Outer retinal tubulations (ORT) are tubular structures that are visualized on spectral domain optical coherence tomography in single B-scans as nonedematous circular or ovoid structures at the level of the outer nuclear layer. It is most commonly seen in exudative age-related macular degeneration and pseudoxanthoma elasticum, as well as in multifocal choroiditis, panuveitis, geographic atrophy, central serous chorioretinopathy, polypoid choroidal neovascularization, choroideremia and some other diseases related to outer retinal structural damage. ORT is the structure of dislocation junction of outer membrane and ellipsoid band in the process of self-repair after destroyed. Cystoid retinal edema, subretinal fluid and photoreceptor layer damage are important factors for ORT formation. Anti-vascular endothelial growth factor (VEGF) drugs cannot make ORT disappear, and distinguishing between ORT and retinal cystoid edema is helpful to avoid unnecessary anti-VEGF treatment. ORT has a certain predictive value for the prognosis of vision, and has guiding significance for clinical treatment. However, the mechanism of ORT formation and its relationship with clinical practice are not yet fully understood. More advanced imaging equipment and a large number of cases are needed to study the formation of ORT and its relationship with classical choroidal neovascularization, retinal fibrous scarring and retinal atrophy.
ObjectiveTo compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR). MethodsThis is a prospective randomized study. Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients, 39 eyes) and 25G+ vitrectomy group (27 patients, 36 eyes). Visual acuity, intraocular pressures, ophthalmoscopy, B-scan ultrasound was examined before surgery. The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications and postoperative ocular conditions were analyzed. ResultsThe mean surgical times were (53.35±7.42) minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively, and the difference was significant (t=4.37, P < 0.05). Iatrogenic injuries occurred in 11 eyes (28.21%) and 5 (13.89%) eyes in 23G and 25G+ group respectively, and the difference was significant (χ2=4.93, P < 0.05). The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (χ2=16.81, 18.29; P < 0.05). At last follow-up, there was 25 eyes and 24 eyes with visual acuity≥0.05 in 23G and 25G+ groups respectively, and the difference was not significant (χ2=0.13, P > 0.05). Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively, and the difference was significant (χ2=5.67, P < 0.05). Conclusion25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.
Ras homolog family (Rho)/ Rho-associated coiled-coil kinase (ROCK) signaling pathway widely exists in human and mammal cells, which is closely related to inhibition of repair after optic nerve damage. The expression level of Rho/ROCK signaling pathway-related proteins is up-regulated in glaucoma, and related with the death of retinal ganglionic cell (RGC) and the axon activity. ROCK inhibitors can protect the surviving RGC and promote axon extension with a dose-dependent manner. ROCK inhibitors also can inhibit glial scar formation, lower intraocular pressure and inhibit inflammatory response to some degrees. Rho/ROCK signaling pathway correlates with the optic nerve disease progression, and ROCK inhibitors hope to become a new therapeutic drug.
Leber hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disease. It is clinically recognizable by painless, bilateral loss of vision, and the prognosis of vision is generally poor. In recent years, the information provided by optical coherence tomography (OCT) and OCT angiography (OCTA) has greatly improved people's understanding of LHON, and new progress has been made in the intervention and treatment of LHON. A detailed understanding of the structural changes of retina and choroid under OCT and OCTA of the natural course and after treatment of LHON, may provide reference for revealing the pathogenesis, prediction of onset time, differential diagnosis, follow-up of treatment effect and prognosis of LHON.
The prevention and treatment of retinopathy of prematurity (ROP) is an important strategic content of blindness prevention and treatment in China. Medical institutions including remote areas have strengthened the awareness of neonatal fundus screening, however, there are problems of vague screening standards, mainly manifested in expanding the scope of screening and even universal screening of newborns. At the same time, all kinds of fundus changes found in the examination cannot be correctly interpreted and handled, which increase the economic and psychological burden of children's families. In addition, with the wide application of intravitreal injection of anti-neovascular endothelial growth factor, problems such as improper grasp of indications and improper treatment of complications have become increasingly prominent. At this stage, it is urgent to strengthen the construction of ROP prevention and control network, which is suitable for China's national conditions, led by the government and coordinated participation of health and medical institutions at all levels.