A Model to Achieve International Excellence in Ophthalmology Through a Multidisciplinary and Integrated Approach: An Example in Orbital Diseases Research and Surgery (2021)

The Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine has seen the blossoming of a remarkable department of ophthalmology over the past 2 decades. The Division of Orbital Diseases Research and Surgery deserves a special mention. The Shanghai Jiao Tong University School of Medicine is rated number one in “Clinical Medicine” in China, and the university itself is an old and respected institution of knowledge also referred to as the Massachusetts Institute of Technology of the East. The university affiliations help merge different specialties of academia like engineering, basic science research, molecular biology and medicine, and the amalgamation results in rapid evolution of the scientific atmosphere in the academic community under such an umbrella. The APJO covered the latest developments in oculoplastic surgeries mainly from an oculoplastic surgeon's point of view in a major review in a previous issue of this journal.1 In this issue we address the achievements of the Division of Orbital Diseases Research and Surgery from Shanghai Ninth People's Hospital of the Shanghai Jiao Tong Univeristy. The colleagues of this department use a multidisciplinary and integrated collaborative approach in research and clinical work that has set a shiny model to help achieving international excellence in ophthalmology. Starting with only a handful of ophthalmologists in 1990s, they focused on deciphering the pathogenesis of orbital diseases, developing biomaterials for orbital bone defect repair, and enhancing orbital surgical techniques. By establishing a digital orbital surgery platform and by exploring endoscopic orbital surgery as a niche, the Division of Orbital Diseases Research and Surgery at the Shanghai Ninth People's Hospital has made remarkable progress.2 Their work on induced pluripotent stem cells which was published in the Cell Stem Cell has received critical acclaim and has been remarked as a current research hot spot.3 Their collaborative work on degradable biomaterials such as polyfumarate polyethylene oxide maleate and polyglyceride sebacate have shown promising results in promoting healing by providing scaffolds for personalized orbital bone repair. They have also pioneered the use of vascularized tissue engineered bones to facilitate the repair of orbital bone defects in animal studies. They were the first to use image data to construct digital orbital 3D models and use them to establish normal reference values of orbital multiparametric measurements for Chinese. Based on such knowledge, the team acquired the capability to conduct a precise preoperative planning and to predict postoperative outcomes with high precision. These factors ultimately translate into safe and satisfactory surgical outcomes. The colleagues also explored the 3D printing technology to meet the deficiencies in material development in clinical situations, and successfully demonstrated alternative strategies to manage complex orbital trauma and defects. In their endeavor to enhance the innovations in orbital surgeries, they collaborated with engineers from the Shanghai Jiao Tong University to jointly establish an authentic digital orbital surgical planning platform and explored the potential of an endoscope-based navigation system to aid complicated orbital surgeries. They put forward the concept of ‘Endoscopic-navigation’ to surgically manage complicated and technically challenging orbital pathologies within tiny and narrow anatomical spaces. The Division of Orbital Diseases Research and Surgery has showcased their concerted efforts in an interdisciplinary approach to transform innovative scientific and engineering concepts into excellent clinical solutions. The team leader, Professor Xianqun Fan, is the main founder and pioneer of orbital surgery in China, and has made landmark achievements in orbital diseases research and surgery. Professor Fan highlighted the much-needed “lab to bedside” approach and demonstrated its successful initiation and implementation. As the saying goes, “The wearer knows where the shoe pinches,” the medical professionals know where the deficiencies lie in the current technology and medical science. A “lab to bedside” approach combining skills of basic molecular scientists, engineers, and medical doctors would thus be the ideal solution to advancing medical treatments. The story of the Development of Orbital Diseases Research and Surgery in the Department of Ophthalmology, Shanghai Ninth People's Hospital, founded on such a notion, is a successful model that we can adopt and follow.