Glaucoma stands as the leading cause of irreversible blindness, with primary open-angle glaucoma being the predominant type.Although its pathogenic mechanisms are intricate, lowering intraocular pressure remains the most effective treatment.Mainstream glaucoma surgeries aim to lower intraocular pressure by increasing aqueous humor outflow.Over the past two decades, microinvasive/minimally invasive glaucoma surgery (MIGS) has emerged as a hotspot in this field, focusing on minimizing incisions.Domestic practices have followed closely, but clinical outcomes have not been ideal.Based on a comprehensive understanding of the anatomy and pathophysiology of the aqueous outflow pathway and the design principles of various MIGS procedures, ophthalmologists should recognize the advantages and limitations of each technique.It is important to rationally choose between internal and external drainage MIGS and standardize their implementation.In the future, the use of non-invasive multimodal imaging techniques for preoperative assessment of the structural and functional aspects of the eye is expected to facilitate personalized selection and planning for precise treatment.

The pathogenesis, diagnosis and management of glaucoma are complex and the population with glaucoma is huge in China now.With the development and popularization of cataract surgery, the visual disability and blindness caused by glaucoma are becoming more and more prominent.With the advantages of the combination of clinical pathway and public health in China, it is necessary to pay close attention to the following focuses of the prevention and control of glaucoma according to China's national conditions.(1)The awareness of glaucoma prevention and control should be strengthened, and the relevant screening technology and the construction of special team should be promoted to achieve the goal of early screening, early diagnosis and early treatment.(2)The diagnosis and treatment guidelines for glaucoma should be further well-established to promote the application of appropriate technologies in glaucoma diagnosis and treatment.In addition, glaucoma should be included in the chronic disease management system to accelerate the establishment and improvement of a three-level medical network system.(3)At the same time, the rehabilitation measurement for the patients with glaucomatous low vision should be reinforced to reduce the glaucomatous blindness rate.(4)The whole-process management for glaucoma patients should be enhanced, and nationwide popular science education should be well implemented.

With the accelerated development of aging society, the incidence of glaucoma is increasing in recent years.Glaucoma is a primary cause of irreversible blindness worldwide and affects the visual and life quality of patients, which will bring great burden to the prevention and control of blindness in China. Terminology and Guidelines for Glaucoma formulated by European Glaucoma Society (EGS) is a classic document of Glaucoma guidelines.Recently, EGS released the Terminology and Guidelines for Glaucoma (5th edition), which put forward some updated concepts of diagnosis and therapy of glaucoma, primarily in several renewed key issues and the problems to be avoided in clinical practice.In the document, central corneal thickness is not recommended to correct intraocular pressure during the diagnosis and follow-up of glaucoma, and gonio-imaging devices do not replace gonioscopy in the diagnosis of angle-closure glaucoma, and optical coherence tomogranphy should not be used as the sole indicator in the early evaluation and dynamic monitoring of glaucoma.In addition, some available suggestions about anti-glaucoma drugs and surgeries are recommended for the managements of glaucomatous patients.The updated recommendations in the Terminology and Guidelines for Glaucoma (5th edition) are enunciated in this paper.

Somatostatin, also called somatotropin release-inhibiting factor (SRIF), is a kind of neurotransmitter, neuromodulator and neurotrophic factor, which participates in a variety of physiological functions in the central nervous system by activating the five G-protein-coupled receptors (sst 1-sst 5). SRIF and its receptors are extensively expressed and distributed in retina.Activation of SRIF receptors modulates voltage-gated K + and Ca 2+ channels, and regulates multiple intracellular signaling pathways in retinal cells, then influences neurotransmitter release and synaptic transmission, which plays an important role in the regulation of retinal visual information processing.In addition, SRIF and its receptors may provide protective effects against retinal injuries, such as retinal ischemia, excitotoxic injury and diabetic retinopathy.In this article, connected with related previous researches of our team, the distribution of SRIF and its receptor in retina, as well as the role of SRIF and its receptor in the physiological regulation and neuroprotection of retina were reviewed.

Objective:To evaluate the clinical application of the SITA faster (SFR) visual field strategy in glaucoma patients.Methods:A diagnostic test was adopted.A total of 72 subjects who visited the Eye and ENT Hospital Affiliated to Fudan University during September 2018 to February 2019 were collected, including 28 normal subjects (56 eyes) and 44 glaucoma patients (86 eyes). The consistency and convenience of visual field tests were evaluated using SITA Standard (SS) and SITA Fast (SF), or SS and SITA Faster (SFR) in normal subjects and glaucoma patients.Test duration, visual field index (VFI), mean deviation (MD) and the number of defect points with probabilities of <5%, <2%, <1%, and <0.5% in the pattern deviation probability plots were recorded, and tested for difference, correlation and consistency.This study followed the Declaration of Helsinki.Written informed consent was obtained from all subjects prior to their entering the study cohort.The study protocol was approved by the Ethics Committee of the Eye and ENT Hospital of Fudan University.Results:For all of the included subjects, the mean test durations of SF and SFR were (64±13)% and (44±10)% compared to that of SS, respectively.MD and VFI evaluated by SS and SF, or by SS and SFR, showed no significant difference in either the normal subjects or the glaucoma patients (all at P>0.05). Across all included subjects, the positive correlation and consistency of MD and VFI were good ( r=0.99, P<0.01). However, for the results of the probability points in the pattern deviation probability blot, there was no difference among normal subjects, but the correlation and consistency were not good.In the deviation probability blot, there was a greater number of defect points of P<0.5% in glaucoma patients evaluated via SS compared to those evaluated by SFR, and the difference was statistically significant ( Z=-2.28, P=0.02). Apart from this, the number of defect points in glaucoma patients showed no difference between SS and SF, or between SS and SFR, and the correlation and consistency were higher in glaucoma patients than those in the normal subjects. Conclusions:Compared with SF and SS, SFR saves more test time.Except for partial variances in the pattern deviation probability blot, the difference between visual field strategies is relatively small and the results are basically consistent.

The pathogenesis and clinical manifestations of glaucoma in children are quite complex and diverse.Because the visual function of childhood is in a developing stage, even the intraocular pressure is controlled well, the visual function of childhood glaucoma patients is often poor from ametropia and amblyopia.So the prognosis is unsatisfying.New diagnostic classification of childhood glaucoma of the World Glaucoma Association showed that, except for glaucoma associated with acquired conditions and secondary glaucoma following cataract surgery, ocular anterior segment dysplasia in tissue structure and genetic factors are involved in the pathogenesis to different degrees in other classifications of childhood glaucoma.Therefore, it is very important for researchers to actively carry out genetic evaluation for childhood glaucoma.Current research status of molecular genetics in childhood glaucoma is briefly described here to emphasize that the researchers should make full use of available disease resources in China to carry out the study of molecular genetics in the diagnosis and classification of childhood glaucoma, which can provide more evidences for the prevention and treatment of blindness in children and healthy birth policy.

Objective To explore the rare nonsynonymous variants of ABCA1 gene in primary open angle glaucoma (POAG).Methods A prospective cohort study was carried out.Three hundred and ninety-eight POAG patients and 198 healthy controls matched in age and gender were recruited from March 2017 to March 2018 in Eye and Ear Nose Throat (ENT) Hospital of Fudan University.The periphery blood of 2-5 ml from all the subjects was collected for extraction of DNA,and rare variant analysis of the ABCA1 gene was conducted by whole exome sequencing (WES) data of these subjects.The study protocol was approved by Ethic Committee of Eye and Ear Nose Throat Hospital of Fudan University and Sichuan Provincial People's Hospital (No.2016-32-1,and written informed consent was obtained from each subject prior to entering the study cohort.Results A total of 21 rare nonsynonymous variants (minor allele frequency MAF＜0.O1) were detected in the coding regions of ABCA1 gene in 27 subjects of the 398 POAG,with the detection rate of 6.8％.Among them,c.4310C＞A (p.Thr1437Asn),c.3772G＞T(p.Asp1258Tyr),c.775A＞G (p.Lys259Glu) and c.1507_1508insGAGGT (p.Glu503GlyfsX7) were four novel variants.In the 198 healthy controls,five rare nonsynonymous variants were detected in the ABCA1 gene from five subjects respectively,with the detection rate of 2.5％,the detection rate of nonsynonymous in POAG group was higher than that in healthy control group,showing a significant difference (x2=4.72,P =0.03,OR =2.81).Conclusions Rare nonsynonymous variants in ABCA1 is associated with the pathogenesis of POAG.These variants can enrich the variation spectrum of ABCA1.

Reducing intraocular pressure is the only proven effective treatment of glaucoma.Drug therapy,laser and open surgery are the mainstay clinical tools to achieve this goal and surgical treatment has always been one of the most important method.In recent years,a variety of new methods of glaucoma surgeries were employed in clinical practice,which gave glaucoma surgeons more options.Minimally invasive glaucoma surgery (MIGS) is undoubtedly a topic of intense interest.In addition to new surgical procedures,many glaucoma treatment concepts have been updated.The role of lens extraction in the treatment of angle-closure glaucoma is another hot debate recently.For some classic glaucoma surgery,such as the well-known ciliary body destructive surgery used to treat for absolute glaucoma,has been found useful for early or mid-term glaucoma patients.It suggests that we need to reconsider these classic surgeries.Finally,Chinese ophthalmologists are facing special challenges of our own.Without the aid of mitomycin C (MMC),how to achieve good effects of filtering surgery is a conundrum for everyone.With the abovementioned numerous questions,how to choose a reasonable glaucoma surgery method has become the concern of glaucoma specialists.This article will discuss the development of glaucoma surgery as well as special issues in glaucoma surgery in China,aiming to illustrate the above mentioned questions.

Objective To investigate the ultrastructural changes of mitochondria and dynamic changes of mitochondrial dynamics related genes in chronic ocular hypertension rat models.Methods Forty Sprague-Dawley (SD) rats were randomized into normal control group,modeling 3 day-group,modeling 7 day-group and modeling 14 day-group.Glaucoma models were induced by translimbal laser photocoagulation of trabecular meshwork in rats.The number of survival retinal ganglion cells was evaluated by retrogradely labeling of FluoroGold.The morphological change of mitochondria in optical nerve was observed under the transmission microscope.The dynamic changes of mitochondrial dynamic-related gene expression in the retina in gene and protein levels were detected by real-time fluorescence quantitative PCR and Western blot assay,respectively.The experiment complied ARVO Statement for the Use of Animals in Ophthalmic and Vision Research and approved by the Animal Experimentation Ethics Committee of the Eye and ENT Hospital of Fudan University.Results The intraocular pressure was significantly higher in the modeling 3-day group,modeling 7-day group and modeling 14-day group than that in the normal control group (all at P＜0.01).Compared with the normal control group,the immunoreactivity of glial fibrillary acidic protein (GFAP) was increased in the Müller cells in all modeling retinas,and the relative expressing levels of GFAP protein were significantly mcreased in all modeling groups (F =91.47,17.58,both at P＜0.01).Compared to the normal control group,the number of mitochondria was increased,and the mitochondrial health degree in the optic nerve and the nearest neighbor distance between adjacent mitochondria were decreased in the modeling 3-day group and 14-day group (all at P＜0.05).The expression levels of dynamics-related protein 1 (Drp1),parkin protein,PINK1,KIF5B and Miro1 mRNA in the retina were significantly elevated in the modeling 3-day group (all at P＜0.05).In addition,the expression levels of optineurin,parkin and OPA1 proteins were higher in the modeling 3-,7-and 14-day groups than those in the normal control group (all at P＜0.05).Conclusions Dysfunction of mitochondria and changes of mitochondrial dynamics exist in RGCs of glaucomatous rats,including increased mitochondrial fission and fusion as well as the activation of mitophagy pathway,which probably are the mechanism of RGC damage in glaucoma.

Objective To explore the relationship between blood lipid level and primary open angle glaucoma(POAG)and intraocular pressure(IOP).Methods A retrospective case-control study was designed.80 POAG patients from EYE & ENT hospital of FUDAN university were collected as a case group from January 2015 to May 2016.Meanwhile 80 age and gender matched healthy people were collected as a control group.The differences of gender in men subgroup (POAG:44,Control:39) and female subgroup (POAG:36,Control:41) showed no statistic significance.Serum total cholesterol(TC),total triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(Apo A) and apolipoprotein B(Apo B) were measured using Roche automatic biochemical analyzer.The analysis of the above mentioned lipid levels between POAG group and control group was conducted by independent student′s T test and multivariate logistic regression.The relationship between lipid level and IOP was analysied using Pearson correlation test.Results The TG level was (1.40±0.71)mmol/L in the POAG group,(1.00±0.37)mmol/L in the control group.The difference had statistic significance (t=4.467,P<0.001).The HDL-C level in the POAG group was (1.22±0.36)mmol/L,(1.38±0.25)mmol/L in the control group.The difference also had statistic significance (t=-3.228,P=0.002).Comparison between the men subgroup and female subgroup found that the TG level in the POAG group of men was (1.47±0.71)mmol/L,(1.01±0.36) mmol/L in the control group and the HDL-C level were (1.14±0.31) mmol/L,(1.32±0.20)mmol/L in two groups.Both the level of TG and HDL-C had statistic significance in men (t=3.717,P<0.001;t=-3.240,P=0.002).The TC,TG level in the POAG group and control group of women respectively were (4.59±0.81)mmol/L,(1.33±0.72)mmol/L and (4.21±0.64)mmol/L,(0.99±0.38)mmol/L.Both blood level were significantly higher than the control group in women (t=2.278,P=0.026;t=2.503,P=0.016).Logistic regression analysis showed that the TG level correlated with POAG (P=0.004,OR=2.831,95% CI=1.392-5.759)and both POAG in the men and women (P=0.025,OR=3.223,95% CI=1.156-8.989;P=0.045,OR=2.554,95% CI=1.020-6.395).Pearson test showed that the TG level of POAG patients was positively associated with IOP in spite of gender(P<0.05).Conclusion The peripheral blood level of TG was significantly increased in the POAG patients and significantly correlated with IOP,which indicated that the increased peripheral blood level of TG may be the independent risk factor for the POAG..