[Emphasizing the timing and procedure selection for vitrectomy in pathological myopic traction maculopathy].

Myopic maculopathy is the primary cause of irreversible visual impairment in patients with pathologic myopia, and myopic traction maculopathy often requires vitrectomy for treatment. Myopic traction maculopathy encompasses epiretinal membrane, foveoschisis, macular hole, and macular hole-related retinal detachment. It is recommended to perform vitrectomy combined with inner limiting membrane peeling for Type II epiretinal membrane, foveal-sparing inner limiting membrane peeling for foveoschisis, inverted inner limiting membrane flap technique for macular hole, and vitrectomy combined with macular buckle for refractory macular hole-related retinal detachment. Myopic traction maculopathy is a chronically progressive condition, and surgeons need to accurately determine the timing of surgery and choose appropriate procedures to maximize the benefits for patients.

[Preliminary study on automatic quantification and grading of leopard spots fundus based on deep learning technology].

Objective: To achieve automatic segmentation, quantification, and grading of different regions of leopard spots fundus (FT) using deep learning technology. The analysis includes exploring the correlation between novel quantitative indicators, leopard spot fundus grades, and various systemic and ocular parameters. Methods: This was a cross-sectional study. The data were sourced from the Beijing Eye Study, a population-based longitudinal study. In 2001, a group of individuals aged 40 and above were surveyed in five urban communities in Haidian District and three rural communities in Daxing District of Beijing. A follow-up was conducted in 2011. This study included individuals aged 50 and above who participated in the second 5-year follow-up in 2011, considering only the data from the right eye. Color fundus images centered on the macula of the right eye were input into the leopard spot segmentation model and macular detection network. Using the macular center as the origin, with inner circle diameters of 1 mm, 3 mm, and outer circle diameter of 6 mm, fine segmentation of the fundus was achieved. This allowed the calculation of the leopard spot density (FTD) and leopard spot grade for each region. Further analyses of the differences in ocular and systemic parameters among different regions' FTD and leopard spot grades were conducted. The participants were categorized into three refractive types based on equivalent spherical power (SE): myopia (SE<-0.25 D), emmetropia (-0.25 D≤SE≤0.25 D), and hyperopia (SE>0.25 D). Based on axial length, the participants were divided into groups with axial length<24 mm, 24-26 mm, and>26 mm for the analysis of different types of FTD. Statistical analyses were performed using one-way analysis of variance, Kruskal-Wallis test, Bonferroni test, and Spearman correlation analysis. Results: The study included 3 369 participants (3 369 eyes) with an average age of (63.9±10.6) years; among them, 1 886 were female (56.0%) and 1, 483 were male (64.0%). The overall FTD for all eyes was 0.060 (0.016, 0.163); inner circle FTD was 0.000 (0.000, 0.025); middle circle FTD was 0.030 (0.000, 0.130); outer circle FTD was 0.055 (0.009, 0.171). The results of the univariate analysis indicated that FTD in various regions was correlated with axial length (overall: r=0.38, P<0.001; inner circle: r=0.31, P<0.001; middle circle: r=0.36, P<0.001; outer circle: r=0.39, P<0.001), subfoveal choroidal thickness (SFCT) (overall: r=-0.69, P<0.001; inner circle: r=-0.57, P<0.001; middle circle: r=-0.68, P<0.001; outer circle: r=-0.72, P<0.001), age (overall: r=0.34, P<0.001; inner circle: r=0.30, P<0.001; middle circle: r=0.31, P<0.001; outer circle: r=0.35, P<0.001), gender (overall: r=-0.11, P<0.001; inner circle: r=-0.04, P<0.001; middle circle: r=-0.07, P<0.001; outer circle: r=-0.11, P<0.001), SE (overall: r=-0.20; P<0.001; inner circle: r=-0.19, P<0.001; middle circle: r=-0.20, P<0.001; outer circle: r=-0.20, P<0.001), uncorrected visual acuity (overall: r=-0.18, P<0.001; inner circle: r=-0.26, P<0.001; middle circle: r=-0.24, P<0.001; outer circle: r=-0.22, P<0.001), and body mass index (BMI) (overall: r=-0.11, P<0.001; inner circle: r=-0.13, P<0.001; middle circle: r=-0.14, P<0.001; outer circle: r=-0.13, P<0.001). Further multivariate analysis results indicated that different region FTD was correlated with axial length (overall: ß=0.020, P<0.001; inner circle: ß=-0.022, P<0.001; middle circle: ß=0.027, P<0.001; outer circle: ß=0.022, P<0.001), SFCT (overall: ß=-0.001, P<0.001; inner circle: ß=-0.001, P<0.001; middle circle: ß=-0.001, P<0.001; outer circle: ß=-0.001, P<0.001), and age (overall: ß=0.002, P<0.001; inner circle: ß=0.001, P<0.001; middle circle: ß=0.002, P<0.001; outer circle: ß=0.002, P<0.001). The distribution of overall (H=56.76, P<0.001), inner circle (H=72.22, P<0.001), middle circle (H=75.83, P<0.001), and outer circle (H=70.34, P<0.001) FTD differed significantly among different refractive types. The distribution of overall (H=373.15, P<0.001), inner circle (H=367.67, P<0.001), middle circle (H=389.14, P<0.001), and outer circle (H=386.89, P<0.001) FTD differed significantly among different axial length groups. Furthermore, comparing various levels of FTD with systemic and ocular parameters, significant differences were found in axial length (F=142.85, P<0.001) and SFCT (F=530.46, P<0.001). Conclusions: The use of deep learning technology enables automatic segmentation and quantification of different regions of theFT, as well as preliminary grading. Different region FTD is significantly correlated with axial length, SFCT, and age. Individuals with older age, myopia, and longer axial length tend to have higher FTD and more advanced FT grades.

[Construction of Tianjin occupational disease prevention and control ability assessment system based on Delphi method].

Objective: To establish a systematic, scientific, reasonable, feasible and reliable evaluation system for occupational disease prevention and control capability, in order to provide reference for occupational disease prevention and control work in Tianjin City. Methods: In August 2022, literature review was conducted to propose indicators for the evaluation system. Two rounds of anonymous consultation with occupational health experts were conducted using the Delphi method to form expert opinions. According to the boundary value method and expert opinions, eliminate, screen, and modify the evaluation system indicators to ultimately determine the system indicators. Use Cronbach's alpha to test the reliability of the system indicators and form a Tianjin occupational disease prevention and control capability evaluation system. Results: It showed that the effective response rates of the two rounds of consultation conducted by experts in this study were 92.3% and 100.0%, respectively. The expert authority coefficients were 0.84 and 0.82, respectively. The Kendall coordination coefficient was tested for differences, and the differences were statistically significant (P<0.05). The Tianjin occupational disease prevention and control capability evaluation system includes 7 primary indicators, 17 secondary indicators, and 54 tertiary indicators. The Cronbach's alpha of the primary, second, third level indicators and all indicators were 0.91, 0.98, 0.98, 0.98 (>0.7) . Conclusion: The preliminary evaluation system for occupational disease prevention and control capacity in Tianjin City has been established, providing a reference basis for the investigation of occupational disease prevention and control capacity in Tianjin City.

[Analysis of the correlation between peripapillary retinal nerve fiber layer cross-sectional area and myopia in individuals aged 50 years and above].

Objective: To measure the peripapillary retinal nerve fiber layer (RNFL) cross-sectional area in individuals aged 50 years and above with different refractive errors, and analyze its correlation with axial length and refractive error. Methods: This was a cross-sectional study conducted as part of the "Beijing Eye Study". The study was population-based and longitudinally designed. In 2001, a cohort of individuals aged 40 years and above from five urban communities in Haidian District and three rural communities in Daxing District, Beijing, were surveyed. Follow-up examinations were conducted in 2011. In this study, the follow-up data from 2011 were collected and analyzed. One eye of each participant was randomly selected, and the participants were categorized into four groups based on their spherical equivalent: emmetropia group (-0.50 D≤spherical equivalent≤0.50 D), low myopia group (-3.00 D≤spherical equivalent<-0.50 D), moderate myopia group (-6.00 D≤spherical equivalent<-3.00 D), and high myopia group (spherical equivalent<-6.00 D). Spectral-domain optical coherence tomography (OCT) was used to perform circular scans with a diameter of 12° centered on the optic disc. ImageJ software and Heidelberg Eye Explorer software were used to calculate the RNFL cross-sectional area. One-way analysis of variance was used to compare the differences in RNFL thickness and RNFL cross-sectional area among different groups. Linear regression analysis was performed to analyze the correlation between RNFL thickness and axial length and spherical equivalent, as well as the correlation between RNFL cross-sectional area and axial length and spherical equivalent. Results: A total of 184 participants (184 eyes) were included in the study, including 88 males and 96 females. The median age was 59 (54, 66) years, with 87 right eyes and 97 left eyes. There were 50 participants (50 eyes) in the emmetropia group, low myopia group, and moderate myopia group, and 34 participants (34 eyes) in the high myopia group. There were no significant differences in age, gender, and eye laterality among the groups (all P>0.05). The RNFL cross-sectional areas in the emmetropia, low myopia, moderate myopia, and high myopia groups were (1.115±0.106), (1.122±0.136), (1.105±0.105), and (1.096±0.106) mm2, respectively, with no significant differences observed (F=0.43, P=0.730). The RNFL thickness in the emmetropia, low myopia, moderate myopia, and high myopia groups were (102.5±9.5), (102.5±12.1), (94.2±8.3), and (90.2±8.9) µm, respectively, with a significant difference observed (F=16.42, P<0.001). Univariate linear regression analysis was performed with spherical equivalent as the independent variable and peripapillary RNFL thickness as the dependent variable, yielding the regression equation: peripapillary RNFL thickness=102.651+1.634 × spherical equivalent (R2=0.21, P<0.001). Similarly, when axial length was used as the independent variable and peripapillary RNFL thickness as the dependent variable, the regression equation was: peripapillary RNFL thickness=174.161-3.147 × axial length (R2=0.18, P<0.001). There was no significant correlation between RNFL cross-sectional area and spherical equivalent (P=0.065) or axial length (P=0.846). Conclusions: There were no significant differences in peripapillary RNFL cross-sectional area among individuals aged 50 years and above with different axial lengths or refractive errors.

[A retrospective analysis of 147 cases of orbital exenteration].

Objective: To investigate the main indications and prognosis of patients undergoing orbital exenteration (OE). Methods: It was a retrospective case series study. The medical records were collected of patients who underwent OE surgery at Beijing Tongren Hospital from January 2007 to December 2021, and their general information, tumor characteristics, lymph node metastasis, diagnosis and treatment, specific surgical techniques, pathological diagnosis and prognosis were analyzed. Kaplan-Meier survival curves were used to evaluate overall survival and recurrence-free survival. Results: A total of 147 patients were included, with a median age of 58 (48, 68) years. Among them, 82 patients (55.8%) were male and 65 (44.2%) were female, and all underwent unilateral OE. Five patients (3.4%) had benign lesions. Among the 142 patients with malignant tumors, conjunctival malignancies (37.3%) were the most common, followed by eyelid (29.6%), orbital (19.0%), and ocular (14.1%) malignancies. Among the 53 patients with conjunctival tumors, 38 (71.7%) had conjunctival melanoma and 14 (26.4%) had squamous cell carcinoma. Among the 42 patients with eyelid malignancies, 19 (45.2%) had sebaceous gland carcinoma and 16 (38.1%) had basal cell carcinoma. Among the 20 patients with ocular malignancies, 10 (50.0%) had choroidal melanoma and 9 (45.0%) had retinoblastoma. The most common pathological types among the 142 patients with malignant tumors were melanoma (51 cases, 35.9%), squamous cell carcinoma (20 cases, 14.1%), sebaceous gland carcinoma (19 cases, 13.4%), and basal cell carcinoma (16 cases, 11.3%). Of the 135 patients included in the survival analysis, all 5 patients with benign lesions were alive at the last follow-up. The median follow-up time for the 130 patients with malignant tumors was 6.9 (2.5, 6.9) years, ranging from 0.2 to 14.0 years. The overall survival rates at 1, 3, and 5 years after surgery were 90.9% (95%CI: 85.8%-96.0%), 68.4% (95%CI: 59.6%-77.2%), and 60.1% (95%CI: 50.5%-69.7%), respectively. The recurrence-free survival rates of patients with and without lymph node metastasis before surgery were 57.6% and 56.7%, respectively (OR=1.062, 95% CI: 0.525-2.148, P=0.864), and the overall survival rates were 61.5% and 57.7%, respectively (OR=1.019, 95% CI: 0.512-2.033, P=0.957), with no significant differences both. The recurrence-free survival rates of patients with melanoma (47 cases) and non-melanoma (83 cases) were 40.4% and 67.5%, respectively (OR=2.576, 95% CI: 1.390-4.775, P<0.001), and the overall survival rates were 42.6% and 67.5%, respectively (OR=2.845, 95% CI: 1.549-5.225, P<0.001), with significant differences both. Conclusions: The primary indications for OE are malignant tumors of the conjunctiva and eyelids, with melanoma being the most common malignant tumor of the conjunctiva. Melanoma patients who undergo OE have a lower survival rate compared to other types of malignant tumors. Nevertheless, even in the presence of tumor lymph node metastasis, patients can achieve a relatively good prognosis through OE.

[Attention should be paid to the lifelong monitoring of diabetic retinopathy in people with diabetes].

Diabetic retinopathy (DR) is one of the severe complications of diabetes, and also the most common reason of vision loss in Chinese adults over 30 years old. Regular fundus examination and continuous glucose monitoring can prevent 98% of blindness caused by DR. However, due to the irrational allocation of medical resources and the weak awareness of DR patients, only about 50% to 60% of diabetes patients have an annual DR screening. Therefore, it is necessary to build a follow-up system for early screening, prevention, treatment and lifelong monitoring of DR patients. In this review, we discuss the importance of lifelong monitoring, the hierarchical medical system and the follow-up of pediatric DR patients. Novel and multi-level screening methods are cost-saving to patients and cost-effective to healthcare systems, and also can help improve the detection and early treatment of DR.

[Ultrasonographic features of retinal pigment epithelial adenoma].

Objective: To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma. Methods: It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI). Results: Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification. Conclusion: The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

[Clinical characteristics and prognostic factors of 1 166 patients with uveal melanoma].

Objective: To analyze the clinical characteristics and survival of Chinese uveal melanoma (UM) patients. Methods: It was a retrospective case series study. Clinical data and demography characteristics of 1 166 UM patients who were diagnosed in Beijing Tongren Hospital from January 2004 to January 2020 were collected. The disease was followed up after informed consent was obtained. Kaplan-Meier plots were used to visualize survival outcomes, and the different risk groups were compared using the Log-rank test. The multivariate Cox proportional hazards model was used to select independent prognostic risk factors. Results: A total of 1 166 individuals (598 men, 568 women) were included in this study. The average age was (47.6±12.2) years. Median follow-up time was 38 months. Treatment included episcleral brachytherapy in 881 (75.6%) patients, local tumor resection in 38 (3.2%) patients, laser therapy in 115 (9.9%) patients and primary enucleation in 119 (10.2%) patients. In 120 patients out of the 881 patients with primary brachytherapy, enucleation was performed due to an increasing tumor size or uncontrolled neovascular glaucoma. The Kaplan-Meier survival analysis showed the 5-and 10-year metastasis rates were 18.5% and 26.8%, and the melanoma-related mortality rates were 13.6% and 22.2%, respectively. The Log-rank test showed that patient age (χ²=5.01) and gender (χ²=7.19), as well as tumor grade (χ²=49.11), shape (χ²=34.73), location (χ²=18.60), pathological type (χ²=8.07), presence of subretinal fluid (χ²=15.71) and ciliary body involvement (χ²=19.72) were factors influencing patient prognoses (all P<0.05). In the multivariate Cox analysis, the T2, T3, T4 tumors (compared with the T1 tumor, HR=4.41, 6.82, 10.49), subretinal fluid (HR=1.98), ciliary body involvement (HR=1.79), being male (HR=1.53) and advanced age (greater than 53 years old) (HR=1.83) were independent risk factors for poor prognoses (all P<0.05). Conclusions: UM occurs at a significantly earlier age and non-pigmented tumors represent smaller proportion in Chinese patients. Higher T-stage, presence of subretinal fluid, ciliary body involvement, advanced age, and being male are independent risk factors for poor outcomes.

[Morphological parameters of the posterior pole in a high myopia population aged over 40 years: a 10-year follow-up study].

Objective To study the long-term changes of the morphological parameters of the posterior pole in highly myopic patients over 40 years old in Chinese natural population. Methods A population-based follow-up study. The study included 71 patients (27 males, 44 females; 110 eyes) with high myopia who completed the Beijing Eye Study in 2001 and 2011 and had assessable color fundus photographs. The age of the patients in 2011 was 56.2±9.5 years old. According to the definition of pathological myopia by the meta-analysis of the Pathological Myopia Research Group, the fundus photos in 2001 were interpreted, and 110 eyes were divided into groups of simple high myopia (79 eyes) and pathological myopia (31 eyes). The morphological parameters during the 2 follow-up visits in 2001 and 2011 were measured in the color fundus photos, including optic disc tilt ratio, optic disc rotation degree, ß zone area, disc-fovea distance, disc-outer ß zone border distance, fovea-outer ß zone border distance, and vertical distance between temporal arterial arcades, and compared in all the subjects, patients with simple high myopia and patients with pathological myopia. Correlations between the 10-year changes of these parameters and other parameters were analyzed using multiple linear regression analysis. Results In all subjects, the incidence of optic disc tilt and rotation was 41.1% (44/107) and 63.3% (68/107), respectively. The optic disc tilt ratio in 2001 and 2011 was 1.34±0.31 and 1.34±0.33, respectively. The optic disc rotation degree was 30.4±26.3° and 30.0±25.3 in 2001 and 2011, respectively. The differences in optic disc tilt ratio (Z=-0.317, P>0.05) and optic disc rotation degree (t=0.159, P>0.05) were not statistically significant. The ß zone area [1.34 (0.45,3.73)mm2, Z=-7.295, P<0.05], disc-fovea distance [(5.18±0.54)mm, t=-3.523, P<0.05], and disc-outer ß zone border distance [1.55 (0.24,2.16)mm, Z=-6.825, P<0.05] in 2011 were significantly increased compared to those in 2001 [1.05 (0.23,1.88)mm2, 5.08±0.43, 1.39 (0.77,1.93)mm]. There was no statistically significant difference in the vertical distance between temporal arterial arcades (Z=-1.858, P>0.05). The fovea-outer ß zone border distance in the simple high myopia group in 2011 was significantly shorter than that in 2001 (Z=-3.221, P<0.05), while there was no significant change in this parameter in the pathological myopia group (t=0.655, P<0.05). In multivariate analysis, larger ß zone area was significantly correlated with longer corneal curvature (r=0.462, P<0.05) and longer axial length (P<0.05). Longer disc-fovea distance was significantly correlated with lower best corrected visual acuity (r=0.348, P<0.05) and longer axial length (P<0.05). Similarly, longer disc-outer ß zone border distance was related to lower best corrected visual acuity (r=0.538, P<0.05) and longer axial length (P<0.05). In addition, the progression of myopic maculopathy (Z=-3.425, P<0.05) and the progression from simple high myopia to pathological myopia (Z=-2.911, P<0.05) were both related to enlargement of the ß zone. Conclusion For patients with high myopia aged over 40 years, the optic disc morphology is relatively stable, while the disc-fovea distance and ß zone area will continue to increase with the progression of myopia. This may be due to the elongation of axial length. Enlargement of the ß zone may be a predictor for the progression of myopic maculopathy. (Chin J Ophthalmol, 2021, 57:908-915).

[Paying attention to the fundus complications and improving the prevention and treatment of pathological myopia].

Pathological myopia, an important blinding eye disease worldwide, has caused a heavy social burden. The patients have become younger in recent years. In general, people have limited knowledge of pathological myopia. They often confuse pathological myopia with high myopia, and do not fully realize that pathological myopia is not only an ametropia disease, but also a fundus disease. Fundus complications of pathological myopia are the main causes of visual impairment, including posterior staphyloma, macular degeneration, and secondary choroidal neovascularization. All of them are related to axial length and can progress throughout the life, while the treatment is limited. At present, myopia prevention has become a national strategy, and pathological myopia is the key and difficult point in myopia prevention. The whole society should pay attention to the prevention and treatment for fundus complications of pathological myopia, take comprehensive measures, and increase scientific researches to protect the eye health of the people. (Chin J Ophthalmol, 2021, 57: 401-405).

[Research progress in relationship between vitamin D and myopia and its mechanisms].

Myopia has become an important global public health problem, especially in East Asia. Due to its high prevalence and multiple ocular complications, it is imperative to take effective measures against the development of myopia. Recent studies have shown that outdoor activity is one of the protective factors for myopia and sunlight can delay the progression of myopia. As a possible mediator between sunlight and myopia, vitamin D gradually comes into public view. Vitamin D refers to a kind of secosteroids responsible for regulating calcium and phosphate metabolism. In addition to this main function, it is also correlated with many eye diseases like diabetic retinopathy, age-related macular degeneration, glaucoma etc. This review summarizes relevant epidemiologic and genetic studies as well as possible biological mechanisms to provide theoretical reference for the plausible application of vitamin D in the prevention and therapy of myopia. (Chin J Ophthalmol, 2021, 57: 470-476).

[The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma].

Objective: To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Methods: A cross-sectional study. Twenty-five patients (25 eyes) with choroidal melanoma treated in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from July to October 2016 were included in this study. There were 13 males and 12 females, with an average age of (48±12) years old. Twenty-five patients (25 eyes) with choroidal hemangioma treated in the same period were selected for differential diagnosis, including 12 males and 13 females, with an average age of (37±13) years. The lesions were examined by ultrasound elastography and scored, and the strain ratio of the tumor to the orbital tissue was measured. Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma. The sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Results: The elastography score of choroidal melanoma was (3.48±0.77) points, including 2 points in 3 cases, 3 points in 8 cases, 4 points in 13 cases, and 5 points in 1 case. The elastography score of hemangioma was (2.28±0.46) points, including 2 points in 18 cases and 3 points in 7 cases. The difference in the elasticity score between patients with the two kinds of tumors was statistically significant (t=6.694, P<0.01). The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma, respectively, and the difference was statistically significant (t=8.392, P<0.01). Using 3 points as the diagnostic critical point of the elastography score, the sensitivity was 88.0%, the specificity was 72.0%, and the area under the ROC curve was 0.80 (95% cofidence interval: 0.663 to 0.900, P<0.01). Using 21.67 as the diagnostic critical point of the strain ratio, the sensitivity was 92.0%, the specificity was 92.0%, and the area under the ROC curve was 0.92 (95% cofidence interval: 0.808 to 0.978, P<0.01). Conclusions: Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma. The differential diagnostic value of the strain ratio method is higher than the scoring method. (Chin J Ophthalmol, 2020, 56: 676-680).

[The clinical observation of external scleral plaque radiotherapy in patients with uveal melanoma].

Objective: To investigate the safety and efficacy of external scleral plaque radiotherapy (PRT) in the treatment of uveal melanoma (UM). Methods: This was a retrospective case series study. The data of 819 patients who underwent ophthalmic PRT from July 2007 to November 2017 at Tongren Hospital Affiliated to Beijing Capital Medical University was collected, including preoperative visual acuity, intraocular pressure and slit lamp microscope, color fundus photography, indirect ophthalmoscopy, color Doppler ultrasound, fundus fluorescein angiography, indocyanine green angiography, orbital nuclear magnetic resonance imaging, PRT times and time, complications, follow-up time, the maximum basal diameter and height of the tumor UM half a year after the applicator was removed, tumor metastasis rate, mortality and visual acuity observed at the last follow-up. The tumor growth was considered when the tumor height increased by 2.0 mm or the extension of any boundary of the tumor was 2.5 mm; otherwise, the treatment was defined as effective. The paired t test and Kaplan-Meier survival curve were used for statistical analysis. Results: There were 408 males and 411 females. The age ranged from 13 to 85 years (mean, 47 years). Nine patients had ciliary body melanoma, 43 patients had choroidal melanoma involving the ciliary body, and 767 patients had choroidal melanoma. In all 819 eyes, the tumor was medium-sized in 697 eyes and large in 110 eyes. All patients were treated with PRT only one time. The average radiotherapy time was 15 days (range, 6 to 50 d). All operations were successfully completed, with no active bleeding, infection, adjacent tissue injury and other related complications. At 6 months after the treatment, the maximum basal diameter of the tumor was (12.41±3.20) mm, which was significantly different from that before treatment (12.82±3.21) mm (t=2.40, P<0.01); the tumor height was (6.18±2.55) mm, which was significantly different from that before treatment (7.21±2.57) mm (t=4.05, P<0.01). The average follow-up time was (34±24) months (range, 1 to 125 months). Twenty-five patients lost follow-up at 2 years after the PRT, and 71 patients underwent enucleation. The effective rate of the PRT treatment was 88.3% (723/819), and the eyeball retention rate was 91.1% (723/794). The visual acuity remained stable in 393 eyes, decreased in 344 eyes, and improved in 82 eyes. Sixty patients had systemic metastasis (liver, bone or breast metastasis). Twenty-two patients died of tumor metastasis. The 5-year metastasis rate was 12.8%; the 5-year mortality rate was 5.8%; the 10-year metastasis rate was 20.6%; the 10-year mortality rate was 5.8%. Conclusions: PRT is safe and effective in the treatment for UM and can preserve some useful visual acuity. PRT can be used as the main treatment for medium-sized UM.(Chin J Ophthalmol, 2020, 56: 670-675).

[Effects of intravenous methylprednisolone pulse therapy on recurrent optic neuritis associated with aquaporin 4 antibody seropositive neuromyelitis optica].

Objective: To observe the effects of intravenous methylprednisolone pulse (IVMP) therapy on the recovery of visual acuity and its influencing factors in patients with the relapse of aquaporin (AQP) 4 antibody positive neuromyelitis optica related optic neuritis (NMO-ON). Methods: Retrospective case series. Forty-eight eyes of 35 patients diagnosed as NMO-ON in the Neuro-ophthalmology Clinic of Beijing Tongren Hospital from September 2012 to April 2018 were included in this research. All patients were AQP4 antibody seropositive, and had clinical manifestations of acute optic neuritis, with a history of optic neuritis treated with glucocorticoids effectively. They received the treatment of IVMP 500 mg/d or 1 000 mg/d for 3 to 5 days. The post-treatment and pre-treatment visual acuities were compared. Improving four lines or more was considered as markedly effective, improving two or three lines as effective, and improving one line or no change or a decline as no effect. The impacts of age, visual acuity at onset, relapse rate and dosage on the acute exacerbation of NMO-ON were analyzed. Mann-Whitney U test and Kruskal-Wallis test were used for statistical analysis. Results: Among the 35 patients, there were 2 males and 33 females, aged from 15 to 73 years (median, 36 years). In the 48 eyes of recurrence, the treatment was effective 41.7% (20/48), effective 20.8% (10/48), and ineffective 37.5% (18/48). The IVMP therapy was effective in 25 of 34 eyes with one recurrence and 5 of 14 eyes with two or more recurrences, and the difference was statistically significant (Z=2.315, P=0.021). The efficacy in 13 eyes with preoperative visual acuity not lower than 0.05 (10/13) was better than 35 eyes with preoperative visual acuity lower than 0.05 (20/35), and the difference was statistically significant (Z=1.994, P=0.046). Different ages and doses (1 000 mg/d and 500 mg/d) made no significant difference in the efficacy (P=0.273,0.105). Conclusions: The IVMP therapy is effective for the NMO-ON relapse in patients who were AQP4 antibody seropositive. The effect of IVMP treatment at doses of 500 mg/d and 1 000 mg/d is similar. Furthermore, visual acuity less than 0.05 and more relapses reduce the efficacy in relapsed NMO-ON patients. (Chin J Ophthalmol, 2020, 56: 509-513).

[A comparative study of retinal nerve fiber layer thickness in AIDS patients with different fundus diseases].

Objective: To investigate the characteristics of retinal nerve fiber layer (RNFL) thickness in AIDS patients with normal fundus, HIV-related microvascular retinopathy (MVR), and cytomegalovirus retinitis (CMVR). Methods: In this cross-sectional study, 111 patients were diagnosed with AIDS from 2012 to 2017 by infectious disease physicians in Beijing You'an Hospital. There were 105 males and 6 females, aged 20-65 years. According to the results of ophthalmic examination, the patients were divided into three groups: 31 patients in the active-stage CMVR group, 47 patients in the MVR group, and 33 patients with normal fundus in the control group. RNFL thickness was measured by optical coherence tomography in all patients. At the same time, visual acuity, intraocular pressure, and fundus were examined, and AIDS-related systemic examination (CD4(+) T lymphocyte count, HAART treatment status, and blood cytomegalovirus DNA level) was performed. The measurement data were compared by t-test, variance analysis or rank sum test. The counting data were compared by chi square test or Fisher exact probability method. Results: In the control group, the thickness of RNFL in the superior quadrant in the left and right eyes was 145 (79, 231) µm and 142 (46, 179) µm, respectively; the difference was statistically significant (Z=-2.481, P=0.013). The RNFL thickness of the diseased and healthy eyes in the MVR group was 116 (91, 138) µm and 122 (82, 192) µm, respectively, with no significant difference (Z=-0.861, P=0.389); the best corrected visual acuity was 0.0 (0.0, 0.2) and 0.0 (0.0, 0.2), respectively, with no significant difference (Z=-0.378, P=0.705). In the CMVR group, the best corrected visual acuity of the diseased and healthy eyes was (0.23±0.48) and (0.02±0.82), respectively, and the difference was statistically significant (t=-2.944, P=0.003); the RNFL thickness was 133 (61, 219) µm and 121 (69, 146), respectively, in the whole optic disc, with statistically significant difference (Z=-2.385, P=0.017), 104 (41, 374) µm and 82 (55, 121) µm, respectively, in the nasal quadrant, and 99 (14, 173) µm and 72 (36, 111) µm, respectively, in the temporal quadrant, with statistically significant difference (Z=-2.045, -2.543; P=0.041, 0.011). The RNFL thickness in the CMVR group, the MVR group, and the control group was 149 (61, 350) µm, 126 (71, 304) µm, and 113 (87, 149) µm, respectively, with statistically significant difference (H=20.908, P=0.000). Conclusions: The fundus of AIDS patients had different characteristics on optical coherence tomography. In active CMVR patients, the thickness of RNFL was generally thickened. In MVR patients, the average thickness of RNFL was thicker than that in the normal control group.(Chin J Ophthalmol, 2020, 56:258-265).

[The consistency of ultra-wide-field retinal imaging and the Superfield lens for fundus screening in HIV/AIDS patients].

Objective: To screen the retinopathy in HIV/AIDS patients with both non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic fundus examinations with the Superfield lens and a slit lamp biomicroscope, and to evaluate the consistency of two methods and provide reference for future clinical screening work and even technological innovation (such as telemedicine screening and artificial intelligence). Methods: Cross sectional study. One hundred and fifty-eight eyes of 80 HIV-positive patients from the Ophthalmology Department of Beijing Youan Hospital were enrolled in this prospective observational study. All patients underwent comprehensive ophthalmological examination. A single image was obtained from each eye using the UWF fundus imaging system (Daytona, Optos, Dunfermline, UK), and then a dilated fundal examination with the Superfield lens was conducted by another expert. The possible type and location of the lesion with these two methods was recorded respectively. The consistency was compared using the detection rate and Kappa value. Results: Fifty-two patients (65%) had fundus changes, and 28 patients (35%) were normal. Seventy-nine eyes (50%) were normal and 79 eyes (50%) had fundus lesions. Sixty-one eyes (77.2%) had HIV-related fundus lesions, while 18 eyes (22.8%) had non-HIV-related fundus lesions. Fifty-two eyes (65.8%) suffered posterior or posterior involving lesions, and 27 eyes (34.2%) suffered isolated peripheral lesions. The detection rate of UWF retinal imaging and slit lamp biomicroscopy with the Superfield lens was 17.7% (28/158) and 18.4% (29/158) (P=1.000>0.05) for HIV-related microvascular retinopathy, 8.2% and 8.2% (13/158) (χ(2)=158.00, P=1.000) for cytomegalovirus retinitis (CMVR), 36.1% and 36.1% (57/158) (χ(2)=71.066, P=1.000) for HIV-related fundus lesions, 41.8% (66/158) and 47.5% (75/158) (χ(2)=63.514, P=0.136) for fundus lesions, 33.5% (53/158) and 31.0% (49/158) (χ(2)=108.268, P=0.388) for posterior/posterior involving lesions, and 6.4% (10/158) and 16.5% (26/158) (χ(2)=42.001, P=0.000) for isolated peripheral lesions, respectively. In general, the consistency of these two methods was moderate in detecting fundus lesions (Kappa=0.630), HIV-related fundus lesions (Kappa=0.671), HIV-related microvascular retinopathy (Kappa=0.551), and isolated peripheral lesions (Kappa=0.450). According to the fundus location, the two methods showed high consistency in the detection of posterior/posterior involving lesions (Kappa=0.826>0.75) and perfect consistency for CMVR (Kappa=1.0). Conclusions: The UWF retinal imaging system and the Superfield lens showed reasonable consistency in fundus screening in HIV/AIDS patients, especially for CMVR, or lesions in the posterior pole. (Chin J Ophthalmol, 2019, 55:763-768).

[Research progress of treatment strategies for choroidal neovascularization secondary to pathological myopia].

Pathological myopia refers to high myopia with fundus pathological changes. Choroidal neovascularization is one of its serious complications, and also the main cause of visual loss. Currently, the first-line treatment is anti-VEGF treatment, with good efficacy, high safety, good prognosis, and other advantages of vision. Commonly used anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept, and conbercept. The main treatment strategies include 1+pro re nata and 3+pro re nata, and the standard of REPAIR test is often used to evaluate the re-injection. This article reviews the advantages of anti-VEGF therapy, drug selection, treatment strategy, and re-injection criteria. (Chin J Ophthalmol, 2019, 55:791-795).

[Efforts to improve the level of clinical diagnosis and treatment of infectious fundus diseases].

In recent years, the incidence of tuberculosis, HIV, syphilis and other infectious diseases has a "rising" trend. The incidence of infectious fundus diseases is also increasing, and missed diagnosis and misdiagnosis are becoming more common. How to diagnose infectious fundus diseases accurately, avoid missed diagnosis and misdiagnosis, carry out standardized treatment in time, carry out research on infectious fundus diseases related to systemic infectious diseases, and save the visual function of patients are the problems we are facing. This article discusses the related issues. (Chin J Ophthalmol, 2019, 55: 241-245).

[Evaluation of the efficacy and safety of a foldable capsular vitreous body in the treatment of severe retinal detachment].

Objective: To determine the efficacy and safety of vitrectomy combined with implantation of a foldable capsular vitreous body in the treatment of severe retinal detachment with early ocular atrophy in human eyes. Methods: This study was a prospective, multicenter, and one-arm phase Ⅱ clinical trial. Patients with severe retinal detachment and early eyeball atrophy attending Beijing Tongren Eye Center from April 2011 to July 2012 were included. A standard three-port pars plana vitrectomy was performed, and a foldable capsular vitreous body was folded and sent into the vitreous cavity; silicone oil was injected into the capsule. Measurement of visual acuity and intraocular pressure, corneal endothelium count, color fundus photography, optical coherence tomography, and ocular ultrasonography were performed to observe retinal reattachment and adverse reactions after surgery. Wilcoxon signed rank test was performed to compare the baseline and postoperative visual acuity, intraocular pressure and corneal endothelium count. Results: A total of 26 patients were enrolled, including 23 males and 3 females. The age was (37.5±11.5) years, with an average follow-up of 33 months. For each patient, only the left or right eye was included (13 left eyes and 13 right eyes). Retinal reattachment was found in all 24 eyes, and the eyeball atrophy was controlled in all patients. Visual acuity was improved in 4 patients (15.4%) and unchanged in 5 patients (19.2%). The mean intraocular pressure [(14.4±3.9) mmHg(1 mmHg=0.133 kPa)] at the last follow-up was higher than the baseline intraocular pressure [(12.0±6.5) mmHg], but the difference was not statistically significant (Z=-1.859, P=0.063). For the 16 patients with ocular atrophy at baseline, the last follow-up intraocular pressure [(14.6±3.9) mmHg] was significantly higher than the preoperative intraocular pressure [(8.5±2.4) mmHg] (t=-5.326, P<0.001). No obvious adverse reactions were observed. Conclusions: Implantation of a foldable capsular vitreous body is an effective way to treat severe retinal detachment with early eyeball atrophy. It can help to reattach the retina, control eyeball atrophy, maintain the eye shape and intraocular pressure, while visual acuity improvement is limited. (Chin J Ophthalmol, 2019, 55: 259-266).