Volume 54 · Issue 08 · 2018

This issue focuses on the contents of ophthalmic epidemiological investigation. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Zhao Jialiang.

Eye health is a new concept that has been put forward in recent years as a result of the long term practice of prevention and treatment of blindness. The full understanding of the origin, goal and value of eye health is of great significance for promoting the prevention and treatment of eye diseases and the development of ophthalmology in China. In the past several decades, China has made great achievements in the development of eye health, while some challenges still remained. We should learn the actual requirements of the prevention of blindness and visual impairment and the public eye care, focus effectively on the major tasks, set explicit goals, gradually promote the development of eye health cause. At present, avoidable cataract blindness and visual impairment and un-corrected refractive error are the key eye diseases, while persons aged 50 years or above are the population that needs special attention in terms of eye health. We should continue to strive for greater achievements in the cause of eye health. (Chin J Ophthalmol, 2018, 54:561-564)

Ultra-wide angle fundus imaging is a new fundus image acquisition technique. The imaging range of traditional fundus photography technology focuses on the posterior pole (including the optic disc, macula, and vascular arch), but the retina in the middle periphery (after the equator) and the distal periphery (before the equator to the serrated margin) cannot be imaged. A technique that can reach the range from the anterior equator to the serrated margin by imaging the orthopedic eyeball at one time is called ultra-wide-angle fundus imaging technique. This technology has been widely used in the screening, diagnosis and prognosis evaluation of a variety of fundus diseases, such as diabetic retinopathy, etc., which has significantly improved the screening, diagnosis and treatment level of diseases.

To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services.

In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent.

Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio ( OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service.

Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579)

To analyze the changes of cataract surgery volume and related influencing factors in Shanghai during 2013 and 2015.

The information of Cataract patients during the period of 2013 and 2015 was collected from Shanghai Cataract Operations Database. The cataract surgery volume and CSR of Shanghai residents and non-registered ones were compared. The cataract surgery volume and CSR of registered Shanghai residents in urban, suburban and exurban areas were calculated, respectively. In addition, the sources of surgery cost, hospitals where surgeries were performed were analyzed.

In Shanghai, the cataract surgery volume grew from 63 915 to 114 688 and the total CSR grow from 2 686 to 4 729 during the years between 2013 and 2015. In this period, the cataract surgery volume of registered Shanghai residents in urban, suburban and exurban areas increased from 27 203, 21 921, 8 847 to 46 415, 40 463, 18 171, respectively. The CSR1 (CSR of registered Shanghai residents) grew rapidly from 4 081 to 7 363, while the CSR2 (CSR of non-registered Shanghai residents) grew slowly from 619 to 949. According to statistics, 93.08% of the registered Shanghai residents paid the medical expenses with their medical insurance, while more than 80% non-registered Shanghai residents afforded it at their own expenses. The number of total CSR in urban, suburban and exurban areas increased from 5 085, 3 600, 3 205 to 3 600, 6 588, 6 513 respectively. In 2015, the number of cataract surgery cases in non-public hospitals exceeded that in public hospital, accounting for 54.71% of the total cataract surgeries. In the same year, 55.44% of the total cases come from suburban and exurban residents.

From 2013 to 2015, there had been a dramatic increase in cataract surgery volume in nonpublic hospitals and exurban area in Shanghai, which effectively solved the problem of low CSR in suburban and exurban area, however the 1ow level of CSR of non-registered Shanghai residents was the key factor that significantly reduced the total CSR in Shanghai. (Chin J Ophthalmol, 2018, 54:580-585)

To investigate the distribution and related factors of intraocular pressure (IOP) in the screened population aged over 50 years in Wenzhou.

This study included 31 170 community residents aged 50 years or older in Wenzhou undergoing screening from March 2014 to January 2016. Participants underwent a complete ocular examination, including visual acuity, eye-ground photography, slit lamp and standardized measurement of IOP by non-contact tonometry. Subjects who had undergone ocular operation or laser peripheral iridectomy, had glaucoma, corneal or other ocular diseases that could possibly affect the IOP, had an IOP lower than 6 mmHg(1 mmHg=0.133 kPa) and visual acuity less than 0.3, or had monocular IOP values were excluded. The relationship between IOP and various parameters were analyzed.

A total of 20 875 subjects (6 902 males and 13 973 females) were enrolled in the current analysis, including 18 677 healthy persons and 2 125 glaucoma suspects, with an average age of (67.3±8.7) years old. The mean IOP (mean±standard deviation) of the healthy population was (13.5±3.0) mmHg (13.4±3.2) mmHg in right eyes and (13.6±3.3) mmHg in left eyes; 2.04% of the left eyes, 1.51% of the right eyes and 2.92% of either eyes of healthy population had an IOP >21 mmHg. The mean IOP in glaucoma suspects was significantly higher than that in the healthy population ( P<0.001); 6.78% of the left eyes, 6.16% of the right eyes and 9.65% of either eyes of glaucoma suspects had an IOP >21 mmHg. Men had lower IOPs than women [healthy population: (12.9±3.2) mmHg versus (13.7±3.2) mmHg; P<0.05]. The linear function of IOP (Y) with age (X₁) and the vertical cup disc ratio (X₂) was ^Y=15.962-0.043X₁+0.837X₂(P<0.05) in the healthy population.

The IOP among healthy persons aged over 50 years living in downtown Wenzhou was decreased with age but increased with the vertical cup disc ratio. The IOP in females was higher than that in males. About 3% of the healthy population had an IOP greater than 21 mmHg. (Chin J Ophthalmol, 2018, 54: 586-592)

To assess the retinal image quality of the normal northern rural Chinese adult population.

A normal population-based, cross-sectional study. From Oct, 2012 to Jan 2013, a clustered, random sampling procedure was used to select normal population who visual acuity≤ 0(LogMAR) and 30-69 years old from 2 villages. All eligible subjects were invited to undergo a comprehensive eye examination, and the retinal image quality related index were examined with pupil 4 mm using objective optical quality analysis systemⅡ(OQAS Ⅱ, Visiometrics, Spain), including MTFcutoff, VA20, VA9, PSF50, PSF10, OSI, SR. And describe the retinal image quality of different age group, including 30-39y, 40-49y, 50-59y, 60-69y.

Among 1 108 participants (61.9%) that completed examinations in our center, 681 participants (1 362 eyes) were recruited. There were 146, 586, 440 and 190 eyes in each group. The spherical equivalent refraction of each group was (-0.35±0.84), (-0.19±0.50), (-0.03±0.54) and (0.20±0.71) D. The best corrected vision acuity of each group was -0.02±0.04, -0.01±0.03, -0.01±0.02 and -0.00±0.01. The MTFcutoff of each group was (37.06±9.31), (36.69±8.93), (36.52±9.05) and (32.61±10.08) c/deg. Retinal imaging parameters were significantly different(MTFcutoff: MD=4.45, SR:MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, A9:MD=0.09, OSI:MD=-0.41, P<0.001)between aged 30-39 group and aged 60-69 group. Objective scattering index (OSI) were significantly different(MD=-0.13, P=0.004)between aged 30-39 group and aged 50-59 group. Retinal imaging parameters were significantly different(MTFcutoff:MD=4.45, SR:MD=0.03, PSF50:MD=-0.45, PSF10:MD=-2.87, VA20:MD=0.13, VA9: MD=0.09, OSI: MD=-0.41, P<0.001)between aged 40-49 group and aged 60-69 group. Retinal imageing parameters were significantly different(MTFcutoff: MD=4.45, SR: MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, VA9:MD=0.09, OSI:MD=-0.41,P<0.001)between aged 50-59 group and aged 60-69 group.

Retinal image quality was gradually worse over time in the northern rural Chinese adult population. (Chin J Ophthalmol, 2018, 54:593-598)

To investigate the attainment of therapeutic targets for glycosylated hemoglobin and blood pressure, ophthalmologic examination, diagnosis and treatment of diabetic retinopathy (DR) with type 2 diabetes mellitus.

A cross-sectional study in type 2 diabetic patients was conducted in a community of Fushun between July 2012 and May 2013. Questionnaire, detailed ophthalmic examination and laboratory tests were completed to collect the information about sociodemographic and healthcare characteristics.

A total of 2 033 eligible patients with complete information were screened from 2 224 type 2 diabetic patients. Of them, the control rates of glycosylated hemoglobin(<7.0%), blood pressure[<140/80 mmHg (1 mmHg=0.133 kPa)] and serum lipid were 39.7%, 31.0% and 2.6%, respectively. Only 22.3% of the participants had ophthalmologic examination after the diagnosis of diabetes mellitus, and 72.2% of the participants in the study reported never receiving any recommendation for eye examinations from their physicians. The prevalence of DR was 44.3% in the study population, 27.1% receiving ophthalmologic examination ever. Among them, 213 patients had vision-threatening DR and required laser treatment or vitreous surgery, but 82.2% had not been treated.

The investigation of the type 2 diabetic patients in a community of Fushun indicated that more than 60% of patients did not attain therapeutic targets for glycosylated hemoglobin, and 70% for blood pressure; 78% had not received ophthalmologic examination after the diagnosis of diabetes mellitus; 82% of vision-threatening DR patients had not been treated. Educational efforts should be aimed at improving knowledge of and compliance with these guidelines among both internists and eye care providers. (Chin J Ophthalmol, 2018, 54: 599-604)

To assess the prevalence of visual impairment and the influencing factors among rural residents aged 60 years and above in Yugan county, Jiangxi province. Researchers analyzed influencing factors and provided scientific rationale for blindness prevention and control.

Stratified cluster random sampling was used in randomly selecting 3 789 rural residents aged ≥ 60 in Yugan county. Eligible residents were invited to receive ophthalmic examinations and epidemiological investigations. Multivariate logistic regression was performed to analyze any influencing factors.

Three thousand seven hundred and eighty-nine rural residents completed the ophthalmic examination and investigation. Based on presenting visual acuity, the prevalence of visual impairment was 24.1%(915), of which blindness and moderate and severe was 2.9%(108) and 21.3%(807). The top five causes ranked are (1) cataract (283, 30.9%), (2) Refractive error (81, 8.9%), (3) macular degeneration (29, 3.2%), (4) Corneal opacity (14, 1.5%). Multivariate logistic regression showed that age, gender, education, occupation, marital status, ophthalmic anamnesis, smoking situation, and daily fruit intake were the main factors that were the influencing factors of visual impairment.

The prevalence of visual impairment in the elderly population in rural areas of Yugan County is quite high. Keep a healthy diet, timely correction of eye disease, could reduce the risk of visual impairment. (Chin J Ophthalmol, 2018, 54:605-610)

Quality of life and the influencing factors in patients with diabetic retinopathy before and after receiving treatment of pan-retinal photocoagulation (PRP) were studied.

Prospective study. A total of 55 diabetic retinopathy patients were collected at Beijing Friendship Hospital, Capital Medical University from November 2016 to August 2017 and were surveyed using Vision Function Questionaire (VFQ-25) to evaluate their quality of life before and 3 months after treatment with PRP. According to diagnostic criteria, the patients were divided into two groups: severe nonproliferative diabetic retinopathy(NPDR) and proliferative diabetic retinopathy group(PDR). SPSS was used for statistical analysis.

The score of VFO-25 general health before PRP treatment was 62.73±14.20, obviously lower the other sub scale scores of VFO-25. The results of variance analysis there was significant statistical difference between the composite score and the different educational levels (F=2.94, P<0.05), but there was no statistical difference for diabetes duration (F=3.01, P<0.05). The composite score was significantly significance between the severe NPDR and PDR group(t=8.95, P<0.05). The patients with hyperlipidemia (t=-3.21, P<0.05), hypertension(t=-2.32, P<0.05) and renal insufficiency(t=-2.05, P=0.045) has lower composite score. There was high relationship for age among the factors of worse logMAR vision, better logMAR vision and age (r=-0.47, P<0.05; r=-0.38, P<0.05; r=-0.26, P<0.05). The scores of VFQ-25 subscale of social function (t=-2.07, P<0.05) , role limitations (t=-2.38, P<0.05) , dependency (t=-2.99, P<0.05) and mental health (t=-2.26, P<0.05) was significantly increased after treatment of PRP. The score of ocular pain was obviously decreased (t=4.19, P<0.001) ; there were no significance in other sub scale scores.

This study showed that the degree of visual acuity, the severity of DR and age were an important factor affecting the quality of life in DR patients. PRP therapy could improve the mental health and social field of DR patients, but failed to improve the scores of other visual functions in the patients. (Chin J Ophthalmol, 2018, 54:611-616)

患者女性，23岁。因左眼视力下降、涩磨就诊。患者于2017年11月6日拟行近视眼矫正手术于解放军第一五九医院眼科就诊，术前视力右眼为0.01，左眼为0.01。双眼睑结膜轻度充血，可见散在滤泡和结石，球结膜无充血，角膜透明。2017年11月22日行双眼飞秒激光小切口角膜基质透镜取出术，手术过程顺利。术后双眼给予妥布霉素地塞米松滴眼液4次/d，连续8 d（每2 d递减1次）；0.1%玻璃酸钠滴眼液4次/d。术后第2天双眼视力均为0.6，第7天均为0.8，眼压正常。停用妥布霉素地塞米松滴眼液，双眼给予氯替泼诺滴眼液4次/d、0.1%溴芬酸钠水合物滴眼液2次/d、玻璃酸钠滴眼液3次/d。术后3周（2017年12月13日）双眼视力均为1.0，眼压正常，双眼睑无肿胀，角膜透明光滑，球结膜无充血，氯替泼诺滴眼液降为2次/d。术后1个月后（2017年12月22日）视力右眼1.0，左眼0.8；眼压右眼为13 mmHg（1 mmHg=0.133 kPa），左眼为14 mmHg。左眼角膜中下方可见小点片状上皮下混浊，增加左眼露替泼诺滴眼液次数至4次/d。术后5周（2017年12月31日）患者诉左眼视力下降、涩磨，来院复查。右眼视力0.8，左眼视力0.5。右眼球结膜无充血，角膜中央细小点片状上皮下混浊。左眼球结膜轻度充血，角膜中下方可见点片状上皮下混浊灶，中央上皮缺失，呈点状凹陷，表面清洁无菌苔。怀疑感染，加用左氧氟沙星滴眼液点左眼3次/d，氟康唑滴眼液点左眼6次/d。2018年1月2日复查，右眼视力0.8，左眼视力0.5，右眼球结膜无充血，角膜中央小片状上皮下混浊灶无变化。左眼球结膜充血加重，角膜中下方上皮下混浊灶密度增大，中央上皮缺损区扩大约3 mm×3 mm，表面有菌苔（图1）。角膜刮片未见真菌菌丝。左眼给予氟康唑滴眼液1次/h，并行共聚焦显微镜检查。2018年1月3日右眼视力0.8，左眼视力0.4，右眼球结膜未见充血，角膜中央可见小片状上皮下混浊灶约1 mm×2 mm。左眼球结膜混合性充血，角膜中下方混浊灶密度高，中央上皮缺失成溃疡状，表面有牙膏状菌苔。左眼角膜病灶刮片吉姆萨染色后光镜下可见大量真菌菌丝，未见细菌。取角膜病灶分泌物做真菌培养，并做药物敏感试验。左眼共聚焦显微镜检查结果显示左眼角膜真菌感染（图2，图3）。停用其他眼药，左眼给予那他霉素滴眼液、伏立康唑滴眼液、特比萘芬滴眼液均每10 min 1次，加替沙星眼用凝胶2次/d；右眼继续用氯替泼诺滴眼液2次/d、玻璃酸钠滴眼液3次/d。2018年1月6日可见左眼角膜中下方病灶无扩大，周边上皮有修复趋势，病灶分泌物培养可见黄曲霉菌生长。治疗4周后（2018年1月27日）左眼球结膜充血明显减轻，角膜病灶明显缩小，上皮大部分修复，混浊减轻。2018年1月30日左眼视力0.5，球结膜轻微充血，角膜病灶完全修复，上皮光滑。将左眼抗真菌三联滴眼液用法改为3次/d巩固治疗。2018年2月23日再行共聚焦显微镜检查，未见真菌菌丝，角膜上皮完全修复，角膜纤维化。视力右眼1.0，左眼0.6（图4）。停用抗真菌滴眼液，双眼给予玻璃酸钠滴眼液3次/d。

The patient was a 16-year-old male. Due to the decrease of visual acuity in both eyes for more than 2 years and aggravation for 2 months, he came to the outpatient clinic of Hefei Purui Eye Hospital on December 16, 2016. The patient had the habit of frequent blinking since childhood. In April 2014, he was diagnosed with binocular keratoconus in a foreign hospital, and underwent binocular corneal collagen cross-linking therapy (transepithelial, iontophoresis). The preoperative visual acuity was 0.15 in the right eye and 0.4 in the left eye; The corrected visual acuity was 0.5 in the right eye and 0.6 in the left eye; IOP was 13 mmHg (1 mmHg =0.133 kPa) in the right eye and 15 mmHg in the left eye. Corneal endothelial cell count was 2 504/mm in the right eye²2 784/mm in the left eye²。 Fleischer sign (+), Vogt sign (+), Mumson sign (-) in both eyes were observed by anterior segment slit lamp examination, and there was no edema, opacity and scar in the cornea. No abnormalities were observed in the fundus of the eye. Corneal topography examined Kmax 61.20 D in right eye and 55.40 D in left eye; The corneal thickness was 434 μ m in the right eye and 443 μ m in the left eye. In December 2016, the patient came to Hefei Purui Eye Hospital for treatment due to obvious visual loss. The outpatient diagnosis was: keratoconus in both eyes, and he was admitted to the hospital. The naked eye visual acuity was 0.06 in the right eye and 0.2 in the left eye; The corrected visual acuity was 0.1 in the right eye and 0.4 in the left eye; IOP was normal in both eyes. Corneal endothelial cell count was 2 504/mm in the right eye²2 784/mm in the left eye²。 Corneal endothelial cell counts were not measured in both eyes. Fleischer sign (+), Vogt sign (+) and Mumson sign (+) were observed in the anterior segment slit lamp examination; Mild edema and cloud-like opacity in the center of the cornea, heavier in the right eye. The bottom of his eyes could not see clearly. Corneal topography examination Kmax was 84.80 D in right eye and 70.40 D in left eye; Corneal thickness was 308 μ m in the right eye and 372 μ m in the left eye (Figure 1）。 Right eye deep lamellar keratoplasty was performed under general anesthesia on 20 Dec 2016. The visual acuity of the right eye on the first day after surgery: 0.2 in the naked eye (0.3 in small hole), edema of corneal graft, a small amount of air bubbles in the anterior chamber, and unclear remaining vision. Visual acuity on the 7th day after surgery: 0.3 in the naked eye (0.5 in small hole), edema of corneal graft was reduced, the depth of anterior chamber was acceptable, the pupil was round, about 3 mm in diameter, and the anterior segment and fundus of the remaining eye were not clear. Visual acuity on the 14th postoperative day: 0.5 in the naked eye (0.8 in small hole), transparent corneal graft, normal anterior chamber depth, transparent lens, and no obvious abnormality in the fundus. Therapeutically, the surgical eye was pressurized and wrapped for 3 days, and anti-inflammatory, anti-infective, anti-rejection drugs and corneal epithelial repair drugs were given locally throughout the body (Figure 2）。

The patient was a 21-year-old female. Due to blurred vision under his left eye, he came to Changchun Aier Eye Hospital on September 15, 2015 and was hospitalized. The patient reported that on September 14, 2015, he received subcutaneous injection of 5 ml of cosmetic hyaluronic acid into his forehead in a private institution. After 30 minutes, he felt that his vision under his left eye was dark. He was diagnosed with retinal branch artery occlusion in his left eye in a local hospital. After symptomatic treatment, he went to Changchun Aier Eye Hospital. The patient was in good health and had no history of systemic medication, long-term systemic medication and ocular trauma. Condition at admission: Redness and swelling of skin on forehead (Figure 1）。 Visual acuity: 1.0 in right eye, 1.0 in left eye, intraocular pressure: 17 mmHg in right eye (1 mmHg =0.133 kPa), 17 mmHg in left eye. The conjunctiva of the right eye is not congested, the cornea is transparent, the anterior chamber depth is normal, the aqueous humor is clear, the iris texture is clear, the pupil is round, the diameter is 3.0 mm, the straight and indirect light reflection is sensitive, the lens is transparent, the vitreous body is transparent, the optic disc boundary of the right eye is clear, the color is pale red, the retinal blood vessels run normally, and the foveal reflection exists; There was no conjunctiva congestion in the left eye, transparent cornea, normal anterior chamber depth, clear aqueous humor, clear iris texture, round pupil, 3.0 mm in diameter, straight and indirect light reflection sensitivity, transparent lens, transparent vitreous body, clear optic disc boundary and acceptable color in the left eye, thin retinal arteries above the nose and superior temporal, gray-white edema of the retina above the nose and superior temporal, and disappearance of foveal reflection in the macular area (Figure 2）。 FFA: There is no filling of the retinal artery above the nose and above the temporal in the left eye in the early stage, an embolus is seen at the bifurcation of the retinal artery above the optic disc, and retrograde filling of the retinal artery above the nose and above the temporal in the late stage (FIG. 3A、FIG. 3B）。 Visual field examination: semi-annular visual field defect under left eye (FIG. 4A）。 Clinical diagnosis: occlusion of branch retinal artery in left eye. Immediate administration of anisodamine 5 mg/d post-left eyeball injection, urokinase 30×10⁵U/d intravenous drip, low-flow oxygen inhalation, intraocular pressure reduction, eyeball massage and other treatments. After 5 d, the visual field was re-examined, and the semi-annular defect area in the lower central visual field was smaller than before treatment (FIG. 4B), the patient was discharged for studying abroad.

In 1856, Virchow first described retinal medullated nerve fibers (RMNFs), which are feathery or flaky lesions in the fundus of the eye that appear white or off-white along the retinal nerve fibers^[1]。 The vast majority of RMNF patients are asymptomatic, and some patients will be accompanied by severe visual impairment. It is reported that the incidence of RMNF is about 0.98%, of which more than 90% are monocular; It has no genetic predisposition, so familial onset reports are extremely rare^[2]。 This article reports a case of a child and her mother with binocular disease.

The patient was a male, 30 years old. Because of the decline of visual acuity in both eyes for several years, he went to the Department of Ophthalmology of Yunnan Red Cross Hospital. Ocular examination: binocular visual acuity 0.15, intraocular pressure 38.6 mmHg (1 mmHg =0.133 kPa) in the right eye and 40.8 mmHg in the left eye; For the anterior segment of both eyes, seeQuintessence Picture 1。 Diagnosis: Axenfeld-Rieger syndrome in both eyes.

Diabetic macular edema (DME) is the leading cause of vision loss in diabetics. The destruction of blood retinal barrier is the primary pathological feature. At present, a large number of animal experiments and clinical studies show that DME not only has abnormal vascular structure, but also is an inflammatory disease. A variety of inflammatory media and chemokine are involved in the process of DME. With the extensive clinical application of anti-vascular endothelial growth factor (VEGF), the treatment of DME got a revolutionary breakthrough. However, unlike proliferative diabetic retinopathy (PDR), DME patients response intensively to anti-VEGF agents and couldn't resolve completely despite of multiple injections. Therefore, in addition to VEGF, other possible therapeutic targets and clinical trials of new drugs are also widely carried out. This article reviews the therapeutic process of DME.(Chin J Ophthalmol, 2018, 54: 625-630)

As an antioxidant, hydrogen-rich water has been widely studied in recent years. It is mild enough neither to disturb metabolic redox reactions nor to affect signaling reactive oxygen species. Therefore, there should be no or few adverse effects of H₂. Numerous studies in biology and medicine show that hydrogen-rich water has achieved good results in nervous system, digestive system, respiratory system, heart and kidney diseases. At present, there are few studies on the treatment of eye diseases with hydrogen-rich water. This review summarizes the research progress of hydrogen-rich water for eye diseases in the domestic and foreign literatures. (Chin J Ophthalmol, 2018, 54: 631-635)

Leber hereditary optic neuropathy (LHON) is a mitochondria hereditary eye disease that involves with retinal ganglion cells (RGCs) resulting eventually in degeneration and atrophy of optic nerve. The three mitochondrial DNA mutations (ND4 G11778A, ND1G3460A, ND6T14484C) have been recognized as the primary mutation locus of LHON. Currently there is no effective therapy for LHON. The result of a clinical trial launched in 2007 indicated that intraocular injection of the recombination of adeno-associated virus and target gene is an effective and safe cure for Leber's Congenital Amaurosis (LCA), which brings hope of treating other hereditary eye diseases with gene therapy. Since LHON mainly involves with RGCs, the target gene can be delivered directly to RGCs with the means of injecting the recombination into vitreous cavity, therefore resulting in less damage to retina as compared to other gene therapy for LCA which require the drug to be injected under the retina. This article summarizes the research progress of the clinical trial relevant to gene therapy for LHON.(Chin J Ophthalmol, 2018, 54: 636-640)