About Prof. Xu Xun
Prof. Xu Xun is a leading ophthalmologist at Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine — one of China's foremost centres for vitreoretinal surgery, diabetic eye disease, and complex retinal pathology. He specialises in vitreoretinal surgery, diabetic retinopathy, age-related macular degeneration, and complex cataract management, and is recognised as a pioneer in minimally invasive retinal surgical techniques in China. His research programme has advanced the science of non-invasive drug delivery to the posterior segment of the eye, with the goal of reducing the burden of repeated intravitreal injections on patients with chronic retinal disease. His clinical philosophy holds that the management of diabetic retinopathy is a long-term commitment — not a single intervention — and that the best outcomes are achieved through early detection, personalised treatment sequencing, and sustained, coordinated follow-up that keeps pace with the natural history of the disease.
Case Overview
Mr. Zhao (pseudonym), a 58-year-old man with a 12-year history of type 2 diabetes and suboptimal glycaemic control, presented with a three-month history of rapidly deteriorating vision in both eyes. Best-corrected visual acuity was 0.15 in the right eye and 0.1 in the left. Fundus examination and fluorescein angiography confirmed bilateral proliferative diabetic retinopathy (PDR) with extensive neovascularisation, vitreous haemorrhage in the right eye, and tractional changes threatening the macula in the left. Optical coherence tomography (OCT) demonstrated diabetic macular oedema in both eyes. Prof. Xu Xun's multidisciplinary assessment — ophthalmology, endocrinology, and internal medicine — established a sequenced treatment plan: intravitreal anti-VEGF therapy to suppress active neovascularisation and reduce macular oedema, panretinal laser photocoagulation to ablate ischaemic retina and reduce the angiogenic drive, and vitreoretinal surgery for the right eye to clear the vitreous haemorrhage and relieve tractional forces. Systemic glycaemic optimisation was coordinated in parallel. Following treatment, best-corrected visual acuity improved to 0.5 in the right eye and 0.3 in the left; both retinas were stabilised with no evidence of active neovascularisation at six-month follow-up. Mr. Zhao described the outcome as transformative: "I came here not knowing whether I would still be able to see my family clearly. The team gave me my vision back — and with it, my independence."
Diagnostic Workup
Fundus photography and fluorescein angiography (FFA) characterised the extent of retinal neovascularisation, identified areas of capillary non-perfusion, confirmed active vitreous haemorrhage in the right eye, and assessed the risk of tractional retinal detachment in the left. Optical coherence tomography (OCT) quantified macular oedema in both eyes and identified the vitreoretinal interface configuration relevant to surgical planning. B-scan ultrasonography assessed the posterior segment of the right eye through the vitreous haemorrhage, confirming the absence of retinal detachment and characterising the tractional configuration. Systemic assessment — HbA1c, renal function, blood pressure, and lipid profile — established the metabolic context and informed the endocrinology team's optimisation plan. Multidisciplinary review confirmed the sequenced treatment strategy and the criteria for proceeding from medical to surgical management.
Prof. Xu's pre-treatment assessment: Proliferative diabetic retinopathy at this stage is a race between the disease and the treatment. The vitreous haemorrhage in the right eye is obscuring our view and threatening the macula — we need to clear it surgically and address the underlying neovascularisation simultaneously. In the left eye, the tractional configuration is the priority: anti-VEGF therapy will reduce the neovascular drive and make the retina safer, but we must monitor closely for any progression toward tractional detachment. The systemic picture — glycaemic control, blood pressure, renal function — is as important as anything we do in the eye. Retinal disease is a window into systemic disease, and we treat both.
Treatment Strategy and Course
Diagnosis: Bilateral Proliferative Diabetic Retinopathy with Vitreous Haemorrhage (Right Eye), Diabetic Macular Oedema, and Tractional Changes (Left Eye) in a 58-year-old patient with longstanding type 2 diabetes.
Treatment principle: sequenced combination of intravitreal anti-VEGF therapy, panretinal laser photocoagulation, and vitreoretinal surgery — with concurrent systemic metabolic optimisation — to suppress active neovascularisation, resolve macular oedema, restore optical clarity, and stabilise both retinas.
- Phase 1 — Intravitreal anti-VEGF therapy (both eyes): Anti-VEGF injections administered to both eyes at monthly intervals; right eye: reduction in neovascular activity and partial resolution of macular oedema; left eye: significant reduction in neovascularisation and macular oedema, with stabilisation of tractional configuration
- Phase 2 — Panretinal laser photocoagulation (both eyes): Completed over two sessions per eye following anti-VEGF-mediated neovascular regression; ablation of ischaemic peripheral retina to reduce VEGF production and consolidate the anti-VEGF response; well tolerated with no significant adverse effects
- Phase 3 — Vitreoretinal surgery (right eye): 23-gauge pars plana vitrectomy; vitreous haemorrhage cleared; epiretinal membrane peeled; residual neovascular fronds treated with endolaser; internal limiting membrane peeled over the macula to address oedema; no intraoperative complications; optical clarity restored
- Systemic optimisation (concurrent): Endocrinology team optimised insulin regimen; HbA1c reduced from 9.8% to 7.1% over the treatment period; blood pressure and lipid management adjusted; renal function monitored
- Six-month follow-up: Right eye BCVA 0.5 (from 0.15 at presentation); left eye BCVA 0.3 (from 0.1); bilateral retinal stabilisation confirmed on FFA and OCT; no active neovascularisation; macular oedema resolved in both eyes; ongoing anti-VEGF maintenance and surveillance scheduled
Prof. Xu's clinical reflection: The right eye result — from 0.15 to 0.5 — reflects what is achievable when surgery, anti-VEGF therapy, and laser are sequenced correctly and the systemic disease is addressed in parallel. The left eye result is equally important: we preserved and improved vision in an eye that was at real risk of tractional detachment. The HbA1c reduction from 9.8% to 7.1% is not a footnote — it is a treatment result in its own right, and it is the foundation on which the retinal stability at six months rests.
Expert Commentary — Prof. Xu Xun
1. Proliferative Diabetic Retinopathy: Pathophysiology, Staging, and the Rationale for Combined Treatment
Diabetic retinopathy is the leading cause of preventable blindness in working-age adults globally, and its proliferative stage — characterised by pathological retinal neovascularisation driven by chronic retinal ischaemia and VEGF overexpression — represents the threshold at which the risk of irreversible vision loss becomes acute. The neovascular response, paradoxically, is the retina's attempt to restore perfusion to ischaemic tissue; but the vessels it produces are fragile, poorly organised, and prone to haemorrhage and fibrosis. The treatment rationale for PDR rests on interrupting this cycle at multiple points simultaneously: anti-VEGF therapy suppresses the molecular driver of neovascularisation; panretinal photocoagulation ablates the ischaemic retina that generates the VEGF signal; and vitreoretinal surgery addresses the structural consequences — haemorrhage, traction, and membrane formation — that medical therapy cannot reverse. The combination of these modalities, sequenced according to the individual patient's disease configuration, produces outcomes that no single modality achieves alone.
2. The Evolving Landscape of Anti-VEGF Delivery in Retinal Disease: From Injection to Non-Invasive Administration
Intravitreal anti-VEGF injection is the current standard of care for neovascular retinal disease, with robust evidence for efficacy across diabetic macular oedema, proliferative diabetic retinopathy, and wet age-related macular degeneration. However, the treatment burden associated with repeated intravitreal injections — procedural risk, patient anxiety, clinic capacity, and the compliance challenges of indefinite monthly or bimonthly administration — represents a significant limitation, particularly for patients with chronic disease requiring long-term maintenance. Research from Prof. Xu Xun's group, published in Advanced Science, has demonstrated a novel approach to this challenge: a topical eye drop formulation (Pene/LQ015) combining a high-affinity anti-VEGFA single-domain antibody with a positively charged cell-penetrating peptide carrier, enabling non-invasive drug delivery to the posterior segment via the conjunctival-scleral-choroidal-retinal pathway. In preclinical models — including a laser-induced choroidal neovascularisation model in cynomolgus monkeys — Pene/LQ015 achieved therapeutic drug concentrations in the retina-choroid complex (approximately 194 ng/mL) and significantly suppressed pathological neovascularisation, with a safety profile comparable to intravitreal injection. This research represents a meaningful step toward a future in which the injection burden of anti-VEGF therapy can be reduced or supplemented by non-invasive topical administration.
3. Systemic-Ocular Integration in Diabetic Eye Disease: Why Glycaemic Control Is a Retinal Treatment
The management of diabetic retinopathy cannot be separated from the management of the systemic disease that drives it. Chronic hyperglycaemia is the primary pathophysiological driver of retinal microvascular damage; hypertension and dyslipidaemia are independent amplifiers of retinal ischaemia and oedema. The evidence that intensive glycaemic control reduces the incidence and progression of diabetic retinopathy is among the most robust in all of diabetes medicine — the DCCT and UKPDS trials established this decades ago, and subsequent real-world data have consistently confirmed it. In clinical practice, this means that the ophthalmologist's treatment plan is incomplete without a parallel endocrinology plan: the anti-VEGF injections and the laser and the surgery are treating the consequences of systemic disease, while the endocrinologist's optimisation of HbA1c, blood pressure, and lipids is treating the cause. In Mr. Zhao's case, the reduction in HbA1c from 9.8% to 7.1% over the treatment period was not incidental to the retinal outcome — it was a prerequisite for the durability of that outcome.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Zhao and his family throughout the diagnostic, treatment, and follow-up pathway at Shanghai General Hospital, Shanghai Jiao Tong University, including: priority consultation coordination with Prof. Xu Xun's vitreoretinal team; bilingual interpretation across all ophthalmology consultations, surgical planning discussions, and follow-up appointments; bilingual explanation of the PDR diagnosis, the sequenced treatment strategy, and each phase of anti-VEGF therapy, laser, and surgery; coordination of fundus photography, fluorescein angiography, OCT, and B-scan ultrasonography with bilingual results communication; bilingual surgical consent for vitreoretinal surgery; coordination of the endocrinology referral and systemic optimisation pathway with bilingual results communication; postoperative coordination including visual acuity assessments, OCT surveillance, and anti-VEGF maintenance scheduling; and long-term follow-up coordination including bilateral retinal surveillance and systemic disease monitoring.
For international patients and expatriates in China living with diabetic eye disease or other retinal conditions, Prof. Xu Xun's team at Shanghai General Hospital offers access to one of Shanghai's most experienced vitreoretinal surgery and medical retina programmes. CMCS ensures that expertise is accessible — in the patient's language, with every step coordinated and communicated 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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