AIM: To explore the neuro-ophthalmological characteristics of acute macular neuroretinopathy(AMN)after SARS-CoV-2 infection.METHODS: A total of 8 patients(14 eyes), including 6 females and 2 males, who were diagnosed with AMN in the neuro-ophthalmology department of Xi'an No.1 Hospital(The First Affiliated Hospital of Northwest University)from December 27, 2022 to February 1, 2023 were included in the study. All patients had a history of SARS-CoV-2 infection before the disease, and the results of best corrected visual acuity(BCVA), non-contact indirect intraocular pressure measurement, fundus color photography, near infrared(IR), spectral-domain optical coherence tomography(SD-OCT), OCT angiography(OCTA), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), visual field, visual evoked potential(VEP), and electroretinogram(ERG)were collected. Furthermore, the neuro-opthalmology characteristics of the included patients were analyzed and summarized.RESULTS: The included 8 patients aged from 20 to 43, with an average age of(30±6.63)years old. The patients had a history of SARS-CoV-2 infection 3 to 11(mean 5±3.51)d before the disease, and 6 out of 8 patients developed visual symptoms within 5 d of infection with SARS-CoV-2, with manifestated with decreased vision or visual scotoma. The visual acuity varied from 0.08 to 1.0, with visual field defect characterized by central, paracentral or peripheral scotoma. VEP showed prolongation latency of P100 or P2, and ERG revealed impaired function of retinal photoreceptor cell. In the early stage of the disease, the size and shape of early visual acuity, visual field, and extraretinal lesions in patients with AMN associated with SARS-CoV-2 infection may not match, and the lower the visual acuity, the later the VEP peaks.CONCLUSION: The neuro-ophthalmic features of SARS-CoV-2 infection-associated AMN require the attention of clinicians. In addition to multi-mode fundus imaging, clinicians should use a variety of methods to comprehensively evaluate visual function and prognosis of patients.

Diabetic retinopathy,a main microvascular complication of diabetes,remains the leading cause of blindness in the working-age population,but its specific pathogenesis has not been fully elucidated.microRNAs(miRNAs)are small non-coding RNAs,acting as post-transcriptional regulators of gene expression.Its aberrant expression plays a key role in modulating pathological processes associated to many diseases.Studies confirmed the role of miRNAs in the regulation of oxidative stress,inflammation,cell death and angiogenesis which influences the development of DR.This review focuses on the role of miRNAs in DR,which may provide a reference basis for diagnosis,prognosis and therapeutics.

Neuromyelitis optica spectrum disorder (NMOSD) is a immune-mediated demyelinating disease of the central nervous system, characterized by high recurrence and disability rates. Preventing relapses is crucial in the treatment of this condition. Monoclonal antibodies have emerged as a novel and rapidly evolving clinical therapeutic strategy targeting NMOSD in recent years. An increasing number of studies and clinical trials have also confirmed the effectiveness and safety of monoclonal antibodies. Rituximab, a monoclonal antibody targeting the B-cell surface antigen CD20, has been widely used in the treatment of NMOSD. Currently, in China, the only approved monoclonal antibody for treating NMOSD is Inebilizumab, which targets the B-cell surface antigen CD19. Additionally, various monoclonal antibodies, such as interleukin-6 receptor inhibitors and complement C5 inhibitors, have been used in the treatment of NMOSD. With the deepening of the research on the pathogenesis of NMOSD, the molecular mechanism of disease-related immune network is further clarified, and multi-center clinical trials are widely carried out. More accurate monoclonal antibody treatment strategies for NMOSD will be applied to clinical practice, benefiting more patients.

Objective:To preliminary investigate the impact of the diagnosis-related groups (DRG) payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders (NMOSD), and to propose potential improvement strategies.Methods:A single-center, retrospective study. From October 1, 2020, to September 30, 2022, 44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University (Xi'an First Hospital) were included in the study. Among them, there were 11 males and 33 females, with an average age of (40.8±20.2) years. According to the implementation time of DRG payment, patients were divided into two groups: group A, which consists of cases one year before the implementation of DRG payment from October 1, 2020 to September 30, 2021, and group B, which consists of cases one year after the implementation of DRG payment from October 1, 2021 to September 30, 2022, with 20 and 24 cases, respectively. Detailed information such as hospitalization duration, treatment methods, and hospitalization costs of the two groups of patients was collected. Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups. For intergroup comparison, t-test was used for normally distributed data, and Mann-Whitney U test was used for skewed distributed data. Results:Among the 44 patients, 5 cases (5/24, 20.8%) received plasma exchange (PE) treatment, all of whom were in group B. The numbers of patients who received and did not receive intravenous immunoglobulin (IVIG) treatment were 9 and 11 in group A, respectively, and 7 and 12 in group B (except for 5 cases who received PE treatment), respectively. Compared with group A, there was no significant decrease in hospitalization duration ( t=0.004) and total hospitalization costs ( Z=0.036), as well as costs for western medicine ( Z=0.036), examinations ( Z=0.011), laboratory tests ( Z=0.040), treatments ( Z=0.017), and nursing ( Z=3.131) in group B, and the differences were not statistically significant ( P>0.05). For patients receiving PE treatment, except for the cost of western medicine ( Z=0.062, P=0.804), the other costs ( Z=8.288, 5.013, 11.400, 10.925, 9.126) were significantly higher than those of patients not receiving PE treatment, and the hospitalization duration ( t=20.474) was significantly prolonged, with statistically significant differences ( P<0.05). The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B, with statistically significant differences ( Z=7.690, 10.314; P<0.05). There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B ( Z=0.137, P>0.05). Conclusions:There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment, especially for patients receiving PE treatment. It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.

Objective:In this study,three methods of removing microglial cells from primary astrocyte culture were compared and analyzed to explore the characteristics of different purification methods.It provides the basis for research-ers to select the appropriate primary astrocyte culture method.Methods:The cerebral cortex cells of SD neonatal rats were isolated and platted and divided into an unpurified group(control group),a traditional oscillation purification group(TO group),a cytosine β-D-arabinofuranoside(AraC)+TO group,and an AraC+L-leucine methyl ester(LME)group according to different purification methods.Cell counts were used to calculate the cell production after different purification treatments.The cell morphology of each group was observed under an optical microscope,and the proportion of glial fibrillary acidic protein(GFAP)positive cells was calculated by immunofluorescence staining.AlamarBlue HS was used to detect cell viability after passage.Results:Compared with the control group,the cell purity(P＜0.0001)and cell viability(P＜0.0001)of purified cells in the TO group were significantly increased after pas-sage,while the total number of purified cells was significantly decreased(P＜0.001).These trends were more obvious in the AraC+TO and AraC+LME group,and the cell purity(P＜0.0001 or P＜0.0001)and cell viability(P＜0.01 or P＜0.001)of purified cells in the AraC+TO and AraC+LME group after passage were significantly higher than those in the TO group.The total amount of cells obtained was significantly decreased compared with the TO group(P＜0.01 orP＜0.01).There was no significant difference between the AraC+TO and AraC+LME group.Conclusion:The culture rich in astrocytes(cell purity＞90％)was obtained by the TO method,and the cell yield was high,which could be applied to routine cell research.The highly enriched astrocyte cultures(cell purity＞99％)obtained by the AraC+TO and AraC+LME purification methods can be applied to study the precise role of astrocytes in the context of neuroinflammation.

Objective:In this study,three methods of removing microglial cells from primary astrocyte culture were compared and analyzed to explore the characteristics of different purification methods.It provides the basis for research-ers to select the appropriate primary astrocyte culture method.Methods:The cerebral cortex cells of SD neonatal rats were isolated and platted and divided into an unpurified group(control group),a traditional oscillation purification group(TO group),a cytosine β-D-arabinofuranoside(AraC)+TO group,and an AraC+L-leucine methyl ester(LME)group according to different purification methods.Cell counts were used to calculate the cell production after different purification treatments.The cell morphology of each group was observed under an optical microscope,and the proportion of glial fibrillary acidic protein(GFAP)positive cells was calculated by immunofluorescence staining.AlamarBlue HS was used to detect cell viability after passage.Results:Compared with the control group,the cell purity(P＜0.0001)and cell viability(P＜0.0001)of purified cells in the TO group were significantly increased after pas-sage,while the total number of purified cells was significantly decreased(P＜0.001).These trends were more obvious in the AraC+TO and AraC+LME group,and the cell purity(P＜0.0001 or P＜0.0001)and cell viability(P＜0.01 or P＜0.001)of purified cells in the AraC+TO and AraC+LME group after passage were significantly higher than those in the TO group.The total amount of cells obtained was significantly decreased compared with the TO group(P＜0.01 orP＜0.01).There was no significant difference between the AraC+TO and AraC+LME group.Conclusion:The culture rich in astrocytes(cell purity＞90％)was obtained by the TO method,and the cell yield was high,which could be applied to routine cell research.The highly enriched astrocyte cultures(cell purity＞99％)obtained by the AraC+TO and AraC+LME purification methods can be applied to study the precise role of astrocytes in the context of neuroinflammation.

Objective:To observe the clinical characteristics and optical coherence tomography (OCT) features of pseudopapilledema (PPE) combined with peripapillary hyper-reflective ovoid mass-like structures (PHOMS) in children.Methods:A retrospective observational study. From October 2019 to May 2021, total 22 eyes from 12 children diagnosed as PPE combined with PHOMS in the Neuro-ophthalmology Department of The First Hospital of Xi’an (Affiliated of The First Hospital of Northwest University) were recruited. Among the children, 6 were male and 6 were female. The average age was (10.6±2.7) years. The average course from disease onset to diagnosis of PPE combined with PHOMS was (8.0±7.5) months. All patients underwent best corrected visual acuity (BCVA), relative afferent papillary defect (RAPD), Ishihara's test, fundus photography, OCT, fundus autofluorescence (FAF), ocular B-mode ultrasound, visual field and patternvisual evoked potential (P-VEP). The clinical and OCT characteristics of the patients were observed.Results:The anterior segments of the patients were normal. The intraocular pressures and Ishihara's test were all normal. All RAPD were negative. Total 22 eyes, BCVA was 1.0 in 21 eyes and one eye was 0.12. The fundus photography revealed blurred optic discs margin, showing mild to moderate edema-like elevation with more prominent in the nasal parts, presenting as a "C" shape halo. No obvious abnormal fluorescence was observed in FAF. The OCT scan of involvement eyes showed an elevated appearance in vary degrees, and the sharply marginated ovoid hyper-reflective mass-like structures which laterally herniated into the peripapillary region under retinal nerve fiber layer and above the Bruch membrane were detected with consecutive nasal enlargement scanning, corresponding to the nasal parts in the fundus photography. The higher degree of elevation, the larger the volume. Macular retina pigment epithelium layer and ganglion cell thickness were normal. Ocular B-mode ultrasound showed that the head of the optic nerve in the posterior wall of the eyeball (in front of the optic disc) was elevated in all affected eyes, and there was no strong signal echo in it. Visual field examination showed physical blind spot enlargement in 3 eyes and visual field defect in 2 eyes. P-VEP examination showed that the peak was slightly delayed in 3 eyes and the amplitude was slightly reduced in 3 eyes.Conclusions:Enlarged nasal optic disc OCT scan can improve the detection rate of PHOMS. PHOMS were detected bilaterally in the cases with binocular PPE while only in the effected eye in the cases of monocular PPE; the higher degree of PPE, the lager volume of PHOMS. PHOMS were could contribute to the diagnosis of PPE in children.

Immune checkpoint inhibitors (ICI) have revolutionized the field of oncology by regulating the interaction between immune cells and cancer cells and promoting the disinhibition of the immune system, thus targeting various types of malignant tumors. However, the regulation of the immune system can also trigger related adverse reactions. Currently, there are no specific clinical guidelines for the treatment of these adverse reactions. Treatment decisions largely depend on clinical judgment and experience.The pathogenesis of ICI-related ocular adverse events is not fully understood at present. Further research on the specific mechanisms of action can provide new insights into the early diagnosis and treatment of ICI-related ocular adverse events.

Transsynaptic retrograde degeneration of optic neuropathy (TRDON) refers to the degeneration and/or apoptosis of presynaptic neurons (retinal ganglion cells) caused by damage to the lateral geniculate body and post-geniculate visual pathway. At present, the pathogenesis of TRDON is secondary apoptosis of P β-type retinal ganglion cells, resulting in the atrophy of optic tract, thinning of the retinal nerve fiber layer and retinal ganglion cell layer thickness and declining of retinal microvascular density, which are consistent with the visual field defect attributed to the primary disease. Of which, the thinning of the retinal ganglion cell layer thickness is considered as the characteristic of TRDON. Now, there is little understanding and related research on TRDON in China. Clinicians should pay attention to the characteristics and severity, occurrence time and location of the above structural changes in these patients through optical coherence tomography, and monitor the activity and progress of the lesions, so as to determine the cut-off point for drug intervention and the drug targets for developing new treatment methods, and bring benefits for patients in partial visual function recovery and disability reduction.

Objective:To provide ideas and references for the prevention and treatment of spaceflight-associated neuro-ocular syndrome (SANS) by reviewing the clinical manifestations and the potential mechanisms of this syndrome. Literature resource and selection 　References on the subject of SANS published at home and abroad. Literature quotation 　Forty published literatures were cited. Literature synthesis 　SANS was originally known as visual impairment and intracranial pressure syndrome. It was first proposed by National Aeronautics and Space Administration in 2011 and was renamed as SANS in 2017. The clinical manifestations of SANS were described as optic disc edema, globe flattening, optic nerve sheath expansion, retinal folds, decreased vision and cotton wool spots. The potential mechanisms of SANS included intracranial hypertension, fragile flow equilibrium partially and one carbon pathway metabolism alterations. Conclusions:In-depth understanding of the clinical manifestations and mechanisms of SANS and developing appropriate preventive measures can provide protection for longer and farther spaceflight.