Zhaotian Zhang

Purpose: To describe a modified technique for negative and positive (Yin-Yang) staining of the internal limiting membrane (ILM) to create a nonstained ILM flap that covers large idiopathic macular holes (MHs). Methods: Consecutive patients with large idiopathic MHs (>400 μm) were prospectively included in the study. After the central vitreous was removed, a droplet of triamcinolone acetonide was injected, covering the MH and surrounding area. Subsequently, indocyanine green (ICG) was injected to stain the outer area of the ILM, followed by creation of a flap from the temporal stained area. Finally, the nonstained ILM flap was inverted to cover the MH. The main outcomes included the best-corrected visual acuity (BCVA), macular contour, and integrity of the outer retina. Results: This study comprised 31 patients (31 eyes). Of the eyes, 28 (90.3%) achieved primary MH closure. The mean minimum linear diameter and base diameter of the MH were 593 ± 119 μm and 1082 ± 242 μm, respectively. At the 6-month follow-up, 12 eyes (38.7%) and 9 eyes (29.0%) had regained a U-shaped or V-shaped macular contour, respectively. In addition, the mean logMAR BCVA improved from 1.06 ± 0.30 preoperatively to 0.56 ± 0.31 ( P < .001). Twenty-one eyes (67.7%) and 16 eyes (51.6%) had regained integrity of the external limiting membrane and ellipsoid zone, respectively, at the 6-month follow-up. Conclusions: The modified ILM staining technique using triamcinolone acetonide and ICG sequentially is a safe and effective method of creating a nonstained ILM flap that covers large MHs and prevents the foveal area from coming into direct contact with ICG.

Purpose: To evaluate the myopia control effect of different concentrations atropine in children and adolescent.Methods: Meta-analyses and systematic reviews available in the Pubmed, Embase, and Cochrane Library databases from the databases’ inception to August 2023 were searched to evaluate the efficacy and tolerability of different concentrations’ atropine in controlling myopia progression. Overall effects were performed using random-effects model. AMSTAR 2 tool was used to assess the quality of included studies. Prespecified outcomes were weight mean difference (WMD) with 95% credible interval (95% CI) of annual spherical equivalent refraction (SER) changes and annual axial length (AL) changes.Results: 19 systematic reviews/meta-analyses of different atropine concentrations were included in the analysis. 14 studies reported SER changes, and 17 reported AL changes. In terms of the studies’ overall methodological quality level (measured using AMSTAR 2), 1 study was rated high, 7 moderate, 7 low, and 4 critically low. The 0.01% atropine was found to have statistically significance (annual SER change WMD 0.27 [95% CI 0.21 - 0.34] D/year; annual AL change WMD -0.09 [95% CI -0.1 to -0.07]) mm/year), 0.05% atropine was preferred considering efficacy and tolerability (annual SER change WMD 0.54 [95% CI 0.49 - 0.58] D/year; annual AL change WMD -0.21 [95% CI -0.12 to -0.02]) mm/year).Conclusions: Different atropine concentrations alleviated children and adolescent myopia progression. However, higher-quality evidence and further investigation are needed to clarify the dose–response relationship, and practical guidelines must be developed to determine myopia control efficacy.

Purpose: To introduce a surgical technique for temporary scleral buckling of noncomplex rhegmatogenous retinal detachment using a combination of nonabsorbable and absorbable sutures that would induce minimal permanent refractive changes. Methods: Twenty consecutive patients (20 eyes) with noncomplex rhegmatogenous retinal detachment were prospectively included. Scleral buckling was performed in all eligible subjects, and encircling buckling was added when necessary. The silicone elements were fixed on the sclera with 5-0 nonabsorbable sutures and tightened to form a ridge with 6-0 absorbable sutures. Best-corrected visual acuity, scleral ridge status, axial length, spherical diopter, and cylinder diopter were collected. Results: All patients achieved primary retinal reattachment with significant improvement of best-corrected visual acuity after surgery. Scleral ridge was obvious and in situ at the 1-month follow-up but diminished at the 3-month follow-up. At the 1-month follow-up, axial length increased from 24.78 mm ± 2.14 mm preoperatively to 25.22 mm ± 2.11 mm, and cylinder diopter increased from −1.99 ± 1.03 to −2.95 ± 1.55 (both P < 0.001). At the 3-month follow-up, axial length, spherical diopter, and cylinder diopter decreased significantly compared with the values at the 1-month follow-up (all P < 0.05). No obvious complications were observed during the whole follow-up. Patients who underwent additional encircling buckling exhibited greater changes in axial length and cylinder diopter at the 1-month follow-up (both P < 0.001). Conclusion: The modified technique of scleral buckling with/without encircling buckling using both nonabsorbable and absorbable sutures offers a safe and effective option to repair noncomplex rhegmatogenous retinal detachment, which would offer an adequate temporary scleral buckling effect and induce minimal permanent refractive changes.

Emmetropization, a natural process of ocular elongation, is closely associated with scleral remodeling. The Fibroblast growth factor-2 (FGF-2) was reported involved in scleral remodeling in myopia models. Herein, we aimed to investigate the role of scleral fibroblast-to-myofibroblast differentiation and FGF-2 in scleral remodeling during maturation. Our findings revealed that the posterior scleral fibroblasts (SFs) from mature guinea pigs exhibit increased stiffness compared to those from young guinea pigs. Moreover, mature SFs displayed decreased cell proliferation but increased levels of α-SMA, matrix metalloproteinase 2 (MMP2), and collagen 1, when compared to young SFs. Additionally, the mRNA expression of scleral Fgf-2, Fgf receptor 1 (Fgfr1), Fgfr2, Fgfr3, and Fgfr4 was increased in mature SFs. Notably, exogenous FGF-2 showed increased cell proliferation and led to decreased expression of α-SMA, MMP2, and collagen 1 in mature SFs. Overall, our findings highlight the influence of maturation on SFs from posterior scleral shells, resulting in increased stiffness and the manifestation of fibroblast-to-myofibroblast differentiation during development. Exogenous FGF-2 increased cell proliferation and reversed the age-related fibroblast-to-myofibroblast differentiation, suggesting a potential role of FGF-2 in regulating scleral remodeling.

Familial exudative vitreoretinopathy (FEVR) is a hereditary disorder that can cause vision loss. CTNND1 encodes a cellular adhesion protein p120-catenin (p120), which is essential for vascularization with unclear function in postnatal physiological angiogenesis. Here, we applied whole-exome sequencing to 140 probands of FEVR families and identified 3 candidate variants in the human CTNND1 gene. We performed inducible deletion of Ctnnd1 in the postnatal mouse endothelial cells (ECs) and observed typical phenotypes of FEVR with reactive gliosis. Using unbiased proteomics analysis combined with experimental approaches, we conclude that p120 is critical for the integrity of adherens junctions (AJs) and that p120 activates Wnt signaling activity by protecting β-catenin from glycogen synthase kinase 3 beta–ubiqutin–guided (Gsk3β-ubiquitin–guided) degradation. Treatment of CTNND1 -depleted human retinal microvascular ECs with Gsk3β inhibitors LiCl or CHIR-99021 enhanced cell proliferation. Moreover, LiCl treatment increased vessel density in Ctnnd1 -deficient mouse retinas. Variants in CTNND1 caused FEVR by compromising the expression of AJs and Wnt signaling activity. Genetic interactions between p120 and β-catenin or α-catenin revealed by double-heterozygous deletion in mice showed that p120 regulates vascular development through the Wnt/cadherin axis. In conclusion, variants in CTNND1 can cause FEVR through the Wnt/cadherin axis.