Retinoblastoma (RB) is the most common intraocular malignant tumor in children. With advanced clinical technologies there are more and more methods available to treat retinoblastoma, and make it is possible to delivery individualized protocol combined traditional treatments with modern regimen to patients now. In order to improve the survival rate and the life quality of RB patients in China, it is very important to make a suitable system of standardized therapy based on results from developed countries and health policies of our own country.
The pathogenesis of diabetic retinopathy is complicated. The vast network of multiple factors including unifying mechanism, inflammatory reaction, neuron degeneration and metabolic memory of glucose, and the four established pathogenic molecular pathways are hotspots of mechanism research for diabetic retinopathy. Nevertheless, these researches may be only one corner of the ldquo;icebergrdquo; of DR mechanism, and we still face enormous challenges in DR mechanism research. Collaboration with multiple disciplines to study the relationship between DR and diabetes and other systemic diseases, search novel therapy targets may increase the result in an unexpected windfall for DR basic research.
Panretinal photocoagulation (PRP) and macular photocoagulation (MPC) are the gold standard treatments for proliferative diabetic retinopathy (DR) and diabetic macular edema. With the development of equipment and technology advancement, photocoagulation has been gradually applied in many Eye Centers all over China. However, there are still several problems such as no standardized guideline and undesirable therapeutic effects. In this article we will summarize the indications and techniques of photocoagulation, and when and how to apply drug treatments for retinal diseases; aim at improving the criterion and clinical effects of photocoagulation.
The application of gene therapy in ocular diseases is gradually expanding from mono-gene inherited diseases to multigene, multifactorial, common and chronic diseases. This emerging therapeutic approach is still in the early exploratory stage of treating diseases, and the expected benefits and risks remain highly uncertain. In the delivery process of gene therapy drugs, viral vector is currently one of the most mature and widely used vectors. The occurrence of vector-associated immunity will affect the short-term and long-term effects of gene therapy, and even cause permanent and serious damage to visual function. Therefore, gene therapy vector-associated immunity is the focus and challenge for the safety and long-term efficacy of gene therapy. During the perioperative and follow-up of gene therapy, attention should be paid to the monitoring of vector-associated immune inflammation, and appropriate measures should be taken to deal with the corresponding immune response, so as to achieve the best visual benefits for patients.
The abnormalities of retinal vessels such as retinal arteriolar narrowing, arteriovenous nicking, micro-aneurysms, retinal hemorrhages, and cotton wool spot are closely related to systemic diseases including hypertension, diabetes mellitus, cardiovascular disorders, stroke and renal diseases. The modern retinal vessels examination technology has features of quick noninvasive, quantitative standardized and intelligent analysis. Taking advantage of these to fully discover the retinal vascular abnormalities and get deeper understanding of the relationship between its' mechanism and systemic vascular diseases is not only helpful to better diagnose and treat retinal vascular diseases, but also contributes to predicting the risk and prognosis of systemic diseases. We suggest emphasizing on the study of correlation between retinal vascular abnormalities and systemic vascular diseases using modern retinal vessels examination technology. It will provide the preventive clue of diseases of circulatory system by finding out the retinopathy. Meanwhile, correctly treating systemic diseases would get a better prognosis of the retinopathy. They exist side by side and play a part together for providing a better prognosis, which would be a new direction for the doctors and scientists in the new era.
The data related signs of ocular fundus associated with COVID-19 published in this journal collected from December 2022, while the pandemic of COVID-19 was in a clustering occurrence. The signs of ocular fundus including acute macular neuroretinopathy (AMN), cotton wool spots or Purtscher-like retinopathy, central retinal vein occlusion (CRVO) and macular edema of unknown etiology. The different lesions can be concurrent existence in some cases is one of the clinical characteristics of COVID-19, other characteristics including both eye involved, predominated affected more women, aged from 13 to 56 years. AMN was mentioned recently in most papers on COVID-19, it has been known as deep capillary ischemia. Cotton wool spots is sign infarct in superficial capillary. Retina dots indicated retinal infarct in the outer plexiform layer. CRVO was demonstrated that the blood clot blocks the flow of blood at the level of the lamina cribro, optic disc edema with macular subretinal fluid showed the retina tissue as well as optic head affected. Eye is part of the body, lesions of ocular fundus are identical with body system. Several study proposed different hypothesis for these alterations in acute phase of COVID-19: direct viral endothelial injury, activation of the immune response by a cytokine storm leading to a procoagulant state or transient hypercoagulability. Retina lesions demonstrated a vasculature impairment in several layers of retina and edema in retina and optic disk. We should monitor in the acute phase of COVID-19 the prothrombotic markers and the treatment should consider anti-virus and preventing thrombosis formation.
The knowledge of uveitis of Chinese eye doctors has been improved in general. While the usage of glucocorticoid agents was more reasonable, other non-corticoid immunosuppressant get more attention recently. The usage of antibiotics also has being reduced gradually. The international impact of our uveitis research has been enhanced. However there are still some problems, such as big difference between different regions of uveitis research, still many misunderstandings on the treatment of uveitis complications, and the reasonable evaluation of intravitreal injection with glucocorticoid needs emphasis. In China Behcetprime;s disease and Vogt-Koyangi-Harada syndrome are the most common uveitis subtypes which can lead to blindness,but some rare subtypes of uveitis are also increasing such as syphilitic uveitis, acquired immune deficiency syndrome（AIDS），mycotic endophthalmitis and masquerade syndrome. In the future we need cooperative studies between multicenters to investigate the effectiveness of different treatment strategies for Behcetprime;s disease and Vogt-Koyangi-Harada syndrome, and to optimizing the best therapeutic schedule. We also need to pay more attentions to the clinical features of those uveitis subtypes which increased recently；and to investigate the prevention and therapeutic effect of induction of immune tolerance to uveitis.
Myopia has become a major problem that threatens human health worldwide. Complications caused by high myopia are one of the leading causes of low vision and blindness. As a chronic disease that seriously threatens ocular health in the clinical practice and public health fields, the prevention and control of high myopia should actively promote a tertiary prevention strategy, and take advantages of the latest fundus imaging technology and big data technology, artificial intelligence to explore the evolution mechanism of “myopia→high myopia→pathological myopia”. Special efforts should be focused on the establishment of a scientific myopia prediction model, implementation of effective high myopia monitoring and management, and early detection and treatment of complications of high myopia to reduce the incidence of low vision and blindness.
Diabetic macular edema (DME) is one of the common causes of visual impairment. Anti-vascular endothelial growth factor (VEGF) has become the preferred therapy for DME because of significant visual improvement. Early and intensive anti-VEGF therapy combined with other individualized treatments are currently the main strategy for DME treatment. Considering the complexity of DME and limitations of anti-VEGF therapy, there are still many problems and difficulties in the treatment of DME. Optimizing treatment strategies, strengthening management of the clinical course and developing new drugs, could improve the efficacy and maintain the improvement of visual acuity and visual performance.
Outer retinopathy does not refer to a specific type of retinal disease. Patients with outer retinopathy often have abnormal vision symptoms, however, no positive signs can be found with conventional routine eye examination. And the diseases are often labeled “occult”. In recent years, optical coherence tomography (OCT) has been widely used in clinical practice. It has been found that many so-called “occult” diseases are actually caused by structural abnormalities of the outer retina. The causes of structural abnormalities are diverse, and the treatments and disease outcomes are also different. Therefore, it is necessary for clinical ophthalmologists to get detailed medical history, make diagnosis and differential diagnosis based on multi-model imaging, rather than roughly name it as “outer retinopathy”. With the development of OCT imaging technology, higher resolution images reveal the finer structure of retinal tissue, allowing us to have a deep understanding of the disease, thus improving diagnosis and treatment in clinical practice.