Objective To comparatively observe features of choroidal osteoma by multimodal fundus imaging methods.Methods This is a retrospective case study.Sixteen patients (16 eyes) with choroidal osteoma were enrolled in this study.The patients included 6 males (6 eyes) and 10 females (10 eyes),with an average age of (30.5±2.4) years.All patients received examination of best-corrected visual acuity,slit lamp microscope,indirect ophthalmoscopy,fundus color photography,fundus autofluorescence (AF),fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (SD-OCT).The tumors were classified as fresh lesion (clear boundary and rosy tumor with smooth surface) and obsolete lesions (pale and flat tumor with obvious patches).The tumor features of color fundus photography,AF,FFA and SD-OCT were comparatively observed.Results There were 5 fresh lesions and 11 obsolete lesions.Color fundus photography showed the tumor color was orange-red or yellow-white with clear boundary and retinal blood vessels on the surface of the tumor.The color of fresh lesion was rosy.In general,choroidal osteoma shown weak AF,however AF of fresh tumor was slightly stronger than the obsolete tumor,and retinal detachment region showed relatively stronger AF.FFA of fresh tumor indicated uniform intense fluorescence with clear boundary at late stage,much stronger than obsolete tumor.SD-OCT showed mesh-like reflected signal in the choroidal layer,but different from the surrounding choroidal vascular structures.Conclusions The tumor color is orange-red or yellow-white in color funds photography,which shown weak AF.FFA showed mottled hyperfluorescence in the early stage and tissue staining at the late stage.SD-OCT showed mesh-like reflected signal in the choroidal layer.

Dome-shaped macula (DSM) of high myopia has been described as an inward convexity or bulge of the macular within the concavity of the posterior staphyloma in highly myopic eyes,with the bulge height over than 50 μm,which can be observed by optical coherence tomography.There are three patterns of DSM,including the typical round dome,the horizontally oriented oval-shaped dome and the vertically oriented oval-shaped dome.The pathogenesis of DSM development remains unclear,several hypotheses have been suggested,such as localized choroidal thickening in the macular area,relatively localized thickness variation of the sclera under the macula,resistance to deformation of sclera staphyloma,ocular hypotony and tangential vitreoretinal traction.Vision-threatening macular complications of DSM including serous retinal detachment,choroidal neovascularization,foveoschisis and retinal pigment epithelial atrophy.Clinically,asymptomatic patients with DSM mainly take regular follow-up observation.Appears serous retinal detachment and significant visual impairment,treatment with half-dose photodynamic therapy,supplementary of laser photocoagulation or oral spironolactone may have a beneficial effect.However,more large clinical studies are required to confirm the exact efficacy of these treatments.

Hypertensive retinopathy (HR) often coexist with carotid lesions in hypertensive patients.Carotid lesions are closely associated with cardiovascular and cerebrovascular diseases,as well as end events,offering early important evidence to screening high risk patients.HR has significant value to predict target organ damage (TOD) of hypertension including carotid lesion.In addition,hypertensive retinopathy and carotid lesions-related ischemic ocular diseases will cause serious vision function damage.This article is going to summarize the value and correlation between hypertensive retinopathy and carotid lesions in terms of clinical manifestations,pathological physiological mechanism and target organ damage.

Optogenetics is a novel technique which combines optics with genetics.Using genetic means,a selected opsin protein is ectopically expressed in target neurons,which are then stimulated by light to moderate the neuronal circuit,as a consequence to regulate the animal's behaviors.Retinal degeneration like retinitis pigmentosa and aged macular degeneration causes visual impairment and eventual blindness.Optogenetics techniques have opened the door to creating artificial photoreceptors in the remaining retinal circuits of retinal degeneration retinas via gene therapy.However,there are still limitations in optogenetics technique,for example,potential risk in virus infection,the choice of target cells and the low visual resolution of the experiment animal.It has been reported that vision was successfully restored to a certain extent in animal model using optogenetics technique.With higher photosensitivity of opsin protein,longer activation kinetics and higher transfection efficiency of virus vector,optogenetics techniques' application in ophthalmology will be improved.

Usher syndrome (USH) is an autosomal recessive hereditary disease,characterized as retinitis pigmentosa and deafness.According to the severity of hearing loss,presence or absence of vestibular dysfunction,Usher syndrome is divided into 3 clinical subtypes..USH1,USH2 and USH3.Due to the genetically heterogeneous,it is important and valuable to find out the gene mutations in USH patients,which will be helpful to prenatal diagnosis,early intervention and gene therapy.Till now,the following 13 USH-related chromosomal loci were reported in the literature:USH1B,USH1C,USH1D (CDH23 gene),USH1F (PCDH15 gene),USH1G (SANS gene),USH1E,USH1H,USH1J and USH1K,USH2A,USH2C,USH2D and USH3 (CLRN1 gene).Ten out of all 13 loci have been located and identified.But more mechanisms should be further investigated,such as the relationship between the locus of gene mutations and clinical symptoms,how the modified protein structures and functions trigger clinical symptoms.

The abnormalities of retinal vessels such as retinal arteriolar narrowing,arteriovenous nicking,micro-aneurysms,retinal hemorrhages,and cotton wool spot are closely related to systemic diseases including hypertension,diabetes mellitus,cardiovascular disorders,stroke and renal diseases.The modern retinal vessels examination technology has features of quick noninvasive,quantitative standardized and intelligent analysis.Taking advantage of these to fully discover the retinal vascular abnormalities and get deeper understanding of the relationship between its' mechanism and systemic vascular diseases is not only helpful to better diagnose and treat retinal vascular diseases,but also contributes to predicting the risk and prognosis of systemic diseases.We suggest emphasizing on the study of correlation between retinal vascular abnormalities and systemic vascular diseases using modern retinal vessels examination technology.It will provide the preventive clue of diseases of circulatory system by finding out the retinopathy.Meanwhile,correctly treating systemic diseases would get a better prognosis of the retinopathy.They exist side by side and play a part together for providing a better prognosis,which would be a new direction for the doctors and scientists in the new era.

Objective To investigate the effects of intravitreous injection of conbercept for macular edema secondary to retinalvein occlusion(RVO) during 6 months period.Methods A retrospective clinical study.34 patients (34 eyes) were included in this study,who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography and other methods.The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart,and the results were converted to the logMAR visual acuity.The average logMAR BCVA was 0.90 ± 0.68,and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment.All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit.Injections were repeated based on the visual acuity changes and the OCT findings.34 eyes received 69 times of injection,the average number of injections was 2.03 ± 1.03.BCVA,OCT were examined before and after treatment using the same method.BCVA and CMT changes,drugs and treatments associated cardiac and cerebral vascular accident,intraocular pressure elevation,retinal tears,retinal detachment,endophthalmitis and other complications after treatment were observed.Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA,correlation between prognosis BCVA and baseline CMT,and also correlation between BCVA and CMT at different time points before and after treatment.Results At 1 week and 1,2,3,6 months after treatment,the average logMAR BCVA was 0.65±0.61,0.56±0.61,0.46±0.55,0.56±0.71,0.44±0.48 respectively.During 1,2,3,6 months after treatment,the mean logMAR BCVA were improved with statistically significant difference (Z=34.029,47.294,41.338,43.603;P＜0.05),while 1 week after treatment showed no obvious improvement (Z=21.941,P＞0.05).At 1 week and 1,2,3,6 months after treatment,the average CMT was (285.89 ± 96.69),(256.65 ± 143.39),(278.68 ± 156.92),(290.11 ± 188.17),(217.15 ± 48.04) μm respectively.At 1 week and 1,2,3,6 months after treatment,the mean CMT were all decreased with statistically significant difference (Z=68.500,98.735,93.235,91.132,109.162;P＜0.05).There was a positive correlation between the prognosis visual acuity and preoperative visual acuity (r=0.682,P＜0.05).However,there was no correlation between the prognosis vision and the degree of macular edema before treatment (r=0.078,P＞0.05).Before and 3,6 months after treatment,BCVA was negatively correlated with CMT (r=0.491,0.416,0.386;P＜0.05),while there was no correlation in other time points (r =0.145,0.217,0.177;P＞ 0.05).Systemic adverse reactions and persistent intraocular pressure elevation,iatrogenic cataract,retinal detachment,retinal tear,endophthalmitis and ocular complications were never found in the follow-up period.Conclusion Intravitreal conbercept is a safe and effective approach for RVO,which can significantly improve visual acuity and reduce CMT.

Objective To observe the contrast sensitivity (CS) of patients with branch retinal vein occlusion (BRVO) without involving the macular region.Methods 92 BRVO patients (93 eyes) and 56 cases (112 eyes) without eye diseases (control group) were included in the study.According to different region,BRVO patients were divided into the nasal BRVO group (31 eyes) and temporal BRVO (62 eyes) group,and the average corrected visual acuity was 1.02 ± 0.13 and 0.98 ± 0.12 respectively.According to the type of ischemia,BRVO patients were divided into the nonischemic BRVO group (58 eyes) and ischemic BRVO group (35 eyes),the average corrected visual acuity was 1.01 ± 0.14 and 0.99 ± 0.12 respectively.The average corrected visual acuity of the control group was 1.03 ± 0.11.There was no statistically significant difference of the average corrected visual acuity between nasal BRVO group,temporal BRVO group and control group (F=3.03,P =0.06),and between nonischemic BRVO group,ischemic BRVO group and control group (F=1.60,P=0.20).Contrast sensitivity (CS) was measured by OPTEC 6500 vision tester (Stereo Company,USA) under the standard lighting conditions and different spatial frequencies including low (1.5 and 3.0 c/d),medium (6.0 c/d) and high frequencies (12.0 and 18.0 c/d).Results The CS under each spatial frequency of the nasal BRVO group was the same as the control group (t=4.25,9.48,3.08,5.86,0.94;P＞0.05),but the CS under each spatial frequency of the temporal BRVO group was different from the control group (t=8.59,19.11,10.38,17.28,6.01;P＜0.05).The CS under high spatial frequency of the temporal and nasal BRVO group was statistically different (t=11.42,6.95;P＜0.05).The CS under each spatial frequency of the ischemic BRVO group was different from the control group (t=8.88,10.56,11.64,19.06,6.67;P＜0.05).The CS under 6,12 and 18 c/d spatial frequency of the nonischemic BRVO group was statistically different with the control group (t =10.14,11.54,2.82;P＜0.05).The CS under 12 and 18 c/d spatial frequency of the nonischemic BRVO group was statistically different with the ischemic BRVO (t=7.52,3.84;P＜0.05).Conclusions The CS of the temporal BRVO and ischemic BRVO decreased more significantly under each spatial frequency.CS is a better indicator to evaluate the visual function than the visual acuity in BRVO without involving the macular region.

The hallmark of the recent latest advances in diagnostic fundus imaging technology is combination of complex hierarchical levels and depths,as well as wide-angle imaging,ultra-wide imaging.The clinical application of wide-angle and ultra-wide imaging,not only can reevaluate the role of the peripheral retina,the classification types and treatment modalities of central retinal vein occlusion,and enhance the reliability of diabetic retinopathy screening,improve the classification and therapeutic decision of diabetic retinopathy,and but also can help guide and improve laser photocoagulation.However we must clearly recognize that the dominant role of ophthalmologists in the diagnosis of ocular fundus diseases cannot be replaced by any advanced fundus imaging technology including wide-angle imaging.We emphasize to use the three factors of cognitive performance (technology,knowledge and thinking) to improve the diagnosis of ocular fundus diseases in China.

Fundus photograph,angiography,optical coherence tomography,ultrasonography and other image technology and visual electrophysiology can provide a wealth of information for the diagnosis and treatment of pediatric retinal diseases.However,it put forward higher requirements on pediatric retinal imaging equipment and techniques which will be quite different from adult,because of pediatric retinal disease has its own characteristics,such as disease spectrum,pathogenesis,and pathophysiology.The principles and methods of image results interpretation on adult were not quite ready for children.It is necessary to further study the fundus imaging techniques suitable for children,gradually establish standardized examination procedures and clinical interpretation system,to promote the diagnosis of retinopathy in children.