Neovascular glaucoma (NVG) is a dreadful pathology and it will be rapid spontaneous evolution responsible for eventual visual loss in many cases,with poor therapeutic efficiency.The main challenges in clinical practice for the management of NVG are as follows:(1) What is the goal of NVG treatment,to decrease intraocular pressure (IOP) or to reserve visual function? (2) How to create an optimal condition or timing for the treatment of primary disease? (3)What is exactly the key of NVG treatment? Anti-vascular endothelial growth factor (VEGF) medication,anti-glaucoma surgery or pan-retinal photocoagulation (PRP) for strict control of clinical situations potentially responsible for retinal ischemia ? (4)How to set up a comprehensive management strategy for NVG? In this paper,we established a comprehensive treatment strategy for NVG,including a core aim for preserving visual function,a goal of completing PRP and the main methods of anti-VEGF injection and anti-glaucoma surgery in order to preserve visual status of NVG patients as much as possible.

Multicenter randomized controlled studies can recruit more subjects in a relatively short period of time,avoiding the bias of single research institution studies,resulting in reliable conclusions and providing strong guidance to clinical practice.They are the most scientific and most reliable methods to evaluate clinical researches.However,there are few multicenter clinical trials in China as Chinese doctors are often trapped in difficulties in clinical research,including imperfect research system,lack of experience,capital investment deficient,the tension in the doctor-patient relationship and so on.Although the above problems are related to medical system architecture of our country in a certain extent,compared with the overseas,we also have our own advantages,such as resource of our patients,doctors,and diseases type.Pay attention to discovering of new type of diseases,looking for genetics discipline,and exploring new medical technology is an important task of clinical research.We have plenty of high level ophthalmology centers at present,which provide favorable conditions for launching multi-center clinical trial studies.We have good reasons to believe that,if we can effectively exploit the resources in our hands,carefully observe and discover clinical problems,there will be more convincing clinical results present in the world after bring up hypothesis boldly while prove it conscientiously and carefully.

The concept of treatment of central serous chorioretinopathy (CSC) has evolved dramatically with the understanding of its pathogenesis recently. Initial clinical studies found that CSC is a self-limiting disease, therefore advocated observation or conservative treatment was recommended. Further study by fundus fluorescein angiography indicated that CSC results from barrier dysfunction of retinal pigment epithelium (RPE), which leads to serous RPE and (or) neural retinal detachment; so laser photocoagulation to close RPE leakage points by its thermal effects became a strategy to treat CSC. Recent study by indocyanine green angiography revealed that increased choroidal vascular permeability can induce high hydrostatic pressure and focal RPE detachment, resulting in mechanical breakage of RPE barrier. This is likely the major pathological basis of CSC now. Photodynamic therapy (PDT) can embolize of choroidal capillary network, thereby preventing choroidal leakage caused by increased capillary permeability, and thus cure the CSC. However the search for the pathogenesis and better treatment of CSC is far from over.Further investigation about pathogenesis and improvement of diagnosis and treatment is an urgent need for clinic work, but also major issues challenging the wisdom of an ophthalmologist. We need to work together to promote more and better clinical and basic research of CSC.

Mefformin is the first-line oral medicine used to treat type 2 diabetes.Besides its glucose-lowering effect,Mefformin can inhibit the proliferation of cancer cells,especially colorectal cancer cells.In recent years,there is mounting evidence that mefformin could reduce the risk and mortality of colorectal cancer, and its mechanism includes activating AMP activated protein kinase pathway,interfering with cell cycle,redu-cing insulin resistance,inhibiting the inflammatory response and killing colorectal cancer stem cells,etc.

Objective To investigate the related factors of effects on distant visual acuity after photodynamic therapy (PDT) for choroidal neovascularization (CNV). Methods One hundred and thirty-five cases (135 eyes) of CNV treated with PDT were observed. The gender, preoperative distant and near visual acuity, disease course, pathogeny, area of CNV, types of CNV ascertained by fundus fluorescein angiography (FFA), and changes of CNV in FFA were recorded. Multi-factor regression analysis of visual acuity within 1 month and 3 months after PDT was performed with SPSS statistics software. Results The distant visual acuity within 1 month postoperatively was related to the preoperative distant visual acuity, the area of CNV and the changes in the FFA(P=0.000,0.030,0.062), and 3 months after PDT, it was related to the distant and near visual acuity preoperatively and the changes in the FFA(P=0.000,0.054,0.034). The condition of distant visual acuity within 1 month postoperatively was related to the FFA type of CNV and the disease course(P =0.018,0.08). Conclusion The smaller the area of CNV is, the better postoperative distant visual acuity would be. The proportion of improvement of visual acuity is relatively higher in patients with classic CNV. Early treatment for the patients with the indicatio may improve the visual acuity effectively.

Objective To compare the clinical results of photodynamic therapy(PDT) and transpupillary thermotherapy (TTT) for patients with choroidal neovascularization caused by exudative age-related macular degeneration. Methods Seventy cases (82 eyes) with exudative AMD were divided into PDT and TTT groups. Thirty-five cases (42 eyes) were treated with PDT. Nineteen eyes had occult or predominantly occult CNV. Twenty-three eyes had classic or predominantly classic CNV. Thirty-five cases (40 eyes) were treated with TTT. Twenty-five eyes had occult or predominantly occult CNV. Fifteen eyes had classic or predominantly classic CNV. Visual acuity, FFA, ICGA and OCT were evaluated before and after treatment. All cases were subfoveal or juxtafoveal CNV. The follow-up was (3-6 months.) Results Visual acuity in 3 eyes (15.8%) of PDT group and 1 eye (4.0%) in TTT group increased at least 2 lines. The difference was no significant(P=0.1778), FFA showed cessation or reduction of fluorescein leakage from CNV in 15 eyes(78.9%) in PDT group and 13 eyes(52.0%) in TTT group. The difference was not significant (P=0.0657). Three months after treatment, The visual acuity of 2 eyes(10.5%) in PDT group and 2 eyes (8.0%) in TTT group increased at least 2 lines. The difference was not significant (P=0.7728). FFA showed cessation or reduction of fluorescein leakage from CNV in 8 eyes(42.1%) in PDT group and 21 eyes(84.0%) in TTT group. The difference was significant (P=0.0037). Conclusion For classic CNV, the short-term effect of PDT is better than TTT concerning visual acuity. The effect of PDT is apparently better than TTT in cessation or reduction of fluorescein leakage one month after treatment. But there was no significant difference between PDT and TTT in cessation or reduction of fluorescein leakage three month after treatment. For occult CNV, there is no significant short-term difference between PDT and TTT concerning visual acuity. There was no significant difference between PDT and TTT in cessatin or reduction of fluorescein leakage one month after treatment. But three month after treatment TTT is apparently better than PDT in cessation or reduction of fluorescein leakage. We need more cases and longer follow -up to evaluate these two kinds of treatments in treating exudative age-related macular degeneration.

Objective To seek the evidence-based medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema. Methods All articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. Results In the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious side-effect in 4 eyes (1.35%). Conclusions Intravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.

Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ Ⅳ idiopathic full thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate,change of visual acuity,findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups ( P

Objective To investigate the manifestations of indocyanine green angiography (ICGA) of the choroidal neovascular membrane (CNV) and the relationship with histopathological changes in patients with age-related macular degeneration (AMD). Methods Twenty-one eyes of 21 patients with AMD diagnosed by ICGA were classified into three types based on ICGA findings: developing type in 9 eyes, degenerating type in 9, and stabilizing type in 3. CNV was extracted by vitrectomy and the histopathological characteristics of CNV was observed under the light and electron microscope. Results The histopathological characteristics of the specimens of developing type revealed abundant CNV partly enwrapped with non-pigmental cells and fibrous tissue or a few pigmental cells; degenerating type revealed reduced activation duration of CNV, many pigmental cells and a little fibrous tissue; stabilizing type revealed a mass of fibrous tissue,few CNV and nonexistence of pigmental cells. Conclusion The histopathological characteristics of exudative AMD may be related to the manifestations of ICGA.

Objective:To measure and analyze the corneal biological parameters of Tibetan junior middle school students who have lived in Mozhugongka County of Lhasa city for a long time.Methods:A cross-sectional study was performed.The basic information including gender, age and grade of 1 784 Tibetan junior high school students who have lived in Mozhugongka County of Lhasa city for a long time was collected, and the corneal biological parameters were measured in May, 2020.The available data of 690 students were obtained in this study.Unilateral eye of each subject was randomly selected for statistical analysis using computer random number method.Three hundred and forty-five right eyes and 345 left eyes from 366 males and 324 females were included.There were 461 eyes from students aged 12 to 15 years, and 229 eyes from students aged 16 to 20 years.Sirius 3D corneal topography and anterior segment analysis system were used to measure the thinnest corneal thickness (TCT), central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal corneal angle, simulated K1 and simulated K2, thinnest point position.Histogram and Q-Q chart were used to assess the distribution of continuous variables except the thinnest point position of cornea.The differences in biological parameters were compared between males and females, 12-15 years group and 16-20 years group as well as right eyes and left eyes.The literature of corneal biological parameters from other ethnic group was reviewed and compared with the Tibetan subjects.This study complied with the Declaration of Helsinki and was approved by an Ethics Committee of Tibet Hospital (No.QZYY2019-IRBPJ-21).Results:The ACD of the right eye of the students was (3.31±0.27)mm, which was significantly greater than (3.26±0.26)mm of the left eye ( t=0.745, P=0.012). Mean TCT, CCT, iridocorneal angle, simulated K1 and simulated K2 were (504.99±30.73)μm, (509.10±35.82)μm, (47.45±5.70)°, (43.15±1.89)D, and (44.16±2.29)D of the right eye, and thoes of the left eyes were (503.34±29.22)μm, (508.36±28.75)μm, (47.86±5.88)°, (43.06±1.40)D and (44.16±1.53)D, respectively, with no significant differences between the right and left eyes (all at P>0.05). The ACD and iridocorneal angle were significantly greater, and the simulated K1 and simulated K2 were significantly smaller in males compared with females (all at P<0.05). There were no significant differences in TCT and CCT between males and females (both at P>0.05). The corneal biological parameters were not signficantly different between different age groups (all at P>0.05). The thinnest point of cornea distributed mainly at inferior temporal quadrant zone for the right eyes, and superior temporal quadrant zone for the left eyes. Conclusions:Corneal biological parameters of Tibetan junior high school students in high altitude areas might be different from those of other ethnic students.Ophthalmologists should pay attention to this population in diagnosis and treatment of corneal diseases and refractive error.