There are lots of imaging technologies in the ocular fundus disease field,including ultrasound biomicroscopy (UBM),fundus fluorescein angiography (FFA),indocynine green angiography (ICGA),fundus photograph (FP) and Optical Coherence Tomography (OCT).However there is no standard for image formats among various fundus imaging equipment,technology application processes,thus the relevant data cannot be compared and analyzed.And improper operation of the instruments causes unstable image quality or image missing.Also lack of appropriate evaluation guidelines results in different interpretation of same image data.These three factors not only affect the fundus imaging device application efficiency,limit the sharing of fundus imaging resource,but also hinder the development of fundus imaging diagnostic applications.Therefore,instrument types,data acquisition protocol and data presenting formats should be standardized for ocular fundus image acquisition.The technicians who operate the machine should be trained regularly to follow the standard operating procedure of data acquiring,thus to ensure integrity,truthful and reliable data is collected.In order to enhance the application efficiency of fundus imaging equipment,save public health resources,to promote fundus imaging diagnostic technology development,we need to develop evaluation guidelines for fundus image data,establish a comprehensive system including remote consultation center,reading center and quality control center.

Objective To compare the axial length (AL) measured by Lenstar and contact A-Scan in the patients with idiopathic macular hole and study the correlation between the difference of the two measurements and the foveal thickness measured by optical coherence tomography (OCT).Methods Twenty-seven eyes of 26 idiopathic macular hole patients (IMH group) and 27 eyes of 25 patients with mild cataract (control group) were enrolled in this study.Foveal thickness was measured with 3D OCT.The AL was measured by Lenstar and contact A-Scan,and the consistency of the two measurements was determined by Bland Altman analysis.The correlation between the difference of the two measurements and foveal thickness was analyzed by Pearson correlation analysis.Results Mean foveal thickness of IMH and control eyes were (372.85±60.02) μm and (243.44±22.50) μm,respectively.The difference between the foveal thickness of the two groups was highly significant (t=-10.490,P＜0.001).In the IMH group,the AL measured by Lenstar and contact A-Scan were (23.20± 1.12) mm and (23.18± 1.13) mm,respectively,the difference between the two measurements was not statistically significant (t =-0.549,P =0.588),whereas in the control group,the AL was (23.41 ± 0.72) mm by Lenstar and (23.33 ± 0.74) mm by contact A-Scan,the two measurements were significantly different (t=-4.832,P＜0.001).However,no correlation was found by Pearson correlation analysis between the difference of the two measurements and the foveal thickness in either IMH or control group (r=0.181,-0.141; P＞0.05).Conclusions Although there is no difference of axial length measurements using Lenstar and contact A-Scan in IMH eyes,in clinical measurements the results of two instruments should be taken into comprehensive consideration.

Objective To measure optic disc parameters in Mongolian and Han healthy subjects with or without family history of glaucoma,to explore the causes of the differences and their significance in the diagnosis of early glaucoma.Methods Fifteen healthy Mongolian individuals (30 eyes),30 healthy Han individuals (60 eyes) with a family history of open-angle (30 eyes) or angle-closure (30 eyes) glaucoma,and 45 healthy Han individuals (90 eyes) without a family history of glaucoma were enrolled in this study.The 45 healthy Han individuals without a family history of glaucoma included three age-groups:20 to 29 years old group,30 to 39 years old group and 40 to 49 years old group,each group have 15 subjects (30 eyes).Thirteen parameters were measured by Heidelberg retina tomography (HRT) for all subjects,including disc area,cup area,rim area,cup volume,rim volume,cup/disc area ratio,linear cup/disc ratio,mean cup depth,maximum cup depth,cup shape,disc height variation contour,mean retinal nerve fiber layer (RNFL) thickness and optic nerve fiber layer cross-sectional area.The results were analyzed and compared between the above groups.Results There was no statistically significant (t=0.791,P=0.132) of the height variation contour between Mongolian and Han without a family history of glaucoma (20 to 29 years old) group.The other parameters of Mongolian were smaller than Han without a family history of glaucoma (20 to 29 years old) group,but the difference was not statistically significant (t=-1.039,-0.799,-0.840,-1.108,-0.956,-0.695,-0.931,-1.099,-1.074,-0.580,-0.204,-1.425; P＞ 0.05).The parameters in Han with a family history of open-angle glaucoma group were bigger than Han without a family history of glaucoma (30 to 39 years old) group.The differences were statistically significant for disc area,cup area,rim area,cup volume,rim volume,cup area ratio,linear cup/disc ratio,mean cup depth,cup shape measure,nerve fiber layer cross-sectional area (t =4.758,3.187,2.544,2.674,1.798,3.676,2.721,2.715,2.510,2.373; P＜0.05),but were not statistically significant for maximum cup depth,disc height variation contour and mean RNFL thickness (t=1.649,1.565,0.767; P＞0.05).Most parameters in Han with a family history of angle-closure glaucoma group were the same as that in Han without a family history of glaucoma (40 to 49 years old) group,including cup area,rim area,cup volume,rim volume,cup/disc area ratio,linear cup/disc ratio,mean optic cup depth,maximum cup depth,cup shape,disc height variation contour,mean RNFL thickness,optic nerve fiber layer cross-section (t=1.201,1.697,1.000,0.516,0.740,-0.172,-0.070,-0.972,1.530,-0.390,-0.091,0.659; P＞ 0.05) ; but the difference of disc area between these 2 groups was statistically significant (t=2.224,P＜0.05).Conclusions The family history of glaucoma can change the optic disc parameters of healthy individuals,especially those with a family history of open-angle glaucoma.There is no difference of optic disc parameters between healthy Mongolian and Han subjects.

Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment.Methods It was a retrospective case series study.A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study.All patients underwent vitrectomy operation.Additionally,they were given heavy water,membrane peeling,retinotomy or partial cutting,intraocular laser photocoagulation or frozen,gas-liquid exchange or direct oil exchange operation accordingly.Ninety-eight eyes with multiple holes,old retinal detachment,hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously.Intravitreal silicone oil was padded at the end of operation.Cutting,stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR.Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation.One week after SOR and during follow-up,the visual acuity,intraocular pressure (IOP),slit lamp microscope,and ophthalmoscope examination were examined with the same technique and methods as preoperation.The eyes were divide into two groups based on the attachment status of retina after SOR,which were reattached group (419 eyes) and redetached group (39 eyes) respectively.The following data were recorded.,the age of patients,ocular axial length,logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR,the number of retinal breaks,the duration of silicone oil filling,the duration of follow-up,and the related factors during vitrectomy operation and SOR.The relation of age,sex,high myopia,the size and location of holes,aphakic eye,proliferative vitreoretinopathy (PVR) C3 level and above,previous history of failed retinal detachment operation,360° preventive laser photocoagulation,assistant scleral buckling surgery,SOR via corneal puncture to RRD after SOR were analyzed.Odds ratio (OR) and its 95％ confidence interval (CI) were calculated for the age ＜40 years old and gender.High myopia,assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation.Results After SOR operation,the total average logMAR BCVA was 0.86 ± 0.63.The average logMAR BCVA was 0.82 ± 0.59 and 0.99 ± 0.70 respectively for the reattached and redetached groups,which was not statistically different (F=1.559,P＞0.05).The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes,respectively,accounted for 27.7 ％ and 56.4 ％,and the difference was statistically significant (x2=13.984,P＜0.01).Three eyes underwent vitrectomy with scleral buckling occured RRD,accounting for 3.1％; while 36 eyes underwent vitrectomy without scleral buckling occured RRD,accounting for 10.0％.The incidence of RRD between them was statistically significant (x2 =4.761,P＜0.05).The incidence of RRD was not retated to the PVR levels before the operation,previous history of failed retinal detachment operation,aphakic eye and preventive laser photocoagulation (OR=1.626,1.699,1.986,0.709; 95％ CI:0.836-3.162,0.832-3.658,0.921-4.279,0.268-1.875; P＞0.05).RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380,0.284; 95％CI:1.733-6.595,0.086-0.944; P＜0.05).The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95％CI:1.043-4.306; P＞0.05).The incidence of RRD after SOR was 8.5％; of which,35.9％ originated from new breaks and 69.2％ were related to new breaks,in contrast,only 5.1％ originated from PVR but 51.3％ were related to PVR.Conclusions High myopia is an independent prognostic risk factor of RRD after SOR.Combined scleral buckling surgery is a protective factor of RRD after SOR.To the well reattached eyes before SOR,the new breaks seems to be the main cause of RRD,wheras PVR was probably a secondary phenomenon.

Objective To investigate the effect of N-methyl-N-nitrosourea (MNU) on expressions of interphotoreceptor retinoid-binding protein (IRBP) and recoverin in rat retinal.Methods Thirty female Sprague-Dawley (SD) rats were randomly divided into five groups,including normal control group,and MNU treatment one day,three days,seven days and 10 days groups,each group had six rats.Rats in MNU-treatment groups received a single intraperitoneal injection of 40 mg /kg MNU,while rats in the normal control group received intraperitoneal injection of saline 5 ml/kg.Reverse transcription-polymerase chain reaction (RT-PCR) and immunofluorescence were used to detect the retinal expression of IRBP and recoverin.Results RT-PCR results indicated that retinal IRBP levels decreased after MNU injection compared with normal control (P＜0.01),while recoverin levels increased (one day:P＞0.05; three days:P＜0.05; seven days:P＜0.5; 10 days:P＜0.05).Immunofluorescence assays demonstrated that normally IRBP protein is mainly in the inner and outer segments of photoreceptors.After MNU treatment,IRBP protein was detected in all retinal layers but much faint.Recoverin was expressed in the inner nuclear layer,inner plexiform layer and ganglion cell layer,and its expression was increased after MNU injection.Conclusion MNU suppresses IRBP expression and promotes recoverin expression in rat retina.

Intravitreal injection of antiangiogenic agents is widely used to treat retinal vascular disease.This therapy can induce regression of neovascular vessels; reduce intraocular inflammation and retinal vascular permeability,and control macular edema.However the action period of these agents is short,and thus this therapy need repeated injections which cause higher operation risk and cost.Retinal laser photocoagulation therapy can close retinal capillary non-perfusion area and neovascular vessels,reduce macular edema caused by vascular leakage.However,as its therapeutic effect is based on the destruction of the retinal tissues in the lesion area,this therapy need longer time to show its effects.When the disease is controlled by this method,it may already induce some structural irreversible damages to the retina,especially the macular.This is why the visual acuity is not satisfactory in some patients,even though the disease get controlled,macular edema gets disappeared and anatomical structure of retina get improved.Properly evaluating all the pros and cons of retinal photocoagulation and intravitreal injection of antiangiogenic agents,will allow us to explore a better way to combine these two therapies to treat retinal vascular diseases.

Objective To observe the serum lipid level of patients with branch retinal vein occlusion (BRVO).Methods A total of 71 BRVO patients (BRVO group) were enrolled in this study.The patients included 31 males and 40 females,with an average age of (52.75 ± 10.2) years.All the patients were examined for visual acuity,slit lamp ophthalmoscopy combine with preset lens,fundus color photography and fundus fluorescein angiography (FFA) examination.Seventy-two age-and sex-matched normal subjects were enrolled in this study as control group.The subjects included 32 males and 40 females,with an average age of (53.10±9.5) years.The BRVO and control group were divided into four subgroup which including age with ＜40 years,40-49 years,50-59 years and ≥60 years.The plasma cholesterol and triglyceride level of BRVO group,control group,and age subgroups of BRVO and control group were comparatively analyzed.Results The average plasma cholesterol levels were (4.529±0.100) and (4.274±0.106) mmol/L in BRVO and control group,respectively.There was no difference between two groups (t=-1.738,P＞0.05).The average triglyceride levels were (1.500±0.129) and (1.319±0.095) mmol/L in BRVO and control group,respectively.There was no difference between two groups (t=-1.135,P＞0.05).There was no difference of average plasma cholesterol (t=-1.755,1.850,-1.892,-0.507) and triglyceride (t=0.846,-0.074,-1.288,-1.887) level in age subgroups of BRVO and control subgroup (P＞0.05).Conclusion There is no significant difference of serum lipid level between BRVO patients and controls.

Objective To observe the clinical features of combined central retinal artery and vein occlusion.Methods The clinical data of eight patients of combined central retinal artery and vein occlusion diagnosed by fundus examination and fundus fluorescein angiography (FFA) was analyzed retrospectively,including the causes,fundus manifestations and FFA features.Results 4/8 patients had hypertension and dyslipidemia,2/8 patients had traumatic retrobulbar hemorrhage,one patient had orbital cellulitis and one patient had systemic lupus erythematosus.All the patients had posterior pole retinal edema,hemorrhage,thin retinal artery,dilated vein,and papilledema.FFA showed delayed arterial filling,and there was no filling of retinal arterial branches until the late stage of FFA.Laminar flow delayed in large retinal veins,and there was no filling or only retrograde filling in retinal vein branches.Large areas with dot-like or patchy weak choroidal fluorescence can be observed in five patients.Conclusions Combined central retinal artery and vein occlusion is rare with complex etiology.The fundus manifestations and FFA features are atypical,but have features of central retinal artery occlusion and central retinal vein occlusion.

Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM).Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study.All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision.There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI).The patients were divided into PDR with CRVO group (group A,41 eyes) and PDR group (group B,200 eyes) according to the results of fundus examination.All patients received vitrectomy with silicone oil and C3F8 gas tamponade.There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B.The difference of number in silicone oil-filled eyes in two groups was statistically significant (x2=5.110,P＜0.05).There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B.There was no difference in C3F8 gas-filled eyes numbers in two groups (x2 =0.048,P＞0.05).The follow-up ranged from one to 60 months,with the mean of (28.69± 17.28) months.The corrected vision,retinal reattachment,persisting macular edema (ME),neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed.Results Of 241 eyes,there were 41 eyes (17.0％) with CRVO.Before surgery,the differences of corrected vision (Z=-0.138),intraocular pressure (t=0.966),whether there was TRDor not (x2=0.412),whether underwent panretinal photocoagulation or not (x2 =1.416) were not statistically significant (P＞0.05),but the difference of whether NVI were present or not was statistically significant (x2=31.724,P＜0.05)between two groups.After surgery,the corrected vision improved in both two groups (Z=2.319,4.589;P＜0.05).There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05).Postoperative complications occurred in 94 eyes,including 26 eyes in group A and 68 eyes in group B.The differences of incidence of reoperation (x2 =0.498),retinal reattachment (x2 =0.818),persisting ME (x2 =2.722) between two groups after surgery were not statistically significant (P ＞ 0.05).The incidence of repeated VH (x2 =5.737) and NVG (x2 =6.604) in group A were higher than those in group B (P＜ 0.05).Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH.Combined with CRVO patients are more likely to suffer NVI.Vitrectomy can improve the visual function in PDR with CRVO patients.

Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis.Methods This is a retrospective non-comparative interventional clinical research.A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study.Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis.The patients,seven males and two females,aged from 19 to 66 years,with an average of 43.89 years.The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days.Visual acuity,slit lamp ophthalmoscopy,fundus fluorescein angiography (FFA),optical coherence tomography (OCT),hematological and tuberculosis related investigations were examined and analyzed.All patients had standard anti-tuberculosis treatment.Treatment outcomes were followed for six to 37 months with an average of 14.11 months.Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28.Among 11 eyes,six presented mild to moderate vitritis,five presented as retinal vein occlusion with no obvious vitirits.Fundus examination showed six cases with retinal hemorrhage,four cases with macular edema,two with macular epiretinal membrane,and two with vitreous hemorrhage.FFA revealed 11 cases with leakage of vessels,11 with nonperfusion area,four with macular edema,three with retinal neovascularization,and two with choroidal lesions.OCT of nine eyes suggested six eyes with retinal edema,three with macular edema,three with macular epiretinal membrane.TST of seven patients were all strong positive.T-SPOT.TB of four patients were all positive.Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection.Four to six weeks after the start of anti-tuberculosis treatment,vitritis,exudates,retinal and macular edema subsided.During follow up,inflammation was stable with no recurrence observed.The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51.Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis,retinal vein occlusion,and retinal hemorrhage.Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.