Objective: To explore the application of Optical Coherence Tomography Angiography (OCTA) in non proliferative diabetic retinopathy (NPDR) in Kashi area. Methods: Thirty two patients with non proliferative diabetes and 50 normal controls were selected from the ophthalmology department of our hospital. OCTA data of the areas of the Superficial Retinal Vascular Plexus (SVP), the Deep Retinal Vascular Plexus (DVP) and the Deep Capillary Free Zone (FAZ) were obtained from the two groups. Results: In the NPDR group, there were 11 males (34.375%) and 21 females (65.625%), with an average age of 58 ± 9.89 years, an average age of 13.39 ± 7.2 years of diabetes, an average glycosylated hemoglobin value of 9.48 ± 2.28 mmol/L, and an optimal corrected visual acuity (BCVA) of 0.54 ± 0.3. There are 50 cases in the normal control group, with 21 males (42%) and 29 females (58%). The best corrected visual acuity (BCVA) is 0.97 ± 0.12. The SVP blood flow density (%) in the NPDR group was (21.65 ± 5.38), while the normal control group was (26.36 ± 6.23). The DVP blood flow density (%) in the NPDR group was (19.12 ± 4.3), while the normal control group was (27.51 ± 2.95). The FAZ area (mm2) in the NPDR group was (0.51 ± 0.15), while the normal control group was (0.41 ± 0.14). Compared with the normal control group, the SVP blood flow density and DVP blood flow density in the NPDR group were significantly reduced, while the FAZ area was significantly increased, And it has statistical significance (P=0.001, P=0.000, P=0.003, respectively). Conclusion: OCTA is helpful for the diagnosis of non proliferative diabetes patients in Kashi area, and may be able to detect the retinal blood flow changes of diabetes retinopathy earlier.
A 5 years old girl complained of “right eye exotropia and poor vision of the right eye for 4 years” visited to the Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine on November 15, 2023. The child had a full-term vaginal delivery, and there was no abnormality in her personal and family history. Eye examination showed normal palpebral fissures in both eyes and no obvious ptosis. Both eyes had clear corneas, normal anterior chamber depth, and clear lenses. The pupil of the right eye was approximately 6mm dilated and unresponsive to direct light reflection, and the pupil of the left eye was approximately 2.5mm and sensitive to direct light reflection. Fundus examination showed clear optic disc border in both eyes and no obvious abnormality in retina. The visual acuity of both eyes was 0.3 in the right eye and 0.7 in the left eye. The cycloplegic refraction of compound tobicamide eye drops was +1.25D=0.3 in the right eye and +1.25D=0.7 in the left eye. The intraocular pressure was normal in both eyes. Eye movement examination showed a normal eyelid position, dilated pupil, weakened response to light, and the exotropia was increased lasted for about 2 minutes of the right eye in paralysis stage. While during the spasm period, the eyelid position of the right eye was normal, and the eye position of the right eye gradually changed from exotropia to esotropia. The pupil of the right eye was constricted and the response to light weakened for about 15s (Video 1). Brain and orbit enhanced magnetic resonance imaging showed no abnormal lesions. We diagnosed “periodic oculomotor nerve palsy and right amblyopia in the right eye.”
Dominant optic atrophy (DOA) is an inherited optic neuropathy and more than 75% of DOA patients harbor pathogenic mutations in OPA1. We reported a 39-year-old female harboring c.2119G>T mutation of OPA1 and manifested progressive visual impairment after hydroxychloroquine (HCQ) therapy. The patient’s visual impairment remained stable for 10 years until she began to take HCQ 13 months ago. She complained about progressively decreased vision in both eyes. Bilateral pale temporal optic disc was similar with that of 11 years ago. Optical coherence tomography showed bilateral moderate retinal nerve fiber layer thinning other than the nasal quadrant and general thinning of the inner retina in the macular. Microcystic macular edema was noted in nasal macular in both eyes. Visual field testing showed paracentral scotoma and microperimetry showed decrease sensitivity in the macular in both eyes. After the patient stopped taking HCQ, her functional tests including visual acuity, field testing and microperimetry testing was stable compared with those of 2 years ago. However, progressive inner macular and RNFL thinning was shown by OCT. OPA1 c.2119 G>T found in this patient was a mutation that had been rarely reported in previous studies. The patient has been followed up for over 10 years and her visual acuity stayed stable for decades long until she took HCQ for 13 months. Her vision decline terminated after she stopped taking HCQ. Although HCQ toxicity is highly related to the duration and daily dose, HCQ may aggravate visual impairment in certain individuals harboring OPA1 mutation. Patients with DOA should avoid using neurotoxic HCQ and other medications that may interfere mitochondrial metabolism.
Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm2 to postoperative (2 472.54±394.32)/mm2 (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia
Polypoidal choroidal vasculopathy (PCV) is a common blinding disease in Asian populations. Massive hemorrhage secondary to PCV includes subretinal hemorrhage (SRH) and vitreous hemorrhage (VH). The risk factors for SRH include a long duration, clustered PCV, and non-regression of polyp lesions. The treatments for SRH including anti-vascular endothelial growth factor drugs, photodynamic therapy, laser, vitreous pneumatic displacement, intravenously injected tissue plasminogen activator, vitrectomy and combination therapy. Whether macular fovea is involved and the time since bleeding onset are the main factors affecting the choice of treatment for SRH. Older age of onset, history of hypertension, retinal pigment epithelium detachment, photodynamic therapy history and larger SRH area were associated with higher risk of VH. PCV patients with massive VH should be treated with vitrectomy, while the timing and technique of operation should be paid attention to. At present, the risk factors of PCV massive bleeding are not completely clear, and its treatment methods are diverse, which requires a large number of studies to prove its effectiveness and establish expert diagnosis and treatment consensus.
This paper raises questions on the article titled Expert consensus on the application of retrobulbar block issued by Eye Science, Vol. 38, No. 9, 2023. We consider that there are objections to the contraindications, operating steps, and causes of postoperative ptosis and contralateral amaurosis of retrobulbar block anesthesia.
Objective: To review the medical records and genetic etiology of a family with congenital nuclear cataract. Method: A slit lamp photo was used to capture the characterization of the anterior segment. High throughput sequencing technology was applied to detect genetic eye disease related genes in the proband, screen for related variants, and Sanger sequencing method was used to verify mutation sites in the proband and family members, determining a new type of CRYGC gene mutation. Result: The second generation of this family is autosomal dominant inheritance, with clinical phenotypes of congenital nuclear cataracts and microphthalmia; The CRYGC gene test showed a new heterozygous mutation on chromosome 2q33.3 C130fs, mutation type is frameshift mutation. Conclusion: The CRYGC (p.C130fs) mutation is one of the pathogenic molecular basis for this congenital nuclear cataract family.
Ferroptosis is a newly identified form of cell death distinguished by iron accumulation and lipid peroxidation. In the field of ophthalmology, research on ferroptosis is progressively expanding, particularly focusing on age-related macular degeneration, glaucoma, diabetic retinopathy, retinitis pigmentosa, and retinal degenerative diseases. The iron metabolism pathway is a primary mechanism for regulating iron homeostasis. Key proteins such as transferrin (TF), divalent metal transporter 1 (DMT1), ferritin (FT), and ferroportin 1 (FPN1) play critical roles in ferroptosis, which is implicated in retinal degenerative diseases. This article provides a review of the concept of ferroptosis, its relationship with the retina, the regulatory pathways of ferroptosis, and the key proteins involved in iron metabolism within retinal degenerative diseases.
