Background A preliminary study determined an application of manganese ion eyedrops in tracing observation of visual system in vivo,but whether manganese ion has toxic effects on ocular anterior segment tissues is still unclear.Objective This study was to investigate the toxic effects of different concentrations of manganese ion eyedrops on ocular anterior segment tissues.Methods Thirty-two clean New-Zealand white rabbits were divided into 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group and normal control group according to random number table.The experimental eye was randomly chosen from each rabbit for eyedrops application.The manganese ion eyedrops at concentration of 1.00 mol/L,0.50 mol/L or 0.25 mol/L was topically administered in any lateral eye of each rabbit in the 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group,and normal saline solution was used in the same way in the normal control group.In 2 hours,1 day and 3,7,14,21,28 days after eyedrops application,the irritative response of ocular surface was examined under the slit lamp microscope,and corneal damage was evaluated by corneal fluorescence staining,and corneal endothelial cell density (ECD) and corneal thickness were assessed using corneal specular microscope.The eyeball samples were prepared in 3,7,14 and 28 days after eyedrops application and hematoxylin and eosin staining was performed for histopathological examination of conjunctiva,cornea,trabecular meshwork and ciliary body tissue.The use and care of experimental animals complied with the Statement of ARVO.Results Severe hyperemia and edema in palpebral conjunctiva appeared in the 1.00 mol/L MnCl2 group and 0.50 mol/L MnCl2 group,and the symptoms reached a maximum level 1 day after eyedrop application and disappeared 7 days after eyedrops application in the 1.00 mol/L MnCl2 group.These symptoms were milder in the 0.50 mol/L MnCl2 group in comparison with the 1.00 mol/L MnCl2 group.There were no ocular irritative response in the 0.25 mol/L MnCl2 group.Significant differences were found in the corneal fluorescence scores among the groups 2 hours,1 day,3 and 7 days after eyedrop application (X2 =17.350,19.200,12.200,10.140,all at P＜0.05),with the highest score in the 1.00 mol/L MnCl2 group.The ECD was not significantly different among the groups and different time points (Fgroup =0.38,P＞0.05;Ftime =1.79,P＞0.05).The corneal thickness value was significantly different among the groups and different time points (Fgroup =18.22,P＜0.05;Ftime =116.75,P ＜ 0.05).The corneal thickness value was elevated during 2 hours to 3 days after administration of eyedrops in the 1.00 mol/L MnCl2 group and closed to normal from 7 days to 28 days.The corneal thickness value was higher from 2 hours to 14 days than that in 28 days after administration of eyedrops in the 1.00 moL/L MnCl2 group,and the corneal thickness value was higher in 2 hours to 1 day than that in 28 days after administration of eyedrops in the 0.50 mol/L MnCl2 group (all at P＜0.05).Inflammatory cell infiltration and stromal edema were exhibited in conjunctival,trabecular meshwork and ciliary body tissue in the 1.00 mol/L MnCl2 group 3 days and 7 days after eyedrops application,and only inflammatory cell infiltration in conjunctival tissue in the 0.50 mol/L MnCl2 group 3 days after eyedrops application.No obvious abnormity was seen in the 0.25 mol/L MnCl2 group.Conclusions 1.00 mol/L manganese ion eyedrops has a remarkable toxic effect on ocular anterior segment tissue in rabbit.With the lowing of drug concentrations,the toxic effects were reduced.The manganese-enhanced MRI using 0.25 mol/L manganese ion eyedrops is feasibility bacause of its non-toxicity to ocular tissues.

Background Diabetic retinopathy (DR) seems to be rarely found in high myopia patients with diabetes mellitus.This finding suggests that myopia,especially high myopia,plays a protective effect against DR.It is well-known that the primary pathological base of DR is neovescularization,and the changes of vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) are associated with DR.Objective This study was to analyze the expressions of VEGF and PEDF in retina and investigate the influence of high myopia on the pathogenesis of DR.Methods Forty-eight 3-day-old guinea pigs were randomly divided into normal control group,high myopia group,diabetic group and diabetes with high myopia group.Translucent goggles were worn in the right eyes of the guinea pigs for consecutive 8 weeks to induce high myopia,and streptozocin (STZ) was intraperitoneally injected at a dose of 60 mg/kg for four times,every three days for once,to establish diabetic models in the corresponding groups.Twelve weeks after modeling,the animals were sacrificed by excessive anesthesia,and the retinas were isolated for the histopathological examination.Expressions of VEGF and PEDF in the retinas were detected by immunohistochemistry.The use and care of experimental animals conformed to Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results The diopter of the normal control group,high myopia group,diabetic group and diabetes with high myopia group were (+0.25±0.07),(-7.50±0.04),(+0.25±0.03) and (-7.50±0.02) D,the fasting glucose of the four groups were (5.3 ±0.1),(5.1 ±0.2),(19.7 ±0.4) and (18.5±0.3)mmol/L,respectively.Compared with the normal control group,the retinas of high myopia group were thin,and the ganglion cells were less.The retinas of diabetic group were loose and oedematous.The retinas of diabetes with high myopia group were thin and oedematous.The expressing level of VEGF in retinas (absorbance value,A) were 128.61 ±5.57,118.24±2.59,155.60±9.70 and 135.15±5.22 in the normal control group,high myopia group,diabetic group and diabetes with high myopia group,respectively,showing a significant difference among the groups (F=17.365,P=0.032),and the VEGF level was significantly lower in the diabetes with high myopia group than that of the diabetic group (t =5.210,P＜0.05).The expressing level of PEDF in retinas (A value) were 145.57± 8.35,149.54±6.20,127.71±2.45 and 137.53±7.38,in the normal control group,high myopia group,diabetic group and diabetes with high myopia group,respectively,with a statistically significant difference among the four groups (F =19.210,P =0.019),and the PEDF level was significantly higher in the diabetes with high myopia group than that of the diabetic group (t=4.521,P＜0.05).Conclusions The expression of VEGF is downregulated and PEDF is upregulated in the retinas of diabetes with high myopia guinea pigs,which may be an accountable mechanism for the low incidence of DR in high myopia eyes.

The suprachoroidal space is a potential space between the sclera and choroid. Suprachoroidal spacedrug delivery is becoming an applicable method to the ocular posterior segment diseases. Because it targets the choroid, retinal pigment epithelium and retina with high bioavailability and safety, while maintaining low levels elsewhere in the eye. In recent years, new discoveries has been carried out in different areas of interest, such as drug delivery methods, pharmacokinetics and clinical trials. Clinical trials with suprachoroidal space injection of triamcinolone acetonide are executed with promising findings for patients with noninfectious uveitis and diabetic macular edema. Suprachoroidal space triamcinolone acetonide injectable suspension is the first and currently the only agent specifically approved for uveitic macular edema by Food and Drug Administration. Nowadays, many clinical trails with suprachoroidal space drug delivery have been explored, although there are still many risks and uncertainties. With the development of technology in the future, suprachoroidal space drug delivery appears to be a promising treatment modality for ocular posterior segment diseases.

Objective:To evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD).Methods:A prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10± 0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. Results:At 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes.Conclusion:Amniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.

Objective:To observe the demographic data, disease composition and convenience of remote consultation in ophthalmology.Methods:A retrospective study. From 2015 to 2021, the demographic data, changing trends, disease classification of teleconsultation patients, and hospitals participating in teleconsultation, and the waiting time of patients for teleconsultation was analyzed retrospectively; remote consultation physician level composition and other data was analyzed.Results:During the 7-year period, 1 216 patients with remote consultation were obtained through the platform of the telemedicine center. Among them, there were 680 males and 536 females; the average age was 50.8 years. In 2016 and 2017, the number of patients participating in telemedicine consultations reached a peak of 260 and 221 cases, respectively. Among the ophthalmic diseases, there were 490 cases (40.30%, 490/1 216) of retinal and optic nerve-related diseases, 212 cases (17.43%, 212/1 216) of ocular trauma. 678 cases (56.27%, 678/1 205) of remote consultation waiting time were less than 24 hours, 991 cases (82.24%, 991/1 205) were less than 48 hours. Among the physicians who participated in the remote consultation, there were 733 chief physicians (60.3%, 733/1 216) and 466 deputy chief physicians (38.3%, 466/1 216).Conclusions:During the seven-year period from 2015 to 2021, there are relatively few patients with ophthalmology teleconsultation; retinal and optic nerve-related diseases accounted for a high proportion. Remote consultation has high convenience.

Based on the duality of "healthy" and "pathogenic" of the immune system in physiological and pathological states， and combined with the analogy between "immune function" and "healthy qi"， the theory of "transformation of healthy qi into pathogenic qi" was proposed to guide the pattern identification and treatment of autoimmune diseases. The theory of "transformation of healthy qi into pathogenic qi" means that "healthy qi"， which is originally used by the body's original ability to defend and remove harmful factors or normal functional activities， transformed into "pathogenic qi"， which is factors that damage and destroy the human body or abnormal body state. In the pathogenesis of autoimmune diseases， the pathogenic factors and causes of congenital endowment， tissue damage under the influence of external pathogens， abnormal function of zang-fu （脏腑） organs and meridians， abnormal transmission and transformation of qi， blood， body fluids was proposed. Autoimmune diseases have the dynamic mechanism of latent pathogen at early stage， internal and external contraction at the onset stage， and the expansion of the pathogenic qi at the complete period， and also have the characteristics of the specificity， invisibility and contradiction of healthy qi and pathogenic qi. In terms of treatment， it advocates the ideas of treatment with both attack and supplementation throughout the disease， identifying diseases with special prescriptions and formulas for specific diseases， dynamically adjusting treatment by identifying the remission and onsets of the disease， observing the changes in the dynamics of healthy qi transforming into pathogenic qi， and treating disease before it arises with early intervention.