Insight into small eyes: a practical description from phenotypes presentations to the management

This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.

Time trends in myopia and high myopia prevalence in young university adults in China

AIM:To investigate time trends in myopia and high myopia prevalence over 6y among young university adults in China.METHODS:This is a 6-year series cross-sectional study from 2016 to 2021.Totally 4910 freshmen were enrolled and completed a questionnaire concerning age,gender,and disease history.Students with eye diseases were excluded after a detailed eye examination.The refractive status was measured by non-cycloplegic objective refraction and ocular parameters were measured by Lenstar 900.The examination followed the same protocol each year.Trends over time in myopia and high myopia prevalence,as well as ocular biometry parameters,were analyzed.RESULTS:From 2016 to 2021,the axial length(AL)and corneal radius(CR)increased significantly(P=0.002 for AL;P=0.04 for CR).However,the spherical equivalent(SE)and the ratio of axial length to the corneal radius(AL/CR)did not change significantly(P=0.59 for SE;P=0.24 for AL/CR).The frequency of AL≥26.0 mm increased from 26.6%in 2016 to 29.3%in 2021(P=0.05 for trend).The prevalence of myopia and high myopia did not change significantly in our study(P≥0.18).Compared to a similar cross-sectional study conducted 10 years ago,the prevalence of myopia decreased significantly(94.9%vs 91.8%,P<0.001).Whereas the prevalence of high myopia increased largely(18.12%vs 27.6%,P<0.001).CONCLUSION:The prevalence of high myopia increases in young university adults during 10y period.Myopia control should begin earlier in childhood.However,these interventions are still needed for high myopia even in young adulthood.

Role of lymphotoxin alpha as a new molecular biomarker in revolutionizing tear diagnostic testing for dry eye disease

Dry eye disease(DED),primarily classified as multifactorial ocular surface disorder,afflicts tens of millions of individuals worldwide,adversely impacting their quality of life.Extensive research has been conducted on tear film analysis over the past decades,offering a range of tests to evaluate its volume,health,and integrity.Yet,early diagnosis and effective treatment for DED continue to pose significant challenges in clinical settings.Nevertheless,by recognizing key phenomena in DED such as ocular surface inflammation,hyperosmolarity,and tear film instability,this article provides a comprehensive overview of both traditional and recently developed methods for diagnosing and monitoring DED.The information serves as a valuable resource not only for clinical diagnosis but also for further research into DED.

Analysis of postoperative ocular surface changes and intervention effect after pars plana vitrectomy in meibomian gland dysfunction dry eye patients

AIM:To observe ocular surface changes after phacovitrectomy in patients with mild to moderate meibomian gland dysfunction(MGD)-type dry eye and track clinical treatment response using a Keratograph 5M and a Lipi View interferometer.METHODS:Forty cases were randomized into control group A and treatment group B;the latter received meibomian gland treatment 3d before phacovitrectomy and sodium hyaluronate before and after surgery.The average non-invasive tear film break-up time(NITBUTav),first noninvasive tear film break-up time(NITBUTf),non-invasive measured tear meniscus height(NTMH),meibomian gland loss(MGL),lipid layer thickness(LLT)and partial blink rate(PBR)were measured preoperatively and 1wk,1 and 3mo postoperatively.RESULTS:The NITBUTav values of group A at 1wk(4.38±0.47),1mo(6.76±0.70),and 3mo(7.25±0.68)were significantly lower than those of group B(7.45±0.78,10.46±0.97,and 11.31±0.89;P=0.002,0.004,and 0.001,respectively).The NTMH values of group B at 1wk(0.20±0.01)and 1mo(0.22±0.01)were markedly higher than those of group A(0.15±0.01 and 0.15±0.01;P=0.008 and P<0.001,respectively);however,there was no difference at 3mo.The LLT of group B at 3mo[91.5(76.25-100.00)]significantly exceeded that of group A[65.00(54.50-91.25),P=0.017].No obvious intergroup difference was found in MGL or PBR(P>0.05).CONCLUSION:Mild to moderate MGD dry eye worsens in the short term after phacovitrectomy.Preoperative cleaning,hot compresses,and meibomian gland massage as well as preoperative and postoperative sodium hyaluronate promote the rapid recovery of tear film stability.

Supporting suture combined scleral fixation of toric IOL implantation in traumatic aniridia,aphakia and corneal astigmatic eye:a case report

Dear Editor,Ocular trauma can cause severe visual functional impairment.The management is often challenging due to multistructures affected.Toric intraocular lens(IOL)implantation can be an effective method for the treatment of traumatic corneal astigmatism^([1]).Because of the optic design,the toric IOLs require more precise centration.Conventional toric IOL fixation methods require two-point fixation,which make the IOL tilting unpredictable,and have not been the first choice for patients without sufficient capsule and iris support.Now,we report a rare case of a woman with posttraumatic aniridia.

Two become one:combination of two risk factors in a new glaucoma animal model

Glaucoma is a group of eye diseases characterized by progressive loss of retinal ganglion cells(RGCs)and optic nerve degeneration.During this process,the visual field is reduced,and blindness may ultimately occur.Worldwide,glaucoma is the second leading cause of blindness,with about 80 million people affected.Glaucoma is a multifactorial disease and due to its complexity,the exact pathomechanisms are not fully understood yet.However,different risk factors,such as elevated intraocular pressure(IOP),age,or myopia,have been identified to date(EGS,2021).

Does HSP27 injection induce glaucoma damage in mice?

In a further aging society,excellent eyesight is an integral part of overall well-being and quality of life.Preserving good vision is crucial to maintaining mobility,independence,and mental health.There can be several reasons for visual impairment in elderly people,these include age-related macular degeneration,the leading cause of vision loss among older adults,cataract,glaucoma,diabetic retinopathy,retinal detachment,and others.

Neuroprotective effects of acteoside in a glaucoma mouse model by targeting Serta domain-containing protein 4

AIM:To explore the therapeutic effect and main molecular mechanisms of acteoside in a glaucoma model in DBA/2J mice.METHODS:Proteomics was used to compare the differentially expressed proteins of C57 and DBA/2J mice.After acteoside administration in DBA/2J mice,anterior segment observation,intraocular pressure(IOP)monitoring,electrophysiology examination,and hematoxylin and eosin staining were used to analyze any potential effects.Immunohistochemistry(IHC)assays were used to verify the proteomics results.Furthermore,retinal ganglion cell 5(RGC5)cell proliferation was assessed with cell counting kit-8(CCK-8)assays.Serta domain-containing protein 4(Sertad4)mRNA and protein expression levels were measured by qRT-PCR and Western blot analysis,respectively.RESULTS:Proteomics analysis suggested that Sertad4 was the most significantly differentially expressed protein.Compared with the saline group,the acteoside treatment group showed decreased IOP,improved N1-P1 wave amplitudes,thicker retina,and larger numbers of cells in the ganglion cell layer(GCL).The IHC results showed that Sertad4 expression levels in DBA/2J mice treated with acteoside were significantly lower than in the saline group.Acteoside treatment could improve RGC5 cell survival and reduce the Sertad4 mRNA and protein expression levels after glutamate injury.CONCLUSION:Sertad4 is differentially expressed in DBA/2J mice.Acteoside can protect RGCs from damage,possibly through the downregulation of Sertad4,and has a potential use in glaucoma treatment.

Construction and validation of a neovascular glaucoma nomogram in patients with diabetic retinopathy after pars plana vitrectomy

BACKGROUND Neovascular glaucoma(NVG)is likely to occur after pars plana vitrectomy(PPV)for diabetic retinopathy(DR)in some patients,thus reducing the expected benefit.Understanding the risk factors for NVG occurrence and building effective risk prediction models are currently required for clinical research.AIM To develop a visual risk profile model to explore factors influencing DR after surgery.METHODS We retrospectively selected 151 patients with DR undergoing PPV.The patients were divided into the NVG(NVG occurrence)and No-NVG(No NVG occurrence)groups according to the occurrence of NVG within 6 months after surgery.Independent risk factors for postoperative NVG were screened by logistic regression.A nomogram prediction model was established using R software,and the model’s prediction accuracy was verified internally and externally,involving the receiver operator characteristic curve and correction curve.RESULTS After importing the data into a logistic regression model,we concluded that a posterior capsular defect,preoperative vascular endothelial growth factor≥302.90 pg/mL,glycosylated hemoglobin≥9.05%,aqueous fluid interleukin 6(IL-6)≥53.27 pg/mL,and aqueous fluid IL-10≥9.11 pg/mL were independent risk factors for postoperative NVG in patients with DR(P<0.05).A nomogram model was established based on the aforementioned independent risk factors,and a computer simulation repeated sampling method was used to internally and externally verify the nomogram model.The area under the curve(AUC),sensitivity,and specificity of the model were 0.962[95%confidence interval(95%CI):0.932-0.991],91.5%,and 82.3%,respectively.The AUC,sensitivity,and specificity of the external validation were 0.878(95%CI:0.746-0.982),66.7%,and 95.7%,respectively.CONCLUSION A nomogram constructed based on the risk factors for postoperative NVG in patients with DR has a high prediction accuracy.This study can help formulate relevant preventive and treatment measures.

The prevalence of vision impairment and refractive error in 3654 first year students at Tianjin Medical University

AIM:To determine the prevalence of vision impairment(VI)and refractive error in first year university students at the Tianjin Medical University.METHODS:This is a cross-sectional observational cohort study of VI and refractive error among first year university students at the Tianjin Medical University.The first year university students were involved in this study and were given a detailed questionnaire including age,birth date,and spectacle wearing history.A standardized ophthalmologic examination including visual acuity(VA),slit-lamp examination,non-cycloplegic auto-refraction,objective refraction,fundus photography,and examination of their spectacles were recorded.RESULTS:A total of 3654 participants were included in this study.Totally 3436(94.03%) individuals had VI in this population.Totally 150(4.10%) individuals had VI due to ocular disease,including amblyopia,congenital cataract,retinal atrophy or degeneration,strabismus,congenital nystagmus,refractive surgery orthokeratology.Totally 3286(89.93%) subjects had VI due to refractive error.Only 218(5.97%) students were emmetropia.Moreover,refractive error was the main cause for the VI(95.63%).Totally 3242(92.52%) students were myopia and the prevalence of mild,moderate,and high myopia subgroup was 27.05%,44.35%,and 21.26% respectively.Totally 44(1.29%) subjects were hyperopic.The rates of uncorrected visual acuity(UCVA),presenting visual acuity(PVA)and best corrected visual acuity(BCVA)which better than 20/20 in both eyes were 5.65%,22.32% and 82.13% respectively.The rates of correction,under correction and well correction in myopia subjects were 82.73%,84.39% and 15.61%,respectively. CONCLUSION:We present a high prevalence of refractive errors and high rates of under correction refractive error among first year university students.These results may help to promote vision protection work in young adults.

PPARγ: the dominant regulator among PPARs in dry eye lacrimal gland and diabetic lacrimal gland

AIM: To investigate the regulatory roles of the members of the peroxisome proliferator-activated receptor(PPAR)family in lacrimal gland dysfunction under conditions of desiccating stress or diabetes.METHODS: Quantitative polymerase chain reaction(qPCR) was used to examine the expression of PPARs in the cornea, conjunctiva, meibomian gland, and lacrimal gland in adult rats. The rats were divided into 3 groups:a control group, dry eye group, and diabetic group. The phenol red threads test, tear film break-up time(BUT) test and fluorescein staining were carried out to evaluate the development of dry eye. Based on bioinformatics research,qP CR was used to examine the expression level of PPARγ,tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β),interleukin-6(IL-6), sirtuin 1(Sirt1), myeloid differentiation factor 88(MyD88) and transforming growth factor-β(TGF-β)in the lacrimal glands.RESULTS: PPARα and PPARβ/δ were mainly expressed in the conjunctiva and the lacrimal gland, respectively.However, PPARγ was expressed in both the conjunctiva and lacrimal gland, at much higher levels than those measured for PPARα and PPARβ/δ. Dry eye rats and diabetic rats both showed decreased tear secretion, shortened BUT,and increased corneal staining. Significant changes in gene expression were observed compared with the control group. In the lacrimal glands of dry eye rats and diabetic rats, expression of PPARγ decreased(P<0.05), expression of Sirt1 also decreased(P<0.01), whereas expression of TNF-α, IL-1β, IL-6, MyD88, and TGF-β increased(P<0.05).CONCLUSION: Among PPARs, PPARγ might play a dominant role in the regulation of metabolic-and inflammatorysignaling pathways on the ocular surfaces and in lacrimal glands. Down-regulation of PPARγ is highly relevant to lacrimal gland dysfunction under desiccating-stress and diabetic conditions. PPARγ, thus, is a potential therapeutic target in the treatment of environment-or diabetes-induced dry eye diseases.

Effects of congenital ptosis on the refractive development of eye and vision in children

AIM:To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children.METHODS:In this prospective observational study,41 patients with unilateral congenital ptosis were enrolled(age range 3-15y).The blepharoptosis was divided into 3 subgroups according to the margin reflex distance-1(MRD-1),including mild group(MRD-1>2 mm),moderate group(0<MRD-1<2 mm),and severe group(MRD-1<0 mm).The fellow eyes served as controls.All subjects underwent ocular examinations,including axial length,keratometry,and refractive error.RESULTS:The incidence of astigmatism(ptotic eyes:58.5%vs fellow eyes:24.4%,P=0.002)and magnitude of cylindrical power(ptotic eyes:-0.86±0.79 D vs fellow eyes:-0.43±0.63 D,P=0.003)differed significantly between the ptotic eyes and the fellow eyes.The spherical equivalent refraction(P=0.006),spherical power(P=0.01),cylindrical power(P=0.011),axial length-corneal radius(AL/CR)ratio(P=0.009),frequency of hyperopia(P=0.002)and astigmatism(P=0.004)were significantly different among the ptotic eye subgroups and the fellow eye group.In addition,in patients with congenital ptosis,the incidence of amblyopia is 43.9%and the incidence of anisometropia is 24.4%.More importantly,the ratio of AL/CR showed significantly positive correlation with the severity of ptosis(P=0.002).CONCLUSION:Congenital ptosis may lead to a delayed eyeball development in the aspect of AL/CR.The risk of amblyopia is also increased due to visual deprivation and aggravated anisometropia,particularly in severe ptosis case.

Effect of terahertz pulse on gene expression in human eye cells

In recent years, the advances in terahertz applications have stimulated interest in the biological effects associated with this frequency range. We study the gene expression profile in three types of cells exposed to terahertz radiation,i.e., human ARPE-19 retinal pigment epithelial cells, simian virus 40-transformed human corneal epithelial cells, and human MIO-M1 Müller cells. We find that the gene expression in response to heat shock is unaffected, indicating that the minimum temperature increases under controlled environment. The transcriptome sequencing survey demonstrates that 6-hour irradiation with a broadband terahertz source results in specific change in gene expression and also the biological functions that are closely related to these genes. Our results imply that the effect of terahertz radiation on gene expression can last over 15 hours and depends on the type of cell.

Commentary review on peripapillary morphological characteristics in high myopia eyes with glaucoma:diagnostic challenges and strategies

The incidences of open angle glaucoma(OAG)and high myopia are increasing concomitantly.Considering the aging population and concurrent rapid increase in the number of individuals with myopia,the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades.However,precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc,as well as extensiveβ-zone parapapillary atrophy in highly myopic eyes.Recent advances in optical coherence tomography(OCT)and OCT angiography(OCTA)technologies imply that both modalities are promising tools for the detection of highly myopic OAG.Notably,the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages(e.g.visual field defect,visual electrophysiological changes).We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.

Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to uveitis

AIM:To assess the correlation between disorganization of the retinal inner layers(DRIL)and best-corrected visual acuity(BCVA)in patients with uveitis and macular edema(UME)who underwent systemic treatment using optical coherence tomography(OCT).METHODS:A retrospective clinical study of 23 patients(30 eyes)with DRIL and 23 patients(31 eyes)without DRIL secondary to UME were included.All patients underwent comprehensive ophthalmic examinations at baseline,3,6,and 12 mo after local and systemic treatment.The OCTbased parameters included foveal center point thickness(FCPT),mean thickness(MT),and diameters of DRIL in horizontal and vertical directions.BCVA and OCT-based parameters were compared between the two groups.The relationship between each OCT parameter and BCVA was evaluated using linear correlation and regression analysis.RESULTS:At the initial visit,the mean baseline FCPT was 441.03±128.68μm in the eyes with DRIL and 337.26±99.31μm in the eyes without DRIL(P=0.001).No significant differences were observed in MT(P=0.357).The mean size of transverse and vertical diameters of DRIL was 684.07±267.51 and 267.07±104.61μm at baseline,respectively.There was significant improvement in BCVA and OCT-based parameters at 3,6,and 12 mo in all cases(P<0.001 for each timepoint).In addition,significant differences were detected in BCVA and OCT parameters between eyes with and without DRIL at each time point(P<0.01 for each timepoint).A greater DRIL range at baseline was associated with a worse baseline BCVA(transverse diameter of DRIL:r=0.875,P<0.001;vertical diameter of DRIL:r=0.622,P<0.001).The transverse diameter of baseline DRIL was found to be significantly correlated with the final BCVA(P=0.003).CONCLUSION:The improvement in BCVA is associated with DRIL in patients with UME.DRIL is an easy-todetermine and robust imaging biomarker that could help predict BCVA prognosis in eyes with UME.

Prevalence and inconformity of refractive errors and ocular biometry of 3573 medical university freshman students for 4 consecutive years

AIM:To evaluate the prevalence of refractive errors and ocular biometry in 3573 freshman students at Tianjin Medical University for 4 consecutive years.METHODS:In this university-based, cross-sectional study, comprising 3573 students, visual acuity(VA), slitlamp examination, non-cycloplegic auto-refraction, and ocular biometry were recorded.RESULTS:The prevalence of myopia increased annually, from 2017 to 2020 were 93.5%, 94.5%, 95.9%, and 96.2%, respectively(P=0.03), and the prevalence of high myopia was 25.7%, 26.9%, 28.6%, and 28.6%, respectively. Males tended to have a higher percentage of total astigmatism than females, with astigmatism ≥0.75 and ≥1.0 D criteria. The percentage of with-the-rule astigmatism, against-therule astigmatism, and oblique astigmatism was 90.3%, 5.8%, and 3.9%, respectively, with astigmatism ≥1.00 D criteria. The mean spherical equivalent, axial length(AL), central corneal thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), corneal radius(CR), and lens position(LP) were 4.37±2.52 D, 25.28±1.24 mm, 539.49±34.98 μm, 3.31±0.34 mm, 3.47±0.21 mm, 7.8±0.28 mm, and 5.04±0.32 mm, respectively. With diopter increase in myopia, the AL became longer, CR became steeper, ACD became deeper, LT became thinner, and LP became more posterior(all P<0.01). Females had a shorter AL, thinner CCT, smaller CR, shallower ACD, thicker lens, and more anterior LP than males(P<0.01). The 64% of high myopia had AL≥26 mm, meanwhile, 5.8% mild myopia and 21.1% moderate myopia had AL≥26 mm. With AL≥26 mm, mild and moderate myopia compared to high myopia, AL was shorter(26.51±0.46 vs 26.87±0.70 mm), CR was larger(8.10±0.3 vs 7.85±0.23 mm) and LT was thinner(3.39±0.19 vs 3.45±0.19 mm, P<0.001).CONCLUSION:The prevalence of myopia and high myopia is significantly high in freshman students. The majority of astigmatism is with-the-rule. Inconformity of refractive errors and ocular biometry existed in some students. Attention should be paid to the ocular biometry of myopia.

Apoptotic retinal ganglion cell loss is accompanied by complement and cytokine response in theβB1-CTGF primary open-angle glaucoma mouse model

Glaucoma is a multifactorial disease and occurs in many different species.In humans,glaucoma is accounted one of the leading causes for blindness worldwide.Due to glaucoma's complexity,it is still unclear what pathomechanisms may be involved in its development in humans as well as in other species,such as canines.Diagnosis of glaucoma can be delayed because patients often do not notice a visual field loss until approximately30%of retinal ganglion cells(RGCs)are lost(Kerrigan-Baumrind et al.,2000).Although the exact undergoing pathomechanisms of glaucoma disease are not fully understood yet,an increased intraocular pressure(IOP)is related to RGCdeath and is considered the main risk factor.

The pathology behind glaucoma:what we already know using omics technologies

The term glaucoma encompasses a spectrum of eye diseases pathologically characterized by an irreversible loss of retinal ganglion cells and their associated axons. Patients initially suffer from gaps in their visual field, the part of the visual range that can be perceived without eye movement. In the early stages of the disease, this damage can be compensated very well by eye movements. This, in turn, means that glaucoma is often not diagnosed until the disease is more advanced.

Comparison of biological behavior of lacrimal gland adenoid cystic carcinoma with high-grade transformation cells

AIM:To evaluate the differences between human lacrimal gland adenoid cystic carcinoma with high-grade transformation(LACC-HGT)primar y cells cultured by high-grade transformation tissue and non-high-grade transformation(non-HGT)primary cells cultured by non-highgrade transformation tissue in proliferation,metastasis,drug susceptibility,and genes.METHODS:LACC-HGT primary cells were established by tissue block culture,and the 4^(th)to 10^(th)generation primary cells were selected as research objects.The cells were preliminarily identified by immunofluorescent staining.The differences between non-HGT and LACC-HGT primary cells in terms of proliferation,metastasis,and drug susceptibility were compared by cell counting kit-8(CCK-8)assay,wound healing,and drug sensitivity experiments.Differentially expressed genes were screened using mRNA array.Gene expression was analyzed using real-time quantitative polymerase chain reaction(RT-qPCR).RESULTS:LACC-HGT primary cells were successfully cultured by tissue block culture.Immunofluorescence staining results showed that cytokeratin(CK)and CK7 expression levels were positive in LACC-HGT primary cells.CCK-8 results showed that the proliferation ability of LACCHGT cells was significantly higher than that of non-HGT cells.Wound healing experiment showed that the migration ability of LACC-HGT cells was significantly higher than that of non-HGT cells.LACC-HGT cells were also less sensitive to cisplatin and paclitaxel than non-HGT cells.Compared with non-HGT cells,9566 differentially expressed genes were found in LACC-HGT primary cells,of which 5162 were upregulated and 4404 were down-regulated.The expression of N-acetylneuraminate pyruvate lyase(NPL),MARVEL domain containing 3(MARVELD3),syntabulin(SYBU),and allograft inflammatory factor 1(AIF1)was higher in LACCHGT cells than in non-HGT cells,whereas that of periostin(POSTN)was lower.CONCLUSION:LACC-HGT primary cells have faster proliferation,stronger migration ability,and poorer sensitivity to chemotherapy drugs than non-HGT primary cells.The expression of mRNAs in non-HGT and LACC-HGT primary cells are significantly different.These features are speculated to be the reasons why high-grade transformation tissues exhibit higher malignant degree and poorer prognosis than their counterparts.

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

AIM:To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy(AMN)lesions following severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.METHODS:Retrospective case series study.From December 18,2022 to February 14,2023,previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study.Totally 5 males and 9 females[mean age:29.93±10.32(16-49)y]were presented for reduced vision,with or without blurred vision.All patients underwent best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscopy,indirect fundoscopy.Simultaneously,multimodal imagings fundus photography(45°or 200°field of view)was performed in 7 cases(14 eyes).Near infrared(NIR)fundus photography was performed in 9 cases(18 eyes),optical coherence tomography(OCT)in 5 cases(10 eyes),optical coherence tomography angiography(OCTA)in 9 cases(18 eyes),and fundus fluorescence angiography(FFA)in 3 cases(6 eyes).Visual field was performed in 1 case(2 eyes).RESULTS:Multimodal imaging findings data from 14 patients with AMN were reviewed.All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA.Fundus photography(45°or 200°field of view)showed irregular hypo-reflective lesion around the fovea in 7 cases(14 eyes).OCTA demonstrated that the superficial retinal capillary plexus(SCP)vascular density,deep capillary plexus(DCP)vascular density and choriocapillaris(CC)vascular density was reduced in 9 case(18 eyes).Among the follow-up cases(2 cases),vascular density increased in 1 case with elevated BCVA;another case has vascular density decrease in one eye and basically unchanged in other eye.En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance.NIR image mainly show the absence of the outer retinal interdigitation zone in AMN.No abnormal fluorescence was observed in FFA.Corresponding partial defect of the visual field were visualized via perimeter in one case.CONCLUSION:The morbidity of SARS-CoV-2 infection with AMN is increased.Ophthalmologists should be aware of the possible,albeit rare,AMN after SARS-CoV-2 infection and focus on multimodal imaging features.OCT,OCTA,and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.