The pathogenesis of polypoidal choroidal vasculopathy (PCV) is still controversial.More evidence of clinical and basic research is needed to distinguish PCV from an independent disease to a subtype of age-related macular degeneration.Not only that,there are also many puzzles in the diagnosis,treatment options and prognosis of PCV.In addition to these common problems,we also face a large population with risk factors,a large number of PCV patients with multiple and complex challenges in China.There is a long way to go to reduce the damage effects of PCV on visual function.To fulfil this goal,we need make full use of the huge resources of PCV patients and turn these challenges into opportunities,and contribute the improvement of diagnosis and better understanding of PCV pathogenesis.

Autofluorescence is produced by lipofuscin in retinal pigment epithelium (RPE) cells which is induced by exciting light and enables the visualization of lipofuscin changes in the RPE cells, thus showing the function of RPE and photoreceptor cells. Fundus autofluorescence (FAF) imaging is a non-invasive imaging technique providing information of RPE and photoreceptor cells, which is not obtainable with other imaging modalities. The scope of applications includes identification of diseased RPE in retinal diseases, elucidating pathophysiological mechanisms, estimating disease progression and prognosis, guiding treatment protocols. Common fundus diseases have different pathological types, levels and causes, so they can cause various damages of RPE and photoreceptor cells which induce complicated FAF. It is worth further observing and investigating the common retinal diseases' FAF characteristics and clinical applications.

Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation.According to its fundus feature,lesion location,imaging feature and disease progression,PCV can be divided into different types or stages.It can be divided into hemorrhage and exudation PCV according to the fundus features,into macular,peripapillary,periphery and mixed types according to the lesion locations.It can also be divided into type 1 and 2 according to the ICGA (indocyanine green angiography) manifestations,and can be classified as early stage and late stage according to disease progression.There were different correlations between different types of PCV and some risk genetic loci,such as ARMS2 (age-related macular degeneration factor 2)/HTRA1 (high temperature essential protein A1),C2,complement factor B,complement factor H,and elastin genes.The response to therapy and prognosis are also different between different types.It is important to further study the clinical classification of PCV,to explore the genetic characteristics,influencing factors and treatment or prognosis features of different types of PCV.The results will improve the differential diagnosis of PCV,and the effectiveness of individualized treatment.

Background Central retinal vein occlusion (CRVO) causes macular edema.The treatment options are limited.There have been a series of randomized controlled trials (RCTs) to investigate the effectiveness of anti-vascular endothelial growth factor (VEGF),but the systematic review of the literature to assess the strength of evidence supporting the interventions is lack.Objective This study was to evaluate the effectiveness of anti-VEGF therapy for improving vision and reducing macular edema in patients with CRVO associated with macular edema.Methods A systematic review and Meta-analysis was performed.According to guidelines of Cochrane collaboration,the literature of RCTs for anti-VEGF therapy treating CRVO with macular edema was searched from Cochrane Library,Pubmed,Embase,Wanfang databases and conference documents without the limiting of language or date.The literature was screened independently by two searchers,and the methodology quality of the included papers was estimated.The proportion of patients with the best corrected visual acuity (BCVA) ≥ 15 ETDRS letters,the change ranges of BCVA (LogMAR) and central fovea thickness (CFT) were analyzed.The overall effect size was analyzed using Review Manager 5.1 in The Cochrane Collaboration as weighted mean difference (WSD).Fixed effect mode was used to evaluate and compare the treating effectiveness between the anti-VEGF group and sham treating group.Results Six RCTs were incorporated with 948 eyes and generated 3 comparisons in the study,including 5 multi-central studies and 1 single central study.Pegaptanib was administered in 1 study,and ranibizumab was used in 2 studied,bevacizumab in 1 study and VEGF Trap-Eye in 2 studies.The results demonstrated that anti-VEGF therapy resulted in more patients who gained 15 ETDRS letters or more during one-year duration (Z =8.43,P＜0.000 01) in the 6th month after intravitreous injection.BCVA logMAR was significantly improved in the anti-VEGF therapy group in comparison with sham treating group during the initial 6 months of trial (Z=28.27,P＜0.000 01) with the maximal difference in the 6th month.CFT value was significantly lower in the anti-VEGF therapy group than that of the sham treating group during the first 6 months (Z=35.38,P＜0.000 01) in the 3rd month.Topical adverse events occurred occasionally,including vitreous hemorrhage in 19 eyes,cataract in 16 eyes,endophthalmitis in 8 eyes and iris neovascularization in 2 eyes.No system adverse event was found after administration of the drugs.Conclusions Anti-VEGF therapy is efficient in CRVO with macular edema with little side effect.However,in order to maintain the effect,multiple injections are needed.Early onset treatment of anti-VEGF drugs is recommended,but the delayed onset is still beneficial.

Objective To determine the role of CTGF in PVR, we successfully down - regulated the expression of CTGF by RNA interference( RNAi) technology in ARPE-19 cell line. Methods Design and synthesis three CTGF siRNA, screen effective targeted points in Western blot, combine Oligo DNA of effective targeted point, anneal to form double chain DNA, connect with linearing pGC-LV-GFP carrier, sequence DNA in PCR screening positive clones. Results The shRNA-expression vector of CTGF was constructed successfully. And RT-PCR and Western Blot results showed that CTGF expression was significantly inhibited by siRNA transfectants in ARPE-19 cells at mRNA and protein levels. Conclusion We successfully construct shRNA-expression vector of CTGF which paves a way for CTGF-targeted gene therapy of proliferative vitreoretinopathy.

Objective To observe the efficacy of adjuvant intravitreal injection of anti-vascular endothelial growth factor (VEGF) therapy for advanced Coats disease.Methods This study is a retrospective case series study.Fourteen patients (14 eyes),presenting Coats Stages 3B and 4 (8 and 6 eyes,respectively) were enrolled.All the patients were treated with adjuvant intravitreal anti-VEGF therapy.The intravitreal anti-VEGF injections varied from 1 to 7,with a median injections of 2.14.In 14 eyes,combined therapy was subretinal fluid drainage in 4 eyes,photocoagulation in 2 eyes,vitrectomy in 8 eyes.The follow-up period was ranged from 4 to 36 months,with a median follow-up of 18.8 months.Visual acuity and retinal reattachment were observed in follow up.Results At last follow up,global suvival was 100.0％ with no enucleation performed in any patient because of disease progression.Except for 2 children who were unable to cope with the visual acuity test,visual acuity was improved in 2 patients,stable in 8 patients,and decreased in 2 patients.5 patients (35.7％) achieved in complete retinal reattachment,3 patients (21.4％) were succeed in partial retinal reattachment,and the remain 6 patients(42.8％) failed in retinal reattachment.Two patients developed cataract after vitrectomy,and no other adverse reaction was observed during follow-up.Conclusion Anti-VEGF therapy combined with classic treatments in advanced Coats disease can keep or impove the visual acuity in most patients by reducing of subretinal exudation.

Objective To systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV),and to investigate the primary treatment tentatively.Methods A systematic search of Pubmed,Embase,the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone,intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy.Outcomes of interest included the regression and recurrence rate of polypoidal lesions,best corrected visual acuity (BCVA),central retinal thickness (CRT),therapeutic times,and the occurrence rate of adverse events.2 randomized controlled trials (RCT) and 19 non-RTCs were identified.According to treatment methods,the data extracted was classified to 3 groups,analyzed with odds ratio (OR),weighted mean difference (WMD) and 95％confidence interval (95％CI).Results Meta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34,0.07;95％CI=0.13-0.88,0.02-0.36) and BCVA (WMD=0.25,0.11;95％CI=0.14-0.36,0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P＜0.05).The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35,95％CI=0.16-0.74,P=0.006).BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36,95％CI=6.04-603.50,P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group.Conclusions Combined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone.Combined treatment takes priority over all others in the primary treatment of PCV.

Objective To evaluate the efficacy of transpupillary thermotherapy(TTT)on three kinds of intraocular benign tumors. Methods Seventeen patients with 3 kinds of intraocular tumors,3 eyes of 3 patients with papillary hemangioma,9 eyes of 9 patients with choroidal hemangioma and 8 eyes of 5 patients with choroidal osteoma were treated with transpupillary thermotherapy.All patients underwent pretreatment ocular examination,including visual acuity,biomicroscopy for anterior segment and fundus examination,fundus fluorescein and indocyanine green angiography,optic coherence tomography,perimetry test,ultrasonography,and CT.TTT was conducted with infrared diode laser at810nm.with power of 360- 1 200 mW; beam diameter of 3 mm or combined 2-5 spots according to the tumor size;the exposure time was 60-80 seconds.The treatment was completed in one session,and another treatment was given 1-3 month later if active leakage demonstrated.The follow-up period was 6-36 months(mean 14.5 month). Results The best corrected visual acuity with Snellen chart on average for papillary hemangioma was 0.17 before TTT and 0.27 after;for choroidal hemangioma was 0.39 before TTT and 0.46 after;for choroidal osteoma was 0.20 before TTT and 0.31 after.Three eyes with papillary hemangioma had operation to release subretinal fluid and intraocular laser coagulation;the tumor remained reddish color with dilated vessels and patches of hemorrhages on the surface.After TTT the color appeared pale yellowish,hemorrhages absorbed,subretinal fluid subsided,and choroidal retinal atrophy disclosed along the lower border of the tumor.In 9 eyes with choroidal hemangioma, the red-light area disappeared, subretinal fluid subsided, and the pigment proliferation in the treatment area was found.Eight eyes with choroidal osteoma had choroidal neovessels and macular hemorrhages;after TTT blood disappeared,subretinal fluid absorbed,and the color of tumor showed pale yellow with dark pigment and thin scar tissue.There was no significant complication associated with TTT. Conclusions Transpupillary thermotherapy is effective on papillary hemangioma,circumscribed choroidal hemangioma and choroidal osteoma either as preliminary or supplementary treatment.

Objective To evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).Methods 35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT.Best-corrected visual acuity(BCVA),central macular thickness (CMT) were measured before and after treatment (1,3 and 6 months).The mean BCVA was 0.28± 0.22,mean CMT was(384.5 ± 85.0) μm.The situation of subretinal fluids (SRF) absorption was observed.Results In 35 eyes,SRF of 29 eyes (82.9％) completely absorbed and 6 eyes (17.1％) not completely absorbed after one month of treatment.SRF of all eyes (100.0％) completely absorbed after three months of treatment.After 6 months of treatment,SRF of 3 eyes (8.6％) were recurrence,which might be completely absorbed when a half-dose maintenance therapy PDT was used again.The mean BCVA significantly improved to 0.14±0.13 at 1 months,0.05±0.11 at 3 months and 0.05± 0.12 at 6 months after PDT (t=5.410,7.830,7.758; P＜0.05).The mean CMT decreased to (224.3± 61.4) μm at 1 months,(199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856,11.781,11.900; P＜0.05).The mean CMT of controlled 32 eyes after treatment was (198.5± 33.9) μm,much lower than the fellow eyes(232.3 ± 17.5) μm (t =-3.988,P＜0.05).Conclusions Half-dose verteporfin PDT was safe and effective in treating chronic CSC,but may cause thinning of CMT.

In recent years, the prevalence of cardiovascular disease (CVD) in China has been increasing year by year, and it has become a major public health concern. The prevention and control of chronic CVD is inseparable from effective early screening. However, due to the imbalance in the level of economic and social development in various parts of China, the universality and accessibility of screening in some areas still need to be improved. The fundus retinal blood vessel is the only vessel in the whole body that can be directly observed. Studies have found that its morphological and functional changes are related to the occurrence and development of many CVD, and it has the potential to become a tool for assessment and prediction. This review intends to introduce the research progress of retinal blood vessels in the evaluation and prediction of cardiovascular disease in recent years.