AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 pat...AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.展开更多
AIM:To assess the long-term efficacy and safety of yttrium-aluminum garnet(YAG)laser vitreolysis for vision degrading myodesopsia(VDM)caused by posterior vitreous detachment(PVD).METHODS:This retrospective study revie...AIM:To assess the long-term efficacy and safety of yttrium-aluminum garnet(YAG)laser vitreolysis for vision degrading myodesopsia(VDM)caused by posterior vitreous detachment(PVD).METHODS:This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis.The baseline demographic information,the patterns of floaters,the number of floaters,and the subjective improvement of floater sympotoms(ranging from 0 to 100%)from medical records were collected.Significant improvement was defined as a relief of floater symptoms of≥50%at the final visit.The long-term efficacy and safety of YAG laser vitreolysis were analyzed.The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses.RESULTS:The final analysis included 221 patients with VDM.The mean age of patients was 61.08±7.74y,and the mean length of follow-up was 21.38±5.61mo.Totally 57.01%of patients experienced a significant improvement in their floater symptoms after YAG laser therapy,and none of them developed delayed retinal abnormalities such as retinal tears or detachments.Age(OR=1.049,95%CI=1.007-1.092,P=0.021)was identified as a significant risk factor for significant improvement in VDM.CONCLUSION:YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM,and patients of advanced age are more likely to get favorable outcomes.展开更多
AIM:To access the agreement of intraocular pressure(IOP)values obtained from biomechanically corrected tonometer[Corvis ST(CST)],non-contact tonometer(NCT),and Goldmann applanation tonometer(GAT)in children with NCT m...AIM:To access the agreement of intraocular pressure(IOP)values obtained from biomechanically corrected tonometer[Corvis ST(CST)],non-contact tonometer(NCT),and Goldmann applanation tonometer(GAT)in children with NCT measured-IOP(NCT-IOP)values of 22 mm Hg or more,and related factors.METHODS:A total of 51 eyes with NCT-IOP≥22 mm Hg in children aged 7 to 14y were examined and IOP was measured by CST,NCT,and GAT.Based on GAT measured IOP(GAT-IOP),ocular hypertension(OHT)group(≥22 mm Hg,24 eyes)and the non-OHT group(<22 mm Hg,27 eyes)were defined.We compared the agreement of the three measurements,i.e.,CST measured IOP(CST-IOP),GAT-IOP,and NCT-IOP,and further analyzed the correlation between the differences in tonometry readings,central corneal thickness(CCT),axial length(AL),optic disc rim volume,and age.RESULTS:Compared with the OHT group,thicker CCT,larger rim volume,and higher differences between NCTIOP and GAT-IOP,were found in the non-OHT group.The differences between CST-IOP and GAT-IOP were lower than the differences between NCT-IOP and GAT-IOP in both groups.The mean differences in CST-IOP and GAT-IOP were 1.26 mm Hg(95%limit of agreement ranged from 0.1 to 2.41 mm Hg,OHT group)and 1.20 mm Hg(95%limit of agreement ranged from-0.5 to 3.00 mm Hg,non-OHT group),and the mean differences in NCT and GAT were 3.90 mm Hg(95%limit of agreement ranged from-0.19 to 9.70 mm Hg,OHT group)and 6.00 mm Hg(95%limit of agreement ranged from 1.50 to 10.50 mm Hg,non-OHT group).The differences between CST-IOP and GAT-IOP were not related to CCT,age,and AL in both groups;while the differences between NCT-IOP and GAT-IOP were related to CCT in the OHT group(r=0.93,P<0.001)and to CCT and AL in the non-OHT group(r=0.66,P<0.001,r=-0.81,P<0.001).CONCLUSION:The accuracy of NCT in the diagnosis of pediatric OHT is low.The agreement of CST-IOP and GATIOP was significantly higher in children with and without OHT than in those with NCT-IOP and GAT-IOP.Therefore,CST can be used as a good alternative for IOP measurement in children.The impacts of CCT and AL on NCT measurement need to be fully considered when managing childhood IOP.展开更多
AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:Th...AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.展开更多
AIM:To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children.METHODS:Databases(PubMed,EMBASE,the Cochrane Library and Web of science)were co...AIM:To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children.METHODS:Databases(PubMed,EMBASE,the Cochrane Library and Web of science)were comprehensively searched from inception to April 2022.Types of studies included were randomized clinical trials(RCTs).The published languages were limited to English.Two researchers assessed the quality of included studies independently using Cochrane risk of bias tool based on the Cochrane Handbook for Systematic Reviews of Interventions.Funnel plots and Egger’s test were used for detection of publication bias.Meta-analyses were conducted using STATA(version 15.0;StataCorp).RESULTS:A total of 15 RCTs involving 2268 patients were included in the study.In the atropine group,spherical equivalent progressed at a significantly lower rate[weighted mean difference(WMD)=0.39,95%confidence interval(CI):0.23,0.54]than in the control group.A WMD of 0.15 mm was associated with less axial elongation(95%CI-0.19,-0.10).Different doses showed statistically significant differences(P<0.05)and an improved effect could result from a higher concentration.Changes in photopic pupil size and mesopic pupil size in atropine group is 0.70 mm(95%CI:0.33,1.06)and 0.38 mm(95%CI:0.22,0.54)more than the control group.In the present Meta-analysis,no changes in accommodative amplitude(AA)were associated with atropine administration.Atropine administration increased the risk of adverse effects by 1.37 times.CONCLUSION:Concentrations of less than 1%atropine are able to effectively retard diopter and axis growth of myopia in Asian children in a dose-dependent manner.Meanwhile,it caused pupil enlargement,but induced no change in the AA within this range.Further study is required to determine the dosage needed to achieve maximum efficacy and minimal side effects.展开更多
The natural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone...The natural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body.展开更多
AIM: To investigate the findings of infrared fundus autofluorescence(IR-AF) and spectral-domain optical coherence tomography(SD-OCT) in eyes with optic disc melanocytoma(ODM).· METHODS: IR-AF findings and those o...AIM: To investigate the findings of infrared fundus autofluorescence(IR-AF) and spectral-domain optical coherence tomography(SD-OCT) in eyes with optic disc melanocytoma(ODM).· METHODS: IR-AF findings and those of other ophthalmologic imaging examinations, including short-wave autofluorescence(SW-AF), fluorescein angiography(FA), fundus color photography, and SD-OCT of 8 eyes of 8 consecutive cases with ODM were assessed.·RESULTS: The ODMs in all cases(100%) presented similar IR-AF, SW-AF, and FA findings. On IR-AF images, ODMs showed outstanding hyper-AF with well-defined outline. On SW-AF images, the area of ODMs presented as hypo-AF. FA images revealed the leaking retinal telangiectasia on the surface of the ODMs. On SDOCT images in 8 cases(100%), the ODMs were sloped with highly reflective surface, which were disorganized retina and optic nerve layers. In 7 cases(87.5%), peripapillary choroids were involved. The melanocytomas of 8 cases(100%) presented as optically empty spaces. Vitreous seeds were found in one case(12.5%).· CONCLUSION: IR-AF imaging may provide a new modality to evaluate the pathologic features of ODMs,and together with SW-AF imaging, offers a new tool to study biological characteristics associated with ODMs.SD-OCT is a valuable tool in delimitating the tumor extension and providing morphological information about the adjacent retinal tissue.展开更多
文摘AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.
基金Supported in part by the Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program(No.RC210267).
文摘AIM:To assess the long-term efficacy and safety of yttrium-aluminum garnet(YAG)laser vitreolysis for vision degrading myodesopsia(VDM)caused by posterior vitreous detachment(PVD).METHODS:This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis.The baseline demographic information,the patterns of floaters,the number of floaters,and the subjective improvement of floater sympotoms(ranging from 0 to 100%)from medical records were collected.Significant improvement was defined as a relief of floater symptoms of≥50%at the final visit.The long-term efficacy and safety of YAG laser vitreolysis were analyzed.The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses.RESULTS:The final analysis included 221 patients with VDM.The mean age of patients was 61.08±7.74y,and the mean length of follow-up was 21.38±5.61mo.Totally 57.01%of patients experienced a significant improvement in their floater symptoms after YAG laser therapy,and none of them developed delayed retinal abnormalities such as retinal tears or detachments.Age(OR=1.049,95%CI=1.007-1.092,P=0.021)was identified as a significant risk factor for significant improvement in VDM.CONCLUSION:YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM,and patients of advanced age are more likely to get favorable outcomes.
基金Supported by Medical Science Research Project of Hebei Province in 2023(No.20231818).
文摘AIM:To access the agreement of intraocular pressure(IOP)values obtained from biomechanically corrected tonometer[Corvis ST(CST)],non-contact tonometer(NCT),and Goldmann applanation tonometer(GAT)in children with NCT measured-IOP(NCT-IOP)values of 22 mm Hg or more,and related factors.METHODS:A total of 51 eyes with NCT-IOP≥22 mm Hg in children aged 7 to 14y were examined and IOP was measured by CST,NCT,and GAT.Based on GAT measured IOP(GAT-IOP),ocular hypertension(OHT)group(≥22 mm Hg,24 eyes)and the non-OHT group(<22 mm Hg,27 eyes)were defined.We compared the agreement of the three measurements,i.e.,CST measured IOP(CST-IOP),GAT-IOP,and NCT-IOP,and further analyzed the correlation between the differences in tonometry readings,central corneal thickness(CCT),axial length(AL),optic disc rim volume,and age.RESULTS:Compared with the OHT group,thicker CCT,larger rim volume,and higher differences between NCTIOP and GAT-IOP,were found in the non-OHT group.The differences between CST-IOP and GAT-IOP were lower than the differences between NCT-IOP and GAT-IOP in both groups.The mean differences in CST-IOP and GAT-IOP were 1.26 mm Hg(95%limit of agreement ranged from 0.1 to 2.41 mm Hg,OHT group)and 1.20 mm Hg(95%limit of agreement ranged from-0.5 to 3.00 mm Hg,non-OHT group),and the mean differences in NCT and GAT were 3.90 mm Hg(95%limit of agreement ranged from-0.19 to 9.70 mm Hg,OHT group)and 6.00 mm Hg(95%limit of agreement ranged from 1.50 to 10.50 mm Hg,non-OHT group).The differences between CST-IOP and GAT-IOP were not related to CCT,age,and AL in both groups;while the differences between NCT-IOP and GAT-IOP were related to CCT in the OHT group(r=0.93,P<0.001)and to CCT and AL in the non-OHT group(r=0.66,P<0.001,r=-0.81,P<0.001).CONCLUSION:The accuracy of NCT in the diagnosis of pediatric OHT is low.The agreement of CST-IOP and GATIOP was significantly higher in children with and without OHT than in those with NCT-IOP and GAT-IOP.Therefore,CST can be used as a good alternative for IOP measurement in children.The impacts of CCT and AL on NCT measurement need to be fully considered when managing childhood IOP.
基金Supported by National Natural Science Foundation of China(No.81470654)Natural Science Foundation of Shaanxi Province(No.2019SF-047)。
文摘AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.
文摘AIM:To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children.METHODS:Databases(PubMed,EMBASE,the Cochrane Library and Web of science)were comprehensively searched from inception to April 2022.Types of studies included were randomized clinical trials(RCTs).The published languages were limited to English.Two researchers assessed the quality of included studies independently using Cochrane risk of bias tool based on the Cochrane Handbook for Systematic Reviews of Interventions.Funnel plots and Egger’s test were used for detection of publication bias.Meta-analyses were conducted using STATA(version 15.0;StataCorp).RESULTS:A total of 15 RCTs involving 2268 patients were included in the study.In the atropine group,spherical equivalent progressed at a significantly lower rate[weighted mean difference(WMD)=0.39,95%confidence interval(CI):0.23,0.54]than in the control group.A WMD of 0.15 mm was associated with less axial elongation(95%CI-0.19,-0.10).Different doses showed statistically significant differences(P<0.05)and an improved effect could result from a higher concentration.Changes in photopic pupil size and mesopic pupil size in atropine group is 0.70 mm(95%CI:0.33,1.06)and 0.38 mm(95%CI:0.22,0.54)more than the control group.In the present Meta-analysis,no changes in accommodative amplitude(AA)were associated with atropine administration.Atropine administration increased the risk of adverse effects by 1.37 times.CONCLUSION:Concentrations of less than 1%atropine are able to effectively retard diopter and axis growth of myopia in Asian children in a dose-dependent manner.Meanwhile,it caused pupil enlargement,but induced no change in the AA within this range.Further study is required to determine the dosage needed to achieve maximum efficacy and minimal side effects.
基金Supported by the "Twelfth Five-Year" Plan for Science & Technology Support Grant (No. 2012BAI08B02)the National 863 Project (No. 2009AA02Z404)the Guangdong Provincial Industry University Research Cooperation Plan (No. 2010A090200074)
文摘The natural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body.
文摘AIM: To investigate the findings of infrared fundus autofluorescence(IR-AF) and spectral-domain optical coherence tomography(SD-OCT) in eyes with optic disc melanocytoma(ODM).· METHODS: IR-AF findings and those of other ophthalmologic imaging examinations, including short-wave autofluorescence(SW-AF), fluorescein angiography(FA), fundus color photography, and SD-OCT of 8 eyes of 8 consecutive cases with ODM were assessed.·RESULTS: The ODMs in all cases(100%) presented similar IR-AF, SW-AF, and FA findings. On IR-AF images, ODMs showed outstanding hyper-AF with well-defined outline. On SW-AF images, the area of ODMs presented as hypo-AF. FA images revealed the leaking retinal telangiectasia on the surface of the ODMs. On SDOCT images in 8 cases(100%), the ODMs were sloped with highly reflective surface, which were disorganized retina and optic nerve layers. In 7 cases(87.5%), peripapillary choroids were involved. The melanocytomas of 8 cases(100%) presented as optically empty spaces. Vitreous seeds were found in one case(12.5%).· CONCLUSION: IR-AF imaging may provide a new modality to evaluate the pathologic features of ODMs,and together with SW-AF imaging, offers a new tool to study biological characteristics associated with ODMs.SD-OCT is a valuable tool in delimitating the tumor extension and providing morphological information about the adjacent retinal tissue.
