Recent years have witnessed tremendous progress in vitreoretinal surgery. The treatment of vitreoretinal diseases has increased enormously and its related indications expanded widely with the contribution of the emerging novel technologies, methods, equipment and new ideas. Attaching importance to minimally invasive surgery, application of auxiliary drugs, development of improved equipment and surgical technique were the main features. Further basic and clinical research is necessary to promote innovation and development of vitreoretinal surgery in China to keep pace with and surpass advanced technology.
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.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
Comparison of age-related macular degeneration treatments trials (CATT) reported the results of the first year: At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. Bevacizumab is a monoclonal antibody (MAb) and full-length antiVEGF antibody that successfully prevents binding of all the biologically active isoforms of VEGF to the receptor. Ranibizumab is a isolated antigenbinding fragment (Fab) from bevacizumab using recombinant genetic techniques. Ranibizumab has been clinically evaluated in 4 Phase I/II studies. The cost of Avastin is 50 per dose compared with 2000 per dose for Ranibizumab. If Avastin could improve vision and macular anatomy, then it would not only be clinically superior to Ranibizumab. The CATT data support the continued global use of intravitreal bevacizumab as an effective, low-cost alternative to ranibizumab, particularly for patients paying all costs out of pocket.
Fundus disease is a kind of common ophthalmic disease with high blindness rate and great harm. Although great breakthroughs have been made in medical treatment, laser photocoagulation, radiotherapy and gene therapy of fundus disease, with the further understanding of the essence of fundus disease, there are higher requirements for the treatment of fundus disease. To strengthen scientific research on the etiology, pathological mechanism and clinical treatment of fundus diseases, to control the quality of research, to develop reasonable treatment plans and explore new treatment methods under the guidance of evidence-based medicine theory, to further improve the level of medical treatment and benefit patients with fundus diseases will still be a formidable challenge in the future.
The treatment of ocular fundus diseases is of significant issue in the clinic, but there exists large controversy on how to standardize the clinical treatment and how to evaluate the effectiveness of treatment on ocular fundus diseases. Emerging application of evidencebased medicine (EBM) provides us a rigorous and feasible pathway for the clinical treatment of ocular fundus diseases. We can improve the quality of clinical treatment research by exploring high quality randomized control trial (RCT) on the basis of patients with ocular fundus diseases in China; and by making full use of the best clinical evidences at home and abroad according to the EBM methods, which may further improve diagnosis and treatment of common ocular fundus diseases in China.
Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography (OCT) images: outer layer retinoschisis, outer + middle layer retinoschisis, outer + inner layer retinoschisis and multilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane (ILM) around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on multilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
The debate on the cell of origin of human retinoblastoma lasted for more than one century. In the recent issue of ldquo;cellrdquo;, David Cobrinikprime;s group shows that L/M cone precursors are the most likely answer as they have an intrinsic circuitry, including murine double minute 2 (MDM2), Nmyc, the nuclear receptors retinoid X receptor and thyroxine receptor 2, making them extremely sensitive to transformation following retinoblastoma gene inactivation.
Corticosteroids are widely used to treat ocular fundus diseases such as inflammatory disease, macular edema and choroidal neovascularization. To increase local drug concentration and reduce systemic side effects, corticosteroids are often delivered by periocular or intravitreal injection. However there are still more and more clinical complications with the expanded scope of application of these drugs. In order to achieve the best riskbenefit ratio, fully understanding the pharmacological characteristics, indications, contraindications and complications of corticosteroid is critical for clinicians to prescribe this drug to their patients.
