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Abstract Objective The aim of this study is to elucidate the factors contributing to the occurrence of retinal detachment (RD) following prophylactic vitrectomy in cases of acute retinal necrosis (ARN) syndrome. Methods A retrospective examination was undertaken, encompassing the medical records of patients diagnosed with ARN who underwent prophylactic vitreous intervention at the Ophthalmology Department of Wuhan University Renmin Hospital East Campus between October 2019 and September 2023. Subsequently, patients who manifested RD in the postoperative period were identified, and a comprehensive analysis was conducted to ascertain the factors underlying the occurrence of RD post-surgery. Results This study comprised 14 cases (involving 14 eyes) of patients diagnosed with ARN who underwent prophylactic vitreous intervention. The findings revealed that 4 patients experienced postoperative RD, resulting in an incidence rate of 28.57%. Notably, among these cases, 3 cases of RD manifested in the presence of silicone oil, while 1 case occurred subsequent to the removal of silicone oil. All 4 cases of RD exhibited varied degrees of proliferative vitreoretinopathy. Following the occurrence of RD, all patients underwent a secondary vitreous intervention coupled with silicone oil tamponade, leading to successful reattachment of the retina. However, despite these interventions, there was no significant enhancement observed in postoperative visual outcomes when compared to preoperative levels. Conclusion RD following prophylactic vitrectomy in cases of ARN is not an infrequent occurrence and is primarily linked to the postoperative onset of proliferative vitreoretinopathy.

Maintaining the homeostasis of intracellular components degradation and recycling, autophagy is a critical control mechanism of cellular quality. It promotes the degradation of cell components to provide nutrients and energy for cellular metabolism in stress response. The retina is a light-sensitive tissue that transduces and processes visual images in the eye, and it has a high demand for substances and energy. Basal autophagy is essential for holding retinal homeostasis and the normal function of the visual system. Therefore, the latest studies that investigating the participation of autophagy in eye diseases such as glaucoma, age-related macular degeneration, diabetic retinopathy, retinal dystrophies, and retinal detachment were summarized, providing a theoretical basis for the future treatment of eye diseases by regulating autophagy.

Abstract Background Posterior lenticonus is an uncommon congenital abnormality that causes a progressive, localized spherical or conical bulging of the posterior capsular membrane, resulting in an abnormal shape of the lens. Case presentation A 13-year-old girl presented with ametropia in both eyes. After mydriasis, examination revealed an oval bubble-shaped alteration with a distinct boundary above the temporal region on the center of the posterior capsule of her left lens. The subcortical region surrounding the alteration appeared feathery and turbid. The patient had no history of trauma or family history of visual impairment. Systemic investigations were normal. A thorough eye examination was performed, which included optometry, ultrasound biomicroscopy, ocular B-Scan, and anterior segment optical coherence, to assess the disease. The patient was diagnosed with posterior lenticonus in the left eye, as well as ametropia and anisometropia in both eyes. Conservative treatment was initiated since the patient’s current best corrected visual acuity was good, and regular monitoring of the condition’s progression was scheduled. Conclusions This case report presents a rare instance of posterior lenticonus. The findings of this report raise new considerations regarding the necessity of surgical intervention for this condition.

Epiretinal membrane(ERM)is a retinal disease characterized by a fibrocell membranes that can develop on the inner surface of the retina. The existing clinical guidelines and literature have reached a consensus on the diagnosis and treatment of ERM, but the explanation of their mechanism is still controversial. Transforming growth factor-β(TGF-β)is a highly pleiotropic cytokine that plays an important role in wound healing, angiogenesis, immune regulation, cancer, inflammation and fibrosis diseases. Studies have increasingly shown that ERM is a kind of pathological changes in fibrosis that caused by the posterior vitreous detachment(PVD)and lead to the retinal inflammatory damage and epithelial to mesenchymal transition(EMT)of retinal pigment epithelial cells. A variety of cytokines regulate TGF-β-mediated EMT process by participating in the non-classical TGF-β-Snail pathway and the classical TGF-β-Smad pathway. At present, some drugs targeting cytokines related to the above pathway have entered the development stage, which is of great significance to provide new ideas for clinical treatment and prevention of ERM. This review reviews the progress of TGF-β related cytokines in ERM formation.

With the continuous progress and development of modern surgical equipment, the types of intraocular lens and the continuous improvement of people's requirements for visual quality, cataract surgery has been transformed from traditional vision restoration surgery into a high-quality and high-demand refractive surgery. Piggyback intraocular lens implantation was originally a new surgical method for clinicians to implant two or more posterior chamber intraocular lenses in patients' eyes to correct hyperopia or secondary correction refractive errors after cataract surgery. With the birth and promotion of functional lenses in recent years, this surgical method has been applied to the field of refractive cataract surgery, which expanded the application of functional intraocular lens and achieved good postoperative effect. This review discusses the development and current clinical application of Piggyback intraocular lens implantation, and further expounds its development trend in the future.

Refractory macular hole(MH)mainly includes large MH, high myopia MH, persistent MH, recurrent MH, and traumatic MH. Compared with ordinary MH, the closure rate in patients with refractory MH through conventional vitrectomy combined with internal limiting membrane(ILM)peeling is greatly reduced. Currently, the ILM flap technique has gradually been applied for the treatment of refractory MH and achieved higher MH closure rate and better visual function recovery. The ILM flap technique has many variations, including the difference of size, shape, number, and method in which the flaps put on the MH, but each has its own advantages, disadvantages and application limitations. So far, there is no recognized standard procedure for the treatment of refractory MH. This paper reviewed the surgical methods and therapeutic effects of ILM flap technique appeared in domestic and foreign literature, which is aimed to provide a reference for the selection of clinical procedures for refractory MH by new ILM flap technique needs to be explored in the future.

AIM: To investigate effects of different corneal protective agents on ocular surface in vitrectomy in patients with diabetes.METHODS: Totally 90 patients(90 eyes)with diabetes who received vitrectomy were randomly divided into HPMC group(30 eyes), SHSCS group(30 eyes)and BSS group(30 eyes). Hydroxypropyl methyl cellulose(HPMC)and sodium hyaluronate sodium chondroitin sulfate(SHSCS)were used to cover the corneal surface to avoid the cornea drying in HPMC group and SHSCS group, respectively. Balanced salt solution(BSS)was continuously dripped on the cornea to keep the cornea moist in BSS group. Schirmer Ⅰ test(SⅠt), breaking up time(BUT)and central corneal thickness were performed before and after operation. Their changes were observed and compared.RESULTS: At 1wk and 1mo after operation, compared with HPMC group and SHSCS group, SⅠt was significantly increased and BUT was significantly shortened in BSS group(P0.05). At 1d after operation, the corneal thickness of BSS group was significantly increased compared with HPMC group and SHSCS group(P0.05).CONCLUSION:The patients with diabetes use HPMC and SHSCS can protect the cornea and maintain the stability of tear film in vitrectomy. Different corneal protectors can be selected according to the clinical practice.

AIM: To compare the effect of platelet-rich fibrin(PRF)grafts and conjunctival-limbal autografts in pterygium excision.METHODS: Totally 62 cases(62 eyes)of primary pterygium were randomly divided into group 1(32 eyes)and group 2(30 eyes). After pterygium excision, conjunctival-limbal autografts was performed in group 1 and PRF grafts was performed in group 2. PRF was prepared by centrifugation and compression of venous blood from patients before the surgery. The follow-up period was 6mo. The surgery time, complications and recurrence rate were evaluated and compared between the two groups.RESULTS: The operation time of group 1 and group 2 were 27.3±4.3min and 22.0±4.0min respectively. There was significant difference between the two groups(t=4.990, PP=0.484). Pterygium recurred in one eye in group 1 and in one eye in group 2. There was also no significant difference in recurrence rate between group 1 and group 2(P=1.000). There was no significant difference in intraocular pressure between group 1 with 14.69±2.44mmHg and group 2 with 14.96±2.93mmHg before the surgery(t=0.399, P=0.691). As well, there was no significant difference in intraocular pressure between group 1 with 14.68±1.65mmHg and group 2 with 15.11±2.12mmHg after the surgery(t=0.888, P=0.378). The dissolution time of PRF membrane in PRF grafts group was 3.5±0.8d.CONCLUSION: The use of PRF in pterygium surgery is safe, effective, easier and timesaving. It's a promising method for clinical application.

Age-related macular degeneration(ARMD)is one of the main causes which lead to irreversible blindness. Wet ARMD, which is featured by choroidal neovascularization(CNV), takes up 90% in ARMD related blind patients. With the increasing population of aged people in China, wet ARMD has become a severe social and medical issues. Currently, management aiming at wet ARMD is the applications of anti-VEGF agents. Anti-VEGF drugs not only postpone the development of CNV, but also preserve the visual function, improve the prognosis, and reduce the incidence of blindness. However, we still need to focus on the non-response during treatment, long-term maintenance, drug resistance, adverse reactions, and economic effectiveness. Here we review the recent clinical medications on wet ARMD.

Neovascular glaucoma(NVG)is a common refractory glaucoma in ophthalmology, which is usually secondary to central retinal vein occlusion(CRVO), diabetic retinopathy(DR), long-standing retinal detachment, ocular tumors, etc. Previous treatments mainly included panretinal photocoagulation(PRP), drugs, anti-glaucoma surgery or ciliary destruction, but the therapeutic effect was unsatisfactory. With the continuous development and application of anti-vascular endothelial growth factor(VEGF)drugs, combination therapy of anti-vascular endothelial growth factor(VEGF)drugs has been proposed gradually, and the success rate of NVG surgery has been increased significantly, and NVG can be controlled. The treatment progress of NVG in recent years will be described in detail.

AIM: To investigate the association between interleukin-10 (IL-10) genetic polymorphisms and risk of POAG through a case-control study in a Han population of China. METHODS: A total of 210 patients with POAG and 420 normal subjects were recruited during the period from Dec. 2013 to Dec. 2016. The IL-10 -1082A>G (rs1800870), -819T>C (rs1800871) and -592C>A (rs1800872) polymorphisms were determined using iPlex GOLD SNP genotyping analysis (the SequenomMassARRAY® System, Sequenom, San Diego, USA). The association between IL-10 -1082A>G (rs1800870), -819T>C (rs1800871), and -592C>A (rs1800872) polymorphisms and risk of POAG was assessed by singlelogistic regression analysis. RESULTS: We observed that those carrying the CC genotype of rs1800871 was associated with an increased risk of POAG when compared with those harboring the TT genotype (OR=1.84, 95%CI=1.01-3.38). Those with AA genotype of rs1800872 had a 10.62 fold risk of POAG in comparison to the CC genotype (OR=10.62, 95%CI, 3.41-33.09). A completely linkage disequilibrium was found between IL-10 rs1800871-rs1800872 (D’=1.00, r2=0.16). The A-C-A (OR=2.60, 95%CI, 1.48-4.58) and G-T-A (OR=2.34, 95%CI, 1.42-3.86) haplotypes were associated with an increased risk of POAG, while the A-T-C haplotype showed a decreased risk of POAG (OR=0.63, 95%CI, 0.49-0.81). CONCLUSION: Our data suggest that IL-10 rs1800871 and rs1800872 can be predictive factors for the pathogenesis of POAG in the Chinese population.

Serpiginous choroiditis(SC)is a rare, chronic-idiopathic inflammatory disease mainly involving choriocapillaris and the retinal pigment epithelium(RPE), characterized by grayish yellow geographic lesions. Pathogenesis is unclear, the choriocapillaris is a main pathology of SC. Based on clinical presentation, it can be classified into peripapillary, macular, and ampiginoustype. The clinical appearance of SC is varied and similar to those of acute posterior multifocal placoid pigment epitheliopathy(APMPPE), tuberculosis, toxoplasmosis and choroidal ischemia. So, it is still difficult to diagnose SC without typical fundus symptoms.With the development of science and technology, multimode imaging such asfundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography are helpful for the diagnosis of SC, assessment of lesion extent, activity, and complications. Besides, it's very important to avoid unnecessary drug use.

AIM: To observe the effect of topical 0.05% cyclosporine A (CsA) on the ocular surface and tear protein lacritin in a botulinum B-induced dry eye rat model. METHODS: A total of 36 female SD rats were randomly divided into 3 groups, botulinum B was injected into the right lacrimal gland of all rats. Group A and group B were treated with 0.05% CsA and 0.1% sodium hyaluronate, respectively, 3 times daily. The control group was not treated. Basal tear flow, corneal epithelial defects, and lacritin levels were measured. RESULTS: Tear secretion in all rats was reduced on day 3 and was even lower on day 7 postoperation (P

AIM: To explore the effects of overnight orthokeratology lens and conventional frame glasses on the myopic diopter, uncorrected visual acuity and ocular parameters of myopia adolescent. METHODS: Totally 102 cases of(204 eyes)of adolescent myopia patients were randomly divided into observation group and control group with 51 cases(102 eyes)in each group during April 2014 to April 2017. Control group was only given conventional frame glasses, and observation group was given overnight orthokeratology lens. The myopic diopter and uncorrected visual acuity(UCVA)before wearing glasses and at 1wk, 1, 3, 6mo and 1a of wearing glasses, and the ocular parameters before wearing glasses and at 1a after wearing glasses were observed in the two groups, and the occurrence of complications was compared between the two groups. RESULTS: After 1wk to 1a of wearing glasses, the myopic diopter in observation group was gradually decreased(PP>0.05), but there was statistically significant difference between-groups at different time points(PPPP>0.05), and the axial length in control group was significantly longer than that before wearing glasses and that in observation group(PP>0.05).CONCLUSION: Overnight orthokeratology lens for adolescent myopia can effectively correct the myopic diopter, and improve the uncorrected visual acuity. It is less harmful to the eyes and less complications, and it is safe and reliable in clinical application.

Familial exudative vitreoretinopathy(FEVR)is a rare inherited disorder of retinal angiogenesis. It is characterized by avascular peripheral retina. Mutations in FZD4, NDP, LRP5, TSPAN12, ZNF408, KIF11 have been found the causation genes of FEVR. The phenotypic features are variable, when some patients are asymptomatic while some may suffer from neovascularization, exudation, hemorrhage, retinal folds and retinal detachment. The use of FFA can help to identify the disease in the earlier stage, enabling timely treatment. The current treatments include laser photocoagulation, scleral buckling, vitrectomy and intravitreal anti-VEGF injections as an adjunctive therapy before surgery. With the development of genome research on this disease, the more effective diagnosis and treatments would be available.

In recent years,with the widespread application of highly effective antiretroviral therapy(HAART), the incidence of human immunodeficiency virus(HIV)and acquired immunodeficiency syndrome(AIDS)related eye complications was significantly reduced. The absolute number of patients infected with HIV and AIDS increased year by year, and the survival rate increased and the survival time prolonged. The clinical manifestations of associated ocular complications in these patients are variable, affecting almost all ocular structures. At present, there is a lack of large-scale and long-term systematic observation of eye lesions in HIV-infected and AIDS patients in China. Misdiagnosis and missed diagnosis occur in many hospitals and even in some of the top-three hospitals. This not only delays the treatment of patients, but also easily cause iatrogenic transmission. Therefore, ophthalmologists and even other medical workers should enhance their knowledge of HIV/AIDS. This paper reviews the common complications of non-infection, opportunistic infection, and immune reconstitution inflammatory response syndrome(IRIS)in the HIV/AIDS patients, and discusses the manifestations and research progress of posterior ocular complications of HIV/AIDS.

AIM:To compare the effectiveness of inverted internal limiting membrane flap(ILMF)coverage combined with sterile air tamponade or C3F8-filled surgery for idiopathic macular hole(IMH). METHODS: In this retrospective study, 165 patients(175 eyes)who underwent pars plana vitrectomy(PPV)combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air(Group A)and C3F8-filled(Group B)groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity(BCVA), macular hole closure rate, and major postoperative complications were analyzed. RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively(PPPPPCONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C3F8-filling, sterile air tamponade can avoid IOP elevation; it may replace C3F8-filling in PPV for IMH.

AIM: To explore the modulation effects of 17-β estradiol(E2)and tamoxifen(TAM)in chronic intraocular hypertension mouse model. METHODS: We performed anterior chamber injection of magnetic beads to induced chronic ocular hypertension models. Adult C57BL/6 male mice were used in the experiments and randomly divided into four groups: control, Beads group, E2 group and E2+TAM group. The intraocular pressure(IOP)were measured by Tonolab tonometer. Central retinal thickness was evaluated by HE staining. Brn3a as a specific marker of retinal ganglion cells(RGCs), were stained and counted by immunohistochemistry(IHC)staining. Glial fibrillary acidic protein(GFAP)as a marker of proliferation of astrocytes, was quantified using western blotting. RESULTS: The IOP level was significantly elevated after anterior chamber injection of magnetic beads compared to control group(PPvs Beads group), especially in E2+TAM group in 2wk. The RGCs happened to degenerated in Beads group after 2wk, while the effects were reversed by E2+TAM(PP>0.05). The expression level of GFAP increased caused via beads injection, however, decreased in E2 and E2+TAM group(PCONCLUSION: E2 and E2+TAM could both effectively decrease the IOP level in chronic intraocular hypertension mouse model, increase the survival of RGCs from high intraocular pressure, suppress expression of GFAP, which indicated neuroprotective effects of E2 and TAM in glaucoma through an anti-inflammatory effects.

AIM: To explore the effect of ciliary neurotrophic factor (CNTF) on retinal ganglion cell (RGC)-5 induced by hydrogen peroxide (H2O2). METHODS: After cell adherence, RGC-5 culture medium was changed to contain different concentrations of H2O2 from 50 to 150 µmol/L at four time points (0.5, 1, 1.5 and 2h) to select the concentration and time point for H2O2 induced model. Two different ways of interventions for injured RGC-5 cells respectively were CNTF as an addition in the culture medium or recombinant lentiviral plasmid carrying CNTF gene transfecting bone mesenchymal stem cells (BMSCs) for co-culture with RGC-5. RESULTS: Compared to the control group, H2O2 led to RGC-5 death closely associated with concentrations and action time of H2O2 and we chose 125 µmol/L and 2h to establish the H2O2-induced model. While CNTF inhibited the loss of RGC-5 cells obviously with a dose-dependent survival rate. Nevertheless two administration routes had different survival rate yet higher rate in recombinant lentiviral plasmid group but there were no statistically significant differences. CONCLUSION: Both the two administration routes of CNTF have effects on RGC-5 cells induced by H2O2. If their own advantages were combined, there may be a better administration route.

AIM: To observe the concentration of RBP4 and IL-6 in vitreous of proliferative diabetic retinopathy(PDR). METHODS: A total of 65 patients(66 eyes)were enrolled in Department of Ophthalmology, Renmin Hospital of Wuhan University from February 2017 to July 2017 with the informed consent. The patients were divided into PDR group(23 cases)and NPDR group(16 cases). Twenty-six patients without diabetic mellitus(DM)served as control group. The demography was matched among the groups, but the course of DM, the blood glucose level and the HbA1c level were elevated in the PDR group and the NPDR group(all PRESULTS: The concentration of RBP4 in PDR group, the NPDR group and control group were 13.68±2.66, 11.03±1.12, 10.45±1.17μg/mL, and the concentration of IL-6 were 56.0±10.27, 20.92±5.77, 10.26±1.91pg/mL. RBP4 and IL-6 concentrations were elevated in PDR group compared with NPDR group and control group, with significant difference among three groups(F=12.135, 161.167; PPP>0.05). Pearson correlation coefficient was significant positive between RBP4 concentration and IL-6 concentration(r=0.606, P=0.001). CONCLUSION: RBP4 is probability involved in the inflammation pathogenesis of PDR. These results indicate that RBP4 could be a new target for the diagnosis and treatment of PDR.

Familial exudative vitreoretinopathy(FEVR)is a hereditary disease associated with abnormal angiogenesis in the pediatric period. The most prominent finding of the disease is avascularity in the peripheral retina.Whereas, the phenotypic features are variable. In some minor cases, missed diagnosis would happened due to asymptom, while, in severe FEVR, neovascularization, retinal exudation, retinal folds, macular heterotopy and retinal detachment may occur and give rise to extremely poor vision or even blindness. Mutations in the FZD4, LRP5, NDP, TSPAN12, ZNF408, and KIF11 genes have been reported to contribute to FEVR with X-linked recessive, autosomal dominant, and autosomal recessive inheritance manners. We have summarized aspects of pathogenesis, clinical features and classification, mutations genes as well as diagnosis and treatment of FEVR in this review.

Given the poor prognosis of proliferative diabetic retinopathy(PDR), the morbidity of PDR has also increased recent years. Modern surgery has undergone a very impressive development over the last 10a due to the evolution of methods, techniques and extension of surgical indications. In this article, we will review the current choices of the surgery time, perioperative managements, as well as the methods of the vitrectomy.

AIM: To evaluate the long-term safety and efficacy of vitrectomy and internal limiting membrane (ILM) peeling with or without gas tamponade for highly myopic foveoschisis. METHODS: We performed an open-label, observer-blinded clinical trial of 85 patients with myopic foveoschisis between 2000 and 2012. Patients were randomly allocated to one of two groups, those who received vitrectomy and ILM peeling without gas tamponade (no-gas group) or those who with gas tamponade (gas group) and follow up at least 5y. RESULTS: Visual acuity of gas group improved from 0.82±0.33 to 0.79±0.73 in 6mo, improved to 0.71±0.67 in 1y and within this range in the following 4y. Visual acuity of no-gas group improved from 0.81±0.46 to 0.78±0.66 in 6mo, improved to 0.70±0.65 in 1y. The finial visual acuity of two groups were significantly increased compared with the baseline (P

AIM: To investigate the effect of HtrA1 on the proliferation, migration and apoptosis of human retinal pigment epithelium (RPE) cells in the light injured model, as well as the expression of the apoptosis related molecules. METHODS: The human RPE cell line ARPE-19 was exposed to blue light to establish the light injured model. The cells were transfected with HtrA1 siRNA to knockdown HtrA1 expression. Subsequent expression of HtrA1 was determined by real-time polymerase chain reaction (RT-PCR) and Western blot, respectively. Changes in cell proliferation, migration and apoptosis were assessed by cell counting kit-8 (CCK-8), Transwell assay and flow cytometry respectively, as well as changes in the mRNA and protein levels of Bax, Caspase-3 and Bcl-2 expression. RESULTS: HtrA1 was highly expressed in ARPE-19 cells after blue light irradiation. Knockdown of HtrA1 expression inhibited the proliferation, migration and apoptosis of the blue-light-irradiated ARPE-19 cells (P

AIM: To evaluate the effectiveness of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap technique for macular hole retinal detachment(MHRD)of high myopia. METHODS: This was a retrospective case series. Totally 27 patients(27 eyes)who were diagnosised with MHRD of high myopia and underwent vitrectomy combined with inverted ILM flap covering technique were eIlrolled in this study. The diopter was ≥-6.00D and axial length was ≥26mm. The mean age was 53.69±7.23 years. And there 9 males and 18 females. The logarithm of the minimum angle of resolution(LogMAR)best-corrected visual acuity(BCVA)was 1.41±0.28. All patients were performed PPV with inverted ILM flap, resected the vitreous gel and cortex completely. Bright blue G stained the ILM around the fovea. The ILM was peeled off around the MH, and some portion of the ILM flap was left attached to the edge of the MH. Covering the MH with the ILM flap.Then, C3F8 gas or silicone oil was injected into the vitreous cavity. The mean follow-up was more than 6mo and BCVA, MH closure, retinal reattachment, complications were retrospectively observed. RESULTS: After surgery, visual acuity improved in 21 eyes(78%), unchanged in 4 eyes(15%), decreased in 2 eyes(7%). The mean LogMAR BCVA was 0.84±0.40, the difference was significant(t=7.32, PCONCLUSION: PPV combined with inverted internal limiting membrane flap is an effective and safe management for the MHRD of high myopia.

AIM: To observe the expression of proline hydroxylase domain 2 (PHD2) in the retina of diabetic rats and investigate the relationship between PHD2 and relevant intraocular vascular proliferation factors. METHODS: Sixty male specific pathogen free (SPF) Sprague-Dawley (SD) rats were randomly divided into two groups: the diabetic group and the control group. The rats in the diabetic group were intraperitoneally injected with 60 mg/kg (0.60 mL/100g) of streptozotocin to induce a diabetic rat model. The rats in the control group were injected with an equal volume of sodium citrate buffer solution by the same method. Hematoxylin-eosin (HE) staining and immumofluorescence (IF) method were adopted to observe the pathological changes of retinal tissues and the expression of PHD2, glial fibrillary acidic protein (GFAP), vascular endothelial growth factor (VEGF) by 8wk. RT-PCR method was applied to detect the expressions of mRNA of PHD2, VEGF and GFAP. The relationship between PHD2 and other vascular proliferation factors was analyzed. RESULTS: HE staining showed that there was the retinal tissue edema in the diabetic group, and the arrangement was in disorder, and proliferation could be seen. IF staining: in the retina of normal rats, PHD2 was not expressed, GFAP and VEGF were mainly expressed in astrocytes; while in the diabetic rats, PHD2, GFAP and VEGF staining showed strong positivity in all retinal layers, mainly in neurogliocytes. PHD2 was co-expressed with VEGF and GFAP. The mRNA expression levels of PHD2, GFAP and VEGF in the diabetic group were obviously higher than that in the control group,respectively 1.83 times, 1.75 times and 2.08 times. The difference had statistical significance (P

Letter to the editor

AIM: To determine the optimal concentration for inducing the differentiation of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) into neuron-like cells, although it is understood that all-trans retinoic acid (ATRA) regulates cell proliferation in the nervous system by modulating the balance between mitosis and apoptosis. METHODS: The abilities of ATRA to promote apoptosis as well as neural differentiation were assessed in cultured hUC-MSCs by morphological observation, MTT assay, annexin V-FITC/PI flow cytometry and immunocytochemistry. RESULTS: The data showed that low concentrations of ATRA (0.5 µmol, 0.25 µmol) had no effect on the number of cells. However, treatment with 1.0 µmol or 2.0 µmol ATRA induced a 24.16% and 52.67% reduction in cell number, respectively, compared with vehicle-treated cultures. Further, 4.0 µmol ATRA had a potent effect on cell number, with almost no adherent cells recovered after 24h. We further showed that 0.5 µmol ATRA caused these cells to express characteristic markers of neuronal progenitor cells. CONCLUSION: Taken together, we conclude that ATRA has a dose-dependent influence on the neural differentiation and apoptosis of hUC-MSCs. These findings have implications on the use of ATRA-differentiated hUC-MSCs for the study of neural degeneration diseases.

AIM: To investigate the time-effect relationship between the expression of rhodopsin and recoverin and photoreceptor damage induced by N-nethl-N-nitrosourea(MNU). METHODS: Thirty-six 7-week old Sprague-Dawley(SD)rats were intraperitoneally injected with MNU(60mg/kg)and were put to death by dislocation of cervical vertebra 6, 12, 24h; 3, 7d after injection(6 per group), respectively. As a control, six rats were injected with phosphate buffer saline(PBS)5mL/kg and sacrificed on d3 after injection. The degree of photoreceptor apoptosis was detected by HE staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling(TUNEL)and transmission electron microscope(TEM)in the right eyes. The mRNA expressions of rhodopsin and recoverin were detected different time after injection by Western blot and immunohistochemical method in the left eyes. RESULTS: The dissolution of photoreceptor nucleus and apoptosis body were first perceived at 12h by TEM; most of cells at outer nuclear layer were presented positive reaction. The apoptotic index reached peak(29.7%±2.3%)at 24h which was coincided with the observation of TEM. The results of immunohistochemistry displayed that rhodopsin and recoverin were on a declining curve with time extension. Furthermore, the results of Western blot indicated that rhodopsin had dramatic decline at 6h after injection(P<0.05), and extremely significant difference comparing to control group after 12h(P<0.01); while recoverin dramatic declined at 12h, and extremely significant difference after 24h(P<0.01). CONCLUSION: 60mg/kg MNU intraperitoneally injection one-time may specifically induce photoreceptor apoptosis, The mechanism of down-regulation of rhodopsin and recoverin may be related to the selected apoptosis of photoreceptors.

AIM: To compare the best corrected visual acuity (BCVA) between Verteporfin with photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in patients with myopic choroidal neovascularization (CNV).METHOD: Published literature from Medline, Premedline, Embase and the Cochrane Library from inception until November 2013 were retrieved. All studies evaluating the BCVA between Verteporfin with PDT and intravitreal anti-VEGF for myopic CNV were included. The results were pooled using mean difference (MD), a corresponding 95% confidence interval (CI).RESULTS:Finally, five studies enrolled 349 eyes were included in the meta-analysis. We inferred that the BCVA of myopic CNV after the treatment of anti-VEGF was significantly better compared with Verteporfin with PDT (MD=0.25, 95％CI:0.17-0.33, Z=5.97, PCONCLUSION: This meta-analysis suggests that intravitreal anti-VEGF could have a better BCVA after treatment than Verteporfin with PDT for myopic CNV.

AIM:To investigate the protective mechanism of Gingko Biloba extract (EGb761) on the ability of retinal pigment epithelial (RPE) cells to resist light-induced damage in a comparative proteomics study.METHODS:Human RPE cells (ARPE-19) were randomly distributed to one of three groups:normal control (NC group) and light-damaged model without or with EGb761 group (M and ME groups, respectively). The light-damaged model was formed by exposing to white light (2 200±300)lx for 6h. The RPE cells in ME group were conducted with EGb 761 (100μg/mL) before light exposure. The soluble cellular proteins extracting from each groups were separated by two-dimensional electrophoresis and stained by silver staining. Different proteins in the profiles of the gels were analyzed by Image Master Software. Two-fold expressing protein spots were identified by Matrix-assisted laser desorption/ionization tandem time-of-flight (MALDI-TOF/TOF) mass spectrometry.RESULTS: NC, M and ME groups displayed 1 892±71, 2 145±23 and 2 216±85 protein spots, respectively. We identified 33 proteins with different expression levels between the NC and M groups, 25 proteins between the M and ME groups, and 11 proteins between the NC and ME groups. MALDI-TOF/TOF mass spectrometry successfully identified 16 proteins, including metabolic enzymes, cytoskeletal proteins, anti-oxidation proteins, and others.CONCLUSION:Differences in some important proteins, such as cathepsin B, heat shock protein, and cytochrome creductase, indicated that multiple pathways may be induced in light-damaged RPE cells and the protective effect of EGb761.

AIM: To evaluate the clinical efficacy of intravitreous injection of Lucentis combined with argon laser photocoagulation on retinal macroaneurysm.METHODS: A retrospective observation about intravitreous injection of Lucentis combined with argon laser photocoagulation was performed on 9 patients(9 eyes)with retinal macroaneurysms with macular edema between January 2011 and July 2013. Through the collection of clinical data in patients best-corrected visual acuity, change of the retinal macroaneurysm, optical coherence tomography and fluoresce in fundus angiography before therapy and 1 mouth,3 mouths after therapy, comparative analysis the changes in best-corrected visual acuity and central macular retinal thickness(CMT)between before and after treatment.RESULTS: Followed for more than 3 months, all patients' best-corrected visual acuity were improved obviously, the difference was significant(PPCONCLUSION:Intravitreous injection of Lucentis combined with argon laser photocoagulation is effective and security to improving visual acuity of retinal macroaneurysms with macular edema.