With the continuous advancement of technology, the field of retinal surgery is poised to witness an increasing array of innovations and breakthroughs. The innovation in retinal surgery plays a pivotal role in enhancing the success rate of operations, reducing the risk of complications, and improving patient prognosis and quality of life. This encompasses innovations in vitrectomy systems, the novel application of vitrectomy in treating other ocular diseases, advancements in retinal surgical techniques, technological and conceptual innovations, as well as multidisciplinary collaboration, all of which contribute to the ongoing development in the treatment of retinal diseases. Therefore, innovations in retinal surgery should receive significant attention from ophthalmologists specializing in retinal diseases with the best service to patients.
Familial exudative vitreoretinopathy (FEVR) is a hereditary retinal vascular dysplasia. So far, 6 genes have been found to be associated with FEVR: Wnt receptor Frizzled Protein 4, Norrie's disease, co-receptor low-density lipoprotein receptor-related protein 5, tetraspanin 12, zinc finger protein 408, and kinesin family members 11 genes. Its clinical manifestations, pathological processes and genetic patterns are diverse, and it shows the relationship between gene polymorphism and clinical manifestation diversity. It is characterized by different symptoms between the same individual, the same family, and the same gene mutation; different clinical stages and gene mutation types of parents or unilateral genetic children; different clinical characteristics and gene mutation patterns of full-term and premature infant; combined with other eye disease and systemic diseases; double gene mutations and single gene mutations have different clinical manifestations and gene mutation characteristics. A comprehensive understanding of the different clinical manifestations and diverse genetics of FEVR can provide better guidance for the treatment of FEVR.
Retinitis pigmentosa (RP) is a genetic disorder of photoreceptor cell apoptosis and retinal pigment epithelium (RPE) cell atrophy caused by gene mutation. The clinical manifestations are night blindness, peripheral visual field loss and progressive vision loss. RPE cell apoptosis plays an important role in the progression of RP, and exogenous implantation of RPE cells as an alternative therapy has shown certain efficacy in animal experiments and clinical trials. With the diversification of cell sources, the update of surgical techniques and the continuous emergence of biological materials, more possibilities and hopes are provided for cell therapy. To further promote the development of this field in the future, it is still necessary to strengthen the cooperation between medicine, bioengineering and other disciplines in the future to jointly promote the innovation and development of therapeutic methods. It is believed that RPE cell transplantation therapy will show a brighter prospect in the future
Neurovascular unit (NVU) refers to a functional complex of neural cells and vasculature, which plays an important role in maintaining retinal homeostasis and matching metabolic demands. In physiological situation, retinal NVU mainly exerts two effects: (1) maintaining blood-retinal barrier for retinal homeostasis maintenance; (2) regulating local blood flow to meet metabolic and functional demands of the retina. The pathological changes in retinal diseases are reflected in each functional part of retinal NVU, including cell-cell connections, signal pathways, metabolic activities and cellular functions. However, the main pattern and manifestation of NVU impairment differs among retinal diseases due to different etiologies. At present, understanding on retinal NVU is still insufficient, and its clinical application is even more limited. Further application in the diagnosis and treatment of retinal diseases is an important direction for future research on NVU.
Diabetic macular edema (DME) is the most threatening complication of diabetic retinopathy that affects visual function, which is characterized by intractability and recurrent attacks. Currently, the clinical routine treatments for DME mainly include intravitreal injection, grid laser photocoagulation in the macular area, subthreshold micropulse laser, periocular corticosteroid injection, and vitrectomy. Although conventional treatments are effective for some patients, persistent, refractory, and recurrent DME remains a clinical challenge that needs to be urgently addressed. In recent years, clinical studies have found that certain combination therapies are superior to monotherapy, which can not only restore the anatomical structure of the macular area and effectively reduce macular edema but also improve visual function to some extent while reducing the number of treatments and the overall cost. This makes up for the shortcomings of single treatment modalities and is highly anticipated in the clinical setting. However, the application of combination therapy in clinical practice is relatively short, and its safety and long-term effectiveness need further exploration. Currently, new drugs, new formulations, and new therapeutic targets are still under research and development to address different mechanisms of DME occurrence and development, such as anti-vascular endothelial growth factor agents designed to anchor repetitive sequence proteins with stronger inhibition of vascular leakage, multiple growth factor inhibitors, anti-inflammatory agents, and stem cell therapy. With the continuous improvement of the combination application of existing drugs and treatments and the development of new drugs and treatment technologies, personalized treatment for DME will become possible.
According to different experimental methods of induced diabetic retinopathy (DR) and different characteristics of the observed retinopathy, DR animal models can be divided into drug or dietary-induced models, oxygen-induced retinopathy (OIR) models, spontaneous inheritance models, and transgenic models. At present, induced model is one of the most commonly used animal model for DR study, which has the advantages of short modeling cycle, low cost, simple experimental operation and good repeatability. However, the drugs have certain side effects on various organs of animals and the risk of animal death is higher. OIR model has good repeatability, good stability and relatively low cost. However, due to the lack of metabolic changes of hyperglycemia in OIR mice, this model cannot accurately reflect the effects of metabolism on retina under hyperglycemia. The pathological changes of the spontaneous model are relatively stable, however, the application of this model is limited because the genetic homogeneity of diabetes differs from that of human and the cost is high. Transgenic model has definite etiology, however, its application is limited owing to the high cost and the high requirements of technology, operation and equipment. Therefore, researchers should comprehensively consider characteristics and limitations of different models while choosing suitable DR model based on research objectives, observation indicators, experimental conditions, and funds. In addition, animal models that can more accurately simulate DR need to be developed to provide more effective tools for studying the mechanism of DR and developing feasible prevention and treatment approaches.
Objective To analyze the risk factors of postoperative vitreous hemorrhage (PVH) after pars plana vitrectomy (PPV) for vitreous hemorrhage (VH) secondary to retinal vein occlusion (RVO). Methods A retrospective case-control study. A total of 195 RVO patients (195 eyes) with VH were first treated with PPV from November 2015 to December 2021 were included in this study. There were 102 males (102 eyes) and 93 females (93 eyes), with an age of (62.93±9.78) years. The patients were divided into PVH group (17 patients, 8.72%) and non-PVH group (178 patients, 91.28%) according to the occurrence of PVH. The time of occurrence of PVH was (140.33±130.85) days after PPV. All eyes were performed 23G or 25G systematic PPV by the same doctor. During the operation, different types of intraocular tamponade and intravitreal injection of anti-vascular endothelial growth factor or triamcinolone acetonide after operation were selected according to the severity of retinopathy. The follow-up time was (9.45±6.68) months. The baseline systemic parameters, ocular parameters and intraoperative parameters affecting the occurrence of PVH were analyzed. Baseline systemic parameters included sex, age, diabetes mellitus and hypertension; ocular parameters included RVO type, lens status, VH course, preoperative best corrected visual acuity and intraocular pressure; intraoperative parameters included cataract phacoemulsification, removal of internal limiting membrane, type of intraocular tamponade, type of intravitreal injection drug at the end of operation, etc. Kaplan-Meier survival analysis, and Cox univariate and multivariate regression analysis were performed to analyze the risk factors of PVH after PPV in RVO with VH patients. Results In PVH group, the number of patients with diabetes was more than that in the non-PVH group, and the course of diabetes was longer, and differences were statistically significant. There were significant differences in RVO type, lens status and type of intraocular tamponade. Univariate Cox regression analysis showed that the combination with diabetes [odds ratio (OR)=2.724, 95% confidence interval (CI) 1.006-7.374, P=0.049], duration of diabetes (OR=1.071, 95%CI 1.013-1.134, P=0.016), central retinal vein occlusion (OR=4.387, 95%CI 1.421-13.546, P=0.010), intraocular lens (OR=3.493, 95%CI 1.229-9.925, P=0.019), and intraocular gas tamponade (OR=3.640, 95%CI 1.365-9.702, P=0.010) were associated with PVH. Multivariate Cox regression analysis showed that intraocular gas tamponade was independent risk factor for PVH. Conclusion Intraocular gas tamponade can increase the risk of PVH after PPV in patients with VH secondary to RVO.
Diabetes retinopathy (DR) is listed as one of the chronic diseases that should be focused on in the “14th Five-Year” National Eye Health Plan (2021-2025). Early screening is one of the effective measures to reduce blindness caused by DR. Establishing an efficient and practical community screening model is a powerful guarantee for completing early screening. The Ocular Fundus Diseases Group of the Ophthalmology Branch of the Chinese Medical Association has led the development of Expert consensus on community screening of diabetic retinopathy among DR community screening experts that is suitable for the current national situation, in order to guide and promote the further improvement of DR community screening work in China. This Expert Consensus provides detailed specifications on the current domestic trend of DR, the necessity of screening, the role of artificial intelligence grading, screening process, and quality control. This interpretation further emphasizes the importance of DR community screening, while emphasizing the responsibilities of different departments in the screening process. Finally, recommendations are provided for the sustainability of DR community screening. It is hoped that the screening rate of DR in China can be improved and blindness can be reduced by DR through Expert consensus on community screening of diabetic retinopathy and interpretation of the content.
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.
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe itching and recurrent eczema-like lesions. With the increase in the global incidence of AD, the incidence of ocular complications in patients also increases. Retinal detachment (RD) seriously affects the vision of patients, and is more common in young and middle-aged people, often involving both eyes with poor prognosis. What’s more, there are many similarities between RD associated with AD and traumatic RD, such as peripheral retinal breaks, giant retinal tears and retinal dialysis. Regarding the mechanism of AD complicated with RD, the trauma theory is widely accepted. Scholars have also reported on the theory of anterior eye developmental abnormalities, inflammation-traction theory, and ectodermal origin theory. On AD complicated with RD, regardless of scleral buckling surgery or vitrectomy surgery, the rate of first retinal reattachment is low with severe proliferative vitreoretinopathy or chronic uveolar inflammation after surgery, which cause traction on the ciliary body and the retina separation appearance again or new cracks appearance. Combination of behavioral therapy, drug therapy and psychotherapy can effectively reduce the occurrence of RD; prevention of eye rubbing, reduction of traumatic exercise, rational use of glucocorticoids or immunosuppressants under the guidance of dermatologists are effective ways for AD patients to prevent RD occurrence. Regular eye examinations can help patients find RD as soon as possible so that they can be treated in time.
