ObjectiveTo observe the blood perfusion changes of peripapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).MethodsRetrospective cohort study. Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People’s Hospital of Wuhan University from November 2017 to January 2019 were included in this study. There were 10 males and 9 females, with the mean age of 55.05±7.11 years. Forty eyes of 20 normal subjects matched with NAION patients were included as controls. BCVA, fundus color photography, SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks, 1-2 months, 3-5 months intervals. OCT quantitative measurements: average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL), average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC). OCTA quantitative measurements: average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC), average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD), average vascular density of deep layer retina (aDVD), areas of foveal avascular zone (FAZ). The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed. Independent sample t test, paired sample t test or nonparametric rank sum test were performed for comparison among three groups. Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC, GCC and SVD, RNFL and GCC, RPC and SVD.ResultsAt baseline, the aRNFL, aRPC and aDVD of NAION patients were significantly higher than those of normal controls. Compared with the fellow eyes, the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes. The overall differences of aRNFL, aRPC, aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05). The average sRNFL, sRPC, sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL, iRPC, iGCC and iSVD (P＜0.05). Correlation analysis: at 1-2 months interval, aGCC was positively correlated with aSVD (r=0.482, P=0.037); at 3-5 months interval, aRNFL was positively correlated with aRPC (r=0.631, P=0.037).ConclusionThere is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.
Objective
To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure.
Methods
Prospective clinical case-control study. A total of 26 patients (30 eyes) with acute primary angle-closure glaucoma (APACG) were in the APACG group, whose intraocular pressure were control after a single episode acute primary angle closure; 30 age-and sex-matched healthy subjects (30 eyes) in the control group. All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm×6 mm macular scanning. The parameters included average thickness of entire CP-RNFL, thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The foveal retinal thickness, center retinal thickness (≤1 mm from the fovea), 4 quadrants of macular inner-ring ( > 1 mm but≤3 mm from the fovea) retinal thickness, 4 quadrants of macular outer-ring ( > 3 mm but≤6 mm from the fovea) retinal thickness, average thickness of macular retinal thickness and macular volume were measured and analyzed.
Results
The disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22, 4.12, 3.90, 3.00, 3.23; P < 0.05), rim area was smaller than the control group (t=-2.63, P < 0.05). The average thickness (t=-6.68) and the thickness of superior (t=-5.90), temporal (t=-11.64) and inferior (t=-5.06) quadrants of CP-RNFL, center retinal thickness (t=-2.50), 4 quadrants of macular inner-ring retinal thickness (t=-4.91, -4.88, -2.83, -3.59), nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outer-ring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P < 0.05), and the macular volume (t=-2.69) was significantly smaller than the control group (P < 0.05). There was no statistically difference at nasal CP-RNFL (t=-0.11), foveal retinal thickness (t=-0.59), temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P > 0.05).
Conclusions
In comparison with the healthy subjects, the disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio, C/D vertical diameter ratio in APACG eyes were bigger, while rim area was smaller; the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL, fovea, temporal and inferior quadrants of macular outer-ring retinal.
ObjectiveTo observe the changes of optic disc structure and retinal nerve fiber layer thickness (RNFL) in patients with different degrees of Parkinson's disease (PD).MethodsThirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study. The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients). All the patients underwent OCT examination. The optic disc area, cup area, C/D area ratio, rim volume, disc volume, cup volume, rim area, C/D area, linear C/D, vertical C/D, the thickness of average RNFL, superior, inferior, temporal upper (TU), superior temporal (ST), superior nasal (SN), nasal upper (NU), nasal lower (NL), inferior nasal (IN), inferior temporal (IT), temporal lower (TL) quadrant RNFL thickness. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsOptic disc structure parameters: there was no significant difference in the area of optic disc between the three groups (F=1.226, P＞0.05). The other optic disc parameters were significantly different in the three groups (F=5.221, 5.586, 6.302, 5.926, 5.319, 5.404, 5.861, 6.603; P＜0.05). The cup area, cup volume, C/D area, linear C/D, vertical C/D of the mild to moderate PD group and severe PD group were higher than that of the control group (P＜0.05). The cup area, cup volume, C/D area, linear C/D, vertical C/D of the severe PD group were higher than those of mild to moderate PD group (P＜0.05), the rim area, rim volume and disc volume of the severe PD group were smaller than that of mild to moderate PD group (P＜0.05). The thickness of RNFL: there was no significant difference between the three groups of ST, SN, NU and NL (F=3.586, 2.852, 2.961, 2.404; P＞0.05). The average thickness of RNFL, TU, IN, IT and TL in patients of the mild to moderate PD group and severe PD group were less than that in the control group (P＜0.05). The thickness of the average RNFL, TU, IN, IT and TL in patients of the severe PD group were less than that in the mild to moderate PD group (P＜0.05). With the increase of PD severity, the RNFL of TL and TU thinned most significantly.ConclusionsWith the increase of the severity of PD, the optic disc structure and RNFL thickness changes obviously, showing reduced optic disc area and volume, enlarged cup area and volume significantly enlarged C/D ratio. The average RNFL thickness of PD patients is significantly thinner than that of the controls, and it is the most obvious in the TU and TL quadrant.
ObjectiveTo observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy. MethodsA cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age (F=8.333), sex composition ratio (χ2=0.863), and CCT (F=1.425) among the four groups (P＞0.05); while, there were significant differences in AL (F=69.956), diopter (F=37.711), visual field index (VFI) (F=43.254) and mean defect (MD) (F=49.793) among the four groups (P＜0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. ResultsTilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased (P＜0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group (P＜0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD (r=－0.302, －0.235; P=0.002, 0.017), and negatively correlated with VFI (r=－0.291, －0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group (P＜0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group (P＜0.05). The results of correlation analysis showed that the cup-disc area ratio (r=－0.584), the average BMO (r=0.650) had the highest correlation with the average RNFL thickness (P＜0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses (r=0.431, 0.656, 0.362, 0.375; P＜0.05); the optic disc rim area, the average BMO were positively correlated with MD (r=0.449, 0.618) and VFI (r=0.449, 0.605) (P＜0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD (r=－0.346,－0.559) and VFI (r=－0.312,－0.548) (P＜0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group (P＜0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group (P＜0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI (r=－0.402, P＜0.001), VFI (r=－0.405, P=0.001); LC was positively correlated with MD and VFI (r=0.403, P＜0.001), VFI (r=－0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. ConclusionsOptic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance．
ObjectiveTo observe the changes of glaucoma optic nerve head (ONH) parameters and macular ganglion cell complex (GCC) structure in preperimetric glaucoma (PPG) patients.
Methods Eighteen PPG patients (18 eyes, PPG group), 22 primary open-angle glaucoma (POAG) patients (22 eyes, POAG group), and 20 patients (20 eyes) with physiologic large optic cup (physiological big optic cup group) were included in this study. Seventeen healthy volunteers (17 eyes) were the normal control. The optic nerve head and macular was scanned by fourier-domain optic coherence tomography (FD-OCT) for all subjects. The following 15 parameters, including nerve fiber layer thickness (RNFL), the optic disk rim volume (RV), optic nerve head volume (NHV), optic disc area (ODA), rim area (RA), cup volume (CV), cup/disc area ratio (CDAR), vertical cup/disc ratio (VCDR), horizontal cup/disc ratio (HCDR) and optic cup area (CA), macular GCC, superior GCC, inferior GCC thickness, focal loss of volume (FLV) and global loss of volume (GLV), were measured at 10 different quadrants. The relationship between macular GCC thickness or optic disc RNFL thickness and RA was analyzed by simple linear regression analysis.
ResultsThe RNFL thickness of PPG patients was (99.29±19.93) μm (superior quadrant), (97.29±22.86) μm (inferior), (114.61±15.64) μm (superior temporal, ST), (119.22±26.19) μm (inferior temporal, IT), (116.11±39.32) μm (superior nasal, SN), (111.33±37.65) μm (inferior nasal, IN), (77.56±17.22) μm (temporal upper, TU), (76.78±10.34) μm (temporal lower, TL), (88.94± 42.54) μm (nasal upper, NU), and (82.33±43.83) μm (nasal lower, NL) respectively, which was thinner than normal control group and physiologic large cup group, but thicker than POAG patients. Compared to normal controls and physiologic large cup patients, PPG patients also had 4 parameters reduced (RV, NHV, ODA and RA), and 5 parameters increased (CV, CDAR, VCDR, HCDR and CA), the differences are statistically significant (P < 0.05). However, these parameters were similar to POAG patients (P > 0.05). For macular GCC parameters, PPG patients also had 3 parameters reduced (average GCC, superior and inferior GCC thickness), and 2 parameters increased (GLV and FLV) compared to normal control group and physiologic large cup patients (P < 0.05). However, these parameters were similar to POAG patients (P > 0.05).Simple linear regression analysis showed that, with the GCC macular thinning, reducing the number of ganglion cells reduced, optic disc RNFL thickness became thinner (regression coefficient=1.25, P=0.00) and RV reduced (regression coefficient=0.037, P=0.00).
ConclusionsPPG patients and normal control had a similar distribution of optic disc RNFL. Five parameters (RV, NHV, ODA, RA, macular GCC thickness) were less than normal control and physiological big optic cup group, but had no significant differences compared with POAG group.
Objective To observe the changes of optic disc structure in patients with high myopia and the correlation with the morphological markers of the fundus. MethodsA retrospective study. From July 2018 to January 2020, 90 patients (155 eyes) diagnosed as high myopia in Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University were included in the study. Among them, there were 31 males (52 eyes) and 59 females (103 eyes), with age of 57.1±14.2 years old and axial length (AL) of 28.5±2.6 mm. According to the classification of myopic macular degeneration, patients were divided into 4 groups based on forms and degree of lesions, including non-pathological myopia group, mild traction lesions group, severe traction lesions group and neovascular lesions group, 35, 58, 41, 21 eyes, respectively. The digitized fundus photographs and an Image J system were used to measure the horizontal, vertical, maximal, and minimal diameter of the optic disc, the horizontal and vertical diameter of the parapapillary δ zone and γ zone, ovality index, distance between the most superior point of the temporal superior arterial arcade and most inferior point of the temporal inferior arterial arcade (VDA), angle between the temporal arterial arcade and optic disc (angle kappa), distance between the optic disc center and the fovea (DFD), angle between the horizontal disc axis and the disc–fovea line (DFA). The correlation between the diameter of the optic disc and other parameters was analyzed. Univariate and multivariate analysis were used to compare differences between groups. ResultsThe horizontal diameter of the optic disc was positively correlated with the horizontal diameter of the δ zone (r=0.300, P＜0.001), Kappa angle (r=0.260, P=0.003), and elliptic index (r=0.650, P＜0.001); it was negatively correlated with DFD (r=－0.190, P=0.030). Optic disc vertical diameter and optic disc horizontal diameter (r=0.280), δ-zone horizontal diameter (r=0.330) and vertical diameter (r=0.460), γ-zone horizontal diameter (r=0.430) and vertical diameter (r=0.390), DFD (r=0.390) was positively correlated (P<0.001); it was negatively correlated with DFA (r=－0.210, P=0.001) and Kappa angle (r=－0.210, P=0.004). Compared with the non-pathological myopia group, there were statistically significant differences in the horizontal and vertical diameters of the optic disc in the severe traction disease group (P＜0.05). Among them, the horizontal diameter difference did not depend on the eye axis and age difference; the vertical diameter difference was caused by the eye axis difference. Compared with the non-pathological myopia group, the difference in the horizontal diameter of the optic disc in the neovascular disease group was statistically significant (P＜0.05), and did not depend on the difference in the axis and age; the difference in the vertical diameter of the optic disc was not statistically significant (P＞0.05). ConclusionThe morphology of optic disc was related to several fundus morphological markers, which was differentiated according to the age, AL and the degree of disease in patients with high myopia.
Optic disc drusen (ODD) is an acellular deposit located in front of the cribriform of the optic disc. ODD has been much underdiagnosed due to few obvious clinical symptoms. These clinical symptoms are easily confused with optic disc edema caused by systemic high-risk diseases. The current mainstream view is that optic nerve fiber axon metabolism is disordered, leading to intracellular mitochondrial calcification. After axon chronic disintegration, calcified mitochondria continuously release outside the cell, resulting in a much higher concentration of extracellular calcium than inside the cell. The continuous deposit and accumulation of extracellular calcification fuse to small calcified corpuscles, which lead to ODD formation. OCT enhanced deep imaging can detect ODD sensitively, and its image feature is a weak reflection core completely or partially surrounded by a strong reflection edge. ODD is one of the common causes for optic disc crowding. During adolescence, the accumulating calcified bodies buried in the deep optic disc gradually extrude and migrate to the superficial optic disc, which turn into superficial ODD. As a consequence, part of these ODD patients rapidly progress during adolescence and generally become stable in adulthood with anterior ischemic optic neuropathy, or other vascular complications.
Non-arteritic ischemic optic neuropathy (NAION) is a neurological disease due to poor perfusion in optic disk. It causes severe visual function impairment, characterized by loss of vision and visual field defect. Optical coherence tomography (OCT) is vital for detecting anterior laminar depth, peripapillary?nerve?fiber layer thickness, ganglion cell complex thickness and peripapillary choroid thickness change in eyes with NAION at different course of the disease. In addition, OCT features are in accordance with visual function impairment. OCT angiography (OCTA) reveals retinal and choroidal vasculature networks in optic and macular area. OCTA revealed vasculature perfusion decline in eyes with NAION, even if their visual sensitivity and visual evoked potential were normal. Studying OCT and OCTA features is vital for exploring the pathogenesis and prognosis of NAION.
ObjectiveTo evaluate the clinical features of 18 cases of juxtapapillary capillary hemangioma.MethodsIn 18 cases of 18 cases of juxtapapillary capillary hemangioma,the clinical datd of 19 eyes,the results of funds fluorescein angiography(FFA) of 16 eyes ,and the follow-up observation of 7eyes were retrospectively analyzed.ResultsIn 18 cases,the sex retio of male and female is 1:2 with the average age of 28.9 years.Peripheral retinal angioma was found in 3 cases(4eyes). In19 eyes,thr center of hemangioma was located beyond the rim of optic,most of which was in inferotemporal quadrant of the optic (7/19) with the size of 1-2.5 disc diameter (DD).Most of the tumors were red in colour (12/19).In the result of FFA of 16 eyes ,wash-out at the late phase was found in 13 eyes.decreased acuity was found in all 7 cases that were followed up more than 12 months (including 5 cases treated by laser photocoagulation).retinal detachment did't occur in 6 cases without exudative retinal detachment after being follow-up for 54.5 months of the average term.ConclusionMost of the juxtapiallary capillary hemangioma are orange or red oval tumors.The center of hemangioma are located beyond the rim of the optic.The patients often complain gradually decreased visual acuity when they are in prime of their life with exudation and edema in different degree around the tumor,FFA is helpful for the diagnosis and differential diagnosis of this disease.(Chin J Ocul Fundus Dis，2004，20：1-4)
ObjectiveTo observe the differences of horizontal optic disc diameter and cup/disc (C/D) ratio in eyes with different kinds of retinal vein occlusion (RVO).
MethodsA total of 392 eyes from 385 RVO patients diagnosed by fundus fluorescein angiography (FFA) were included in this study. The patients included 192 males and 193 females. The average age was (58.30±11.51) years. The disease duration was from 7 days to 1 month. The eyes were divided into RVO group (356 eyes), RVO combining diabetes mellitus (DM) group (20 eyes) and RVO combining high blood pressure (HP) group (16 eyes). One hundred normal eyes examined by FFA in the same testing period were selected as the control group. Among the 356 eyes in the RVO group, there were 201 eyes with branch RVO (BRVO), 100 eyes with central RVO (CRVO), 17 eyes with hemi CRVO (H-CRVO), and 38 eyes with macular BRVO (M-BRVO). Among the 101 non-ischemic RVO eyes, there were 17 eyes with BRVO, 53 eyes with CRVO, 6 eyes with H-CRVO, and 25 eyes with M-BRVO. Among the 255 ischemic RVO eyes, there were 184 eyes with BRVO, 47 eyes with CRVO, 11 eyes with H-CRVO and 13 eyes with M-BRVO. The diameter of optic cup and disk, and the C/D ratio was measured on fundus infrared radiation (IR) IR30°image by Heidelberg confocal laser fundus imaging system.
ResultsThere was no significant difference of horizontal optic disc diameter among 4 groups (F=1.17, P>0.05). The difference of C/D ratio was significant among 4 groups (F=82.24, P<0.05). The differences of horizontal optic disc diameter and C/D ratio in different kinds of RVO in normal group and RVO group were significant (F=4.49, 61.396; P<0.05). The horizontal optic disc diameter of eyes with CRVO was a little smaller than normal eyes (P<0.05). There was no difference of horizontal optic disc diameter between the eyes with BRVO, M-BRVO, H-CRVO and normal eyes (P>0.05). The difference of C/D ratio was significant between the eyes with BRVO, CRVO, M-BRVO, H-CRVO and normal eyes (P<0.05). The differences of horizontal optic disc diameter and C/D ratio were significant between RVO group (in different kinds of RVO eyes) and control group (F=3.94, 33.16; P<0.05). Compared the horizontal optic disc diameters of RVO eyes with the same subtype, the difference was significant between non-ischemic H-CRVO and ischemic H-CRVO (P<0.05), while the differences were not significant between other non-ischemic RVO and ischemic CRVO (BRVO:P=0.35,CRVO:P=0.86,M-BRVO:P=0.22). The difference of C/D ratio between non-ischemic RVO and ischemic CRVO was not significant (BRVO:P=0.35,CRVO:P=0.48,H-CRVO:P=1.00,M-BRVO:P=1.00).
ConclusionsThe C/D ratio increased with varying degrees in RVO eyes. There is no obvious change in horizontal optic disc diameters except for CRVO eyes.
