Phenotypic heterogeneity in family members of patients with retinitis pigmentosa

Purpose: To describe the phenotypic variations in family members of patients with retinitis pigmentosa (RP) with different modes of inheritance and to assess the ocular abnormalities in RP families. Methods: A descriptive analysis of three types of inheritance of RP was carried out, where 64 family members were examined at a tertiary eye care center, South India. They underwent comprehensive eye examination, fundus photography, fundus autofluorescence (FAF), full?field electroretinogram (FFERG), and spectral domain optical coherence tomography (SD?OCT). Analysis was performed between mild and severe forms of abnormalities to delineate retinal structural and functional defects in RP families. Results: The mean age was 38.55 ± 17.95 years. Males were 48.4%. In autosomal recessive and X?linked recessive groups, 74.2% and 77.3%, respectively, were asymptomatic, whereas in autosomal dominant group, 27.3% were asymptomatic. The proportion of the cases with abnormalities in all three groups was higher on ERG (59.6%), followed by OCT (57.5%), visual acuity (43.7%), peripheral FAF (23.5%), and macular FAF (11.8%). However, these abnormalities and the clinical pictures of the family members had no statistical difference across the three groups of inheritance. Conclusion: Structural and functional retinal alterations were noted in four out of five asymptomatic members, suggesting the need for careful screening of RP families and the pressing need for pre?test (genetic) counseling

Retinopatía asociada a melanoma. Reporte de caso y revisión de literatura / Melanoma associated retinopathy. Case report and literature review

Introducción: La retinopatía asociada a melanoma (RAM) es un desafío para el equipo tratante de pacientes oncológicos debido a la inespecificidad del cuadro clínico y a la dificultad de realizar exámenes que ofrezcan un diagnóstico. Métodos: Paciente 55 años, sexo femenino con diagnóstico de melanoma, consulta por escotoma central asociado a síntomas visuales positivos. Resultados: Examen oftalmológico dentro de rangos normales. Electrorretinograma (ERG) estándar muestra respuesta máxima electronegativa en ambos ojos, sugerente de RAM. Discusión: El reconocimiento temprano de RAM mediante ERG tiene importancia diagnóstica, permitiendo iniciar tratamiento temprano y reducir el riesgo irreversible de daño a la retina.

Introduction: Melanoma-associated retinopathy (MAR) is a challenge for the oncology team due to the non-specific clinical presentation and the associated difficulty of performing indicative tests for diagnosis. Methods: A 55-year-old female patient initially diagnosed with melanoma consults due to vision with central scotoma associated with positive visual symptoms. Results: Ophthalmological examination within normal ranges. Standard electroretinogram (ERG) shows the maximum electronegative response in both eyes, suggesting MAR. Discussion: The early recognition of MAR by ERG has diagnostic importance because it would allow a possible early treatment and could reduce the risk of irreversible retina damage.

Changes of photopic negative response of multifocal electroretinogram after treatment with Aflibercept in patients with diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the changes of photopic negative response(PhNR)of multifocal electroretinogram(mf-ERG)in patients with diabetic macular edema(DME)before and after treatment with Aflibercept.METHODS: A total of 37 patients(37 eyes)with DME who visited the Aier Eye Hospital of Wuhan University(Wuhan Aier Eye Hospital)from May 2019 to June 2022, and 0.05 mL of aflibercept was injected per month for consecutive 3mo were included in this retrospective cohort study. Another 20 cases(20 eyes)with normal physical examination to exclude related eye diseases were selected as the control group. The PhNR amplitude of mf-ERG, best-corrected visual acuity(BCVA; LogMAR), central retinal thickness(CRT), capillary plexus in macular area and vessel density(CPVD)of the participants between the two groups were compared before and after treatment.RESULTS: The PhNR amplitude of mf-ERG in DME patients before treatment(201.69±80.92nV)was significantly lower than that in the normal control group(398.87±77.92nV; P<0.01), and the average PhNR amplitude of mf-ERG in DME patients at 6mo after treatment was significantly higher than that before treatment(P=0.036), but it was still significantly lower than the normal control group at 6mo after treatment(P=0.031). In addition, the BCVA(LogMAR)of DME patients increased from 0.64±1.33 to 0.37±1.39(P=0.021)at 6mo after treatment, and CPVD significantly increased compared to that before treatment(P=0.029). Meanwhile, the PhNR amplitude of mf-ERG in DME patients at 6mo after treatment was positively correlated with CPVD at 6mo after treatment(r=0.448, P=0.043), and negatively correlated with BCVA(LogMAR)and CRT(r=-0.647, P=0.011; r=-0.337, P=0.032).CONCLUSION: The PhNR amplitude of mf-ERG in DME patients increased significantly after receiving aflibercept, and it can be used to observe and evaluate the functional changes of retinal ganglion cells in DME patients.

Distinction and processing of common artifact in clinical visual electrophysiology / 中华实验眼科杂志

Objective:To explore the common causes and solutions for artifacts in clinical visual electrophysiological examination.Methods:A cross-sectional study was performed.The clinical visual electrophysiological examination results of 25 001 cases were collected from 2012 to 2020 at the Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University). Artifacts were identified and analyzed according to the standard waveform provided by the International Society for Clinical Electrophysiology of Vision.The characteristics and causes of the artifact were analyzed.The solutions to reduce and eliminate the artifact were proposed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University) (No.KY2020053).Results:There were 60 typical artifacts identified among the 25 001 cases.Common causes of the artifacts were classified as three categories, the factors related to subjects, environment, or instruments.Among the 60 cases, 42(70.0%) were caused by tension in head and facial muscles of patients, 9(15.0%) due to blinking of patients, 4(6.7%) resulted from 50 Hz power frequency artifact, 2(3.3%) arisen from abnormal amplifier, and 3(5.0%) for other reasons.The strategies to avoid artifact were as follows.First, examiners could inform patients of the examination process in advance to help patients to relax and avoid the influencing factors, such as muscle tension in head and face, blinking, inattention and so on; second, high-quality 50 Hz hardware wave trap was recommended to reduce 50 Hz artifact, with good ground connection and removing of the high-power electrical appliances near the visual electrophysiological instrument; third, clean the skin sufficiently to reduce the reference electrode impedance to less than 1 kΩ.Conclusions:There is a variety of artifact waveforms and causes.The technicians should make correct judgments and handle the artifact in time to provide more accurate examination results.The doctors should know about artifact, which is helpful for better interpretation of visual electrophysiological examination reports.

Progress in imaging and functional assessment of myopic fundus tessellation changes / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia has become a serious global burden of visual impairment and blindness, and the World Health Organization has included the prevention and treatment of myopia in its global blindness prevention program. Many ocular pathological alterations that follow from advanced myopia could cause visual impairment and even blindness in severe situations. Myopia is becoming more prevalent and has a greater impact on young people. Myopia's social repercussions are becoming more widely known. One of the several fundus alterations linked to myopia is tessellated fundus, which is the earliest lesion in the natural course of myopic fundus lesions and an important clinical marker for the development of retinopathy. Currently, there are several different methods of grading fundus tessellation, all of which are graded subjectively by fundus color photography. One can investigate the morphological characteristics and functional status of the tessellated fundus with ophthalmoscope, fundus photography, optical coherence tomography, electroretinogram, microperimetry and other modal images. In this study, the imaging properties and common applications of the tessellated fundus are reviewed to provide appropriate resources for clinical ophthalmology.

Electroretinogram changes in patients and carriers with Leber hereditary optic neuropathy / 中华眼底病杂志

Objective:To observe the characteristics of pattern electroretinogram (PERG) and the photopic negative response (PhNR) of flash electroretinogram (FERG) in patients and carriers with Leber hereditary optic neuropathy (LHON).Methods:A cross sectional, observational study. Thirty-two patients (64 eyes) diagnosed with LHON (LHON group) and 15 normal members with the same mutation in patient's family (carrier group) were included in this study from February 2021 to November 2021 in the Department of Ophthalmology of Renmin Hospital of Wuhan University. All patients in LHON group were males (100.0%, 32/32) and the average age was 23.34±7.41 years. In the carrier group of 15 cases (30 eyes), there were 2 males (13.3%, 2/15) and 13 females (86.7%, 12/15). The average age was 43.44±7.65 years. Twenty-four healthy subjects (48 eyes) in the same period were selected as the control group. Among them, there were 8 males (33.3%, 8/24) and 16 females (66.7%, 16/24). The average age was 23.42±2.54 years. All subjects were examined with the GT-2008V-VI visual electrophysiology instrument of Chongqing Gotec Medical Equipment Limited Company for PERG and FERG. P50 and N95 amplitudes of PERG and PhNR, a wave and b wave amplitudes of FERG were recorded. The peripapillary retinal nerve fiber layer (pRNFL) thicknesses of the nasal, superior, temporal, inferior and average quadrants were measured by spectral domain optical coherence tomography (SD-OCT). The amplitudes of a wave, b wave, PhNR, P50 wave, N95 wave and pRNFL thickness between the three groups were compared by one-way ANOVA. Pearson correlation analysis was used to analyze the correlation between different parameters.Results:Compared with the control group, the amplitudes of PhNR in LHON group and carrier group decreased significantly ( F=11.973, P<0.001). The results of correlation analysis showed that the amplitude of PhNR in LHON group was significantly correlated with the thickness of nasal and temporal pRNFL ( r=0.249, 0.272; P=0.048, 0.030). There was no significant difference in P50 wave amplitude between patients, carriers and controls ( F=1.342, P=0.265). There was no significant difference in N95 wave amplitude between patients and controls ( P=0.960). Conclusion:The PhNR amplitudes of FERG in LHON patients and carriers decrease significantly compared to controls.

Protective effect of tert-butylhydroquinone on retinal morphology and function in early diabetic rats and its mechanism / 中华实验眼科杂志

Objective:To investigate the protective effects of an antioxidant tert-butylhydroquinone (tBHQ) on the morphology and function of retina in early-stage experimental diabetic rats, and to explore the mechanism of its protective effect.Methods:Forty-five healthy SD rats of clean degree were randomized into normal control group, diabetes model group and tBHQ intervention group, with 15 rats in each group according to a random number table.The diabetes model was established via a single intraperitoneal injection of streptozotocin (STZ) in diabetes model group and tBHQ intervention group.Normal control group was intraperitoneally administered with an equal-volume injection of sodium citrate buffer.Rats in the tBHQ intervention group maintained a diet with 1% tBHQ for 2 weeks before the STZ injection, and the other two groups were fed with normal rat food only.Blood from tail vein was collected to assay the blood glucose level at 72 hours, 2 weeks and 4 weeks following modeling.Rat electroretinogram (ERG) was detected at 4 weeks after modeling.Morphological changes of rat retina were observed by hematoxylin and eosin staining.The apoptosis of retinal cells in different layers was detected by TUNEL assay.The expression of protein kinase B (Akt), p-Akt, endothelial nitric oxide synthase (eNOS) and p-eNOS was detected by Western blot.Müller cell line rMC-1 cells cultured in vitro were divided into 5 groups, including normal control group (72-hour culturing in normal medium), mannitol control group (72-hour culturing in medium containing 5.5 mmol/L glucose and 24.5 mmol/L mannitol), high glucose group (72-hour culturing in high-glucose medium), tBHQ intervention group (24-hour culturing in normal-glucose medium containing 5 μmol/L tBHQ, 72-hour culturing in high-glucose medium containing 5 μmol/L tBHQ), and phosphoinositide 3-kinase (PI3K) inhibitor group (6-hour culturing in normal medium containing 5 μmol/L LY294002, 24-hour culturing in normal-glucose medium containing 5 μmol/L LY294002 and 5 μmol/L tBHQ, 72-hour culturing in high-glucose medium containing 5 μmol/L LY294002 and 5 μmol/L tBHQ). The expression of Akt, p-Akt, eNOS and p-eNOS in the cells was detected by western blot.The use and care of animals complied with Regulations for the Administration of Laboratory Animals in Southwest Medical University.The study protocol was approved by the Animal Ethics Committee of Southwest Medical University (No.201711189). Results:The blood glucose level at 72 hours, 2 weeks and 4 weeks after modeling was higher in diabetic model group than tBHQ intervention group and normal control group (all at P<0.01). Four weeks after modeling, the scotopic ERG a-wave and b-wave amplitudes of diabetic model group were lower than those of normal control group and tBHQ intervention group (all at P<0.05). With edema and thickening of inner plexiform layer, thinning of inner nuclear layer and outer nuclear layer, as well as loosely arrangement and disorder of retinal layers, the number of retinal ganglion cells was decreased in diabetic model group in comparison with normal control group, all of which were improved in tBHQ intervention group in comparison with diabetic model group.There were more apoptotic retinal cells in diabetic model group than normal control group and tBHQ intervention group (both at P<0.05), which mainly existed in the outer nuclear layer.The relative expressions of p-Akt/Akt and p-eNOS/eNOS in rat retina of normal control group, diabetic model group and tBHQ intervention group were 0.76±0.11 and 0.83±0.06, 0.52±0.10 and 0.52±0.08, 1.14±0.31 and 1.03±0.13, respectively.The relative expressions of p-Akt/Akt and p-eNOS/eNOS in diabetic model group were lower than those of normal control group and tBHQ intervention group (all at P<0.01). The relative expressions of p-Akt/Akt and p-eNOS/eNOS in normal glucose group, mannitol control group, high glucose group, tBHQ intervention group and PI3K inhibitor group were 0.95±0.38 and 0.86±0.11, 0.94±0.27 and 0.74±0.29, 0.33±0.25 and 0.45±0.29, 1.32±0.37 and 1.28±0.22, 0.24±0.09 and 0.73±0.29, respectively.The relative expressions of p-Akt/Akt and p-eNOS/eNOS were significantly lower in high glucose group than those in normal glucose group and tBHQ intervention group (all at P<0.05), which were significantly lower in PI3K inhibitor group compared with tBHQ intervention group (both at P<0.01). Conclusions:tBHQ has protective effects on the morphology and function of retina in early diabetic rats, and the mechanism may be related to the activation of Akt/eNOS signaling pathway.

Multifocal electroretinogram manifestation of strabismic amblyopia with eccentric central fixation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the characteristic changes of multifocal electroretinogram(mfERG)in strabismic amblyopia eyes with eccentric fixation.<p>METHODS: A total of 20 patients with strabismus amblyopia and eccentric fixation visited our hospital from January 2018 to December 2020 were collected as the study group(4 patients with exotropia and 16 patients with esotropia), while 20 patients with ametropic amblyopia were collected as the control group. The mfERG was examined under the state of mydriasis, and the amplitude density and incubation period of P1 wave were recorded.<p>RESULTS: Compared with the fellow eyes, the first ring(<i>P</i>=0.001), the second ring(<i>P</i><0.001), the third ring(<i>P</i>=0.001), the fourth ring(<i>P</i>=0.009)and the fifth ring(<i>P</i>=0.026)of strabismus amblyopia eyes were reduced significantly. Compared with the control group, the first ring(<i>P</i>=0.033), the second ring(<i>P</i>=0.002), the third ring(<i>P</i><0.001)and the fourth ring(<i>P</i>=0.014)of strabismus amblyopia eyes were reduced significantly. The incubation period of amblyopia eyes in the strabismus group showed significantly shortened in the first ring(<i>P</i>=0.017)and the second ring(<i>P</i>=0.001)compared with the fellow eyes, and in the second ring(<i>P</i>=0.007)compared with the control group.<p>CONCLUSION: The amplitude density of mfERG P1 wave in strabismic amblyopia eyes with eccentric fixation reduced more with the closer to macular fovea, and reduced more significantly than that in the ametropic amblyopia eyes.

Generation and characterization of Cyp4v3 gene knockout mice / 北京大学学报(医学版)

OBJECTIVE@#Bietti crystalline dystrophy (BCD) is a rare degenerative eye disease caused by mutations in the CYP4V2 gene, and Cyp4v3 is the murine ortholog to CYP4V2. To better understand the molecular pathogenesis of this disease and to explore the potential treatment we have established a Cyp4v3 knock-out mouse model.@*METHODS@#Cyp4v3-/- mice were generated by clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 in embryonic stem cells of C57BL/6J mice. Ocular morphologic characteristics were evaluated via fundus imaging, histologic analysis of rods and cones via immunofluorescence, and phalloidin stain to observe retinal pigment epithelium (RPE) in whole-mounts, electroretinogram (ERG) was also conducted to examine the retinal function.@*RESULTS@#The characteristic features of BCD recurred in the Cyp4v3-/- mice, including retinal crystalline deposits, atrophy and degeneration of RPE cells, and ERG amplitude decline of dark and light adapted a- and b- wave; however, the immunofluorescence stain of rod and cone cells did not show obvious differences when compared with the wild type (WT) mice. In the early stage of the disease, no crystal-like deposits were found in the fundus, ERG detection of the retinal function did not find a significant decline, and the morphological structure and quantity of the neural retina and RPE did not change significantly. Crystalline deposits occurred and converged when the Cyp4v3-/- mice at the end of 6 months, and the deposits disappeared when the Cyp4v3-/- mice at the end of 12 months. The ERG amplitude started to decline when the Cyp4v3-/- mice at the end of 6 months and deteriorated at the end of 12 months. The RPE cells of the 12-month old Cyp4v3-/- mice showed irregular shape by phalloidin staining of F-actin. The Cyp4v3-/- mice behaved normally and were viable and fertile when maintained under specific pathogen-free (SPF) housing conditions.@*CONCLUSION@#Just like BCD patients, the disease progress of Cyp4v3-/- mouse is correlated with the age, which provides a good model for pathogenesis and gene therapy study in the future. The atrophy and degeneration of RPE take the lead in progressing of the disease, but the mechanism is not clear yet.

Monitoring methods of chloroquine induced retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Hydroxychloroquine and chloroquine play more and more important roles in the treatment of rheumatism, skin diseases and autoimmune diseases. Irreversible macular diseases,retinopathy and even permanent blindness are common side effects of them. High dose per kilogram of body weight, duration of treatment, presence or absence of keratosis and renal or liver dysfunction are all related to this. Therefore, the examination of the two kinds of drug lesions is also relatively complicated. FAF and SD-OCT are required for wide field examination. For patients with complicated retinopathy, multifocal electroretinogram and the like are also required for diagnosis. The specific examination methods need to be determined by clinical ophthalmologists according to the patient's medication and preliminary examination.

Evaluation of the effects of Hydroxychloroquine on macular central visual function by multifocal electroretinogram / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To use multifocal electroretinogram(MFERG)to evaluate patients' functional changes of the cone system in the macular center of the retina after taking hydroxychloroquine.<p>METHODS:Retrospective study. Totally 264 eyes of 132 patients with rheumatoid arthritis examined in the Ophthalmology Department of the First Medical Center of the PLA General Hospital from January 2017 to November 2019 were included in the analysis. According to the length of medication period, patients were divided into 6 groups: 38 cases 76 eyes in group A did not take hydroxychloroquine, 38 cases 76 eyes in group B took hydroxychloroquine for 1a, 17 cases 34 eyes in group C took hydroxychloroquine for 2a, 18 cases 36 eyes in group D took hydroxychloroquine for 3a, 13 cases 26 eyes in group E took hydroxychloroquine for 5a, and 8 cases 16 eyes in group F took hydroxychloroquine for 5a or more and stopped for 3a. The changes of the best corrected visual acuity(BCVA)and the P1 wave amplitude density value of the first ring retinal response area in the central MFERG were compared among groups.<p>RESULTS:There was no significant difference in BCVA among groups A to F(<i>F</i>=1.287, <i>P</i>=0.270), BCVA in A-F groups were(0.11±0.11, 0.11±0.10, 0.13±0.10, 0.15±0.10, 0.15±0.11, 0.14±0.10 LogMAR),but the amplitude density of P1 wave in group A(122.68±1.87nV/deg2)was significantly higher than other groups(115.76±1.71, 113.38±1.51, 109.10±2.52, 94.61±0.78, 94.02±0.91nV/deg2, all <i>P</i><0.05). <p>CONCLUSION:After long-term administration of hydroxychloroquine, even if the central visual acuity does not change, the results of MFERG examination show that the function of the central cone system of the macular retinal system will decrease with the prolonged administration time, and the visual function cannot recover after stopping taking hydroxychloroquine.

Imaging of Muller cell sheen dystrophy

To report a rare case of Muller cell sheen dystrophy and to describe its clinical and diagnostic aspects. A 42-year-old woman presented with unilateral defective vision. Fundus evaluation revealed bilateral glistening retinal reflexes throughout the posterior pole with a wrinkled appearance in the right. Spectral Domain-OCT in the right showed abnormal internal limiting membrane, intraretinal schisis with serous detachment at macula. Angiography revealed staining along vessels. Electroretinogram in the affected eye was negative. At 4 months of follow up, vision dropped and intraretinal schisis increased. Family screening was negative.

Distrofia macular oculta / Occult macular dystrophy

Resumo Apresentamos um caso de distrofia macular oculta bilateral, em paciente de 70 anos com queixa de baixa acuidade visual progressiva, sem achados fundoscópicos ou angiográficos justificáveis. Foram realizados exames de imagem do sistema nervoso central que afastaram lesões expansivas e testes eletrofisiológicos que sugeriram diagnóstico.

Abstract We report a case of bilateral occult macular dystrophy in a 70-year-old woman with progressive low visual acuity, without justifiable fundoscopic or angiographic findings. Imaging tests were done to excluding expansive lesions and electrophysiological tests that suggested the diagnosis.

Impact of simulated microgravity on flash electroretinogram and retinal microcirculation in adult mice / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe changes in the flash electroretinogram(ERG)and retinal microcirculation in mice suspended by their tails, an animal model that simulates cephalad movement of bodily fluids under conditions of microgravity.<p>METHODS: Thirty-six adult male C57BL/6J mice(36 eyes)were randomly divided into three experimental groups and three control groups. Mice in the experimental groups were tail-suspended for 15d(Group one), tail-suspended for 30d(Group two), or tail-suspended followed by returning to normal position for 30d(Group three). Three control groups were similarly fixed with a harness but kept in the normal position for corresponding periods of 15, 30, and 60d. The mice were immediately examined using scotopic ERG(including oscillatory potentials \〖OPs\〗)and fundus fluorescein angiography(FFA)<i>in vivo</i>, and subsequently sacrificed to analyze the retinal histology(methods including immunohistochemistry and TUNEL staining)<i>in vitro</i>. Independent sample <i>t</i>-test was used for data comparison between the same time-point groups.<p>RESULTS: Following 15-days' tail-suspension, scotopic ERG showed a decline in OPs, but not in the b-wave; the second OP(O2)showed an amplitude of 197±33μV, which was about 60% of the control level(<i>t</i>=-5.938, <i>P</i><0.001). Following 30-days' tail-suspension, ERG recovered, with O2 showing an average value of 264±39μV; when compared to the corresponding control group(308±41μV), no significant difference was observed(<i>t</i>=-1.887, <i>P</i>>0.05). Morphologically, only the 15-days' tail-suspended mice showed FFA with microvascular dilation and tortuosity. Rhodopsin and cone-opsin were almost normal and no apoptotic-positive signals were detected in the retinas of the three tail-suspended groups.<p>CONCLUSION: Simulating cephalad shifting of bodily fluids as under microgravity, using short-term tail-suspension can affect rodent ERG and retinal microcirculation; however, the change is reversible with no obvious permanent injury observed in the retinas.

Progress in the application of multifocal electroretinogram in retinal diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Multifocal electroretinogram(mf-ERG)is a common type of electroretinogram. It can objectively, accurately and quantitatively detect the function of each tiny part of the retina, so it is widely used in clinical, especially in retinal diseases. It not only plays an important role in the diagnosis and efficacy evaluation of retinal diseases, but also has an important value in the follow-up and prevention of diseases, even the scope of its application can be extended to basic research. Therefore, this paper reviews the application of multifocal electroretinogram in retinal diseases.

Analysis on the clinical effect and visual acuity prognostic factors of BRVO-ME treated with Ranibizumab / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the functional and structural changes of foveal macula after intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion(BRVO-ME)and screen the factors that can predict the final visual acuity of the patients. <p>METHODS: Prospective, clinical study. In this prospective single-arm study, we observed 25 patients(25 eyes)diagnosed with BRVO-ME who were enrolled from 2018.6-2019.5 in the first central hospital of Baoding. All patients received monthly ranibizumab 0.5mg injections for 3 consecutive months. The best-corrected visual acuity(BCVA),the central macular thickness(CMT)and the vessel perfusion density(VPD), vessel length density(VLD)and fovea avascular zone(FAZ)of superficial capillary plexus(SCP)were evaluated detected by optical coherence tomography(OCT and OCTA)before and 1mo after the third injection. Mf-ERG was used to analyze the amplitude density of P1 wave and latency of P1, N1 wave from ring 1 and ring 2. <p>RESULTS: After treatment, BCVA(LogMAR)was improved significantly compared with that before(0.323±0.086 <i>vs</i> 0.773±0.304, <i>P</i><0.05). CMT was lower than before(239.385±33.175μm <i>vs</i> 489.346±137.453μm, <i>P</i><0.05), but there was no significant change in FAZ, VPD and VLD of SCP within 6mm×6mm of macular area before and after treatment(<i>P</i>>0.05). The latency of P1, N1 wave of ring 1 and ring 2 were significantly decresed from baseline, while the amplitude density of P1 wave was increased(<i>P</i><0.05). Pearson correlation analysis shows that age, baseline BCVA, VLD, VPD, FAZ were significantly correlated with changes in visual acuity before and after treatment(<i>P</i><0.05).<p>CONCLUSION: In patients with BRVO-ME, ranibizumab therapy can reduce CMT, improve BCVA and improve the structure and function of macular area. Age, BCVA before treatment and microstructure parameters of macular area can be used as predictors of vision improvement.

Functional and morphological evaluation of autologous retinal graft in large traumatic macular hole

A 7-year-old boy presented with history of blunt trauma 1 month back. Best corrected visual acuity (BCVA) was 20/200 with optical coherence tomography (OCT) showing a large macular hole. Spontaneous closure of the macular hole seemed unlikely following a month of observation. Pars plana vitrectomy along with autologous retinal graft was performed. At subsequent follow up, hole appeared closed with nasal shrinkage of graft and BCVA improved to 20/100. OCT showed mechanical integration of the graft with adjoining retina. Autologous retinal graft is a feasible option in cases where conventional internal limiting membrane peeling shows lower anatomical success.

Postoperative efficacy and influencing factors of patients with severe proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy and influencing factors of patients with proliferative diabetic retinopathy(PDR)after vitrectomy.<p>METHODS: Totally 94 patients(112 eyes)with stage VI of PDR in our hospital from January 2015 to January 2018 divided into maculopathy group(<i>n</i>=61 cases, 70 eyes)and non-maculopathy group(<i>n</i>=33 cases, 42 eyes)according to the OCT. The visual acuity, P1 wave amplitude density and retinal reattachment in macular area were compared between the two at 6mo of follow-up. Postoperative efficacy and influencing factors of stage VI of PDR were analyzed by taking vision improvement as a standard of efficacy evaluation.<p>RESULTS: The visual acuity grading in maculopathy group at 6mo after operation was better than that in non-maculopathy group(<i>P</i><0.05). The P1 wave amplitude density in the(1+2)ring in maculopathy group was lower than that in non-maculopathy group(<i>P</i><0.05). Among patients, there were 95 eyes(84.8%)of one-time retinal anatomical reduction, 10 eyes(8.9%)of twice reduction, 2 eyes(1.8%)of 3 times reduction, 1 eye(0.9%)of 4 times reduction and 4 eyes(3.6%)without reduction, and the total reduction rate was 96.4%. The effective rate in patients with maculopathy and patients with long course of diabetes mellitus was lower than that in patients without maculopathy and patients with short course of diabetes mellitus(<i>P</i><0.05), and maculopathy and diabetes duration were independent factors affecting the postoperative efficacy of patients with severe proliferative diabetic retinopathy(<i>P</i><0.05).<p>CONCLUSION: Vitrectomy can improve postoperative visual acuity of patients with stage VI of PDR, and preoperative combination of significant maculopathy and course of diabetes mellitus are important factors affecting postoperative efficacy in patients with severe PDR.

Retinal neuroprotective effect of GLP-1 analogs liraglutide in early diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study glucagon-like peptide-1(GLP-1)analogues(liraglutide)in patients with mild to moderate nonproliferative diabetic retinopathy(NPDR)and the clinical efficacy of retinal neuroprotection.<p>METHODS: Sixty patients with type 2 diabetes mellitus with mild or moderate NPDR were treated in our department of endocrinology. They were randomly divided into two groups. Patients in the experimental group used metformin, insulin combined with liraglutide to regulate blood glucose, while the control group used metformin, insulin for hypoglycemia. Comparing the two groups of patients before and after the treatment, including HbA1c and pattern visual evoked potential(P-VEP)P100 amplitude and P100 latency, full field electroretinogram(F-ERG)oscillatory potentials(Ops)total amplitude, and light and dark adaptation 3.0 the amplitude of the a-, b-wave varies.<p>RESULTS: After 6mo treatment, the total amplitude of Ops in the experimental and control groups increased compared with that before treatment. The difference was statistically significant(all <i>P</i><0.01). And the total amplitude of Ops in the experimental group was higher than that of the control group, the difference was statistically significant(<i>P</i>=0.049). Meanwhile the b-wave amplitudes of the light and dark adaptation 3.0 in the experimental group were higher than those in the control group(<i>P</i>=0.001, <i>P</i>=0.014); however, there was no statistical significance in a-wave amplitude between the light and dark adaptation 3.0 in both groups after treatment(<i>P</i>=0.505, 0.441, 0.193, respectively). the b-wave amplitudes of the experimental group with dark and light adaptation 3.0 increased compared with that before treatment, and the difference was statistically significant(<i>P</i><0.01, <i>P</i>=0.019). The a-wave amplitude of light and dark adaptation in the experimental group increased compared with that before treatment, but the difference was not statistically significant(<i>P</i>=0.130, 0.147). <p>CONCLUSION: GLP-1 analogues can improve the function of retinal neurons in patients with mild to moderate NPDR to a certain extent, and have a positive effect on the prognosis of DR.