Subfoveal choroidal thickness (SFCT) in highly myopic eyes was found to be correlated with increasing age, refractive error (spherical equivalent), and axial length. Which factor is the most significant predictor of SFCT remains controversial. A hospital-based cohort of highly myopic eyes (with spherical equivalent equal to or over 6.00 diopter) were retrospectively screened. Data from only right eye in those bilateral high myopia, and unilateral high myopia in any eye, were used for analysis. Correlations among the four biometric factors were analyzed. Linear correlation was performed to analyze the predictors of SFCT. A cohort of 312 eyes from 312 adults (98 men) was enrolled. Statistical analysis showed that axial length (R = − 0.592), spherical equivalent (R = − 0.471), and age (R = − 0.296) were significantly correlated with SFCT (P < 0.001). No significant correlation was found between age and axial length, or age and spherical equivalent. Partial correlation with controlled age confirmed that axial length (R = − 0.628) was a more significant predictor of SFCT than spherical equivalent (R = − 0.507). SFCT was inversely correlated with increasing age, spherical equivalent and axial length, with axial length as the most significant predictor of SFCT, in adult highly myopic eyes.

Aims To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP). Methods In this multicentre retrospective cohort study, a total of 330 MH eyes with 1082 optical coherence tomography (OCT) images and 3300 clinical data enrolled from four ophthalmic centres were used to train, validate and externally test the DL and MDFN models. 266 eyes from three centres were randomly split by eye-level into a training set (80%) and a validation set (20%). In the external testing dataset, 64 eyes were included from the remaining centre. All eyes underwent macular OCT scanning at baseline and 1 month after VILMP. The area under the receiver operated characteristic curve (AUC), accuracy, specificity and sensitivity were used to evaluate the performance of the models. Results In the external testing set, the AUC, accuracy, specificity and sensitivity of the MH aetiology classification model were 0.965, 0.950, 0.870 and 0.938, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative MH status prediction model were 0.904, 0.825, 0.977 and 0.766, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative idiopathic MH status prediction model were 0.947, 0.875, 0.815 and 0.979, respectively. Conclusion Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH.

To evaluate the role of optical coherence tomography angiography (OCTA) in observation of fundus vascular abnormalities. Patients (n = 50, 10 in each group) with fundus disorders including branch retinal vein occlusion (BRVO), non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), exudative age-related macular degeneration (AMD), and polypoidal choroidal vasculopathy (PCV) were examined. They underwent imaging of OCTA and fluorescein angiography/indocyanine green angiography. The split-spectrum amplitude-decorrelation angiography algorithm was employed to obtain angiography within a 6 × 6 mm scanning area at the posterior retina. Segmentation algorithm was used to obtain 2-dimensional images from arbitrary layers. The OCTA features were analyzed and compared with the findings of conventional angiography. The contralateral eyes of the patients with BRVO and the eyes of 20 healthy volunteers served as controls. OCTA showed precise images of normal and abnormal vasculature in the posterior retina and choroid by the given layers. Vascular abnormalities such as enlarged foveal avascular zone (FAZ), non-perfusion area of retina, microaneurysm, retinal neovascularization, choroidal neovascularization (CNV), branching vascular network and polypoidal lesions in choroid were clearly displayed by OCTA. OCTA provided a better projection of vascular pathologies of the posterior retina and choroid and could determine the precise location of the vascular lesion. The noninvasive OCTA can benefit the diagnosis of vascular abnormalities in the posterior retina and choroid.

Objective: To compare the efficacy and safety of macular buckling and vitrectomy for myopic traction maculopathy showing macular schisis (MS) and associated macular detachment (MD) but without full‐thickness macular hole (FTMH).Design: Prospective, randomized, parallel, open‐label study.Methods: Patients were randomly assigned to either buckling or vitrectomy group. Macular buckling and intravitreal C3F8 gas injection were performed in the buckling group. Small gauge vitrectomy, internal limiting membrane peeling (ILMP) and C3F8 gas tamponade were performed in the vitrectomy group. The patients were followed for 12 months.Main outcome measures: Best‐corrected visual acuity (BCVA) at 12 months.Results: A total of 85 patients were randomized, 80 eyes were included (41 receiving buckling, 39 received vitrectomy), and 78 patients completed the study. There were less eyes determined as surgical failure and required a second surgery in the buckling group than vitrectomy the group (2.4% versus 18.4%, p = 0.021). After surgery, macular buckling achieved more improvement in BCVA (+21.7 versus +4.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p = 0.002). FTMH development was observed in only 1 (2.4%) eye, after removing of the implant due to recurrent conjunctival erosion, in the buckling group and 10 (26.3%) eyes (seven with‐, three without MD) in the vitrectomy group (p < 0.001). More eyes developed cataracts in the vitrectomy group than did in the buckling group (28.9% versus 7.5%, p = 0.014). Macular buckling‐associated strabismus (esotropia), binocular diplopia and implant exposure were observed in limited cases.Conclusions and relevance: Macular buckling is superior to vitrectomy with ILM peeling plus gas injection for surgical treatment of MS and associated MD in high myopia.

Background: To evaluate the global, regional, and national trends of vision impairment associated with diabetic retinopathy (DR) in the working‐age population (20–65 years) from 1990 to 2021.Methods: This was a population‐based analysis using data from the Global Burden of Disease Study 2021. Vision impairment was defined as low vision (Snellen visual acuity of < 6/18 to ≥ 3/60) and blindness (Snellen visual acuity of < 3/60 or central visual field < 10°). The burden of DR‐related vision impairment, that is, prevalence and years lived with disability (YLD), was analyzed by sex, age, location, and sociodemographic index (SDI). A Bayesian age‐period‐cohort analysis was employed to forecast the future burden up to 2035.Results: From 1990 to 2021, the global prevalence rate and YLD rate of DR‐related vision impairment increased significantly. In 2021, 2.85 million prevalent cases and 250 117 YLDs were reported, representing 2.8‐fold and 3.0‐fold increases compared to 1990, respectively. South Asia and China were identified as the most severely burdened region and country in 2021, respectively. Throughout 1990–2021, females consistently bore a greater burden than males. In terms of SDI, the burden was predominantly concentrated in middle‐SDI countries. Predictive analysis suggests a continued increase in the number of patients and YLDs by 2035.Conclusions: Globally, there has been a substantial increase in the burden of DR‐related vision impairment among working‐age individuals, with disparities observed in terms of sex, location, and SDI. Given the projected worsening of this burden, targeted interventions are needed to address this global health challenge.