Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022) is based on evidences in recent clinical trials and a system of Grading of Recommendations, Assessment, Development and Evaluation of evidence quality and strength of recommendations. The main key points around why the diabetic macular edema (DME) changes the classification, what thresholds for initiating anti-vascular endothelial growth factor (VEGF) drug therapy; eyes with center-involved DME (CI-DME) and good vision for clinical significant macular edema still treated by focal laser even with good vision, the clinical pathway for CI-DME changes first-line treatment from laser to anti-VEGF, loading dose of anti-VEGF for CI-DME in non-proliferative diabetic retinopathy (DR) from 3 injections up to 4-5 injections is recommended; severe non-proliferative DR and proliferative DR with vision impairment but without hemorrhages and retinal traction could be considered first treatment of anti-VEGF comparing to initiate pan-retinal photocoagulation (PRP) (weakly recommended), PRP is still gold-standard for progressive non-perfusion area of retina. With the rapid development of DR evaluation devices such as optical coherence tomography, wide-angle optical coherence tomography angiography and wide-angle fluorescein fundus angiography, imaging biomarkers have been provided for the degree of DR lesion, treatment response and prognosis. It is believed that the clinical practice will be promoted a new height by the 2022 edition of Chinese DR guideline.
Retinal vein occlusion (RVO) is a closely related disease of ophthalmology and systemic diseases. The Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China (consensus) emphasizes that etiological diagnosis and treatment should be paid primary attention to, and etiological exploration should be placed in an important position in the diagnosis and treatment path. In addition to etiological treatment, the consensus emphasizes that clinical attention should be paid to the management of anterior segment neovascularization, neovascular glaucoma and macular edema. Especially for patients with short course of central retinal vein occlusion, the occurrence of 100-day glaucoma should be vigilant, and active anti-vascular endothelial growth factor (VEGF) drugs, laser photocoagulation and intraocular pressure treatment should be taken. For the treatment of macular edema, the consensus points out that anti-VEGF drugs and intraocular glucocorticoid sustained-release agents are effective, but the latter should be used cautiously to avoid problems such as high intraocular pressure glaucoma and accelerated cataract formation. For deficient RVO, the consensus defines its concept, defines the time point of treatment when combined with macular edema, and clarifies the applicable conditions of laser therapy.
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.
Prevention and treatment of infants and young children can avoid blindness, effectively reduce the incidence of children's blindness and vision loss. Eye diseases causing blindness in infants and young children mainly include retinopathy of prematurity, retinoblastoma, familial exudative retinopathy, persistent embryonic blood vessels, vitreous hemorrhage, congenital cataract, etc. Most of them are preventable and controllable, however, many diseases have strict requirements for the effective treatment time window. The basic form and path to carry out the prevention and control of blinding eye diseases in infants and young children are building a prevention and control system with a combination of multi-party medical forces, referral to pediatric eye disease institutions with relevant technical resources for further diagnosis and treatment, so as to achieve early detection, standardized treatment and visual training.
Retinal vein occlusion (RVO) is the second visual threatening retinal disorders followed by diabetic retinopathy in the elderly. In the past decades, increasing knowledge of the natural history, aetiology and risk factors, medical management investigation, together with the support of high level evidence-based medical evidence and the results of real-world clinical trials play key roles in guiding the clinical practice. However, without understanding the pathogenesis and pathogeny of the disease, it is difficult to implement a comprehensive, precise and personalized treatment strategy for the RVO patients. It is of significance in the clinic to discuss the pathological process of RVO, analyze the etiological characteristics of the disease, reveal the clinical outcomes, which aim to facility the optimal treatment and follow-up procedure for the patients.
Objective To observe the effects of intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity (AP-ROP). Methods It is a retrospective case study. Twenty-one patients (40 eyes) with AP-ROP were enrolled in this study. There were 9 males (18 eyes) and 12 females (22 eyes), with the mean gestational age of (28.30±1.79) weeks and the mean birth weight of (1 021.40±316.70) g. All the lesions of 40 eyes were located in posterior zone, with 24 eyes in zone I and 16 eyes in zone II. All the eyes were treated with intravitreal injection of conbercept 0.025 ml (0.25 mg). During follow-up, nonresponders or patients with deterioration were retreated with intravitreal injection of conbercept or photocoagulation; patients with progressive deterioration to stage 4 had received vitrectomy. At the 1, 2, 4, 8, 12, 16, 20, 24 weeks after treatments, the disappearance or decrease of retinal vessel tortuosity and neovascularization, and the growth of the normal retinal vessels toward the peripheral retina were evaluated. Results Thirty-six eyes were cured for only one injection, the cured rate was 90.00%. However, 2 eyes (5.00%) had progressed to stage 4 with contractive retinal detachment, which underwent vitrectomy. Two eyes (5.00%) had received twice injections, whose remaining avascular zone area treated by photocoagulation. No major systemic or ocular complications after injection appeared. All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-up. Conclusion Intravitreal injection of conbercept is effective in the treatment of AP-ROP.
Purpose To assess the efficacy of pars plana vitrectomy,autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes. Methods The procedures consisted of pars plana vitrectomy with removal of posterior cortical vitreous，air-fluid exchange, instillation of autologous platelet concentrate onto the posterior pole and 20%～30%SF6 tamponade,were performed in treating 6 eyes of 6 patients with idiopathic macular holes. The patients were instructed to lie in a supine position for l hour after surgery,then adviced to remain in a facedown position for 2 weeks. Results Flattening of the surrounding retina and closure of the hole were achieved postoperatively in all the 6 affected eyes.Visual acuity improved two lines or more in 5 eyes (83.3%).Four eyes(66.7%)reached a postoperative visual acuity of 0.3 or more. Retinal detachment ocurred in one eye owing to peripheral new hole formation. Conclusion Pars plana vitrectomy, autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes are able to close macular hole and improve the visual acuity. (Chin J Ocul Fundus Dis,1998,14:14-15)
ObjectiveTo evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M). MethodsA retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA assessment was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane peeling and vitreous cavity filling with 16% SF6. Among them, autologous platelet concentrate (APC) was simultaneously used in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. ResultsIn the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant (Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery (Z=0.609, P=0.543). ConclusionsPPV combined with internal limiting membrane peeling and gas tamponade can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical macular restoration, and improve BCVA. Combined APC filling
By using the different light stimuli, the flash ERG of 32 cases of central retinal vein occlusion(CRVO) (13 of ischemic type,19 of non-ischemic type) during acute phase were examined. The results showed that the a-wave and b-wave latency of CRVO elongated,while the b-wave amplitude of ischemie type decreased and that of non-ischemic type varied in different stimulus: decreased,increased or normal.Therefore,b-wave amplitude and b/a ratio,and selection of suitable ERG condition of stimulus are thought to be important in differetiating ischemic from non-ischemic CRVO. (Chin J Ocul Fundus Dis,1994,10:7-10）
Diabetic retinopathy is one of the microvascular complications of diabetes and a major cause of blindness in adults. Early screening is an effective way to reduce blindness caused by diabetic retinopathy. The diabetic retinopathy is one of the chronic retinal diseases highlighted in the “14th Five-Year” National Eye Health Plan (2021-2025). The establishment of effective and practical community screening model is a powerful guarantee to complete early screening. It is of great significance to standardize screening methods, screening personnel duties, equipment allocation, referral conditions and screening sustainability. Chinese fundus disease and related field experts developed the consensus through a serious, comprehensive, and complete discussion, to provide more reference for establishing a suitable community screening model of diabetic retinopathy and increasing the screening rate of diabetic retinopathy.