Retinopathy of prematurity, familial exudative vitreoretinopathy and Coats disease are the most common neonates and infants retinal vascular diseases, which may lead to severe visual damage because of either tractional retinal detachment caused by the proliferation of pathogenic neovascularization, or exudative retinal detachment due to the extremely leakage from abnormal retinal vessels. Classic treatment is retinal laser photocoagulation which could destroy these abnormal vessels or reduce non vascular areas to diminish the growth of new vessels, however the side effects induced by laser it self such as visual field damage, hemorrhage, retinal tear, fail to control the progression of the disease make the laser treatment hard to improve the vision of these young patients. Anti-vascular endothelial growth factor (VEGF) agents have been widely applied in various adult retinal and choroidal vascular diseases, they are even possible to replace the pan retinal photocoagulation in proliferative diabetic retinopathy, while there are still many unsolved problems in the applying in neonates and infants retinal vascular diseases, like dosage, timing, retreatment and systemic side effects. We should realize the importance of selecting the laser photocoagulation and anti-VEGF for neonates and infants retinal vascular diseases.
ObjectiveTo investigate macular microvascular abnormalities in eyes with subfoveal fibrotic nodules secondary to Coats' disease. MethodsA cross-sectional study. From January 1, 2018 to July 30, 2021, 45 eyes of 45 patients diagnosed with Coats' disease with or without subfoveal fibrotic nodules in Eye and ENT Hospital, Shanghai Medical College of Fudan University were included in this study. There were 40 eyes in 40 males and 5 eyes in 5 females. All were under 21 years old. According to the presence or absence of subfoveal fiber nodules, the patients were divided into fibrotic group (26 cases, 26 eyes) and non-fibrotic group (19 cases, 19 eyes). Optical coherence tomography angiography was used to scan 3 mm×3 mm or 6 mm×6 mm macular area of both eyes. The software of the device automatically processed the images. The presence of FAZ edge anastomotic vascular arch ring breakage and abnormal microvascular branch (AMB) in the foveal avascular zone (FAZ) were observed. ResultsIn 26 eyes of fibrosis group, AMB originating from the parafoveal retinal capillary network was observed, which grew into and destroyed the integrity of the vascular arch ring at the edge of FAZ. AMB was crisscrossing and winding, and its curvature expands. B-scan images showed the blood flow signal in the subfoveal fiber nodule, and the blood flow signal traversed between the inner retina and the fiber nodule in 23 eyes (88.46%, 23/26). In the non-fibrosis group, all the vascular abnormalities were characterized by capillary dilation and defect, and no breakage of FAZ anastomotic vascular arch ring or AMB was observed. ConclusionsIn Coats' disease with subfoveal fiber nodules, staggered and dilated AMBs emerge from the parafoveal vascular network, grow into and destroy the integrity of the vascular arch ring at the edge of FAZ, and grow down longitudinally into the fiber nodules.
This study aimed to explore the possible association between single nucleotide polymorphism (SNP) rs189037 C > T in the promoter region of ataxia telangiectasia mutated (ATM) gene and essential hypertension (EH). We performed a case-control study to collect randomly 369 hospitalized patients aged 50 years and above. They were divided into EH group (190 patients) and control group (179 subjects) according to the diagnostic criteria of hypertension. The SNP rs189037 genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism. The genotype frequencies of ATM gene polymorphism rs189037 for the whole sample were 33.9% CC, 48.0% CT, and 18.1% TT. There was no significant difference in the genotype frequency distributions of the SNP rs189037 between EH and control groups (P=0.619). After adjustment of the major confounding factors, the SNP rs189037 was still not associated with EH (P > 0.05). We further analyzed data from different groups divided by genders and age respectively, and the relationship was retained (P > 0.05). In addition, we found that the percentage of the TT genotype was much lower in coronary artery disease (CAD) patients than those in the CC or CT genotype (OR=0.49, 95% CI=0.26~0.90, P=0.021). In conclusion, our study suggests that SNP rs189037 in the promoter of ATM gene is not associated with EH. But it is related to the incidence of CAD, and TT genotype seems to be a protective factor for CAD.
Macular pigment (MP) is composed of lutein, zeaxanthin, and meso-zeaxanthin, which accumulate mainly at the macula. MP has antioxidant function and can filtering blue wave. Measurement of MP is about its optical density, that is, macular pigment optical density (MPOD). This review summarizes the function and clinical use of MP and MPOD. Researches has show that MPOD is related to some ocular disease such as age-related macular degeneration, macular telangiectasia type 2, diabetic retinopathy, Stargardt disease et al. MPOD can be used in the judgment of clinical diagnosis, treatment effect. The specific mechanism of MP metabolism in the retina and in the pathogenesis of the disease, genotype specific nutritional therapy of xanthophyll, the establishment of a database combined with artificial intelligence and the rapid and convenient MP determination are all issues of great contention that need to be resolved.
ObjectiveTo observe the efficacy of intravitreal injection of ranibizumab (IVR) and combined treatment for severe Coats disease. MethodsNineteen Coats disease patients (24 eyes) were enrolled in this retrospective non-comparative interventional clinical study. The patients included 17 males and 2 females. The age was ranged from 1 to 42 years old, with an average of (13.05±6.78) years. The patients included 15 children (age ≤14 years old) and 4 adults (age ≥18 years old). There were 13 patients with 3a stage and 6 patients with 3b stage. The treatment methods including IVR only, IVR combined with cryotherapy, IVR combined with cryotherapy and sclerotomy to drain subretinal fluid, IVR combined with vitrectomy. Treatments were repeated if it was necessary at the first day, the first week and the first month after injection. The interval between treatments was ≥1 month. Eleven patients (57.9%) underwent one treatment, 3 patients (15.8%) underwent 2 treatments, 3 patients (15.8%) underwent 3 treatments, 2 patients (10.5%) underwent 4 treatments. The treatment frequency including 22 times of IVR only, 6 times of IVR combined with cryotherapy, 5 times of IVR combined with cryotherapy and sclerotomy to drain subretinal fluid, 1 time of IVR combined with vitrectomy. The follow-up period was ranged from 6 to 36 months, with an average of (19.11±7.05) months. Visual acuity, retinal reattachment and ocular adverse events were observed. ResultsThree children (15.8%) were failing to test the visual acuity. Visual acuity was improved in 2 patients (10.5%), stable in 13 patients (68.4%) and decreased in 1 patient (5.3%). Three patients (15.8%) achieved totally retinal reattachment after treatment, while 16 patients (84.2%) achieved partially retinal reattachment. One patient had vitreous hemorrhage. One patient had neovascular glaucoma. ConclusionIVR and combined treatment were effective for severe Coats disease.
ObjectiveTo study the effects and outcomes of green diode laser therapy under indirect ophthalmoscope in the treatment of juvenile Coats disease. MethodsNineteen juvenile Coats disease patients (19 eyes) well enrolled in this study. Average age at presentation was 73.5 months (27-146 months). Best corrected visual acuity (BCVA) was ≥0.1 in 7 eyes; 0.01 to 0.09 in 8 eyes; counting finger in 3 eyes and light perception in 1 eye. The macular of all eyes was involved. There were 3 eyes with macular exudative retinal detachment, 4 eyes with sub-macular fibrosis, 1 eye with macular atrophy. Exudative area was more than two quadrants in 17 eyes, and less than two quadrants in 2 eyes. The abnormal blood vessels located in the superior or nasal-superior retina (2 eyes) or inferior or temple-inferior area (17 eyes). Exudative retinal detachment occurred in 13 eyes, in which macular was not involved in 10 eyes, and macular was involved in 3 eyes. All patients were treated with green diode laser (532 nm) ablation therapy under general anesthesia and indirect ophthalmoscope to areas of the retina telangiectasia. 3 patients received a single intravitreal 2 mg triamcinolone injection (IVTA). Average follow-up was 18.5 months (6-51 months). Main outcome measures included visual acuity, retinal vascular abnormalities, subretinal exudates and exudative retinal detachment. ResultsAmong 3 patients treated with IVTA, one needed cataract extraction and one needed pre-retinal membrane peeling surgery. After laser photocoagulation, resolution of telangiectasia lesions was achieved in all patients at the end of follow-up. Exudation was resolved in 8 eyes, reduced in 9 patients and no change in 2 eyes. Exudative detachment was resolved in 8/13 eyes, reduced in area in 3/13 eyes and no change in 2 eyes. There were 9 eyes with sub-macular fibrosis and 3 eyes with macular atrophy at the end of follow-up. The visual acuity was stable in most cases. BCVA was ≥0.1 in 6 eyes; 0.01 to 0.09 in 11 eyes; counting finger in 1 eyes and light perception in 1 eye. Compared to the normal eyes, eyes with Coats disease tended to be more hyperopic (t=3.6,P=0.003) and astigmatic (t=3.6, P=0.004), but no correction were needed for these refractive errors. ConclusionsGreen diode laser therapy under indirect ophthalmoscope can be an effective treatment for juvenile Coats disease with little complications. IVTA can be helpful, but must be used with cautions as it can induce some complications.
Idiopathic parafoveal telangiectasis (IPT) is a retinal vascular disease which is characterized by foveal and parafoveal telangiectasia. The main clinical manifestations are retinal telangiectasis, reduced retinal transparency, retinal venular dilatation, yellow exudation, retinal pigment epithelial lesions, retinal hemorrhage, macular atrophy, macular hole or lamellar hole, subretinal neovascularization and retinal detachment. According to the clinical characteristics and features of fluorescein angiography, IPT can be divided into 3 types and 6 subtypes. Laser photocoagulation, photodynamic therapy, and intravitreal injection of glucocorticoid or anti-vascular endothelial growth factor drugs, can reduce the macular edema and neovascularization. However, due to the unclear etiology of IPT, the existing treatment measures are not specific for its etiology. We need to work hard to understand further the clinical features and pathogenesis of IPT and search the targeted treatments based on its pathogenesis mechanism.