目的：研究玻璃体腔注射曲安奈德(triamcinolone acetonide,TA)和雷珠单抗(Lucentis)治疗视网 膜中央静脉阻塞(central retinal vein occlusion,CRVO)的黄斑水肿的疗效。方法：配对病例对照研究。将2013年1月至2015年6月，在我院因CRVO并发黄斑水肿而接受玻璃体腔注射TA或Lucentis 的患者，根据患者基线水平的最佳矫正视力(best-corrected visual acuity,BCVA)(logMAR视力)和黄斑中心厚度(central macular thickness,CMT)将两组患者进行配对，选出12对患者，主要的观察 指标为随访1年时两组患者的BCVA和CMT。结果：TA组患者的BCVA由基线时的0.78±0.12提高到 0.55±0.24(P=0.005),CMT由基线时的(598.92±192.67) μm减少到(258.28±75.38) μm (P=0.002)。Lucentis组患者的BCVA由基线时的0.78±0.11提高到0.48±0.21(P=0.002), CMT由基线时的 (591.75±181.68) μm减少到(281.17±63.08) μm (P=0.002)。TA组和Lucentis组患者基线及最终的 BCVA和CMT直接均无显著差异。TA组的平均注药次数为(2.4±0.9)次，Lucentis组为(4.0±1.6)次， 两组有统计学差异(P=0.012)。结论：玻璃体腔注射TA或Lucentis均能减轻CRVO所致的黄斑水肿并提高视力，两者的疗效并无显著差异。TA的平均注射次数比Lucentis组少，但是TA更容易引起眼压升高。应该根据患者的综合情况制定个性化的治疗方案。

Objective: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of ranibizumab for macular edema secondary to central retinal vein occlusion (CRVO). Methods: In a retrospective assessment 12 TA-treated patients and 12 ranibizumab-treated ones with macular edema after CRVO were pairmatched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT). BCVA and CMT were the main endpoints. Results: The initial BCVA of 0.78±0.12 increased significantly to 0.55±0.24 in the TA-treated patients (P=0.005). And the initial CMT of (598.92±192.67) μm decreased significantly to (258.28±75.38) μm (P=0.002). In the ranibizumab-treated patients, the initial BCVA of 0.78±0.11 increased significantly to 0.48±0.21 (P=0.002) and the initial CMT of (591.75±181.68) μm decreased significantly to (281.17±63.08) μm (P=0.002). There was no significance between the initial and final BCVA and CMT of TAtreated patients and ranibizumab-treated patients. Conclusion: Both treatments decreased the CMT and induced an improvement in BCVA from baseline.

年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种发生在黄斑区的退行性变，其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)以黄斑区新生血管为主要病理特征，是导致老年人视力受损甚至失明的重要原因，视网膜下纤维化是wAMD最常见的自然后遗症，可导致光感受器、视网膜色素上皮(retinal pigment epithelial,RPE)和脉络膜毛细血管受损，导致不可逆转的中心视力丧失。多种基线特征被发现是视网膜下纤维化的危险因素，可用于预测早期视网膜下纤维化的发生。迄今为止，还没有有效的抗纤维化治疗方法，抗血管内皮生长因子(anti-vascular endothelia growth factor, anti-VEGF)治疗是wAMD的一线治疗方案，该治疗方法不能改善视网膜下纤维化，但及时启动治疗可能有助于预防或延缓纤维化的进展，目前多种靶向分子药物正被研发用于抗纤维化的治疗。该文综述了wAMD视网膜下纤维化的临床表现及意义、预测纤维化形成的基线特征、基本发病机制及潜在的抗纤维化治疗方法，旨在为临床诊治工作提供参考。

Age-related macular degeneration (AMD) is a degenerative disease of the macular, and wet age-related macular degeneration(wAMD) is mainly characterized by macular neovascularization, which is an important reason of visual impairment or even blindness in the elderly. Subretinal fibrosis is the most common natural sequelae of wAMD, which can lead to irreversible central vision loss by damaging photoreceptors, RPE, and choroidal capillaries. Multiple baseline features have been identified as the risk factors for subretinal fibrosis, which can be used to predict the early subretinal fibrosis. Heretofore, no anti fibrotic treatment method is effective. Anti vascular endothelial growth factor (anti VEGF) treatment is the first-line treatment for wAMD. This therapy cannot improve subretinal fibrosis, but timely initiation of treatment may help prevent or delay the progression of fibrosis. Currently, multiple targeted molecular drugs are being developed for anti fibrotic treatment. This article reviews the clinical manifestations and significance of subretinal fibrosis in wet age-related macular degeneration, baseline features for predicting the formation of fibrosis, basic pathogenesis, and potential anti-fibrosis treatment methods,aiming to provide reference for clinical diagnosis and treatment.

眼黄斑囊样水肿(cystoid macular edema,CME)是白蛋白结合型紫杉醇的罕见并发症。该文报告了一例60岁女性患者，在右侧乳腺癌根治术后进行为期7周的白蛋白结合型紫杉醇化学治疗，治疗过程中出现双眼视力下降，经眼科检查诊断为由白蛋白结合型紫杉醇引起的双眼CME。确诊后即刻停用白蛋白结合型紫杉醇，并采用口服乙酰唑胺治疗。经随访，患者停药20个月时双眼CME基本消失，同时双眼矫正视力恢复至1.0。该病例为化学治疗药物引起的CME，机制可能与紫杉烷类药物对Müller细胞和视网膜色素上皮层产生毒性作用有关。值得注意的是，其典型的特征表现为荧光素眼底血管造影未见明显的荧光渗漏。文章回顾了该病例的病程发展，并对其他文献中报道的白蛋白结合型紫杉醇诱导的CME病例的临床特点及诊疗进行了总结。同时，对白蛋白结合型紫杉醇诱导CME的潜在发病机制进行了讨论，旨在为眼科医生提供早期诊断和治疗此类疾病的思路。

Cystoid macular edema (CME) is a rare complication of nab-paclitaxel.. In our article, it is reported a case of a 60-year old woman who had undergone nab-paclitaxel chemotherapy for 7 weeks after a radical surgery for breast cancer.During the treatment, she reported vision declined, and was diagnosed as CME caused by nab-paclitaxel through ophthalmic examinations. The nab-paclitaxel was immediately discontinued after the diagnosis, and the patient was treated with oral acetazolamide instead. In the follow up visit, after stopping nab-paclitaxel for 20 months, CME was found to disappear basically, and the corrected visual acuity was restored to 1.0 in patient's both eyes. his case is CME caused by chemotherapy drugs. Its mechanism may be related to toxic effects of paclitaxel to Müller cells and the retinal pigment epithelial layer. Notably, its typical feature is that there is no obvious fluorescence leakage could be observed on fundus fluorescein angiography. In the article, the course and development of this case is reviewed, and the clinical characteristics and diagnosis and treatment of nab-paclitaxel induced CME cases reported in other literature are also summarized. At the same time, the potential the potential pathogenesis of nab-paclitaxel-induced CME is discussed, to provide reference to ophthalmologists for early diagnosis and treatment for this disease.

目的：测量黄斑区视网膜神经节细胞层和内界膜-视网膜色素上皮层厚度，分析其与新发缺血性脑卒中的相关性。方法：采用前瞻性研究，选择2021年12月至2022年3月在潍坊医学院附属医院体检的健康者30例(60眼)为对照组(A组)；选择同期收治且年龄匹配的新发缺血性脑卒中患者30例(60眼)为卒中组(B组)。比较两组黄斑区神经节细胞层(ganglion cell layer,GCL)和内界膜-视网膜色素上皮层(inner limiting membrane-Retinal pigment epithelium,ILM-RPE)厚度及平均GCL厚度/ILM-RPE平均容积厚度(GCL/ILM-RPE厚度比)。结果：共纳入120只眼，A、B组分别60只眼。A组的平均GCL为(83.5±4.7)μm，B组的平均GCL厚度为(78.7±10.5)μm，组间比较差异有统计学意义(P<0.001)。A组的GCL最小厚度为(80.4±4.4)μm，B组的GCL最小厚度为(70.7±16.3)μm，组间比较差异有统计学意义(P<0.001)。A组的ILM-RPE中心子区厚度为(247.5±19.8)μm，B组的ILM-RPE中心子区厚度为(241.6±36.3)μm，组间比较差异无统计学意义(P=0.393)。A组的ILM-RPE平均容积厚度为278.4±9.8μm，B组的ILM-RPE平均容积厚度为(278.5±15.3)μm，组间比较差异无统计学意义(P=0.448)。A组的GCL/ILM-RPE厚度比为0.300 3±0.012 2，B组的GCL/ILM-RPE厚度比为0.286 2±0.028 6，组间比较差异有统计学意义(P<0.001)。结论：缺血性脑卒中影响GCL厚度和GCL/ILM-RPE厚度比， GCL厚度和GCL/ILM-RPE厚度比与新发缺血性脑卒中可能有关。

Objective: To measure the thickness of retinal ganglion cell layer and inner limiting membrane-retinal pigment epithelium layer in the macular region, and analyze its correlation with new-onset ischemic stroke. Methods: By using a prospective study, 30 healthy subjects (60 eyes) who underwent physical examination in Affiliated Hospital of Weifang Medical University from December 2021 to March 2022 were selected as the control group (Group A). Thirty age-matched patients with new-onset ischemic stroke admitted at the same time (60 eyes) were selected as the stroke group (Group B). The ganglioncelllayer (GCL) and innerlimitingmembrane-Retinalpigmentepithelium (ILM-RPE) were compared between the two groups. It included the thickness and mean GCL thickness/Mean Volume thickness of ILM-RPE (GCL/ILM-RPE thickness ratio). Results: A total of 120 eyes were included, with 60 eyes in group A and B. The average GCL thickness in group A was (83.5±4.7) μm, and the average GCL thickness in group B was (78.7±10.5) μm,and the difference between groups was statistically significant (P<0.001). The minimum thickness of GCL in group A was (80.4±4.4) μm, and the minimum thickness of GCL in group B was (70.7±16.3) μm, showing statistical significance(P<0.001). The thickness of the central subregion of ILM-RPE in group A was (247.5±19.8) μm, and the thickness of the central subregion of ILM-RPE in group B was (241.6±36.3) μm, and the difference was not statistically significant between two groups (P=0.393). The mean volumetric thickness of ILM-RPE in group A was (278.4±9.8) μm, and the mean volumetric thickness of ILM-RPE in group B was (278.5±15.3) μm, and the difference was not statistically significant (P=0.448). The GCL/ILM-RPE thickness ratio of group A was (0.300 3±0.012 2), and that of group B was (0.286 2±0.028 6), showing a statistical difference between groups (P<0.001). Conclusion: Ischemic stroke affects the GCL thickness and the thickness ratio of GCL/ILM-RPE, which may be related to new-onset ischemic stroke.

抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗视网膜静脉阻塞(retinal vein occlusion，RVO)继发黄斑水肿(macular edema，ME)的有效性及安全性已得到广泛证实。但抗VEGF治疗方案尚无统一标准。现行的治疗方案主要包括固定治疗方案、按需(pro re nata，PRN)治疗方案、稳定性标准驱使的按需(stabilization criteria-driven PRN)治疗方案、治疗与延长(treat and extend，T&E)方案。近年来不少研究综合比较了各个治疗方案在改善视功能、量化评估疾病活动性、调整随访频率等多个维度的表现，为临床医生提供选择抗VEGF治疗方案的参考依据。本文旨在回顾并总结近年来对抗VEGF药物治疗RVO继发ME的研究，阐述抗VEGF治疗方案的研究进展。

The efficacy and safety of anti-vascular endothelial growth factor (VEGF) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) have been widely confirmed. However, there is no unified standard for anti-VEGF treatment regimens. Current treatment regimens mainly include fixed treatment regimen, pro re nata (PRN) treatment regimen, stabilization criteria-driven PRN treatment regimen, and treat and extend (T&E) regimen. In recent years, many studies have compared different treatment regimens in composite dimensions,including improving visual function, assessing disease activity quantitatively and adjusting the follow-up frequency,to provide clinicians with a reference of choosing anti-VEGF treatment regimens. The purpose of this article is to review and summarize recent researches on anti-VEGF drugs in the treatment of ME secondary to RVO, and to clarify the research progress in the anti-VEGF treatment regimens.

目的：观察并分析不同类型黄斑裂孔的患病相关影响因素。方法：回顾性分析2012年1月 至2018年12月在兰州大学第二医院住院治疗的1 150例(1 202只眼)全层黄斑裂孔患者的年龄、性别、民族、最佳矫正视力、黄斑裂孔类型以及是否继发孔源性视网膜脱离等临床资料。结果：黄斑裂孔患病人数随年龄增长呈趋势性分布，60~69岁年龄段患病人数最多；男女患病差异有统计学意义(P<0.05)，眼别差异无统计学意义(P>0.05)；特发性黄斑裂孔继发孔源性视网膜脱离的占比明显低于其他类型；特发性黄斑裂孔的入院最佳矫正视力较高，与高度近视黄斑裂孔相比，差异有统计学意义(P<0.05)。结论：黄斑裂孔多发于老年人，女性多见，高度近视黄斑裂孔容易继发孔源性视网膜脱离，可考虑尽早安排手术治疗；外伤性黄斑裂孔好发于中青年男性，常见于眼球钝挫伤，若未引发视网膜脱离等并发症，应适当观察而不急于手术。每1例黄斑裂孔都可能有其特殊性，需要认真分析病情综合判断，酌情选择观察或手术。

Objective: To observe and analyze the disease related factors of different types of macular hole. Methods: Clinical data including age, sex, ethnicity, best corrected visual acuity, macular hole type and whether accompanied by rhegmatogenous retinal detachment were retrospectively analyzed in 1 150 patients (1 202 eyes) hospitalized in our hospital from January 2012 to December 2018. Results: The number of patients with macular hole increased with age. There was statistically significant difference between male and female patients (P<0.05), and no statistically significant difference between eyes (P>0.05). The rate of rhegmatogenous retinal detachment caused by idiopathic macular hole was significantly lower than other types. The optimal corrected visual acuity of idiopathic macular hole was higher in admission, which was statistically different from that of high myopia macular hole and ametropia macular hole (P<0.05). Conclusion: Macular hole is more common in the elderly and more common in women. High myopia and ametropia macular hole are easily associated with rhegmatogenous retinal detachment, so surgical treatment should be arranged as soon as possible. Traumatic macular hole often occurs in young and middle-aged men and is often seen in blunt contusion of the eyeball. Each case of macular hole may have its particularity, which requires careful analysis of the condition, comprehensive analysis, and appropriate choice of observation or surgery.

目的：探究特发性黄斑前膜(idiopathic macular epiretinal membrane，IMEM)患者在光学相干断层扫描(optical coherence tomography，OCT)的形态学改变与视力的相关性。方法：回顾性研究。基于OCT图像4级分级方案，纳入3级及以下的特发性黄斑前膜患者35例共37只眼进行OCT扫描，并借助第三方软件分析并获取每只眼在黄斑中心凹直径分别为1、3、6 mm共3个同心圆区域内视网膜各层的平均厚度值，并按照是否存在内核层(inner nuclear layer，INL)囊样改变分为两组。通过建立最小分辨角对数(minimum resolution angle in logarithmic，logMAR)最佳矫正视力(best corrected vision acuity，BCVA)与视网膜各层厚度值的多元线性回归方程，以及比较有INL囊样改变及无INL囊样改变两组的视力，分析视力与视网膜各层厚度值及INL囊样改变的关系。结果：多元线性回归分析显示，在直径1 mm的区域内，logMAR BCVA与神经纤维层(retina nerve fiber layer，RNFL)、INL的厚度值均呈正相关(均P<0.05)，而在直径3 mm和6 mm的区域内，logMAR BCVA仅与INL的厚度值呈正相关(均P<0.05)。与无INL囊样改变组相比，有INL囊样改变组视力及INL厚度差异均有统计学意义(均P<0.05)。结论：特发性黄斑前膜患者当前的视力主要与RNFL和INL厚度值相关。发生在INL层的囊样改变可能很好的提示INL增厚，其与视力具有相关性，具有这种囊样改变的患者往往视力也较差。

Objective: To investigate the morphological changes detected by spectral domain optical coherence tomography (OCT) and their relevance to vision in patients with idiopathic macular epiretinal membranes (IMEM). Methods: This is a retrospective study. OCT recorded 37 eyes with stage 3 and below IMEM according to the 4-level grading system based on OCT images among 35 patients. We managed to obtain thickness of all retina layers in three concentric circular regions with a diameter of 1 mm, 3 mm and 6 mm across macular fovea with the help of a third-party software. Plus we divided all 37 eyes into two groups according to whether there were cystic changes in the inner nuclear layer (INL). Multiple linear regression analyses were performed between thickness of all retina layers and current minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The difference of BCVA between groups with cystic changes and without was also compared. Thus, the relationships between visual acuity and thickness of retina layers, cystic changes in INL were analyzed. Results: Multiple linear regression analyses revealed that thickness of both retina nerve fiber layer (RNFL) and inner nuclear layer have positive correlation with logMAR BCVA in the region with a diameter of 1 mm (P<0.05), while in regions of a diameter of 3 mm and 6 mm, only INL thickness remained positively relevant (all P<0.05). There were significant differences in BCVA and thickness of INL between groups with INL cystic changes and without (all P<0.05). Conclusion: Current visual acuity among preoperative IMEM patients was mostly associated with thickness of RNFL and INL. Cystic change in INL layer may be a good indicator of INL thickening and was visually correlated. Those with this change tend to have worse vision.

目的：探讨无糖尿病性视网膜病变(diabetic retinopathy，DR)的糖尿病人群中，糖尿病与近视对黄斑区节细胞-内丛状层(ganglion cell layer and inner plexiform layer，GCIPL)厚度纵向变化的影响。方法：纳入广州糖尿病眼病研究中1165名基线无视网膜病变的糖尿病和正常对照者，纵向随访2年。根据是否存在近视[等效球镜(spherical equivalent，SE)≤-3屈光度(diopter，D)]和糖尿病分为健康组(n=508)、糖尿病组(n=525)及糖尿病合并近视组(n=132)。扫频光学相干断层成像(swept source-optical coherence tomography，SS-OCT)技术测量并比较三组间GCIPL厚度的变化，以确定糖尿病和近视的影响，三组间差异使用协方差分析，采用线性混合模型分析评估GCIPL厚度与相关因素的关系。结果：对照组的SE为(1.07±1.06) D，糖尿病组为(1.02±1.00) D，糖尿病合并近视组为(-5.36±2.30) D，组间差异有统计学意义(P<0.001)。对照组基线GCIPL厚度为(71.1±0.3) μm，糖尿病组为(74.4±0.2)μm，糖尿病合并近视组为(71.7±0.5) μm。在2年随访过程中，对照组GCIPL厚度下降-0.10(95%CI：-2.03~0.05) μm/年，糖尿病组GCIPL厚度下降的速度为对照组的12倍[-1.21(95%CI：-24.04~0.05) μm/年，P<0.001]，糖尿病合并近视组GCIPL厚度下降的速度为对照组的22倍[-2.17(95%CI：-21.63~0.10)μm/年，P<0.001]。结论：近视是无DR的糖尿病患者中GCIPL加速变薄的危险因素，糖尿病和近视在GCIPL损伤中可能存在协同作用。

Objective: To investigate the association between myopia and ganglion cell layer and inner plexiform layer (GCIPL) in diabetic population without diabetic retinopathy (DR). Methods: In this Guangzhou Diabetic Eye study, a total of 1 165 patients aged 30–80 years were recruited followed up longitudinally for 2 years. According to the presence or absence of myopia [spherical equivalence (SE)≤-3 diopter (D)] and diabetics, the patients were divided into a healthy group (n=508), a diabetes mellitus group (n=525), and a diabetes mellitus + myopia group (n=132). GCIPL was measured via swept-source optical coherence tomography. Univariable and multivariable mixed models were used to show the association of GCIPL change and baseline parameters. Results: SE was (1.07±1.06) D in the healthy group, (1.02±1.00) D in the diabetes mellitus group and (-5.36±2.30) D in the diabetes mellitus + myopia group (P<0.001). The baseline GCIPL thickness were (71.1±0.3), (74.4±0.2), and (71.7±0.5) μm, respectively. The slope of GCIPL thickness was -0.10 (95% CI: -2.03 to 0.05) μm/year in the healthy group, which was 12 folds faster than those in the diabetes mellitus group [-1.21(95% CI: -24.04 to 0.05 μm/year, P<0.001] and 22 folds higher among those in diabetes mellitus + myopia group [-2.17 (95% CI: -21.63 to 0.10) μm/year, P=0.009]. Conclusion: Both myopia and diabetes status accelerate macular ganglion cell layer and inner plexiform layer thinning in diabetic patients without diabetic retinopathy.