Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography

AIM:To compare the three-dimensional choroidal vascularity index(CVI)and choroidal thickness between fellow eyes of acute primary angle-closure(F-APAC)and chronic primary angle-closure glaucoma(F-CPACG)and the eyes of normal controls.METHODS:This study included 37 patients with unilateral APAC,37 with asymmetric CPACG without prior treatment,and 36 healthy participants.Using swept-source optical coherence tomography(SS-OCT),the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally.Pearson’s correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors.RESULTS:The mean subfoveal CVIs were 0.35±0.10,0.33±0.09,and 0.29±0.04,and the mean subfoveal choroidal thickness were 315.62±52.92,306.22±59.29,and 262.69±45.55μm in the F-APAC,F-CPACG,and normal groups,respectively.All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes(P<0.05),while there were no significant differences between the F-APAC and F-CPACG eyes.In the peripapillary region,the mean overall CVIs were 0.21±0.08,0.20±0.08,and 0.19±0.05,and the mean overall choroidal thickness were 180.45±54.18,174.82±50.67,and 176.18±37.94μm in the F-APAC,F-CPACG,and normal groups,respectively.There were no significant differences between any of the two groups in all peripapillary sectors.Younger age,shorter axial length,and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness(P<0.05).CONCLUSION:The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls.Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG.A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Impact of binocular visual field loss on driving performance in glaucoma patients

AIM:To evaluate the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test.METHODS:Twenty-nine participants were included in this study:nine patients with glaucoma but pass the binocular Esterman visual field test,ten patients with glaucoma and fail the binocular Esterman visual field test,and ten age-matched healthy controls.A driving simulation test was designed as a frequency-based analysis of a lanekeeping task.The total performance error,the controlresponse amplitude and delay were calculated.RESULTS:Esterman visual field test fail group showed the longest delay of control-response among three groups(P=0.02).And the delay in lane-keeping task was significantly associated with inferior field of better-eye(r=0.51,P=0.004)and integrated visual field(r=0.55,P=0.002).CONCLUSION:Young and middle-aged glaucoma patients with binocular visual field loss suffered from a longer delay of response in driving simulation test,while inferior visual field having more impact than superior visual field.

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM:To characterize spectral-domain optical coherence tomography(SD-OCT)features of chorioretinal folds in orbital mass imaged using enhanced depth imaging(EDI).METHODS:Prospective observational case-control study was conducted in 20 eyes of 20 patients,the uninvolved eye served as a control.All the patients underwent clinical fundus photography,computed tomography,EDI SDOCT imaging before and after surgery.Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5;the remaining patients underwent tumor excision.Patients were followed 1 to 14mo following surgery(average follow up,5.8mo).RESULTS:Visual acuity prior to surgery ranged from 20/20 to 20/200.Following surgery,5 patients’visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10(range 4 to 26 letters).Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery.Following surgical excision,photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients.CONCLUSION:Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis.Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Preliminary proteomic analysis of human tears in lacrimal adenoid cystic carcinoma and pleomorphic adenoma

·AIM: To detect proteomic differences in tears between adenoid cystic carcinoma(ACC) and pleomorphic adenoma(PA).·METHODS: Tear samples were collected from 4 patients with ACC, 5 with PA, and 4 control cases. Label-free analysis and parallel reaction monitoring(PRM) were used to screen and validate the tear proteome. Gene Ontology(GO) annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG) were conducted for bioinformatics analysis.·RESULTS: In total, 1059 proteins in tear samples were identified by label-free analysis. Between ACC and PA, 415 differentially expressed proteins were detected. Based on the GO annotation, enzyme regulator activity and serinetype endopeptidase inhibitor activity in the molecular function category, blood microparticle and extracellular matrix in the cellular component category, and response to nutrient levels in the biological process category were most predominant. By KEGG pathway annotation, the different proteins between ACC and PA mainly par ticipated in complement and coagulation cascades, amoebiasis, African trypanosomiasis and cholesterol metabolism. Eight proteins with mostly significant differences were verified by PRM, and five proteins with more than 10-fold increases in ACC compared with PA, including integrin β, α-2-macroglobulin, epididymal secretory sperm binding protein Li 78p, RAB5C, and complement C5, were identified.·CONCLUSION: The combined tools of label-free analysis and PRM are very effective and efficient, especially for samples such as tears. Some proteomic dif ferences in tears between ACC and PA are identified and these protein candidates may be specific biomarkers for future exploration.

Clinical Characteristics of Macular Hole and Macular Epiretinal Membrane in Dominant and Nondominant Eyes

Ocular dominance(OD) is referred to the superiority of one eye over the other when the visual sense is produced[1]. This condition can be considered as a preference for the particular laterality of the eye during a mono-visual task or the relative contributions of visual signal transduction between eyes[2]. Empirically, OD tendencies are exhibited in habitual and subconscious behavior.

Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia

Primary rhegmatogenous retinal detachment(RRD)is a major cause of visual impairment.Extensive studies have shown that high myopia is a significant risk factor for RRD[1].A bimodal age distribution of RRD has been reported in Chinese populations,with a major peak in the group of 60–69 years old and a smaller peak in the group of 20–29 years old[2].A study in China has revealed a similar distribution and further indicated that the proportion and number of patients with RRD and high myopia peaked at the age range of 20–29 years[3].Correspondingly,a high prevalence of myopia has been reported in Asians aged 20–29 years[4].Thus,patients<30 years with RRD and high myopia require special attention.However,limited studies have been conducted on RRD in young individuals with high myopia.Therefore,this study aimed to describe the clinical characteristics and surgical outcomes of patients<30 years with RRD and high myopia.Furthermore,we focused on various factors that may correlate with surgical outcomes.

Analysis of N6-methyladenosine-modified mRNAs in diabetic cataract

BACKGROUND Cataracts remain a prime reason for visual disturbance and blindness all over the world,despite the capacity for successful surgical replacement with artificial lenses.Diabetic cataract(DC),a metabolic complication,usually occurs at an earlier age and progresses faster than age-related cataracts.Evidence has linked N6-methyladenosine(m6A)to DC progression.However,there exists a lack of understanding regarding RNA m6A modifications and the role of m6A in DC pathogenesis.AIM To elucidate the role played by altered m6A and differentially expressed mRNAs(DEmRNAs)in DC.METHODS Anterior lens capsules were collected from the control subjects and patients with DC.M6A epitranscriptomic microarray was performed to investigate the altered m6A modifications and determine the DEmRNAs.Through Gene Ontology and pathway enrichment(Kyoto Encyclopedia of Genes and Genomes)analyses,the potential role played by dysregulated m6A modification was predicted.Real-time polymerase chain reaction was further carried out to identify the dysregulated expression of RNA methyltransferases,demethylases,and readers.RESULTS Increased m6A abundance levels were found in the total mRNA of DC samples.Bioinformatics analysis predicted that ferroptosis pathways could be associated with m6A-modified mRNAs.The levels of five methylation-related genes-RBM15,WTAP,ALKBH5,FTO,and YTHDF1-were upregulated in DC samples.Upregulation of RBM15 expression was verified in SRA01/04 cells with high-glucose medium and in samples from DC patients.CONCLUSION M6a mRNA modifications may be involved in DC progression via the ferroptosis pathway,rendering novel insights into therapeutic strategies for DC.

Publication trends of primary angle-closure disease during 1991-2022:a bibliometric analysis

AIM:To perform a bibliometric analysis in the field of primary angle-closure disease(PACD)research to characterize current global trends and compare contributions from different countries,institutions,journals,and authors.METHODS:All PACD-related publications from 1991 to 2022 from the Web of Science Core Collection database were extracted.Microsoft Excel and VOSviewer were used to collect publication data,analyze publication trends,and visualize relevant results.RESULTS:A total of 1721 publications with 34591 citations were identified.China produced the most publications(554)while ranking third in citations(8220 times).The United States contributed the most citations(12315 times)with publications(362)ranking second.The Investigative Ophthalmology Visual Science was the most productive journal concerning PACD,and Aung Tin was the author with the highest number of publications in the field.Keywords were classified into three clusters,epidemiology and pathogenesis research,optical coherence tomography(OCT)and other imaging examinations,and glaucoma surgery treatment.Genome-wide association,susceptibility loci,OCT,and combined phacoemulsification have become new hot research topics in recent years since 2015.CONCLUSION:China,the United States,and Singapore make the most outstanding contributions in the field of PACD research.OCT,combined phacoemulsification,and gene mutation-related study,are considered the potential focus for future research.

A highly sensitive fluorescent probe RN-NA reveals peroxynitrite as a novel biomarker for primary open angle glaucoma

AIM:To directly quantify peroxynitrite(ONOO-)using a highly sensitive fluorescence resonance energy transfer probe RN-NA,investigate the association between ONOOand primary open angle glaucoma(POAG),and clarify whether RN-NA could be used as a potential tool for POAG diagnosis.METHODS:Plasma and aqueous humor(AH)samples were collected from POAG patients(n=100,age:59.70±6.87y)and age-related cataract(ARC)patients(n=100,age:61.15±4.60y)admitted to our hospital.Next,RN-NA was used to detect ONOO-in plasma and AH samples,and the relationship between ONOO-level and POAG was analyzed using binary logistic regression.Besides,Pearson correlation analysis was applied to characterize the correlation of the levels of ONOO-with the patients’age,intraocular pressure(IOP),and mean deviation of visual field testing.The ONOO-scavenger MnTMPyP was employed to treat the 3-morpholinosyndnomine(SIN-1)-induced ocular hypertension in mice(n=7,6-8wk).Finally,the IOP and ONOO-in both eyes were measured 30min after the last drug treatment.RESULTS:ONOO-levels of AH and plasma were significantly higher in the POAG group than in the ARC group(P<0.01).Additionally,ONOO-levels were closely correlated with POAG in a binary logistic regression analysis[odds ratio(OR)=1.008,95%confidence interval(CI):1.002-1.013,P<0.01 for AH;OR=1.004,95%CI:1.002-1.006,P<0.001 for plasma].Pearson correlation analysis showed that ONOO-levels in AH or plasma were positively associated with visual field defects(R=0.51,P<0.01 for AH;R=0.45,P<0.001 for plasma),and ONOO-levels in plasma and AH were correlated in the POAG group(R=0.69,P<0.001).However,administering MnTMPyP to mouse eyes reversed the elevated IOP caused by SIN-1(P<0.05).CONCLUSION:ONOO-levels in AH and plasma,detected by RN-NA,are significantly related to POAG and positively correlated with visual field defects in POAG patients.Hence,ONOO-is a potential biomarker of POAG,especially advanced POAG.Besides,anti-nitration compounds may be novel ocular hypotensive agents based on the animal study.

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases

AIM: To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital METHODS: The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative bestcorrected visual acuities(BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. RESULTS: A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101 y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73%(2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1 d, 1 wk, and 1 mo post surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12%(171/4151) had posterior capsule rupture, 0.79%(33/4151) had iris or ciliary body injury, and 0.048%(2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38%(182/4151) had cornea edema, 7.78%(323/4151) had intraocular hypertension, 0.096%(4/4151) had IOL toxicity syndrome, 0.28%(12/4151) had retained lens cortex, and 0.048%(2/4151) had hyphema. The delayed discharge rate was 0.82%(44/4151) and the unplanned re-admission to the hospital was 0(0/4151). The patient satisfaction rate was 91.42%(3795/4151). CONCLUSION: Day-case cataract surgery is safe and effective with good prospects for development.

Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis

AIM： To report the long-term surgical outcomes of pathologic myopic foveoschisis（MF） following vitrectomy.METHODS： We performed a retrospective case series analysis of 50 consecutive patients diagnosed with MF who experienced vision loss due to progression of foveoschisis.The 50 patients（67 eyes） were treated in our hospital with vitrectomy with internal limiting membrane（ILM） peeling from December 2004 to September 2010.Best corrected visual acuity（BCVA）,refractive error,optical coherence tomography（OCT）,and routine examination results were analysed.The changes of BCVA,foveal anatomical features on OCT scan,and complications were the main outcome measures.RESULTS： The mean follow-up duration was 42±17mo（range 24 to 93mo）.BCVA improved significantly postoperatively（0.76±0.65 logM AR） compared with preoperative baselines（1.31±0.78 log MAR,P〈0.0001）,and in 53 eyes（79%） including 3 lines gain in 44 eyes（66%） at the last follow-up visit.OCT scans showed that central retinal thickness decreased from 580.0±270.0 μm preoperatively（n=67） to 179.7±84.7 μm postoperatively（n=58,P〈0.0001）.Total resolution of foveoschisis occurred in 41 eyes（61%）.Preoperative BCVA correlated well with postoperative BCVA,whereas other factors such as age,axial length,and refractive error were not correlated.The most common complications were cataract and full-thickness macular hole formation in 14 and 9 cases,respectively.CONCLUSION： Patients with progressive vision loss due to MF who were treated with vitrectomy with ILM peelingshow favourable outcomes.In most eyes,visual acuity and foveal structure remain stable during long-term observation.

Effects of intravitreal conbercept before panretinal photocoagulation on lipid exudates in diabetic macular documented by optical coherence tomography

AIM: To evaluate the effects of intravitreal conbercept(IVC) as adjunctive treatments before panretinal photocoagulation(PRP) to decrease hyperreflective dots(HRDs) in Chinese proliferative diabetic retinopathy(PDR) patients. METHODS: Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC(0.5 mg/0.05 m L) 1 wk before PRP(Plus group) or PRP only(PRP group). Six months later, we measured the best corrected visual acuity(BCVA), central macula thickness(CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. RESULTS: The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. CONCLUSION: IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.

Microarray expression profile and functional analysis of circular RNAs in choroidal neovascularization

Choroidal neovascularization(CNV) is a leading cause of visual loss in age-related macular degeneration(AMD). However, the molecular mechanism for CNV progression is still unclear. This study aimed to identify CNV-related circular RNAs(circRNAs), a novel class of non-coding RNAs with diverse functions. A total of 117 circRNAs were differentially expressed in the murine CNV model by microarrays. Gene ontology(GO)enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) analysis were performed to identify the functions of selected circRNAs. The host genes of these circRNAs were predicted to be targeted to neurogenesis(ontology: biological process), proteinaceous extracellular matrix(ECM)(ontology: cellular component), and binding(ontology: molecular function). Differentially expressed circRNAs-mediated regulatory networks were enriched in ECM receptor interaction. Most of the dysregulated circRNAs could potentially bind to five different mi RNAs by Target Scan and mi Randa. Specifically, circ_15752 was identified in this circRNAs pool which may facilitate vascular endothelial cell proliferation, migration, and tube formation, suggesting a critical role in endothelial angiogenesis. Our work suggests that dysregulated circRNAs may be involved in CNV pathogenesis and serve as potential biomarkers for CNV.

Effects of perfluorooctane on the retina as a short-term and small amounts remnant in rabbits

AIM: To investigate changes in the rabbit retina after shortterm and small amounts tamponade of perfluorooctane(PFO).METHODS: New Zealand rabbits were used, and 48 eyes were randomly and evenly assigned into four different groups. The PFO groups received a residue of 0.1 mL of PFO for ophthalmic surgery or 0.1 mL of F-Octane at the end of surgery; eyes from the pars plana vitrectomy(PPV) group were filled with balanced salt solution and those having not received surgical intervention served as controls. Eyes were collected at 1, 4 and 12 wk and studied.RESULTS: Under a microscope, nuclear counts of the inner nuclear layer(INL) and outer nuclear layer(ONL) did not differ among the four groups at all time points; however, slight disarrangement of the ONL and occasional vacuolization of the INL were found in the inferior retina only at 12 wk in two PFO groups. Four of the groups had similar results of Caspase-3 and TNF-α staining at all time points. Alternatively, IL-8 was increased in PFOa and PPV control groups at 4 wk and in all three PPV groups at 12 wk; also, the apoptotic index(%) was similarly increased in all three PPV groups at 4 and 12 wk.CONCLUSION: Both PFOs are well tolerated in rabbit eyes for up to 12 wk, which suggests that they can be used safely as intraoperative tools or for short-term and small amounts tamponade after surgery.

Profile of biological characterizations and clinical application of corneal stem/progenitor cells

Corneal stem/progenitor cells are typical adult stem/progenitor cells.The human cornea covers the front of the eyeball,which protects the eye from the outside environment while allowing vision.The location and function demand the cornea to maintain its transparency and to continuously renew its epithelial surface by replacing injured or aged cells through a rapid turnover process in which corneal stem/progenitor cells play an important role.Corneal stem/progenitor cells include mainly corneal epithelial stem cells,corneal endothelial cell progenitors and corneal stromal stem cells.Since the discovery of corneal epithelial stem cells(also known as limbal stem cells)in 1971,an increasing number of markers for corneal stem/progenitor cells have been proposed,but there is no consensus regarding the definitive markers for them.Therefore,the identification,isolation and cultivation of these cells remain challenging without a unified approach.In this review,we systematically introduce the profile of biological characterizations,such as anatomy,characteristics,isolation,cultivation and molecular markers,and clinical applications of the three categories of corneal stem/progenitor cells.

Characteristics of retinal vein occlusion with final vision better than 78 letters after sequential therapy with ranibizumab and triamcinolone acetate

AIM： To analyze the reasons that may lead to the different vision result by combining the ranibizumab and triamcinolone acetate（TA） in sequence to treat macular edema in retinal vein occlusion（RVO）.METHODS： Ranibizumab and TA were combined in sequence to treat 43 patients with macular edema secondary to RVO.Six months after the treatment,patients with central fovea thickness（CFT） less than 300 μm in optical coherence tomography（OCT） were collected into Groups I and II,based on vision acuity（VA） better than 78 letters or less than 60 letters.The age,baseline VA,duration from onset to treatment,CFT at the baseline,sub-retinal fluid（SRF）,sub-foveal exudates and injection times of TA and ranibizumab were taken into comparison.RESULTS： The mean age of the subjects was 46.4y in Group I but 57.5y in Group II.The difference of age was significant between groups（P〈0.01）.The mean baseline VA was 51.4 letters in Group I and 43.9 letters in Group II（P〈0.05）.The baseline CFT were 670.9 μm in Group I with SRF in 54.3% patients and 678.1 μm in Group II with SRF in 52.9%（P〉0.05）.The mean number of injections of TA was 0.9 and the mean number of injections of ranibizumab was 2.3 in Group I but 1.7 and 2.9 respectively in Group II.The treatment times of ranibizumab had no difference between the 2 groups（P〉0.05） but the difference of TA injection times was significant（P〈0.05）.Subfoveal exudates at final stage happened in no subjects in Group I but in 45.83% subjects in Group II.CONCLUSION： This combined treatment is safer than TA injection and cheaper than ranibizumab injection alone.Younger patients and earlier treatment will help to get better vision outcome.Subfoveal exudates at the final stage have significant relationship with vision outcome.No relationship existed between the baseline CFT,SRF and the vision outcome.

Calpastatin participates in the regulation of cell migration in BAP1-deficient uveal melanoma cells

AIM: To detect how BRCA-associated protein 1(BAP1) regulates cell migration in uveal melanoma(UM) cells. METHODS: Wound healing and transwell assays were performed to detect UM cell migration abilities. Protein chip, immunoprecipitations and surface plasmon resonance analyses were applied to identify BAP1 protein partners. Western blot and calpain activity assays were used to test the expression and function of calpastatin(CAST). RESULTS: CAST protein was confirmed as a new BAP1 protein partner, and loss of BAP1 reduced the expression and function of CAST in UM cells. The overexpression of CAST rescued the cell migration phenotype caused by BAP1 loss.CONCLUSION: BAP1 interacts with CAST in UM cells, and CAST and its subsequent calpain pathway may mediate BAP1-related cell migration regulation.

Evaluation of axial length/total corneal refractive power ratio as a potential marker for ocular diagnosis of Marfan’s syndrome in children

AIM:To investigate whether the axial length(AL)/total corneal refractive power(TCRP)ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan’s syndrome(MFS)in children.METHODS:The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were evaluate.The biological characteristics,including age,sex,AL,and TCRP,were collected from medical records.Receiver operating characteristic(ROC)curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects.The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59.RESULTS:Of 96 subjects(mean age 7.46±3.28 y)evaluated,56(110 eyes)had a definite diagnosis of MFS in childhood based on the revised Ghent criteria,41(82 eyes)with diagnosis of congenital ectopia lentis(EL)were included as a control group.AL was negatively correlated with TCRP,with a linear regression coefficient of-0.36(R2=0.08).A significant correlation was found between age and the AL/TCRP ratio(P=0.023).ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other patients at a threshold of 0.59.MFS patients were present in 24/58(41.38%)patients with an AL/TCRP ratio of≤0.59 and in 34/39(87.18%)patients with an AL/TCRP ratio of>0.59.CONCLUSION:An AL/TCRP ratio of>0.59 is significantly associated with the risk of MFS.The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS.Changes in the AL/TCRP ratio should be monitored over time.

Clinical features and changes of disease spectrum of zoneⅡretinopathy of prematurity:a 10-year review

AIM:To report the clinical features and evolution of zoneⅡretinopathy of prematurity(ROP).METHODS:RetCam images of preterm infants with zoneⅡROP at our hospital between January 2009 and January 2019 were reviewed.The location,extent,and severity of ROP were recorded.Eyes were classified as typeⅠzoneⅡ,type 2 zoneⅡ,and mild zoneⅡROP.The clinical features and evolution of zoneⅡROP were analyzed.RESULTS:In total,184 infants(302 eyes)were enrolled.Of these,55 eyes(18%)developed typeⅠzoneⅡROP,39 eyes(13%)developed type 2 zoneⅡROP,and 208 eyes(69%)developed mild zoneⅡROP.The proportion of typeⅠzoneⅡROP significantly decreased over the IOy.The onset of type 2 zoneⅡand mild zoneⅡROP were Iwk earlier than typeⅠzoneⅡ,and both regressed at 45wk.Isolated neovascular tuft(popcorn)and double track signs were characteristic manifestations of zoneⅡROP.Eighty-seven percent of typeⅠzoneⅡROP regressed completely with an unfavorable outcome that emerged in seven eyes after laser treatment.CONCLUSION:ZoneⅡis an area with ROP disease at various risk levels.ZoneⅡROP has unique clinical presentations like popcorn and double track signs.Over time,the proportion of zoneⅡROP with high risk gradually decrease and respond well to therapy.

A simple new technique for the induction of residual posterior vitreous cortex removal and membrane peeling

AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.