Age-related macular degeneration (AMD), a set of age-related macular disease, is induced by a variety of factors. New intervention Methods help us to understand the AMD pathogenesis further; however, we only have limited knowledge of these novel Methods . To improve diagnosis and treatment practices of AMD, it is a priority to propose a standardized clinical procedure of AMD management in China. The Chinese Ocular Fundus Association has just proposed a Chinese AMD clinical pathway based on expertsprime;opinions and evidence based medicine. This clinical guideline is implementable for different stages and subtypes of AMD patients, and hopefully will be updated frequently with more clinical practice. Implementing this AMD pathway in China will improve the quality of clinical practice and research of AMD in China.
Polypoidal choroidal vasculopathy (PCV) is one of the exudative maculopathy, which is characterized by retinal pigment epithelium detachment, subretinal hemorrhages and sensory retinal detachment. The prevalence of polypoidal choroidal vasculopathy (PCV) reached 33.5% in neovascular age related macular degeneration (AMD) for Chinese population. Indocyanine green angiography showed a single or multiple focal nodular areas of hyperfluorescence arising from the choroidal circulation and currently is recognized a gold standard for diagnosis of PCV. The histopathologic findings indicated that hyalinization of choroidal vessels, like arteriosclerosis. Up to now there is no reliable evidence to demonstrate the difference in genetic study. The study of environment factor showed hypertension is associated with PCV closely than with AMD. PCV and AMD is different genotype or different phenotype as well as difference in pathogenesis need further studies.
Comparison of age-related macular degeneration treatments trials (CATT) reported the results of the first year: At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. Bevacizumab is a monoclonal antibody (MAb) and full-length antiVEGF antibody that successfully prevents binding of all the biologically active isoforms of VEGF to the receptor. Ranibizumab is a isolated antigenbinding fragment (Fab) from bevacizumab using recombinant genetic techniques. Ranibizumab has been clinically evaluated in 4 Phase I/II studies. The cost of Avastin is 50 per dose compared with 2000 per dose for Ranibizumab. If Avastin could improve vision and macular anatomy, then it would not only be clinically superior to Ranibizumab. The CATT data support the continued global use of intravitreal bevacizumab as an effective, low-cost alternative to ranibizumab, particularly for patients paying all costs out of pocket.
Up-regulation of vascular endothelial growth factor (VEGF) is demonstrated to be a key role in formation process of intraocular neovascularization. Anti-VEGF treatment is the breakthrough of intraocular neovascular diseases therapy. Intrav itreal injection of antineovascularization drug looks to be an effective method on ocular neovascular diseases which with the advantages of good biocompatibility, low prices and longer intravitreal half-time etc. However, at present, it lack of multi-center study; the long-term efficacy and the systematic safety needs the further clinical verification. Various types of CNV showed the different therapeutic reactions to either PDT or Anti-VEGF agent, the treatment methods for exudative AMD include laser, PDT, and drug like Triamcinolone Acetonide，several anti-VEGF preparations. Therefore, understanding the pathogenesis of neovascular AMD and choosing a reasonable therapeutic methods are necessary. We should try to explore a safe, effective, economic, new approach. （Chin J Ocul Fundus Dis，2008，24：157-159）
Objective To observe the therapeutic effect of radial optic neurotomy (RON) for ischemic central retinal vein occlusion (CRVO) with macular edema. Methods The clinical data of 6 patients with ischemic CRVO combined with macular edema who had been treated with vitrectomy and radial optic neurotomy were retrospectively analyzed. The pre- and post-operative visual acuity, results of fundus fluorescein angiography (FFA) and optic coherence tomography (OCT), including the macular thickness, fluorescein filling in retinal veins, retinal hemorrhages and papilloedema were analyzed and compared. Results In the 6 patients, the visual acuity increased in different degrees and retinal hemorrhages decreased evidently. Macular edema was alleviative in 5 patients, retinal vein dilatation meliorated in 4, and papilloedema disappeared in 2. Conclusion RON may alleviate macular edema in patients with ischemic CRVO, but the relation of the therapeutic effect and vitrectomy can not be eliminated. (Chin J Ocul Fundus Dis, 2005,21:3-5)
Chinese Guideline of Diabetic Retinopathy was developed by the Chinese Ocular Fundus Society and Chinese Ophthalmological Society. It is the first prevention and intervention guideline document of diabetic retinopathy (DR) in China. Clinical pathways and strategies are clearly identified and described in this document for DR screening, referral, intervention, systematic management and patient education. The new DR stage classification combines the first Chinese DR classification since 1985 and the updated international classification of DR. This guideline is based on Chinese health care system, but also reflects the tradition and innovation, and reaches international practice standard. Learning and practice the guideline will promote the prevention and reduce the occurrence and development of DR in China.