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 experts' 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.

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.

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.Intravitreal injection of anti-neovascularization 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 clinicsl 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.

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 anti-VEGF antibody that successfully prevents binding of all the biologically active isoforms of VEGF to the receptor.Ranibizumab is a isolated antigen-binding 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.

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.

The treatment of ocular fundus diseases is of significant issue in the clinic, but there exists large controversy on how to standardize the clinical treatment and how to evaluate the effectiveness of treatment on ocular fundus diseases. Emerging application of evidence-based medicine (EBM) provides us a rigorous and feasible pathway for the clinical treatment of ocular fundus diseases. We can improve the quality of clinical treatment research by exploring high quality randomized control trial (RCT) on the basis of patients with ocular fundus diseases in China; and by making full use of the best clinical evidences at home and abroad according to the EBM methods, which may further improve diagnosis and treatment of common ocular fundus diseases in China.

Objective To determine the effect of thiazolidinediones (TZDs) on early retinopathy in rats with experimental diabetes. Methods In 40 rats, diabetic models were set up in 36 by one-off intraperitoneal injection with streptozotocin (STZ), and other 4 were in the normal control group. Twenty-four diabetic rats with the disease-duration of more than 6 months underwent intravitreous injection (with rosiglitazone or pioglitazone in 10 rats, respectively), and the rest 4 rats weren′t injected with drugs as the diabetic positive control group. Immunohistochemical treptomycin-avidin-biotin-complex (SABC) method, in situ hybridization of retinal vascular endothelial growth factor (VEGF) mRNA, and TdT-dUTP terminal nick-end labelling (TUNEL) were performed on the ocular paraffin section to detect the cellular apoptosis. The difference of VEGF expression and cellular apoptosis between TZDs and control group was observed and analyzed. Results The results of immunohistochemical staining and hybridization in situ were negative in the normal control group. The positive expression rate of VEGF was lower in rosiglitazone and pioglitazone group than which in the diabetic positive control group, and there was no obvious differences of positive expression of VEGF mRNA and cellular apoptosis between the 2 groups. Conclusion TZDs (rosiglitazone and pioglitazone) may inhibit the positive expression of VEGF protein in retina of STZ-induced diabetic rats to some extent, but not affect the growth of VEGF in retina.

Optical coherence tomography (OCT) has developed from time-domain into Fourier-domain OCT (FD-OCT) which indicates clearer details and higher resolution of images. FD-OCT can indicate the structure and pathological changes of each retinal layer, and reveal the retinal external limiting membranes and changes of inner-and outer-segment of visual cells by 3D solid reconstruction. FD-OCT not only provide detailed information of the images for the clinical diagnosis, but also help us investigting the characteristics and pthological mechanisms of ocular fundus diseases, which lead us to a new era of technology of observation on ocualr fundus diseases. In the application, we should pay attention to the significance of different colors of OCT images, and focus on the cohenrence of the position in the image acquistion during the follow-up period. Dynamic observation on the lesions by FD-OCT and aggregated anaylsis of resutls of several imageological examination would be the development direction of imageological examination of ocular fundus diseases.

Background The improvement of the eye care system has being a strong guarantee for blindness prevention.However,medical resources of eye care in Tibet autonomous region cannot jet meet the effective requirement.Knowing the present situation of medical resources of eye care in Tibet can help reasonably allocate scarce medical resources.Objective This survey was to understand the status of eye care in Tibet area.Methods A questionnaire-based study was performed in Lhasa from April 2016 to June 2016,human resources,equipments were issued toward to all level of medical structures and answered by eye doctors.Results The coverage of the questionnaires was 100％ in Tibe area,and the effective response rate was 100％.Up to 2015,Tibet autonomous region had a total of 21 medical institutions with eye clinical ability with 1/151 000 per capita according to the Tibetan population released by national statistics bureau in 2014 and without any eye hospitals or eye clinics.In the 21 medical hospitals,19 (90.5％) had professional eye doctors,13 (61.9％) had independent eye departments,and 11 (52.4％) had operating room special for eye surgeries.One hundred and twenty ward beds were set in Tibet,and 1.6 eye doctors served in average for 100 000 Tibetan.Only 3 eye doctors with master degree and 14 eye nurses in Tibet area.There were a few elementary diagnostic and surgical instruments with an average of 326.2 eye simple operations in 2015.Conclusions The human resources and equipments as well as instruments are still insufficient for eye care in Tibet autonomous region,particularly in community-and county-level.

Background Vitrectomy is a primary approach to the treatment of proliferative diabetic retinopathy (PDR).However,postoperative rehaemorrhagia often occur.Ranibizumab is an effective drug of antivascular endothelial growth factor,but whether the combination of intravitreal injection of ranibizumab with vitrectomy can reduce the incidence of postoperative rehaemorrhagia in PDR patients is still unclear.Objective This study was to investigate the preventive effect of the combination of intravitreal injection of ranibizumab with 25-gauge vitrectomy on postoperative rehaemorrhagia.Methods A retrospective cohort study was perfomed.The clinical data of Ⅴ-Ⅵ stage of PDR patients who received 25-gauge vitrectomy in Peking University Interuational Hospital from January 2014 to July 2015 were collected and analyzed.The PDR patients were divided into only surgery group and drug with surgery group.The patients in the only surgery group (34 eyes of 49 patients) received 25-gauge vitrectomy,and the patients in the drug with surgery group (32 eyes of 25 patients) received the intravitreal injection of ranibizumab 0.05 ml (0.5 mg) 7 days before 25-gauge vitrectomy.The distribution of eye number in different grades of visual acuities was observed and compared between the two groups in 1 day,1 week,1 month and 3 months after surgery,and the incidence of rehaemorrhagia was intergrouply compared in 1 day,3-7 days and 1 month after surgery.Results The eye number and percentage of the different visual acuities in the drug with surgery group was not significantly different from the only surgery group in 1 day,1 week,1 month and 3 months after surgery (1 day:Z=0.673,P=0.412;1 week:Z=0.113,P=0.737;1 month:Z=1.755,P=0.185;3 months:Z=2.474.P=0.116).Rehaemorrhagia occurred in postoperative day 1 and day 3-7 was 1 eye and 1 eye respectively in the drug with surgery group,and that in the only surgery group was 9 eyes and 9 eyes respectively,showing significant difference between the two groups (all at P＜0.05).The eye number of rehaemorrhagia in postoperative 1 month was 4 in the only surgery group,and no rehaemorrhagia appeared in the drug with surgery group.Conclusions The combination of intravitreal injection of ranibizumab with 25-gauge vitrectomy can efficiently reduce the incidence of postoperative rehaemorrhagia.