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.

Fundus autofluorescence (FAF) relies primarily on the presence of accumulated lipofuscin in the retinal pigment epithelium (PRE) cells. It has emerged as a valuable tool to detect and evaluate the viability and structural changes of the RPE in live. As a non-invasive, repeatable, simple and efficient means of detection. FAF imaging can provide information of RPE structure and function to assistant the diagnosis of many retinal diseases with other conventional fundus imaging technologies. With quantitative analysis and complementary analysis with other fundus imaging technologies, the FAF features of different retinal diseases will be further understood. This knowledge will not only extend the reasonable and unique clinical applications of FAF, but also will contribute to the understanding the pathogenesis and improving the treatment of many retinal diseases.

Objective To observe the changes of autoflurorescence (AF) in periphery retina after scleral buckling.Methods The examination of peripheral fundus autoflurorescence with Optos 200Tx was performed in 46 patients (46 eyes) who underwent successful scleral buckling. The correlation between changes of AF in surgical area and visual function were analyzed by multiple linear stepwise regression analysis. Results One week after surgery, completely atrophy of retinal pigment epithelium (RPE) with disappeared AF was found in the cryotherapy area of 15 eyes (32.6%), uneven area with enhanced AF and scattered weak AF spots was found in 31 eyes (67.4%). The area of RPE atrophy caused by cryocoagulation was 4 times larger than that of the primary retinal tear or holes in 9 eyes (19.6%), and was 2 to 4 times larger in 11 eyes (23.9%), and was 2 times less in the rest of 26 eyes (56.5%). A few granular hyper-AF was observed at the compressed retinal area in 11 eyes (23.9%), normal AF was observed at the compressed retinal area in 35 eyes (76.9%). When α = 0.05, the area with AF changes was significantly correlated with both vertical and horizontal diameter of peripheral visual filed (β=-0.024,-0.019; P＜0.001), but was not correlated with the best corrected visual acuity (F=51.22, P=0.312)by multiple linear stepwise regression analysis. Conclusions SBS can cause peripherial AF changes.Peripheral AF examination is helpful to evaluate the surgical retinal damage of scleral buckling.

Objective To evaluate quantification of metamorphopsia in eyes with idiopathic macular hole (IMH) before and after surgical treatment, and investigate its relationship between postoperative visual acuity, the macular hole index (MHI), and the macular hole prognostic factor (HPF). Methods Thirty eyes of 30 patients, who underwent successful vitrectomy and internal limiting membrane (ILM) peeling for IMH and were followed up more than 6 months, were included in the study. The uncorrected visual acuity of the fellow eyes was better than 20/25 and there was no metamorphopsia in that eye. The macular hole closure was confirmed by optical coherence tomography (OCT) scans. Metamorphopsia was evaluated by metamorphopsia-charts (M-chart). OCT, best corrected visual acuity (BCVA) and metamorphopsia were obtained before and after surgery. Vertical (MV) and horizontal (MH) metamorphopsia, macular hole index (MHI, the ratio of the height to the diameter of the base) , and macular hole prognostic factor (HPF,the ratio of the height to the minimum diameter) were measured. The metamorphopsia score was the average value of MV and MH. SPSS 16. 0 statistical analysis software was used for data analysis. Results Preoperative MV and MH were (1.82±0.04)° and (1.81±0.04)°, respectively. Six months after surgery,the MV and MH were (0.17±0.03)° and (0.11±0.03)° respectively. There was significant difference between pre- and post-operative metamorphopsia results (Z=-0.788, P＜0.05). The metamorphopsia score at 6 months after surgery were positively correlated with the value of the postoperative BCVA (LogMAR) (r=0.540, P=0.004) and negatively correlated with the values of preoperative MHI and HPF (r=-0.676,-0.518; P＜0.05). Conclusions Successful vitrectomy and ILM peeling can improve metamorphopsia of IMH. Postoperative metamorphopsia was correlated with the postoperative BCVA and the preoperative macular hole contour.

Objective To investigate the clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious endophthalmitis. Methods Sixty-two patients (62 eyes)with endophthalmitis, diagnosed by the examinations of the best corrected visual acuity (BCVA),intraocular pressure, slit-lamp microscopy, direct and (or) indirect ophthalmoscopy and ocular B-ultrasound. There are 44, 17 and 1 eyes with posttraumatic, postoperative and endogenous infectious endophthalmitis, respectively. The patients were randomly divided into the group A (32 eyes) and B (30eyes). The former was treated immediately by vitrectomy combined with silicone oil tamponade after diagnosis, while the latter was treated by the same surgery after drug treatment depended on patients'choice. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. 19/62 (30.65%) vitreous samples were positive for culture. The follow-up was ranged from 6 to 26 months. The visual acuity, intraocular pressure and eye retention situation before and after surgery were comparatively analyzed. Results In group A, endophthalmitis was controlled in all eyes after surgery;the visual acuity and intraocular pressure improved significantly after surgery (χ2=43.72, 6.83; P＜0.05). In group B, endophthalmitis was controlled in 19/30 eyes (63.33%) after surgery; evisceration was performed on 11 eyes (36.67%) because of the atrophy of the eyeball. There was no significant difference of visual acuity before and after surgery. Conclusions Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected endophthalmitis. Performing the surgery immediately after the diagnosis is the key to achieve good effect.

Objective To investigate the risk factors and treatment of silicone oil glaucoma (SOG).Methods Ninety-five eyes of 93 patients who underwent pars plana vitrectomy and silicone oil tamponade were evaluated in this study. The lens was removed in 58 eyes in which intraocular lens (IOL) was implanted in 10 eyes, so 48 eyes were aphakic. Silicone oil tamponade time was ≤6 months in 32 eyes,and ＞6 months in 63 eyes. The follow-up time ranged from 2 to 25 months, with a mean of (9.5±5.1)months. The fundus and intraocular pressure (IOP) were evaluated at 1 week, 2 weeks and 1 month after surgery. The diagnosis of SOG was established if the one-month postoperative IOP ＞ 21 mm Hg (1 mm Hg=0.133 kPa), and primary and neovascular glaucoma were excluded. After the diagnosis of SOG, carteolol hydrochloride and brinzolamide solution were immediately applied to the eye, and intravenous mannitol infusion was performed. If the IOP still can not be controlled after 1 week of such treatment, silicone oil removal surgery will be performed. If removal of silicone oil can not control the IOP,trabeculectomy surgery will be performed. Results SOG occurred in 21 eyes (22.1%), including 5 phakic eyes (10.6% of 47 phakic eyes) and 16 aphakic eyes (33.3% of 48 aphakic eyes) , 3 eyes (9.4% of 32 eyes)with short tamponade time (≤6 months) and 18 eyes (28.6% of 63 eyes) with long tamponade time (＞6months). The average silicone oil tamponade time was (10.8±5.1) months. Emulsification of the silicone oil occurred in 17 eyes (81.0%). After silicone oil removed, IOP was controlled in 17 eyes (81.0%) within one week. Conclusions Aphakic eye and the duration of silicone oil tamponade are the risk factors of SOG.Emulsification of silicone oil is the main cause. Silicone oil removal is an effective way to treat SOG.

Objective To assess the effects of 670nm LED (light-emitting diode) to protect the photoreceptor from the light-induced damage in a rat model. Methods 32 SD rats were randomly assigned to one of eight groups: untreated control group, the LED-treated control group, three groups of light-induced damage,and three groups of light-induced damage treated with LED. Light-induced damage result from exposing to constant light for 3 hours of different illuminations of 900,1800 and 2700 lx, respectively. The LED treatment (50 mW) was delivered for 30 minutes at 3 hours before the light damage and 0,24 and 48 hours after the light damage. Retinal function and morphology were measured by electroretinogram (ERG) and histopathology assay. Results The illumination of 900 lx for 3 hours did not damage the rat retina. The illumination of 1800 lx for 3 hours resulted in thinner ONL and no OS and IS. The ratio of damaged area/total retinal area was 0.48±0.12, the damaged thickness of ONL/normal ONL (L5) was 0.39±0.07,and the amplitude of ERG b wave was (431±120) μV. With the LED treatment the ratio of damaged area decreased (M6=0.17±0.12, P5/6=0.002), and the ratio of the damaged thickness of ONL also decreased (L6=0.22±0.09, P5/6<0.01), and the amplitude of ERG b wave increased to (1011±83) μV(P5/6 <0.001). The illumination of 2700 lx for 3 hours caused severed damage to the rat retina and the LED could not protect them significantly. Conclusions 670 nm LED treatment has an evident protective effect on retinal cells against light-induced damage, which may be a simple and effective therapy to prevent or to delay age-related maeular degeneration.

Objective To observe the effect of amniotic homogenate on closing holes in experimental rhegmatogenous retinal detachment and investigate its mechanism.Methods Forty rabbits were randomly divided into group A,B,C and D with 10 rabbits in each group.Group A and C were the treatment groups,and group B and D were the control groups.All eyes of rabbits underwent pars plana vitrectomy,retinectomy,and fluid-air exchange.The surface of the breaks was treated with 0.1 ml amniotic homogenate in experimental groups and 0.1 ml PBS in control groups.At the end of operation,20% SF6 was tamponaded and the retina reattaced.The animals were executed 14 (group A and B) and 28 days (group C and D) after the surgery.The tissue sections were observed by light microscope,electron microscope and immunocytochemistry method.Results Fourteen days after the surgery,the retina reattached in 6 eyes in group A (60%) and 2 eyes in group B (20%) (P=0.021),Twenty-eight days after the surgery,the retina reattached in 8 eyes in group C (80%) and 3 eyes in group D (30%) (P=0.046).The difference of the rate of retinal reattachment among the 4 groups were statistical significant (P<0.05).Light postoperative inflammation of ocular anterior segment was observed,which was controlled 3-5 days after treated with topical steroids.The result of light microscopy showed that the eyes in treatment groups had multilayer of fibroblast like cells around the retinal breaks,adhering to the choroid and retinal pigment epithelial cells.The proliferative cells around the retinal breaks obvious less in control groups than that in the treatment groups,and the retina could not adhere to the choroid.The results of electron microscopy were the same as that of light microscopy.Immunohistochemistry staining of the fibroblast-like cells revealed positve glial fibrillary acidic protein,which suggested that the proliferative cells around the retinal breaks were retinal glial cells.Conclusions Amniotic homogenate helps to seal retinal breaks and promote retinal reattachment by stimulating the proliferation of retinal glial cells around the breaks.

Objective To observe the incidence of ciliary detachment and its relationship with intraocular hypotension soon after vitrectomy.Methods A total of 46 eyes of 46 patients who underwent vitrectomy were examined by ultrasound biomicroscope (UBM).The patients were divided into three groups according to different tamponade: gas group (11 eyes),silicone oil group (8 eyes) and balanced saline solution (BSS) group (27 eyes).Basing on the postoperative intraocular pressure (IOP),the patients were divided into two groups: IOP<10 mm Hg (25 eyes) and IOP≥10 mm Hg (21 eyes).UBM was applied to determine the tomographic features of the ciliary body 3 days after the surgery.IOP were monitored by non-contact tonometer daily after the surgery.The eyes with ciliary detachment were then examined once a week till the ciliary detachment reattached.The follow-up period was from 14 to 35 days.Results After vitrectomy,ciliary detachment was observed in 20 eyes of 46 eyes (43.5%),The incidence of ciliary detachment was 27.3% in gas group,25.0% in silicone oil group,and 55.6% in BSS group.The average IOP in eyes with ciliary detachment [(6.47±4.49) mm Hg (1 mm Hg=0.133 kPa)] was significantly lower than that in the eyes without ciliary detaehmen [(15.61±7.72) mm Hg] (t=8.031,P<0.001).The incidence of ciliary detachment was higher in eyes with postoperative IOP <10 mm Hg (68.0%) than that in the eyes with postoperative IOP≥10 mm Hg (14.3%) (χ2=15.60,P<0.001).All eyes with postoperative ciliary detachment got spontaneous reattaehment within 30 days after the surgery except that one eye had optic disc edema due to severe intraocular hypotension.Conelusions Early postoperative ciliary detachment is a common complication after vitrectomy.Eyes filled with BSS have the highest incidence of postoperative ciliary detachment.Most of the patients with ciliary detachment may get spontaneous reattahment within 30 days after the surgery.

ObjectiveTo evaluate the therapeutic effect of vitreo-retinal surgery on oclular siderosis. MethodsThe clinical data of 22 patinets (22 eyes) with ocular siderosis due to the magnetic foreign body at intraocular postsegment were retrospectively analyzed. The patients aged from 6 to 54 years (average 40 years), including 21 males and 1 femal. The duration of the magnetic foreign body remained in the eye lasted for 1 month to 20 years. The preoperative best corrected visual acuity (BCVA) was <0.01 in 15 eyes, 0. 01-0. 15 in 5 eyes and 0.1-0.2 in 2 eyes. There was Intra-vitreous foreign body in 18 eyes and ocular wall embedded foreign body in 4 eyes; intraocular foreign body (IOFB) combined with cataract in 18 eyes; combined with retinal detachment in 3 eyes; scleral buckling combined with silicon oil filled in 12 eyes and C3F8 filled in 7 eyes.Cataract extraction was performed in 12 eyes, and 2 eyes underwent filtrating surgery. ResultsThe IOFB was successfully removed by one-off surgery in 22 eyes. BCVA increased in 20 eyes (90.9%) and kept unchanged in 2 eyes (9. 1%), including<0.1 in 7 eyes, 0. 1-0.4 in 8 eyes, and 0.5-1.0 in 7 eyes. Operative complications involved retinal holes with retinal detachment in 2 eyes and vitreous haemorrhage secondary to enlarge sclera incision in 2 eyes.Postoperative complications included secondary cataract in 4 eyes, retinal detachment due to silicon oil removal 3 months after submacular removal of foreign body in 1 eye, and retinal detachment 7 days after C3F8 filling in 1 eye; the latter two eyes had reattached retina after another silicon oil filling. At the end of the follow-up period, retina reattached in 22 eyes. ConclusionAdvanced modern vireo-retinal operation is ffective on oclular siderosis, which can avoid the release of Fe+ and improve the patients' visual function.