[Preventive early intervention strategies for neurodevelopmental disorders of high-risk infants]. / é«˜å±å„¿ç¥žç»å‘è‚²éšœç¢é¢„é˜²æ€§æ—©æœŸå¹²é¢„ç ”ç©¶è¿›å±•.

Neurodevelopmental disorders in children have become a significant global public health concern, impacting child health worldwide. In China, the current intervention model for high-risk infants involves early diagnosis and early treatment. However, in recent years, overseas studies have explored novel preventive early intervention strategies for neurodevelopmental disorders in high-risk infants, achieving promising results. This article provides a comprehensive review of the optimal timing, methods, and intervention models of the preventive early intervention strategies for neurodevelopmental disorders in high-risk infants. The aim is to enhance the awareness and knowledge of healthcare professionals regarding preventive early intervention strategies for neurodevelopmental disorders in high-risk infants, facilitate clinical research and application of such interventions in China, and ultimately reduce the incidence of neurodevelopmental disorders in this high-risk population.

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022).

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.

Development of Diagnostic Recommendations for Vitreoretinal Lymphoma.

PURPOSE: To develop diagnostic recommendations for diffuse large B-cell vitreoretinal lymphoma (VRL) in Chinese patients. METHODS: Retrospective observational case series. Seventy-three eyes of 40 VRL patients and 8 control patients were analyzed. Eighteen patients from Beijing Tongren Hospital and 46 patients from literature were involved as validations. RESULTS: Diagnostic methods included (1) typical clinical manifestations; (2) vitreous cytology; (3) immunohistochemical examination of vitreous or choroid/retina; (4) aqueous humor or vitreous cytokine; (5) vitreous cell gene rearrangement; (6) vitreous flow cytometry. If patients meet (1)+(2)+(3), or if they meet (1), and two of (4), (5), (6) are positive, they can be diagnosed as VRL. The sensitivity and specificity values for accurate diagnosis were 0.975 and 1.00. One hundred percent eyes from Beijing Tongren Hospital and 92.7% eyes from literature can be diagnosed. CONCLUSION: We developed diagnostic recommendations for diffuse large B-cell VRL through vitreous cytology combined with multiple auxiliary examinations.

PUMCH experience and strategy for the management of idiopathic macular hole: a retrospective cohort study.

PURPOSE: To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH). METHODS: A retrospective review of patients with diagnosis of IMH from July 2016 to January 2020 at Peking Union Medical College Hospital. These patients were managed strictly according to our therapeutic strategy. Their comprehensive clinical data were collected and analyzed. RESULTS: 209 eyes suffering stage II to IV IMH were identified. For stage II IMH, the spontaneous closure rate was 8.9%, the initial success rate of intravitreal injections (IVI) of expansile gas and pars plana vitrectomy (PPV) + internal limiting membrane peeling (ILMP) + air tamponade was 84.2% and 100%, respectively. The initial success rate of PPV + ILMP + air tamponade for stage III and stage IV IMH was 89.8% and 86.4%, respectively. Following our intervention strategy, stage II IMH achieved a final IMH closure rate of 100%, stage III of 99% and stage IV of 97%. The final best corrected visual acuity was significantly improved (P < 0.05). Sitting position air-fluid (A-F) exchange alone successfully induced IMH closure in 7/19 eyes that did not achieve IMH closure by initial PPV. For three refractory cases that failed additional PPV + ILM stuffing, intraoperative OCT assisted PPV + sub-retinal BSS injection successfully induced the IMH closure. As the remaining three unclosed IMH cases were dry and stable, no more interventions were conducted. CONCLUSION: The general IMH closure rate based on our therapeutic strategy was satisfactory with a favorable prognosis. IVI expansile gas and sitting position A-F exchange were effective and highly cost-effective under certain circumstances.

Wide-field swept source optical coherence tomography evaluation of posterior segment changes in highly myopic eyes.

BACKGROUND: To investigate the features in the posterior pole of highly myopic (HM) eyes using a wide-field high-resolution swept source optical coherence tomography (SS OCT). METHODS: This observational cross-sectional study involved 262 eyes of 139 patients, who were diagnosed as HM and had consecutively been examined by SS OCT in the Ophthalmology Department of the Peking Union Medical College Hospital between March 2019 and December 2019. The characteristics of OCT images were documented and analyzed. RESULTS: In our study, SS OCT could demonstrate the entire layer of the choroid and detect the sclera in all eyes. The mean subfoveal retinal/choroidal/scleral thickness were 204.84 ± 119.86 µm, 92.80 ± 75.78 µm and 394.734 ± 123.09 µm, respectively. 138 eyes (52.67%) had posterior precortical vitreous pocket. Myopic foveoschisis was detected in 110 eyes (41.98%), and significantly associated with the presence of posterior staphyloma. 36 eyes (13.74%) had DSM in our study, of which 8 eyes (22.22%) showed a round dome, 16 (44.44%) were horizontal oval-shaped, 9 (25%) were vertical oval-shaped and 3 (8.34%) were oblique oval-shaped. Both SFCT and SFST were inversely and significantly associated with age and refractive errors. Macular neovascularization was significantly correlated with intrascleral vessels. Different deformation of the sclera and posterior staphyloma were vividly identified on SS OCT images. CONCLUSIONS: This study provided a relatively comprehensive picture of posterior pole in HM eyes. Such good visualization of ocular fundus provided by wide-field SS OCT could be useful for the therapy option, disease condition monitoring and pathogenesis investigation.

Artificial intelligence can assist with diagnosing retinal vein occlusion.

AIM: To assist with retinal vein occlusion (RVO) screening, artificial intelligence (AI) methods based on deep learning (DL) have been developed to alleviate the pressure experienced by ophthalmologists and discover and treat RVO as early as possible. METHODS: A total of 8600 color fundus photographs (CFPs) were included for training, validation, and testing of disease recognition models and lesion segmentation models. Four disease recognition and four lesion segmentation models were established and compared. Finally, one disease recognition model and one lesion segmentation model were selected as superior. Additionally, 224 CFPs from 130 patients were included as an external test set to determine the abilities of the two selected models. RESULTS: Using the Inception-v3 model for disease identification, the mean sensitivity, specificity, and F1 for the three disease types and normal CFPs were 0.93, 0.99, and 0.95, respectively, and the mean area under the curve (AUC) was 0.99. Using the DeepLab-v3 model for lesion segmentation, the mean sensitivity, specificity, and F1 for four lesion types (abnormally dilated and tortuous blood vessels, cotton-wool spots, flame-shaped hemorrhages, and hard exudates) were 0.74, 0.97, and 0.83, respectively. CONCLUSION: DL models show good performance when recognizing RVO and identifying lesions using CFPs. Because of the increasing number of RVO patients and increasing demand for trained ophthalmologists, DL models will be helpful for diagnosing RVO early in life and reducing vision impairment.

THE INCIDENCE, CHARACTERISTICS, MANAGEMENT, PROGNOSIS, AND CLASSIFICATION OF BREAKTHROUGH VITREOUS HEMORRHAGE SECONDARY TO POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To describe breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). METHODS: Patients with the diagnosis of PCV from January 2005 to March 2020 at Peking Union Medical College Hospital were retrospectively reviewed, cases with breakthrough vitreous hemorrhage were analyzed. Subgroup analysis was conducted regarding pachychoroid PCV and nonpachychoroid PCV. RESULTS: Among 722 PCV patients (834 eyes), 103 eyes with breakthrough vitreous hemorrhage (12.4%) were included. Pars plana vitrectomy and proper further interventions could significantly improve the best-corrected visual acuity from logMAR 2.15 ± 0.48 (Snellen 20/2825) to 1.65 ± 0.67 (20/893). Hemorrhagic retinal detachment, baseline central macular thickness, and best-corrected visual acuity were factors associated with final best-corrected visual acuity (P < 0.05). In the pachychoroid PCV group, patients were younger, all had hemorrhagic pigment epithelial detachment, with a higher prevalence of choroidal vascular hyperpermeability and hemorrhagic retinal detachment, thicker subfoveal choroidal thickness, and thinner central macular thickness; besides, the initial pars plana vitrectomy were more complicated, more additional surgeries had to be performed. More eyes in the nonpachychoroid PCV group had received anti-vascular endothelial growth factor or photodynamic therapy, mostly fibrovascular pigment epithelial detachment, the best-corrected visual acuity and the status of the fellow eye were significantly worse. For the final ocular status, more eyes in nonpachychoroid PCV group were taking anti-vascular endothelial growth factor monotherapy, whereas more eyes in pachychoroid PCV group were stable. The choroidal parameters of these two groups were all significantly different. CONCLUSION: Breakthrough vitreous hemorrhage is a troublesome complication of PCV. Pars plana vitrectomy and additional interventions are required for better prognosis. Vitreous hemorrhage secondary to pachychoroid PCV or nonpachychoroid PCV have different characteristics and prognosis.

Progress of artificial intelligence in diabetic retinopathy screening.

Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide, and the limited availability of qualified ophthalmologists restricts its early diagnosis. For the past few years, artificial intelligence technology has developed rapidly and has been applied in DR screening. The upcoming technology provides support on DR screening and improves the identification of DR lesions with a high sensitivity and specificity. This review aims to summarize the progress on automatic detection and classification models for the diagnosis of DR.

Roxadustat for treatment of erythropoietin-hyporesponsive anemia in a hemodialysis patient: A case report.

BACKGROUND: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is a prevalent problem in patients with chronic kidney disease. It is associated with increased morbidity and mortality in patients who undergo dialysis. A significant proportion of patients do not respond to iron supplementation and conventional ESAs. We report a case of severe ESA hyporesponsiveness-related anemia that was successfully treated with oral roxadustat. CASE SUMMARY: A 59-year-old Chinese woman had high blood glucose for 25 years, maintenance hemodialysis for 7 years, and recurrent dizziness and fatigue for more than 2 years. Laboratory tests showed severe anemia (hemoglobin level of 54 g/L), though bone marrow biopsy, fluorescence in situ hybridization, and hemolysis tests were within normal ranges. We initially administered first-line therapies and other adjuvant treatments, such as blood transfusions, ESAs, and adequate dialysis, but the patient did not respond as anticipated. Her erythropoietin-resistant anemia was probably not only due to chronic renal insufficiency. The patient received the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (100 mg, three times weekly). After 12 wk of treatment, the patient's hemoglobin increased significantly, and her symptoms were alleviated. During the follow-up period, adverse drug reactions were controllable and tolerable. CONCLUSION: Oral roxadustat is effective and tolerable for the treatment of ESA hypores-ponsiveness-related anemia in patients undergoing hemodialysis.

Choroid changes in vortex vein-occluded monkeys.

AIM: To determine acute and chronic choroidal vascular changes after vortex vein occlusion in monkeys. METHODS: One or two temporal vortex veins were occluded in 8 cynomolgus monkeys. Fluorescein angiography (FA), indocyanine green angiogram (ICGA), and enhanced-depth imaging optical coherence tomography (EDI-OCT) were performed preoperatively and at 1d, 1, 4, 8 and 12wk after occlusion. EDI-OCT images were binarized to calculate the choroid vascular index (CVI). RESULTS: ICGA showed delayed filling of choroidal arteries in occluded quadrants in eyes with two occluded temporal vortex veins within 1wk. The thickness of the superotemporal choroid increased 1d and 4wk after occlusion, the thickness of the superonasal and inferonasal choroid increased 12wk after occlusion, and the CVI of the superonasal quadrant increased 8wk after occlusion in eyes with 2 occluded vortex veins. CONCLUSION: Occlusion of two vortex veins leads to hemodynamic and structural changes in choroidal layers in the acute phase, while autoregulation may play the main role in the long term. Occlusion of one vortex vein has little influence on the hemodynamic and structural status of the choroid.

DNA Methylation and Uveal Melanoma.

OBJECTIVE: The objective of the study was to summarize the role of DNA methylation in the development and metastasis of uveal melanoma (UM). DATA SOURCES: The relevant studies in MEDLINE were searched. STUDY SELECTION: In this review, we performed a comprehensive literature search in MEDLINE using "uveal melanoma" AND ("DNA methylation" OR "epigenetics") for original research/review articles published before February 2018 on the relationship between DNA methylation and UM. References of the retrieved studies were also examined to search for potentially relevant papers. RESULTS: Previous studies on the relationship between DNA methylation and UM covered many genes including tumor suppressor genes (TSGs), cyclin-dependent kinase genes, and other genes. Among them, the TSG genes such as RASSF1A and p16INK4a, which encodes a cyclin-dependent kinase inhibitor, are relatively well-studied genes. Specifically, a high percentage of promoter methylation of RASSF1A was observed in UM cell lines and/or patients with UM. Promoter methylation of RASSF1A was also associated with the development of metastasis. Similarly, a high percentage of promoter hypermethylation of p16INK4a was found in UM cell lines. DNA promoter methylation can control the expression of p16INK4a, which affect cell growth, migration, and invasion in UM. Many other genes might also be involved in the pathogenesis of UM such as the Ras and EF-hand domain containing (RASEF) gene, RAB31, hTERT, embryonal fyn-associated substrate, and deleted in split-hand/split-foot 1. CONCLUSIONS: Our review reveals the complex mechanisms underlying the tumorigenesis of UM and highlights the great needs of future studies to discover more genes/5'-C-phosphate-G-3' sites contributing to the development/metastasis of UM and explore the mechanisms through which epigenetic changes exert their function in UM.

[Promoting effects of CYR61 on proliferation, migration and tube formation of choroid-retinal endothelial cells].

OBJECTIVE: To observe the effects of CYR61 (cysteine-rich 61; CCN1) on the proliferation, migration and tube formation of choroid-retinal endothelial cells (RF-6A cell line). METHODS: Experimental study. RF-6A cells were cultured and treated with CYR61 at different concentrations. Effects of CYR61 on cell proliferation, migration and angiogenesis were observed by MTT assay, transwell assay and tube formation assay. RESULTS: When different concentrations of CYR61 (0, 5, 10, 100 and 500 µg/L) were used to treat RF-6A cells for 72 h, A(490) nm value of the MTT assay was changed dose-dependently (0.511, 0.522, 0.532, 0.597, 0.765 and 0.818), and the difference between different dosage groups was statistically significant (F = 318.828, P < 0.05). When RF-6A cells were treated with 400 µg/L CYR61 for different time periods (0, 12, 24, 48 and 72 h), A(490) nm value increased with the extension of treatment time (0.533, 0.598, 0.643, 0.695 and 0.756), and the difference was statistically significant (F = 42.910, P < 0.05). In transwell assay, migrated cells in cells treated with different concentrations of CYR61 (40, 200, 400 µg/L and 400 µg/L + 25 mg/Lanti-CYR61 antibody), 80 µg/L VEGF, and negative control groups were 66.83 ± 3.87, 77.83 ± 4.26, 96.83 ± 3.49, 70.67 ± 3.83, 98.33 ± 3.14 and 62.00 ± 7.62 per high-power field, respectively. RF-6A cell migration capacity increased with increased concentration of CYR61 (F = 46.987, P < 0.05). In tube formation assay, numbers of tube in different concentrations of CYR61 (40, 200, 400 µg/L, 400 µg/L + 25 mg/L anti-CYR61 antibody), 80 µg/L VEGF and negative control groups were 34.33 ± 2.50, 60.67 ± 3.72, 88.17 ± 2.93, 51.17 ± 2.14, 90.83 ± 3.49 and 31.83 ± 3.31 per field. RF-6A cell tube formation capacity increased with increased concentration of CYR61 (F = 355.224, P < 0.05). There were equal effects between 400 µg/L CYR61 and 80 µg/L VEGF. Anti-CYR61 antibody could inhibit cell migration and tube formation promoted by CYR61. CONCLUSIONS: CYR61 can promote proliferation, migration and tube formation of choroid-retinal endothelial cells in vitro. CYR61 are likely to be involved in the pathogenesis of retinal neovascularization.

Spectral domain optical coherence tomography of Vogt-Koyanagi-Harada disease: novel findings and new insights into the pathogenesis.

OBJECTIVE: To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. METHODS: Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. RESULTS: Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. CONCLUSIONS: Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

[Changes of photoreceptor layer on spectral domain optical coherence tomography in idiopathic macular hole after vitreous surgery combined with air tamponade].

OBJECTIVE: To evaluate the tamponade effect of sterilized air in vitrectomy for idiopathic macular hole (IMH) as well as changes of photoreceptor layer after surgery. METHODS: Forty-five eyes of 45 consecutive cases underwent vitrectomy and air tamponade. Surgical outcomes were retrospectively analyzed, consisting of logarithm of the minimal angle of resolution (logMAR) and SD-OCT findings including the size of IMH and the photoreceptor layer defect. RESULTS: Preoperatively, mean BCVA was 0.08 (range, 0.4 to HM), mean hole diameter was 827.4 µm (range, 204 to 1616 µm), and mean diameter of photoreceptor layer defect was 1988.9 µm (range, 792 to 3444 µm). The primary closure rate was 75.6%. One month after surgery, mean BCVA was 0.13 (range, 0.5 to LP), and mean diameter of photoreceptor layer defect was 1285.1 µm (range, 166 to 2553 µm), both presenting a significant decrease. Preoperative hole diameter and postoperative diameter of photoreceptor layer defect were statistically significantly correlated with postoperative BCVA (r = 0.526, 0.628; P < 0.05). CONCLUSIONS: Vitrectomy plus air tamponade is safe and effective for the treatment of IMH, and the time for face-down positioning is obviously shortened. Preoperative hole diameter and postoperative diameter of photoreceptor layer defect are major predictive factors of visual acuity.

[Relationship between central visual acuity and retinal volume of macular fovea accessed by spectral domain optical coherence tomography in Stargardt disease].

OBJECTIVE: To assess the relationship between central visual acuity and retinal volume of macular fovea in patients with Stargardt disease by spectral-domain optical coherence tomography (SD OCT). METHODS: It was a retrospective case series study. Twenty eyes of 10 patients with Stargardt disease were investigated by three-dimensional spectral-domain optical coherence tomography. SD OCT images were obtained and retrospectively analyzed. The retinal volumes of macular fovea were measured by SD OCT, whose diameters were set as 3 mm and 1 mm separately (volume 3 and volume 1). The retinal thickness of macular fovea (macular thickness) and the width of IS/OS conjunction loss of macular fovea (IS/OS loss) were also measured by SD OCT. We correlated the logMAR BCVA with IS/OS loss, macular thickness, volume 3 and volume 1 by linear regression analysis. RESULTS: LogMAR BCVA was from 0.3 to 1.22. IS/OS loss was from 847 µm to 5306 µm. Macular thickness was from 20 µm to 126 µm. Volume 3 and volume 1 was from 1.06 to 1.76 mm(3) and 0.06 to 0.13 mm(3). LogMAR BCVA correlated with the IS/OS loss (r = 0.695, P < 0.05), macular thickness (r = -0.601, P < 0.05), and volume 3(r = -0.725, P < 0.05). LogMAR BCVA did not correlate with volume 1(r = -0.364, P > 0.05). CONCLUSIONS: SD OCT could demonstrate the retinal structure of Stargardt disease clearly. The retinal volume of macular fovea accessed by SD OCT correlated with the visual acuity of Stargardt disease.

[Prevalence and risk factors of retinal arterial atherosclerosis in urban subjects participating in routine physical examinations].

OBJECTIVE: To determine the prevalence and risk factors of atherosclerotic lesions in retinal arteries of an urban population undergoing routine physical examinations. METHODS: Demographic and clinical information of subjects participating in annual routine physical examinations at Peking Union Medical Center from January to October of 2010 were collected and summarized. Univariate and multivariate Logistic regression analyses were conducted to evaluate the demographic and clinical factors associated with retinal arterial atherosclerosis. RESULTS: Among a total of 17 886 non-diabetic adults evaluated during the study period, retinal arterial atherosclerosis was diagnosed in 1721 (9.6%). There were predominantly grade 1 (88%) and grade 2 (11%) lesions. Prevalence of retinal arterial atherosclerosis increased with age. And traditional risk factors for cardiovascular diseases included overweight or obesity, hypertension, dyslipidemia and elevated fasting serum glucose. In a multivariate Logistic regression model, advanced age, male gender, obesity or overweight, hypertension and dyslipidemia were independently associated with a higher risk of retinal arterial atherosclerosis. Hypertension was prevalent in subjects above 40 years old while overweight or obesity had a high prevalence in all age groups. CONCLUSION: Retinal arterial atherosclerosis is common in this urban population. And aging, overweight/obesity and hypertension are the dominant risk factors. Routine physical examination is valuable for both the prevention and an early diagnosis of this disease.

[Recovery of photoreceptor inner/outer segment junction in spectral domain optical coherence tomography after surgery in idiopathic macular hole].

OBJECTIVE: To evaluate the findings of spectral domain optical coherence tomography (SD-OCT) in patients with idiopathic macular hole (IMH). METHODS: It was a retrospective case series study. Pre- and post-operative data from patients with IMH during 14 months were analyzed retrospectively. The main outcome data included logarithm of the minimal angle of resolution (logMAR) and SD-OCT findings, including the size of the IMH and the disruption of the boundary line between inner segments (IS) and outer segments (OS) of the photoreceptors. The data were analyzed using the statistical software SPSS14.0. The correlation among various data was analyzed by Bivariate correlation. The pre-and post-operative data were compared by paired-samples t-tests. RESULTS: Thirty two eyes of 32 patients were studied. The mean logMAR was 1.16 ± 0.46 (ranged from 0.40 to 2.00), the mean diameter of macular hole was (859.7 ± 292.0) µm (ranged from 332 to 1568 µm). The mean diameter of IS/OS disruption was (1965.1 ± 584.1) µm (ranged from 867 to 3444 µm). In eyes after surgery, the mean logMAR was 0.89 ± 0.46 (ranged from 0.30 to 2.00), the mean diameter of the IS/OS disruption was (1350.4 ± 642.6) µm (ranged from 153 to 2546 µm), both were decreased significantly as compare with the preoperative data (t = 3.384, 6.360; P < 0.05). Preoperative diameter of macular hole (r = 0.583) and IS/OS disruption (r = 0.416) were correlated significantly with postoperative logMAR (P < 0.05). CONCLUSIONS: Preoperative diameter of macular hole and IS/OS disruption play the main role in vision prognosis. The IS/OS disruption is decreased significantly after the operation.

Idiopathic phacodonesis in senile cataract patients in Qinghai, China.

AIM: To investigate the frequency of idiopathic phacodonesis (IP) in senile cataract subjects and the short-term clinical outcomes following cataract surgery. METHODS: This institutional case-control study included 1301 consecutive low-income cataract subjects from June to November 2009. Anterior segment were carefully evaluated with dilated pupil under slit-lamp. IP were screened and graded by a criteria set by the authors. Risk factors, surgical outcomes, and operative complications were analyzed. RESULTS: A total of 42 subjects (3.2%) with IP were diagnosed and classified as grade 1 (36 subjects), grade 2 (5 subjects) and grade 3 (1 subject). Harder lenses and intumescent cataracts were observed in the IP group than the control group (P<0.05). Logistics regression test also indicated the main risk factor was the hardness of the lens. The incidence of zonular dialysis during surgery was 23.8% (10 eyes), which was significantly higher than the controls (0.7%, P<0.001). Visual outcomes of the two groups were not statistically or clinically significant. CONCLUSION: Hard nucleus and intumescent cataract are related to IP in senile cataract subjects in Qinghai, China. With more care being taken, grade 1 and some of the grade 2 IP subjects achieved similar surgical outcomes as compared to controls.