Volume 61 · Issue 03 · 2025

This issue focuses on the research progress in the diagnosis and treatment of fundus diseases. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Lu Hai.

There are many clinical methods for the treatment of macular hole (MH), which have attracted extensive attention and discussion. Given the various etiologies and pathogeneses of different types of MHs, the mechanisms of the treatments are different, and the choices of treatment methods and the prognoses of MHs are also different. Clinicians should pay more attention to optimize the integral quality of treatments in addition to the closure rate of MHs by making a comprehensive and accurate diagnosis, a thorough inquiry of the disease course, and a precise selection of appropriate surgical strategies, as well as enhancing the treatment safety and postoperative follow-ups. The elaboration in this article aims to provide guidance and approaches for improvement of the MH treatment.

Diabetic retinopathy (DR) and central retinal vein occlusion (CRVO) are both vascular diseases of the retina, accompanied by macular edema and complications caused by ocular ischemia, but the pathogenesis and course of these two diseases are quite different, so the treatments for them are susceptible to deviation and confusion. This article emphasizes the importance of fully understanding the pathogenesis and clinical characteristics of DR and CRVO, and elaborates on the treatment concepts and strategies, as well as the differentiation of treatment methods, with a view to identifying the differences in the diagnosis and treatment of DR and CRVO, and to providing guidance and reference for clinical work and improvement of diagnostic and treatment effects.

To study the 5-year long-term efficacy and complications of adjuvant external drainage of subretinal fluid therapy in patients with severe exudative retinal detachment (ERD) secondary to stage 3B juvenile Coats disease.

This was a retrospective case series study. From January 2014 to December 2018, twenty-three eyes of 23 patients with severe ERD secondary to stage 3B juvenile Coats disease diagnosed at Beijing Tongren Hospital, Capital Medical University were included in this study. All patients underwent wide-field retinal imaging, fluorescein fundus angiography (FFA) and ocular color Doppler imaging. All cases received external drainage of subretinal fluid therapy combined with treatments including intravitreal injection of anti-vescular edothelial growth factor (VEGF) agents, retinal photocoagulation and/or cryotherapy. Clock-hour extent and occlusion of retinal vascular telangiectasia, changes of subretinal fluid, best corrected visual acuity (BCVA, logMAR) and incidences of complications including vitreous fibrosis, subretinal fibrosis, tractional retinal detachment (TRD), retinal cyst and complicated cataract were observed. Statistical analyses were performed using Fisher′s exact test, corrected chi-square test and chi-square test, Mann-Whitney U test, paired-sample Wilcoxon signed-rank test and Logistic regression analysis.

Among 23 eyes of 23 patients, 22 patients (95.7%) were male and 1 patient (4.3%) was female. All patients had unilateral Coats disease. The median age of initial visit was 43.0 (38.0, 47.0) months (range, 26 to 129 months). The median clock-hour extent of retinal vascular telangiectasia was 9.0 (7.0, 10.0) (range, 5 to 12). The median time of external drainage of subretinal fluid therapy was 1.0 (1.0, 2.0). The median time of retinal photocoagulation was 2.0 (2.0, 3.0). The median time of intravitreal injection of anti-VEGF agents was 4.0 (3.0, 6.0). Retinal cryotherapy was performed in 14 eyes (60.9%). The median follow-up after initial treatment was 66.5 (64.0, 70.0) months (range, 60 to 89 months). At last follow-up, retinal vascular telangiectasia of all patients were completely or partially occluded, and subretinal fluid was completely absorbed or obviously reduced; of which 8 eyes (34.8%) were completely occluded, and 15 eyes (65.2%) were partially occluded. The incidences of vitreous fibrosis, TRD and complicated cataract in the completely occluded eyes were lower than those in the partially occluded eyes (all P<0.005). No global enucleation was performed in any patient because of disease progression. Among 15 eyes of 15 patients underwent BCVA examination, 3 eyes had an improved vision, 10 eyes had a stable vision and 2 eyes had a decreased vision. The difference between median BCVA after treatment and that before treatment was not statistically significant [2.6 (2.6, 2.9) vs. 2.9 (2.6, 3.2), Z=-0.14, P=0.891]. Seventeen eyes (73.9%) developed vitreous fibrosis; 21 eyes (91.3%) developed subretinal fibrosis; 12 eyes (52.2%) developed TRD, 5 eyes (21.7%) developed retinal cyst and 15 eyes (65.2%) developed complicated cataract. Patients with complicated cataract had a higher incidence of TRD than that in patients without complicated cataract (11/15 vs. 1/8; χ²=10.96, P=0.001). The occurrence of TRD was associated with the greater clock-hour extent of retinal vascular telangiectasia and the presence of complicated cataract (OR=2.04, 95%CI: 1.14-3.64, P=0.016; OR=73.18, 95%CI: 4.58-1 168.40, P=0.002).

External drainage of subretinal fluid is a long-term effective adjuvant therapy in stage 3B juvenile Coats disease with severe ERD. However, there are possible complications such as TRD and complicated cataract after surgeries.

To analyze the ocular and systemic clinical features of children with CHARGE syndrome, which is a congenital autosomal dominant developmental disorder mainly characterized by coloboma (C), heart disease (H), atresia choanae (A), retarded growth and central nervous system anomalies (R), genital hypoplasia (G), and ear anomalies and deafness (E).

This was a retrospective caseseries study. Eight children (16 eyes) with CHARGE syndrome who visited the Department of Ophthalmology, Xijing Hospital, Air Force Medical University from January 2018 to December 2022 were included in this study. All 8 children underwent ocular and systemic examinations; 4 children underwent genetic testing. The basic birth conditions, medical history, and family history of the children were recorded in detail. The ocular and systemic clinical manifestations of the children were summarized, and the results of gene sequencing were analyzed.

Among the 8 children, 5 were male and 3 were female. The age at the first ophthalmological visit ranged from 2 months to 15 years. Five children were first diagnosed in the ophthalmology department, and 3 were referred from the otolaryngology department. All 8 children had ocular abnormalities such as characteristic, asymmetric, and congenital choroidal coloboma. Among them, the proportion of children with hearing impairment was 7/8, ear malformation was 8/8, developmental delay was 7/8, heart malformation was 5/8, intellectual disability was 3/8, choanal stenosis was 1/8, renal malformation was 1/8, and skeletal malformation was 1/8. All 4 children who underwent genetic testing were found to have mutations in the chromodomain helicase DNA-binding protein 7 (CHD7) gene, and all were pathogenic de novo mutations.

The clinical manifestations of children with CHARGE syndrome are diverse and highly associated with CHD7 gene mutations. The main ocular manifestation is tissue coloboma, and it is often accompanied by severe malformations in multiple organ systems such as the ears, heart, nervous system, and endocrine system.

To explore the correlation between the characteristics of color Doppler flow imaging (CDFI) and histopathological manifestations of choroidal melanoma (CM).

This was a retrospective case series study. The clinical and histopathological data of 49 patients (49 eyes) with CM who underwent enucleation at Tianjin Eye Hospital from February 2004 to March 2022 were collected. All patients underwent CDFI examination and histopathological examination to measure the number of tumor blood vessels. The relationships between the blood flow signals shown by CDFI and the internal blood flow characteristics of the tumor, tumor size, clinical stage, extra-scleral extension grade of the tumor, and cell type were analyzed. The consistency between CDFI and histopathological results was compared using the Adler semi-quantitative method. Paired Wilcoxon signed-rank test and Hodges-Lehman method were used for statistical analysis.

Among the 49 CM patients, 28 were male (57.1%) and 21 were female (42.9%). The age was (52.1±11.0) years old, and all cases were unilateral. Regarding the tumor shape detected by CDFI, 26 cases (53.1%) were mushroom-shaped, 11 cases (22.4%) were dome-shaped, and 12 cases (24.5%) were flat and diffuse-shaped. Among the 49 patients, 9 cases (18.4%) had blood flow signal grade Ⅰ, 16 cases (32.7%) had grade Ⅱ, and 24 cases (48.9%) had grade Ⅲ. The location with abundant blood flow inside the tumor was in the superotemporal quadrant in 19 cases (39.6%). The blood flow in the peripheral part of the tumor was more than that in the central part in 34 cases (69.4%). There were 13 large-sized tumors (26.5%), among which 6 cases had grade Ⅰ blood flow signal; 36 medium-sized tumors (73.5%), among which 20 cases (55.6%) had grade Ⅲ blood flow signal. There were 38 cases (77.6%) in the intraocular stage, among which 20 cases (52.6%) had grade Ⅲ blood flow signal; 4 cases in the glaucoma stage, among which 3 cases had grade Ⅰ blood flow signal; 6 cases in the extra-ocular extension stage, among which 4 cases had grade Ⅰ blood flow signal; 1 case in the systemic metastasis stage, showing grade Ⅲ blood flow signal. The extra-scleral extension grade of the tumor was grade Ⅰ (tumor cells involving the sclera) in 31 cases (63.3%), among which 17 cases (54.8%) had grade Ⅲ blood flow signal. There were 32 cases (65.3%) of mixed cell type, among which 17 cases (53.1%) had grade Ⅲ blood flow signal. Histopathological examination showed that the number of blood vessels was 9.0 (6.5, 11.0), the number of blood vessels measured by CDFI was 7.0 (4.0, 9.0), and the difference was 2.0 (1.0, 4.0) [95%CI: 1.5-3.0], and the difference was statistically significant (Z=4.376, P<0.001). The consistency analysis between CDFI and histopathological results showed that the grading was consistent in 40 cases (81.6%) and inconsistent in 8 cases (16.3%).

There is a high correlation between the CDFI characteristics of CM patients and histopathological examination, but the former cannot completely replace the latter in measuring the blood vessel situation inside the tumor.

To investigate the role of high mobility group protein B1 (HMGB1), cysteine aspartic protease 1 (caspase-1) and gasdermin D in the pathogenesis of high altitude retinopathy (HAR).

This study is an experimental research. Twelve 8- to 10-week-old male c57BL/6J mice without a specific pathogen grade were randomly divided into the HAR group (HAR model) and control group (normal pressure and oxygen environment) according to the random number table method. Hematoxylin-eosin staining was used to observe the histopathological morphology of the mouse retina, and immunofluorescence staining was used to detect the distribution and expression of HMGB1, caspase-1 and gasdermin D in the mouse retina. The relative expression levels of HMGB1, caspase-1 and gasdermin D proteins in the mouse retina were detected by Western blot. Independent sample t test was used for statistical analysis.

Hematoxylin-eosin staining showed that compared with the control group, the retinal nerve fiber layer in the HAR group was thickened, the ganglion cell layer was swollen significantly, the intercellular edema in the inner nuclear layer was increased significantly, and the outer nuclear layer distance was loosened. Immunofluorescence staining results showed that HMGB1 expression in the retina of mice in the HAR group was higher than that in the control group, and it was mainly in the ganglion cell layer, inner nuclear layer and outer nuclear layer. Caspase-1 and gasdermin D expressions in the retina of mice in the HAR group were higher than those in the control group, and they were mainly in the ganglion cell layer, inner plexiform layer and outer plexiform layer. The immunofluorescence values of HMGB1, caspase-1 and gasdermin D in the HAR group [(116.8±62.92), (104.7±13.81) and (95.43±10.72) arbitrary fluorescence units] were higher than those in the control group [(52.93±30.08), (66.00±15.19) and (62.54±16.36) arbitrary fluorescence units]. The differences were statistically significant (all P<0.05). The results of the Western blot test showed that the gray band values of HMGB1, caspase-1 and gasdermin D proteins in the retina of HAR group (1.134±0.060, 1.598±0.165 and 1.422±0.142) were higher than those in the retina of control group (1.000±0.021, 1.000±0.155 and 1.000±0.218), with statistically significant differences (all P<0.05).

The expressions of HMGB1, caspase-1 and gasdermin D were significantly increased in the retina of HAR mice. HMGB1-mediated pyroptosis in the retinal tissue of HAR mice through the caspase-1/gasdermin D signaling pathway led to retinal structure destruction and the occurrence or development of HAR.

Exploring the effect of transforming growth factor β receptor inhibitor SB431542 on autophagy and the formation of retinal epithelial mesenchymal transition (EMT) in retinal pigment epithelial cells under high glucose conditions.

This study was an experimental research. RPE cells were divided into normal group (N group), mannitol group (M group), high glucose group (HG group), high glucose combined with DMSO group (HG+DMSO group) and high glucose combined with SB431542 group (HG+SB431542 group). MTT assay was used to detect cell proliferation. Cell scratch assay was used to detect cell migration. Phalloidin staining was used to detect Fibrotic actin, real-time quantitative PCR (qPCR) and immunofluorescence were used to detect the expression of EMT related proteins Vimentin and E-cadherin. The cell autophagy staining kit detects the expression of autophagosomes. Western blotting (WB), qPCR, and immunofluorescence were used to detect the expression of Beclin1. One-way ANOVA and LSD-t test were used for statistical analysis.

The MTT assay showed that the cell optical density values of HG+DMSO group and HG+SB431542 group were 2.02±0.10 and 1.35±0.04, respectively (t=15.39, P<0.001); The results of cell scratch assay showed that the migration rates of cells in HG+DMSO group and HG+SB431542 group were 58.33%±2.07% and 28.17%±1.94%, respectively (t=26.07, P<0.001); Ghost pen cyclic peptide staining revealed spindle shaped changes in HG+DMSO group cells, while HG+SB431542 group cells were able to restore their normal polygonal structure; The qPCR and cell immunofluorescence results showed that the mRNA levels of vimentin in the HG+DMSO group and HG+SB431542 group were 1.03±0.04 and 0.93±0.05, respectively, with fluorescence intensities of (61 828±760) and 46 680±671 AU (t_qPCR=3.85, P=0.003; t_IF=36.62, P<0.001); The mRNA levels of epithelial calcium adhesion protein were 0.86±0.03 and 1.00±0.04, respectively, with fluorescence intensities of (38 637±880) and (54 988±1 264) AU (t_qPCR=8.89, P<0.001; t_IF=26.01, P<0.001); Autophagy staining showed that the fluorescence intensity of autophagosomes in HG+DMSO group and HG+SB431542 group was (22.75±1.39) and (33.21±1.95)AU, respectively (t=10.70, P<0.001); WB, qPCR, and cell immunofluorescence results showed that the protein levels of Beclin1 in the HG+DMSO group and HG+SB431542 group were 0.38±0.04 and 0.75±0.08, respectively, and the mRNA levels were 0.77±0.08 and 1.05±0.05, respectively. The fluorescence intensities were (42 639±1 713) and (49 027±1 024) AU, respectively (t_WB=9.51, P<0.001; t_qPCR=6.90, P<0.001; t_IF=7.84, P<0.001).

SB431542 inhibits high glucose induced EMT by inducing autophagy in the RPE cells.

A 39-year-old male patient presented with"decreased bilateral visual acuity for more than one year". He has been infected with human immunodeficiency virus (HIV) for more than 10 years, and was diagnosed as "binocular panuveitis" "binocular optic disc vasculitis"in the local hospital, with no improvement after six months of systemic hormone shock, intermittent oral hormone and immunosuppressive treatment. Comprehensive examinations were conducted after arrival, Optical coherence tomography revealed the damage of posterior retina, macular edema, fluorescein fundus angiography showed diffuse punctate transmitted fluorescence and vascular leakage, rapid syphilis serotonin response (RPR) 1∶64, leading to the diagnosis of binocular syphilitic uveitis. After three weeks of antibiotic treatment, oral hormone sequential reduction treatment, disease control, vision recovery.

A 11-year-old male patient presented with a 4-month history of decreased vision in the left eye, which gradually worsened to complete loss of vision in the left eye over the past 1 month. The patient had a 6-year history of acute lymphoblastic leukemia and had been clinically cured after chemotherapy for 3 years. The visual acuity of the left eye was hand-motion at near. Fundus examination revealed asymmetric papilledema in both eyes. The right eye showed typical papilledema, while in the left eye, the optic disc margin was blurred, and there were numerous thick patchy yellow-white lesions and exudates in the subretinal area of the posterior pole around the optic disc, accompanied by obvious neurosensory retinal detachment. Through fluorescein fundus angiography, optical coherence tomography, magnetic resonance imaging of the orbit and skull, cerebrospinal fluid examination, and peripheral blood tests, the patient was diagnosed with central nervous system leukemia recurrence with infiltrative optic neuropathy in the left eye and papilledema in the right eye. After three courses of chemotherapy (methotrexate 3.4-7.5 g) combined with intrathecal injection (methotrexate 12.5 mg+cytarabine 35 mg), the intracranial pressure gradually decreased. The papilledema in the right eye completely subsided, and the visual acuity was not affected. The papilledema in the left eye gradually subsided, and the subretinal lesions and exudates decreased. During the 4-year follow-up, the patient′s general condition was stable, and the visual acuity of the left eye recovered and stabilized at 0.05.

The patient was a 54-year-old male. After right eye trauma, visual acuity decreased with nasal shadow occlusion for 3 d, and he was seen in the Eye Hospital affiliated to Chengdu University of Traditional Chinese Medicine. Eye examination: the naked eye vision of the right eye is manual (no improvement in correction); 0.2 cm ×1.0 cm scar on the skin of the upper lid of the right eye, and a scar about 4 mm in diameter below the cornea; The right fundus of the eye is grayish and bulged from 5: 30 to 2: 30, the peripheral retina is huge, and the retina is wrinkled from 8: 00 to 1: 00, and the peripheral retina is about 2 horseshoe-shaped holes with the diameter of the optic disc at 6: 30. The macula is occluded by the detached retina, and the rest of the retina is flat, without bleeding or exudation (Quintessential Picture 1). Clinical diagnosis: Rhegmatogenous retinal detachment in right eye; Proliferative vitreoretinopathy of the right eye (grade B).

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus and a leading cause of vision loss in diabetic patients. Pathological processes such as inflammatory response, oxidative stress, and vascular dysfunction play important roles in the pathogenesis of DR. Changes in the levels of cytokines associated with these pathologic processes correlate with the onset, progression, and extent of DR. In this review, we address the role of various potential cytokines in aqueous humor in the pathogenesis of DR, with a view to identifying potential targets that may diagnose and treat DR and providing a basis for developing new therapeutic approaches.

Focal photoreceptor defects refer to a group of diseases characterized by changes in the foveal structure caused by rarefaction or absence of the outer retina. Due to their diverse clinical manifestations and the limitations of previous imaging techniques, these diseases have not received sufficient attention and accurate diagnosis. Their causes can be mainly classified into diseases with primary lesions occurring in the outer retina and outer retinal lesions secondary to other sites of disease. Understanding the potential causes of foveal photoreceptor damage can provide better guidance for the clinical diagnosis and treatment of these diseases. This article reviews the etiology of focal photoreceptor defects.

Integrated Microscope Coherence Light Tomography (OCT) is an OCT device integrated into a surgical microscope to perform OCT scans at the same time as surgical operations, which can provide important lesions and surgical information in real time throughout the surgical procedure. In order to facilitate ophthalmologists to understand and grasp the clinical advantages and value of integrated microscope OCT, this paper summarizes the application of integrated microscope OCT in the surgery of macular lesions in children.