The diagnosis and treatment of age-related macular degeneration (AMD) is an international hotspot of eye research. Successful clinical applications of antiVEGF drugs promoted both basic research and clinical practice of AMD. A number of countries and professional societies have established clinical guidelines for AMD management, including the epidemiology, risk factors, diagnosis, classification, and treatment process. These AMD guidelines are mostly based on recently published results of clinical trials, provided good model of evidence based medicine. It is urgent and necessary to have our own guideline which is suitable for Chinese patients. Reviewing and learning existed guidelines will help us to improve the clinical practice of AMD in China.
PURPOSE:To search for the occult choroidal neovascularization(CNV)of age-related macular degeneration (AMD)with macular hemorrhage using indocyanine green angiography(ICGA). METHODS:FFA and ICGA were performed in a series of 22 cases(24 eyes)of AMD with macular hemorrhage,and the findings of both angiograms were compared each other. RESULTS :ICGA was found to be superior than FFA in evaluating the occult CNV of AMD with hemorrhage owing to the following outstanding findings in this series,i.e,in judging the presence,position,number and range of the occult CNV. CONCLUSION:ICGA is an important technique in diagnosing the subretinal occult CNV in AMD with macular hemorrhage,and useful in selecting therapeutic measures including photocoagulation and surgical treatment. （Chin J Ocul Fundus Dis,1997,13: 146-149）
Objective To analyse the indocyanine green angiographic findings in contralateral eyes of patients with unilateral exudative age-related macular degeneration(AMD). Methods Fundus photograph,fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA) were performed in a series of 70 patients with unilateral AMD and drusens and pigmentary changes in the macular region in contralateral eyes.The findings of fluoroangiograms were observed and analysed. Results ICGA revealed the characteristics of the contralateral eyes as follows:(1)Drusen could be hypofluorescent,hyperfluorescent or normal fluorescent;(2)14 eyes revealed plaque-like late hyperfluorescent;(3)13 eyes revealed choroidal filling defect;(4)18 eyes revealed pindot-like clusters of late hyperfluorescence. Conclusion ICGA is useful in evaluating the lesions and circulation disturbance of the contralateral eye,and may help to find the risk factors of developing future exudative changes. (Chin J Ocul Fundus Dis, 1999, 15: 216-218)
Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.
Objective To observe the fundus characteristics of human immunodeficiency virus with acquired immune deficiency (HIV/AIDS). Methods A total of 1041 HIV/AIDS patients were enrolled in this study. The patients included 882 males (88.70%) and 159 females (11.30%). The patientsprime; ages ranged from 12 to 73 years, with a mean age of 41 years. The median time of HIV/AIDS diagnosis was 12 months, which ranged from one month to 10 years. HIV infection was acquired through sexual contact, intravenous drug use, blood transfusion or mother-to-child transmission in 475 patients (45.63%), 508 patients (48.80%), 44 patients (4.25%) and 14 patients (1.34%), respectively. Ocular examinations (vision acuity, slit lamp microscope and fundus examination) were performed on recruited patients with HIV/AIDS. Additional exams (intraocular pressure, fundus photography and fundus fluorescein angiography) were done if abnormal ocular fundus was found. The ocular manifestations were diagnosed according to clinic reference. Results Ocular manifestations of HIV/AIDS were detected in 247 patients (23.73%). Of 247 patients, the most common ocular manifestation was HIV retinopathy, which was present in 132 patients (53.44%); cytomegalovirus retinitis (CMVR) was second place, affecting 70 participants (28.34%). Clinic findings of HIV retinopathy included retina microaneurysm, hemorrhage along the blood vessel with cotton-wool spots, while irregular dry edge, granular appearing border, were present in CMVR, and the optic nerve may be affected. Fluorescein angiogram of HIV retinopathy demonstrated that hemorrhage was shown as sheltered fluorescence, with b fluorescence without leakage in center of hemorrhage. Fluorescein angiogram of CMVR demonstrated significant hemorrhage appearing as sheltered fluorescence with leakage and/or transparent fluorescence. The optic disk and lesioned area were stained with fluorescence. Conclusions There are various HIV/AIDS related ocular manifestation. HIV retinopathy and CMVR are common ocular manifestations. The main clinical findings of HIV retinopathy are hemorrhage and/or cotton-wool spots, while irregular granular appearing edges and hemorrhage were observed in CMVR.
Objective To study the ultrasonographic manifestation character of age-related macular degeneration (AMD). Methods The ultrasonographic manifestation of thirty-five cases (38 eyes) of AMD diagnosed by fundus fluorescein angiography (FFA) with positive findings of ultrasonic B-scan were analysed． Results The ultrasonic appearance of interlamellar transaudient cleft were found in 26 eyes, in which FFA appearance were serous detachment of pigment epithelium and subretinal neovascularization, 5 of them associated with small excavation of choroid, 4 of them associated with b echo belt at the posterior edge of the interlamellar transaudient cleft in which the FFA appearance was extensive subretinal neovascularization．In another 4 eyes with choroidal hematoma under FFA revealed thin echo light spots in the interlamellar transaudient cleft． There was scar-staining in the other 8 eyes in which the ultrasonic appearance showed an unequal thickening of the ocular wall in the posterior pole,unequal echo of interior edge and irregular inner echo． Conclusion The main ultrasonographic manifestation of AMD is the presence of interlamellar transaudient cleft in the thickened ocular wall. (Chin J Ocul Fundus Dis,2000,16:228-230)
Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with human immunodeficiency virus (HIV) retinopathy. Methods Eighty eyes of 52 AIDS patients with HIV retinopathy were enrolled in this study. The patients included 42 males (67 eyes) and 10 females (13 eyes). The patients ages ranged from 16 to 78 years, with a mean age of (43plusmn;12) years. All patients' visual acuity, intraocular pressure, slit-lamp microscopy and mydriatic indirect ophthalmoscopy, fundus color photography and CD4+ T cell count was documented. Experienced ocular fundus doctors carried out fundus examinations. Retinopathy characteristics were recorded. Seventeen patients (24 eyes) were followed for a period between two days to two years, with a median of 125 days. We failed to follow up the remaining 35 patients (56 eyes) due to death or moving away. Results Among 52 patients (80 eyes), 28 patients (56 eyes, 70.0%) had bilateral HIV retinopathy and 24 patients (24 eyes, 30.0%) had unilateral HIV retinopathy. Cotton-wool spots (CWS), mostly located close to temporal peripapillary vessels, were found in 46 patients (72 eyes, 90.0%). Six patients (eight eyes, 10.0%) were found to have flaming or spotting hemorrhage located in posterior pole. Among 72 eyes with CWS, 57 eyes were found to have CWS only and 15 eyes were found to also have retinal hemorrhage, mostly located near CWS. Among 24 eyes of 17 followed-up patients, three eyes of three patients were found with no significant changes during the less than two week follow-up. In 18 eyes of 11 patients, CWS or hemorrhage disappeared after one to three months without treatment and in five eyes new CWS or hemorrhage were found in other parts of the posterior pole. Three eyes of three patients initially considered as lint plaque-like lesions were eventually detected with CMVR as lesions during one to five months follow-up. Conclusion CWS are the most common ocular lesions in HIV retinopathy.
Objective To observe and estimate the image characters of indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) in atrophic age-related macular degeneration(AMD) and macular drusen. Methods FFA, ICGA and fundus photography were performed on 95 eyes of 73 atrophic AMD patients, in cluding 19 patients (26 eyes) with depigmentation and atrophy of retinal pigment epithelium (RPE), 15 (30 eyes) with macular drusen, and 39 (39 fellow eye) with unilateral exudative AMD.Results In 26 eyes with depigmentation and atrophy of RPE, the result of FFA of 24 eyes with depigmentaion showed patch hyperfluore scence, and of ICGA showed patch hyperfluorescence and hypofluorescence on the late photographs; in 2 eyes with maplike atrophy of RPE, the result of FFA showed patch hyperfluorescence, and of ICGA showed choriocapillaris defect with sharply demarcated boundaries and hypofluorescence of large choroidal vessels. In 30 eyes with macular drusen, the result of FFA of 8 eyes with hard drusen showed hyperfluorescence, and of ICGA showed patch and spot hyperfluorescence; the result of FFA of 16 eyes with soft drusen showed hyperfluorescence, and of ICGA showed persistent patch hypofluorescence intermixed with cluster hyperfluorescence; and the result of FFA of 6 eyes with both soft and hard drusen showed hyperfluorescence, and of ICGA showed patch hyperfluorescence intermixed with hypofluorescence. When it was hypofluorescence in ICGA in patients with macular drusen, larger quantity and range of fluorescence were found in FFA than in ICGA; when it was hyperfl uorescence in ICGA, smaller quantity and range of fluorescence were found in FFA than in ICGA. In 39 fellow eyes of unilateral exudative AMD, 32 or 31 eyes, examined by ICGA or FFA, had abnormal fluorescence of drusen and depigmentation and atrophy of RPE damage.Conclusions Simultaneous examination of IC GA and FFA can be useful for accurate evaluation of fundus image characters of types of angiography in atrophic AMD.(Chin J Ocul Fundus Dis，2003，19：79-82)
ObjectiveTo study the prevalence of age-related macular degeneration (AMD) in the population aged 50 and over in Qidong County of Jangsu Province. Methods3644 individuals from 4 villages were randomly selected by clustering sampling method, according to the household registration information and door to door visits. Visual acuity was measured by modified Bailey-Lovie E logMAR chart. The examination of eyelids, cornea, lens and fundus were also carried out. The diagnosis of AMD was made according to the clinical hierarchy system by Age-Related Eye Diseases Study. χ2 test was used to analyze the prevalence of AMD and its related factors. ResultsAmong 3644 selected individuals, 2985 individuals received examination with a participating rate of 81.92%. In total 97 patients (136 eyes) had AMD with a prevalence rate of 3.25%. Among them, 71 patients (105 eyes) had early stage of AMD (2.38%); 26 patients (31 eyes) had late stage of AMD (0.87%). In these late stage patients, there were 9 patients (13 eyes) of exudative lesions (0.30%). There were 32 male (3.11%) and 65 female (3.32%) patients. There was no statistically significant difference between male and female prevalence (χ2=0.29, P > 0.05). Correlation analysis results showed that the long-term smoking (χ2=15.19) and heart cerebrovascular disease (χ2=81.50) was associated with AMD (P < 0.05). ConclusionsThe prevalence rate of AMD is 3.25% in the residents aged 50 and above in the rural area of Qidong County, Jangsu Province. Long-term smoking, high blood pressure and cardiovascular disease are the risk factors of AMD.
Objective To investigate the manifestations of indocyanine green an giography (ICGA) of the choroidal neovascular membrane (CNV) and the relationship with histopathological changes in patients with age-related macular degeneration (AMD). Methods Twenty-one eyes of 21 patients with AMD diagnosed by ICGA were classified into three types based on ICGA findings: developing type in 9 eyes , degenerating type in 9, and stabilizing type in 3. CNV was extracted by vitrectomy and the histopathological characteristics of CNV was observed under the light and electron microscope. Results The histopathological characteristics of the specimens of developing type revealed abundant CNV partly enwrapped with non-pigmental cells and fibrous tissue or a few pigmental cells; degenerating type revealed reduced activation duration of CNV, many pigmental cells and a little fibrous tissue; stabilizing type revealed a mass of fibrous tissue，few CNV and nonexistence of pigmental cells. Conclusion The histopathological characteristics of exudative AMD may be related to the manifestations of ICGA. (Chin J Ocul Fundus Dis，2004，20：71-74)