Objective To investigate the peripheral retinal defocus and its influencing factors in children and adoles-cents with low to moderate myopia.Methods Totally 281 children and adolescents aged 6-15 years were included in the study,and only the right eye was selected.After cycloplegic refraction as well as axial length(AL)and average corneal curvature(AveK)measurements,the patients were divided into low myopia(LM)group(-3.00 D≤SE≤-0.50 D)and moderate myopia(MM)group(-6.00 D≤SE＜-3.00D)according to spherical equivalent(SE),and stratified compari-sons were made according to AL[AL1 group(23.00 mm≤AL≤24.00 mm),AL2 group(24.00 mm＜AL≤25.00 mm),and AL3 group(25.00 mm＜AL≤26.00 mm)]and AveK[AveK1 group(40.00 D≤ Ave K≤43.00 D)and AveK2 group(43.00 D＜AveK≤46.00 D)].Multispectral refraction tomography was used to measure the refraction difference value(RDV),in-cluding TRDV(0° to 53°),RDV-15(0° to 15°),RDV-30(0° to 30°),RDV-45(0° to 45°),RDV-15-30(15° to 30°),RDV-30-45(30° to 45°),RDV-45-53(45° to 53°),RDV-S(superior),RDV-I(inferior),RDV-T(temporal)and RDV-N(na-sal).The RDV was compared in the groups divided according to SE,AL and AveK individually,and the correlation be-tween RDV and age,SE,AL and AveK was analyzed.Moreover,the factors affecting RDV in all ranges were analyzed by multiple linear regression.Results Compared with the LM group,the MM group had significant increases in TRDV,RDV-30,RDV-45,RDV-15-30,RDV-30-45,RDV-45-53,RDV-S,RDV-I and RDV-N(all P＜0.05)and no significant differ-ence in RDV-15 and RDV-T(both P＞0.05).According to the comparisons of AL groups and AveK groups,the TRDV,RDV-30,RDV-45,RDV-15-30,RDV-30-45,RDV-45-53,RDV-S,RDV-I and RDV-N in the AL2 group were significantly higher than those in the AL1 group(all P＜0.05);the TRDV,RDV-30,RDV-45,RDV-15-30,RDV-30-45,RDV-45-53,RDV-S and RDV-N in the AL3 group were significantly higher than those in AL2 and AL1 groups,and RDV-I and RDV-T in the AL3 group were significantly higher than those in the AL1 group(both P＜0.05);the TRDV,RDV-30,RDV-45,RDV-15-30,RDV-30-45,RDV-45-53,RDV-S,and RDV-I in the Ave K1 group were significantly higher than those in the AveK2 group(all P＜0.05).The correlation analysis showed that TRDV,RDV-45,RDV-30-45,RDV-45-53,RDV-S and RDV-N were positively correlated with age and AL and negatively correlated with SE and Ave K;RDV-30,RDV-15-30 and RDV-I were positively cor-related with AL and negatively correlated with SE and AveK;RDV-T was positively correlated only with AL;RDV-15 was not correlated with age,SE,AL and AveK.Multiple linear regression analysis showed that age was the influencing factor of RDV-45-53 and RDV-S;AL was the influencing factor of TRDV,RDV-30,RDV-45,RDV-15-30,RDV-30-45,RDV-45-53,RDV-S and RDV-T;AveK was the influential factor of RDV-I;SE had no significant effect on RDV in all ranges.Conclu-sion Peripheral retinal defocus in children and adolescents with low to moderate myopia has reached hyperopic defocus,and hyperopic defocus is the least in patients with relatively short AL.Age,AL and AveK can affect peripheral retinal defo-cus in children and adolescents with low to moderate myopia,among which AL is the most important influencing factor.

Objective:To compare and analyze the application of anti-vascular endothelial growth factor (VEGF) drugs for intravitreal injection in the real world before and after the establishment of one-stop intravitreal injection center, as well as the advantages and disadvantages of different management modes.Methods:A retrospective clinical study. A total of 4 015 patients (4 659 eyes) who received anti-VEGF drugs for ocular fundus diseases at the Tianjin Medical University Eye Hospital from July, 2018 to June, 2022 were included in the study. There were 2 146 males and 1 869 females. The ocular fundus diseases in this study were as follows: 1 090 eyes of 968 patients with wet age-related macular degeneration (wAMD); 855 eyes of 654 patients with diabetic macular edema (DME); 1 158 eyes of 980 patients with diabetic retinopathy (DR); 930 eyes of 916 patients with macular edema secondary to retinal vein occlusion (RVO-ME). A total of 294 eyes of 275 patients with choroidal neovascularization secondary to pathological myopia (PM-CNV); 332 eyes of 222 patients with other fundus diseases. A total of 13 796 anti-VEGF needles were injected. A total of 1 252 patients (1 403 eyes) from July 2018 to June 2020 were regarded as the control group. From July 2020 to June 2022, 2 763 patients (3 256 eyes) who received anti-VEGF treatment in the intravitreal injection center were regarded as the observation group. The total number of intravitreal injection needles, the distribution of anti-VEGF therapy in each disease according to disease classification, the proportion of patients who chose the 3+ on-demand treatment (PRN) regimen and the distribution of clinical application of different anti-VEGF drugs were compared between the control group and the observation group. The waiting time and medical experience of patients were investigated by questionnaire. χ2 test was used to compare the count data between the two groups, and t test was used to compare the measurement data. Results:Among the 13 796 anti-VEGF injections in 4 659 eyes, the total number of anti-VEGF drugs used in the control and observation groups were 4 762 and 9 034, respectively, with an average of (3.39±3.78) and (2.78±2.27) injections per eye ( t=6.900, P<0.001), respectively. In the control and observation groups, a total of 1 728 and 2 705 injections of anti-VEGF drugs were used for wAMD with an average of (5.14±4.56) and (3.59±2.45) injections per eye, respectively; a total of 982 and 2 038 injections of anti-VEGF drugs were used for DME with an average of (4.36±4.91) and (3.24±2.77) needles per eye, respectively. Additionally, a total of 942 and 2 179 injections of anti-VEGF drugs were injected for RVO-ME with an average of (3.98±3.71) and (3.14±2.15) injections per eye, respectively; a total of 291 and 615 injections of anti-VEGF drugs were injected for PM-CNV with an average of (3.31±2.63) and (2.99±1.69) injections per eye, respectively. A total of 683 and 1 029 injections of anti-VEGF drugs were injected for DR with an average of (1.60±1.26) and (1.41±1.05) injections per eye, respectively. The clinical application and implementation of "3+PRN" treatment were as follows: 223 (66.4%, 223/336) and 431 eyes (57.2%, 431/754) in the wAMD ( χ2=8.210, P=0.004), 75 (33.3%, 75/225) and 236 (37.5%, 236/630) eyes in the DME ( χ2=1.220, P>0.05), and 97 (40.9%, 97/237) and 355 eyes (51.2%, 355/693) in the RVO-ME ( χ2=7.498, P=0.006), 39 (44.3%, 39/88) and 111 eyes (53.9%, 111/206) in the PM-CNV ( χ2=2.258, P>0.05), respectively. In addition, the results of the questionnaire survey showed that there were significant differences between the control and observation groups regarding the time of appointment waiting for surgery ( t=1.340), time from admission to entering the operating room on the day of injection ( t=2.780), time from completing preoperative treatment preparation to waiting for entering the operating room ( t=8.390), and time from admission to discharge ( t=6.060) ( P<0.05). Conclusions:The establishment of a one-stop intravitreal injection mode greatly improved work efficiency and increased the number of injections. At the same time, the compliance, waiting time, and overall medical experience of patients significantly improved under centralized management.