Retinal vascular diseases (RVDs) are leading causes of vision impairment and blindness, often associated with systemic diseases such as diabetes and hypertension. Despite treatment advancements, managing RVDs, particularly retinal vein occlusion (RVO), remains challenging due to the lack of a definitive cure and reliance on controlling complications. Microglia, the retina’s resident immune cells, play a crucial role in maintaining retinal health, regulating inflammation, and modulating angiogenesis. In pathological conditions, microglia adopt heterogeneous and context-dependent activation states, contributing to both inflammatory injury and vascular repair. Studies suggest that modulating microglial activation and their secreted cytokines may provide novel therapeutic strategies for RVDs. This review examines the role of microglia in RVDs and their potential as therapeutic targets, exploring strategies such as inhibiting microglial activation, regulating pro-angiogenic factor secretion, and targeting specific signaling pathways. Future research should focus on understanding the specific roles of microglial subtypes, their contributions to disease progression, and developing targeted therapies for early diagnosis and treatment of RVDs.
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Open Access
Review Article
Issue
Open Access
Review Article
Issue
With the acceleration of global aging, the incidence of retinal vein occlusion (RVO) has risen markedly. Its pathogenic mechanisms are closely linked to iron dyshomeostasis and microglial polarization and age-related degenerative changes in retinal microvessels. We systematically summarize the regulatory mechanisms of ferroptosis—an iron-dependent, lipid peroxidation-driven form of cell death, and elucidate the central pathway by which iron overload exacerbates retinal injury through the synergy of hypoxia-reoxygenation (H/R). Specifically, iron metabolic imbalance catalyzes the production of reactive oxygen species (ROS) via the Fenton reaction, which drives the polarization of microglia toward the proinflammatory M1 phenotype and activates the acyl-CoA synthetase long-chain family member 4 (ACSL4)-mediated lipid peroxidation cascade. This review proposes novel insights for combinatorial therapeutic strategies targeting key ferroptotic pathways (e.g., the SLC7A11/GPX4 axis) and modulating microglial polarization, while also addressing the translational challenges associated with iron chelators (deferoxamine), lipid peroxidation inhibitors (liproxstatin-1), and targeted delivery systems for RVO.
Open Access
Clinical Research
Issue
To evaluate the therapeutic effects of ranibizumab on optic disc and macular microvascular perfusion in central retinal vein occlusion (CRVO) with macular edema (ME).
Optical coherence tomography angiology (OCTA) parameters, including optic disc vessel density (VD; including whole-disc VD, intra-disc VD, and peripapillary VD), superficial/deep capillary plexus (SCP/DCP) VD, and central macular thickness (CMT) were analyzed. Additional assessments included best-corrected visual acuity (BCVA) via Early Treatment Diabetic Retinopathy Study (ETDRS) chart and hemorheological profiling. CRVO patients received monthly intravitreal ranibizumab injections for three consecutive months. Pre- and post-treatment parameters were statistically compared.
The study comprised 60 CRVO-ME patients (28 males; 32 females), aged 50–78y (mean 63.3±7.6y) and 60 age-/sex-matched healthy controls. As compared with participants exhibiting normal funduscopic findings, CRVO patients demonstrated significantly elevated levels of low-shear-rate whole blood viscosity (LSR-WBV), high-shear-rate whole blood viscosity (HSR-WBV), and aggregation index (AI, all P<0.05). In CRVO-affected eyes, vertical cup-to-disc (C/D) ratio and optic cup volume were significantly smaller, whereas retinal nerve fiber layer (RNFL) thickness was significantly greater, compared to both unaffected contralateral eyes and normal control eyes (all P<0.05). Following treatment, VD of the entire optic disc (P<0.05), intra-disc VD (P<0.05), and peripapillary VD (P<0.05) all increased significantly relative to baseline. CMT decreased significantly (P<0.05), whereas macular SCP-VD and macular DCP-VD showed non-significant slight reductions (P>0.05). At baseline, BCVA of CRVO eyes correlated with whole-disc VD (r=-0.276, P=0.033), intra-disc VD (r=-0.342, P=0.009), and peripapillary VD (r=-0.335, P=0.007), with intra-disc VD demonstrating the strongest association. Besides, BCVA improvement, after the treatment, correlated positively with whole-disc VD (r=0.342, P=0.008) and intra-disc VD (r=0.396, P=0.002).
Optic disc blood perfusion is more closely associated with visual acuity than macular perfusion, suggesting intra-disc VD may serve as a potential biomarker for monitoring visual acuity changes in CRVO. Multiple ranibizumab injections significantly improve optic disc perfusion but may have exerted detrimental effects on the macula. CRVO patients shows higher hemorheological parameters than those with normal fundi. Reduced vertical C/D ratio and optic cup volume may be linked to CRVO incidence, potentially acting as susceptibility factors.
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