AIM: To evaluate the application effectiveness of the 3D surgical video system and intraoperative optical coherence tomography(OCT)in idiopathic epiretinal membrane vitrectomy.METHODS: A retrospective analysis was conducted on 61 patients(61 eyes)with idiopathic epiretinal membrane at our hospital from January 2023 to October 2023. The patients were divided into two groups based on the surgical methods: with 31 patients(31 eyes)who underwent surgery using the 3D surgical video system and intraoperative OCT technology in 3D group, and 30 patients(30 eyes)underwent surgery using the Resight non-contact wide-angle lens system in traditional surgery group. Surgical time, membrane peeling time were recorded, followed-up for 6 mo, post-operative best-corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT), and complications were analyzed for the two groups.RESULTS:All patients successfully underwent surgery without experiencing serious intraoperative complications such as major retinal hemorrhage, retinal tears, or retinal detachment. Additionally, no postoperative complications such as endophthalmitis or secondary glaucoma occurred. The surgical duration and membrane peeling time in the 3D group were significantly shorter than those in the traditional surgery group(20.13±1.59 vs 25.97±2.09 min; 3.74±0.89 vs 8.13±1.72 min, respectively; both P<0.001). There were no significant differences in BCVA and CMT between preoperative and 1-month postoperative values for both groups of patients(both P>0.008). However, both BCVA and CMT improved significantly at 3 and 6 mo postoperatively compared to preoperative levels(both P<0.008). At 6 mo postoperatively, the BCVA in the 3D group was significantly better than that in the traditional surgery group(P=0.007). There were no significant differences in CMT or IOP between the two groups at any postoperative time point(all P>0.05).CONCLUSION: Both the 3D surgical video system and the traditional surgical group can treat idiopathic epiretinal membrane, but the 3D surgical video system has advantages in shortening the surgical time, improving surgical efficiency, and enhancing the precision of surgical steps during surgery with the assistance of intraoperative OCT.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

AIM: To investigate the efficacy of modified silicone oil removal combined with scleral buckling in the treatment of patients with retinal detachment under silicone oil tamponade.METHODS:The retrospective study included a total of 14 patients(14 eyes)who underwent treatment for retinal detachment with silicone oil tamponade at our hospital between January 2021 and February 2023. The modified silicon oil extraction combined with scleral buckling procedure was employed. A self-made 23-gauge suction device was applied in the silicon oil extraction, which involved removing the needle from a disposable blood transfusion set, trimming it to 2.5-3.0 mm near the beveled end, and connecting the other end to a 10 mL syringe without the plunger. The opposite end of the syringe was connected to the negative pressure system of the vitreous cutter to accomplish the silicon oil removal. Scleral compression blocks in scleral buckling surgery using a homemade composite device. No additional silicon oil was injected after the procedure. Follow-up was conducted for 6 mo, assessing retinal reattachment, best-corrected visual acuity(BCVA), intraocular pressure, and complications.RESULTS: At the 6 mo follow-up, the retina was completely reset in 13 eyes, with a retinal reset rate of 93%, and an improvement in BCVA(LogMAR)compared with the preoperative period(0.95±0.18 vs 1.15±0.21, P=0.002). Transient high IOP occurred in 6 eyes at 1 d postoperatively and returned to normal after medication control. There were no intraoperative complications such as retinal hemorrhage, retinal incarceration, or iatrogenic retinal breaks, and no postoperative complications such as endophthalmitis or choroidal detachment.CONCLUSIONS:Modified silicone oil removal combined with scleral buckling can effectively treat retinal detachment in the silicone oil tamponade and induce retinal reattachment.

Objective To investigate the relationship between the expression of Klotho,apoptosis-related factors and oxidative stress injury of the trabecular meshwork in patients with glaucoma.Methods Totally 86 patients(86 eyes)with glaucoma admitted to our hospital from October 2021 to October 2023 were selected as the study group.Tissue sam-ples of trabecular meshwork were obtained during the operation.Trabecular meshwork donor tissues(45 cases)from pa-tients with non-eye diseases were taken as the control group.Hematoxylin-Eosin(HE)staining was used to examine the histopathological characteristics,and the expression levels of Klotho,apoptosis-associated speck-like protein containing a CARD(ASC),cysteine-aspartic proteases-1(Caspase-1),superoxide dismutase(SOD)and peroxidase(POD)in trabecu-lar meshwork tissues were detected.The expression levels of Klotho,ASC,Caspase-1,SOD and POD of patients in the two groups and those expression levels in glaucoma patients with different average visual field defects were compared.The cor-relation between expression levels of Klotho,apoptosis-related proteins and oxidative stress injury of the trabecular mesh-work in glaucoma patients was analyzed by the Pearson method.Results HE staining results showed that the trabecular meshwork structure of patients in the study group was disorganized,with interlaced layers,thickened trabecular bundles and cell nucleus shrinkage,while the lamellas of trabecular meshwork tissues and trabecular cell bundles in the control group were orderly arranged,with normal forms of trabecular cells.In the study group,the expression level of Klotho in trabecular meshwork tissues was lower and the expression levels of ASC and Caspase-1 were higher than those of the con-trol group(all P＜0.05).There were statistically significant differences in the expression levels of Klotho,ASC,Caspase-1,SOD and POD in patients with different average visual field defects(all P＜0.05).With the increase in disease severity,the expressions of Klotho and SOD showed a significant decrease,while the expressions of ASC,Caspase-1 and POD showed a significant increase(all P＜0.05).Pearson correlation analysis showed that Klotho in the trabecular mesh work was negatively correlated with POD and positively correlated with SOD,while ASC and Caspase-1 were positively correlated with POD and negatively correlated with SOD(all P＜0.05).Conclusion The expression of Klotho is low in the trabec-ular meshwork tissues of patients with glaucoma,while the expressions of ASC and Caspase-1 are high.These expressions are correlated with the average visual field defect,reflecting the stress injury degree of trabecular meshwork tissues.

Objective:To observe the changes of visual acuity and fixation properties of eyes with idiopathic macular hole (IMH) before and after surgery.Methods:A prospective clinical study. From September 2019 to December 2020, 25 patients with 25 eyes of IMH diagnosed in Department of Ophthalmology of The Fourth People's Hospital of Shenyang were included in the study. All patients underwent pars plana vitrectomy (PPV) combined with internal limiting membrane stripping. All eyes underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and microperimetry before and after surgery. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into logarithmic minimum resolution angle (logMAR) visual acuity during statistics. The 12° macular sensitivity (MS) and bivariate contour ellipse area (BCEA) were measured by MP-3 microperimetry. The minimum diameter (MIN) and base diameter (BASE) of the macular hole were measured by OCT; the distance between the preferred retinal location (PRL) and the center of the fovea was measured by Image-proplus 6.0 image processing software. At 1 and 3 months follow-up after surgery, the same equipment and methods as before surgery were used to conduct related examinations. The changes of BCVA, PRL distance from the fovea, MS, BCEA, and macular hole shape before and after surgery were compared and observed. One-way analysis of variance was used to compare the indicators before and after surgery. Pearson correlation analysis was used for the correlation between BCVA and preoperative BCVA, PRL and foveal center distance at 3 months after surgery. The correlation between MIN, BCVA, PRL and foveal center before surgery distance, MS, BCEA and BCVA at 3 months after surgery were analyzed by multiple linear regression.Results:Among 25 eyes of 25 cases, 1 male had 1 eye, and 24 females had 24 eyes. The macular hole in stage Ⅲ and Ⅳ were 11 eyes and 14 eyes, respectively. MIN and BASE were 537.68±200.09 and 905.48±278.79 μm, respectively. One month after surgery, the hiatus was closed. Before surgery and 1 and 3 months after surgery, the logMAR BCVA of the affected eyes were 0.80±0.17, 0.70±0.21, 0.60±0.25, and the MS were 22.20±3.86, 23.60±3.14, 24.38±2.68 dB, the distances between PRL and the center of the fovea were 537.72±426.05, 402.00±395.06, 236.80±219.54 μm, and BCEA were 7.90±3.43, 6.40±2.67, 4.80±2.32 deg 2. Compared with before operation, BCVA ( F=7.047, 20.104) and MS ( F=1.980, 5.390) were significantly improved at different time after operation, the distance between PRL and fovea center ( F=1.265, 9.530), BCEA ( F=2.762, 13.617) were decreased, the difference were statistically significant ( P<0.05). The results of correlation analysis showed that BCVA at 3 months after surgery was significantly associated with preoperative MIN ( r=0.810), BASE ( r=0.664), BCVA before surgery and 1 month after surgery ( r=0.854, 0.940), preoperative and surgical MS at 1 month after surgery ( r=-0.548, -0.578), distance between PRL and foveal center before surgery and at 1 month after surgery ( r=0.833, 0.915), BCEA before surgery and at 1 month after surgery ( r=0.636, 0.732) were significantly correlated ( P<0.05). The results of multiple linear regression analysis showed that the distance between PRL and foveal center before surgery and BCVA were risk factors for poor prognosis of BCVA at 3 months after surgery. Conclusions:The BCVA and MS of eyes with IMH are significantly improved after surgery, and the distance between PRL and foveal center and BCEA decreased. BCVA, PRL and foveal center distance before surgery are risk factors for poor visual acuity after surgery.

Objective:To explore the differences of anterior segment parameters in Uyghur patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG) and age-related cataracts in Xinjiang.Methods:A retrospective study was conducted, Uyghur patients included 114 eyes of 84 cases with PEX, 96 eyes of 70 cases with PEXG, 88 eyes of 72 cases with POAG and 80 eyes of 80 cases with age-related cataracts (control, CON) who had received treatment in Ophthalmology Center of Xinjiang Military Region General Hospital of Chinese People's Liberation Army from April 2019 to July 2020 were selected to obtained central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL) and corneal curvature (horizontal curvature K1 and vertical curvature K2).Results:There was no significant difference in gender ratio and age of patients between CON, PEX, PEXG and POAG groups ( P > 0.05). The CCT of patients in CON, PEX, PEXG and POAG groups were (545.52 ± 34.22), (536.81 ± 42.64), (516.74 ± 32.39) and (530.38 ± 28.72) μm, respectively, the CCT in CON, PEX and POAG groups were all higher than those in PEXG group ( P < 0.05), and the CCT in PEXG group became thinner. The ACD of patients in CON, PEX, PEXG and POAG groups were (3.05 ± 0.38), (2.87 ± 0.36), (2.77 ± 0.41), (2.81 ± 0.32) mm, respectively, compared with CON group, the ACD in PEX, PEXG and POAG groups were all lower ( P < 0.05). There was no significant difference in LT, AL, K1 and K2 of patients between each group ( P > 0.05). Conclusion:This study has showed that the ACD of Uyghur patients with PEX in Xinjiang is shallower than that of CON group, but the CCT of PEXG patients is thinner than that of PEX patients.

Objective:To observe the positional relationship between the central fixation point of the retina and the fovea in normal adults.Methods:A retrospective clinical study. From August 2019 to January 2020, 100 eyes of 100 normal adults who underwent physical examination at the Fourth People's Hospital of Shenyan g were included in the study. All patients underwent BCVA, diopter, microfield, OCT examination, and axial length (AL) measurement. There were 42 males and 58 females with the average age was 46.4±14.7 years. The average diopter was -1.02±1.99 D, the average AL was 23.22±0.47 mm, the average foveal avascular zone (FAZ) area was 0.38±0.13 mm 2. The MP-3 microperimetry was used for central fixation examination. After the examination, high-definition fundus images were automatically taken and the central fixation point of the retina were automatically calculated by the equipment. The Nidek Overlay functional multi-mode imaging platform was used to superimpose the images containing the central fixation point of the retina and the macular fovea, the positional relationship between the two was observed, and the distance between the two was measured. Pearson correlation analysis was performed on the distance between the fixation point of the center of the retina and the center of the fovea, age, diopter, and FAZ area of the macula. Results:The fixation point of the retinal center of all tested eyes was within the range of the macular fovea, which did not coincide with the center of the macular fovea. Among 100 eyes, the fixation point of the center of the retina were 53, 23, 15, and 9 eyes at the nose, lower, temporal, and upper sides, respectively. The average distance between the fixation point of the center of the retina and the center of the fovea was 158.31±71.56 μm. The distance between the fixation point of the retinal center and the center of the macular fovea and age ( r=0.140), diopter ( r=-0.009), FAZ area( r=0.038) were not correlated ( P=0.165, 0.932, 0.707) in correlation analysis. Conclusion:The central fixation point of normal adult retina is more common on the fovea nasal side.

Objective:To investigate the effects of anemoside B4 on apoptosis of retinal cells in diabetic rats.Methods:Sixty Sprague-Dawley rats were randomized into three groups: the normal control(control), diabetic rats(DM)and diabetic rats treated with Anemoside B4(B4)groups(n=20, each group). Rats in the DM and B4 groups were rendered diabetic with an intraperitoneal injection of streptozotocin(STZ, 60 mg/kg). After 3 days of successful modeling, rats in the B4 group were intraperitoneally injected with anemoside B4(5 mg/kg), twice/day, for 8 weeks, while rats in the control and DM groups were injected with an equivalent volume of normal saline.After 8 weeks of anemoside B4 and normal saline injection, rats were sacrificed and retinas were harvested for examination.Paraffin sections of retina were stained with the hematoxylin-eosin(H-E)method for morphological evaluation.Protein levels of Bax and Bcl-2 were detected by using Western blot.The expression of caspase-3 mRNA was detected with quantitative PCR.Results:H-E staining results showed the control group had intact retinal structure and clear morphological features, whereas disordered retinal structure, thinner layers, and sparse and disorganized cells were seen in the DM group.However, retinal structure and morphology were improved after treatment with anemoside B4.Compared with the control group, the protein expression of Bcl-2 was lower( t=57.81, P<0.01), the protein expression of Bax was higher( t=10.47, P<0.01), and the Bcl-2/Bax ratio was lower( t=23.98, P<0.01)in the DM group.Compared with the DM group, the protein expression of Bcl-2 was higher( t=41.07, P<0.01), the protein expression of Bax was lower( t=6.811, P<0.01), and the Bcl-2/Bax ratio was higher( t=14.70, P<0.01)in the B4 group.Caspase-3 mRNA expression was higher in the DM group than in the control group( t=7.916, P<0.01), but was lower in the B4 group compared with the DM group( t=6.221, P<0.01). Conclusions:Anemoside B4 can inhibit the apoptosis of retinal cells by up-regulating Bcl-2 expression and down-regulating Bax and caspase-3 expression in diabetic rats.

Objective: To study the microstructure development of mandibular bone in rats on timing sequence and under different occlusal force. Methods: 63 male SD rats aged 23 days were randomly divided into three groups (n = 7): Baseline group, soft-diet (SD) group and hard-diet (HD) group. 7 rats were killed at week 0, 2, 4, 6 and 8 respectively after feeding the food with different hardness.Micro-CT was used to reconstruct and analysis microstructure of the region of interest in mandible of the rats. Results: Compared with HD group, bone volume/total volume (BV/TV) and trabecular thickness (Tb. Th) decreased significantly after 4 th week (P ＜ 0. 05), the bone surface/bone volume (BS/BV) and trabecular separation (Tb. Sp) increased significantly during the 4 th to the 6 th week (P ＜0. 05) . Conclusion: In the process of mandibular development in rats, reduction of occlusal force may lead to reduction of bone mass, and the changes of microstructure are closely related to the time of intervention.