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.
The prevention and treatment of retinopathy of prematurity (ROP) is an important strategic content of blindness prevention and treatment in China. Medical institutions including remote areas have strengthened the awareness of neonatal fundus screening, however, there are problems of vague screening standards, mainly manifested in expanding the scope of screening and even universal screening of newborns. At the same time, all kinds of fundus changes found in the examination cannot be correctly interpreted and handled, which increase the economic and psychological burden of children's families. In addition, with the wide application of intravitreal injection of anti-neovascular endothelial growth factor, problems such as improper grasp of indications and improper treatment of complications have become increasingly prominent. At this stage, it is urgent to strengthen the construction of ROP prevention and control network, which is suitable for China's national conditions, led by the government and coordinated participation of health and medical institutions at all levels.
Ras homolog family (Rho)/ Rho-associated coiled-coil kinase (ROCK) signaling pathway widely exists in human and mammal cells, which is closely related to inhibition of repair after optic nerve damage. The expression level of Rho/ROCK signaling pathway-related proteins is up-regulated in glaucoma, and related with the death of retinal ganglionic cell (RGC) and the axon activity. ROCK inhibitors can protect the surviving RGC and promote axon extension with a dose-dependent manner. ROCK inhibitors also can inhibit glial scar formation, lower intraocular pressure and inhibit inflammatory response to some degrees. Rho/ROCK signaling pathway correlates with the optic nerve disease progression, and ROCK inhibitors hope to become a new therapeutic drug.
Outer retinal tubulations (ORT) are tubular structures that are visualized on spectral domain optical coherence tomography in single B-scans as nonedematous circular or ovoid structures at the level of the outer nuclear layer. It is most commonly seen in exudative age-related macular degeneration and pseudoxanthoma elasticum, as well as in multifocal choroiditis, panuveitis, geographic atrophy, central serous chorioretinopathy, polypoid choroidal neovascularization, choroideremia and some other diseases related to outer retinal structural damage. ORT is the structure of dislocation junction of outer membrane and ellipsoid band in the process of self-repair after destroyed. Cystoid retinal edema, subretinal fluid and photoreceptor layer damage are important factors for ORT formation. Anti-vascular endothelial growth factor (VEGF) drugs cannot make ORT disappear, and distinguishing between ORT and retinal cystoid edema is helpful to avoid unnecessary anti-VEGF treatment. ORT has a certain predictive value for the prognosis of vision, and has guiding significance for clinical treatment. However, the mechanism of ORT formation and its relationship with clinical practice are not yet fully understood. More advanced imaging equipment and a large number of cases are needed to study the formation of ORT and its relationship with classical choroidal neovascularization, retinal fibrous scarring and retinal atrophy.