Diabetic macular edema (DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids (dexamethasone implants and fl uocinolone acetonide inserts) and anti-vascular endothelial growth factor (VEGF) (ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.

Diabetic macular edema (DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids (dexamethasone implants and fl uocinolone acetonide inserts) and anti-vascular endothelial growth factor (VEGF) (ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.

A 55-year-old male complained of right eye blurry vision for 3 days. His best-corrected visual acuity (BCVA) was 0.2 for the right eye and 1.0 for the left eye. Anterior segment and vitreous body examinations of both eyes were normal. Yellowish-white focal lesions in the macula of the right eye were observed and subtly changes of lesions were found along the superotemporal and inferotemporal arcades in the macula two days later. Fluorescein fundus angiography (FFA) revealed slight ffuorescent leakage from the lesions in the macula of the right eye, and segmental venous leakage and optic disc hyperffuorescence were observed in both eyes. Indocyanine green angiography (ICGA) demonstrated that the lesions in the macula of the right eye had hypofluorescence at a late stage and spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed focal impairment of the inner segment and outer segment (IS/OS). The blood investigation indicated a positive treponema pallidum hemagglutination assay (TPPA) and a rapid plasma reagin test (RPR) of 1:32. After antisyphilitica treatment for 6 weeks, the yellowish-white lesions had vanished and the BCVA was 1.2 followed by restoration of the IS/OS for the right eye, with an RPR of 1:4. In conclusion, ophthalmologists should alert unilateral focal lesions in the macula may be the ffrst sign of syphilis. Prompt treatment is highly effective in resolving vision.

A 55-year-old male complained of right eye blurry vision for 3 days. His best-corrected visual acuity (BCVA) was 0.2 for the right eye and 1.0 for the left eye. Anterior segment and vitreous body examinations of both eyes were normal. Yellowish-white focal lesions in the macula of the right eye were observed and subtly changes of lesions were found along the superotemporal and inferotemporal arcades in the macula two days later. Fluorescein fundus angiography (FFA) revealed slight ffuorescent leakage from the lesions in the macula of the right eye, and segmental venous leakage and optic disc hyperffuorescence were observed in both eyes. Indocyanine green angiography (ICGA) demonstrated that the lesions in the macula of the right eye had hypofluorescence at a late stage and spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed focal impairment of the inner segment and outer segment (IS/OS). The blood investigation indicated a positive treponema pallidum hemagglutination assay (TPPA) and a rapid plasma reagin test (RPR) of 1:32. After antisyphilitica treatment for 6 weeks, the yellowish-white lesions had vanished and the BCVA was 1.2 followed by restoration of the IS/OS for the right eye, with an RPR of 1:4. In conclusion, ophthalmologists should alert unilateral focal lesions in the macula may be the ffrst sign of syphilis. Prompt treatment is highly effective in resolving vision.

目的：观察睡眠呼吸暂停综合征（Sleep apnea syndrome, SAS）患者睡眠前后黄斑厚度的改变。

方法：选择 2003 年 8 月至 2007 年 1 月经确诊的在我院门诊和住院部治疗的 SAS 患者共 32 例（63 只眼），分别在上午 11:00 ～ 12:00（睡眠前）及患者晨起 20 ～ 30 分钟内（睡眠后）采用相干光断层扫描仪（Optical Coherence Tomography, OCT）进行黄斑中心凹厚度的测量。

结果：睡眠前黄斑中心小凹平均视网膜厚度为（123.00 ± 19.98）μm，睡眠后黄斑中心小凹平均视网膜厚度为（134.25 ± 19.92）μm。睡眠后黄斑中心凹厚度比睡眠前厚度增加（11.25 ± 9.04）μm，95% 可信区间为（8.98，13.53）μm，差异有统计学意义（t = 9.878，P < 0.05）。

结论：睡眠呼吸暂停综合征患者睡眠时的缺血缺氧可以导致黄斑视网膜的水肿增厚。

Purpose: To observe the changes of macular thickness in patients with sleep apnea syndrome (SAS) before and after sleep.

Methods: Thirty-two patients (63 eyes) diagnosed as SAS from August 2003 to January 2007 were enrolled. Macular thickness was measured using Optical Coherence Tomography (OCT) at 11:00 ~ 12:00 evening (before sleep) and 20 ~ 30 minutes after sleep, respectively.

Results: The mean macular thickness was (123.00 ± 19.98) μm and (134.25 ± 19.92) μm before and after sleep, respectively. The mean difference was (11.25 ± 9.04) μm before and after sleep (t = 9.878, P < 0.05), 95% CI (8.98, 13.53) μm.

Conclusions: The macular thickness of SAS is increased in SAS patients, which may be due to anoxia of SAS. 

Background: To find the changes of macular perimetry (MP) and the correlations between MP and best correct visual acuity (BCVA) in different phases of the acute central serous chorioretinopathy (CSC).

Methods: Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively. MP at 2°, 4° and BCVA in the active and resolved phase were collected and analyzed. The differences of these parameters in CSC eyes and fellow eyes were analyzed. Spearman correlation was used for analysis of correlation between MP and BCVA.

Results: From 29 eyes with CSC analysed 27eyes (93.10%) recovered to the previous VA. Compared with the active phase, MP at 2°, 4° and BCVA were significantly improved in the resolved phase(P=0.000, 0.000, 0.000, respectively). MP at 2°, 4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase (P=0.000, 0.000, 0.000, respectively). In the resolved phase there was no significant difference between the CSC eyes and fellow eyes (P=0.339, 0.141, 0.161, respectively). BCVA was shown to significantly correlate with MP at 2° in the active phase (ρ=–0.630, P<0.001).

Conclusions: The acute CSC often had a good prognosis both in BCVA and MP. MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC. 

Background: To find the changes of macular perimetry (MP) and the correlations between MP and best correct visual acuity (BCVA) in different phases of the acute central serous chorioretinopathy (CSC).

Methods: Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively. MP at 2°, 4° and BCVA in the active and resolved phase were collected and analyzed. The differences of these parameters in CSC eyes and fellow eyes were analyzed. Spearman correlation was used for analysis of correlation between MP and BCVA.

Results: From 29 eyes with CSC analysed 27eyes (93.10%) recovered to the previous VA. Compared with the active phase, MP at 2°, 4° and BCVA were significantly improved in the resolved phase(P=0.000, 0.000, 0.000, respectively). MP at 2°, 4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase (P=0.000, 0.000, 0.000, respectively). In the resolved phase there was no significant difference between the CSC eyes and fellow eyes (P=0.339, 0.141, 0.161, respectively). BCVA was shown to significantly correlate with MP at 2° in the active phase (ρ=–0.630, P<0.001).

Conclusions: The acute CSC often had a good prognosis both in BCVA and MP. MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC. 

目的：研究玻璃体腔注射曲安奈德(triamcinolone acetonide,TA)和雷珠单抗(Lucentis)治疗视网 膜中央静脉阻塞(central retinal vein occlusion,CRVO)的黄斑水肿的疗效。方法：配对病例对照研究。将2013年1月至2015年6月，在我院因CRVO并发黄斑水肿而接受玻璃体腔注射TA或Lucentis 的患者，根据患者基线水平的最佳矫正视力(best-corrected visual acuity,BCVA)(logMAR视力)和黄斑中心厚度(central macular thickness,CMT)将两组患者进行配对，选出12对患者，主要的观察 指标为随访1年时两组患者的BCVA和CMT。结果：TA组患者的BCVA由基线时的0.78±0.12提高到 0.55±0.24(P=0.005),CMT由基线时的(598.92±192.67) μm减少到(258.28±75.38) μm (P=0.002)。Lucentis组患者的BCVA由基线时的0.78±0.11提高到0.48±0.21(P=0.002), CMT由基线时的 (591.75±181.68) μm减少到(281.17±63.08) μm (P=0.002)。TA组和Lucentis组患者基线及最终的 BCVA和CMT直接均无显著差异。TA组的平均注药次数为(2.4±0.9)次，Lucentis组为(4.0±1.6)次， 两组有统计学差异(P=0.012)。结论：玻璃体腔注射TA或Lucentis均能减轻CRVO所致的黄斑水肿并提高视力，两者的疗效并无显著差异。TA的平均注射次数比Lucentis组少，但是TA更容易引起眼压升高。应该根据患者的综合情况制定个性化的治疗方案。

Objective: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of ranibizumab for macular edema secondary to central retinal vein occlusion (CRVO). Methods: In a retrospective assessment 12 TA-treated patients and 12 ranibizumab-treated ones with macular edema after CRVO were pairmatched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT). BCVA and CMT were the main endpoints. Results: The initial BCVA of 0.78±0.12 increased significantly to 0.55±0.24 in the TA-treated patients (P=0.005). And the initial CMT of (598.92±192.67) μm decreased significantly to (258.28±75.38) μm (P=0.002). In the ranibizumab-treated patients, the initial BCVA of 0.78±0.11 increased significantly to 0.48±0.21 (P=0.002) and the initial CMT of (591.75±181.68) μm decreased significantly to (281.17±63.08) μm (P=0.002). There was no significance between the initial and final BCVA and CMT of TAtreated patients and ranibizumab-treated patients. Conclusion: Both treatments decreased the CMT and induced an improvement in BCVA from baseline.

年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种发生在黄斑区的退行性变，其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)以黄斑区新生血管为主要病理特征，是导致老年人视力受损甚至失明的重要原因，视网膜下纤维化是wAMD最常见的自然后遗症，可导致光感受器、视网膜色素上皮(retinal pigment epithelial,RPE)和脉络膜毛细血管受损，导致不可逆转的中心视力丧失。多种基线特征被发现是视网膜下纤维化的危险因素，可用于预测早期视网膜下纤维化的发生。迄今为止，还没有有效的抗纤维化治疗方法，抗血管内皮生长因子(anti-vascular endothelia growth factor, anti-VEGF)治疗是wAMD的一线治疗方案，该治疗方法不能改善视网膜下纤维化，但及时启动治疗可能有助于预防或延缓纤维化的进展，目前多种靶向分子药物正被研发用于抗纤维化的治疗。该文综述了wAMD视网膜下纤维化的临床表现及意义、预测纤维化形成的基线特征、基本发病机制及潜在的抗纤维化治疗方法，旨在为临床诊治工作提供参考。

Age-related macular degeneration (AMD) is a degenerative disease of the macular, and wet age-related macular degeneration(wAMD) is mainly characterized by macular neovascularization, which is an important reason of visual impairment or even blindness in the elderly. Subretinal fibrosis is the most common natural sequelae of wAMD, which can lead to irreversible central vision loss by damaging photoreceptors, RPE, and choroidal capillaries. Multiple baseline features have been identified as the risk factors for subretinal fibrosis, which can be used to predict the early subretinal fibrosis. Heretofore, no anti fibrotic treatment method is effective. Anti vascular endothelial growth factor (anti VEGF) treatment is the first-line treatment for wAMD. This therapy cannot improve subretinal fibrosis, but timely initiation of treatment may help prevent or delay the progression of fibrosis. Currently, multiple targeted molecular drugs are being developed for anti fibrotic treatment. This article reviews the clinical manifestations and significance of subretinal fibrosis in wet age-related macular degeneration, baseline features for predicting the formation of fibrosis, basic pathogenesis, and potential anti-fibrosis treatment methods,aiming to provide reference for clinical diagnosis and treatment.