Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

AIM: To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. METHODS: Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. RESULTS: Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. CONCLUSION: This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

A classification of idiopathic epiretinal membrane based on foveal avascular zone area using optical coherence tomography angiography.

OBJECTIVE: To evaluate the characteristics and prognoses of idiopathic macular epiretinal membrane (iERM) using a classification based on the foveal avascular zone (FAZ) area. METHOD: IERMs were classified into four stages based on the FAZ area. Baseline FAZ-related parameters, pre-and postoperative central macular thickness (CMT), and best corrected visual acuity (BCVA) were observed and compared between different stages. The correlations of structural parameters with pre-and postoperative logMAR BCVA were analyzed. RESULTS: 162 iERM eyes were enrolled, including 105 eyes followed up for 12 months after surgery. The preoperative BCVA was better at the early stage. Postoperative BCVA at Stages 2 and 3 were better compared to Stage 4. The early stage was associated with thinner CMT pre-and postoperatively. However, there was no significant difference in CMT between postoperative Stages 1 and 2 or Stages 3 and 4. Preoperative logMAR BCVA was negatively correlated with FAZ area, perimeter, and FD-300 and was positively correlated with CMT and acircularity index (AI). CMT correlated positively with BCVA for each stage, except Stage 4; FAZ area, perimeter, and FD-300 had a negative correlation at Stage 1. Baseline BCVA and CMT positively correlated with BCVA at the last follow-up, while FAZ area and FD-300 were negatively correlated. Baseline BCVA had a positive correlation for each stage, except Stage 1; FD-300 had a negative correlation at Stages 2 and 3; CMT had a positive correlation at Stage 3. CONCLUSION: A classification based on the FAZ area was established innovatively. This classification can reflect the progression of iERM and is helpful to the postoperative prognosis.

(1) Classification based on FAZ area facilitate automation and consistency compared to the previous OCT-based qualitative grading.(2) With baseline FAZ stage advanced, thickened CMT and worsened BCVA was observed at baseline and 1-year post-operation. (3) Baseline FAZ area and FD-300 negatively correlated with logMAR BCVA at the last follow-up, reflecting the nonnegligible prognostic impact of macular vascular changes.

Myopic choroidal neovascularization with neovascular signal around perforating scleral vessel prone to recur after anti-VEGF therapy.

BACKGROUND: To compare the recurrence of myopic choroidal neovascularization (mCNV) based on the neovascular signal of mCNV around the perforating scleral vessel (PSV). METHODS: A consecutive series of naïve patients with mCNV accepted anti-VEGF therapy with a minimum 12-month follow-up period. The neovascular signal relationship between PSV and mCNV were classified into the presence of neovascular signal of CNV around PSV or not. The recurrence of mCNV, best-corrected visual acuity (BCVA), hyperreflective foci height, CNV area and CNV flow area were analyzed between two groups. RESULTS: Neovascular signal of CNV around PSV was detected in 20 eyes (39.2%). The one-year recurrence rate in the group with neovascular signal of CNV around PSV was significantly higher than that in the group without neovascular signal of CNV around PSV (P = 0.045). The recurrence time in the group with neovascular signal around PSV was shorter than that in the group without neovascular signal around PSV (P = 0.030). Cox proportional hazard model showed that the presence of neovascular signal of CNV around PSV [hazard ratio (HR): 2.904] and subfoveal choroidal thickness ≤ 50 µm (HR: 0.368) were risk factors for recurrence of mCNV. In the group with neovascular signal around PSV, the BCVA was worse (P = 0.024) and the CNV flow area was more unstable (P = 0.027) after therapy. CONCLUSIONS: PSV was commonly detected in patients with mCNV. The presence of neovascular signal of CNV around PSV was prone to recur with a shorter time in mCNV patients.

The performance of a deep learning system in assisting junior ophthalmologists in diagnosing 13 major fundus diseases: a prospective multi-center clinical trial.

Artificial intelligence (AI)-based diagnostic systems have been reported to improve fundus disease screening in previous studies. This multicenter prospective self-controlled clinical trial aims to evaluate the diagnostic performance of a deep learning system (DLS) in assisting junior ophthalmologists in detecting 13 major fundus diseases. A total of 1493 fundus images from 748 patients were prospectively collected from five tertiary hospitals in China. Nine junior ophthalmologists were trained and annotated the images with or without the suggestions proposed by the DLS. The diagnostic performance was evaluated among three groups: DLS-assisted junior ophthalmologist group (test group), junior ophthalmologist group (control group) and DLS group. The diagnostic consistency was 84.9% (95%CI, 83.0% ~ 86.9%), 72.9% (95%CI, 70.3% ~ 75.6%) and 85.5% (95%CI, 83.5% ~ 87.4%) in the test group, control group and DLS group, respectively. With the help of the proposed DLS, the diagnostic consistency of junior ophthalmologists improved by approximately 12% (95% CI, 9.1% ~ 14.9%) with statistical significance (P < 0.001). For the detection of 13 diseases, the test group achieved significant higher sensitivities (72.2% ~ 100.0%) and comparable specificities (90.8% ~ 98.7%) comparing with the control group (sensitivities, 50% ~ 100%; specificities 96.7 ~ 99.8%). The DLS group presented similar performance to the test group in the detection of any fundus abnormality (sensitivity, 95.7%; specificity, 87.2%) and each of the 13 diseases (sensitivity, 83.3% ~ 100.0%; specificity, 89.0 ~ 98.0%). The proposed DLS provided a novel approach for the automatic detection of 13 major fundus diseases with high diagnostic consistency and assisted to improve the performance of junior ophthalmologists, resulting especially in reducing the risk of missed diagnoses. ClinicalTrials.gov NCT04723160.

Long-Term Quantitative Analysis of Inner Retinal Dimples and Visual Function Post Internal Limiting Membrane Peeling in Macular Diseases.

INTRODUCTION: Inner retinal dimples (IRDs) are frequently detected after internal limiting membrane (ILM) peeling. However, the distribution of IRDs and its effect on postoperative visual function remain unclear. We aim to quantify the distribution of IRDs after ILM peeling in different macular diseases and analyze its influence on postoperative visual function. METHODS: We retrospectively reviewed patients undergoing vitrectomy with ILM peeling and followed up until 12 months in our center. The distribution of IRDs were quantitatively determined using optical coherence tomography (OCT) and OCT angiography in a different sector of Early Treatment Diabetic Retinopathy Study grid. Visual function was evaluated by retinal sensitivity (RS) using microperimetry. Spearman correlation was performed between RS and IRDs within the same sectors. Multivariate linear regression analysis was performed to analyze the association between baseline characteristics and IRDs. RESULTS: A total of 43 idiopathic macular hole (iMH) cases, 56 idiopathic epiretinal membrane (iERM) cases and 42 myopic foveoschisis (mFS) cases were included. IRDs increased gradually at ILM-peeled area, interrupting ganglion cell layer. Most IRDs were observed in temporal sector. A negative correlation was depicted between the increase of IRDs and the progress of RS at both perifovea and parafovea in iERM, but only at perifovea in iMH. No significant correlation between the change of IRDs and RS was found in mFS. Multivariable linear regression model showed that preoperative axial length was significantly associated with postoperative IRDs in all patients. CONCLUSIONS: IRDs distributed mostly at temporal sector after ILM peeling, interrupting ganglion cell layer. IRD progression may influence postoperative RS only in iMH and iERM. Ophthalmologists may avoid temporal sector especially in eyes with normal axial length or strong ILM-ERM adherence.

Edge-Guided Contrastive Adaptation Network for Arteriovenous Nicking Classification Using Synthetic Data.

Retinal arteriovenous nicking (AVN) manifests as a reduced venular caliber of an arteriovenous crossing. AVNs are signs of many systemic, particularly cardiovascular diseases. Studies have shown that people with AVN are twice as likely to have a stroke. However, AVN classification faces two challenges. One is the lack of data, especially AVNs compared to the normal arteriovenous (AV) crossings. The other is the significant intra-class variations and minute inter-class differences. AVNs may look different in shape, scale, pose, and color. On the other hand, the AVN could be different from the normal AV crossing only by slight thinning of the vein. To address these challenges, first, we develop a data synthesis method to generate AV crossings, including normal and AVNs. Second, to mitigate the domain shift between the synthetic and real data, an edge-guided unsupervised domain adaptation network is designed to guide the transfer of domain invariant information. Third, a semantic contrastive learning branch (SCLB) is introduced and a set of semantically related images, as a semantic triplet, are input to the network simultaneously to guide the network to focus on the subtle differences in venular width and to ignore the differences in appearance. These strategies effectively mitigate the lack of data, domain shift between synthetic and real data, and significant intra- but minute inter-class differences. Extensive experiments have been performed to demonstrate the outstanding performance of the proposed method.

The impact of green finance on total factor carbon emission reduction efficiency in China.

Based on an analysis of the relationship between green finance and total factor carbon emission reduction efficiency, this article measures the levels of green finance and total factor carbon emission reduction efficiency in 30 provinces and cities in China. It also establishes a spatial Durbin model to quantitatively explore the impact of green finance on China's total factor carbon emission reduction efficiency. The results indicate that currently, green finance and total factor carbon emission reduction efficiency in China follow a distribution pattern of high in the east, medium in the central region, and low in the west. The impact of green finance on total factor carbon emission reduction efficiency demonstrates a U-shaped relationship, and the spatial spillover effect between the two displays a similar U-shaped trend. The mechanism analysis demonstrates that green finance exerts a U-shaped influence on the efficiency of reducing total factor carbon emissions through the interplay of technological progress and technical efficiency enhancements. Other variables, such as research and development investment, comprehensive energy consumption, human capital, infrastructure construction, and government regulation, also have an impact on total factor carbon emission reduction efficiency. Therefore, it is recommended that regions strengthen their green finance initiatives, support efforts to carbon emission reduction, and contribute towards achieving the "dual-carbon" goal.

Analysis of Cytokine Levels Based on Optical Coherence Tomography Findings in Acute and Chronic Central Serous Chorioretinopathy.

Purpose: To investigate the characteristics of optical coherence tomography (OCT) and aqueous humor cytokine differences between acute and chronic central serous chorioretinopathy (CSC) and to evaluate the relevance of these findings.Methods: This was a cross-sectional, observational study. Patients with CSC were divided into acute and chronic groups based on the symptom duration and were compared with normal controls. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CT), hyperreflective foci (HF), and cytokines including vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein-10 (IP-10), and monocyte chemoattractant protein-1 (MCP-1) were used as comparison metrics.Results: A total of 62 patients (62 eyes) with CSC (22 with acute CSC and 40 with chronic CSC) and 35 patients as controls were included in this study. The chronic CSC group had significantly older average ages and worse BCVA than the acute CSC group (both p < 0.05). Both CSC groups showed significant increases in CMT and CT (both p < 0.05). In chronic CSC, the CMT was thinner, with more HF in the neuroretina (p = 0.034). VEGF levels were significantly higher in patients with chronic CSC than in those with acute CSC and controls (p < 0.05). The levels of inflammatory cytokines showed no significant difference between the CSC and control groups. Spearman's correlation analysis showed that the number of HF was positively correlated with disease duration (r = 0.311, p = 0.014), logMAR BCVA (r = 0.487, P < 0.001) and MCP-1 levels (r = 0.256, p = 0.045).Conclusions: Chronicity of CSC could lead to upregulation of VEGF. HF was associated with a more severe visual impairment in CSC patients and had relations with the levels of MCP-1.

The Characteristic of Optical Coherence Tomography Angiography and Retinal Arteries Angle in Familial Exudative Vitreoretinopathy with Inner Retinal Layer Persistence.

PURPOSE: To compare the angle of retinal arteries and macular vessel density and foveal avascular zone (FAZ) in early stage familial exudative vitreoretinopathy (FEVR) patients with inner retinal layer (IRL) persistence with FEVR patients without IRL persistence and normal people. METHODS: This study enrolled 113 early stage FEVR patients and 55 age-matched normal subjects. FEVR patients were divided into IRL group and non-IRL group based on the presence or absence of IRL in fovea. The angle of superior temporal and inferior temporal branch retinal arteries on ultra-wide-field fundus images were measured. Superficial and deep vessel density of whole image, fovea and parafovea, the area and perimeter of FAZ, A-circularity index (AI, perimeter/standard circle perimeter with equal area) and vessel density around the 300-µm width of the FAZ (FD), central macular thickness (CMT) on 3 mm × 3mm OCTA were measured. RESULTS: 30 FEVR patients in IRL group, 83 FEVR patients in non-IRL group, 55 normal people in control group were evaluated. BCVA were worst in IRL group (p < .001). The angle of retinal arteries was smaller in FEVR groups (p < .001) and were smallest in IRL group (p < .001). Superficial and deep vessel density of whole and parafovea area in FEVR patients were significantly lower than that in normal people (p < .05), AI were biggest (p = .01) and FD were smallest in IRL group (p < .001). CMT in IRL group were thicker than non-IRL group and control group (p < .05). CONCLUSION: Worse BCVA, smaller angle of retinal arteries (more vessels traction), lower macular vessel density, smaller and more irregular FAZ and thicker CMT were observed in FEVR patients with IRL persistence even in early stage.

Quantitative assessment of retinal microvascular remodeling in eyes that underwent idiopathic epiretinal membrane surgery.

Purpose: To explore the surgical outcomes of the macular microvasculature and visual function in eyes with idiopathic epiretinal membrane (iERM) using spectral-domain optical coherence tomography angiography (SD-OCTA). Methods: This observational, cross-sectional study included 41 participants who underwent iERM surgery with a 3-month (3M) follow-up. Forty-one healthy eyes formed the control group. The assessments included best-corrected visual acuity (BCVA) and mean sensitivity (MS) by microperimetry and SD-OCTA assessment of vessel tortuosity (VT), vessel density (VD), foveal avascular zone, and retinal thickness (RT). Results: The findings showed statistically significant differences in VT, foveal avascular zone parameters, RT, BCVA, and MS between the iERM and control groups (p < 0.05). After iERM surgery, the macular VT, SCP VD, and RT decreased significantly (p < 0.01) while the DCP VD increased (p = 0.029). The BCVA improved significantly (p < 0.001) and was associated with the MS (rs = -0.377, p = 0.015). MS was associated with the SCP VD and RT at 3M (SCP VD rs = 0.511, p = 0.001; RT rs = 0.456, p = 0.003). In the superior quadrant, the MS improved significantly (p < 0.001) and the improvement of MS was associated with the reduction of VT (ß = -0.330, p = 0.034). Conclusion: Microcirculatory remodeling and perfusion recovery were observed within 3 months after iERM surgery. VT was a novel index for evaluating the morphology of the retinal microvasculature in eyes with iERM and was associated with MS in the superior quadrant.

Total and horizontal distances of the foveal stereotaxic displacement can be prognostic indicators for patients with idiopathic epiretinal membrane.

Introduction: This study aimed to examine the foveal stereo deviations in the different ectopic inner foveal layer (EIFL) stages of idiopathic epiretinal membrane (iERM) and assess its predictive utility for the baseline and postoperative best-corrected visual acuity (BCVA). Methods: Based on the calculational combination of foveal displacements in the horizontal and vertical axial optical coherence tomography (OCT) images, the foveal stereotaxic displacement was estimated through the total distance (TD, the distance from the foveal bottom to the inner edge of displaced central foveal) and horizontal distance (HD, projection of the TD in the retinal plane). The preoperative TD, HD, and other OCT- and OCT angiography (OCTA)-related indicators were obtained. The correlations between structural parameters and baseline and postoperative BCVA were evaluated through correlation and multiple linear regression analyses. Results: In patients with advanced EIFL stage, there was a significant increase in the HD, TD, baseline log of the minimum angle of resolution unit for BCVA, central macular thickness (CMT), acircularity index, and incidence of microcystic macular edema (MME; p < 0.05). Further, they showed a decreased foveal avascular zone (FAZ) area and perimeter (p < 0.001). HD, TD, CMT, MME, FAZ area, and FAZ perimeter were significantly correlated with the baseline and postoperative BCVA (p < 0.05). TD had the highest correlation indexic and was an individual predictor of the baseline and postoperative BCVA. Moreover, FD-300 and MME were individual predictors of postoperative BCVA. Discussion: Stereoscopic foveal deviations significantly correlated with the baseline and postoperative visual acuity. TD may be used as an independent prognostic factor for BCVA.

Retrospective validation of G-ROP, CO-ROP, Alex-ROP, and ROPscore predictive algorithms in two Chinese medical centers.

Purpose: To evaluate the sensitivity and specificity of four predictive algorithms (G-ROP, CO-ROP, Alex-ROP, and ROPscore) for retinopathy of prematurity and compare their performances in the Chinese population. Methods: A retrospective study was conducted at two medical centers in China of infants born at Women's Hospital School of Medicine Zhejiang University and Yiwu Maternal and Child Health Hospital. A total of 1,634 infants who met the criteria and who were GA < 32 weeks or BW < 2,000 g according to Chinese guidelines for ROP screening were included. The ROP group was further grouped into severe ROP and mild ROP. The sensitivity and specificity of G-ROP, two simplified G-ROPs, CO-ROP, Alex-ROP, and ROPscore were analyzed. Results: Severe ROP and any ROP were identified in 25 and 399 of 1,634 infants, respectively. According to the criteria of different models, 844, 1,122, 1,122, and 587 infants were eligible in the G-ROP, CO-ROP, Alex-ROP, and ROPscore, respectively. G-ROP had 96.0% sensitivity and 35.0% specificity for severe ROP. For two simplified G-ROPs (180 g and 200 g models), similar sensitivity was showed with original G-ROP and they had specificity of 21.8% and 14.0%, respectively. The sensitivity and specificity of Co-ROP were 96% and 64.3% for severe ROP, while Alex-ROP only had sensitivity of 56.0% and specificity of 61.4% for severe ROP. ROPscore had a sensitivity of 91.3% and a specificity of 62.4% for severe ROP. In 546 infants who met all 4 models' inclusion criteria and included 23 infants with severe ROP, the validation outcomes showed the sensitivity of G-ROP, ROPscore, CO-ROP, and Alex-ROP for severe ROP was 95.6%, 91.3%, 100%, and 56.0%, and their specificity was 38.0%, 60.8%, 39.9%, and 52.9%, respectively. Conclusion: G-ROP, ROPscore, and CO-ROP had high sensitivity for severe ROP in the Chinese population, but both the sensitivity and specificity of Alex-ROP were low. CO-ROP (not high-grade CO-ROP) provided the best performance for severe ROP in a fair comparison. For further application, ROP screening models need to be adjusted by local populations.

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study.

BACKGROUND: Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence. PURPOSE: To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai. METHODS: A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model. RESULTS: The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (ß = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (ß = 0.087, P < 0.001). Health literacy directly influenced adherence (ß = 0.291, P < 0.001). Education indirectly affected adherence through both social support (ß = 0.048, P < 0.001) and health literacy (ß = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (ß = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit. CONCLUSIONS: The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

The effect comparison of ILM flap and traditional ILM peeling in iMH.

Purpose: To compare the changes in anatomical structure and visual function after idiopathic macular hole (iMH) treatment with internal limiting membrane (ILM) peeling and inverted ILM flap and determine the value of the inverted ILM flap for the treatment of iMH. Methods: Forty-nine patients with iMH (49 eyes) were included in this study and followed up for 1 year (12 months) after treatment with inverted ILM flap and ILM peeling respectively. The main foveal parameters assessed included the preoperative minimum diameter (MD), intraoperative residual fragments, and postoperative ELM reconstruction. Visual function was assessed using best-corrected visual acuity. Results: The hole closure rate was 100% for 49 patients; 15 patients were treated with the inverted ILM flap, and 34 patients underwent ILM peeling. There were no differences between the postoperative best-corrected visual acuities and the rates of ELM reconstruction for the flap and peeling groups with different MDs. In the flap group, ELM reconstruction was associated with the preoperative MD, presence of an ILM flap, and hyperreflective changes in the inner retina 1 month after surgery. In the peeling group, ELM reconstruction was associated with the preoperative MD, intraoperative residual fragments at the hole edge, and hyperreflective changes in the inner retina. Conclusion: The inverted ILM flap and the ILM Peeling were both able to obtain high closure rate. However, the inverted ILM flap showed no obvious advantages related to anatomical morphology and visual function over ILM peeling.

Screening of idiopathic epiretinal membrane using fundus images combined with blood oxygen saturation and vascular morphological features.

PURPOSE: To achieve an accurate diagnosis of idiopathic epiretinal membrane (iERM) through analyzing retinal blood vessel oxygen saturation (SO2) and vascular morphological features in fundus images. METHODS: Dual-modal fundus camera was used to obtain color fundus image, 570-nm, and 610-nm images. As iERM affects the macular area, a macular-centered semicircle area as region of interest (MROI) was selected and analyzed SO2 and vascular morphologies in it. Eventually, random forest (RF) and support vector machine (SVM) were as classifiers to diagnose iERM patients. RESULTS: The arterial and venous SO2 levels of the iERM group were significantly higher than that of the control group. There were significant differences in the vessel density and fractal dimension on the artery for vascular morphology, while the tortuosity had a significant difference in the vein. By feeding the SO2 and the vascular morphological features into classifiers, an accuracy of over 82% was obtained, which is significantly better than the two separate inputs for classification. CONCLUSION: Significant differences in SO2 and vascular morphologies between control and iERM groups confirmed that the occurrence of iERM may affect blood supply and vascular structures. Benefiting from the dual-modal fundus camera and machine learning models, accurate judgments can be made on fundus images. Extensive experiments proved the importance of blood vessel SO2 and vascular morphologies for diagnosis, which is of great significance for clinical screening.

Hypodense regions in the peripapillary region increased the risk of macular retinoschisis detected by optical coherence tomography.

Purpose: The purpose of the present study was to investigate the clinical features of peripapillary regions in patients with myopic macular retinoschisis (MRS) and its association with the development of retinoschisis (RS). Methods: In this cross-sectional study, high-myopic patients with or without MRS were recruited, and the hypodense regions were analyzed in the peripapillary regions. The vitreoretinal adhesions around both macular and paravascular arcades were compared between groups. The risk factors for the development of MRS were analyzed by logistic regression. Results: Of 88 myopic eyes, MRS was detected in 45 eyes (51%). The eyes with MRS showed a higher rate of peripapillary and paravascular retinoschisis (P < 0.001 and P = 0.006). Hypodense regions were detected in 25 eyes (20.35%). Higher rates of horizontal and vertical macular MRS were detected in the hypodense group (P = 0.012 and P = 0.002). Lower refractive error, longer axial length, and higher rates of outer retinoschisis both in horizontal and vertical macular regions were observed in the hypodense group (P = 0.012, P = 0.006, P = 0.038, and P = 0.034). Higher rates of inner and outer retinoschisis, vitreoschisis, and microfolds along superior vascular arcade were detected in the hypodense group (P = 0.005, P = 0.001, P = 0.014, and P = 0.014). Higher rates of internal limiting membrane (ILM) detachment, inner and outer RS were detected along the inferior vascular arcade in the hypodense group (P = 0.008, P = 0.001, and P = 0.028). Hypodense regions, the axial length and PICC (peripapillary intrachoroidal cavitation) were significantly correlated with the severity of MRS (Odds ratio = 0.207, P = 0.010; Odds ratio = 1.399, P = 0.016; Odds ratio = 0.142, P = 0.010). Conclusions: The hypodense regions were likely to affect outer retinoschisis both in macular and paravascular regions. It was a risk factor for the development of MRS.

Perforating scleral vessels adjacent to myopic choroidal neovascularization achieved a poor outcome after intravitreal anti-VEGF therapy.

Background: This study aimed to summarize the features of perforating scleral vessels (PSVs) in patients with myopic choroidal neovascularization (CNV) (mCNV) using optical coherence tomography angiography (OCTA) and to identify the associations with the response after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: A consecutive series of naïve patients who had mCNV and received intravitreal anti-VEGF therapy with a follow-up duration of 12 months or more were enrolled. The prevalence, location, and branches of PSVs were analyzed. Projection-resolved OCTA (PR-OCTA) was used to analyze the neovascular signals between CNV and PSVs. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured. The proportion of CMT change relative to baseline was used to assess therapeutic response. Results: A total of 44 eyes from 42 patients with mCNV were enrolled. PSVs were identified in 41 out of 44 eyes. Branches were identified in the PSVs of 24 eyes (57.14%), and 20 eyes did not have PSV branches (47.62%). In eight eyes (18.18%), PSVs were adjacent to mCNV, and in 36 eyes (81.82%), PSVs were not adjacent to mCNV. After anti-VEGF therapy for mCNV, BCVA increased (F = 6.119, p < 0.001) and CMT decreased (F = 7.664, p < 0.001). In the eyes where PSVs were adjacent to mCNV, BCVA improvements (F = 7.649, p = 0.009) were poor, and changes in CMT were small. Conclusion: The eyes with PSVs adjacent to mCNV showed poor therapeutic responses after intravitreal anti-VEGF therapy.

Difference in aqueous concentration and vitreous mass of cytokines in high myopias with and without choroidal neovascularization.

Purpose: To investigate and compare the aqueous humor (AH) concentration and vitreous mass of cytokines in high myopias (HM) with and without myopic choroidal neovascularization (mCNV). And the correlations between cytokines and the size of CNVs on optical coherence tomography angiography (OCTA) images were also be analyzed. Methods: This observational study included 56 highly myopic eyes with and without CNV and 57 control eyes with cataracts. AH samples were obtained prior to the intravitreal injection of anti-VEGF and cataract surgery. This study measured multiple inflammatory cytokines including VEGF, interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein-10 (IP-10), and monocyte chemotactic protein-1 (MCP-1) by multiplex bead assay. AH cytokine level, axial length, and vitreous volume were used to calculate the vitreous mass of cytokines. Results: The vitreous mass of VEGF in eyes with mCNV was significantly higher than that in control group. However, the difference in AH concentration of VEGF between high myopias with mCNV was not observed. Inflammatory cytokines were upregulated (IL-6, IL-10, and MCP-1) in highly myopic eyes both with and without mCNV (all P<0.05). There was also a significant difference in the vitreous mass of IL-8 and IP-10 among all three groups (P<0.05). Conclusion: We confirmed the secretion of VEGF increased in eyes with mCNV from a new perspective. The development of both HM and mCNV were related to inflammatory cytokines and the upregulation of inflammatory cytokines may precede upregulation of VEGF. The vitreous mass might be tried as a more reliable potential biomarker in eyes with longer axial length.

Clinical characteristics and mutation spectrum in 33 Chinese families with familial exudative vitreoretinopathy.

OBJECTIVE: To explore the clinical manifestations and search for the variants of six related genes (LRP5, FZD4, TSPAN12, NDP, KIF11 and ZNF408) in Chinese patients with familial exudative vitreoretinopathy (FEVR), and investigate the correlation between the genetic variants and the clinical characteristics. PATIENTS AND METHODS: Clinical data, including the retinal artery angle, acquired from wide-field fundus imaging, structural and microvascular features of the retina obtained from optical coherence tomography (OCT) and OCT angiography (OCTA) were collected from 33 pedigrees. Furthermore, mutation screening was performed. Variants filtering, bioinformatics analysis and Sanger sequencing were conducted to verify the variants. RESULTS: Twenty-one variants were successfully detected in 16 of 33 families, of which 10 variants were newly identified. The proportion of variants in LRP5, FZD4, TSPAN12, NDP and KIF11 was 38.1% (8/21), 33.3% (7/21), 19.1% (4/21), 4.8% (1/21) and 4.8% (1/21), respectively. Three new variants were considered to be pathogenic or likely pathogenic. The FEVR group tended to exhibit a smaller retinal artery angle, higher incidence of foveal hypoplasia and lower vascular density compared to the control group. Patients who harboured variants of FZD4 exhibited greater severity of FEVR than those with LRP5 variants. However, those who harboured LRP5 variants tended to possess lower foveal vascular density. CONCLUSIONS: Six known pathogenic genes were screened in 33 pedigrees with FEVR in our study, which revealed 10 novel variants. These findings enrich the clinical features and mutation spectrum in Chinese patients with FEVR, revealing the genotype-phenotype relationship, and contributing to the diagnosis and treatment of the disease.Key messagesWe identified 21 variants in 5 genes (LRP5, FZD4, TSPAN12, NDP and KIF11) associated with FEVR, 10 of which are novel (three were pathogenic or likely pathogenic).The proportion of variants was the highest for the LRP5 gene.FZD4 variants may be responsible for greater FEVR severity than LRP5 variants.

Association between inflammatory cytokines in the aqueous humor and hyperreflective foci on optical coherence tomography in patients with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Purpose: To investigate the associations between cytokine levels in the aqueous humor (AH) and hyperreflective foci (HF) on spectral-domain optical coherence tomography (SD-OCT) in neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). Methods: The prospective study included 63 eyes with nAMD, 44 with PCV, and 43 with cataracts (Controls). AH samples were obtained before anti-vascular endothelial growth factor (VEGF) therapy or cataract surgery. Cytokines interleukin 6 (IL-6), IL-8, IL-10, interferon-inducible protein 10 (IP-10), monocyte chemotactic protein 1 (MCP-1), and VEGF were measured by multiplex bead assay. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of HF were evaluated at baseline and 1 month after anti-VEGF treatment. Results: No significances difference in IL-6 and IL-8 levels were noted among the three groups (P = 0.370 and P = 0.067). VEGF, IP-10, and IL-10 levels were significantly higher in nAMD and PCV groups than in Controls (all P < 0.05). In nAMD, HF was positively correlated with VEGF (r s = 0.300, P = 0.025) and in eyes with HF group, VEGF and IL-10 were significantly higher than those without HF (P = 0.008 and P = 0.022). In PCV, no correlation was observed between HF and cytokines (all P > 0.05). After anti-VEGF treatment, patients with HF in nAMD and PCV were predisposed to worse visual outcomes (P = 0.022 and P = 0.015) and a significantly greater reduction in CMT (P = 0.001 and P = 0.057). And nAMD patients with HF were more sensitive to anti-VEGF treatment than those without HF (P = 0.029). Conclusions: In the nAMD group, HF was positively correlated with VEGF. Patients in nAMD with HF had elevated levels of VEGF and IL-10 and responded favorably to anti-VEGF. HF might serve as an inflammatory biomarker and a predictive factor for therapeutic efficacy in patients with nAMD.