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.
Objective To observe the characteristics of multiple evanescent white dot syndrome (MEWDS) with modern multimodal imaging modalities. Methods This was a retrospective case study. Eleven patients (11 eyes) diagnosed with MEWDS were enrolled. There were 10 females and 1 male, mean age was 27.6 years (range 15-41 years). The period between disease onset and visiting to the hospital was between 2 to 13 days, the average time was 4.7 days. All the patients underwent examinations of best corrected visual acuity, slit-lamp biomicroscope, indirect ophthalmoscope, fundus color photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT). The mean follow up duration was 3.2 months. The imaging characteristics were compared. Results Fundus color photography showed foveal orange-red granularity in all eyes. FAF showed strong autofluorescence with a vague boundary. FFA showed a variable number of highly fluorescent fine needle-like dots arranged in a ring in the early stage, and fluorescence remained in the late stage. ICGA showed advanced lesions of vague boundary merged into a large plaque of deep retinal hypofluorescence. SD-OCT showed the hyperreflectant material deposit over the retinal pigment epithelium and extending anteriorly through the interdigitation zone, ellipsoid layer, and toward the external limiting membrane. At the site of extrafoveal lesions, SD-OCT revealed the presence of discontinuities or disruptions centered on the ellipsoid zone to include the interdigitation. Conclusions In MEWDS patients, fundus photography showed foveal orange-red granularity; FFA showed early fluorescent dots distributed in a ring pattern; ICGA showed hypofluorescent lesions in the later stage; SD-OCT showed disruption of the interdigitation zone and ellipsoid zone and accumulations of hyperreflective material that was of variable size and shape; FAF showed strong autofluoresce areas that correlated to spots observed with FFA and ICGA.
目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
Objective To discuss the CT appearances and clinicopathologic features of gastrointestinal neuroendocrine neoplasms (GI-NENs). Method The clinical and CT materials of 33 cases of GI-NENs who treated in our hospital from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Results Of the 33 cases, 25 males and 8 females were enrolled. The median age was 62-year old (27–78 years), and the age at diagnosis mainly focused in the 50–70 years period. GI-NENs situation: 12 cases in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The main clinical symptoms included: abdominal pain in 13 cases, dysphagia and obstruction in 9 cases, hematemesis and hematochezia in 8 cases, abdominal distention in 5 cases, stool and bowel habits change in 5 cases, subxyphoid pain in 3 cases, belching in 2 cases, diarrhea in 1 case, protrusion of the neoplasm when defecation in 1 case, obstructive jaundice in 1 case. Seven cases of G1 grade, 6 cases of G2 grade, 15 cases of G3 grade, and 5 cases of mixed adenoneuroendocrine carcinomas were found according to pathologic grading. The immunohistochemical marker: synaptophsin was positive in 31 cases, cytokeratin A was positive in 23 cases, and cytokeratin was positive in 9 cases. The CT appearances of GI-NENs were mainly thickening of the walls and formation of nodules or masses in local area. Moderately homogeneous enhancement (in 20 cases) and irregularly heterogeneous enhancement (in 13 cases) were both commonly seen. In addition, 13 cases of lymphadenophathy, 6 cases of liver metastasis, and 3 cases of lung metastasis were also detected by CT. Conclusions GI-NENs have a preference for elderly male. The most common site of onset is the stomach. Its clinical symptoms and CT appearances are nonspecific, however, the enhancement pattern of the tumors has a certain characteristic.
目的 探讨强直性脊柱炎（AS）受累骶髂关节、腰椎小关节及髋关节的病变CT表现特点，以提高诊断与鉴别诊断水平。 方法 2011年1月－10月对临床确诊的强直性脊柱炎患者44例骶髂关节、28例腰椎及14例髋关节行CT扫描，回顾性分析骶髂关节、腰椎小关节及髋关节的CT表现。 结果 AS患者的CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧，腰椎小关节及髋关节则表现为关节间隙改变、关节面毛糙及囊状破坏、面下骨硬化或吸收等改变。 结论 AS骶髂关节、腰椎小关节及髋关节的CT表现具有一定特征，CT具有重要的诊断及鉴别诊断价值。