Objective:To develop a simple and effective subretinal injection pipeline system to enhance the accuracy and precision of subretinal injection volume control.Methods:A retrospective case series study. From May to October 2023, 18 patients (18 eyes) with submacular hemorrhage (SMH) who continuously received modified subretinal injection treatment in Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 10 males and 8 females. The mean age was (60.00±7.41) years. The primary causes included polypoid choroidal vasculopathy (14 cases), retinal macroaneurysm (2 cases), traumatic retinopathy (1 case), and Valsalva retinopathy (1 case). Hemorrhage affected 14 eyes of the fovea centralis. All affected eyes underwent standard three-channel 25G vitrectomy via the flat part of the ciliary body combined with modified subretinal injection of recombinant tissue plasminogen activator. The improved injection system consisted of a 1 ml syringe, a Q-Syte TM connector, a 41G subretinal microinjection needle, a converter and a viscoelastic substance control pipeline. The drug preparation time for subretinal injection (i.e., the time consumed by the system connection step), the injection time, whether bubbles occur during the injection process, and the perioperative complications were recorded and analyzed. Results:The preparation time prior to drug injection ranged from 230 to 335 seconds, while the injection completion time varied between 43 and 75 seconds. Both times decreased progressively as operator proficiency improved. Among the treated eyes, five received a target injection dose of 0.05 ml and thirteen received 0.10 ml, with all eyes achieving the preset dose accurately. No subretinal bubbles were observed during the injection procedure. Additionally, no intraoperative complications such as retinal hemorrhage or tear secondary to mechanical trauma at the injection site were recorded. Postoperatively, one eye developed anterior chamber hemorrhage, which resolved following intraocular pressure-lowering treatment. No other postoperative complications, including hemorrhage, rhegmatogenous retinal detachment, or infection, were observed in the remaining eyes.Conclusion:The retinal drug injection system developed in this study has a simple structure, safe and stable operation, can achieve precise drug injection, and effectively avoid the formation of bubbles.

Objective:To develop a simple and effective subretinal injection pipeline system to enhance the accuracy and precision of subretinal injection volume control.Methods:A retrospective case series study. From May to October 2023, 18 patients (18 eyes) with submacular hemorrhage (SMH) who continuously received modified subretinal injection treatment in Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 10 males and 8 females. The mean age was (60.00±7.41) years. The primary causes included polypoid choroidal vasculopathy (14 cases), retinal macroaneurysm (2 cases), traumatic retinopathy (1 case), and Valsalva retinopathy (1 case). Hemorrhage affected 14 eyes of the fovea centralis. All affected eyes underwent standard three-channel 25G vitrectomy via the flat part of the ciliary body combined with modified subretinal injection of recombinant tissue plasminogen activator. The improved injection system consisted of a 1 ml syringe, a Q-Syte TM connector, a 41G subretinal microinjection needle, a converter and a viscoelastic substance control pipeline. The drug preparation time for subretinal injection (i.e., the time consumed by the system connection step), the injection time, whether bubbles occur during the injection process, and the perioperative complications were recorded and analyzed. Results:The preparation time prior to drug injection ranged from 230 to 335 seconds, while the injection completion time varied between 43 and 75 seconds. Both times decreased progressively as operator proficiency improved. Among the treated eyes, five received a target injection dose of 0.05 ml and thirteen received 0.10 ml, with all eyes achieving the preset dose accurately. No subretinal bubbles were observed during the injection procedure. Additionally, no intraoperative complications such as retinal hemorrhage or tear secondary to mechanical trauma at the injection site were recorded. Postoperatively, one eye developed anterior chamber hemorrhage, which resolved following intraocular pressure-lowering treatment. No other postoperative complications, including hemorrhage, rhegmatogenous retinal detachment, or infection, were observed in the remaining eyes.Conclusion:The retinal drug injection system developed in this study has a simple structure, safe and stable operation, can achieve precise drug injection, and effectively avoid the formation of bubbles.

This manuscript is a narrative review on experience in the healthcare public-private partnerships (PPP) field project in China. The PPP model allows healthcare officials to share the risk of building new facilities with the private sector. The objective of this study is to evaluate and to review the PPP of healthcare sector in China, and to investigate the critical success factors and best practice of PPP. We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures. The current study systematically reviewed the evolution and current status of public and private hospitals development in China, and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China, and to develop best practice models of PPP among hospitals of China. We found that the PPP organizations providing finance and political risk coverage, thus enabling specific PPP transactions to reach financial closure—potentially setting demonstration effects. Such PPPs may then contribute to improving access to infrastructure and social services, which drives economic growth and other optimal outcomes.

This manuscript is a narrative review on experience in the healthcare public-private partnerships (PPP) field project in China. The PPP model allows healthcare officials to share the risk of building new facilities with the private sector. The objective of this study is to evaluate and to review the PPP of healthcare sector in China, and to investigate the critical success factors and best practice of PPP. We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures. The current study systematically reviewed the evolution and current status of public and private hospitals development in China, and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China, and to develop best practice models of PPP among hospitals of China. We found that the PPP organizations providing finance and political risk coverage, thus enabling specific PPP transactions to reach financial closure—potentially setting demonstration effects. Such PPPs may then contribute to improving access to infrastructure and social services, which drives economic growth and other optimal outcomes.

Objective To evaluate the optical coherence tomograghy (OCT) morphological parameters for predicting anatomical outcomes and postoperative visual acuity in idiopathic macular hole (IMH) after pars plana vitrectomy (PPV).Methods A retrospective study.A total of 26 eyes in 23 IMH patients underwent PPV,internal limiting membrane (ILM) peeling and gas filling surgery were included in this study.The patients included 8 eyes of 7 males and 18 eyes of 16 females,with the mean age of (63.9 ± 9.4).All patients received the best corrected visual acuity (BCVA),slit lamp microscope,indirect ophthalmoscopy and three-dimensional optical coherence tomography (3D OCT) examinations.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution visual acuity.According to the standard classification system of International Vitreomacular Traction Study (IVTS) Group,8 eyes were medium full-thickness macular hole (FTMH) and 18 eyes were large FTMH,none of which were with vitreomacular traction (VMT).The minimum diameter (MIN),base diameter (BASE),height (H),left and right arm length (LAL and RAL),diameter of ellipsoid zone absence (DEZA) were measured.Macular hole index (MHI),hole form factor (HFF),tractional hole index (THI),diameter hole index (DHI) were calculated.The average follow-up period were (9.2 ± 9.7) months.The postoperative DEZA were measure at the last time.Anatomical outcomes were divided into 3 groups.The multiple factors related with predicting anatomical outcome and visual acuity were analyzed.Results In the 26 eyes,the hole was closed in 16 eyes of type 1,7 eyes of type 2,3 eyes of type 3.The mean pre-and post-operative logMAR BCVA were 0.9 ± 0.3,0.7 ± 0.3 respectively.The MIN,BASE,H were (533 ± 176),(1 035 ±270),(462 ± 138) μm respectively.The MHI,HFF,THI,DHI were 0.46 ±0.15,0.72 ±0.19,0.95 ±0.37,0.52 ±0.11 respectively.The mean preand post-operative DEZA were (1 775 ± 486),(960 ± 138) μm respectively.Postoperative logMAR BCVA were correlated significantly with MHI,THI (all P ≤ 0.01),correlated weakly with MIN,BASE,HFF (all P ≤ 0.05),but not correlated with age,sex,DHI,pre-and post-operative DEZA (all P ＞ 0.05).Anatomical prognosis types were significantly correlated with MHI,HFF,THI (all P ≤ 0.01),weakly correlated with MIN,DHI (all P ≤ 0.05),but not correlated with age,sex,BASE,pre-and post-operative DEZA (all P ＞ 0.05).Conclusions For medium and large FTMH in IVTS classification system,MHI,THI have the best correlation with postoperative BCVA and can be considered as key indicators for predicting postoperative BCVA.MHI,HFF,THI have the best correlation with anatomical outcomes and can be considered as key indicators for predicting anatomical outcomes of IMH.

Objective To study the effectiveness of scleral buckling without subretinal fluid drainage for macula-on rhegmatogenous retinal detachment (RRD),and to analyze the correlation between bestcorrected visual acuity (BCVA) and the height of foveal subretinal fluid as well as the thickness of central retina measured by optical coherence tomography.Methods The medical records of 27 patients (27 eyes)who underwent scleral buckling without subretinal fluid drainage for macula-on RRD were retrospectively analyzed.The BCVA,height of foveal subretinal fluid and central subfield thickness (CST) were evaluated preoperatively and 1 week,1 month,3 months,6 months and 12 months postoperatively.Results Postoperative BCVA of all eyes were improved significantly (P ＜ 0.05),and no significant improvement of BCVA was observed after 3 months postoperatively.After surgeries,the height of foveal subretinal fluid as well as the thickness of central foveal retina were correlated with the length of postoperative period significantly,respectively (P ＜ 0.05),but had no correlation with the improvement of postoperative BCVA (P ＞ 0.05).Conclusions Scleral buckling without subretinal fluid drainage for macula-off RRD improved the BCVA,especially in the first 3 months postoperatively.The postoperative alterations of subretinal fluid and central foveal retinal thickness had no correlation with BCVA.

Objective To analyze the results of diagnostic pars plana vitrectomy (PPV) in patients with uveitis of unknown cause.Methods This is a retrospective case series study.Sixty-five patients (67 eyes) with uveitis of unknown cause were enrolled in this study.There were 31 males (32 eyes) and 34 females (35 eyes).The ages were from 6 to 84 years,with the mean age of (55.00± 18.56) years.All eyes were received PPV.Examination of vitreous samples consisted of microbial stains and culture,microbial DNA and antibody detection,cytokine measurement,cytology,flow cytometry and gene rearrangement detection.Results Vitreous analysis was positive in 40 of 67 eyes (59.7％).Positive results indicated bacterial endophthalmitis in 20 of 40 eyes (50.0％),lymphoma in 11 eyes (27.5％),viral IgM and IgG increased significantly in 3 eyes (7.5％),fungal endophthalmitis in 3 eyes (7.5％),IgG of toxocara increased significantly in 2 eyes (5.0％),IgG of toxoplasma Gondii increased significantly in 1 eye (2.5％).Conclusion The diagnostic yield of vitreous samples in uveitis eyes of unknown cause is 59.7％.

Age-related macular degeneration (AMD) has become one of the leading causes of irreversible blindness worldwide.With the advancement of stem cell technology,tissue engineering and biomaterials,cell-based therapy has been inspiring for many degenerative diseases.For its unique advantages,AMD has become one of the most promising fields for cell-based therapy,which involve retinal pigment epithelium(RPE)cells,induced differentiation of neural retina cells and related cytokine regulations.RPE cells can be derived from human embryonic stem cells (hESC) or Induced pluripotent stem cells (iPS).Recently hESC-derived RPE cells have been applied to patients with dry AMD with initial success in clinical trials.In terms of tissue engineering,studies are focused on factors affecting the long-term survival of transplanted cells,including tissue scaffolds,soluble hybrid materials and scaffold anchoring.This article briefly reviews the RPE differentiation,neural retina differentiation and related cytokines of cell-based therapy and scaffolds,materials,and cell-scaffolds interactions of tissue engineering in AMD treatment.

Objective To review the ophthalmic features of granulomatosis with polyangiitis (GPA).Methods Clinical data of 164 GPA patients diagnosed in Peking Union Medical College Hospital during the past 10 years were retrospectively reviewed.Results Among 164 patients,48 (29.3％) had ocular involvement with a male to female ratio of 1.4:1 and an average age of (45 ± 15) years.Nine patients (5.5％) were first diagnosed at the ophthalmology department.Scleritis (15.9％,26/164),orbit lesions (13.4％,22/164) and peripheral corneal ulcer (9.1％,15/164) were the three most common ophthalmic complications.Twenty-two patients (13.4％) had positive findings in the orbit imaging.Six patients (3.7％,6/164) lost their vision due to GPA.Conclusion The ocular manifestations of GPA are diverse and complicated.GPA may affect every component of the eye,sclera,orbit and cornea are the most frequently affected sites of the eye.