Objective: To discuss the systemic and ocular manifestations of patients with multiplex Takayasu arteritis (TA) and improve the ability of ophthalmologists to diagnose and treat TA. Methods: Retrospective case series study was used. From March 2018 to May 2022, a total of 14 TA patients were admitted to the Department of Rheumatology and Ophthalmology in Shandong Provincial Hospital Affiliated to Shandong First Medical University. They were diagnosed by ophthalmology consultation and treated in the Department of Rheumatology and Immunology. Their systemic manifestations, ocular clinical manifestations, and treatment outcomes were summarized. Results: There were 13 female patients and 1 male patient in our TA cohot. Mean age was (35.57±9.77) years. The most common classification of TA was 7 cases of type I (50%). Others were type II (2 cases of Abdominal aorta and/or renal arteries involved, 14.3%) and 5 cases of type IV (combination of type I and type II, 35.7%), 0 cases of type III. The most common location of involvement was brachiocephalic arterial trunk (85.7%). TA patients had a variety of systemic manifestations, the most common was upper extremity hypotension-related manifestations. Severe cardiovascular and cerebrovascular complications occurred in 4 patients (28.6%). Ocular abnormal was the initial manifestation in 5 patients (35.6%), and 3 eyes were misdiagnosed as cataract (21.4%). Best corrected visual acuity (BCVA) of the TA patients was -1.0 with no light perception, among with 21 eyes had 1.0 (75%) and 4 eyes had a BCVA less than 0.1 (14.3%). Only 4 eyes were totally normal (14.3%) and the remaining 24 eyes (85.7%) had ocular abnormalities. Lens opacity, chronic scleral hyperemia and dilated pupil were the most frequent manifestations in ocular anterior segment. Fundus manifestations were dominated by hypoperfusion retinopathy (20 eyes, 71.4%) and 4 eyes suffered from hypertensive retinopathy (14.3%). Patients with Type I had a higher prevalence for developing hypoperfusion retinopathy than type II patients. Ischemia-induced fiscrete arteriovenous shunt and wreath-like anastomosis around the optic disc were the most typical fundus manifestations. Retinal neovascularization, proliferative vitreoretinopathy and retinal detachment were the most serious retinal complications. Corticosteroids and immunosuppressive agents were administered in all the patients. Most of the patients remained stable, while progression of retinopathy still could be seen in 3 eyes even after pan-retinal photocoagulation and intravitreal injection of anti-VEGF drug treatemnt. Conclusions: TA is a relatively rare chronic vasculitic obstructive lesion that occurs more often in young women. This group of cases mainly involved brachiocephalic artierial trunk. TA has a high possibility of ocular involvement and may lead to various ocular abnormalities. Anterior segment manifestations secondary to ischemia were the relative recognizable signal for diagnosis of TA. Hypoperfusion retinopathy was the most common fundus manifestations, and might cause serious ocular complications. Ophthalmologists should improve awareness and diagnostic capacity for multiple TA and value the detailed eye examination of TA patients.

Eyes can be affected by systemic diseases. Ocular manifestations can be used to evaluate, help to diagnose and observe systemic diseases including cardiovascular diseases, neurological disorders, autoimmune diseases, infectious diseases and drug-related eye diseases. Paying attention to the manifestations of systemic diseases in the eye is of great significance for the improvement of clinical diagnosis and treatment in ophthalmology and related specialties.

Objective: To evaluate the repeatability and reproducibility of quantification of macular and peri-papillary superficial capillaries in normal eyes using Cirrus HD-OCT 5000 angiography. Methods: Forty normal eyes were included in this prospective study. Angiography 3 mm × 3 mm scan protocol centered on the disc or macula of the same eye was repeated 3 times by operator A in the same period on 3 days (T1, T2, T3) within 1 week,and the FastTrac^TM image tracking function was turned on during the scan. Operator B repeated the same scan independently at T2 after operator A. Angio Plex Metrix^TM quantification software (version 10.0) was used to automatically measure the vessel length density (VD) and vascular perfusion density (PD) of macular and peri-papillary superficial capillaries. One-way analysis of variance or nonparametric test was used to compare the VD and PD measurements of the 3 scans. The intraclass correlation coefficient (ICC) and coefficient of variation (CV)were calculated to evaluate the intra-operator repeatability. Consistent correlation coefficient (CCC), repeatability coefficient (CR), and CV were calculated to evaluate the inter-operator reproducibility. Results: There was no statistically significant difference in the measurements of VD and PD between the 3 scans of the macular and peri-papillary superficial capillaries by operator A (P>0.05). The ICC values for the 3 scans of VD and PD of the macular and peri-papillary superficial capillaries by operator A were 0.260–0.517 and 0.362~0.898, respectively.The CV values of the VD and PD of the macular and peri-papillary superficial capillaries were all <8.1%. The inter-operator CCC values of the macular and peri-papillary superficial capillaries were 0.3130–0.5665 and 0.5149~0.7801,respectively; the CR values of the VD and PD of macula were 3.2212–4.6399 and 0.0574–0.0832, respectively; the CR values of the VD and PD of optic disc were 2.0675–4.0630 and 0.0447–0.0730, respectively. The CV values of macular were all <9.0%, and the CV values of optic disc were all <6.9%. Conclusion:The macular and peri-papillary superficial capillaries parameters in the same period on different days have a good repeatability and reproducibility,while the superficial macular blood flow parameters have relatively poor repeatability and reproducibility.

Objective: To investigate the correlation between the retinal vessel density (VD) and the degree of visual field loss in chronic primary angle-closure glaucoma (CPACG). Methods: Eighty-nine CPACG patients (112 eyes)with different degrees of visual field loss were measured with optical coherence tomography angiography (OCTA) for macular VD and para-optic microcirculation VD, and the correlation between them and the degree of visual field defect were analyzed. Results: There was a negative correlation between the VD of the microcirculation in each zone next to the optic disc and the degree of visual field loss (r>–0.728, P<0.05). The receiver operating characteristic (ROC) and area under the curve (AUC) of the total VD of the superficial macula is 0.874. Under the condition of controlling age, intraocular pressure and vision, for every 1% decrease in the total superficial macular VD, the average visual field defect mean deviation (MD) value increases –0.639 dB. Conclusion: The VD of CPACG patients is linearly negatively correlated with visual field defects. OCTA can conveniently and non-invasively observe the blood flow of the fundus in patients with glaucoma. It is found that the retinal VD is reduced before visual field defects, which can be used as a reference index for early diagnosis of CPACG.

Objective: To investigate the progression of visual field defect in primary open angle glaucoma (POAG), and to explore the related risk factors for its progression. Methods: A retrospective analysis was performed on patients with POAG who had at least 4 visual field examinations in the Department of Ophthalmology, Peking University Third Hospital from January 2014 to July 2018. The visual field was staged according to the mean deviation or mean defect of the first visual field examination. Linear regression analyses of mean deviation or mean defect were performed against time, and corresponding regression slopes (in decibels per year) were calculated. Patients were divided into progressive and non-progressive groups according to the mean deviation slope or mean defect slope. The relationship between retinal nerve fiber layer (RNFL) thickness lesion location, mean follow-up interval, baseline visual field staging, and the progression of visual field defect in glaucoma were analyzed. Results: A total of 128 patients (252 eyes) were included. Among them, 129 eyes were followed up with an Octopus perimeter, and the average mean defect value of the baseline visual field was 10.91±5.76 dB; while the other 123 eyes were followed up with a Humphrey perimeter, and the average mean deviation value of the baseline visual field was –10.62±6.89 dB. The proportion of early, middle and late visual field defects was 26.19%, 36.51% and 37.30%. There were 31 eyes (12.30%) in the progressive group and 221 eyes (87.70%) in the non-progressive group. Patients with severe damage to both the upper and lower RNFLs had more visual field defects (P<0.001). Patients with an average follow-up interval ≤4 months had a higher rate of progression than those with an average follow-up interval >4 months (P=0.058).There were no significant differences in baseline visual field stage, age, gender, and total follow-up time between the progression and progression-free groups. Conclusion: Deterioration of visual function impairment is common in glaucoma patients. The progression of visual field defects is associated with severe impairments which are present both in the upper and lower RNFLs, and short follow-up intervals. Optic nerve structure changes are related to functional impairment, and the location of structural changes is suggestive of functional impairment progression.Regular follow-up visits are of great significance for disease monitoring. For patients who may progress rapidly, the follow-up interval should be shortened.

Objective: To observe and analyze the changes of anterior segment and refractive state in patients with chronic angle closure glaucoma after trabeculectomy. Methods: It was a prospective study. A total of 20 cases with 20 eyes that have met the inclusion criteria undergoing trabeculectomy were collected. The diopter of spherical power,corneal curvature, axial length (AL) and anterior chamber depth (ACD) were measured before the surgery and 1 week, 1 month, and 3 months after the surgery respectively. Results: There was significant difference (P<0.05)for the diopter of spherical power before and 1 week after the trabeculectomy, the difference was (?1.20±0.55) D.After 1 month and 3 months, the diopter of spherical power was not statistically significant (P>0.05). The corneal curvature in the vertical direction was (44.89±1.20) D, (45.72±1.54) D, (45.65±1.35) before, 1 week and 1 month after operation. The corneal curvature in the vertical direction increased significantly at 1 week and 1 month after operation (P<0.05), and there was no significant difference (P>0.05) after 3 months. The preoperative mean ocular axis length (22.49±0.43 mm) and mean anterior chamber depth (2.75±0.45 mm) compared with postoperative mean ocular axis length (21.60±0.59 mm) and mean anterior chamber depth (2.25±0.34 mm) were statistically significant (P<0.01). Comparing 1 month and 3 months after operation, there was no significant difference in the depth of the anterior chamber and the length of the eye axis (P>0.05).Conclusion: In the early stage after trabeculectomy (1 month after operation), the diopter of spherical power can be increased. The ACD became shallower, the eye axis became shorter, and the curvature of vertical direction increased resulting in myopic drift,which affected postoperative visual acuity. Over time (3 months after operation), the anterior chamber deepened,the axial length gradually increased, the vertical astigmatism and myopia drift degree gradually decreased, the anterior segment and refractive changes gradually stabilized, and the postoperative visual acuity gradually recovered.

Objective: To compare the ocular biometric parameters between the acute primary angle closure (APAC) eyes and the fellow eyes as well as the risk factors associated with APAC. Methods: From January 2008 to March 2020,222 monocular APAC patients over 45 years old from the Glaucoma Department of Zhongshan Ophthalmic Center, Sun Yat-sen University were retrospectively studied. Patients with binocular attack, previous attack in the fellow eyes, and secondary factors such as lens-induced and traumatic glaucoma were excluded. Ocular biometric parameters including axial length (AL) and lens thickness (LT) were measured with A-scan ultrasound, while the anterior chamber depth (ACD) was measured by ultrasonic biological microscope. AL, ACD, LT and relative lens position (RLP) were compared between the APAC and the fellows eyes. Results: The average age of onset was (62.57±9.14) years. The ACD was (1.75±0.27) and (1.88±0.31) mm, AL was (22.34±0.80) and (22.35±0.83) mm,LT was (5.14±0.38) and (5.17±0.42) mm, and the RLP was 0.195 and 0.198 for the APAC and the fellow eyes,respectively. Compared with the fellow eyes, the ACD of the APAC eyes was shallower, and the RLP was more anterior (both P<0.001), while the differences of AL and LT were not statistically significant (both P>0.05).Furthermore, AL of patients with a younger age of onset (aged 45 to 59 years) was shorter than that of those with an older age of onset (aged 60 to 69 or over 70 years); patients with an onset age of over 70 years have shallower ACD and more anterior RLP, all statistically significant (P<0.05). In addition, correlation analysis indicated that younger onset age was significantly correlated to shorter axial length of APAC eyes (P<0.001). Conclusion:APAC eyes had shallower ACD and more anterior RLP. Shorter AL and female were associated with APAC attack between individuals. Shallower ACD, thicker lens and more anterior RLP are potential risk factors for APAC among aged population.

Objective: To explore the effect of Silent Information Regulator 1 (SIRT1) on cell function of human trabecular meshwork cell (HTMC) under oxidative stress by overexpressing SIRT1 in HTMC. Methods: This is an experiment research. HTMCs were transfected with SIRT1-ovexpressed lentivirus and GFP-negative control lentivirus (Lv-GFP) at the optimal multiplicity of infection (MOI). Real-time quantitative PCR was used to verify whether SIRT1 was overexpressed in HTMC. The following experiments were divided into four groups: normal control group, H₂O₂ group,H₂O₂+Lv-SIRT1-OE group, H₂O₂+Lv-GFP group. Cell migration was detected by transwell assay. Cell viability was detected by CCK8 assay. Student’s t-test was used for two groups. P<0.05 was set as statistical signifificance. Results: The number of migration per well of normal control group, H₂O₂ group, H₂O₂+Lv-SIRT1-OE group, H₂O₂+Lv-GFP group were 436±73,254±25, 510±51, 327±46, respectively. Compared with H₂O₂ group and H₂O₂+Lv-GFP group, transwell assay demonstrated that the number of migrations per well of H₂O₂+Lv-SIRT1-OE group significantly increased (P<0.01). Likewise, CCK8 assay indicated that cell viability of H₂O₂+Lv-SIRT1-OE group was higher than both of H₂O₂ group and H₂O₂+Lv-GFP group (P<0.01). Compared with H₂O₂+Lv-SIRT1-OE group and negative control group (H2O2+Lv-GFP), the expression level of Bax decreased significantly,and the expression level of Bcl-2 increased significantly (P<0.01). ROS assay showed that the ROS level in H₂O₂+Lv-SIRT1-OE group was significantly lower than that in H2O2 group (P<0.05). Conclusion:SIRT1 overexpressed in HTMC can effectively reduce the effect of oxidative stress on migration ability and proliferation activity of HTMC, which lays a foundation for further study on the regulatory mechanism of SIRT1 protecting HTMC under oxidative stress.

Glaucoma is a leading cause of irreversible blindness in the world. It brings great damage and heavy economic burden to patients, their families and society. Under the Vision 2020 initiative, great progress has been achieved in the glaucoma prevention and treatment in China, but there are still severe challenges ahead. In the future, the Guideline for Glaucoma Care in China (2020) will act as the blueprint of the prevention and treatment of glaucoma in China. Efficient, convenient and accurate screening and diagnosis of glaucoma will be achieved relying on the artificial intelligence technology. Personalized and precision therapy will be carried out based on individual and disease characteristics and social environment. Also, lifelong monitoring and guidance of patients will be realized in the context of the whole life cycle of chronic diseases. Glaucoma care will be further improved to continuously reduce vision impairment and blindness caused by glaucoma.

Glaucoma is the first irreversible blinding eye disease in the world. How to detect early, diagnose timely, treat appropriately and adhere to follow-up management has always been the direction of Chinese ophthalmic clinical workers. At present, the world is undergoing profound changes, and China is in the best period of development since modern times. In the next 5–10 years, there will be many remarkable achievements in the field of glaucoma prevention and treatment in China. Based on our personal understanding of this specialty, we look forward to the development of glaucoma management in China in the future, and wish to make greater progress in blindness prevention and treatment in China.