Objective To observe the efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH).Methods Retrospective case review.Twenty-eight eyes of 28 patients with LMH were enrolled in this study.There were 2 males (2 eyes) and 26 females (26 eyes).Best corrected visual acuity (BCVA),medical optometry,slit-lamp biomicroscop,indirect ophthalmoscope,spectral domain optical coherence tomography,b-scan ultrasonography and axial length detection were performed on all patients.Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity.There were 10 eyes (35.7％) with degenerative type LMH (flap insertion group) and LHEP.There were 18 eyes (64.3％) with tractional type LMH (general group).The differences of BCVA,AL,horizontal hole diameter from retina and lens state between two groups were not significant (P＞ 0.05).The differences of horizontal hole diameter of internal limiting membrane (ILM),central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P＜ 0.05).LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group.Vitrectomy combined ILM peeling were used in eyes of general group.The follow-up was ranged from 3 to 14 months.The changes of CFT,central foveal form and logMAR BCVA were observed.Results At latest follow-up,the BCVA of flap insertion group and general group were 0.34±0.27,0.31±0.29;which significantly better than the preoperative BCVA (Z=-3.519,-4.945;P＜ 0.001).The CFT of flap insertion group and general group were (200.10±58.78),(226.61±70.49) μm.There was no difference between pre-and post-operative CFT in eyes of general group (Z=-1.455,P=0.146).There was significant difference between pre-and post-operative CFT in eyes of flap insertion group (Z=-2.798,P=0.005).In flap insertion group,regular recovery of the foveal contour occurred in 9 eyes (90.0％),improvement in 1 eyes (10.0％).In general group,regular recovery of the foveal contour occurred in 10 eyes (55.6％),improvement in 8 eyes (44.4％).The closure rate of LMH were 100％ both in two groups.Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.

·AIM: To study the effect of oxaliplatin on the survival rate of Y79 after down-regulation of Mcl-1 by SiRNA.·METHODS: Y79 cells were cultured in RPMI1640. The cultured cells were stimulated with 0. 25μmol/L of oxaliplatin. The expression of Mcl - 1 protein was detected by Western blot after 6, 16 and 24h respectively. Cells in logarithmic phase were collected and used for single-cell suspension. Then they were transfected with empty plasmid, Mcl-1-homo-991, Mcl-1-homo-1114 and Mcl - 1 - homo - 1235. After 6h, fluorescence microscope was used to observe the transfection efficiency and the optimal one was selected. The cells were divided into Group A and transfected with empty plasmids. The cells transfected with Mcl-1 were divided into Group B and Group C. Group A and Group C were treated with 0. 25μmol/L oxaliplatin for stimulating induction, and the apoptotic rate was compared after 24h.·RESULTS: The expression of Mcl-1 in Y79 stimulated by oxaliplatin was the most after 24h of culture. Mcl-1-homo-991 significantly inhibited the expression of Mcl-1 in Y79 after transfection. There was no significant difference in the apoptosis rate in Group A ( 11. 1% ± 1. 2%) and in the control group (6. 1%±0. 6%)(P>0. 05). The apoptotic rate of Group C ( 49. 2% ± 2. 7%) was significantly higher than that of Group B (20. 8%±1. 9%).At the same time, the apoptotic rates of these two groups were significantly higher than those of Group A and control group, the difference was statistically significant (P<0. 05).·CONCLUSION:Downregulation of Mcl-1 by siRNA can reduce the drug resistance of Y79, thereby enhancing the apoptosis of Y79, and reducing the survival rate of Y79.

Objective To observe the clinical efficacy and safety of ranibizumab injection combined with dexamethasone intravitreal implant in the treatment of macular edema secondary to retinal vein obstruction(RVO-ME).Methods The RVO-ME patients were divided into control and treatment groups.Control group received intravitreal ranibizumab injection 0.05 mL once a month for 3 consecutive times.Treatment group received the intravitreal ranibizumab injection 0.05 mL combined with intravitreal injection of dexamethasone intravitreal implant 0.7 mg.Two groups were given another intravitreal injection of ranibizumab as needed,if the macular edema did not fully subside or relapsed.Two groups were followed up for six months.The best-corrected visual acuity(BCVA),central macular thickness(CMT),macular vascular density(MVD)of superficial retinal vascular complex(SVC)and macular deep vascular complex(DVC),the area of foveal avascular area(FAZ),number of injections on-demand treatment and adverse drug reactions were compared between two groups.Results Twenty cases in the control group were included,and 16 cases in the treatment group were included.After 6 months of treatment,the BCVA of treatment and control groups were 0.58±0.16 and 0.47±0.19;CMT were(313.00±53.55)μm and(293±40.47)μm;SVC-MVD were(56.82±8.89)％and(53.18±8.17)％;SVC-FAZ were(0.58±0.16)and(0.47±0.19)mm2;DVC-FAZ were(0.29±0.07)and(0.31±0.08)mm2;and the differences were not statistically significant(all P＞0.05).After 6 months of treatment,the DVC-MVD of treatment and control groups were(52.68±6.72)％and(43.87±3.18)％;the number of injections on-demand treatment was 0.25±0.45 and 1.05±0.76,the differences were statistically significant(all P＜0.05).The adverse drug reactions in the treatment group were subconjunctival hemorrhage and increased intraocular pressure,and those in control group were subconjunctival hemorrhage.The total incidences of adverse drug reactions in treatment and control groups were 12.50％and 15.00％,without significant difference(P＞0.05).Conclusion The clinical efficacy of ranibizumab injection combined with dexamethasone intravitreal implant and ranibizumab injection alone in the treatment of the patients with RVO-ME was similar.However,the recovery of blood flow density in the retinal DVC layer after the former treatment is faster,which can obtain more lasting clinical efficacy,without increasing the incidence of adverse drug reactions.

Objective To evaluate the accuracy of corneal power mea-surements by a rotating scheimpflug camera ( Pentacam ) in eyes after myopic excimer laser surgery .Methods This prospective comparative interventional case series comprised 19 eyes of 15 patients who had myopic excimer laser surgery.Used Pentacam, clinical history method and IOL -Master measured keratometry reading .The median absolute error ( MedAE ) , the mean absolute error ( MAE ) and postoperative re-fractive error were compared among three methods.Results MedAE and MAE of Pentacam EKR method were significantly lower than those of clinical history and IOL -Master methods ( P <0.05 ) . Keratometry reading were significantly lower than that of IOL -Maste method (P<0.05).During the ±0.25 D, ±0.50 D, ±1.00 D range, eye number ratio of EKR method was significantly higher than that of IOL-Master method ( P<0.05 ). Conclusion Pentacam EKR can accurately measure the intraocular lens power .When historical refractive data are not available , scheimpflug imaging with the Pentacam provides an alternative method of measuring the central corneal power in eyes that previously received corneal refractive surgery.

Objective:To study the therapeutic effect of 1.8 mm micro incision prechop phacoemulsification (PE) in patients with nuclear cataract.Methods:The clinical data of 120 patients with nuclear cataract from June to December 2018 in Ningbo Medical Center Lihuili Hospital were retrospectively analyzed. Among them, 60 patients were treated with 1.8 mm micro incision prechop PE (prechop group), and 60 patients were treated with 1.8 mm micro incision PE (non-prechop group). The effective ultrasonic time and ultrasonic energy were recorded. The changes of optimum corrected vision, astigmatism degree and related indexes of corneal endothelial cells 1 d before operation and 1 d, 1 week, 1 month, 3 months, 6 months, 12 months after operation were compared between 2 groups.Results:The effective ultrasonic time and ultrasonic energy in prechop group were significantly lower than those in non-prechop group: (44.04 ± 8.93) s vs. (59.03 ± 9.98) s and (11.29 ± 1.08)% vs. (14.15 ± 1.16)%, and there were statistical differences ( t = 4.139 and 5.289, <0.05). No serious complications occurred in both groups. There was no statistical difference in optimum corrected vision 1d before operation and 1 d after operation between 2 groups ( P>0.05); the optimum corrected vision 1 week, 1 month, 3 months, 6 months, and 12 months after operation in prechop group was significantly better than that in non-prechop group, and there was statistical difference ( P<0.05). There was no statistical difference in astigmatism degree before and after operation ( P>0.05). The density of corneal endothelial cells and the proportion of hexagonal cells after operation in prechop group were significantly higher than those in non-prechop group, the area of corneal endothelial cells and variation coefficient were significantly lower than those in non-prechop group, and there were statistical differences ( P<0.05). Conclusions:The 1.8 mm micro incision prechop PE to treat nuclear cataract can effectively reduce astigmatism degree after operation and damage corneal endothelial cells in lower degree. And it is better to patients′ postoperative visual recovery.

Objective To investigate the application value of deep learning optical coherence tomography ( OCT) on wet age-related macular degeneration ( wAMD) assisted diagnosis. Methods Weakly supervised deep learning algorithms was applied on the premise that only disease or not can be provided as a marker. The OCT image automatically assisted in the diagnosis of diseased areas of wAMD,and thermograms were applied to provide a basis for doctors to detect disease areas. Based on the deep learning of weak supervision,a new network algorithm structure was proposed for detecting disease area in ophthalmic OCT images. At the same time, thermograms were adopted to improve the accuracy of the lesion map,which is the location of the lesion area. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Ningbo Eye Hospital ( No. 2018-YJ05 ) . Written informed consent was obtained from each subject before entering study cohort. Results Resnet-based deep learning algorithm gave a diagnostic accuracy rate of 94. 9％ for the disease, which was much higher than that of AlexNet 85. 3％,VGG 88. 7％, and Google-Net 89. 2％. The thermograms with different colors provided a more convenient auxiliary diagnosis basis for doctors. Conclusions Compared with the original classification network,which needs disease area markers as empirical knowledge, deep learning algorithm model not only provides better results in the classification of retinal diseases,but also marks potential disease areas. The lesion area provides a basis for judging the area of the lesion for the diagnosis of wAMD.