Peripapillary intrachoroidal cavitation (PICC) is a common pathological change observed in high myopia. The exact pathogenesis of PICC is still unclear. Expansion and mechanical stretching of the peripapillary sclera, breakage and defect in the retina near the border of the myopic conus and communication between intrachoroidal cavity and the vitreous space may be important segments during the development of PICC. Color fundus photography shows a localized and well-circumscribed peripapillary lesion with yellow-orange colour, often accompanied by fundus changes, such as myopic conus excavation, optic disc tilting and inferotemporal retinal vein bending at the transition from the PICC to the myopic conus. However, the PICC lesion is not easy to be recognized in the fundus photography. Fluorescein angiography shows early hypofluorescence and later progressively staining in the lesion. Indocyanine green angiography shows hypofluorescence throughout the examination. Optical coherence tomography (OCT) is vital in diagnosing PICC. Hyporeflective cavities inside the choroid, sometimes communicating with the vitreous chamber, can be observed in OCT images. OCT angiography indicates lower vessel density or even absence of choriocapillary network inside or around PICC lesions.
ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.
ObjectiveTo observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).MethodsA retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.ResultsThe postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=−11.66, −7.52, −4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,ConclusionsThe macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
The lamina cribrosa (LC) is a complicated collagenous meshwork of trabeculae and laminar pores contain capillaries, nerves and neurogliocytes, which provides structural and nutrient support to the retinal ganglion cell axons as they exit the eye. The intraocular pressure causes direct damage or deformation and remodeling of LC, leads to axoplaxmic transport and blood supply disturbance. The preponderance of evidence suggests that LC is the principal site of glaucomatous damage. The development of optic coherence tomography (OCT) technology has improved the imaging quality of deep structures of the optic nerve head and makes it possible to detect LC. The quantitative research indexes of LC structure include LC depth, laminar curvature, laminar thickness, prelaminar tissue, laminar pore, laminar defect and hemodynamics. To improve the understanding of LC structure, explore the characteristics of LC and understand the biomechanical and hemodynamic pathogenesis of glaucoma, which would be contribute to the application of big data research in the diagnosis and treatment of glaucoma.
As a new and non-invasive imaging technology, optical coherence tomography angiography (OCTA) has been using in ocular fundus diseases, glaucoma and neuro-ophthalmic disorders for more than 4 years. The most valuable and efficient application of OCTA is in detecting neovascular diseases in the macula. The big advantage of OCTA is for diagnosing all kinds of choroidal neovascularization. OCTA can observe blood flow information in different layers of the retina. To a large extent, it changes our diagnostic thinking and pathway in macular diseases. Before acquiring OCTA image, the operator should be well trained to ensure to get high quality images with good signal strength and less artifact. OCTA report should show the segmentation slab that the ophthalmologist wants to see. So far, OCTA has difficulty to reach peripheral retina with default setting. Even so, OCTA has provided much information of blood flow within retinal vascular arcade for evaluating structural and functional changes. We are expecting that the swept source OCTA could give us better observation of the choroidal blood flow. That should be the breakthrough of the new generation of OCTA.
ObjectiveTo observe the macular retinal thickness and volume 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. There were 17 males and 13 females, with the mean age of 63.2±6.4 years and disease course of 3.9±2.4 years. The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients). The macular area was automatically divided into 3 concentric circles by software, which were foveal area with a diameter of 1 mm (inner ring), middle ring of 1 to 3 mm, and outer ring of 3 to 6 mm. The middle and outer ring were divided into 4 quadrants by 2 radiations, respectively. The changes of retinal thickness and macular volume of the macular center and its surrounding quadrants were analyzed. SPSS 16.0 software was used for statistical analysis. One-way ANOVA were used to analyze all data.ResultsCompared with the control group, the retinal thickness and volume in macular center and each quadrant of the mild to moderate PD group and severe PD group were reduced. Compared with the mild to moderate PD group, the retinal thickness and volume in macular center and each quadrant of the severe PD group were reduced. The differences of retinal thickness and macular volume among 3 groups were significant (F=5.794, 5.221, 5.586, 5.302, 5.926, 5.319, 5.404, 5.261, 5.603; P=0.001, 0.007, 0.003, 0.005, 0.000, 0.004, 0.004, 0.006, 0.002). In inner ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the upper and the nasal were the largest, the inferior was followed, and the temporal was the smallest. In outer ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the nasal was the largest, the upper was the second, the temporal and the inferior were the smallest.ConclusionsThe retinal thickness and volume of the macular central fovea and its surrounding areas in PD patients are significantly thinner than that in the healthy subjects. And with the increase of the severity of PD, the macular structure changes obviously, showing macular center and its surrounding macular degeneration thin, macular volume reduced.
ObjectiveTo observe the changes of choriocapillary blood flow area (CBFA) and diameter of ellipsoid zone absence (DEZA) of eyes with idiopathic macular hole (IMH) before and after surgery and its correlation with visual function.MethodsA prospective study. From May 2019 to January 2020, 23 IMH patients (IMH group and fellow eyes group) diagnosed in the Department of Opthalmology of The First Affiliated Hospital of Bengbu Medical College, and 30 age and gender-matched normal controls (30 eyes, control group) were included in this study. All patients were examined the best corrected visual acuity (BCVA) before and after surgery. The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. CBFA and DEZA were obtained by optical coherence tomography angiography (OCTA). CBFA was measured on the choriocapillary with a circle of 1.0 mm radius centered in the fovea. DEZA was the diameter of ellipsoid zone absence horizontally. The differences of CBFA and logMAR BCVA in the three groups, and the changes of CBFA, DEZA, logMAR BCVA in IMH group before and after surgery were analyzed. The measurement data between the three groups were compared by one-way analysis of variance, and the independent samples t test was used for the comparison between the two groups. Pearson correlation analysis was used for the correlation between the index, multiple linear regression analysis were performed between postoperative visual acuity and preoperative parameters.ResultsBefore and 6 months after surgery, the logMAR BCVA in IMH group were 1.26±0.7 and 0.48±0.22, CBFA were 1.49±0.30 and 1.92±0.17 mm2, DEZA were 1 080.22±576.98 and 433.78±423.04 μm, respectively. Compared with those before surgery, BCVA and CBFA were significantly improved, DEZA obviously decreased and the differences were statistically significant (t=5.53, 7.77, 6.58; P＜0.01). CBFA in IMH group was lower than fellow eyes group and control group, the difference was statistically significant (F=14.13, P＜0.01). After surgery, CBFA in IMH group increased similar to that of fellow eyes group (t=4.32, P=0.37), but lower than that of control group with the significant difference (t=4.07, P＜0.01). The results of Pearson correlation analysis showed that logMAR BCVA and DEZA were positively correlated (r=0.69, 0.75; P＜0.01), CBFA and DEZA were negatively correlated (r=−0.49, −0.89; P＜0.05) before and after surgery. Multivariate linear regression analysis showed that the postoperative logMAR BCVA was positively correlated with DEZA (t=2.32, P=0.02).ConclusionsAfter surgery, BCVA and CBFA of IMH eyes are significantly increased, DEZA is obviously reduced. Before and after surgery, logMAR BCVA is positively correlated with DEZA, and CBFA is negatively correlated with DEZA.
Objective To observe retinal thickness changes of diabetes patients after shortterm insulin intensive treatment. Methods Thirty-two eyes of 32 diabetes patients with non-proliferative diabetic retinopathy who underwent short-term insulin intensive treatment were enrolled in this study. There were 12 males and 20 females. The patients aged from 35 to 72 years with a mean age of (56plusmn;9) years. The macular edema index (MED) and morphosis parameter of the optic disc including cup area (CA), rim area (RA), cup volume (CV), rim volume (RV), mean retinal nerve fiber layer thickness (mRNFLT), height variation contour (HVC), the ratio of cup/rim area (C/DAR) in all the patients were measured by Heidelberg retinal tomography Ⅱ (HRTⅡ) before treatment and at the 1st, 3rd and 6th month after treatment. The repeated measurement and leastsignificant difference (LSD) pairwise comparison statistical methods were used to analyze the data. Results At the 1st, 3rd and 6th month after treatment, the 1string and the 2nd-ring MED both decreased after treatment, which were significantly different compared with before treatment (1st-ring: t=2.169, 2.261, 2.306; P＜0.05. 2nd-ring: t=2.293, 2.147, 2.038; P＜0.05).There was no significant difference on the 3rd-ring MED between before and after treatment (t=1.719, 1.145, 1.280; P＞0.05). There was no significant difference in CA, RA, CV, RV, mRNFLT and C/DAR between before and after treatment. There was significant difference in HVC between before treatment and at the 1st month after treatment (t=-2.242, P=0.037), but no significant differences at the 3rd and 6th month after treatment (t=-1.485, -0.527; P＞0.05). Conclusions The MED of diabetes patients decreases within six months after short-term insulin intensive treatment, but there is no obvious change in morphosis parameters of the optic disc.