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AIM: To predict cutting formula of small incision lenticule extraction (SMILE) surgery and assist clinicians in identifying candidates by deep learning of back propagation (BP) neural network. METHODS: A prediction program was developed by a BP neural network. There were 13 188 pieces of data selected as training validation. Another 840 eye samples from 425 patients were recruited for reverse verification of training results. Precision of prediction by BP neural network and lenticule thickness error between machine learning and the actual lenticule thickness in the patient data were measured. RESULTS: After training 2313 epochs, the predictive SMILE cutting formula BP neural network models performed best. The values of mean squared error and gradient are 0.248 and 4.23, respectively. The scatterplot with linear regression analysis showed that the regression coefficient in all samples is 0.99994. The final error accuracy of the BP neural network is -0.003791±0.4221102 μm. CONCLUSION: With the help of the BP neural network, the program can calculate the lenticule thickness and residual stromal thickness of SMILE surgery accurately. Combined with corneal parameters and refraction of patients, the program can intelligently and conveniently integrate medical information to identify candidates for SMILE surgery.

AIM: To explore the effects of anti-vascular endothelial growth factor(VEGF)agents(Conbercept)before pars plana vitrectomy(PPV)on inflammatory cytokine levels of patients with proliferative diabetic retinopathy(PDR).METHODS: A total of 49 patients(49 eyes)who diagnosed with PDR at the First Affiliated Hospital with Nanjing Medical University from June 2017 to January 2018 were recruited and randomly divided into two groups. A total of 25 cases(25 eyes)who did not receive intravitreal injection before PPV were included in no-intravitreal injection of Conbercept(IVC)group, and 24 cases(24 eyes)who received IVC 5～7d before PPV were included in IVC group. The vitreous samples were collected from all the patients at the start of PPV. Levels of VEGF-A, monocyte chemotactic protein-1(MCP-1)and inflammatory cytokines in the vitreous humor were measured using Luminex technology.RESULTS: Compared with the no-IVC group, the level of VEGF-A decreased significantly(P

AIM: To study the cutting error of central corneal thickness(CCT)after small incision lenticule extraction(SMILE)in patients with different degrees of myopia. METHODS: Myopic patients who had undergone SMILE surgery from May 2020 to September 2020 at the Jiangsu Province Hospital were included in the study. Data were organized by refractive status into low, moderate, and high myopia groups. The CCT was measured by the Pentacam anterior segment analysis system preoperatively and postoperatively at 1 and 3mo. Among different myopia groups, the cutting error(ΔCCT, defined as the difference between actual CCT and the predicted CCT)was calculated simultaneously during each visit. The difference ratio of ΔCCT and the relationship between ΔCCT, CCT, and cutting diameter were analyzed. RESULTS: There were 221 patients(432 eyes)included in our study. At 3mo after operation, the ΔCCT in the high myopia group was larger than the low and moderate myopia group(χ2=225.74, 62.55; all P

AIM: To explore the functions of Chordin-like 2, which is encoded by CHRDL2, in the process of retinal pigmented epithelium (RPE) differentiation and damage repair. METHODS: The fetal RPE cells (fRPE) was obtained from aborted fetus which obeyed medical ethics. Real-time quantitative polymerase chain reaction was used to measure expression quantity of CHRDL2 and other functional genes expression. Knocking down and overexpression was used to analyze the functions about Chordin-like 2. Enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of bone morphogenetic proteins 4 (BMP4). Flow cytometry was used to analyze cell cycle. Cell morphology was observed by phase contrast microscope (PCM). RESULTS: In normal RPE cells, CHRDL2 was firstly upregulated and followed a downregulation but eventually, it was expressed higher than the cells which undergone epithelial-mesenchymal transition (EMT). After knocking down CHRDL2, the secretion of BMP4 was decreased, RPE-related genes (OTX2, MITF, RPE65) were downregulated while EMT-related genes (SNAI1, VIM) were upregulated. However, the expression of these related genes after overexpression of CHRDL2 had contrary results. Chordin-like 2 also regulated the cell cycle by regulating BMP pathway. When CHRDL2 was knocked down, more fRPE cells stayed in S phase of cell cycle, while adding BMP4 reduced the proportion of the cells in S phase. However, overexpression of CHRDL2 increased more BMP4 secretion, this effect decreased the number of cells in S phase, but exogenous BMP inhibitor also could change this effect. At last, in the process of RPE cells differentiation, adding BMP4 at early stage could intervene normal RPE differentiation. Compared with BMP4, inhibiting BMP pathway had no significant negative effect at early stage, but suppressed differentiation at late stage. CONCLUSION: BMP pathway can be activated in a correct temporal order, otherwise, the cells have incorrect differentiation orientation. And Chordin-like 2 plays a role in dynamic regulation of BMP pathway and it also regulates the differentiation of RPE cells. Therefore, this research enlightens a new direction to inhibit EMT and promote cell redifferentiation after injury.

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P

AIM: To evaluate the effectiveness of rectangular 3-snip punctoplasty versus punch punctoplasty via Kelly punch with silicone intubation for the management of acquired external punctal stenosis (AEPS). METHODS: A prospective, randomized, comparative study was performed on 123 eyes of 94 patients with AEPS. Patients were recruited into either group of rectangular 3-snip punctoplasty (group A) or group of punch punctoplasty with silicone intubation (group B). Outcomes measured were Munk score, grade of punctal stenosis, fluorescein dye disappearance time test (FDDT) and tear meniscus height (TMH) 6 and 12mo after surgery. RESULTS: Twelve months after surgery, Munk score, FDDT and TMH significantly decreased in both groups compared with the baseline (all P

AIM: To investigate the role of microRNA-25 (miR-25) in proliferation and apoptosis of retinal Müller glia (MG) under high glucose condition. METHODS: The purity of the cultured cells was verified by immunocytochemistry and flow cytometry using antibodies that specifically recognized MG. The expression level of miR-25 under normal and high glucose conditions were validated by quantitative reverse transcription polymerase chain reaction (RT-qPCR). miR-25 mimics and negative control were transfected into MG and multiple functional experiments including cell counting kit-8 assay, EDU assay, and flow cytometry were conducted to explore the effects of miR-25 on the proliferation and apoptosis of high glucose cultured MG (HGMG). RESULTS: Immunocytochemistry and flow cytometry confirmed the high purity of primary cultured MG. RT-PCR results showed that the expression level of miR-25 was significantly repressed in HGMG, while over-expression of miR-25 by miR-25 mimic markedly inhibited the high glucose induced cell apoptosis and promoted the proliferation of MG. CONCLUSION: The expression level of miR-25 is significantly downregulated in HGMG and its overexpression could attenuate the high glucose damages on MG by promoting proliferation and reducing apoptosis.

AIM: To observe the clinical effect of 25G vitrectomy combined with inner limiting membrane(ILM)peeling in the treatment of severe proliferative diabetic retinopathy(PDR)with macular displacement.METHODS: Clinical data of 36 cases(36 eyes), diagnosed as severe proliferative diabetic retinopathy with macular displacement in Jiangsu Province Hospital were collected. Eighteen cases admitted from January to December 2016 were included in the control group(18 eyes, treated by 25G vitrectomy), while 18 cases admitted from January to December 2017 were included in the combined group(18 eyes, treated by 25G vitrectomy with ILM peeling). Best corrected visual acuity(BCVA), intraocular pressure(IOP), complications, and the thickness of macular center area(CMT)were examined during follow-up at 7d, 1mo, 3mo and 6mo postoperative.RESULTS: BCVA showed a significant improvement at postoperative 6mo compared with baseline in both groups (PPP=1.000).CONCLUSION: In the treatment of severe PDR with macular displacement, 25G vitrectomy combined with ILM peeling can effectively and safely improve visual acuity and reduce the thickness of macular center area.

Retinoblastoma (RB) is the most common intraocular malignancy of childhood caused by inactivation of the Rb genes. The prognosis of RB is better with an earlier diagnosis. Many diagnostic approaches and appropriate clinical treatments have been developed to improve clinical outcomes. However, limitations exist when utilizing current methods. Recently, many studies have identified identify new RB biomarkers which can be used in diagnosis, as prognostic indicators and may contribute to understanding the pathogenesis of RB and help determine specific treatment strategies. This review focuses on recent advances in the discovery of RB biomarkers and discusses their clinical utility and challenges from areas such as epigenetics, proteomics and radiogenomics.

"AIM: To introduce a new method for suprachoroidal fluid drainage before 23-gauge pars plana vitrectomy. METHODS: A 15º side-port blade was firstly used to create a sclerotomy into the suprachoroidal space for initial drainage. A 30-guage needle was then applied to inject balanced saline solution through the existing sclerotomy for further drainage. After most of the suprachoroidal fluid was drained, standard 3-port 23-guage pars plana vitrectomy was performed. RESULTS: We have succeeded in using this technique to treat five patients with retinal detachment and kissing choroidal detachment (KCD). The choroidal detachment was visibly recessed in all cases after drainage with no intraoperative complications. After removal of silicon oil at 3mo follow-up, all patients obtained a reattached retina. No postoperative complications such as hypotony and endophthalmitis occurred. CONCLUSION: The new technique is efficient and safe for suprachoroidal fluid drainage for patients with rhegmatogenous retinal detachment. In future, further larger series are needed to attest to its safety and efficacy."

AIM: To compare the clinical efficacy of two methods for treating refractory glaucoma.METHODS: A total of 30 patients with refractory glaucoma(32 eyes)selected from our hospital from January 2014 to September 2018 were retrospectively analyzed. According to the treatment methods, they were divided into experimental group(16 eyes treated by modified Ahmed glaucoma valve implantation)and control group(16 eyes treated by traditional Ahmed glaucoma valve implantation). The visual acuity, intraocular pressure, number of anti-glaucoma drugs, the success rate, complications and average length of hospitalization were compared between the two groups, during follow-up at post operative 1d, 1wk, 1mo, 3mo and 6mo.RESULTS:There was no significant difference in intraocular pressure between the two groups at post-operative 1d, 1wk, 1mo, 3mo, 6mo(all P>0.05). The total success rate was 87%(14/16)in experimental group while 75%(12/16)in control group(P=0.654). BCVA did not improve significantly at post operative 6 mo compared with baseline in both groups(P>0.05). The average length of hospital stay in the experimental group(4.50±1.37d)was significantly lower than that in the control group(7.63±3.69d)(P=0.003). The incidece of shallow anterior chamber was 31% in control group, while in experimental group, it was 0, which showed significant difference.CONCLUSION: Modified Ahmed drainage valve implantation is an effective method for treating refractory glaucoma, with more simple operations, shorter hospitalizing time and lower incidence of shallow anterior chamber.

Retinal degeneration is the primary cause of visual impairment and blindness. However, in advanced stage of the disease, the majority or all photoreceptors are lost, effective therapeutics has not been established. In recent years, a large number of studies have provided new ways for the replacement of photoreceptors and three-dimensional retinal culture has emerged to produce retinal photoreceptors and tissues of both fetal mouse and human, providing the cell source of photoreceptors replacement therapy for treating retinal degenerative diseases. This review focuses on the development of three-dimensional retinal culture techniques and photoreceptors transplantation experiments, and the existing application strategies and limitations of retinal organoids in the replacement therapy of retinal degeneration, which provide a theoretical reference for the optimization of 3D retina in photoreceptors replacement therapy.

Optical coherence tomography(OCT)is one of the fastest growing techniques in ophthalmic imaging field. With the gradual improvement and update of OCT technology, optical coherence tomography angiography(OCTA)has emerged. It serves as a valuable diagnostic tool for retinal and choroidal neovascularization-related disease. This article reviews the principles of OCTA, OCTA imaging of microaneurysms(MAs), retinal ischemia, retinal neovascularization(RNV)in patient with different stages of diabetic retinopathy, and the limitations and future prospects of OCTA.

AIM: To compare the visual acuity, contrast sensitivity and visual quality of cataract patients after the implantation of AT LISA tri 839MP multifocal intraocular lenses and CT SPHERIS 209M monofocal intraocular lenses.METHODS: Fifty-two patients(52 eyes)were involved and divided into two groups in the study. The trail group(26 patients, 26 eyes)received AT LISA tri 839MP multifocal intraocular lens implantation and the control group(26 patients, 26 eyes)received CT SPHERIS 209M monofocal intraocular lens implantation after phacoemulsification. Visual acuity, contrast sensivity at different spatial frequencies(3, 6, 12, 18c/d)in bright and dark circumstances and patient satisfaction questionnaire were monitored at 3mo postoperatively. The postoperative visual acuity included the information of uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA), best corrected distance visual acuity(BCDVA), distance corrected intermediate visual acuity(DCIVA)and distance corrected near visual acuity(DCNVA).RESULTS: The UCIVA, UCNVA, DCIVA, DCNVA, independent spectacles ratio and satisfaction of the trail group were better than those of the control group 3mo postoper atire(PP=0.041). The incidence of glare and halo showed no significantly statistical difference between the two groups(P=0.668).CONCLUSION: AT LISA tri 839MP multifocal intraocular lens provided better intermediate and near visual acuity, independent spectacles ratio and satisfaction compared with CT SPHERIS 209M monofocal intraocular lens.

AIM: To find out an animal-free, xeno-free culture method for human fetal retinal pigment epithelium (fRPE) cells aiming for cell-replacement therapy. METHODS: Human AB serum, knock-out serum replacement (KSR) and B27 were supplemented as a substitute of fetal bovine serum (FBS) in culture medium of human fRPE cells. Cell morphology was examined by light microscope and transmission electron microscope. Proliferation ability was detected by cell cycle analysis and examination of KI67 expression. Apoptosis was analyzed using FACS. The expression of RPE-specific markers was demonstrated by quantitative real-time polymerase chain reaction (qPCR), Western blot (WB) and immunocytochemistry. Paracrine function was determined using enzyme-linked immunosorbent assay method. RESULTS: Our results indicated that the optimum concentration of KSR was 15%, the optimum concentration of B27 was 2%, and the optimum concentration of human AB serum was 10%. fRPE cells cultured in 15% KSR and 2% B27 media showed repressed propagation and differentiation ability, and gradually lost epithelial morphology and RPE function. While fRPE cells cultured in 10% human AB serum media showed a typical cobblestone morphology with pigmentation, elevated proliferation ability, satisfying paracrine function and expressed RPE-specific markers. CONCLUSION: Our study indicates that culturing fRPE cells in 10% human AB serum-supplemented medium is more favorable compared with KSR, B27 and traditional FBS-supplemented mediums when fRPE cells are to be applied in cell-based therapy.

AIM: To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital METHODS: The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative best-corrected visual acuities (BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. RESULTS: A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73% (2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1d, 1wk, and 1mo post-surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12% (171/4151) had posterior capsule rupture, 0.79% (33/4151) had iris or ciliary body injury, and 0.048% (2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38% (182/4151) had cornea edema, 7.78% (323/4151) had intraocular hypertension, 0.096% (4/4151) had IOL toxicity syndrome, 0.28% (12/4151) had retained lens cortex, and 0.048% (2/4151) had hyphema. The delayed discharge rate was 0.82% (44/4151) and the unplanned re-admission to the hospital was 0 (0/4151). The patient satisfaction rate was 91.42% (3795/4151). CONCLUSION: Day-case cataract surgery is safe and effective with good prospects for development.

Epithelial-mesenchymal transition(EMT)of retinal pigment epithelial cells(RPE)plays a key role in proliferative vitreoretinopathy(PVR), and also decreases the therapeutic effect of anti-vascular endothelial growth factor(anti-VEGF)to choroidal neovascularization(CNV). In addition, cells transplantation has been becoming a potential therapeutic method to treat age-related macular degeneration(AMD), and some cells sources like human embryonic stem cells(hESC)or induced pluripotent stem cell(iPSC)induced RPE cells, and fetal RPE cells have been attempted. However, EMT, as a common problem, decreases cells proliferation and differentiation efficiency, and it will reduce therapeutic effect and the number of therapeutic populations. So, in this article, we reviewed some possible methods to inhibit EMT.

AIM: To research the protection of Mcc950, the inhibitor of NLRP3, against the inflammatory injury to human retinal pigment epithelium cell line ARPE-19. METHODS: Cultured cell line ARPE-19 was divided into control group, H2O2 treating group, Mcc950 treating group and Mcc950+H2O2 treating group. Different concentrations of H2O2 and Mcc950 were used to treat the cells. Cell activity was detected by using CKK8 and proper experimental concentration of H2O2 and Mcc950 were determined. After the treatment, the concentration of IL-1β were detected by using ELISA. The change of NLRP3 related proteins were detected by Western blot. And cell apoptosis was examined by TUNEL stain. RESULTS: Cell ability was gradually decreased along with the increasing treating concentrations of H2O2. Cell ability showed statistical difference when the concentration of H2O2 arrived 400μmol/L. With the concentration of 0.1 and 1μmol/L, Mcc950 had no effect on cell ability. So we chose 400μmol/L H2O2 and 1μmol/L Mcc950 as the experimental concentrations. Compared with the normal control group, the cell viability in the H2O2 treating group was significantly reduced, the IL-1β in the supernatant was significantly increased, and the apoptosis rate was significantly increased, with statistically significant differences(P2O2 treating group, cell viability was significantly increased, the IL-1β in the supernatant and the apoptosis rate were significantly decreased(P2O2, the IL-1β, NLRP3, pro-caspase1 and caspase1 were obviously increased compared to control group. After treated with Mcc950, the NLRP3 and pro-caspase1 still were at high level, the expression of caspase1 was suppressed, which indicated that Mcc950 effectively inhibited the activation of NLRP3 inflammasome consequently disturbed the formation of caspase1.CONCLUSION: Mcc950 can inhibits the function of NLRP3, leading to increasing of the cell ability and decreasing of the cell apoptosis.

Myopia, a worldwide condition, is a multifactorial disease resulting in many ocular complications. Early onset of myopia has a great tendency to develop high myopia and pathological myopia later in life. The pathophysiology and progression of myopia is still unclear. Owing to its involving in visual function, optic disc and peripapillary change in high myopia can’t be neglected, and it may help in better understanding of the pathophysiology or mechanism of myopia progression. Recently, advanced imaging techniques have been developed, such as optical coherence tomography (OCT), allowing for better detecting of optic disc and peripapillary change. OCT is a high-resolution and noninvasive measurement for detection of ocular structure. Herein, we provide an updated review of optic disc and peripapillary change in OCT image, including its characteristics and clinical significance. We also propose some problems needed further investigation.

AIM:To explore the effectiveness of a new non-inverted pedicle internal limiting membrane(ILM)flap transposition technique in the treatment of large macular holes(MH).METHODS: This was a prospective pilot study which included 9 patients with 10 eyes in Jiangsu Province People's Hospital from December 2016 to February 2017. All patients was diagnosed with large MH(size >400μm)by the spectra-domain optical coherence tomography(SD-OCT)and underwent the non-inverted pedicle ILM flap transposition surgery. Best-corrected visual acuity(BCVA), SD-OCT images, and MP-1 microperimetry tests were performed pre-operation, 1d, 1wk, 1, 3, and 6mo post-operation. RESULTS: The macular hole closure rate after 6mo was 100%. The averaged BCVA improved from 1.19±0.54(LogMAR)pre-operation to 0.70±0.50(LogMAR)post-operation(P=0.005). The mean retinal sensitivity within 8° and 2° improved from 3.14±4.52dB to 8.91±5.53dB(P=0.008), and 1.46±2.94dB to 6.33±4.90dB(P=0.008)respectively. Preoperative unstable fixation in seven eyes resolved at the last postoperative follow-up. CONCLUSION: Our non-inverted pedicle internal ILM flap transposition technique shows effectiveness in the treatment of large macular holes with high MH closure rate and improving visual function.

AIM: To explore the effect of the Notch signaling pathway on retinal ganglion cells (RGCs) and optic nerve in rats with acute ocular hypertension (OH). METHODS: Totally 48 Sprague-Dawley (SD) rats were included, among which 36 rats were selected to establish acute OH models. OH rats received a single intravitreal injection of 2 μL phosphate buffered solution (PBS) and another group of OH rats received a single intravitreal injection of 10 μmol/L γ-secretase inhibitor (DAPT). Quantitative real-time polymerase chain reaction (qPCR) and Western blot assay were adopted to determine the mRNA level of Notch and the protein levels of Notch, Bcl-2, Bax, caspase-3, and growth-associated protein 43 (GAP-43). The RGC apoptosis conditions were assessed by TUNEL staining. RESULTS: The OH rats and PBS-injected rats had increased expression levels of Notch1, Bax, caspase-3, and GAP-43, decreased expression levels of Bcl-2, and increased RGC apoptosis, with severer macular edema and RGCs more loosely aligned, when compared with the normal rats. The DAPT-treated rats displayed increased expression levels of Notch1, Bax, caspase-3, and GAP-43, decreased expression levels of Bcl-2, and increased RGC apoptosis, in comparison with the OH rats and PBS-injected rats. RGCs were hardly observed and macular edema became severe in the DAPT-treated rat. CONCLUSION: The Notch signaling pathway may suppress the apoptosis of retinal ganglion cells and enhances the regeneration of the damaged optic nerves in rats with acute OH.

AIM: To estimate the effectiveness of phacoemulsification and foldable intraocular lens (IOL) implantation combined with transpupillary silicone oil removal. METHODS: There were 168 eyes of 168 candidate patients with cataract and silicone oil-filled eyes recruited in our study. All of the patients received the intraocular silicone oil removal surgery by transpupillary drainage and cataract extraction by phacoemulsification. Then the IOL implantation were also performed through corneal incision. RESULTS: The surgery was successfully completed in all eyes. Best corrected visual acuity (BCVA) and postoperative complications were recorded in three months after surgery. There were 143 eyes with BCVA improved, otherwise 25 eyes remained stable at the last follow-up visit. The mean BCVA statistically improved from 20/400±0.02 to 20/100±0.15 (P

AIM: To observe and analyze the safety and clinical efficacy of full-thickness scleral incision and in situ paracentesis in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment using minimally invasive vitrectomy. METHODS: From April 2015 to April 2017, 20 patients(20 eyes)with coexisting rhegmatogenous retinal detachment and choroidal detachment who were treated in Department of Ophthalmology, Jiangsu Province Hospital were enrolled in this retrospective analysis. All patients received modified scleral puncture drainage combined with 23G minimally invasive vitrectomy. This study analyzed and compared intraoperative paracentesis success rate, the incidence of intraoperative, postoperative visual acuity, intraocular pressure, and postoperative retinal reattachment rate. RESULTS: Suprachoroidal fluid from all patients were drainaged successfully. Compared with preoperative conditions, the postoperative visual acuity was significantly improved(PPCONCLUSION: The modified scleral puncture surgery in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment in 23G vitrectomy has great clinical effects. It not only simplifies the procedure of operation, but also reduces the difficulty and complication of operation.

Letter to the editor

Age-related macular degeneration(AMD)is the leading cause of blindness among the elderly worldwide. AMD is classified as either neovascular(wet)or non-neovascular(dry). The dysfunction and loss of retinal pigment epithelial(RPE)cells is regarded as the main pathological changes of AMD. The recent development of regenerative medicine has witnessed RPE cell-replacement therapy as a new approach to treat AMD, resulting in obvious visual improvement in various studies. However, there are still many problems and challenges that remain unsolved, including graft rejection. This review introduces subretinal immune environment under both normal and AMD condition, putting emphasis on immune response to allogeneic RPE. Lastly, strategies to prevent graft rejection are discussed.

AIM: To discuss the protective effect of α-mangostin on retinal light damage in mice.METHODS: Totally 30 Balb/c mice, aged 6～8wk, were randomly divided into the control group, light-exposure group and α-mangostin group. Every group contained 10 mice. Mice of α-mangostin group were treated with alpha-mangostin at the dose of 30mg/(kg·d)body weight by intragastric administration daily for 7d, and then exposed to white light at the 5thd. The light-exposure group and α-mangostin group were exposed to 5 000±200lx white light-emmiting diodes(LEDs)for continuously 1h to establish the mice model of retinal light damage. Flash-electroretinograme was recorded 72h after light exposure. The changes in retinal morphology of mice were observed by light microscopy. Retinas were extracted to detect the malondialdhyde(MDA)content change of the retinal homogenate.RESULTS: Flash-electroretinogram(F-ERG)showed that retinal dysfunction was less severe in α-mangostin group than in light-exposure group(PPPCONCLUSION: α-mangostin inhibits lipid peroxidation induced by light damage and protect retina against light damage.

AIM:To prove anthrax lethal toxin (LeTx) blocks the mitogen activated protein kinases (MAPKs) activation by degrading theMAPK/ERK kinases (MEKs) to suppress vascular endothelial growth factor (VEGF) secretion. METHODS:Human adult retinal pigmented epithelium (ARPE) cells were cultured and treated with normal glucose, high glucose or high glucose with LeTx for additional 24, 48 or 72h for viable cell count. Total RNA from the ARPE was isolated for reverse transcription polymerase chain reaction (RT-PCR). The conditioned medium of ARPE cells treated in different group for 48h was filtered and diluted to detect the concentration of VEGF by enzyme-linked immunosorbant assays. Evaluate the role of MEK/MAPK pathway in the secretion of VEGF by immunoblotting. RESULTS:In this study, we proved high glucose induced activation of the MAPK extracellular signal-regulated kinase (ERK1/2) and p38 in the ARPE cell line was blocked by anthrax LeTx. LeTx also inhibited high glucose induced ARPE cell over proliferation. CONCLUSION:LeTx suppressed high glucose induced VEGF over secretion in the ARPE cells, mainly through a post-translational mechanism.

AIM: To study protective effects of α-Mangostin in human retinal pigment epithelial(RPE)cells induced by hydrogen peroxide(H2O2).METHODS:ARPE-19 cells were treated with different concentrations of α-Mangostin and H2O2.The effect of α-Mangostin and H2O2 respectively on cell activity was detected by CCK8. ARPE-19 cells were pretreated with different concentrations of α-Mangostin for 24h before they were administrated with 200μmol/L H2O2for another 24h.Then the changes of cell activity were observed. The expression of reactive oxygen species(ROS)level was detected by flow cytometry(FCM)and the expression of NF-κB protein was measured by Western blot analysis.RESULTS:CCK8 examination results showed that: within 0～12μmol/L, α-Mangostin had no damage effects on cell activity. When the concentration of 16μmol/L, cell viability began to decrease(P2O2 when the concentrations of α-Mangostin were within 0～16μmol/L. ROS results showed: the expression of ROS level significantly increased after H2O2 induced(P2O2(P<0.05). Western blot results showed that the expression of NF-κB protein after H2O2 induced increased(P<0.05); 12μmol/L α-Mangostin pretreatment up-regulated NF-κB of ARPE-19 induced by H2O2(P<0.05).CONCLUSION: H2O2 induced oxidative damage in RPE cells by decreasing cell viability and increasing the expression of ROS level. α-Mangostin can protect RPE cells from the injury of H2O2, the mechanism may be related to the clear of ROS and the activation of NF-κB.

AIM: To evaluate the meaning of using optical coherence tomography with enhanced depth imaging(OCT-EDI)to measure choroidal thickness of central serous retinopathy(CSC). METHODS: With the retrospective case control study, 65 patients(65 eyes)with CSC and 50 healthy controls(50 eyes)with age, gender and diopter-matched were recruited in this study. OCT-EDI were used to measure the subfoveal choroidal thickness(SFCT)in CSC eyes, the fellow eyes and also the control eyes. Of which 40 of the 65 CSC patients self-cured, 14 of them were treated with photodynamic therapy(PDT), the left 11 accepted the laser photocoagulation(LP). SFCT were measured 3mo after that. Compared with the previous data, the statistical analysis was carried out.RESULTS: The SFCT value of 65 CSC eyes, 65 fellow eyes and 50 control eyes were 436.23±89.50, 389.45±101.03 and 329.36±95.87μm, respectively. The SFCT of suffer and fellow eyes increased significantly compared to the control eyes(P=0.008 and 0.013, respectively). There was also significant difference in SFCT between the CSC eyes and the fellow eyes(P=0.021). The SFCT were significantly decreased after PDT(P=0.032), but with no significant changes after LP or self-cured(P=0.057 and 0.076, respectively).CONCLUSION: OCT-EDI is a useful method to assess the choroidal topographic changes of CSC. The SFCT are significantly increased in the CSC eyes compared with that in the fellow eyes and the control eyes.

AIM: To investigate the factors that may influence the successful corneal donation among adults in China.METHODS:This retrospective study was conducted in 2012. The eligible participants were all the adults registered in Nanjing Red Cross Eye Bank to donate their corneas after death during the period of 2001 and 2012. Multivariate logistic regression models were applied to investigate the influence factors for successful donation, the outcome events.RESULTS:Totally, 210 of 328 (64.0%) registered potential donors successfully donated their corneas after death. The mean (SD) age at registration was 64.7 (12.5) for all participants, with 65.5 (10.1) and 63.2 (15.8) for successful and unsuccessful donors, respectively. With multivariate logistic regression analysis, five factors, the willingness of donation, age, education level, residence area, and cause of death were identified to be associated with successful corneal donation.CONCLUSION:The willingness of donation and some socio-demographic factors might substantially affect their successful donation after death for people who registered to donate corneas.

AIM: To evaluate the effect of different bevacizumab concentrations on retinal neovascularization in a retinopathy of prematurity (ROP) mouse model.METHODS: A total of 60 of C57BL⁄6 J mice were exposed to 75%±2% oxygen from postnatal d7 to postnatal d12. Fifteen nonexposed mice served as negative controls (group A). On d12, 30 mice (group C) were injected with 2.5 µg intravitreal bevacizumab (IVB), 30 mice (group D) were injected with 1.25 µg IVB in one eye. The contralateral eyes were injected with balanced salt solution (BSS) (control group=group B). The adenosine diphosphatase (ADPase) histochemical technique was used for retinal flat mount to assess the oxygen-induced changes of retinal vessels. Neovascularization was quantified by counting the endothelial cell proliferation on the vitreal side of the inner limiting membrane of the retina. Histological changes were examined by light microscopy. The mRNA levels of vascular endothelial growth factor (VEGF) were quantified by Real-time PCR. Western-blotting analysis was performed to examine the expression of P-VEGFR.RESULTS:Comparing with the control group B, regular distributions and reduced tortuosity of vessels were observed in our retinal flat mounts in groups C and D. The endothelial cell count per histological section was lower in groups C (P<0.0001) and D (P<0.0001) compared with the control group B. Histological evaluation showed no retinal toxicity in any group. In all oxygen treated groups VEGF mRNA expression was significantly increased as compared to age-matched controls. No significant change in VEGF mRNA expression could be achieved in either of the treatments or the oxygen controls. The results of the Western blot were consistent with that of the Real-time PCR analysis.CONCLUSION:An intravitreal injection of Bevacizumab is able to reduce angioproliferative retinopathy in a mouse model for oxygen-induced retinopathy.

AIM: To investigate the effect of low intensity white light irradiation on the retinas of mice.METHODS: Thirty C57BL/6J mice were randomly divided into two groups. The number of the mice in each group was 15. The mice in experimental group received dark adaptation from 5:00p.m. to 6:00p.m.,and then exposed to LED white light from 6:00p.m. to 7:00p.m. everyday for a month. At 1, 3, 7, 14 and 30d after the beginning, we examed the histology of mice retinas, calculated the thickness of outer nuclear layer(ONL),inner nuclear layer(INL)and analyzed electrophysiology of mice.RESULTS:One month after experiment, compared to the control group, the latency of Rod-R a wave of the mice in experimental group significantly prolonged, the amplitude of Cone-R b wave of the mice in experimental group significantly decreased and the latency of b wave of the mice in experimental group significantly prolonged(PCONCLUSION: 100lux low intensity white light could give rise to the impairment of the retinal functions in dark-adapted mice.

Advances in spectral-domain optical coherence tomography(SD-OCT)technology provide improved monitoring of progression and assistance in quantifying response to treatment modalities in neovascular age-related macular degeneration(NVAMD). There is little doubt that anti-vascular endothelial growth factor(anti-VEGF)drug therapy is becoming a new approach to the management of NVAMD, while long-term follow-up and necessary retreatments are the key issues to remain obtained visual acuity.SD-OCT imaging helps to identify early recurrence of choroidal neovascularization during treatment with anti-VEGF. This review discusses the present applications of the commercially available SD-OCT systems in the follow-up of after the injection of intravitreal anti-VEGF in NVAMD.