Objective To observe the optical coherence tomography (OCT) features of Best vitelliform macular dystrophy (BVMD) at different stages.Methods Twenty-eight BVMD patients (56 eyes) were enrolled in this study. All the patients were examined for visual acuity, slit-lamp microscopy, direct ophthalmoscope, fundus photography, electrooculogram, fundus fluorescein angiography (FFA) and OCT. Fifty-six eyes were classified into stage 0 (eight eyes)、Ⅰ (two eyes)、Ⅱ(10 eyes)、Ⅱa （12 eyes）、Ⅲ (six eyes) 、Ⅳa (six eyes)、Ⅳb (five eyes) and Ⅳc (seven eyes) accordingly. The OCT features of BVMD at different stages were observed.Results The OCT results showed that the macular area was normal in eyes of stage 0; disturbance of retinal pigment epithelium (RPE) and subretinal hyporeflective area were found in eyes of stage I; the location of the yellowish material between RPE and the inner segment and outer segment (IS/OS) with normal appearance in RPE and IS/OS interface were found in eyes of stage Ⅱ. In all the other progressing stages from Ⅱa、Ⅲ and Ⅳ, the vitelliform material appeared as a thicker highly reflective lesion located between the outer nuclear layer and RPE layer, usually accompanied by optical hyporeflective lesion. Images of stage Ⅳc were in similar appearance besides edema of retina. OCT images of Ⅳb stage were demonstrated atrophy of retinal layer and IS/OS loss with fibrosis. Conclusions OCT demonstrated the location of the yellowish material between RPE and IS/OS. Optical hyporeflective lesion between the outer nuclear layer and RPE layer accompanied thicker highly reflected lesion might be the characteristic image in stages II a to IV of BVMD.
ObjectiveTo compare the consistency and difference of non-mydriatic two-field 45° ultra-wide field Optos and Clarus500 fundus imaging in a large-scale diabetic retinopathy (DR) screening. MethodsA diagnostic methodology study. From November 2020 to August 2021, 526 eyes of 277 patients with type 2 diabetes who diagnosed in Department of Ophthalmology, Henan Provincial People's Hospital were included in the study. Among them, there were 175 males with 328 eyes and 102 females with 198 eyes; the age was 53±10 years old. The same experienced technician performed the non-mydriatic dual-field 45° fundus imaging and the non-mydriatic ultra-wide-angle imaging system Optos, Clarus500 single-field fundus imaging examination on the patient on the same day, and obtained the dual-field 45° fundus image and Optos, Clarus500 single-field fundus image. The Optos and Clarus500 single-field fundus images in the same area as the dual-field 45° fundus image were captured by Photoshop software, and the Optos and Clarus500 dual-field fundus images were obtained. Subsequently, two experienced ophthalmologists performed interpretation and DR grading of the 5 groups of images, respectively. Images with inconsistent grading results were interpreted by a third ophthalmologist and used as the final grading result. In order to avoid the mydriatic dual-field 45° imaging interpretation results as the standard, the consistency and detection rate difference of the two ultra-wide-angle imaging systems in the rapid DR screening results were evaluated. The weighted Kappa (κ) test was used to analyze the consistency of DR diagnosis between dual-field 45° fundus imaging and Optos and Clarus500 fundus imaging; χ2 test was used to compare the detection rates of DR between different imaging systems. ResultsCompared with the dual-field 45° fundus image, the Clarus500 single-field had a higher DR detection rate (χ2=24.965, P＜0.001), and the Optos dual-field fundus image had a lower DR detection rate (χ2=49.559, P＜0.001). Compared with the DR detection rate of dual-field 45° fundus image, Optos single-field fundus image, Clarus500 double-field fundus image had no significant difference (χ2=2.572, 0.649; P=0.109, 0.421). Compared with Optos, Clarus500 single-field and dual-field fundus images DR detection rate, the difference was statistically significant (χ2=43.214, 61.216; P＜0.001). Consistency assessment of DR grading results: dual-field 45° fundus images and Clarus500 dual-field fundus images (κ value=0.932, 95% confidence interval (CI) 0.907-0.956) were highly consistent; dual-field 45° fundus images and Optos single-field fundus images [κ value=0.474, 95%CI 0.417-0.532], Optos dual-field fundus image (κ value=0.495, 95%CI 0.438-0.551), Optos dual-field fundus image (κ value=0.495, 95%CI 0.438-0.551) and Clarus500 dual-field fundus image (κ value=0.452, 95%CI 0.395-0.506) were moderately consistent; dual-field 45°fundus images and Clarus500 single-field fundus images (κ value=0.354, 95%CI 0.303-0.403) and Optos single-field fundus images and Clarus500 single-field fundus images (κ value=0.347, 95%CI 0.287-0.393) showed general agreement. ConclusionsCompared with Optos dual-field fundus image, dual-field 45°fundus image and Clarus500 dual-field fundus image have high consistency in the grading results of DR rapid screening. Compared with Optos single-field fundus image, the detection rate of the DR of Clarus500 single-field fundus image is higher.
ObjectiveTo observe the subfoveal choroidal thickness (SFCT) and choriocapillary blood flow area (CBFA) in the patients with idiopathic macular hole (IMH).MethodsThis is a prospective clinical study. Thirty-two patients with unilateral IMH (4 in stage 2, 17 in stage 3, 11 in stage 4) and 32 age- and sex-matched normal controls were enrolled in this study. All eyes were divided into three groups, including group A (32 affected eyes), group B (32 fellow eyes) and group C (32 normal eyes of controls). There was no significant difference in age (t=0.865) and gender (χ2=0.000) in IMH patients versus normal control subjects (P＞0.05). There was no significant difference in refraction (F=0.957) and ocular axial length (F=0.562) between group A, B and C. The SFCT was detected by enhanced depth imaging of spectral-domain optical coherence tomography (OCT). The CBFA was detected by OCT angiography. The differences of SFCT and CBFA in three groups were analyzed by Kruskal-Wallis and non-parametric test.ResultsThe mean SFCT was (182.53±64.52) μm in group A, (199.21±73.07) μm in group B and (254.21±56.85) μm in group C respectively. The SFCT was thinner in group A and B than that in group C (Z=?4.362, ?3.190; P＜0.05), but was the same in group A and B (Z=?1.171, P＞0.05). The mean CBFA was (5.09±0.31) mm2 in group A, (5.41±0.20) mm2 in group B and (5.39±0.15) mm2 in group C respectively. The CBFA was reduced in group A than that in group B and C (Z=?4.467, ?4.048; P＜0.05), but was same in group B and C (Z=0.420, P＞0.05).ConclusionSFCT and CBFA are both reduced in IMH eyes.
ObjectiveTo investigate the clinical characteristics and surgical management of the familial exudative vitreoretinopathy (FEVR)-associated rhegmatogenous retinal detachment (RRD).
MethodsRetrospective noncomparative case series. Thirty-three eye of 32 patients were diagnosed FEVR-associated RRD by Fluorescein fundus angiography. There were 26 males and 6 females. The male to female ratio is 4.3:1 with an average age of 19.35±8.83 years. The detection of best corrected visual acuity (BCVA), refraction status, fundus photograph and fluorescein fundus angiography(FFA)were underwent in all patients. FEVR was confirmedby FFA and positive family history. The BCVA, refraction status, morphology of retinal detachment, location, size and shape of retinal hole, presence and grade of proliferative vitreoretinopathy (PVR), and subretinal proliferation were recorded.
ResultsAs for the refractive status, the scope of refraction was +2.0 D to-13.0 D andthe BCVA were range from light perception to 0.7. Atrophy holes which located at the temporal half were responsible for retinal detachment in all cases. Besides, horseshoe tears were noted in 6 eyes (18.18%), while macular tears were noted in 2 eyes of RRD (6.06%). The PVR greater than stage C2 was noticed in 10 eyes (30.30%), while subretinal proliferation was presented in 23 eyes (69.70%).
ConclusionsMale predominance, juvenile onset and associated with moderate to high myopia are the main characteristics in FEVR-associated RRD. Atrophy holes at the temporal half and the subretinal proliferations were most commonly in FEVR-associated RRD. Detailed fuduns and FFA examination of the fellow eye should be undergone to avoid misdiagnosis.
Objective
To observe the imaging features of ultra-wide field short wave fundus autofluorescence (SW-FAF) in eyes with multiple evanescent white dot syndrome (MEWDS), and analysis the correspondence to conventional images.
Methods
It was a retrospective case series study. Thirteen patients (14 eyes) diagnosed with MEWDS were enrolled. There were 12 females and 1 male, aged from 22 to 57 years, mean age was 34.5 years. All the eyes underwent fundus color photography, optical coherence tomography (OCT) and ultra-wide field autofluorescence (FAF). Simultaneous fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed in 6 eyes. The characteristic changes of SW-FAF in studied eyes were observed and compared with the images of FFA and ICGA. All the eyes were followed up every 1 to 2 weeks, with an average of 16.7 weeks. The characteristic images of SW-FAF and corresponding OCT were studied during follow up.
Results
MEWDS presented with numerous multiple hyper-autofluorescent spots, sized from 50-500 μm, with a vague boundary in ultra-wide field SW-FAF. These spots located mainly at the peripapillary area and the posterior pole with a confluent pattern. The lesions extended to the mid-peripheral retina as well and became more scattered. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to that of the greyish-white spots seen in color photograph and the hyper-fluorescent spots detected by FFA. It was consistent with the distribution of hypo-fluorescent spots in late-phase ICGA as well. But the number of the spot showed in FAF is much more than that in FFA, and slightly less than that in ICGA. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina. After the recovery, the hyper-autofluorescent spots disappeared with the outer retina structure repaired completely.
Conclusions
MEWDS presented with numerous multiple hyper-autofluorescent spots which located mainly at the peripapillary area in ultra-wide field SW-FAF. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to color photograph, FFA and ICGA in late-phase. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina.
Objective To compare the macular imaging and measurements of patients with idiopathic epiretinal membranes (ERM) by stratus optical coherence tomography (OCT) and two different types of spectral-domain OCT. Methods Forty-six consecutive patients (46 eyes) diagnosed as idiopathic ERM in the period of August 2008 to October 2008 were enrolled in this study. The patients included 11 males and 35 females, with a mean age of (61.04plusmn;10.13) years. Twenty-one age- and sex- matched normal subjects (21 eyes) were enrolled in this study as control group. All the subjects underwent stratus OCT, cirrus OCT and 3D OCT-1000 examinations. The macular area was divided into three concentric circles which including central region with 1 mm diameter, inner area with ＞1 mm but le;3 mm diameter, and outer ring area with ＞3 mm but le;6 mm diameter. The inner area and outer ring area were divided into superior, nasal, inferior and temporal quadrants by two radioactive rays. The characteristics of OCT images and the quantitative measurements were compared among these three machines. The macular thickness of ERM group and control group was also compared. And the correlation of visual acuity and the macular thickness in idiopathic ERM patients was evaluated. Results The increased macular retinal thickness, disorder structure of inner retina, uneven surface and proliferative inner and outer plexiform layer were observed in ERM group by stratus and spectral-domain OCT. But the minor pathological changes on inner retina structure and internal surface proliferation could be observed more clearly by spectral-domain OCT than those by stratus OCT.The macular thicknesses of all the subjects measured by Cirrus OCT and 3D OCT-1000 were thicker than those measured by Stratus OCT (t=7.445-11.253,P=0.000). The correlations of measurements between three OCTs were good (r＞0.9). The flatted or disappeared fovea of ERM patient group was observed by all three OCTs. The macular thicknesses on different subfields of patients in ERM group were thicker than those in control group, especially in the 1-3 mm inner ring (t=2.477-10.139,P＜0.05). Moderate negative correlations were shown on the macular thickness and visual acuity in ERM group (r=-0.216-0.517). Conclusions Spectral domain OCT yields better visualization of the intraretinal layers than time domain OCT. The images in spectral domain OCT are more clear and fine compared to stratus OCT. Stratus OCT correlates with spectral domain OCT, but they are different, and cannot be replaced by each other.
Objective To observe the choroidal thickness of patients with chronic central serous chorioretinopathy (CSC) in affected eyes and unaffected fellow eyes.Methods Forty-five chronic CSC patients diagnosed by fundus pre-set lens, fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study. The patients included 36 males and nine females, with a mean age of (46.18plusmn;8.20) years, with a mean duration of (16.34plusmn;7.23) months. Thirty-six patients were affected unilaterally and nine patients affected bilaterally. The patients were divided into affected eyes group (group A, 51 eyes) and unaffected fellow eyes group (group B,39 eyes). Fifty age-, sex- and diopter- matched normal subjects (50 eyes) were enrolled in this study as control group (group C). Enhanced depth imaging (EDI) choroidal scans were obtained in all eyes by using spectral-domain optical coherence tomography. Subfoveal choroidal thickness (SFCT) and choroidal thickness at 3 mm nasal (NCT3 mm), temporal (TCT3 mm), superior (SCT3 mm), inferior (ICT3 mm) to the fovea were measured.Results The mean SFCT of group A, B and C were (436.76plusmn;87.01), (394.71plusmn;61.63), (294.86plusmn;75.30) mu;m respectively. The mean SFCT of group A and B were thicker than group C, the difference was significant among three groups (F=44.791,P＜0.001). There were difference between group A, B, C in NCT3 mm, TCT3 mm, SCT3 mm and ICT3 mm (F=15.816, 22.823, 15.147, 11.527;P＜0.001). The mean SFCT in affected eyes of unilateral patients was (416.34plusmn;79.44) mu;m, which was thicker than that in unaffected fellow eyes (t=2.897, P=0.007). Conclusion Choroidal thickness increased significantly in affected eyes and unaffected fellow eyes in patients with chronic CSC.
Objective To analyze the status of applying diagnostic test in imaging scientific study internationally and domestically, and to compare the application of the image diagnostic studies of our country with that of abroad. Method We hand-searched the diagnosis tests published in the "Chinese Journal of Radiology", the most influential in China, and in "Radiology’’, the most influential abroad, from 1998 to 1999 respectively. Then we evaluated each of the diagnosis tests according to the international standards. Results We searched 408 original articles in "Chinese Journal of Radiology" in which the diagnostic test articles were 12%, and 796 original articles in "Radiology" with the diagnostic test articles 23% from 1998 to 1999 respectively. In these diagnosis tests, by comparing the "Chinese journal of radiology" with the "Radiology", it was found that 19% applied blind comparison with Gold Standard, 28% calculated sensitivity, specificity and accuracy, 9% both calculated negative predictive value and positive predictive value and none calculated likelihood ratios in the former versus 64%, 57%, 33% and 26% and 3% respectivdy in the latter. Conclusions Compared with the international level, both the quality and the quantity of the diagnosis tests applied in the specialty of imaging scientific study in China are much lower and far from meeting the clinical requirement. Improving the methods of scientific study and carrying on more diagnosis tests with high qualities are of important significance in improving the diagnostic level of imaging.
Objective To evaluate the morphological changes of retinal neuroepithelium of central serous chorioretinopathy (CSC) by Fourierdomain optical coherence tomography(FD-OCT). Methods FD-OCT scan was performed on 92 eyes of 88 patients with CSC. The CSC diagnosis was established by international visual acuity chart, slit-lamp microscope, direct/indirect ophthalmoscope, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). 6 mm horizontal line OCT scan was performed utilizing the infrared light emitted by diode, the scan depth was 2 mm with a 6 mmtimes;6 mm transverse area. The vertical and horizontal resolution was 5 mu;m and 18 mu;m respectively. The scan mode was 512times;128. Results The uplift of retinal neuroepithelium, separation or abnormal band of retinal pigment epithelial (RPE) were found in all eyes. There were 83 eyes (90.22%) of pigment epithelial detachment (PED), 68 eyes (73.91%) of nodular protruding of RPE, 5 eyes (5.43%) of localized RPE defects in the PED lesion, 36 eyes (39.14%) of dust-like reflects in the subretinal space and 59 eyes (64.14%) of granular deposits in the subretinal space. Conclusion Fourier-domain OCT scans can detect detailed morphologic changes in the retina of CSC patients.
ObjectiveTo observe the characteristics of magnetic resonance angiography of (MRA) ophthalmic artery in patients with diabetic retinopathy (DR).MethodsA total of 36 eyes of DR patients (DR group) diagnosed by clinical examination were included in the study. Among them, there were 42 eyes in 21 males and 15 eyes in 15 females. The average age was 55.2 years old. The average duration of diabetes was 7.56 years. All eyes were examined by MRA and fluorescein fundus angiography (FFA) in the ophthalmic artery. At the same time, 24 eyes of 12 patients were examined by computed tomography angiography (CTA). Twenty-two healthy volunteers with age and gender matching were selected as the control group. Among them, there were 13 males and 9 females. All patients underwent MRA examination of the ophthalmic artery; at the same time, 5 eyes of 5 eyes were examined by CTA. MRA and CTA were classified into three grades according to the development condition and shape change of the ophthalmic artery. 0 grade : no abnormality; grade Ⅰ: mild lesion; grade Ⅱ: obvious lesion. According to the results of FFA examination, it was divided into no obvious disease stage, background stage, proliferative stage, proliferative stage. The morphological features of the MRA of the ophthalmic artery in the DR group and the control group were compared. The relationship between the MRA grading of the ophthalmic artery and the FFA staging was observed in the DR group. The consistency analysis between the MRA and CTA grades of the ophthalmic artery in the DR group was performed by Kappa test; the relationship between the MRA grade and the FFA staging of the ophthalmic artery was analyzed by Spearson correlation analysis of the same data with two-way ordered attributes.ResultsIn 44 eyes of the control group, the MRA in grade 0 and Ⅰ of the ophthalmic artery were 41 and 3 eyes, respectively; all eyes of the CTA examination of the ophthalmic artery were grade 0. In 72 eyes of the DR group, the MRA in grade 0, Ⅰ, and Ⅱ of the ophthalmic artery were 28, 28, and 16 eyes, respectively. Among the 24 eyes examined by CTA, there were 13, 6, and 5 eyes in grade 0, Ⅰ, and Ⅱ, respectively. In the DR group, the classification of MRA and CTA of the ophthalmic artery was highly consistent (Kappa value = 0.86). There were significant differences in the number of eyes with different grades of MRA in the DR group and the control group (Z=-5.74, P=0.000). In 72 eyes of the DR group, there were 8, 12, 22, and 30 eyes in no obvious disease stage, background stage, proliferative stage, and proliferative stage, respectively. Correlation analysis showed that there was a significant correlation between MRA grading and FFA staging in the DR group (r=0.405, P=0.000).ConclusionsMRA can show the changes of ophthalmic artery morphology and reflect DR staging to a certain extent. It has a high consistency with FFA vascular changes.
