Uveitis is a group of inflammatory diseases affecting the uveal tract, retina, retinal blood vessels and vitreous. Due to its complex etiology, various entities, diverse and lack of constancy in treatment, some patients can experience visual impairment and even loss. In view of the fact that blindness caused by uveitis is mostly incurable and occurs usually in young and middle-aged people, it accounts for an important part of blinding eye diseases and has attracted worldwide attention. With the continuous development of precision medicine, clinicians will face new problems and challenges in disease diagnosis, and further in-depth research is needed to explore more optimized and efficient diagnostic processes and examinations to improve the diagnosis of uveitis in China.
Macular hole is a retinal hole locates in macular fovea, and can be idiopathic, traumatic and high myopic. Although its etiology, disease course, treatment and prognosis varied from case to case, enforcing macularhole closure and retinal reattachment are challenges to all cases. Completely removal of premacular vitreous cortex is the key to successful repair, and inner limiting membrane (ILM) staining and peeling can greatly help the removal of those cortexes. Selections and usages of different dyes, methods of ILM peeling, and strategies to promote macular retinachoroidal adhesion warrant further study to improve treatment and prognosis of macular holes.
Optical coherence tomography angiography (OCTA) is a new and non-invasive imaging technique that is able to detect blood flow signal in the retina and the choroid within seconds. OCTA is different from the traditional angiography methods. The major advantages of OCTA are that it can observe blood flow signal in different layers of the retina and the choroid without injecting any dye, provide blood flow information that traditional angiography cannot provide, and enrich pathophysiological knowledge of the retinal and choroidal vascular diseases., which help us to make an accurate diagnosis and efficient evaluation of these diseases. However there is a large upgrade potential either on OCTA technique itself or on clinical application of OCTA. We need to fully understand the advantage and disadvantage, and differences of OCTA and traditional angiography. We also need to know how to interpret the result of OCTA. With that we could make a fast diagnosis in a non-invasive way and improve our knowledge of the retinal and choroidal vascular diseases.
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.
Fundus autofluorescence (FAF) relies primarily on the presence of accumulated lipofuscin in the retinal pigment epithelium (PRE) cells. It has emerged as a valuable tool to detect and evaluate the viability and structural changes of the RPE in live. As a noninvasive, repeatable, simple and efficient means of detection, FAF imaging can provide information of RPE structure and function to assistant the diagnosis of many retinal diseases with other conventional fundus imaging technologies. With quantitative analysis and complementary analysis with other fundus imaging technologies, the FAF features of different retinal diseases will be further understood. This knowledge will not only extend the reasonable and unique clinical applications of FAF, but also will contribute to the understanding the pathogenesis and improving the treatment of many retinal diseases.
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.
Photodynamic therapy is the first treatment confirmed to be effective in the treatment of exudative age-related macular degeneration in 2000, which had been introduced to China in the same year. The pathological new vessels were destructed by the singlet oxygen and oxygen free radical released by activated photosensitizer. In the next 12 years, it has been widely applied for the treatment of subfoveal and parafoveal choroidal neovascularization caused by all kinds of chorioretinal diseases. More than a treatment, it also help us to explore the pathogenesis of fundus disease, the capability to embolize the capillaries within the treating area let us not only understand the mechanism of central serous chorioretinopathy and polypoidal choroidal vasculopathy, but also make it a effective cure for them. However, there are still a lot of unsolved questions such as the mechanism of photodynamic therapy, the relationship with human genomic difference, and even the development of angiogenesis. Besides with the more novel medications and strategies available, we also face the appropriate application for indications, selection of combined therapy and optimization of treatment regimens. Further investigations about the photodynamic therapy and disease and their relations from both basic and clinical study will guide us the treatment in clinic and also reveal the truth of related fundus diseases deep under the surface.
Most fundus diseases leading to irreversible blindness are associated with genetic variations. Some sequence changes directly cause retinal diseases while others lead to a higher susceptibility to environmental insults common in daily life. Studies of genes related to fundus diseases will lead to a revolutionary change in the prevention and treatment of irreversible blindness. Application of high throughput nextgeneration sequencing and exome capture techniques will greatly enhance our ability to elucidate genes responsible for fundus diseases. With such technical and analytical advances, we are likely to see continuing and accelerating progress in the genetic study of fundus diseases, particularly in those fields requiring collaborative study of common fundus diseases using large cohorts of samples. The translational clinical application of understanding about these newly identified genes responsible for fundus diseases is also increasing in promise. Thus, strengthening current genetic studies of fundus diseases in both of these areas will make a valuable contribution to the prevention and treatment of blindness in both the near and especially the distant future.
Optical coherence tomography angiography (OCTA) is a new and noninvasive imaging technique that generates real-time blood flow pattern on chorioretinal vasculature. In order to apply this novel technology in the practice to diagnose and treat ocular fundus diseases, we need to further strengthen the quality of OCTA image acquisition and reporting specifications. We need to understand its technical principle, and multiple factors affecting the OCTA image acquisition and interpretation. Furthermore, In the process of image acquisition, as well as analysis and interpretation, we need to pay attention to the stratification, interpretation of blood flow signals and identification of artifacts of OCTA images.
There are over 8 million blind patients in China, 1/3 of them are suffered from retinal degeneration diseases. Stem cells transplantation can delay the photoreceptor cell degeneration or replace the dead photoreceptor cells, provides hopes for these patients. How to make enough seed cells is the major barrier for cell therapy. Good seed cells should be safe and with great pluripotency, and can be made from a wide range of sources, easy to be standardized and industrialized. Seed cells made from three-dimensional embryonic stem cells cultures can reach the above criteria, thus three-dimensional embryonic stem cell culture is a new strategy for making seed cells for cell treatment of blind diseases.
