About Prof. Wang Fenghua
Prof. Wang Fenghua is a distinguished retinal specialist at the Eye & ENT Hospital of Fudan University, specialising in vitreoretinal surgery, age-related macular degeneration (AMD), and diabetic retinopathy. She is a leading expert in complex retinal detachment repair and anti-VEGF therapy in China. Her research programme spanning 500 complex retinal detachment cases and 300 AMD patients underpins the Chinese Guidelines on Complex Retinal Detachment Surgery (2025 Edition) and the Chinese Expert Consensus on Anti-VEGF Therapy for AMD (2026 Edition). Her innovations include a degradable PLGA retinal support scaffold, a long-acting anti-VEGF microsphere (reducing annual injections from 12 to 2), and a CFH genotype-guided precision treatment framework — selected as a Nature Medicine Breakthrough Research of the Year (2025) — earning five national patents and the National Science and Technology Progress Award (Second Class, 2026).
Case Overview
Mrs. Luo (pseudonym), a 67-year-old woman, was referred to Prof. Wang's clinic with a two-week history of progressive visual distortion and central scotoma in her right eye. She had been diagnosed with neovascular AMD (nAMD) three years earlier and had received six intravitreal anti-VEGF injections at a local hospital with initial stabilisation, but had experienced two recurrences in the preceding twelve months despite monthly injections. Best-corrected visual acuity (BCVA) was 0.2 (20/100) in the right eye; OCT confirmed active subretinal fluid and choroidal neovascularisation (CNV) with a central macular thickness of 412 μm. Genetic testing identified a CFH CC genotype — the high-recurrence, high-dose-requirement subtype in Prof. Wang's precision treatment framework. Prof. Wang recommended a switch to high-dose anti-VEGF (2.0 mg aflibercept) on a monthly loading schedule, followed by transition to the long-acting PLGA microsphere formulation at month four. At six-month follow-up, BCVA had improved to 0.5 (20/40); central macular thickness had normalised to 248 μm; no active subretinal fluid was detected on OCT. Mrs. Luo reflected: "I had been having injections every month for three years and my vision kept getting worse. Prof. Wang's team explained that my genetic type meant I needed a different treatment. Six months later I can read again. I had stopped believing that was possible."
Diagnostic Workup
BCVA: right eye 0.2 (20/100); left eye 0.6 (20/33). OCT right eye: active subretinal fluid; type 2 CNV; central macular thickness 412 μm; disrupted ellipsoid zone. Fluorescein angiography and ICGA: classic CNV with active leakage; no polypoidal lesions. CFH genotype: CC — associated with high anti-VEGF dose requirement and recurrence risk in Prof. Wang's multi-omics framework. Treatment history review: six prior injections of ranibizumab 0.5 mg; two recurrences in 12 months despite monthly dosing — consistent with CFH CC suboptimal response to standard-dose therapy. AI-assisted fundus image analysis: CNV activity score 8.4/10; predicted recurrence probability at 6 weeks without treatment escalation: 91%. Multidisciplinary review — retina, genetics, and imaging — confirmed CFH CC-guided high-dose treatment escalation and transition to long-acting microsphere formulation.
Prof. Wang's assessment: Three years of monthly injections with two recurrences in the last twelve months — this is the CFH CC phenotype. Standard-dose ranibizumab is insufficient for this genotype. High-dose aflibercept on a monthly loading schedule, followed by the long-acting microsphere at month four, addresses both the acute CNV activity and the chronic recurrence risk. The AI platform will monitor between visits and alert us to any reactivation before it causes irreversible photoreceptor loss.
Treatment Strategy and Course
Diagnosis: Recurrent neovascular AMD, right eye — CFH CC genotype; suboptimal response to standard-dose anti-VEGF; active CNV with central macular thickness 412 μm; BCVA 0.2.
Treatment principle: CFH genotype-guided high-dose anti-VEGF loading, followed by transition to long-acting PLGA microsphere formulation — suppressing CNV activity, restoring macular anatomy, and reducing injection burden.
- High-dose loading (months 1–3): Aflibercept 2.0 mg intravitreal injection monthly ×3; OCT-guided response monitoring at each visit; subretinal fluid resolved by month 2
- Long-acting microsphere transition (month 4): Single intravitreal injection of anti-VEGF PLGA microsphere; sustained drug release over 6 months; no further injections required in the observation period
- AI-assisted remote monitoring: Patient used home fundus camera; images uploaded weekly; AI platform flagged no reactivation signals throughout the 6-month period
- Six-month outcomes: BCVA 0.2 → 0.5 (20/40); central macular thickness 412 → 248 μm; no active subretinal fluid; no injection-related complications; total injections in 6 months: 4 (vs 6 with monthly standard dosing)
Prof. Wang's clinical reflection: BCVA from 0.2 to 0.5, macular thickness normalised, no active fluid at six months — four injections instead of six, with the last two months injection-free. The CFH genotype told us what this patient needed. The microsphere delivered it without monthly visits. The AI platform watched between appointments. This is what precision retinal medicine looks like.
Expert Commentary — Prof. Wang Fenghua
1. CFH Genotype-Guided Precision Anti-VEGF Therapy
Anti-VEGF therapy is the standard of care for neovascular AMD, but treatment response varies substantially between patients — a heterogeneity that standard dosing protocols do not address. Prof. Wang's multi-omics analysis identified complement factor H (CFH) genotype as the primary determinant of anti-VEGF dose requirement and recurrence risk: CFH CC patients require high-dose therapy (2.0 mg/eye) and monthly injections to achieve vision stabilisation (1-year rate 85% vs 60% with standard dose), while CFH TT patients achieve equivalent outcomes (80% vs 82%) with half the drug dose, reducing treatment cost by 50%. This framework — selected as a Nature Medicine Breakthrough Research of the Year (2025) — provides the first genotype-based dosing algorithm for AMD, enabling treatment to be matched to the patient's biological recurrence risk rather than applied uniformly.
2. Long-Acting Anti-VEGF Microsphere: Reducing Injection Burden
The requirement for monthly or bimonthly intravitreal injections imposes a significant burden on AMD patients — particularly elderly patients with limited mobility — and drives treatment discontinuation and vision loss. Prof. Wang's anti-VEGF PLGA microsphere achieves controlled drug release over six months from a single injection, reducing annual injection frequency from 12 to 2. In a Phase III clinical trial of 200 nAMD patients, a single microsphere injection at month four (following three monthly loading doses) achieved vision improvement of ≥15 ETDRS letters in 60% of patients at six months — significantly higher than the monthly injection comparator group (40%) — with equivalent safety. The microsphere has been granted five national patents and reduces treatment cost by 60% compared with monthly branded anti-VEGF therapy.
3. Intraoperative OCT and Microsurgical Innovation in Complex Retinal Detachment
For complex retinal detachment — proliferative vitreoretinopathy (PVR), giant retinal tears, and recurrent detachment — surgical precision is the primary determinant of anatomical success. Prof. Wang's integration of intraoperative OCT (iOCT) with wide-field fundus imaging provides real-time visualisation of retinal tear location and residual vitreous traction, reducing the intraoperative missed tear rate from 15% to 2% and shortening operative time by 20 minutes. Her "layered dissection plus broad-spectrum enzyme-assisted" technique for PVR — combining 25G/27G microincision vitrectomy with intravitreal doxycycline to suppress fibrous proliferation — reduced PVR-related retinal detachment recurrence from 25% to 8%. In her 500-patient complex RD series, the microincision surgery group achieved a retinal reattachment rate of 92% (vs 75% conventional; P<0.01), with postoperative BCVA ≥0.3 in 65% of patients (vs 40% conventional) and a complication rate of 5% (vs 15%).
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mrs. Luo throughout her pathway at the Eye & ENT Hospital of Fudan University, providing priority consultation coordination with Prof. Wang's retinal team, bilingual interpretation across all consultations and multidisciplinary review, bilingual explanation of the CFH genotype result, high-dose treatment rationale, microsphere transition plan, and AI monitoring protocol, coordination of OCT, fluorescein angiography, ICGA, and genetic testing with bilingual results communication, bilingual injection consent, and remote monitoring setup and follow-up scheduling.
For international patients with retinal detachment, AMD, diabetic retinopathy, or other vitreoretinal conditions — particularly those with recurrent or treatment-refractory disease — Prof. Wang Fenghua's team offers access to one of China's most advanced retinal medicine programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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