Anti-vascular endothelial growth factor (VEGF) drugs have become the firstline medications for the treatment of choroidal neovascularization (CNV). Its efficacy and safety have been confirmed by evidence-based medicine and a large number of clinical studies. However there are several issues need to be discussed before reaching a consensus for the clinical application of anti-VEGF drugs. These issues include, but not limited to the individual treatment regimen for different CNV lesions, the best anti-VEGF drug regimen, the indications and schemes of combination therapy, the factors affecting the efficacy, the potential risks of systemic and local deliveries. How to establish a reasonable personalized regimen of anti-VEGF drugs is the 1st issue need to be explored. Ranibizumab will come into China market soon. We need utilize the existing evidence-based medical research findings; take our advantages of rich resources of patients to investigate those issues to further promote the anti-VEGF applications in China.
Diabetic retinopathy (DR) is the leading causes of blindness in workingaged people, of which diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are the two main causes of visionthreatening. Through the regular screening of patients with diabetes, the risk factors of DR can be identified and proper interventions can prevent the incidence of DR. Timely retinal laser photocoagulation and application of the reninangiotensin system inhibitors (candesartan or fibrates), lipidlowering drug fenofibrate can inhibit DR progress. Macula local and (or) grid pattern photocoagulation or in combination with bevacizumab intravitreal injection can effectively relief DME. In regard to late PDR, vitrectomy could restore or retain useful vision, importantly, minimally invasive 23G vitrectomy and preoperative bevacizumab intravitreal injection greatly improved the surgical outcomes. However DR pathogenesis is not entirely clear. Also there is a lack of effective and feasible DR screening strategy in China. Furthermore existing evidencebased data of medical and surgical treatment of DR is insufficient. Therefore, the DR prevention and treatment is still a long way to go in China.
Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
There are many types of fundus diseases and their causes are complex. They can be caused by metabolic factors or inflammatory factors. Fundus examination and imaging examination tools are the main methods for diagnosing fundus diseases. However, in terms of determining the cause and early diagnosis, if the intraocular fluid detection technology can be reasonably combined, the advantages will be greater. Intraocular fluid is the general term for fluid in the eyeball, including aqueous humor, vitreous humor, etc. The molecular components that can be tested include DNA, RNA, antigens, antibodies, and cytokines. With the advancement of molecular testing technology and equipment, intraocular fluid testing as an evidence-based method has gradually been incorporated into the consensus and guidelines of more fundus disease experts, and is mainly used for infectious fundus diseases and camouflage syndromes. Reasonable use of intraocular fluid testing can help improve the personalized diagnosis and treatment of fundus diseases and reduce unnecessary drug overuse. However, it is worth noting that intraocular fluid detection is only one of many tools and cannot replace other examinations and clinical experience. Excessive intraocular fluid testing not only increases the risk of clinical infections because of invasiveness, but also increases the burden on patients.
Children with retinoblastoma (RB) typically survive their cancer due to advances in early diagnosis and treatment. Extraocular invasion and metastasis, and secondary malignant tumor carry a very high mortality rate. Prerequisites for metastasis include tumor initiating capacity, altered cellular adhesion and cell motility, resistance to extracellular death signals and disruption of the basement membrane and extracellular matrix. All those changes can be determined by the cell of origin and the genetic instability of the tumor, responding to the multiple layers of pressure such as hypoxia, from the tumor microenvironment or niche. The interaction between tumor cells and the tumor stroma is regulated by several metastasissuppressor proteins and microRNA. This knowledge has important implications for our understanding and the treatment of extraocular spreading of RB.
The diagnosis and treatment of age-related macular degeneration (AMD) is an international hotspot of eye research. Successful clinical applications of antiVEGF drugs promoted both basic research and clinical practice of AMD. A number of countries and professional societies have established clinical guidelines for AMD management, including the epidemiology, risk factors, diagnosis, classification, and treatment process. These AMD guidelines are mostly based on recently published results of clinical trials, provided good model of evidence based medicine. It is urgent and necessary to have our own guideline which is suitable for Chinese patients. Reviewing and learning existed guidelines will help us to improve the clinical practice of AMD in China.
In recent years, with the deepening of understanding of children's retinal diseases and the continuous updating of treatment techniques, the efficacy of children's retinal diseases has also been improved. Due to the particularity of the anatomical structure of the retina of children in the growth and development stage and the pathogenesis, clinical manifestations and outcomes of children's retinal diseases are different from those of adults, the principles of treatment of adult retinal diseases cannot be directly applied to children's retinal diseases. Cryotherapy, laser photocoagulation, intravitreal injection of anti-VEGF drugs, and vitreoretinal surgery are the main treatment methods for children's retinal diseases. However, there are still many problems in the selection of indications, equipment parameters, and treatment of complications. The treatment norms of the disease need to be further improved. Therefore, research on the treatment of children's retinal diseases, and the establishment of surgical standards and norms through expert consensus and other methods are helpful for the treatment of children's retinal diseases.
Vitrectomy is the preferred surgical method for diabetic retinopathy, especially in the stage of proliferative diabetic retinopathy. Vitrectomy for diabetic retinopathy involves all aspects of vitrectomy, which is one of the signs of maturity of retinal surgeons. With the application of minimally invasive vitrectomy and perioperative anti-neovascularization drugs, indications and timing of surgery, perioperative medication, management of vitreous, and whether combined with cataract surgery have changed greatly, and new understanding is needed. Evidence-based clinical research on the timing of diabetic retinopathy surgery and perioperative drug use should be carried out to provide a new theoretical basis for the surgical treatment of diabetic retinopathy.
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.
It is clear that genetic background contributes to the development and progression of diabetic retinopathy (DR). However, the identification of susceptibility loci through candidate gene approaches, linkage disequilibrium analysis of case-control data and genome wide association study is still in its infancy and faces many challenges due to the complexity of the disease itself. China has rich resources of clinical samples. In order to facilitate elucidating the susceptibility genes of DR in China, we look forward multi-disciplinary, multi-regional collaboration studies integrating novel technologies, such as proteomics, metabolomics and next-generation sequencing to analyze gene-gene and gene-environment interaction factors comprehensively.
