Objective To observe the clinical features of acute zonal occult outer retinopathy (AZOOR).Methods Eighteen patients (18 eyes) with AZOOR were enrolled in this study. All the patients were examined for corrected visual acuity, fundus examination, visual field and electroretinography (ERG). For part of these patients, fluorescein angiography (FFA), optic coherence tomography (OCT), visual evoked potential (VEP) and multifocal ERG (mf-ERG) were performed. Clinical features were observed. Comparative analysis was performed on the electrophysiological results between affected eyes and fellow eyes. The consistency of OCT, visual field and mf-ERG results was investigated.Results The patients included three males and 15 females. All patients were unilateral involved. 16 eyes (88.9%) were myopia, two eyes (11.1%) were emmetropia. 11 eyes (61.1%) have normal fundus; single yellow-white punctuate lesion or old RPE lesion near macular were found in three eyes (16.7%); depigmented zones in temporal retina were found in four eyes (22.2%). All central visual field results were abnormal, but peripheral visual field results were normal. OCT findings included irregularity, absence or breaks of the photoreceptor inner segment/outer segment (IS/OS) junction. Amplitudes of full-field ERG were reduced in the affected eyes (t=3.516，2.689，3.103，3.517，2.999，3.309；P＜0.05), and implicit times were delayed in most responses except for rod response (t=1.023,P=0.306). Amplitudes of P100 wave of visual evoked potential were reduced statistically (t=2.04,P=0.041), but the differences of implicit times between the affected eyes and the fellow eyes were not statistically significant (t=1.687,P=0.092). Amplitude reduction of multifocal ERG existed in all affected eyes. Coincidence was found between results of OCT and mf-ERG. But abnormal zones found by central visual field did not always coincide with those by mf-ERG. Conclusions The majority of patients who develop AZOOR are young women with myopia. Most patients have normal fundus. Central visual field and electrophysiological examinations are always abnormal. Irregularity, absence or breaks of the photoreceptor IS/OS junction can be proved by OCT.
ObjectiveTo assess the consistency of diagnostic results using optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) in the central retinal vein occlusion (CRVO).
MethodsThis is a retrospective case series of 26 eyes of 26 patients with CRVO. There were 10 females (10 eyes) and 16 males (16 eyes). The mean age was (49.19±10.50) years. The mean course of the disease was (27.81±21.60) days. Simultaneous OCTA and FFA were performed in all patients using 7-standard field of Early Treatment Diabetic Retinopathy Study (ETDRS) to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weighted Kappa statistic values. Kappa≥0.75, consistency is excellent; 0.60≤Kappa < 0.75, consistency is good; 0.40≤Kappa < 0.60, consistency is general; Kappa < 0.40, consistency is poor.
ResultsBased on OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21 eyes. Based on FFA, 23 eyes were diagnosed to have microaneurysms, 14 eyes have nonperfused area, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms and optical disc/retinal neovascularization (Kappa=0.772, 0.766; P < 0.01), good for nonperfused areas and macular edema (Kappa=0.703, 0.600,P < 0v01).
ConclusionThere is high consistency between OCTA and FFA in the diagnosis of microaneurysms, macular edema, nonperfused areas and optical disc/retinal neovascularization in CRVO patients.
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.
ObjectiveTo observe the OCT characteristics of lamellar hole-associated epiretinal proliferation (LHEP).MethodsA retrospective case analysis. A total of 128 patients (133 eyes) with lamellar macular hole (LMH) and 202 patients (212 eyes) with full-thickness macular hole (FTMH) diagnosed by the examinations of spectral-domain OCT (SD-OCT) in Department of Ophthalmology, The Third People's Hospital of Chengdu from January 2013 to December 2016 were included in this study. Among 133 eyes with LMH, there were 53 eyes (39.8%) with LHEP and 80 eyes (60.2%) without LHEP. Among 212 eyes with FTMH, there were 12 eyes (5.7%) with LHEP and 200 eyes (94.3%) without LHEP. The mean age of LMH with or without LHEP patients were 70.88±10.98, 64.76±13.60 years old, respectively. The difference of mean age between LMH with or without LHEP patients was statistically significant (U=1521.5, P=0.006). The inner diameter, median diameter and base thickness of the LMH, the height, base diameter and minimum diameter of FTMH were measured by SD-OCT. The traction index (THI) and the macular hole index (MHI) were calculated. An independent sample t-test or rank-sum test was used to compare the inner diameter, median diameter, and base thickness of the LMH in patients with or without LHEP, and χ2 test was used to compare the injury rate of ellipsoid zone.ResultsOf the LMH patients with or without LHEP, the inner diameter were 611.15±209.83 and 521.70±198.05 μm, the median diameter were 961.22±571.09 and 497.01±172.30 μm, the base thickness were 99.83± 38.69 and 154.12±43.17 μm. The differences of the inner diameter, median diameter and the base thickness between LMH patients with or without LHEP were statistically significant (t=2.490, 5.747, －7.395; P=0.014, 0.000, 0.000). Among the 53 eyes with LHEP, There were 50 eyes (94.34%) were injured in ellipsoid zone among 53 eyes with LHEP, while 17 eyes (21.25%) were injured in ellipsoid zone among 80 eyes without LHEP. The injury rate of ellipsoid zone between LMH patients with or without LHEP was statistically significant (χ2=68.126, P=0.000). In 12 eyes of FTMH with LHEP, there were 10 eyes with THI＜1.0 and MHI＜0.5.ConclusionCompared with the LMH without LHEP, the LMH with LHEP has larger inner diameter and median diameter, thinner base and higher injury rate of ellipsoid zone.
Objective To observe the relationship between shallow optic cup，small disc and occurrence in patients with nonarteritic anterior ischemic optic neuropathy (NAION).Methods Ninetysix patients（96 diseased eyes）who accorded with the diagnosis criteria for NAION，with duration ge; three months and optic disc edema in paracmasis were selected. The fellow eyes of 96 NAION patients and 80 normal eyes were selected in our study. The horizontal and vertical disc and cup diameters，optic cup depth, and peripapillary retinal nerve fiber layer (RNFL) thickness were measured by quot;crossquot; and quot;ringquot; scan of optical coherence tomography (OCT，Humphrey 2000，German Carl Zeiss Company) inspection system. The cup depth were classified four grades by cup shape according to OCT images：GradeⅠ，bottom of optic cup above the anterior plane of peripapillary neuroepithelial layer（PNL）；GradeⅡ，bottom of optic cup above the plane of PNL；Grade Ⅲ，bottom of optic cup between the plane of PNL and choroidal pigment epithelium；Grade Ⅳ，bottom of optic cup under the plane of choroidal pigment epithelium connection. The grades of optic cup and value in three groups were statistically analyzed. The follow up ranged from six months to three years.Results The disc diameter in horizontal scanning of diseased eyes，fellow eyes and normal eyes were (1.29plusmn;0.19), (1.32plusmn;0.17), (1.40plusmn;0.15) mm，and diameters in vertical scanning were (1.52plusmn;0.14), (1.49plusmn;0.17), (1.60plusmn;0.22) mm, respectively. Compared the diseased eyes and fellow eyes with normal eyes，the difference were statistically significant in horizontal scanning (t=4.291,3.315; P＜0.05) and in vertical scanning (t=2.812, 3.654; P＜0.05). Compared the diseased eyes with fellow eyes，the difference of average diameter were not statistically significant in horizontal and vertical scanning (t=1.153,1.335; P＞0.05). Of the diseased eyes，GradeⅠoptic cup in 36 eyes（37.50），Grade Ⅱ-Ⅲoptic cup in 52 eyes（54.17%），Grade Ⅳoptic cup in eight eyes（8.33%），and GradeⅠ-Ⅲ optic cup in 88 eyes（91.67%）were found. Of the fellow eyes，GradeⅠoptic cup in 18 eyes（18.75%），Grade Ⅱ-Ⅲoptic cup in 69 eyes（71.88%），Grade Ⅳoptic cup in nine eyes（9.34%），and GradeⅠ-Ⅲ optic cup in 87 eyes（9066%）were found. Compared the average RNFL thickness of diseased eyes with the fellow eyes and normal eyes，the differences were statistically significant in temporal, upper, nasal, lower quadrant(t=12.862，10.147，15.046，8.180，12.859，9.562，12.174，8.632；P＜0.001). Compared the average RNFL thickness of the fellow eyes and normal eyes，the differences were not statistically significant in all quadrants（t=1.040，1.576，1.062，1.192；P＞0.05）. During the followup，eight eyes with recurrence which optic cup were GradeⅠand Ⅱin diseased eyes；44 eyes（45.8%）occurred NAION. Correlation analysis showed that there was negative correlation between incidence of fellow eye and optic cup depth(t=-0.757, P=0.000). Conclusion Optic cup and disk in NAION patients are smaller than that in the normal，the anatomical characteristics of shallow cup and small disc was one of the NAION pathogenesis.
ObjectiveTo compare the short-term efficacy of conbercept and ranibizumab for macular edema in central retinal vein occlusion (CRVO)and explore the relationship between the integrity of ellipsoidal zone and visual acuity.
MethodsForty-four eyes of 44 patients with macular edema in CRVO were enrolled into this retrospective and comparative study. There were 15 eyes of 15 males, 29 eyes of 29 females; age ranged from 49-61 years old,with an average age of (54.65±3.10) years. All patients were examined with best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp, fundus photograph, fundus fluorescein angiography (FFA), optical coherence tomography(OCT). BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution acuity. Twenty-three eyes were intravitreal injected with conbercept 0.5 mg (group A) and 21 eyes were intravitreal injected with ranibizumab 0.5 mg (group B). There was no statistical difference of age (t=-1.41), gender (χ2= 0.55),the percentage of hypertension patients (χ2=0.27), average BCVA (t=-2.06), IOP (t=-2.52), central macular thickness (CMT) (t=-1.96), number of different integrity of ellipsoidal zone patients (χ2=1.00) and number of different types of macular edema patients (χ2=1.03) among the two groups (P > 0.05). The change in BCVA and CMT at 3, 6 months between the two groups were compared. The relationship between BCVA at 6 months and BCVA, CMT at baseline were explored. The relationship between three groups of ellipsoidal zone and BCVA at baseline were evaluated. The change of BCVA after treatment between the three groups of ellipsoidal zone were Compared. The number of intravitreal injections between two groups was compared.
ResultsDuring the 3, 6 months after treatment, the mean BCVA were all improved with statistically difference in group A (t=5.13, 7.39; P < 0.05) and group B (t=6.60, 11.52; P < 0.05). There was no significant difference of BCVA at 3, 6 moths between group A and group B (t=-0.99, -0.40; P > 0.05). During the 3, 6 months after treatment, the mean CMT were all decreased with statistically difference in group A (t=11.58, 15.96; P < 0.05) and group B (t=18.77, 35.16; P < 0.05). There was no significant difference of CMT at 3, 6 months between group A and group B (t=-1.52, -1.63; P > 0.05). In both groups,BCVA at 6 months was related to BCVA at baseline (r= 0.44, 0.62; P < 0.05), but not related to CMT at baseline (r=0.19, 0.01; P > 0.05). In the two groups, BCVA at baseline was related to the integrity of ellipsoidal zone (r=0.97, 0.70; P < 0.05). There was statistical difference of the number of intravitreal injections in the two groups (t=-6.88, P < 0.05). There was no systemic or ocular serious side effects during the follow up.
ConclusionsComparing to ranibizumab, conbercept has the same effective to the treatment of macular edema in CRVO, but the number of intravitreal injections is less. The integrity of ellipsoidal zone is related to BCVA.
ObjectiveTo observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreous retinal surgery and the influencing factors of the imaging quality.
MethodsA retrospective case study. A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital. All the subjects were taken vitreous retinal surgery and iOCT scanning. The patients included 46 males and 86 females, with an average age of 61.7 years. 111 cases had macular diseases and 21 cases had vitreous hemorrhage. Cases are divided into high myopia and non-high myopia group according to ocular axial length (AL), 28 eyes in high myopia group (AL≥26 mm),104 eyes in non-high myopia (AL<26 mm).The scanning time, image quality and eye conditions were observed during the operation. The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed.
ResultsThe iOCT images were identified in 124 of 132 subjects, while were not identified in 8 eyes. For the macular area morphology change, iOCT tips and surgeon judgment rate was inconsistent in 22 eyes (16.7%). For the operation guidance value, change the operation rate of 12/132,accounted for 9.1%. The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups (χ2=17.13, P=0.001). Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups (r=3.75, 6.18; P=0.049, 0.013). There were no complications such as endophthalmitis.
ConclusionsThe surgeon can observe morphological changes in the macular area through iOCT which is difficult to be observed by operating microscope and selected reasonable operation method during the surgery. High myopia, corneal edema and operation time affect the image quality.
The abnormalities of retinal vessels such as retinal arteriolar narrowing, arteriovenous nicking, micro-aneurysms, retinal hemorrhages, and cotton wool spot are closely related to systemic diseases including hypertension, diabetes mellitus, cardiovascular disorders, stroke and renal diseases. The modern retinal vessels examination technology has features of quick noninvasive, quantitative standardized and intelligent analysis. Taking advantage of these to fully discover the retinal vascular abnormalities and get deeper understanding of the relationship between its' mechanism and systemic vascular diseases is not only helpful to better diagnose and treat retinal vascular diseases, but also contributes to predicting the risk and prognosis of systemic diseases. We suggest emphasizing on the study of correlation between retinal vascular abnormalities and systemic vascular diseases using modern retinal vessels examination technology. It will provide the preventive clue of diseases of circulatory system by finding out the retinopathy. Meanwhile, correctly treating systemic diseases would get a better prognosis of the retinopathy. They exist side by side and play a part together for providing a better prognosis, which would be a new direction for the doctors and scientists in the new era.
