Table of Content

25 September 2025, Volume 34 Issue 5

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Inner retina cloudy swelling 

Huang Houbin

2025, 34(5):  333-340.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.001

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  Mistaken as edema, inner retina cloudy swelling in fact is the ischemic whitening and oncosis of inner five layers of retina following retinal artery occlusion. Its pathological nature is cellular swelling, or intracellular edema, but not fluid accumulation intercellularly as edema. The inner retina cloudy swelling is different from cotton spot, outer retina cloudy swelling, whole-thickness retina cloudy swelling and inflammatory cloudy swelling, although the pathological natures of them are cellular swelling too. However, the appearance of Berlin edema mimics inner retina cloudy swelling very much, although it is neither cellular swelling nor edema. It is injures, malpositions, even fractures of the interdigitation  between photoreceptors and retinal pigment epithelia. Strictly discrimination of these conceptions especially their phathophysiological bases is of vital importance to recognize and illuminate the associated diseases.

Short term observation of IOL centration after cataract surgery in eyes undergoing vitrectomy

He Siqing, Shi Yuqing, Zhang Chuan, Dong Zhe

2025, 34(5):  341-345.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.002

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Objective To observe the decentration and tilt of intraocular lenses (IOLs) after cataract surgery in eyes that have undergone vitrectomy. Design Retrospective comparative case series. Participants Sixty-two patients (62 eyes) who underwent cataract surgery at Beijing Tongren Hospital from August 2024 to January 2025 were included. Among them, 31 patients (31 eyes) with cataract after vitrectomy were assigned to the observation group, and 31 patients (31 eyes) with age-related cataract without previous surgical history were assigned to the control group. The axial lengths of both groups were within the normal range. Methods All patients underwent IOL Master 700 and AS-OCT (CASIA 2) examinations to measure axial length, anterior segment biological parameters, and lens position parameters before cataract surgery. All patients underwent phacoemulsification and IOL implantation under topical anesthesia by the same surgeon. One month after surgery, AS-OCT was used to measure the position parameters of the IOL. Main Outcome Measures Axial length, white-to-white distance, lens thickness, equatorial diameter of the lens, preoperative lens tilt and decentration, and postoperative IOL tilt and decentration. Results There were no statistically significant differences between the observation group and the control group in axial length [24.56(23.72, 25.97)mm vs. 24.91(23.58, 26.02)mm], white-to-white distance [11.70(11.40, 12.10)mm vs.  11.60(11.50, 11.70)mm], lens thickness [4.43(4.30, 4.73)mm vs. 4.45(4.19, 4.86)mm], and equatorial diameter of the lens [10.28(9.94, 10.65)mmvs.11.60(11.50, 11.70)mm)] (P =0.916, 0.419, 0.949, 0.104). There were no statistically significant differences in preoperative lens tilt [4.30(3.50, 5.20)° vs. 4.50(3.80, 6.30)°] and decentration [0.19(0.09, 0.24)mm vs.  0.12(0.07, 0.20)mm] between the two groups (P values were 0.275 and 0.123, respectively). There were no statistically significant differences in postoperative IOL tilt [4.70(3.40, 5.10)°  vs. 4.60(3.70, 5.20)°] and decentration [0.17(0.11, 0.26)mm vs. 0.19(0.08, 0.29)mm] between the two groups (P=0.827， 0.767). There were no statistically significant differences in the changes in postoperative IOL tilt [1.10(0.40, 1.80)° vs. 0.80(0.30, 1.30)]° and decentration  [0.06(0.04, 0.12)mm vs. 0.07(0.04, 0.15)mm)] between the two groups (P=0.084, 0.693). Conclusion The short-term follow-up of this study showed that patients with normal axial length who have undergone vitrectomy and subsequently cataract surgery do not experience more significant IOL decentration and tilt.

One year clinical observation of XEN gel stent implantation for advanced primary glaucoma

Li Qiumei, Wang Weilin, Zhao Ruihua, Bi Huiwen, Li Shaowei

2025, 34(5):  346-352.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.003

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 Objective  To evaluate the efficacy and safety of XEN gel stent implantation in the treatment of advanced primary glaucoma. Design Retrospective case series. Participants From March 2022 to December 2023, 29 patients (33 eyes) with advanced primary glaucoma underwent consecutive XEN gel drainage tube implantation in Beijing Aier-Intech Eye Hospital. There were 16 cases (19 eyes) in the XEN group and 13 cases (14 eyes) in the Phaco combined XEN group. Method The patient's medical records were reviewed. Main Outcome Measures Visual acuity, intraocular pressure (IOP), number of IOP-lowering drugs, surgical success rate, and postoperative complications. Results  For all patients preoperative IOP，number of IOP-lowering medications and visual acuity (LogMAR) were 25.0 (IQR: 19.0, 34.0) mmHg, 4 (IQR: 3, 4) medications and 0.4 (IQR: 0.9, 0.2), respectively. At 1 year postoperatively, the IOP, mean IOP reduction, number of IOP-lowering medications, surgical success rate and visual acuity were 13.0 (IQR: 11.0, 16.0) mmHg, 46.0%, 0 (IQR: 0, 0) medications, 80.7% (25/31) and 0.3 (IQR: 1.0, 0.1), respectively. In the XEN group, preoperative IOP, number of IOP-lowering medications and visual acuity (LogMAR) were 26.0 (IQR: 19.0, 30.0) mmHg, 4 (IQR: 2, 4) and 0.2 (IQR: 0.7, 0.1), respectively. At 1 year postoperatively, the IOP, mean IOP reduction, number of IOP-lowering medications, surgical success rate and visual acuity (LogMAR) were 13.0 (IQR: 10.0,15.0) mmHg, 57.7%、0 (IQR: 0, 2) medications, 82.4% (14/17) and 0.3 (IQR: 0.7, 0.1) . In the PhacoXEN group, preoperative IOP, number of IOP-lowering medications, and visual acuity (LogMAR) were 24.5 (19.9, 32.0) mmHg, 3.5 (IQR: 3, 4) medications, and 0.7 (IQR: 2.0, 0.3), respectively. At 1 year postoperatively, the IOP, mean IOP reduction, number of IOP-lowering medications, surgical success rate, and visual acuity (LogMAR) were 13.0 (IQR: 12.0, 16.0) mmHg, 57.1%, 0 (IQR: 0, 0) medications, 78.6% (IQR: 11/14), and 0.3 (IQR: 1.0, 0.2), respectively.  There was no statistically significant difference in the surgical success rate at 1 year between the XEN and PhacoXEN groups (χ2=0.45，P=0.9299). Complications included hyphema (12.1%, 4/33), shallow anterior chamber (21.2%, 7/33), choroidal detachment (12.1%, 4/33), hypotony maculopathy (3.0%, 1/33), and blebitis (3.0%, 1/33), all managed conservatively. Bleb needling was required in 39.4% (13/33) of cases, significantly higher in the PhacoXEN group (50%, 7/14) than in the XEN group (31.5%, 6/19). No complications such as stent migration, exposure, or endophthalmitis occurred. Conclusion The results of the one-year follow-up with a small sample size in this study show that XEN gel stent implantation demonstrates favorable clinical efficacy and safety in advanced primary glaucoma, with comparable outcomes between standalone and combined procedures. However, the PhacoXEN group exhibited a higher rate of postoperative bleb needling.

Analysis of factors affecting the 2-year prognosis of penetrating keratoplasty for congenital corneal leukoplakia

Ma Siyi, Hong Jing

2025, 34(5):  353-358.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.004

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Objective To study the factors affecting the prognosis of children with congenital corneal leukoplakia after corneal penetrating keratoplasty. Design Retrospective case series. Participants 63 children (63 eyes) with congenital corneal leukoplakia who underwent penetrating keratoplasty at Peking University Eye Center from 2018 to 2020. Methods The electronic medical records of children were evaluated retrospective, including gender, age, corneal disease type, diagnosis and treatment history, postoperative complications and so on. A binary multivariate Logistic regression analysis was performed on the survival rate of corneal grafts at 24 months after surgery to explore the factors affecting the prognosis, and survival curves were plotted. Main Outcome Measures Postoperative complications and survival time of corneal grafts. Results The average age of the children who underwent penetrating keratoplasty was （11.71±10.44） months (3~55 months). The 2-year survival rate of the grafts after surgery was 61.9%. Logistic regression analysis showed that persistentcorneal epithelial defects(P=0.048), immune rejection(P=0.002) and postoperative high intraocular pressure (IOP) (P=0.030) were the main factors leading to failure. Persistent corneal epithelial defects occured one week after surgery, and had not fully healed after using medication for more than one month. Immune rejection and high IOP mainly occured between 1 to 6 months after surgery. After the occurrence of persistent corneal epithelial defects, the survival rate of corneal grafts was 33.33% and 22.22% at 1 and 2 years after surgery. After immune rejection, the survival rate of corneal grafts was 22.22% and 11.11% at 1 and 2 years after surgery. After the occurrence of high IOP, the survival rate of corneal grafts was 45.45% and 18.18% at 1 and 2 years after surgery. All of them were significantly lower than the 97.44% (P<0.001) and 87.18% (P<0.001), which were the survival rate of corneal grafts of children without major complications. Conclusion The factors affecting the prognosis of children with congenital corneal leukoplakia after corneal penetrating keratoplasty are immune rejection, high IOP, and corneal epithelial defects.


Observation of the effect of wearing scleral lenses for 6 months in patients with keratoconus

Qi Yan, Hu Yan, Xue Jinsong, Xu Yingnan

2025, 34(5):  359-365.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.005

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  Objective  To observe the clinical efficacy of wearing scleral lenses in patients with keratoconus. Design  Retrospective case series. Participants 21 patients (29 eyes) with keratoconus of completion period stage 3 or below and fitted with scleral lenses at the Affiliated Eye Hospital of Nanjing Medical University. Methods All patients underwent a standard fitting procedure for scleral lenses. The fitting status of scleral lenses, as well as the differences in tear film clearance between the lenses and the central and peripheral cornea at 1 week, 1 month, 3 months, and 6 months was observed and compared. Changes in visual acuity, refractive error, corneal parameters, and other indicators were compared between baseline (before wearing glasses), at 1 week, 1 month, 3 months, and 6 months of wearing scleral lenses. Patients completed the NEI-VFQ-25 questionnaire to assess the quality of life and vision of wearing scleral lenses for 6 months. Main Outcome Measures Corrected visual acuity, intraocular pressure (IOP), flat anterior corneal surface refractive power (K1), steep anterior corneal surface refractive power (K2), steepest anterior corneal surface refractive power (Kmax), corneal thinnest point thickness (TCT), center corneal thickness (CCT), corneal staining score (CSS), corneal endothelial cell density (ECD), NEI-VFQ-25 scores, tear film clearance. Results At 6 months of wearing scleral lenses, the tear film clearance in the central, nasal, temporal, upper, and lower regions of the scleral lenses were 221 (177, 274)μm, 98 (68, 133)μm, 138 (81, 213)μm, 145 (95, 190)μm and 360 (289, 478)μm, respectively, there was no significant differences compared to the 240 (184, 282)μm, 98 (62, 121)μm, 120 (95，207)μm, 145 (82，192)μm and 326 (270, 450)μm at 1 week of wearing scleral lenses (all P>0.05). At 1 week and 6 months of wearing scleral lenses, the corrected visual acuity with scleral lenses was 0.30 (0.05, 0.40) LogMAR and 0.22 (0.02, 0.30) LogMAR, respectively, which were significantly improved compared to the corrected visual acuity with frame glasses of 0.52 (0.22, 0.76) LogMAR (P=0.013, P=0.001). Before wearing scleral lenses, at 1 week and 6 months, K1 was (57.70±10.71) D, (58.05±10.90) D and (58.43±11.20) D, K2 was (63.25±13.17) D, (63.42±13.22) D and (63.24±13.00) D, Kmax was (72.60±16.94) D, (72.46±16.47) D and (72.30±16.04) D, TCT was 410 (356, 453)μm, 416 (362, 457)μm and 400 (336, 462)μm, CCT was (410.55±74.25) μm, (416.93±80.98) μm and (421.31±81.56) μm, IOP was (10.38±3.91) mmHg, (10.41±4.63) mmHg and (9.79±4.29) mmHg, CSS was 0 (0,1), 0 (0,1)and 0 (0,1), with no statistically significant differences at each time point (all P>0.05). After wearing scleral lenses for 6 months, the ECD was 2905 (2542, 3019.5) cells/mm2, and there was no significant change compared to 2876 (2659, 3148.5) cells/mm2 before wearing scleral lenses (P=0.691). After wearing scleral lenses for 6 months, the patients'NEI-VFQ-25 score was 2175 (1925, 2450), which was significantly higher than 1750 (1337.5, 2025) before wearing scleral lenses (P=0.001). Conclusions The 6-month observation results of this small sample size indicate that scleral lenses have good corrective effects and safety in patients with keratoconus at completion period stage 3 or below, and wearing scleral lenses significantly improves the visual function and quality of life of keratoconus patients.
  


A randomized controlled study on myopic and astigmatism control of children aged 6-12 years between single spectacle lenses and defocus incorporated multiple segments spectacle lenses

Chen Ying, Sun Wenfeng, Zhen Yi

2025, 34(5):  366-370.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.006

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 Objective To compare the effects of defocus incorporated multiple segments spectacle lenses (referred to as defocus lenses) and single-vision lenses on astigmatism and myopia in children and whether defocus lenses increase the risk of astigmatism progression and their efficacy in myopia control.  Design Randomized controlled trial. Participants 102 Volunteers aged 6-12 years with myopia, recruited from University of Science and Technology of China Hospital between 2022 and 2023. Method Eligible children were randomly assigned to the defocus lens group (n=51) or single-vision lens group (n=51) for 12 months. Comprehensive ophthalmic examinations were performed, including slit-lamp microscopy, computer-assisted autorefraction under cycloplegia, retinoscopy, and subjective refraction to determine corrective prescriptions. Main Outcome Measures Changes in J0, J45, spherical equivalent refractive error (SER), and axial length. Results At baseline, there were no statistically significant differences between the defocus group and the single-vision group in terms of age, J0, J45, spherical equivalent refraction, or axial length. After 12 months of lens wear, the changes in J0 were (0.08±0.13) D and (0.08±0.13) D in the defocus and single-vision groups, respectively, with no statistically significant difference between the two groups (t=-0.193, P=0.424). The changes in J45 were (0.01±0.06) D and (-0.01±0.07) D, respectively, with no statistically significant difference between the two groups (t=0.029, P=0.977). The changes in spherical equivalent refraction were (-0.51±0.59) D and (-0.74±0.42) D, respectively, showing a statistically significant difference between the two groups (t=2.229, P=0.014). The progression of spherical equivalent refraction in the defocus group was reduced by 31.1% compared with the single-vision group. The axial elongation was (0.25±0.22) mm and (0.39±0.22) mm, respectively, showing a statistically significant difference between the two groups (t=-3.083, P=0.003). Axial elongation in the defocus group was reduced by 35.8% compared with the single-vision group. Conclusions The 12-month observation results show that compared to single-vision lenses, defocus incorporated multiple segments spectacle lenses do not increase the risk of astigmatism progression and demonstrate superior efficacy in controlling myopia progression of children aged 6-12 years.  



Comparison of control efficiency on axial length growth among different kinds of orthokeratology lens and spectacle lenses with aspherical lenslets in children with mild myopia in a year

Qin Shiyuan, Zhang Ruina, Jiang Yujuan, Guo Tengjun, Li Yanjin, Gong Lihua

2025, 34(5):  371-376.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.007

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  Objective To compare the control efficiency on axial length growth among different orthokeratology lenses and spectacle lenses with aspherical lenslets in children with mild myopia in a year. Design  A retrospective cohort study. Participants  A total of 125 low myopic children were recruited.  Method  Myopic children were recruited and divided into three groups: Group A （42 patients wearing orthokeratology lenses(brand: Lucid), group B (44 patients wearing orthokeratology lenses(brand: CRT), and group C(39 patients wearing spectacle lenses with aspherical lenslets). Only right eye data were used for statistical analysis. One-way analysis of variance, LSD-t test and multiple linear regression were employed to compare the changes in axial length growth among groups at 3 months, 6 months, 9 months, and 12 months after wearing glasses and the incidence of corneal staining. Main Outcome Measures Axial length growth, the incidence of corneal staining. Results Axial length elongation in group A at 3 months， 6 months, 9 months and 12 months were (0.013±0.093) mm and (0.088±0.076) mm, (0.137±0.105) mm and (0.242±0.120) mm respectively. Axial length elongation in group B at 3 months， 6 months, 9 months and 12 months were (0.031±0.091) mm and (0.128±0.137) mm (0.178±0.141) mm and (0.291±0.139) mm respectively. No statistical difference (P>0.05) was found between the two groups in axial length elongation at the four time points. The increase of axial length in group C at 6 months and 12 months were (0.094±0.130) mm and (0.230±0.247) mm, which were no statistical difference compared with group A and group B (P>0.05) .After merging the data from Groups A and B, the axial length increase of the orthokeratology lens group at 6 months and 12 months was (0.104±0.113) mm and (0.270±0.131) mm, respectively, with no statistically significant difference compared to Group C (P＞0.05). After adjusting those covariate factors such as gender, age, initial SE, and initial axial length, the multiple linear regression analysis demonstrated that there was no significant difference in axial length growth between group A and group B at 3 months （β： 0.185， t=1.506， P=0.137， 95%CI： -0.010~0.075）, 6 months （β： 0.171， t=1.397， P=0.167， 95%CI： -0.018~0.103）, 9 months（β： 0.225， t=1.816， P=0.075， 95%CI： -0.006~0.124） and 12 months （β： 0.180， t=1.543，P=0.127， 95%CI： -0.016~0.124）. No statistical significant difference in the incidence of corneal staining (χ2=0.940, P>0.05)  was found between group A and group B. Conclusion In this study, there was no significant difference in the control efficiency of axial elongation and the incidence of corneal staining between VST-designed and CRT-designed  orthokeratology lenses. Spectacle lenses with aspherical lenslets demonstrated comparable performance with orthokeratology lenses on slowing axial length growth in low myopia.


One year efficacy observation of fully degradable sinus drug stents in endoscopic dacryocystorhinostomy for chronic dacryocystitis

Zheng Qun, Zhang Yi

2025, 34(5):  377-383.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.008

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 Objective To explore the clinical efficacy of utilizing fully biodegradable sinus drug scaffolds in endoscopic dacryocystorhinostomy for the treatment of chronic dacryocystitis. Design Retrospective case series. Participants From February 2021 to February 2024, 286 patients (286 eyes) underwent endoscopic dacryocys torhinostomy for chronic dacryocystitis in Nanjing Aier Eye Hospital. Method  The patient's medical records were reviewed. 286 patients were divided into three groups: 94 cases with simple dacryocystorhinostomy, 95 cases with dacryocystorhinostomy combined with RS tube insertion, and 97 cases with fully degradable sinus drug stent used as stent support between the lacrimal sac and nasal mucosa during surgery (with a specification of 25 mm×14 mm and 70 degrees). A one-year postoperative follow-up was conducted. The criteria for effective treatment are unobstructed irrigation of the lacrimal passage, no or reduced overflow of tears. Main Outcome Measures The effectiveness rate and the number of endoscopic interventions post-surgery. Results Following a one-year postoperative follow-up, the cure rate for cases utilizing fully degradable sinus drug stents intraoperatively was 97.9%, with an overall effectiveness rate of 100%. The effectiveness rate for simple dacryocystorhinostomy stood at 92.6%, whereas for dacryocystorhinostomy combined with RS tube insertion, it was 94.7%. The statistical difference in effectiveness rates among the three groups was significant (P=0.013). The number of endoscopic interventions within one year after surgery were (1.54±0.60), (2.08±0.54), and (0.13±0.37) times, respectively (P=0.000). Conclusion The combination of endoscopic dacryocystorhinostomy and fully degradable sinus drug stent has significant clinical advantages than simple dacryocystorhinostomy and dacryocystorhinostomy combined with RS tube insertion in the treatment of chronic dacryocystitis and is worthy of clinical application and promotion.


Analysis of multimodal imaging characteristics of combined hamartoma of the retina and the retinal pigment epithelium in macula

Feng Sijia, Liu Wei

2025, 34(5):  384-388.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.009

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 Objective To analyze the multimodal imaging features of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) in macula. Design Retrospective case series. Participants Nine patients (9 eyes) with CHRRPE diagnosed at Daping Hospital, Army Medical University from November 2020 to May 2025. Methods A retrospective review of patient medical records. Main Outcome Measures Image findings of Color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). Results This study included 9 patients (9 eyes) with a mean age of 16.44±10.24 years. All cases were unilateral. Color fundus photography showed that all lesions were located in the macular area, presenting with retinal vascular tortuosity, pigmentary disturbances, and membranous proliferation. Optical coherence tomography (OCT) revealed increased inner retinal thickness and structural disorder in all patients, while the outer retinal layers, RPE band, and choroid remained intact. A "shark-teeth sign" was observed in the outer plexiform layer in all 9 cases, and 6 patients exhibited an "omega sign" configuration in the inner retina. OCT angiography (OCTA) demonstrated high-density filamentous vessels within the macular retina in all 9 cases. Fundus fluorescein angiography (FFA) in the early phase showed tortuous and dilated capillaries across all lesions and patchy blocked fluorescence was seen in 5 cases. In the late phase, slight vascular staining was observed around the tumor in 1case, whereas no leakage was detected in the other 8 cases. Indocyanine green angiography (ICGA) performed in 5cases revealed varying degrees of choroidal fluorescence masking by the tumor, although no obvious choroidal vascular abnormalities were identified in any case. Conclusion The clinical features of CHRRPE in the macular area manifest as membrane-like proliferation at the macula, which can easily be confused with epiretinal membrane. Integrating multimodal imaging, particularly the "shark tooth" sign in the outer plexiform layer on OCT and the Ω-shaped configuration of the inner retinal layers, can significantly improve the diagnostic accuracy of this condition


Discovery and validation of serum hsa_circ_0000615 as a potential biomarker for proliferative diabetic retinopathy

Zhang Qing, Li Jing, Fu Jiao

2025, 34(5):  389-394.  doi:10.13281/j.cnki.issn.1004-4469.2025.05.010

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  Objective To screen and determine whether serum hsa_circ_0000615 can be used as a new non invasive biomarker for proliferative diabetic retinopathy (PDR). Design Prospective case series. Participants  A simple random sampling method was used to select 50 non-diabetic volunteers (as control group), 48 patients with type-2 diabetes mellitus (T2DM), 50 PDR patients and 50 patients with non-PDR (NPDR). Methods  High throughput whole transcriptome sequencing was performed to explore the expression profile of serum circRNAs, and the candidate circRNAs were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic (ROC) analysis evaluated the ability of serum hsa_circ_0000615 in discriminating PDR patients from NPDR patients, T2DM patients and control subjects. Main Outcome Measures  Serum circRNAs expression profile and has_cic_0000615 expression level. Results  By sequencing and qRT-PCR, serum hsa_circ_0000615 expression in PDR patients [12.015 (8.530, 14.325)] was significantly higher than that in control group [3.998 (3.220, 5.156)], T2DM group [5.118 (3.895, 7.247)] and NPDR group [5.250 (4.045, 7.763)] (all P＜0.05).  By correlation analysis and linear regression analysis, the level of hsa_circ_0000615 expression was positively correlated with the course of diabetes (r=0.429, P＜0.001) and the level of glycated hemoglobin (r=0.567, P＜0.001). ROC curve analysis showed that the area under curve of serum hsa_circ_0000615 was 0.803±0.036 (95% CI: 0.731～0.874), 0.796±0.039 (95% CI: 0.719～0.872) and 0.976±0.010 (95%CI: 0.956～0.997), respectively. Conclusion  The present findings indicate that serum hsa_circ_ 0000615 may serve as a novel diagnostic biomarker and potential therapeutic target for PDR.