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Polypoidal choroidal vasculopathy (PCV) is a fundus disease that can cause severe visual impairment. At present, the gold standard for the diagnosis of PCV is indocyanine green angiography (ICGA). Due to its invasiveness and inconvenience in clinical application, researchers are exploring the use of non-invasive optical coherence tomography (OCT) in clinical diagnosis and follow-up of PCV, and non-invasive diagnostic criteria based on OCT are gradually emerging. However, in the clinical application of this technology, there are still some problems, such as poor imaging effect, unclear diagnosis, over-reliance on OCT technology, complex follow-up situations and so on. This paper intends to review the current situation, new diagnostic criteria and related problems of OCT in the clinical diagnosis and treatment of PCV, in order to provide reference for ophthalmologists.
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Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple systems throughout the body, which may cause serious visual impairment when the fundus is involved. In recent years, " looking at health through the eyes" is a hot research topic. Studies on SLE have shown that retinopathy is highly correlated with disease activity. Even there is no clinical manifestation, changes in retinal microvessel density and structure also show a certain correlation with the course of SLE and other organs′ involvement. Therefore, the evaluation of fundus features in SLE patients is not only helpful for early intervention and improvement of patients′ visual function prognosis, but also of great significance for the diagnosis of SLE and prediction of other systems′ impairment.
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A young female patient presented with fever, arthralgia, and rash was diagnosed with adults still's disease. When treated with glucocorticoid steroid, the above patient progressed to anuria, sudden, and confusion. After a teamwork involving different departments, the patient was finally diagnosed with atypical hemolytic uremic syndrome (aHUS) and treated with good outcome. aHUS is a rare disease, while Eculizumab is an orphan drug. The diagnosis and treatment of the patient reveals the importance of multidisciplinary team on the diagnosis and treatment of rare and difficult diseases.
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At present, artificial intelligence (AI) has been widely used in the diagnosis and treatment of various ophthalmological diseases, but there are still many problems. Due to the lack of standardized test sets, gold standards, and recognized evaluation systems for the accuracy of AI products, it is difficult to compare the results of multiple studies. When it comes to the field of image generation, we hardly have an efficient approach to evaluating research results. In clinical practice, ophthalmological AI research is often out of touch with actual clinical needs. The requirements for the quality and quantity of clinical data put more burden on AI research, limiting the transformation of AI studies. The prediction of systemic diseases based on fundus images is making progressive advancement. However, the lack of interpretability of the research lower the acceptance. Ophthalmology AI research also suffer from ethical controversy due to unconstructed regulations and regulatory mechanisms, concerns on patients' privacy and data security, and the risk of aggravating the unfairness of medical resources.
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Diabetic retinopathy (DR) is a retinal microvascular disease associated with diabetes which is the primary cause of impaired vision in working age population. Inflammatory reaction and inflammatory factors such as tumor necrosis factor-α (TNF-α) and interleukin (IL)-1β play an important role in the occurrence and development of DR, and to target at which anti-inflammatory treatments such as glucocorticoids and non-steroidal anti-inflammatory drugs were used, but with disputes on therapeutic effect and drug selection. This review aims to clarify the research on mechanism of inflammatory reaction in DR, summarize the application status of existing anti-inflammatory therapy, and provide some new ideas for the research and clinical application of the treatment of DR.
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Objective:To evaluate the clinical features and follow-up effect of treatment for retinal capillary hemangioma (RCH) of myopic disc.Methods:Retrospective case series studies. A total of 14 patients (15 eyes) diagnosed with juxtapapillary RCH (JRCH) at Peking Union Medical College Hospital and followed up for more than 12 months from January 2007 to December 2019 were included. Among these patients, there were 7 males (7 eyes) and 7 females (8 eyes) with the average age of 29.8±12.7 years. There were 6 isolated JRCH cases, all of which were monocular patients, including 1 case with a single peripheral RCH; 8 cases with von Hippel-Lindau disease, including 5 cases of binocular RCH. Out of 15 eyes, 6 eyes were merged with peripheral RCH. Three eyes were simply observed, and 12 eyes were treated with photodynamic therapy (PDT) alone or PDT combined with other treatments. The average follow-up time was 55.2 months. Its clinical characteristics and long-term treatment effects were analyzed.Results:At the first visit, among the 15 eyes, 3 eyes had visual acuity <0.1, 5 eyes were 0.1-0.4, and 7 eyes were> 0.5. The endogenous and fixed exogenous JRCH were 12 (80%, 12/15) and 3 (20%, 3/15) eyes, respectively. The size of the tumor was 1/4 to 4 optic disc diameters (DD); the combined macular edema, epiretinal membrane, and macular hole were 11, 5, and 1 eyes, respectively. There were 3 eyes with tumor diameter less than 1 DD. The visual acuity at the first diagnosis was 0.6-1.0, and no treatment was given. The follow-up time was 12 months in 2 eyes and 120 months in 1 eye. At the last follow-up, his vision remained stable and the tumor did not enlarge. Six eyes with tumor diameter ranging from 1.0 to 2.5 DD, visual acuity was 0.06 to 0.6 at first diagnosis, accompanied by retinal exudation. 5 eyes were treated with PDT alone, and 1 eye was treated with PDT combined with anti-vascular endothelial growth factor drugs. The follow-up time was 12 to 84 months. At the last follow-up, the visual acuity improved or stabilized in 5 eyes and decreased in 1 eye. There were 6 eyes with peripheral RCH, including 4 eyes with retinal detachment, 2 eyes with epiretinal membrane, and 1 eye with vitreous hemorrhage. The visual acuity at the first visit was 0.02-0.6. All patients were treated with PDT combined with transpupillary thermotherapy, extrascleral drainage, and vitrectomy. The follow-up time was 12 to 132 months. At the last follow-up, all eyesight decreased.Conclusions:Visual decrease cause by JRCH often occurs at young adults. Bilateral JRCH are more common in patients with von Hippel-Lindau's disease. The tumor can cause retinal exudation, macular edema, epiretinal membrane and macular hole, resulting in gradual vision loss. PDT and/or combined anti-vascular endothelial growth factor drugs for medium sized JRCH with retinal exudation can maintain long-term vision stability. Patients with large JRCH or severe complications such as retinal detachment tend to have poor prognosis.
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Objective:To observe the changes of macular microvascular structure in eyes with macular edema secondary to branch retinal vein occlusion (BRVO-ME) after intravitreal injection of conbercept and analyze its relationship with visual function and central retinal thickness (CRT).Methods:A prospective clinical study. From July 2018 to June 2019, 21 eyes of 21 patients with unilateral temporal BRVO-ME diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 14 eyes of 14 males and 7 eyes of 7 females; the average age was 58.0±8.3 years. There were 13 eyes and 8 eyes with occlusion of the superior temporal and inferior temporal branches of the retinal vein, respectively. The affected area was defined as the side of the venous obstruction. All the affected eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination. The BCVA was tested using the international standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistical analysis. All the eyes were treated with intravitreal injection of conbercept once a month for 3 months, and then treated as needed. A 3 mm × 3 mm scan centered on fovea was obtained and the vascular density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), acircularity index (AI), foveal vascular density in a 300 μm wide region around FAZ (FD-300) and central retinal thickness (CRT) were measured. The follow-up time after treatment was 6 months. The vascular density and FAZ parameters were compared before and after treatment by paired t test. The correlations of BCVA, CRT and vascular density, FAZ area and the other parameters at 6 months after treatment were analyzed by linear regression analysis. Results:Before treatment, the logMAR BCVA of the eyes was 0.506±0.159, and the CRT was 375.4±81.3 μm; 6 months after treatment, the logMAR BCVA of the eyes was 0.294±0.097, and the CRT was 266.3±46.7 μm. There was a statistically significant difference of logMAR BCVA and CRT between the eyes before and after treatment ( t=8.503, 9.843; P<0.05). There was no statistically significant difference in the overall vascular density of SCP and DCP before and 6 months after treatment ( t=-0.091, -0.320; P>0.05). The foveal vascular density decreased, and the difference was statistically significant ( t=8.801, 3.936; P<0.05). The vascular density of DCP of the affected area increased, and the difference was statistically significant ( t=-2.198, P<0.05). Compared with those before treatment, the FAZ area and PERIM of the affected eyes had an increasing trend, while AI and FD-300 had a decreasing trend, and the differences were statistically significant ( t=-18.071, -12.835, 2.555, 8.610; P<0.05). The linear regression analysis showed that BCVA and FAZ area 6 months after treatment have significant correlation ( t=2.532, P=0.024). Conclusion:CRT decreased and BCVA increased after intravitreal injection of conbercept in BRVO-ME eyes. After treatment, the foveal vascular density of SCP and DCP decreased while the vascular density of DCP of the affected area increased. The FAZ increased and the PERIM and AI decreased during follow-up. The BCVA was significantly correlated with the FAZ area 6 months after treatment.
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Objective:To evaluate the efficiency of using artificial intelligence reading label system in diabetic retinopathy (DR) grading training among junior ophthalmologists and medical students.Methods:520 diabetic fundus images were randomly divided into 8 groups with 65 images in each group. 13 junior ophthalmologists and medical students were selected as the research objects. Each of them read 8 groups of pictures and evaluated the DR grading of each fundus image. The sensitivity, specificity and diagnostic test consistency (Q-kappa value) of grading results were analyzed with the DR grading given by 3 senior ophthalmologists as the gold standard. The average Q-kappa values of 13 subjects were compared between the first four times and the last four times.Results:Through 8 round reading, the average Q-kappa was elevated from 0.67 to 0.81. Average Q-kappa of round 1 to 4 was 0.77, and average Q-kappa of round 5 to 8 was 0.81. The participants were divided into two groups. Participants in group 1 were junior ophthalmologists and participants in group 2 were medical students. Average Q-kappa of group 1 was elevated from 0.71 to 0.76. Average Q-kappa of group 2 was elevated from 0.63 to 0.84.Conclusions:The artificial intelligence reading label system was a useful tool in training junior ophthalmologists and medical students in doing diabetic retinopathy grading.
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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.
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Objective:To investigate the characteristics of polypoidal lesions and abnormal branching vascular network (BVN) in patients with polypoidal choroidal vasculopathy (PCV) by optical coherence tomography angiography (OCTA).Methods:A case series study was conducted.Untreated 45 eyes of 42 patients with initial diagnosis of PCV from May 2016 to April 2017 in Peking Union Medical College Hospital were enrolled.There were 26 males (27 eyes) and 16 females (18 eyes) with the average age of (68.59±8.52) years.All patients underwent fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and OCTA.The OCTA image features and detection rate of polypoidal lesion and BVN were analyzed.The study protocol was approved by the Ethics Committee of Peking Union Medical College Hospital (No.S-K631). Written informed consent was obtained from each patient prior to any examination.Results:ICGA images showed obvious polyps with higper fluorescence in all PCV patients, and BVN structure was observed in the ICGA images of 38 eyes.Ring, circle, cluster or node like hyper-reflective structures were detected in polypoidal lesions in the en face OCTA images of 35 eyes, and the detection rate was 77.8% (35/45). The BVN structure was detected in the OCTA images of all the 38 eyes, with the 100% (38/38) detection rate.Conclusion:OCTA can detect polypoidal lesions and BVN of PCV non-invasively, which can locate the lesion in combination with en face image and B-scan image.
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Retinal vein occlusion (RVO) is the second common retinal vascular disease after diabetic retinopathy.The Management of Retinal Vein Occlusion-Consensus Document published in 2011 gave a comprehensive explanation of RVO diagnosis and treatment.While the European Society of Retina Specialists (EURETINA) updated the guideline for the management of RVO based on the 2011 consensus in August 2019.The current guideline summarized the latest clinical studies,and standardized the diagnosis and treatment of RVO based on stronger evidence-level data.The 2019 guidelines used the Rationale-Evidence-Recommendation structure to provide a comprehensive summary of RVO.
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Objective To evaluate the sensitivity and specificity of spectral domain optical coherence tomography (SD-OCT) for the differentiation of PCV from wet age-related macular degeneration (wAMD).Methods A cross-sectional study was conducted from Jun 2014 to Apr 2016 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV:double layer sign,pigment epithelium detachment (PED),a sharp PED peak,a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined by κ analyses.Results One hundred and twenty-six patients (132 eyes) with PCV or wAMD were enrolled in the study.In PCV patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 38,35,48,40 and 46,accounting for 67.9％,62.5％,85.7％,71.4％ and 82.1％,respectively.In wAMD patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 12,3,11,8 and 26,accounting for 14.5％,10.5％,34.2％,15.8％ and 3.9％,respectively,which were all lower than PCV,with statistically significant differences (all at P＜0.001).SD-OCT detected PCV in 49 of 56 eyes and 10 PCV patients were misdiagnosed as wAMD.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 87.5％ and 86.8％,respectively.The consistence between SD-OCT and imdocyanine green angiography (ICGA) was moderate (κ:=0.738,P＜0.001).Conclusions SD-OCT exhibits high sensitivity and specificity in PCV diagnosis.The presence of DLS,PED,a sharp PED peak,a PED notch,and a hyporeflective lumen representing polypoidal lesion is suggested to be a new diagnostic strategy for PCV.
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Vascular endothelial growth factor(VEGF), also known as vascular permeability factor, can promote the proliferation and migration of vascular endothelial cells, and enhance vascular permeability.In addition, VEGF family is also related to lymphatic vessel formation, inflammatory response, hematopoiesis and neuroprotective effect.Under the circumstances of ischemia, hypoxia and oxidative stress, VEGF can exert neuroprotective effect by increasing tissue perfusion, inhibiting cell apoptosis and stimulating neurogenesis.Therefore, therapeutic effect of VEGF in neurological diseases, such as neurodegenerative diseases and stroke has increasingly received considerable attention.On the other hand, anti-VEGF therapy for ocular pathologic neovascular diseases may lead to corresponding adverse effect.In this review, the mechanism of neuroprotective effect of VEGF and its roles in neurological diseases and ocular diseases were discussed.
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Retinal vein occlusion(RVO) is the second common retinal vascular disease after diabetic retinopathy.The Management of Retinal Vein Occlusion-Consensus Document published in 2011 gave a comprehensive explanation of RVO diagnosis and treatment.While the European Society of Retina Specialists (EURETINA) updated the guideline for the management of RVO based on the 2011 consensus in August 2019.The current guideline summarized the latest clinical studies, and standardized the diagnosis and treatment of RVO based on stronger evidence-level data.The 2019 guidelines used the Rationale-Evidence-Recommendation structure to provide a comprehensive summary of RVO.
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Objective@#To evaluate the sensitivity and specificity of spectral domain optical coherence tomography (SD-OCT) for the differentiation of PCV from wet age-related macular degeneration (wAMD).@*Methods@#A cross-sectional study was conducted from Jun 2014 to Apr 2016 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV: double layer sign, pigment epithelium detachment (PED), a sharp PED peak, a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined by κ analyses.@*Results@#One hundred and twenty-six patients (132 eyes) with PCV or wAMD were enrolled in the study.In PCV patients, PED notch, a hyporeflective lumen representing polypoidal lesion, PED peak, double layer sign and PED were 38, 35, 48, 40 and 46, accounting for 67.9%, 62.5%, 85.7%, 71.4% and 82.1%, respectively.In wAMD patients, PED notch, a hyporeflective lumen representing polypoidal lesion, PED peak, double layer sign and PED were 12, 3, 11, 8 and 26, accounting for 14.5%, 10.5%, 34.2%, 15.8% and 3.9%, respectively, which were all lower than PCV, with statistically significant differences (all at P<0.001). SD-OCT detected PCV in 49 of 56 eyes and 10 PCV patients were misdiagnosed as wAMD.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 87.5% and 86.8%, respectively.The consistence between SD-OCT and imdocyanine green angiography (ICGA) was moderate (κ=0.738, P<0.001).@*Conclusions@#SD-OCT exhibits high sensitivity and specificity in PCV diagnosis.The presence of DLS, PED, a sharp PED peak, a PED notch, and a hyporeflective lumen representing polypoidal lesion is suggested to be a new diagnostic strategy for PCV.
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Pachychoroidopathy is a type of retinal choroidal disease with similar clinical features, which is characterized by attenuation of the choriocapillaris overlying dilated choroidal veins, and associated with progressive retinal pigment epithelium dysfunction and neovascularization. At present, pachychoroidopathy includes pachychoroid pigment epitheliopathy, central serous chorioretinopathy pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavationm, and peripapillary pachychoroid syndrom. These diseases not only have common imaging features, but also individual imaging features. This not only provides us with important clues about the pathogenesis of pachychoroidopathy, but also provides guidance for their treatment decisions. Although the exact pathogenesis of pachychoroidopathy is still unclear, and the treatment method is still controversial; but it is believed that with the development of imaging technology and the development of high-quality clinical and basic research, patients with pachychoroidopathy can be provided with more reasonable treatment in the future.
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Objective To assess the efficacy and safety ofintravitreal aflibercept injection (IAI) compared with photodynamic therapy (PDT) in the treatment of Chinese patients with predominantly classic subfoveal choroidal neovascularization (CNV) lesions secondary to neovascular age-related macular degeneration (nAMD).Methods A randomized,double-blind,multi-center phase-3 clinical trial lasting for 52weeks (from December 2011 to August 2014).Subjects were randomized in a 3:1 ratio to either IAI group or PDT-to-IAI group.Subjects in the IAI group received 2 mg IAI at baseline and at week 4,8,16,24,32,40,48,with sham injection at week 28,36.Subjects in the PDT-to-IAI group were forced to receive PDT once at baseline and more time at week 12,24 if PDT retreatment conditions were met.Sham injections were given in PDT-to-IAI group at baseline and at week 4,8,16 and 24,followed by 2 mg IAI at week 28,32,36,40,48.The primary outcome of efficacy were the change in mean Best Corrected Visual Acuity (BCVA) from baseline to week 28,and that of week 52.Safety evaluation included the percentage of subjects who suffered treatment emergent adverse events (TEAEs).Results Among the 304 subjects enrolled,there were 228 and 76 cases in IAI group and PDT-to-IAI group respectively.At week 28,the changes of mean BCVA in IAI group,PDT-to-IAI group compared to baseline were +14.0,+3.9 letters,respectively.At week 52,the changes of mean BCVA in two groups were + 15.2,+8.9 letters respectively with the difference of +6.2 letters (95％CI 2.6-9.9,P=0.000 9).At week 52,the mean foveal retinal thickness in the two groups decreased by-189.6,-170.0 μm,respectively.Subjects with the most BCVA increase in IAI group were those aged ＜65,and those with active CNV lesion area ＜50％ of total lesion area.The most common TEAEs in IAI group and PDT-to-IAI group are macular fibrosis [11.8％ (27/228),6.6％ (5/76)] and BCVA decline [6.6％ (15/228),21.1％ (16/76)].There were 3 cases of arterial thromboembolic events defined in the antiplatelet experimental collaboration group,but all were considered unrelated to interventions.Conclusions The efficacy of aflibercept is superior to that of PDT in nAMD patients in China.The therapeutic effect of aflibercept persisted to week 52 in all subjects.The rate of adverse events was consistent with the safety data of aflibercept known before.
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For the past few years,artificial intelligence (AI) technology has developed rapidly and has become frontier and hot topics in medical research.While the deep learning algorithm based on artificial neural networks is one of the most representative tool in this field.The advancement of ophthalmology is inseparable from a variety of imaging methods,and the pronounced convenience and high efficiency endow AI technology with promising applications in screening,diagnosis and follow-up of ophthalmic diseases.At present,related research on ophthalmologic AI technology has been carried out in terms of multiple diseases and multimodality.Many valuable results have been reported aiming at several common diseases of ophthalmology.It should be emphasized that ophthalmic AI products are still faced with some problems towards practical application.The regulatory mechanism and evaluation criteria have not yet integrated as a standardized system.There are still a number of aspects to be optimized before large-scale distribution in clinical utility.Briefly,the innovation of ophthalmologic AI technology is attributed to multidisciplinary cooperation,which is of great significance to China's public health undertakings,and will be bound to benefit patients in future clinical practice.
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Objective To evaluate the optical coherence tomograghy (OCT) morphological parameters for predicting anatomical outcomes and postoperative visual acuity in idiopathic macular hole (IMH) after pars plana vitrectomy (PPV).Methods A retrospective study.A total of 26 eyes in 23 IMH patients underwent PPV,internal limiting membrane (ILM) peeling and gas filling surgery were included in this study.The patients included 8 eyes of 7 males and 18 eyes of 16 females,with the mean age of (63.9 ± 9.4).All patients received the best corrected visual acuity (BCVA),slit lamp microscope,indirect ophthalmoscopy and three-dimensional optical coherence tomography (3D OCT) examinations.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution visual acuity.According to the standard classification system of International Vitreomacular Traction Study (IVTS) Group,8 eyes were medium full-thickness macular hole (FTMH) and 18 eyes were large FTMH,none of which were with vitreomacular traction (VMT).The minimum diameter (MIN),base diameter (BASE),height (H),left and right arm length (LAL and RAL),diameter of ellipsoid zone absence (DEZA) were measured.Macular hole index (MHI),hole form factor (HFF),tractional hole index (THI),diameter hole index (DHI) were calculated.The average follow-up period were (9.2 ± 9.7) months.The postoperative DEZA were measure at the last time.Anatomical outcomes were divided into 3 groups.The multiple factors related with predicting anatomical outcome and visual acuity were analyzed.Results In the 26 eyes,the hole was closed in 16 eyes of type 1,7 eyes of type 2,3 eyes of type 3.The mean pre-and post-operative logMAR BCVA were 0.9 ± 0.3,0.7 ± 0.3 respectively.The MIN,BASE,H were (533 ± 176),(1 035 ±270),(462 ± 138) μm respectively.The MHI,HFF,THI,DHI were 0.46 ±0.15,0.72 ±0.19,0.95 ±0.37,0.52 ±0.11 respectively.The mean preand post-operative DEZA were (1 775 ± 486),(960 ± 138) μm respectively.Postoperative logMAR BCVA were correlated significantly with MHI,THI (all P ≤ 0.01),correlated weakly with MIN,BASE,HFF (all P ≤ 0.05),but not correlated with age,sex,DHI,pre-and post-operative DEZA (all P ＞ 0.05).Anatomical prognosis types were significantly correlated with MHI,HFF,THI (all P ≤ 0.01),weakly correlated with MIN,DHI (all P ≤ 0.05),but not correlated with age,sex,BASE,pre-and post-operative DEZA (all P ＞ 0.05).Conclusions For medium and large FTMH in IVTS classification system,MHI,THI have the best correlation with postoperative BCVA and can be considered as key indicators for predicting postoperative BCVA.MHI,HFF,THI have the best correlation with anatomical outcomes and can be considered as key indicators for predicting anatomical outcomes of IMH.
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Anti-vascular endothelial growth factor (VEGF) therapy is a major strategy for treating ocular neovascular diseases nowadays.It has revolutionarily improved the vision of many patients since its emergence.However,VEGF is essentially a protective growth factor that is compensatorily produced by human body.In the anti-VEGF treatment of the diseases,the physiological effects of VEGF are also inhibited,which may result in some related problems,such as retinal atrophy,retinal pigment epithelium (RPE) tears,systemic adverse effects,and so on.Retinal atrophy has become one of the major causes of visual loss in the late stage of the treatment.The specific mechanism underlying them is not completely known,we should pay enough attention to them.How to improve the anti-VEGF treatment strategy in order to reduce the incidence of these problems will be a great challenge.