Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022) / 中国医学科学杂志(英文版)

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.

Optical Coherence Tomography Angiography-based Follow-up Observation of Wet Age-related Macular Degeneration after Intravitreal Anti-Ranibizumab Therapy / 中国医学科学院学报

Objective To observe the imaging features of optical coherence tomography angiography(OCTA)in eyes with wet age-related macular degeneration(wAMD)after treatment with 3+pro re nata(3+PRN)of intravitreal anti-Ranibizumab.Methods This study included 8 treatment-naive eyes with wAMD diagnosed by fluorescein fundus angiography(FFA)and indocyanine green angiography(ICGA)from September 2016 to May 2017.All the patients were treated with 3+PRN of intravitreal anti-Ranibizumab(0.5 mg/0.05 ml).We performed OCTA with 6 mm×6 mm scans at baseline and 1,3,and 6 months after treatment.We analyzed best corrected visual acuity(BCVA)(logMAR),type of choroidal neovascular(CNV),and morphological features and changes of CNV,central retinal thickness(CRT),outer retina vessel density(ORVD),and choroidal capillary vessel density(CCVD).Results A total of 8 eyes were examined in 8 patients[4 males and 4 females with a mean age of(70.9±10.6)years of age].Three eyes had type Ⅰ CNV and 5 eyes had type Ⅱ CNV.At baseline,month 1,month 3,and month 6,BCVA was 0.55(0.33,0.87),0.35(0.24,0.84),0.35(0.22,0.58),and 0.26(0.10,0.58)logMAR,respectively(all >0.05).CRT was(271.88±91.95),(204.00±45.78),(196.00±31.14),and(219.25±71.32)μm,respectively,and there was a statistical significance between CRT at baseline and CRT at month 3(=2.211,=0.044).ORVD was(41.38±2.77)%,(41.73±3.60)%,(42.53±1.95)%,and(41.40±2.33)%,respectively(all >0.05).CCVD was(64.38±2.24)%,(64.96±1.39)%,(64.16±1.39)%,and(64.63±1.86)%,respectively(all >0.05).Correlation analysis showed BCVA was significantly correlated with both CRT(=0.009, =0.457)and CCVD(=0.001,=0.574),but not with ORVD(=0.093,=0.302).The morphological features at baseline showed that 2 eyes were lump-like,2 eyes were line-like,2 eyes were tangles,1 eye was elliptical ring-like,and 1 eye was fragment.At month 1,the morphologies were improved in 7 eyes,including the CNV showed decreased maximum diameter,rupture/fragment,loss of peripheral capillaries,decreased numbers and density,and reduced maximum cross-sectional area;the condition became worse in 1 eye,including the CNV showed ring formation,increased density,and increased maximum diameter.At month 3,the morphologied of 7 eyes were improved,while no obvious change was seen in 1 eye.At month 6,the CNV became normalized in 5 eyes but worsened in 3 eyes.No intraocular infection or other intravitreal injection-related complication was observed during the follow-up.Conclusion Observing CNV characteristics using OCTA technology can be used to evaluate the efficacy of Ranibizumab in patients with wAMD and guide the treatment and follow-up of wAMD patients.

Ocular risk factors for polypoidal choroidal vasculopathy / 眼科新进展

Objective To evaluate potential risk factors for polypoidal choroidal vasculopathy (PCV) and PCV subtypes.Methods This was a retrospective case-control study.Totally 64 patients (64 eyes) of PCV (PCV group) in our hospital from July 2016 to January 2018 were enrolled and subgrouped into thick PCV and thin PCV.Additional 42 patients (42 eyes) who underwent cataract surgery in our hospital from January 2016 to December 2017 were collected as controls.Then the detailed history of all subjects were collected,including age,gender,best corrected visual acuity (BCVA),hypertension,dyslipidemia,cardiovascular diseases,ever-smoking history,alcohol consumption,and axial length.Univariate analysis and Logistic regression analysis was used to analyze the potential risk factors in patients from PCV group and PCV subgroups compared with controls.Results Univariate analysis showed that PCV had an older age (P =0.046),a higher incidence of hypertension (P =0.021),a greater proportion of smokers (P =0.036),and a shorter axial length (P =0.005) than controls,while there was no statistical difference in dyslipidemia,cardiovascular diseases and alcohol consumption between the two groups (all P ＞ 0.05).Logistic regression showed that age,hypertension,ever-smoking history,and axial length were still statistically significant (all P ＜ 0.05).In addition,comparison between thick PCV patients and controls revealed a statistically significant difference in hypertension,ever-smoking history,and axial length (all P ＜ 0.05),and there was a statistically significant difference between age,ever-smoking history and axial length between the thin PCV group and control group (all P ＜ 0.05).Thick PCV group and thin PCV group had statistically significant differences only in age and axial length (both P ＜ 0.05).Conclusion The potential risk factors for PCV includes age,hypertension,ever-smoking history,and axial length.In both PCV subtype groups,thick PCV patients are younger and have a shorter axial length than thin PCV patients,but systemic risk factors of thick PCV patients are similar to the thin PCV ones.

Correlation of 1-year vision outcomes with baseline factors in polypoidal choroidal vasculopathy patients after anti-VEGF treatment / 眼科新进展

Objective To analyze the correlation between baseline factors and the best corrected visual acuity (BCVA) after 3 monthly anti-vescular endothelial growth factor (VEGF) therapy in naive polypoidal choroidal vasculopathy (PCV).Methods This was a retrospective cohort study in 44 naive PCV patients (44 eyes) treated in our hospital between July 2015 and December 2016,and BCVA,optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) + indocyanine green angiography (ICGA) examinations were performed at first.All patients were treated with monthly antiVEGF (including ranibizumab and conbercept) injections for 3 consecutive months,followed by the needed retreatment,and BCVA at the 12th month during follow-up after the first anti-VEGF treatment was recorded,following the comparison with baseline BCVA,and then the patients were divided into improved and unimproved groups according to BCVA changes.Finally,univariate and logistic regression analysis were used to analyze the correlation between the baseline factors and BCVA.Results The univariate analysis showed that the improved group had shorter onset time,smaller greatest linear dimension (P =0.045 and 0.037,respectively).Logistic regression showed the difference in choroidal vascular hyperpermeability and greatest linear dimension was statistically significant,suggesting that they were the independent predictors of visual outcome (regression coefficient =0.963 and 0.001,P =0.010 and 0.012,odds ratios =0.083 and 1.002,95％ confidence interval =0.013-0.549 and 1.001-1.004,respectively).Conclusion Choroidal vascular hyperpermeability may be a predictor for poor visual acuity prognosis in PCV patients after anti-VEGF,and greatest linear dimension and the time of onset are also related to postoperative visual acuity in PCV patients after anti-VEGF.

Awareness of Age-related Macular Degeneration and Its Risk Factors among Beijing Residents in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Age-related macular degeneration (AMD) is a major cause of irreversible blindness, and awareness of this disease is important in the prevention of blindness. However, lack of public awareness of AMD was shown in previous studies, and there was no report of AMD awareness in the Mainland of China. Therefore, the aim of our study was to assess the awareness of AMD and its risk factors among Beijing residents in China.</p><p><b>METHODS</b>A cross-sectional, computer-assisted, telephone investigation was conducted to measure the awareness of AMD among Beijing residents. All the contacts of potential respondents were randomly generated by computer. Only those above 18 years of age and willing to participate in the study were included. The questionnaire for the study was modified from the AMD Alliance International Global Report. Pearson's Chi-square test and binary logistic regression analysis were used to identify the factors that affected the knowledge of AMD.</p><p><b>RESULTS</b>Among 385 Beijing residents who agreed to participate, the awareness of AMD was 6.8%, far below than that of cataract and glaucoma. Participants who were above 30 years of age (odds ratio [OR] 6.17, confidence interval [CI] 1.44-26.57), with experience of health-related work (OR 8.11, CI 3.25-20.27), and whose relatives/friends or themselves suffering from AMD (OR 32.18, CI 11.29-91.68) had better AMD awareness. Among those familiar with AMD, only 35% of them identified smoking as a risk factor, and only 23.1% of the residents believed that smoking could lead to blindness.</p><p><b>CONCLUSIONS</b>The sample of Chinese population had limited knowledge of AMD. Educational programs need to be carried out to raise public awareness of AMD.</p>

Bilateral Choroidal Occlusion in Antiphospholipid Syndrome Associated with Systemic Lupus Erythematosus / 中国医学科学杂志(英文版)

This article reports a rare case of bilateral choroidal occlusion that occurred in a 24-year-old woman with antiphospholipid syndrome (APS) associated with systemic lupus erythematosus (SLE). This young lady concurred with aorta ventralis thrombosis and bilateral iliac artery occlusion when presented, and experienced a rapid deterioration of vision. She also has a history of recurrent miscarriage. Corticosteroid, immunosuppression and anticoagulation therapy were administered. Patients with APS associated with SLE are at risk for thrombotic phenomena, which may affect the ocular vessels of all sizes, including choroidal vessel. Our case alerts ophthalmologists and rheumatologists that bilateral choroidal occlusion may indeed be developed in patients with APS associated with SLE, and is a potential cause of visual morbidity.

Systemic lupus erythematosus and antiphospholipid syndrome related retinal vasculitis mimicking ocular cysticercosis: a case report / 中国医学科学杂志(英文版)

Making accurate and timely diagnosis is often challenging when patients with a systemic disease first present with ocular manifestations. The possibility that vasculitis associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) can be misdiagnosed as cysticercosis has not been discussed in the literatures.

Sequential bilateral central retinal artery occlusion as the primary manifestation of systemic lupus erythematosus / 中华医学杂志(英文版)

Bilateral central retinal artery occlusion (CRAO) has been rarely reported as the primary manifestation in patients with systemic lupus erythematosus (SLE). The severe retinal vaso-occlusive diseases usually cause devastating and permanent damage to visual function in spite of vigorous treatment. A 42-year-old Chinese woman presented with abrupt bilateral vision loss. The diagnosis of bilateral CRAO was suggested by the ocular presentation and fluorescein angiography. Laboratory studies showed positive results of antinuclear antibody, anti-Ro/SSA anti-La/SSB; decreased levels of C3, C4 complement and normal levels of antiphospholipides antibodies (APAs). Her visual acuity deteriorated despite systemic steroid and immunosuppressant treatment. Severe vaso-occlusive retinopathy may be an earlier manifestation of SLE without elevated level of APAs.

Clinical feature and management of uveal effusion syndrome / 中华实验眼科杂志

Background Uveal effusion syndrome is uncommon in clinic.To understand the clinical characteristics of uveal effusion syndrome is helpful for rescuing visual acuity of patient.Objective This study was to discuss the diagnosis,classification and surgical outcome of uveal effusion syndrome.Methods This was a descriptive study.The clinical data of 14 eys from 10 patients with uveal effusion syndrome,ineluding ophthalmologic examination,B-scan sonography,ultrasound biomicroscopy (UBM),fundus fluorescence angiography (FFA),indocyanine green angiography (ICGA),surgical treatment and prognosis,were retrospectively analyzed.The follow-up period was 6 months.Results The fundus findings of all impacted eyes showed bullous-shape retinal detachment (RD).B-scan sonography revealed retinal and choroidal detachment.A annular peripheral ciliochoroidal detachment was observed in the cases under the UBM.FFA exhibited leopard spots without any leakage from choroid into the subretinal space.ICGA demonstrated diffusely choroidal granular hyperfluorescence in the very early phase,which presented with an increasing intensity as time lapse until the late phase.Full-thickness sclerectomy was performed on 4 eyes of 2 patients and subscleral sclerectomy was performed in 1 eye of 1 patient,achieving a retinal anatomic reattachment after surgery.All of the patients finished the fellow-up.No recurrence of RD was seen during the followup duration.Conclusions Comprehensive preoperative evaluation,including ophthalmologic ultrasonography,MRI and CT,is crucial for accurate classification of uveal effusion syndrome and determine of proper management strategy.

To improve the understanding of risk factors of age-related macular degeneration / 中华实验眼科杂志

Age-related macular degeneration (AMD) has become a leading cause of irreversible visual loss in senior population with serious influence to their ability of living independently.Epidemiological researches have revealed various risk factors of AMD,some of which are not controllable such as age,heredity and race ;while others are modifiable such as lifestyle,eye conditions and other systemic diseases.However,the awareness of AMD risk factors is alarmingly low in public.Meanwhile,the understanding of AMD risk factors among ophthalmologists is also unsatisfactory.Therefore,the risk factors of AMD are reviewed here in order to improve the understanding of the ophthalmologists and better guide the clinical management of AMD.