The optic nerve belongs to the central nervous system (CNS). Because of the lack of neurotrophic factors in the microenvironment of the CNS and the presence of myelin and glial scar-related inhibitory molecules, and the inherent low renewal potentials of CNS neurons comparing to the peripheral nerve system, it is difficult to spontaneously regenerate the optic nerve after injury. Protecting damaged retinal ganglion cells (RGCs), supplementing neurotrophic factor, antagonizing axon regeneration inhibitory factor, and regulating the inherent regeneration potential of RGCs can effectively promote the regeneration and repair of optic nerve. Basic research has made important progress, including the restoration of visual function, but there are still a lot of unsolved problems in clinical translation of these achievements, so far there is no ideal method of treatment of optic nerve injury. Therefore, it is rather urgent to strengthen the cooperation between basic and clinical research, to promote the transformation of basic research to the clinical applications as soon as possible, which will change the unsatisfactory clinical application status.
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.
Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists. The surgical success rate reached 95.0% and above for vitrectomy, macular surgeries with ILM peeling, or local/total scleral buckling. However, the postoperative visual function recovery is nowhere near good enough. Specialists must pay more attention to the visual function recovery of those patients. Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time. At present, the postoperative visual acuity for macular hole depends on many factors, such as macular hole closure conditions, surgical procedures, microsurgical invasive ways, skills of membrane peeling, usage of dye staining, and tamponade material choice. It also depends on residual subretinal fluid under macular area for patients received scleral buckling. It is important for us to investigate these factors affecting recovery of macular anatomy and function, and thus develop some drugs to improve the macular function recovery.
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.
The hallmark of the recent latest advances in diagnostic fundus imaging technology is combination of complex hierarchical levels and depths, as well as wide-angle imaging, ultra-wide imaging. The clinical application of wide-angle and ultra-wide imaging, not only can reevaluate the role of the peripheral retina, the classification types and treatment modalities of central retinal vein occlusion, and enhance the reliability of diabetic retinopathy screening, improve the classification and therapeutic decision of diabetic retinopathy, and but also can help guide and improve laser photocoagulation. However we must clearly recognize that the dominant role of ophthalmologists in the diagnosis of ocular fundus diseases cannot be replaced by any advanced fundus imaging technology including wide-angle imaging. We emphasize to use the three factors of cognitive performance (technology, knowledge and thinking) to improve the diagnosis of 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.
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.
As a new and non-invasive imaging technology, optical coherence tomography angiography (OCTA) has been using in ocular fundus diseases, glaucoma and neuro-ophthalmic disorders for more than 4 years. The most valuable and efficient application of OCTA is in detecting neovascular diseases in the macula. The big advantage of OCTA is for diagnosing all kinds of choroidal neovascularization. OCTA can observe blood flow information in different layers of the retina. To a large extent, it changes our diagnostic thinking and pathway in macular diseases. Before acquiring OCTA image, the operator should be well trained to ensure to get high quality images with good signal strength and less artifact. OCTA report should show the segmentation slab that the ophthalmologist wants to see. So far, OCTA has difficulty to reach peripheral retina with default setting. Even so, OCTA has provided much information of blood flow within retinal vascular arcade for evaluating structural and functional changes. We are expecting that the swept source OCTA could give us better observation of the choroidal blood flow. That should be the breakthrough of the new generation of OCTA.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
Fullfield electroretinalgraphy (ffERG) is an indispensablemeans in assessment of retinal disease; it is invasive, effective, objective, quantifiable, and reproducible. Currently ffERG has been extensively applied domestically, but it also has disadvantages such as too few detected diseases, nonstandardised methodology, and inaccurate description of the results. It is important to place more emphasis on the internationalization, standardisation, and normalization of the application; obtaining the differences of indication, detection techiniques, and description of the results among ffERG, multifocal ERG and pattern ERG; expanding the new fields and methods of clinical applications. So that ffERG could play an more important role in the diagnosis and management for the patients with retinal disease.