Purpose: This study aimed to investigate the incidence of white without pressure (WWOP) and dark without pressure (DWOP) in a young myopic group based on multimode imaging and to explore the quantitative changes in DWOP based on ultra-wide swept-source optical coherence tomography angiography (SS-OCTA). Methods: A total of 138 patients with high myopia (SE < −6.00 D) were recruited. Examinations, including indirect ophthalmoscope, ultra-wide color fundus photograph, and ultra-wide SS-OCTA, were conducted for each eye. A total of 50 of the 138 patients were selected for further analysis since their DWOP lesions in SS-OCTA could be well quantified. Results: The incidence rates of WWOP and DWOP in the young myopic group were 35.24% and 29.96%, respectively. The patients with a lower spherical equivalent (SE) showed a tendency to have a higher axial length (AL) and higher prevalence of WWOP. Multivariate regression analysis illustrated that a more serious SE and a longer AL were risk factors for both WWOP and DWOP. Eyes with DWOP lesions had lower vessel density (VD) in the whole retina (p < 0.001) and a deep vascular complex (DVC) (p < 0.001), and lower thickness of the outer retina (p < 0.001) compared with healthy counterparts. Conclusion: Ultra-wide SS-OCTA provided new insights into myopic-related peripheral retinal degenerations. DWOP was characterized by thinning of the outer retina and lower perfusion in DVC.

Introduction. Diagnosis of uveitis is challenging due to the multitude of possible pathogenies. Identifying infectious and non-infectious uveitis is of great clinical significance. Recently, metagenomic next-generation sequencing (mNGS) was used to detect infectious and non-infectious uveitis, but its efficacy has not been widely evaluated. Hypothesis. Compared with routine diagnostic tests (RDTs), mNGS is more effective in identifying infectious and non-infectious uveitis. Aim. To describe the microbiological diagnostic performance of mNGS in detecting infectious and non-infectious uveitis. Methodology. Patients with suspected infectious uveitis of uncertain pathogenesis were tested by mNGS and RDTs. Infectious and non-infectious uveitis were grouped according to the final diagnosis based on comprehensive analysis of the test results and the effect of therapy. The test results were used to assess the performance of mNGS in actual clinical practice. Results. Fifty-eight cases were enrolled in this project, including 32 cases of infectious uveitis and 26 cases of non-infectious uveitis. The sensitivity of mNGS was 96.88%, which was much higher than that of RDTs. The detected pathogenic micro-organisms included bacteria, fungi, viruses, Toxoplasma gondii and Bartonella. Consequently, mNGS showed a high negative predictive value (NPV) of 94.74%, indicating that an mNGS negative should be a true negative result most of the time, but a low positive predictive value (PPV) of 79.49%. Conclusions. mNGS showed extremely high sensitivity but low specificity, which increased the detection rate of infectious uveitis pathogens but might result in false positives. The excellent NPV suggested that the identification of non-infectious uveitis is of considerable clinical importance.

Background: Previous studies on the biomarkers of pathologic myopia choroidal neovascularization (pmCNV) development merely detected limited types of proteins and provide a meagre illustration of the underlying pathways. Hence, a landscape of protein changes in the aqueous humor (AH) of pmCNV patients is lacking. Here, to explore the potential mechanisms and biomarkers of pmCNV, we analyzed the clinical data and protein profile among atrophic (A) lesions, tractional lesions (T) and neovascular (N) lesions in myopic patients based on the ATN grading system for myopic maculopathy (MM). Results: After investigating demographic data of our patients, a correlation was found between A and N lesions (R = 0.5753, P < 0.0001). Accordingly, groups were divided into patients without MM, patients with myopic atrophic maculopathy (MAM), and patients with pmCNV (N2a lesion). In proteomics analysis, the increased protein level of GFAP and complement-associated molecules in AH samples of the 3 groups also indicated that MAM and pmCNV shared similar characteristics. The GO enrichment and KEGG pathway analysis were performed, which mapped that differential expressed proteins mainly engaged in JAK-STAT pathway between the pmCNV group and two controls. Furthermore, we identified several potential biomarkers for pmCNV, including FCN3, GFAP, EGFR, SFRP3, PPP2R1A, SLIT2, and CD248. Conclusions: Atrophic lesions under pathologic myopic conditions demonstrated similarities to neovascularization development. Potential biomarkers including GFAP were associated with the pathogenesis of pmCNV. In summary, our study provides new insights for further research on pmCNV development.

Purpose: The purpose of this study was to prospectively evaluate the clinical efficacy and safety of baricitinib, a selective Janus kinase (JAK)1/JAK2 inhibitor, in the treatment of patients with Vogt–Koyanagi–Harada (VKH) disease. Design: The study was designed as a prospective, open-label, longitudinal, single-center cohort study. Methods: We enrolled 38 patients (76 eyes) with VKH disease (including both initial-onset and recurrent/chronic cases) at Tongji Hospital, Wuhan, China, between 2022 and 2024. Patients were assigned to one of two treatment protocols based on disease severity and prior treatment history: group A received oral baricitinib (4 mg/day) combined with systemic methylprednisolone, and group B received oral baricitinib monotherapy. Clinical assessments were performed at baseline and at 1, 3, 6, 12, and 18 months. Primary outcome measures included best-corrected visual acuity (BCVA), anterior chamber (AC) cell and flare grades, subfoveal choroidal thickness (SFCT), subretinal fluid (SRF) height, and angiographic inflammatory scores (fluorescein angiography [FA]/indocyanine green angiography [ICGA]). Secondary outcomes included quality-of-life scores (25-item version of the Visual Function Questionnaire [VFQ-25], SF-36), adverse drug reactions (ADRs), and recurrence rates. Results: The cohort included 44 eyes with early-stage (initial-onset) and 32 eyes with late-stage (recurrent) VKH disease (mean age: 43.1 years ± 12.3 years; follow-up: 6–18 months). Inflammation control was achieved in all patients in both groups. In group A, the combination therapy led to rapid resolution of inflammation. In group B (monotherapy), significant improvements were observed from baseline to the final visit, including improved BCVA (0.12 to 0.68, p < 0.001), reduced AC cell grade (1.54 to 0.05, p = 0.007), decreased SFCT (537.6 to 252.4 µm, p = 0.007), and complete resolution of SRF ( p < 0.001). FA and ICGA scores significantly decreased ( p < 0.05), and VFQ-25 scores improved (82.6 to 92.9, p < 0.001). No severe ADRs or disease recurrences were observed during the follow-up period. Conclusion: This study demonstrates that baricitinib is a promising therapeutic option for both early- and late-stage VKH disease. It effectively controls choroidal inflammation, improves visual function, and allows for a substantial reduction in corticosteroid burden with a favorable safety profile. Clinical trial registration: http://www.chictr.org.cn , identifier ChiCTR2100048030.