, further basic research evidence is yet to be explored at present. This review summarizes and analyzes the effects of exercise on AMD and the above-mentioned potential mechanisms in order to improve the understanding of the correlation between physical exercise and AMD and to provide the basis for further basic and clinical studies.

Peripapillary hyper-reflective ovoid mass-like structure (PHOMS) is a newly discovered optical coherence tomography (OCT) sign of optic disc in recent years, which can be presented in a variety of optic nerve diseases. At present, the OCT structural characteristics and pathological manifestations of PHOMS have been initially understood. This paper summarizes the related literature published recently. The relationship and the latest research progress between PHOMS and some optic neuropathy were mainly focused, hoping to further deepen the understanding and facilitate its wider clinical application.

Persistent hyperplastic primary vitreous is a rare congenital ocular developmental malformation caused by the failure of regression of the primary vitreous during the embryonic development period. Peters anomaly is a monogenetic disease of congenital anterior segment dysgenesis. Recent studies have shown that these two diseases may occur concomitantly and be associated with a variety of systemic abnormalities. This review demonstrates the basis of ocular embryonic development, research status of molecular genetics, clinical manifestations, surgical objectives and progress of treatment of persistent hyperplastic primary vitreous with Peters anomaly, in order to provide guidance for clinical practice and research as well as to promote further progression of related gene detection.

The emergence and development of multimodal imaging techniques, such as optical coherence tomography, fundus autofluorescence and adaptive optics, make it much easier to differentiate reticular pseudodrusen (RPD) from other fundus lesions. It is of great significance to understand the imaging characteristics of RPD observed with multimodal imaging techniques. This article reviews the formation mechanism and multimodal imaging characteristics of RPD, so as to provide help for better identification of RPD and assessment of the development and prognosis of the disease.

In recent years, with the further understanding of medical circles on diabetic ocular complications, the ocular surface abnormalities of diabetes has drawn increasing concerns. Nearly 50% of diabetic patients suffer from dry eye symptoms. The main manifestations of diabetes related dry eye were abnormal lacrimal secretion, poor lacrimal stability, decreased corneal sensitivity, persistent corneal epithelial defect and even corneal ulcer, which were mainly related to the changes of structure and function of lacrimal gland, the decrease of goblet cells in conjunctiva, the abnormality of meibomian gland function and the degeneration of corneal nerve caused by diabetes. In this paper, we summarized and analyzed the recent research progress on the effect of diabetes on lacrimal film, corneal innervation and lacrimal gland innervation, and the correlation between oxidative stress, advanced glycation end products and diabetes-related dry eye, to explore the pathogenesis of diabetes-related dry eye and to provide reference for clinical diagnosis, treatment and research.

Age is an important risk factor for primary glaucoma. While the specific mechanism of primary glaucoma remained unclear, the change of ocular anatomy, the disturbance of aqueous humor balance, the change of ocular biomechanics and the disorder of neurometabolism contribute to the occurrence and development of primary glaucoma. This paper reviewes the latest studies on the correlation between age and the risk factors of glaucoma in the above four aspects, so as to provide some references for the in-depth discussion of the pathophysiology of primary glaucoma, and advancement on diagnosis, treatment and research of primary glaucoma.

Presbyopia refers to the decline in the accommodation of eye that occurs with age, symptoms begin to appear after the age of 40 and the clarity of vision at near is insufficient to satisfy an individual′s requirements. The correction of presbyopia include restoring natural accommodation and improving symptom. The former is still difficult to achieve at present, while the latter mainly involves wearing convex lens, and with more and more patients wanting to get rid of frame glasses, refractive surgery is gradually promoted and applied. Corneal refractive surgery, especially laser-assisted in situ keratomileusis, is one of the most common methods for surgical correction of presbyopia. We reviewed the recent literature to introduce the mechanism of corneal refractive surgery treating presbyopia and the efficacy of different surgical algorithms.