Central serous chorioretinopathy （CSC）， a self-limiting disease， is one of the most common diseases of the posterior segment. Whether therapy is necessary and how to treat CSC remain disputable. Recently， progress in photodynamic therapy （PDT） once again draws the attention of domestic ophthalmologists. This article reviews changes in the understandings of CSC pathogenesis and the changes in the treatment concept， analyzes whether CSC needs therapy， and whether PDT is more effective， economically justified and safe.

Objective  To compare the effect of low-fluence photodynamic therapy （PDT） in patients with central serous chorioretinopathy （CSC） by evaluation with MP-1 microperimetry and BCVA and to monitor central retinal functional changes. Methods  This was a prospective longitudinal self-controlled case series study. Thirty-four patients （34 eyes） with CSC who received low-fluence PDT were enrolled from March 4 2011 to July 28 2011 in our hospital. BCVA and OCT were evaluated at baseline and at 3， 6， and 12 months after PDT. Retinal sensitivity in the central 12 degrees and fixation stability were evaluated by MP-1 microperimetry at baseline and at 3 months after PDT. The changes in BCVA and mean central retinal sensitivity were analyzed by a chi-square test. Linear regression was used to compare the retinal sensitivity measured by microperimetry and BCVA. Results  The mean BCVA at 12 months after PDT （85.5±6.8）letters was significantly higher than that at baseline （78.1±6.9）letters （t=78.05， P<0.01）. The mean retinal sensitivity measured by microperimetry at 3 months after PDT was （17.2±2.1）dB， which was significantly higher than that at baseline （13.8±3.7）dB （t=19.28， P<0.01）. The retinal thickness measured by OCT at 12 months after PDT （239.2±21.0）μm was significantly thinner than that at baseline （432.7±142.5）μm （t=18.34， P<0.01）. Mann-Whitney nonparametric analysis showed that the changes in BCVA and microperimetry from baseline to 3 months after treatment were not significantly different （Z=-1.1191， P=0.234）. Linear regression analysis showed that BCVA was correlated with microperimetry both at baseline （r=0.5， P<0.05） and after treatment （r=0.6， P<0.05）， while OCT showed no relationship to microperimetry（r=0.01， 0.002； P=0.79， 0.68）. Conclusion  Low-fluence PDT in patients with CSC can improve BCVA， promote the absorption of the subretinal fluid in the macular region， and improve retinal sensitivity in the macular region. The microperimeter is a useful tool combined with BCVA to monitor the functional changes of eyes with CSC.

Objective  To discuss the clinical features of central serous chorioretinopathy （CSC） caused by systemic corticosteroid application， and to guide the clinical diagnosis and treatment. Methods  This was a retrospective study. The clinical data and fundus characteristics of the 12 cases diagnosed as CSC were analyzed. These patients were diagnosed by fundus fluorescein angiography （FFA） and optical coherence tomography （OCT）， as well as a previous history of corticosteroid application. Results  All the 12 CSC cases secondary to corticosteroid treatment were bilateral. Sensory retinal detachment was found in all the eyes and retinal pigment epithelial （RPE） detachment was found in 6 eyes. Multifocal atrophy of RPE was detected in 2 eyes， 14 eyes had yellow fibirinoid exudation and 4 eyes had bullous retinal detachment. Fluorescein angiography （FFA） showed 4 eyes with single fluorescein leaking， 20 eyes with multiple leaking， 2 eyes with window defect hyperfluorescence corresponding to the areas of atrophy of the RPE， and 4 eyes with a large amount of fluid below the pigment epithelium or sensory retina. SD-OCT indicated most of the eyes had single or multifocal sensory retinal detachment with or without RPE detachment， and 6 eyes with hypereflective spots below the sensory retina．Among these patients， there were 2 who had undergone renal transplantation， 3 had multiple sclerosis， 2 had systemic lupus erythematosus， 2 had nephrotic syndrome， 1 had demyelinating disease， and 2 had a history of a large dosage of systemic corticosteroid application because of fever or other disease. Conclusion  CSC caused by systemic corticosteroid therapy may lead to severe vision loss. The classic fundus features of this disease can help us to diagnose correctly. Regular follow-up should be performed for these patients in case of permanent visual impairment.

Objective  To retrospectively evaluate choroidal thickness after treatment by photodynamic therapy （PDT） or laser photocoagulation （LP） in eyes with acute central serous chorioretinopathy （CSC） using enhanced depth imaging spectral-domain optical coherence tomography （EDI-OCT）. Methods  In this retrospective study， 39 eyes of 39 patients with idiopathic acute CSC were recruited， after the following comprehensive ocular examinations were performed： best-corrected visual acuity （BCVA）， slit-lamp biomicroscopy， indirect ophthalmoscopy， fundus photography， fluorescein angiography （FFA）， and indocyanine green angiography （ICGA）. Patients were divided into 2 types based on FFA characteristics： points of leakage in the foveal avascular zone （FAZ） and points of leakage out from the FAZ. The first type， which is not amenable to LP， was treated with a half-dose of verteporfin PDT guided by ICGA， whereas the other type was treated with LP. Subfoveal choroidal thickness and choroidal thickness at 1500 μm temporal， nasal， superior， and inferior to the fovea were measured. The choroidal thickness was measured with enhanced depth imaging OCT before treatment at baseline， and 1 and 3 months after treatment. The results of the choroidal thickness measurements were analyzed using a repeated measurement ANOVA. Results  In the PDT group， choroidal thickness at all evaluating points had decreased significantly within 3 months compared to baseline. Whereas in the LP group， choroidal thickness had decreased significantly within 3 months only at 1500 μm superior and temporal to the fovea compared to baseline. Conclusion  PDT reduces choroidal vascular hyperpermeability by remodeling the choroidal vascular system resulting in the reduction of choroidal thickness in the macular region and may work by a different mechanism than LP， which targets RPE.

Objective  To observe the effect of stellate ganglion block on central serous chorioretinopathy （CSC） associated with cerebral vascular spasm. Methods  This was a retrospective case control study. Seventy patients with ipsilateral middle cerebral artery eye spasm who had been diagnosed with central serous chorioretinopathy were screened by transcranial doppler （TCD） examination. Fundus fluorescein angiography （FFA）， optical coherence tomography （OCT）， Amsler grid and anterior and posterior segment examination were performed. The patients were then divided into an observation group and a control group. The control group was treated with traditional oral drugs to improve microcirculation （vitamin B， vitamin E， dibazol and compound danshen drops） and the observation group was treated with an oral stellate ganglion block to improve microcirculation. Treatment was given once on alternate days and on 4 consequetive days during one span of the treatment period. Vision， fundus and FFA changes in the two groups of patients were compared at 1， 2， 4， 8 and 12 weeks. A chi square test was used to compare the total rate of effectiveness for the two groups. Results  The total rates of effectiveness for the treatment and control groups were 94.4% and 70.6%. There was a statistically significant difference between the two groups （χ2=7.00， P<0.01）. The course of the treatment was shorter for the treatment group than for the control group. Conclusion  Stellate ganglion block may be effective in the treatment of central serous chorioretinopathy associated with cerebral vascular spasm.

Objective  To compare pseudoaccommodation after cataract phacoemulsification combined with the implantation of different intraocular lenses （IOLs）. Methods  In a prospective study， 73 patients （82 eyes） who had received IOL implants after cataract extraction were divided into three groups according to the implanted IOL： group 1， monofocal IOL， 28 patients， 32 eyes； group 2， multifocal IOL， 24 patients， 27 eyes； and group 3， accommodative IOL， 21 patients， 23 eyes. The uncorrected distance， intermediate and near visual acuity； best-corrected distance and near visual acuity； and pseudoaccommodation （respectively measured by Integrated Refractometer and iTrace Visual Function Analyzer 3.1） were measured. The data were collected at 3， 7， 30 and 90 days after surgery， and analyzed by a single-factor analysis of variance. Results  The differences in the best-corrected distance visual acuity， near visual acuity and uncorrected distance visual acuity was not statistically significant， while uncorrected intermediate distance visual acuity of group 3 was better than groups 1 and 2 （F=4.50， P＜0.05）. The near visual acuity of groups 2 and 3 was better than group 1 （F=26.06， P＜0.05）. Subjective pseudoaccommodation of group 2 was 2.67±0.49 D and objective pseudoaccommodation was 0.93±0.42 D. Subjective pseudoaccommodation of group 3 was 3.0±0.78 D and objective pseudoaccommodation was 0.91±0.58 D. Both groups had better pseudoaccommodation than group 1 with 1.78±0.26 D for subjective pseudoaccommodation （F=18.51， P＜0.05） and 0.37±0.22 D for objective pseudoaccommodation （F=7.39， P＜0.05）. Conclusion  Multifocal and accommodative IOLs can temporarily provide better visual acuity and pseudoaccommodation.

Objective To evaluate the prognosis and factors of vitrectomy for a traumatic macular hole. Methods A retrospective case study was performed on a consecutive series of 54 patients （54 eyes） who underwent vitrectomy for macular hole surgery. The postoperative anatomic closure status of the hole， visual acuity prognosis， and multiple factors related to prognosis， including preoperative visual acuity， duration of disease， size of the macular hole， and preoperative anterior or posterior segment complications， were analyzed. Data were analyzed with a paired t test and chi-square test. Results After surgery， 48（89%） traumatic macular hole eyes had closure； 6 eyes with traumatic macular holes eyes had joint results. The closure time was 20.6±10.1 days. Visual acuity （VA） increased in 28 eyes （52%）. There was a significant difference between preoperative VA and postoperative VA （t=4.496， P＜0.01）. There were no significant differences in preoperative VA， duration of disease， or preoperative anterior segment complications between the two different VA prognosis groups. There were significant differences in macular hole size and preoperative posterior segment complications between the two different VA prognosis groups （χ2=6.006， 10.650， P＜0.05）. Conclusion Using vitrectomy is helpful for the prognosis of anatomy and function in traumatic macular hole patients， but the patients with preoperative posterior segment complications had a poor VA prognosis.

Objective  To evaluate the practical value of first-time iris recognition in wavefront aberration-guided laser in situ keratomileusis (LASIK). Methods  In a randomized contrast study， 101 patients (202 eyes) with myopia were randomly divided into 2 groups： the iris recognition group (50 cases， 100 eyes) that agreed to undergo first-time iris recognition combined with wavefront-guided LASIK， and the non-iris recognition group (51 cases， 102 eyes) that agreed to undergo conventional wavefront aberration-guided LASIK. Uncorrected visual acuity， refractive error， higher order aberrations and contrast sensitivity were compared between the two groups at 1 month， 3 months and 6 months postoperatively. The data were analyzed by SPSS 17.0 statistical software， a t test for the measurement data， and a chi-square test for the enumeration data. Results  Six months after the operation， the number of patients who gained more than 1 line of best spectacle-corrected visual acuity (BSCVA) in the iris recognition group (62 eyes， 62.0%) was significantly more than that of the non-iris recognition group (48 eyes， 47.1%) (x²=4.99， P＜0.05). The degree of astigmatism in the iris recognition group (-0.19±0.24 D) was significantly lower than that in the non-iris recognition group (-0.30±0.36 D) (t=2.49， P＜0.05). At a 6.0 mm pupil size， there was a statistically significant difference in third-order aberration root mean square value between the iris recognition group and non-iris recognition group (t=2.22， 3.31， P＜0.05). Six months after the operation， the contrast sensitivity of the non-iris recognition group returned to their preoperative baseline. However， the iris recognition group had slightly better contrast sensitivity than their preoperative levels. Conclusion  First-time iris recognition can increase visual quality in wavefront aberration-guided LASIK.

Objective  To investigate the differences in positive relative accommodation （PRA） and negative relative accommodation （NRA） in juvenile emmetropes and myopes， and to analyze the relationship between the differences in PRA and NRA and the onset of myopia. Methods  In this cross-sectional study， the subjects were divided into two groups， a juvenile group and young adult group （entrant group）. The juvenile group included 43 emmetropes （+0.5~-0.25 D， 7-16 years old， average age 10.7±3.0 years） and 110 myopes （-0.5~-3.00 D， anisometropia less than -1.00 D， 7-16 years old， average age 11.5±2.6 years）. There were 266 participants （average age 18.76±0.80 years） in the youth group， including 29 emmetropes and 237 myopes. PRA and NRA were measured by a phoroptor based on computer optometry. A one-way ANOVA was used to analyze the comparisons between these two groups. Results  In the juvenile group， PRA was -5.52±1.21 D for emmetropes compared to -2.27±1.19 D for myopes， which was a statistically significant difference （F=227.26， P＜0.01）. The NRA for emmetropes was +2.41±0.65 D and was +2.21±0.73 D for myopes. The difference was not statistically significant. The PRA/NRA ratios for emmetropes and myopes were 2.35±0.45 and 1.10±0.60， and the difference was statistically significantly （F=156.40， P＜0.01）. In the young adult group， PRA was -4.87±1.47 D for emmetropes in comparison to -2.63±1.41 D for myopes， which was a statistically significant difference （F=66.62， P＜0.01）. The NRA of emmetropes was +2.09±0.46 D and was +1.98±0.48 D for myopes. The difference was not statistically significant （F=1.55， P=0.214）. The PRA/NRA ratios for emmetropes and myopes were 2.35±0.51 and 1.34±0.93. The difference was statistically significant （F=47.28， P＜0.01）. Conclusion  The PRA and PRA/NRA ratio for juvenile and young adult myopes is significantly less than for emmetropes. The decrease in PRA， i.e.， accommodation reserve， is a significantly different index between myopes and emmetropes in juveniles and young adults.

Objective  To evaluate the features of position and morphology of stage 1 posterior vitreous detachment （PVD） in young adult myopes. Methods  In a prospective case series study， a total of 305 young adults （607 eyes） with myopia， posterior vitreous detachment was examined under 2D and 3D images by optical coherence tomography. Results  There were 141 eyes at stage 1 PVD. The percent of PVD located within one， two or three quadrants was 26.95%， 59.57%， and 13.48%， respectively. In 24 eyes （17.02%） there was a tendency for PVD to be located in the superior quadrant. But the inferior， temporal or nasal quadrants were also the original quadrants of incomplete PVD. And the PVD in two different quadrants could not form a connection. The morphology of stage 1 PVD was V-shaped in 2D images and dish-shaped in 3D images. Conclusion  Not all PVD in young adult myopes started in the superior quadrant. The initial stage of PVD was V-shaped and had multifocal traits at times.

Objective  To investigate the inhibitory mechanism of plasmin on the formation of posterior capsule opacity （PCO）. Methods  In an experimental study， twenty 4-month-old New Zealand white rabbits were selected （approximate weight 2.0 to 2.5 kg）. No eye-related pathological defects were observed in any rabbits. They were randomly divided into two groups of 10 rabbits each： a control group and an experimental group. All rabbits underwent phacoemulsification surgery under general anesthesia. At the conclusion of the surgery， rabbits in the experimental group were injected with plasmin 1 IU （0.2 ml） in the anterior chamber and the control group was injected with saline 0.2 ml. Inflammation in the anterior chamber and the mobidity of PCO were recorded over a period of time. Basic fibroblast growth factor （bFGF） was measured by the ELISA method for each group. In addition， a semi-quantitative analysis of lens proliferating cell nuclear antigen （PCNA） was performed by immunohistochemical staining using a computer assisted image analysis system. All data were analyzed by the SPSS 13.0 statistical software program （P<0.05 was considered as a significant difference）. Results  ①Inflammation of the anterior chamber （AC）. On the first day after surgery， all rabbit eyes in the two groups presented with variable inflammation of the AC. After 3 days， reaction in the AC was reduced and the morbidity of the inflammation was significantly decreased in the experimental group compared to the control group at 3 days and 7 days （χ2=4.33， P<0.05； χ2=7.06， P<0.01）.②Morbidity of PCO. The morbidity of the PCO was 45% in the experimental group and 90% in the control group at 60 days. The decrease was significant compared to the control group （χ2=6.14， P<0.05）. ③Concentration of basic fibroblast growth factor （bFGF）. ELISA analysis demonstrated that the concentration of bFGF in the experimental group was significantly decreased compared to the control group at all time points from one day to 4 weeks. And there was no significant difference between two groups at 60 days. ④Optical density. There was a single laminar layer of cells in the experimental group and mutiple layers of laminar cells in the control group based on the semi-quantitative analysis of immunohistochemical staining. There was a significant difference in optical density（OD） between the experimental and control groups. Conclusion  ①The use of plasmin is an effective method for controlling inflammation in the AC after phaco surgery. ②Plasmin significantly down regulates the concentration of bFGF in AC. ③Plasmin can decrease the morbidity of PCO and slow its development.

Objective  To observe the expression of transforming growth factor-β2 （TGF-β2） in the vitreous body of patients with proliferative vitreoretinal diseases； to investigate the role of TGF-β2 in the pathogenesis of proliferative vitreoretinal diseases. Methods  In an experimental study， vitreous specimens were obtained during vitrectomy from 61 patients （61 eyes） with proliferative vitreoretinal diseases. The vitreous specimens were obtained from 37 eyes with proliferative diabetic retinopathy （PDR） and 24 eyes with proliferative vitreoretinopathy （PVR）. Eight vitreous fluid samples were obtained from a normal control group. The concentrations of TGF-β2 in the vitreous body were detected by enzyme-linked immunosorbent assay （ELISA）. Results  The concentrations of TGF-β2 in the vitreous bodies of eyes with PDR， PVR and the normal controls were 22.71±2.32 ng/ml， 21.28±1.7）ng/ml， and 19.00±0.62 ng/ml， respectively. Intravitreous concentrations of TGF-β2 were higher in patients with PDR and PVR than in the control group. The difference was statistically significant（F=7.756， P<0.01）. The concentration of TGF-β2 in the vitreous body from eyes of PDR patients was clearly higher than concentrations in PVR patients. The difference was statistically significant （P<0.05）. The concentrations of TGF-β2 in the vitreous body were higher in level Ⅵ of the PDR group in comparison to level Ⅴ of the PDR group. The difference was statistically significant （P<0.01）. The concentrations of TGF-β2 in the vitreous body were higher in the D class of the PVR group in comparison to the C class. The difference was statistically significant （P<0.01）. The concentrations of TGF-β2 in the vitreous bodies were positively correlated with the duration of the diseases： the correlation for the PDR group was r=0.705 （P<0.01） and the correlation for the PVR group was r=0.934（P<0.01）. Conclusion  TGF-β2 may play an important role in the pathogenesis and development of proliferative vitreoretinal diseases.

Objective  To study the long-term （five-year follow-up） changes in posterior corneal curvature and central corneal thickness by using the OrbscanⅡ topographer in patients who had undergone laser in situ keratomileusis （LASIK） for myopia. Methods  Forty-eight eyes of 48 patients who had undergone LASIK for myopia were included in a retrospective observational case series study. The mean preoperative refractive error was -6.25±2.87 D. The preoperative and postoperative changes in the posterior corneal curvature and central corneal thickness of each eye were measured by OrbscanⅡ. The posterior corneal curvature was obtained from the central 6mm zone of the OrbscanⅡ. The postoperative follow-up period was at 1， 3， 6， 9， 12， 24， 36 and 60 months. Using SPSS 16.0 software， a comparison of the least-significant difference （LSD） pairwise was used to analyze the difference in the posterior corneal curvature and central corneal thickness at each follow-up visit. Results  ①The posterior corneal curvature was higher in the 1st month postoperatively compared to preoperative curvature （t=8.211， P<0.01）. There was no statistically significant difference for the change in posterior corneal curvature from the 1st month to the 9th month （P>0.05）. The posterior corneal curvature slowly decreased over time from the 9th month to the 24th month （the values of t were -4.640 and -2.659， the values of P were <0.001 and 0.014）. The posterior corneal curvature did not become stable until after the 24th month （P>0.05）. ②The central corneal thickness was lower in the 1st month postoperatively than preoperative thickness （t=10.08， P<0.01）. The central corneal thickness slowly increased over time from the 1st month to the 9th month （the values of t were -5.402， -4.428 and -2.334， the values of P were <0.001， <0.001 and 0.027）. The central corneal thickness did not become stable until after the 9th month （P>0.05）.③The posterior corneal curvature was correlated with corneal thickness （r=-0.703， P<0.01）. Conclusion  The posterior corneal curvature and the central corneal thickness both increase shortly after LASIK surgery and stabilize after this initial period. There is a negative correlation between posterior corneal curvature and central corneal thickness.

Objective  To investigate the prevalence of complete posterior vitreous detachment in rhegmatogenous retinal detachment （RRD） patients and to evaluate the following diagnostic tests： fundus examination， B-scan ultrasound and optical coherence tomography （OCT）. Methods  Thirty patients （30 eyes） with RRD who underwent vitrectomy in Shanghai First People′s Hospital were included in this prospective case-series study. Patients received comprehensive ocular examinations that included fundus examination， B-scan ultrasound and OCT. TA stain （triamcinolone acetonide） was used to assist during the vitrectomy surgery as well as being the gold standard for PVD diagnosis. Data were analyzed using a Kappa test. Results  The rate of detection for the prevalence of complete PVD was as follows： 10.0% by TA stain， 76.7% by B-scan， 36.7% by fundus examination and 13.3% by OCT. Different rates of PVD detection were found by the above examinations and， of these， the difference was most significant between B-scan and observation during surgery. Conclusion  Observation during surgery with the help of TA is comparatively the most persuasive diagnostic method for PVD. Different examination methods can be selected for individual cases.

Objective  To examine the effectiveness and safety of 3 kinds of surgeries in eyes with refractory glaucoma following vitrectomy. Methods  A retrospective study of a non-comparative case series of 17 eyes of 17 patients who had undergone refractory glaucoma surgery following vitrectomy was conducted from Jan. 2008 to Dec. 2010. Patients were divided into three groups： group A （5 eyes）， patients were treated with trabeculectomy， group B （8 eyes）， patients were treated with glaucoma valve implantation， and group C （4 eyes）， patients were treated with 810 nm laser transcleral cyclophotocoagulation. Data were analyzed using repeated measure ANOVA. Results  All three groups had good control of intraocular pressure （IOP） in nonage after surgery. One year after surgery， the mean IOP of group A was 30.44±4.23 mmHg. Medications were needed to lower IOP in this group. The mean IOP of group B was 20.78±4.54 mmHg， which was considered ideal IOP. The mean IOP of group C was 30.79±3.23 mmHg. The differences were significant （F=32.20， 46.81， 27.69， P<0.01）， compared to preoperative levels. No serious complications occurred after surgery. Conclusion  For refractory glaucoma following vitrectomy， trabeculectomy is less effective over the long term and glaucoma valve implantation is a better treatment method. Treatment with 810 nm laser transcleral cyclophotocoagulation can be useful for blind eyes.

Visual impairment not only affects a patient′s personal life on a daily basis， but also places a heavy burden on the family and society. Nowadays epidemiological surveys on visual impairment have been conducted all over the world， which indicate the prevalence and principal causes in elderly people. We should pay close attention to the rehabilitation of visual impairment in the elderly， and make a great effort to prevent uncorrected visual impairment.