Retinopathy of prematurity (ROP) is one of the leading causes of visual impairment in children. As understanding on the pathogenesis of ROP accumulated, anti-vascular endothelial growth factor (VEGF) drugs and their application have changed the treatment mode. Anti-VEGF therapy, with convenient operation and clear efficacy, has become an important treatment method for ROP. However, due to the dysfunction of organs in children with ROP, anti-VEGF drugs can enter blood circulation after intravitreal injection and then lead to temporarily reduction of the VEGF level in the blood, which may theoretically cause adverse effects on the development of all organs (especially the brain) in children with ROP. Therefore, it's necessary to pay attention to the effect of anti-VEGF drugs on neurodevelopment in children with ROP, strictly grasp the indications, and standardize its clinical application, so as to continuously improve the overall prognosis of ROP.
In recent years, the complexity of intraocular lymphoma has been gradually recognized by ophthalmologists. Although primary vitreoretinal lymphoma is the dominant type of intraocular lymphoma, ophthalmologists should be aware that it is not unique and avoid overgeneralizing specific clinical features to all intraocular lymphoma types. Intraocular lymphoma can be divided into vitreoretinal, uveal (choroid, iris, ciliary body) lymphoma according to the anatomic affected parts. According to pathological cell types, it can be divided into B cells, mantle cells, T cells and natural killer T cells. At the same time, depending on the presence or absence of extra-ocular tissue involvement, it can also be subdivided into isolated intraocular, oculo-central nervous system, oculo-system, and oculo-central nervous system lymphomas. Vitreoretinal lymphoma tends to occur in the elderly with clinical manifestations similar to uveitis and white spot syndrome and limited response to glucocorticoid therapy. The characteristic fundus manifestations include vitreous gauzy or "auroral" opacity and yellowish-white subretinal mass. Optical coherence tomography plays a key role in diagnosis and can reveal specific changes such as vertical strong reflex and intraretinal strong reflex infiltration. It is worth noting that vitreous and retinal involvement may vary, which has guiding significance for the selection of treatment strategies. In contrast, uveal lymphoma has unique clinical and pathological features, such as the chronic course of choroidal mucosa-associated lymphoid tissue (MALT) lymphoma and the equal distribution of T cells and B cells in iris lymphoma. In diagnosis, choroidal lymphoma often requires histopathological examination, and radiotherapy is the first choice for MALT lymphoma. T-cell lymphoma is similar to B-cell lymphoma in ocular fundus appearance, but diagnosis is more difficult and depends on cytopathology and T-cell receptor gene rearrangement. Comprehensive systematic screening is essential for patients with intraocular lymphoma to identify the primary site. Ocular lesions in patients with systemic lymphoma require differential diagnosis, including tumor invasion, secondary infection, and inflammatory lesions. As the incidence of lymphoma increases, ophthalmologists should constantly update their understanding of intraocular lymphoma to provide accurate diagnosis and treatment.
Diabetic retinopathy (DR) is a major and irreversible blinding eye disease in working aged adults. Diabetic macular edema (DME) is a complication of the further development of DR, and it is one of the main causes of vision loss in DR patients. The emergence of anti-VEGF drugs has changed the treatment model of DR and DME. Firstly, for the treatment of DME, the previous focal/grid-like laser photocoagulation is converted to anti-VEGF drugs as the first-line treatment. Secondly, for the treatment of proliferative DR (PDR), panretinal photocoagulation (PRP) was the gold standard in the past, and now anti-VEGF drugs have become an alternative treatment for some PDR patients. In varying degrees of DR and DME, the option of treatment, anti-VEGF drug therapy replacing PRP, and the era of anti-VEGF drug therapy on DR treatment modes are worthy questions for consideration by clinicians. In-depth study of the clinical study of PRP and anti-VEGF drugs in the treatment of DR, the changes attention in clinical guidelines and expert consensus, the gradual establishment of treatment of DR and DME suitable, and the personalized treatment of DR patients may help improve the level of DR treatment in China.
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.
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.
In the research process of uveal melanoma (UM), the Collaborative Ocular Melanoma Study (COMS) is a landmark and outstanding clinical study. Its research conclusions are the foundation for today's UM clinical work and guidelines. COMS is the first and largest randomized clinical trials conducted to date, comparing the survival outcomes of two or more treatment regimens for primary malignant intraocular tumors with high reliability. Its research design, methods, and conclusions are still widely cited in this day. Learning from the research experience of COMS, summarizing research data based on Asian populations, and studying treatment methods suitable for Asian UM patients is a powerful supplement to COMS data, but also an expansion of this global research, further improving the level of UM diagnosis and treatment in China.
Pathological myopia, characterized by progressive elongation of the axial length and formation of posterior staphyloma, is accompanied by chorioretinal irreversible degeneration. It is also the focus and biggest challenge of myopia control and blindness prevention. For managing progressive early-onset pathologic myopia and myopic traction maculopathy, episcleral pressurization of macula is a practical option. It can be divided into posterior scleral reinforcement surgery and macular buckling surgery according to the presence or absence of operative top pressure ridge after surgery, both of which are different in terms of implanted materials, procedures and indications. The implanted materials, procedures and indications are different between the two. Under the background of soaring prevalence of myopia, it is necessary to modify and cautiously popularize the techniques of episcleral pressurization of macula to provide high level clinical evidence for management of pathological myopia.
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.
Retinoblastoma (RB) is the most common intraocular malignant tumor in children. With advanced clinical technologies there are more and more methods available to treat retinoblastoma, and make it is possible to delivery individualized protocol combined traditional treatments with modern regimen to patients now. In order to improve the survival rate and the life quality of RB patients in China, it is very important to make a suitable system of standardized therapy based on results from developed countries and health policies of our own country.
There are many topics in clinical studies of diabetic retinopathy (DR). The current hot topics include the relationship between DR and systemic diseases, major factors for initiation and progression of DR, early DR screening strategies, DR prevention strategies and how to improve the therapeutic effects of DR. However, due to the complexity of DR pathogenesis, multiple risk factors, long cycle of DR prevention and control, it is difficult to exclude all the confounding factors in the DR clinical research. From the long-term perspective, delaying the occurrence and progression of DR and establishing an efficient and practical prevention and control system is the focus of the future DR research in China.