Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.
Retinal leakage is not only a very common pathological phenomenon but also a common pathological feature of many retinal diseases, its pathogenesis is very complex. The application of ultra-wide-angle fluorescein angiography is one of the main means to observe and evaluate retinal leakage. Leakage index is a new index for evaluating retinal leakage. Studies have explored its correlation in diabetic retinopathy, retinal vein occlusion, uveitis and other diseases, evaluating treatment effects and predicting prognosis. However, the number of related studies is small and the conclusions are inconsistent. In the future, it is still necessary to further advance the quantitative analysis of leakage, the application of leakage in more diseases, and the clinical trials of leakage rate to explore its role in predicting and evaluating treatment effects in retinal diseases.
The choroidal vascular index (CVI) is the ratio of the luminal area to the total choroidal area. It can not only reflect the changes in the vascular composition of the choroid, but also serve as an observation index for follow-up treatment effects. CVI is a new biometric tool, which is gradually applied to the observation of choroidal structure in various eye diseases. It has great application prospects in the study of pathophysiological mechanisms, disease process monitoring and efficacy evaluation such as central serous chorioretinopathy, polypoid choroidal vascular disease, age-related macular degeneration, diabetic retinopathy,etc. Understanding the research progress of CVI in various eye diseases can provide reference for clinical research of CVI.
Adult Coats disease is characterized by abnormal expansion of retinal capillaries, often accompanied by massive lipid exudation and exudative retinal detachment. Unlike Coats disease in young children, adult Coats disease is mostly limited to peripheral retina, with slow progress and better prognosis. Adult Coats disease should be identified with Coats-like diseases such as exudative age-related macular degeneration, diabetic retinopathy, obsolete retinal vein occlusion, idiopathic macular telangiectasia 1, obsolete posterior uveitis, retinal vasculitis, or acute retinal necrosis. Because the pathogenesis of Coats disease is not clear, it lacks specific treatment measures for the cause of disease. The purpose of simple or combined laser photocoagulation, freezing, vitreous intravitreal injection against vascular endothelial growth factor drugs or triamcinolone and surgery is to eliminate abnormal blood vessels and exudation, maintain visual function, which can also improve retinal detachment and prevent neovascular glaucoma and other complications. To explore the similarities and differences of adult Coats disease with Coats disease in young children, to further promote the study of the pathogenesis of adult Coats disease and to provide new targets for its treatment are the direction of future research.
ObjectiveTo compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR). MethodsThis is a prospective randomized study. Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients, 39 eyes) and 25G+ vitrectomy group (27 patients, 36 eyes). Visual acuity, intraocular pressures, ophthalmoscopy, B-scan ultrasound was examined before surgery. The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications and postoperative ocular conditions were analyzed. ResultsThe mean surgical times were (53.35±7.42) minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively, and the difference was significant (t=4.37, P < 0.05). Iatrogenic injuries occurred in 11 eyes (28.21%) and 5 (13.89%) eyes in 23G and 25G+ group respectively, and the difference was significant (χ2=4.93, P < 0.05). The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (χ2=16.81, 18.29; P < 0.05). At last follow-up, there was 25 eyes and 24 eyes with visual acuity≥0.05 in 23G and 25G+ groups respectively, and the difference was not significant (χ2=0.13, P > 0.05). Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively, and the difference was significant (χ2=5.67, P < 0.05). Conclusion25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.