Selenium in the treatment of mild-to-moderate Graves' orbitopathy: a 5-year prospective controlled cohort study.

PURPOSE: Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease. However, limited studies have investigated the actual efficacy of selenium in GO therapy. This longitudinal study explored the effect of selenium on QOL and prognosis of patients with mild-to-moderate GO. METHODS: We conducted a 5-year prospective controlled cohort clinical trial to determine the effect of selenium on 74 patients with mild-to-moderate GO. Patients received selenium yeast or placebo orally for 6 months and were followed up at 6 months and at 5 years by biochemical examination, ophthalmologist evaluation and QOL questionnaire to assess oculopathy and QOL. RESULTS: (1) During a follow-up period of 3-6 months, in the selenium group, the symptoms of tearing, grittiness and conjunctival congestion improved (P < 0.01); clinical activity scores and total GO-QOL scores increased relative to baseline (P < 0.01); TRAb was decreased at the 6-month evaluation (P = 0.003); and patients treated with selenium had a higher rate of improvement and a lower rate of worsening than patients treated with placebo (P < 0.05). (2) Exploratory evaluations at 6 months after drug withdrawal confirmed the earlier results; further changes included alleviation of blurred vision and double vision symptoms in the selenium group (P < 0.01). (3) At the 5-year follow-up, compared with baseline, proptosis, clinical activity scores, TRAb level and total GO-QOL scores in both the selenium and placebo groups were significantly improved (P < 0.01). CONCLUSION: Six months of selenium supplementation may effectively change the early course of mild-to-moderate GO, but this regimen makes no difference in long-term outcomes.

Insight into Nrf2: a bibliometric and visual analysis from 2000 to 2022.

Background: Nrf2 plays a pivotal role in governing the antioxidant defense system, triggering the transcription of diverse genes involved in cellular protection. Its role in mitigating oxidative damage and modulating inflammatory processes has made Nrf2 an attractive target for therapeutic interventions. Despite the growing interest in Nrf2 research, a bibliometric analysis is relatively rare. This study aimed to clarify Nrf2's role in multiple diseases, identify emerging trends and hotspots using bibliometric analysis, and provide valuable insights and potential directions for future therapeutic interventions. Methods: The Science Citation Index of Web of Science Core library from 2000 to 2022 was searched on 22 October 2022. Use Microsoft Excel, CiteSpace, Bibliometrix, and VOS viewers for data collection and visualization of research focus and trends. Results: A vast collection of 22,040 research studies on Nrf2 published between 2000 and 2022 were identified. Nrf2 research has seen significant growth globally from 2000 to 2022. China leaded in publication numbers (9,623, 43.66%), while the United States dominated in citation frequency with 261,776 citations. China Medical University was the most productive institutions (459, 2.08%). Masayuki Yamamoto topped in publications (307), while Itoh K. ranked first in citations with 3669. Free Radical Biology and Medicine was the journal with the most studies and citations on Nrf2 (613, 29,687 citations). The analysis of keyword clustering enhanced the categorization of topics and can be summarized as oxidative stress, cancer, disorders in glycolipid metabolism, inflammation, and neurological conditions. Conclusion: China and the United States are the pioneers in Nrf2 research. Recently, there has been a comprehensive exploration of Nrf2 involving both experimental and clinical aspects, as well as mechanisms and therapeutic applications. Investigating novel molecular mechanisms, including NF-κB, Ho1, and Keap1, and developing enhanced, targeted Nrf2 activators or inhibitors to uncover the interplay among cancer, glycolipid metabolic disorder, inflammation, and neurological disorders will be upcoming trends and hotspots.

Establishment of the glioma polyploid giant cancer cell model by a modified PHA-DMSO-PEG fusion method following dual drug-fluorescence screening in vitro.

BACKGROUND: In glioma, cell fusion and the number of the polyploid giant cancer cells (PGCC) were found to be augmented with tumor grades (WHO Ⅰ-Ⅳ) and closely related to poor prognosis. However, the pathological and molecular characteristics of glioma PGCCs remain unclear due to the lack of cell model in vitro and in vivo. NEW METHOD: Here, we reported a novel approach to obtain the glioma PGCCs by the PHA-DMSO-PEG fusion method following dual drug-fluorescence screening in vitro. Glioma cells were labelled by lentiviruses infection and fusion hybrids were obtained by puromycin screening and fluorescence-activated cell sorting (FACS). RESULTS: Glioma tumor-tumor cell fusion efficiency was significantly improved by PHA and DMSO. Glioma PGCCs were successfully obtained after puromycin screening and FACS. Cell size, DNA content and chromosome numbers of the glioma PGCCs were almost twice than that of the parental glioma cells. Moreover, glioma PGCCs showed a decreased proliferation rate but enhanced temozolomide resistance potential compared to the parental cells. COMPARISON WITH EXISTING METHODS: We firstly obtained the glioma PGCCs by a modified fusion method in vitro. The fusion efficiency of the PHA-DMSO-PEG fusion method was much higher compared to PEG fusion method. Moreover, the dual drug-fluorescence screening method was more convenient and effective compared to the single one. CONCLUSIONS: We successfully established the glioma PGCC model through a modified PHA-DMSO-PEG fusion method following dual drug-fluorescence screening in vitro. Glioma PGCCs showed a deceased proliferation rate but increased TMZ resistance capacity.

miR-142 downregulation alleviates the impairment of spatial learning and memory, reduces the level of apoptosis, and upregulates the expression of pCaMKII and BAI3 in the hippocampus of APP/PS1 transgenic mice.

MicroRNA-142-5p (miR-142-5p) has been found to be dysregulated in several neurodegenerative disorders. However, little is known about the involvement of miR-142-5p in Alzheimer's disease (AD). Brain angiogenesis inhibitor 3 (BAI3), which belongs to the adhesion-G protein-coupled receptor subgroup, contributes to a variety of neuropsychiatric disorders. Despite its very high expression in neurons, the role of BAI3 in AD remains elusive, and its mechanism at the cellular and molecular levels needs to be further elucidated. The current study sought to investigate whether miR-142-5p influenced BAI3 expression and neuronal synaptotoxicity induced by Aß, both in APP/PS1 transgenic mice and a cellular model of Alzheimer's disease. Altered expression of miR-142-5p was found in the hippocampus of AD mice. Inhibition of miR-142 could upregulate BAI3 expression, enhance neuronal viability and prevent neurons from undergoing apoptosis. In addition, the reduction of phosphorylation of Synapsin I and calcium/calmodulin-dependent protein kinase II (CaMKII), as well as the expression of PSD-95 in the hippocampus of APP/PS1 transgenic mice, were significantly restored by inhibiting miR-142. Meanwhile, the levels of Aß1-42, ß-APP, BACE-1 and PS-1 in cultured neurons were detected, and the effects of inhibiting miR-142 on spatial learning and memory were also observed. Interestingly, we found that BAI3, an important regulator of excitatory synapses, was a potential target gene of miR-142-5p. Collectively, our findings suggest that miR-142 inhibition can alleviate the impairment of spatial learning and memory, reduce the level of apoptosis, and upregulate the expression of pCaMKII and BAI3 in the hippocampus of APP/PS1 transgenic mice; thus, appropriate interference of miR-142 may provide a potential therapeutic approach to rescue cognitive dysfunction in AD patients.

The Triglyceride-Glucose Index is Associated with Diabetic Retinopathy in Chinese Patients with Type 2 Diabetes: A Hospital-Based, Nested, Case-Control Study.

BACKGROUND: This study aimed to investigate the association between the triglyceride-glucose (TyG) index and diabetic retinopathy (DR) in Chinese patients with type 2 diabetes. METHODS: In this nested case-control study, all diabetic participants were registered hospitalizations during 2012-2018, including 596 with DR as cases and three matching controls per case. DR was assessed using Early Treatment Diabetic Retinopathy Study criteria. The TyG index was calculated: Ln (fasting blood glucose [mg/dL] × fasting triglycerides [mg/dL] ÷ 2). Multivariate logistic regression, a receiver-operating characteristic (ROC) curve, linear regression models, and mediation analysis were used to explore associations. RESULTS: The TyG index was lower in DR and decreased as its severity advanced among 2,112 subjects (P=0.005). After confounders (sex, duration of diabetes, use of antidiabetic agents, heart rate, systolic blood pressure, pulse pressure, height, weight, body-mass index, and glycated hemoglobin) had been accounted for, there were significant associations between the TyG index and any-severity DR (OR 0.83, 95% CI 0.73-0.95; P=0.006), as well as vision-threatening DR (VTDR; OR 0.53, 95% CI 0.36-0.76; P=0.001). ROC analysis indicated that the TyG index showed significant discriminatory ability in any-severity DR (area under curve [AUC] 0.534, P=0.015) and VTDR (AUC 0.624, P=0.001). CONCLUSION: The TyG index was associated with the presence and severity of DR. Our findings suggest that the TyG index may become a useful biomarker in evaluating and following the presence of DR and VTDR.

Global, national and regional prevalence, and associated factors of ocular trauma: A protocol for systematic review and meta-analysis.

BACKGROUND: Ocular trauma is a common eye disease and one of the main causes of blindness. There is a dearth of data on a summary and meta-analysis on the global epidemiology of the disease. Therefore, this systematic review protocol aims to propose the first systematic review and meta-analysis to synthesize existing evidence on the global prevalence and associated factors of ocular trauma worldwide. METHODS: A systematic search will be performed according to the following databases: PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Weipu, and Wanfang. Cross-sectional, case-control, and cohort studies reporting on the prevalence and risk factors of ocular trauma will be included. The primary outcome will be the prevalence in global, regional, and national ocular trauma. Study searching, data extraction, and quality evaluation will be performed by 2 reviewers, independently. Appropriate meta-analysis will then be used to pool studies. STATA software package v 12.0 (Stata Corporation, College Station, TX) and R (version 3.4.1; R Foundation for Statistical Computing, Vienna, Austria) software will be used for all statistical analyses. RESULTS: This study will provide a high-quality synthesis to examine the prevalence and associated factors of ocular trauma worldwide. Furthermore, current study will project disease estimates in the next 50 years. CONCLUSION: This systematic review and meta-analysis will provide first evidence to evaluate the burden of ocular trauma in the general population. ETHICS AND DISSEMINATION: This systematic review and meta-analysis of randomized controlled trials does not require ethical recognition, and the results of this paper will be published in an open access, internationally influential academic journal. TRIAL REGISTRATION NUMBER: CRD42020189166.

Photodynamic therapy for symptomatic circumscribed choroidal hemangioma in 22 Chinese patients: A retrospective study.

The purpose of this study is to describe the effects and complications of photodynamic therapy (PDT) on Chinese patients with circumscribed choroidal hemangioma (CCH). In this retrospective study, 22 CCH patients who underwent PDT performed 15 min after the injection of intravenous verteporfin (6 mg/m2)with multiple 83-second laser spots at 689 nm (50 J/cm2) were studied. Fluorescein angiography and/or indocyanine green angiography, B-scan ultrasonography and optical coherence tomography were performed in all patients. Follow-up was performed until 12 months post-treatment. All patients were treated with one session, except 1 case with prior transpupillary thermotherapy history. At the 12-month follow-up, the mean of the best corrected visual acuity (BCVA) increased from 0.40 ± 0.38 to 0.56 ± 0.42 (p < 0.05), tumors became thinner (1.96 ± 2.65 mm vs. 4.31 ± 2.04 mm) (p < 0.05), and exudative detachment were diminished. The mean fovea center thickness (FCT) decreased from 540.1 ± 470.6 to 171.6 ± 79.3 µm at the 3-month follow-up. The 12-month BCVA was correlated with prior laser treatment, symptom duration, baseline CCH diameter and thickness, baseline FCT and cystoid macular edema. One patient developed a branch retinal artery occlusion. In conclusion, PDT is an effective and safe treatment for CCH. Specific PDT protocols for CCH should be standardized. The retinal arteriole should be spared during the treatment.

Coordinated targeting of MMP-2/MMP-9 by miR-296-3p/FOXCUT exerts tumor-suppressing effects in choroidal malignant melanoma.

Choroidal melanoma is the most common intraocular tumor in adults, and overexpression of matrix metalloproteinase-2 or matrix metalloproteinase-9 (MMP-2/MMP-9) is associated with angiogenesis and tumor metastasis of the choroidal malignant melanoma (CMM). This study aims to investigate the functions and mechanisms of microRNA or long non-coding RNA-targeted MMP-2/MMP-9 in CMM. We demonstrated that expressions of MMP-2/MMP-9 were increased in CMM tissues and C918 cells in comparison with normal choroidal melanocytes. Bio-informatics prediction and our experiments validated that MMP-2 and MMP-9 were simultaneously targeted by miR-296-3p and FOXC1 promoter upstream transcript (FOXCUT); the latter two exerted tumor-suppressing effects on CMM cells by inhibiting cell proliferation, cell cycle progression, migration, invasion, and induction of cell apoptosis. Furthermore, significant downregulations of miR-296-3p and FOXCUT were found in C918 cells compared with choroidal melanocytes from the unaffected eyes, and a positive correlation was observed between their levels in three cases of eye malignant melanomas. Our data indicated that MMP-2/MMP-9 was coordinately targeted by two non-coding RNAs, miR-296-3p and FOXCUT, which were decreased, and tumor-suppressing factors in CMM. Further study will show the possibility of developing them as therapeutic candidates for CMM.

Photodynamic Therapy for an iris metastasis from pulmonary adenocarcinoma.

Uveal metastasis is the most common intraocular malignancy. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement is rarely reported. Here we report a case of iris metastasis from pulmonary adenocarcinoma that was treated with photodynamic therapy (PDT). A 65-year-old Chinese man was referred to our hospital for iris white neoplasm and blurred vision for 2 weeks in his right eye. His accepted pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1year ago and liver metastases were found 2 months earlier. At presentation, anterior segment examination of the right eye showed a hypopigmented, vascularized papillary 3.8 *3.19mm neoplasm located on the temporal iris expanding to 9-clock anterior chamber angle. The patient refused to accept MRI, biopsy and treatment. One week later the tumor grew up to 5.5*7.4mm with diffuse mixed conjunctiva congestion and elevated IOP. A modified PDT was applied. Intravenous verteporfin (3mg/m2) was infused with a 1min bolus. PDT with 3 partly overlapped 5mm laser spots, 689nm (50J/cm2) and 166s were performed 4 minuets later without contact lens. The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3days follow-up. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.

The optical imaging of idiopathic paracentral acute middle maculopathy in a Chinese young man and review of the literature.

We report a case of idiopathic paracentral acute middle maculopathy with typical optical imaging and clinical features. A 26-year-old Chinese policeman presented with a 20-day history of paracentral scotoma in the left eye after early wake-up and long-time working in front of computer the day before. He experienced sudden-onset strong flash in his left eye. Paracentral scotoma appeared in his left eye after 6hours of rest. The general history was negative. His best corrected visual acuity was 20/20 OU. Anterior segment, dilated fundus examination, papillary evaluation and intraocular pressure were normal. Fuorescein angiography and blue light fundus autofluorescence showed no significant abnormality. In multicolor photography, the lesion was visible on the monochromic infrared/blue reflectance images and not clear in green reflectance. The 10 degree visual field examination revealed superior paracentral relative scotoma. Multifocal electroretinogram revealed reduced response in central area in the left eye. Spectral-domain optical coherence tomography showed that hyperreflective plaque was present at the IPL/INL/OPL level with hyperreflective point at the GCL. The plaque became thinner 3 months later and diminished 6 months later with obviously atrophied INL. In the 3 months follow-up, transverse scan revealed that there was a well-demarcated hypo-refractive lesion in IPL and hyper-refractive lesion in INL. OCTA revealed the deceased flow signal intensity of focal deep capillaries. En face OCT imaging of the left eye revealed a relative well-defined, hypo-refractive lesion and non-flow area localized at the level of the deep capillary plexus.

The optical imaging of tarantula hair corneal injury: One case report and review of the literature.

INTRODUCTION: Tarantulas belonging to the Theraphosidae family are more and more popular as family pets. Ocular injuries caused by tarantulas are reported in several articles. We hereby report the first known case of ocular injury caused by a tarantula in China and observed by anterior segment optical coherence tomography (AS-OCT). CASE: A 22-year-old girl was referred to our hospital with one-week history of red and irritated left eye after she grabbed her molting Chilean Rose Tarantula. Her best-corrected visual acuity was 20/20 on both eyes. Her left eyelid was slightly red and edema. Slit-lamp examination found that more than a dozen of microscopic barbed hairs embedded into the cornea. AS-OCT showed that barbed hairs embedded in the cornea in different direction and the length of the hairs ranged from 173µm to 395µm. The anterior chamber was quiet with normal fundus and intraocular pressure. Topical steroid treatment was prescribed and the response was good. No corneal opacity or intraocular inflammation was observed after topical steroid treatment for one month. CONCLUSIONS: As exotic pets become more and more popular, the importance of wearing ocular protection when handling tarantulas should be emphasized when they are sold. Tarantulas are unsuitable pet for children. When a patient presents with an unusual red eye, pet-keeping history, spiders included, should be asked.

The optical imaging and clinical features of tamoxifen associated macular hole: A case report and review of the literatures.

We report a case of tamoxifen associated macular hole with typical optical imaging and clinical features. A 53-year-old woman came to our department for gradual decrease of vision acuity in both eyes for 3 months, after 30 months low-dosage-tamoxifen treatment as adjuvant treatment for invasive ductal breast carcinoma. Her best corrected visual acuity (BCVA) was 0.4 in the right eye and 0.12 in the left eye. Dilated fundus examination showed macular multiple, fine, crystalline deposits and small white points in retina of both eyes. Blue light fundus autofluorescence showed fovea local hyper-fluorescence. Fluorescein angiography showed fovea local hyper-fluorescence in early stage and stain in late stage. Optical coherence tomography was performed. There were many point hyper-reflections in posterior retina in both eyes with fovea local posterior vitreous body detachment. Inner fovea mismatching, intact outer limiting membrane, bluer interdigitation zone, ruptured Ellipsoid zone and granular change of outer segments of photoreceptors were found in right eye. Blured interdigitation zone and granular change of outer segments of photoreceptors were also found in left eye with macular hole. Multifocal electroretinogram revealed reduced response in paracentral and pericentral area in both the eyes. And we reviewed the diagnosis and treatment of the disease.

Relapse of choroidal neovascularization in Bietti's crystalline retinopathy following anti-vascular endothelial growth factor therapy: A case report.

Choroidal neovascularization secondary to retinitis pigmentosa is rarely observed in clinical practice. The present study describes a case of atypical retinitis pigmentosa, crystalline retinal pigmentary degeneration, complicated by choroidal neovascularization (CNV) in a 26-year-old man presenting with blurred vision in the right eye. Heidelberg multimodality imaging was performed to achieve a confirmed diagnosis. Bevacizumab was injected once intravitreally. The 3-month follow-up included visualization of the lesion's regression with spectral domain optical coherence tomography (SD-OCT). However, at 3 months after the injection, the CNV reoccurred. To the best of our knowledge, this is the first time that a case of CNV secondary to retinitis pigmentosa, in which the diagnosis was confirmed via multimodality imaging and the therapeutic efficacy was evaluated by SD-OCT, has been reported in China.

Prevalence and risk factors of diabetes and diabetic retinopathy in Liaoning province, China: a population-based cross-sectional study.

AIM: To evaluate the prevalence and risk factors of diabetes and diabetic retinopathy (DR) in northeast area of China with a population-based study. METHODS: A population of 3173 (aged from 20 to 80 years old) was stratified by geographical location and age in Liaoning province, China. Prediabetes and diabetes were diagnosed according to the guideline of American Diabetes Association. Retinal photographs were obtained by using digital non-mydriatic camera for the presence and grading of DR according to the modified ETDRS Airlie house classification. Blood samples and comprehensive questionnaires were obtained for evaluation of laboratory results and risk factors. RESULTS: The prevalence of prediabetes and diabetes was 20.7% and 10.4%, respectively. Among diabetes patients, DR prevalence was 11.9%. Age, obesity, total cholesterol, triglycerides, hypertension, living in rural areas and diabetes family history are all risk factors for prediabetes and diabetes. Waist-to-hip circumference rate served as a better obesity index to estimate diabetes risk compared with body mass index and waist circumference. Among all risk factors that we investigated, only the length of diabetes history was associated with the incidence of DR. However, DR prevalence in the newly discovered patients in rural areas was significantly higher than that in urban areas. CONCLUSION: According to this study, 1 in 10 people has diabetes, 2 in 10 people have prediabetes, and 1 in 10 diabetics has DR in Liaoning province. In rural areas, diabetes was poorly recognized with limited medical resources, which probably resulted in more diabetes patient at a high risk of DR.

The discrepancy between central foveal thickness and best corrected visual acuity in cystoid macular edema secondary to central retinal vein occlusion after intravitreal lucentis® injection.

Cystoid macular edema is a common retinal disorder with the potential for significant vision-related morbidity, and intravitreal lucentis(®) injection is confirmed to be an effective therapy approach. In the present study, we investigated the discrepancy between central foveal thickness and best corrected visual acuity in such lesions and infered that intravitreal lucentis(®) injection may help the visual function, related to the renewal of cells.

The occurrence and progression of outer retinal tubulation in Chinese patients after intravitreal injections of ranibizumab.

To investigate the occurrence and progression of outer retinal tubulation (ORT) in Chinese patients after intravitreal ranibizumab injections, using spectral domain optical coherence tomography (SD-OCT) with eye tracking function. 15 age related macular degeneration (AMD) and 6 polypoidal choroidal vasculopathy (PCV) eyes of 21 patients were enrolled and assessed by SD-OCT. One patient received photodynamic therapy (PDT) previously, and all patients received intravitreal injections of ranibizumab. At baseline, only one AMD eye (4.8%) showed ORT, which appeared as round or ovoid hyporeflective spaces with hyperreflective borders. During the follow ups, ORT was identified in nine of 15 AMD eyes (60.0%) and one of six PCV eyes (16.7%). These new ORTs in 10 eyes were originated from the intraretinal fluid. Inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL) were pulled down to form "cynapsis", separating each ORT. However, ORT in 3 eyes disappeared after intravitreal ranibizumab injections. This is the first observation on the occurrence and progression of ORT in Chinese AMD and PCV patients, in a point to point manner. The ORT could become stable or disappear after ranibizumab injections, and outer retina involved in the process of ORT formation.

Discrepancy between subjectively reported symptoms and objectively measured clinical findings in dry eye: a population based analysis.

OBJECTIVE: To investigate the discrepancy between patient-reported symptoms and measured clinical findings and influencing factors in dry eye (DE). SETTING: A population-based, cross-sectional study was performed in July-August 2007 in northeast China. The study was performed on populations originating from two rural districts that are respectively located approximately 377 and 177 km from our hospital. PARTICIPANTS: 2600 eligible residents from 1300 households were identified; valid responses were obtained from 2262 residents (mean age 48 (range 12-88) years; 926 men and 1336 women; response rate 87%). PRIMARY OUTCOME MEASURES: Patient-reported symptoms of DE, tear film break up time (BUT) and Schirmer scores (Schirmer II). RESULTS: Subjects with normal BUT and Schirmer scores without any DE symptoms were defined as the control group. Those with abnormal BUT and Schirmer scores and symptoms of DE were defined as the DE group. Subjects with disparities between the occurrence of DE symptoms and measured clinical findings were regarded as the discrepancy. Out of 2262 subjects, the discrepant group contained 960 subjects (42.44%) with significant difference (χ(2)=4.027, p=0.045<0.05). Factors that influenced the subjective reporting of DE symptoms included gender, smoking status, environment and age. Schirmer II test and tear film BUT values were remarkably different among control, DE and discrepant groups. CONCLUSIONS: Development of DE can be related to many factors. It is of great importance to put forward the preclinical phase concept (patients who are symptomatic for DE and yet show no aqueous deficiency or evaporative signs) and to screen outpatients with DE-inducing features. Future interventions should focus on patients demonstrating a discrepancy between self-reported symptomology and measured clinical findings.

Circumscribed choroidal hemangioma associated with choroidal neovascularization in a HIV-infected case: photodynamic therapy and intravitreous ranibizumab.

Circumscribed choroidal hemangioma (CCH) is rarely associated with choroidal neovascularization (CNV), especially in HIV-infected patients. And the therapy is still controversial. In this study, we discussed the mechanism, clinical feature and treatment of such lesions, based on multi-modality imaging evidences. Photodynamic therapy (PDT) might aggravate CNV as a side effect, and we concluded that intravitreal ranibizumab could be suggested as an effective therapy.