Myopic choroidal neovascularization (MCNV) is one of the main reasons of vision loss in working population in Asia, which has brought economical and social-psychological burdens with high incidence in China, The precise pathogenesis of MCNV is unclear. Metamorphosia is the main reported symptom in these patients. The lesions were usually with smaller area, less leakage and relatively slow progression. Currently, intravitreal anti-vascular endothelial growth factor agents are now the established standard of care for MCNV, which was a major breakthrough in the treatment of MCNV achieving visual acuity improvement. Since the natural history, clinical features and therapy response of this disease is significant different from that in choroidal neovascularization secondary to age-related macular degeneration, the treatment dosing, frequency, retreatment criteria and the follow-up interval should been considerately. Facing the myopia boom in China, there is a need for the development of a precise definition and a more detailed classification for pathogenic myopia, optimize the outcome assessment and follow-up strategy, which should benefit to the further basically and clinical studies.
Vascular endothelial growth factor (VEGF) is a multifunctional factor that promotes blood vessel formation and increases vascular permeability. Its abnormal elevation plays a key role in common retinal diseases such as wet age-related macular degeneration and diabetic macular edema. Anti-VEGF therapy can inhibit angiogenesis, reduce vascular leakage and edema, thereby delaying disease progression and stabilizing or improving vision. Currently, the clinical application of anti-VEGF drugs has achieved satisfactory therapeutic effects, but there are also issues such as high injection frequency, heavy economy burden, potential systemic side effects, and non-responsiveness. To address these issues, current research and development mainly aim on biosimilars, multi-target drugs, drug delivery systems, oral anti-VEGF drugs, and gene therapy. Some drugs have shown great potential and are expected to turn over a new leaf for anti-VEGF treatment in ophthalmology.
ObjectiveTo observe the clinical characteristics and surgical outcomes in patients with retinal detachment associated with atopic dermatitis (AD-RD). MethodsA retrospective case series. From January 2015 to April 2023, 8 patients (12 eyes) with AD-RD at Zhongshan Ophthalmic Center of Sun Yat-sen University were included. All patients underwent best-corrected visual acuity (BCVA), ultra-wide-field fundus photography, B-mode ultrasound, ultrasound biomicroscopy (UBM), and wide-field optical coherence tomography (OCT). BCVA was examined by standard logarithmic visual acuity chart and was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical purposes. In the primary surgery, 9 eyes underwent scleral buckling; 1 eye underwent pars plana vitrectomy (PPV) combined with silicone oil tamponade; 1 eye underwent PPV combined with C3F8 tamponade; 1 eye underwent C3F8 tamponade combined with retinal laser photocoagulation. The follow-up time was (29.1±40.9) months. BCVA before and after surgery was compared using paired t test. ResultsAmong the 8 patients, 6 were male and 2 were female. The mean age was (23.38±7.95) years old. Among them, 4 patients had bilateral affliction while the remaining 4 had unilateral involvement. The logMAR BCVA was 0.86±0.86. All 12 eyes were with a history of uveitis. Among 8 eyes with bilateral involvement, 6 of them were misdiagnosed as uveitis with exudative retinal detachment; 11 eyes had anterior uveitis at presentation; 9 eyes had a history of cataract, with 4 eyes having concurrent cataract and 5 eyes with intraocular lens. All affected eyes displayed as focal retinal detachment. UBM revealed ciliary epithelial detachment in 9 eyes, and no definite ciliary epithelial break was found in any case. Retinal breaks were observed in only 2 eyes in the pre-surgery retina examination, while ciliary epithelial holes were discovered in other 10 eyes during surgery. The retina was successfully reattached in 10 eyes after one surgery, including 9 eyes received scleral buckling. During the final follow-up, the logMAR BCVA of the affected eye improved significantly to 0.30±0.25 compared to pre-surgery values (t=2.43, P=0.03). ConclusionsAD-RD is a challenging complication of AD with a high rate of young onset, bilateral involvement, associated with concurrent cataracts, and shallow temporal retinal detachment associated with ciliary epithelial detachment. Scleral buckling is an effective treatment for AD-RD.
ObjectiveTo observe the clinical characteristics of adult patients with ocular toxoplasmosis (OT).MethodsThis study was a retrospective clinical trial. Among the 83 consecutive OT patients diagnosed in the Zhongshan Eye Center of Sun Yat-Sen University, 14 patients (16.9%, adult group) aged ≥18 years were included in the study from January 2017 to December 2019. A total of 14 OT patients (children group) aged less than 18 years who had consecutive visits from July to December 2019 were selected as controls. All patients underwent BCVA, slit lamp microscope, fundus color photography, and B-mode ultrasound examination. Eighteen cases underwent UBM examination, including 6 and 12 cases in the adult group and child group respectively; 23 cases underwent FFA examination, including 12 and 11 cases in the adult group and child group respectively. Snellen visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. We compared the two groups of patients' residence (urban or rural), history of contact with dogs and cats, main symptoms, reasons for treatment, course of disease, and clinical and imaging characteristics and so on. For measurement data conforming to normal distribution, t-test was performed for comparison between groups; for Skewness distribution measurement data, rank sum test was performed for comparison between groups.ResultsCompared with the adult group and the child group, there was no significant difference in the canine-cat contact history (Z=2.661, P=0.257) and the time from first diagnosis to diagnosis (t=−0.186, P=0.351); compared with the children group and the adult group, the patient's living environment was mainly urban, and the course of disease was significantly shorter (Z=−2.005), and the difference was statistically significant (P=0.047). The logMAR BCVA of the adult group and the child group were 0.81±1.08 and 2.08±1.30, respectively, and the difference was statistically significant (Z=−2.811, P=0.004); compared with the child group, the adult group had lighter vitreous opacities, but the difference was statistical significance (Z=7.847, P=0.048). FFA examination revealed 20 cases of "fern-like" leakage of retinal capillaries. Among them, the adult group and child group were 10 (83.3%, 10/12) and 10 (90.9%, 10/11) cases respectively.ConclusionsAdult patients account for 16.9% of OT patients. Compared with children, adult patients mostly live in towns or cities, have a short course of disease, good vision at first diagnosis, and mild inflammation or hyperplasia of the vitreous cavity. FFA is helpful for the diagnosis of adult OT.
ObjectiveTo observe and analyze the clinical features, treatment methods and efficacy of patients with retinopathy associated with incontinentia pigmenti (IP).MethodsA retrospective case study. Twelve clinical confirmed IP patients (24 eyes) in Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2015 to December 2018 were included in this study. The best corrected visual acuity and intraocular pressure examination were performed in patients (＞4 years old). All patients were examined on the anterior segment, vitreous body, and fundus under topical anesthesia or general anesthesia. Eight cases underwent genetic testing. Patients with active disease should be given anti-vascular endothelial growth factor (VEGF) drug treatment, retinal laser photocoagulation or vitrectomy, those without active disease should be observed. All patients were followed up for 1 to 3 months, with an average follow-up time of 18.7 months.ResultsAll patients were all female, with an average age of 6.3±9.8 years old at the first ophthalmology visit. According to the recommendations of the pediatrician, 3 cases were actively screened for ophthalmology (referrals), with an average age of 0.4±0.5 years (median age: 2 months). A total of 9 cases were not recommended for referrals (non-referrals), including 3 cases of ophthalmology who were diagnosed for the first time due to visual impairment, and 6 cases of undiagnosed IP before the ophthalmology visit, the average age of their first visit was 8.2±10.8 years (medium age: 3 years old). The age of the first visit for non-referred patients was larger than that of referrals, and the difference was statistically significant (Z=−2.141, P=0.036). Among the 24 eyes of 12 cases, there were no obvious fundus abnormalities in 1 case or 2 eyes, 11 cases of IP-related retinopathy in 22 eyes (91.7%, 22/24), 8 cases of binocular asymmetry (66.7%, 8/12). There were active lesions on the fundus in 7 eyes (29.2%, 7/24). Patients underwent simple retinal laser photocoagulation and/or anti-VEGF drug therapy. During the follow-up, retinal neovascularization recurred in 1 eye. Among the 8 cases that underwent genetic testing, 3 cases (37.5%, 3/8) were deleted in exons 4-10 of the IKBKG gene.ConclusionsIP is more common in women. IP-associated retinopathy is noted with early-onset, asymmetrical retinopathy, which is identified with retinal neovascularization and vitreous proliferation. Early detection and timely treatment are essential.