Central serous chorioretinopathy (CSC) is one of the representative pachychoroid spectrum disease. Although fundus fluorescein angiography and indocyanine green angiography can be used as the gold standard for the diagnosis of CSC, they are invasive examinations, which may bring certain risks in clinical application and cannot help us obtain quantitative parameters. Optical coherence tomography angiography (OCTA), as a non-invasive and quantitative examination, is an important imaging tool for understanding the pathogenesis, diagnosis and treatment of CSC. With the advancement of OCTA, the swept-source OCTA has a satisfying scanning depth, a wider scanning range and a higher resolution. The development of OCTA broadens the horizons of the pathogenesis of CSC, promotes the understanding of the pathophysiology of CSC, and sheds new light for its clinical diagnosis and treatment. Based on OCTA, the choroid and retina in eyes with CSC are presented with qualitative and quantitative changes in vascular system. OCTA-guided CSC treatment and the discovery of prognostic markers based on OCTA challenge the application of traditional imaging techniques in CSC. With the continuous improvement and progress of OCTA technology, traditional angiography combined with OCTA will bring great benefits to the diagnosis and treatment of CSC. This review summarizes the quantitative application of OCTA in the pathogenesis, diagnosis and treatment of CSC.
ObjectiveTo invesitigate the relationship between the macular histomorphological changes and the prognosis of the visual acuity (VA) in eyes with rhegmatogenous retinal detachment (RRD).MethodsOptical coherence tomography (OCT) was performed on 39 patients (39 eyes) with rhegmatogenous retinal detachment. According to the macular neurepithelial configuration displayed by OCT, the patients were divided into 3 groups: neurepithelial edema group, neurepithelial detachment group, and neurepithelial cystoid degeneration group. The time of retinal detachment, pre- and post-operative VA, and macular neurepithelial thickness OCT images were observed and analyzed statistically.ResultsThere was no difference of pre-operative VA among the three groups (P＞0.05). Significant differences of post-operative VA, time of retinal detachment, and neurepithelial thickness were found (P＜0.05). The differences of time of retinal detachment and neurepithelial thickness between neurepithelial degeneration group and cystoid degeneration group were significant (P＜0.05) except the postoperative VA (P＞0.05).ConclusionsThe time of retinal detachment and post-operative VA in patients with retinal detachment relate to the neurepithelial thickness detected by OCT. When the duration of retinal detachment becomes longer, the macular neurepithelium becomes thicker, the histomorphological changes increase, and the post-operative VA decreases. (Chin J Ocul Fundus Dis, 2005,21:83-85)
ObjectiveTo observe the changes of macula in patients with high myopia after phacoemulsification. MethodsIn 20 patients with high myopia with ocular axial length≥27 mm, optical coherence tomography (OCT) was performed on the operative and contralateral eyes 1 week before and after monocular phacoemulsification, respectively, and the OCT images of macula of the operative eyes were observed and compared.ResultsOne week before and after phacoemulsification, the mean macular fovea thickness of the patients with high myopia was (131.6±16.37) μm and (189.75±45.69) μm, respectively, with a significant difference (t=2.805, P=0.01). Simultaneously, the mean macular fovea thickness of the contralateral eyes was (133.5±15.12) μm and (133.5±14.63) μm, respectively, with a non-significant difference (t=1.367, P=0.853). In 20 operative eyes 1 week after phacoemulsification, 3 had vitreous strand around the macula with retinal thickening, 1 had retinoschisis in macular area, and 2 had obvious retinal thickening with slight retinal edema.ConclusionRetinal thickening occurs in the patients with high myopia after phacoemulsification. Traction of retina by vitreous strand or subclinical retinoschisis may occur in some patients.(Chin J Ocul Fundus Dis, 2005,21:90-92)
Objective To observe the characteristics of the images of optical coherence tomography (OCT) performed on the patients with macular edema, and investigate relationship between the retinal thickness at the central fovea and the best corrected visual acuity. Methods Fourty-seven patients (54 eyes) with macular edema diagnosed by direct and indirect ophthalmoscopy, three mirror contactlens, or fundus fluorescein angiography (FFA) underwent OCT which was also performed on 50 healthy individuals as the control. The examination focused on the horizontal and vertical planes crossing the central fovea to measure the thickness of the fovea. The correlation between retinal thickness at the central fovea and best-corrected visual acuity was analyzed, and the images of OCT in the patients with macular edema were classified according to the macular configuration. Results Significant difference of the macular configuration and best-corrected visual acuity was found between the control and macular edema group. Three characteristics were found in the images of OCT in the patients with macular edema: sponge-like retinal swelling in 20 eyes (37.1%), macular cystoid edema in 26 eyes (48.1%), and serous retinal detachment in 8 eyes (14.8%). The statistical analysis showed that there was a negative correlation between the thickness at the central fovea and best-corrected visual acuity of affected eyes (r=-0.569, P=0.000). Conclusions The images of OCT in macular edema include 3 types: sponge-like retinal swelling, macular cystoid edema, and serous retinal detachment. The retinal thickness at the central fovea of the eyes with macular edema was thicker than that of the normal ones, and the thicker the fovea is, the poorer the visual acuity will be. (Chin J Ocul Fundus Dis，2004，20：152-155)
Objective To observe the signal intensity and homogeneity of subretinal hyperreflective material (SHRM) in neovascular age-related macular degeneration (nAMD) and preliminarily analyze its relationship with macular neovascularization (MNV) morphology. MethodsA prospective cross-sectional observational study. Forty-six eyes of 46 nAMD patients with SHRM who initially visited Zhongshan Ophthalmic Center, Sun Yat-sen University from January 1, 2022 to March 31, 2023 were enrolled. Optical coherence tomography (OCT) examination was performed according to a standardized protocol, and 3D Slicer software was used for three-dimensional reconstruction of SHRM lesions. Signal intensity was represented by the mean gray value (mGV) of the three-dimensional lesion area, and homogeneity was represented by the standard deviation of gray values (GV-SD). OCT angiography (OCTA) was used to scan the 6 mm×6 mm area of the macula. FIJI and Angio Tool software were used to measure MNV vascular network total area, perimeter, maximum and minimum diameters, maximum vessel diameter, vascular component area, total number of vascular network junctions and endpoints, vessel dispersion, and mean lacunarity. The ratio of maximum to minimum diameter of the vascular network, average vessel length, vessel density, and vessel fractal index were calculated. Using the mean mGV of the total sample as the standard, the eyes were divided into low-density SHRM group (20 eyes) and high-density SHRM group (26 eyes); using the mean GV-SD of the total sample as the standard, the eyes were divided into homogeneous SHRM group (29 eyes) and non-homogeneous SHRM group (17 eyes). The morphological characteristics of MNV between groups were compared. Independent samples t-test or Mann-Whitney U test was used for between-group comparisons; a multivariate regression model was established to analyze independent factors affecting SHRM signal characteristics. ResultsAmong the 46 eyes of 46 patients, there were 26 eyes of 26 males (56.52%, 26/46) and 20 eyes of 20 females (43.48%, 20/26). The mean age was (65.61±7.50) years. The average vessel length and vessel dispersion in the high-density SHRM group and low-density SHRM group were (6.88±4.56), (11.30±6.31) mm?1 and 41.30±67.26, 13.22±11.34, respectively. Compared with the low-density SHRM group, the high-density SHRM group had significantly lower average vessel length (t=2.645) and higher vessel dispersion (t=?2.090), with statistically significant differences (P=0.012, 0.046). Compared with the homogeneous SHRM group, the non-homogeneous SHRM group had significantly higher total area (t=?2.338), maximum diameter (t=?3.137), and minimum diameter (t=?2.173), with statistically significant differences (P＜0.05). The total number of vascular network junctions in the non-homogeneous SHRM group and homogeneous SHRM group were (90.71±67.34) and (49.34±41.91), respectively; the non-homogeneous SHRM group had significantly more junctions than the homogeneous SHRM group, with a statistically significant difference (t=?2.286, P=0.032). Multivariate regression analysis showed that average vessel length was an independent factor affecting SHRM intensity (odds ratio=0.819, 95% confidence interval 0.705-0.951, P=0.009); there were no independent vascular indicators affecting SHRM reflectivity homogeneity (P＞0.05). ConclusionIn nAMD, compared with low-density SHRM, high-density SHRM has significantly lower average vessel length and higher vessel dispersion; compared with homogeneous SHRM, non-homogeneous SHRM has a larger spatial dimension of the vascular network.
Objective To analyze the pathogenesis of cystoid macular edema (CME) secondary to exudative age-related macular degeneration (AMD). Methods From October 2000 to December 2003, OCT images of 171 eyes of 140 patients with exudative AMD were evaluated. The CNV types were classified according to its location (above or below the RPE), and the correlation between the types of CNV and the development of CME were analyzed. Results Of the 171 eyes with AMD, 89 eyes (52.0%) had CME, and 82 eyes (48.0%) had no CME. Among the 89 eyes with CME, 76 eyes (85.4% ) had an active CNV lesion, and 13 eyes (14.6%) had a disciform scar. Among the 82 eyes without CME, 69 eyes (84.1%) had an active CNV lesion, and 13 eyes (15.9 %) had a disciform scar. In the 76 eyes with both CME and active CNV, 75 eyes (9 8.7%) had a subretinal CNV, which included 61 eyes (80.3%)with a combined CNV complex and 14 eyes (18.4%) with a Gass 2 type CNV, only 1 eye (1.3%) had a Gass 1 type CNV. Whereas, in the 69 eyes with active CNV but without CME, 57 eyes (82.6%) had a Gass 1 type CNV, only 12 eyes (17.4%) had a subretinal CNV. There was a significant difference in the incidence of subretinal CNV between eyes with or without CME (χ2=99.5838, P=0.0000). Conclusions CME formation was highly corre lated with the invasion of CNV into the subretinal space. Subretinal CNV might be the direct cause of CME secondary to exudative AMD.(Chin J Ocul Fundus Dis，2004，20：299-302)
Objective To investigate the characteristics of optical coherence to mography (OCT) in eyes with repaired idiopathic macular hole (IMH) after operation and the relation with recovery of visual acuity. Methods The characteristics of OCT images of 24 patients (25 eyes) with repaired IMH after vitrectomy,internal limiting membrane（ILM）peeling and auto-serum healing were analyzed retrospectively. In the patients with IMH, the macular hole was found in 9 eyes at st age II, 13 eyes at stage III, and 3 eyes at stage IV. Examinations of best-corrected visual acuity, slit-lamp biomicroscopy with fundus contact lens, fundus photography, fundus fluorescein angiography(FFA) and OCT were performed on the patients 3 to 24 months after surgery. Results OCT images of the repaired IMH were categorized into 3 patterns: U-type (5 eyes ) with relative normal foveal contour; V-type (7 eyes) with steep foveal contour;W-type (13 eyes) with foveal defect of neurosensory retina, but without warped hem of retinal hole or cystic formation. Postoperative visual acuities were improved in all of the patients and the best ones were in group U-type. Conclusion Characteristics of OCT images of repaired IMH may be related to the postoperative visual acuity. (Chin J Ocul Fundus Dis，2004，20：90-93)
ObjectiveTo observe and analyze the influencing factors for the prognosis of anti-vascular endothelial growth factor (VEGF) drug treatment in patients with macular neovascularization (MNV) under 45 years old. MethodsA retrospective clinical case study. A total of 89 MNV patients with 96 eyes who were diagnosed and treated with anti-VEGF drugs in Department of Ophthalmology of The Second Hospital of Lanzhou University from January 2020 to January 2024 were included in the study. The ages of all patients were ＜45 years old. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations; 49 eyes underwent OCT angiography (OCTA) examination. The BCVA examination was carried out using the international standard visual acuity chart and was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity for statistics. The macular foveal thickness (CMT) was measured using an OCT instrument. The size of the MNV lesion was measured using the software of the OCTA self-contained device. The affected eyes were given intravitreal injection of anti-VEGF drugs once, and then the drugs were administered as needed after evaluation. The follow-up time after treatment was ≥6 months. During the follow-up, relevant examinations were performed using the same equipment and methods as before treatment. The last follow-up was taken as the time point for efficacy evaluation. According to the OCT image characteristics of the MNV lesions, the affected eyes were divided into the fibrous scar group and the non-fibrous scar group, with 52 (54.16%, 52/96) and 44 (45.83%, 44/96) eyes respectively. Comparing the CMT and BCVA at the last follow-up with those at the baseline, the affected eyes were divided into the CMT reduction group, the CMT increase group, the BCVA improvement group and the BCVA reduction group, with 66 (68.75%, 66/96), 30 (31.25%, 30/96) eyes and 74 (77.08%, 74/96), 22 (22.92%, 22/96) eyes respectively. The Mann-Whitney U test was used for the comparison of non-normally distributed measurement data between groups. Logistic regression analysis was used to analyze the independent factors affecting the prognosis of MNV patients. ResultsThere were no statistically significant differences in the age (Z=?0.928) and gender composition ratio (χ2= 0.123) between the fibrous scar group and the non-fibrous scar group (P＞0.05); there were statistically significant differences in the number of eyes with a follow-up time of ≥36 months and ＜36 months (χ2= 3.906, P=0.048); there were statistically significant differences in the size of the MNV lesions (Z=?2.385, P=0.017); there were statistically significant differences in the number of eyes with different vascular network morphologies (χ2=12.936, P=0.001). Before treatment and at the last follow-up, the CMT of the affected eyes was 267.50 (237.25, 311.75) μm and 242.00 (217.25, 275.75) μm respectively; logMAR BCVA was 0.20 (0.10, 0.50) and 0.35 (0.16, 0.60) logMAR respectively. There were statistically significant differences in the CMT and logMAR BCVA before treatment and at the last follow-up (Z=?3.311,?1.984; P=0.001, 0.047). There were statistically significant differences in different ages (Z=?2.284), myopic diopter (χ2=7.437), etiology (χ2=6.956), and disease course (Z=?1.687) between the CMT reduction group and the CMT increase group (P＜0.05). There were statistically significant differences in the number of eyes with different subjective feelings between the BCVA improvement group and the BCVA reduction group (χ2=10.133, P＜0.05). The results of logistic regression analysis showed that the etiology was an independent risk factor for CMT thickening. ConclusionsAge, etiology, myopic diopter, disease course, follow-up time, lesion size and the morphology of the neovascular network are the influencing factors for the prognosis of anti-VEGF drug treatment in MNV patients under 45 years old. The etiology is an independent risk factor for CMT increase.
Objective To evaluate different methods in determ ining the postoperative changes of anatomical structures in macular diseases． Methods Thirty-one eyes of 31 cases of macular diseases, were studied among them there were 15 eyes with idiopathic macular hole (IMH),and the others included 8 eyes with macular epiretinal membranes(ERMs), 4 eyes with age relate d macular degeneration(AMD) and 4 eyes with idiopathic submacular neovasculariza tions(SRNV)． All cases were examined with retinoscope or retinogra phy, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT ) pre-and postoperatively． Results Funduscopy showed that all of the 15 IMHs were closed after operation, but OCT showed th at among them 2 affected eyes still had partial retinal detachment at the macular hole edge in one quadrant and the sensory layer in macular area became thinner in 1 affected eye． FFA revealed damage of retinal pigment epithelium (RPE) in 5 cases． As for the ERMs and SRNV, funduscopy could n ot identify wether they were completely removed or not after operation． FFA ind icated that SRNV and SRNV were completely removed and the damage of RPE．OCT discovere d that the ERMs and SRNV were completely removed and the sensory layer became th inner in 3 eyes． Conclusion The combination of funduscopy , FFA and OCT can get the whole view of macular diseases and their postopera tive anatomical evaluation． (Chin J Ocul Fundus Dis, 2001,17:33-36)
Objective To observe and analyze the imaging features of pathologic myopic paravascular abnormalities (PVA) and macular retinoschisis (MRS) and their relationship with clinical features. MethodsA retrospective case series study. A total of 371 eyes of 224 patients with pathological myopia with PVA and/or MRS diagnosed by examination in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2021 to December 2023 were included in the study. There were 74 eyes in 48 males and 297 eyes in 176 females. Age were 54 (49, 61) years; equivalent spherical lens (SE) was ?13.375 (?18.00, ?10.00) D. Axial length (AL) was 29.84 (28.27, 31.24) mm. According to the features of ultra-wide-angle sweep source optical coherence tomography, PVA morphology was divided into blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes. MRS was divided into inner layer, outer layer and mixed layer according to splitting level, and grouped accordingly. The presence of dome-shaped macula (DSM), internal and external lamellar macular hole, and full lamellar macular hole (FTMH) were recorded. According to whether PVA combined with MRS or not, the affected eyes were divided into PVA group and PVA combined with MRS group. According to whether MRS involved the fovea, the affected eyes were divided into two groups: MRS not involved the fovea group and MRS involved the fovea group. Mann-Whitney U test was used to compare age, SE and AL among different groups. Qualitative data were compared by χ2 test. ResultsIn 371 eyes, there were 120 eyes in the simple PVA group; in the MRS group, there were 251 eyes, of which 208 eyes were in the PVA combined with MRS group. There were 33, 27, 3, 14, 12, 56, 28, and 7 eyes with or without retinal detachment, choroidal neovascularization, DSM, preretinal membrane, and simple superficial detachment of neuroepithelium in inner lamina, outer lamina, and FTMH, respectively. In 328 eyes with PVA, blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes were 151, 236, 202 and 72 eyes, respectively. There were 142 eyes with single lesion (43.29%, 142/328). There were 186 eyes with 2 or more lesions (56.71%, 186/328). There were 34 eyes in the inner MRS group, 92 eyes in the outer MRS group and 125 eyes in the mixed MRS group, respectively. It involved 155 eyes in the fovea group; 96 eyes in the fovea group were not involved. There were significant differences in the number of PVA eyes between the outer MRS group, the inner MRS group and the mixed MRS group (χ2=30.614, 28.379; P＜0.001). Compared with PVA group, PVA group combined with MRS group was more likely to have two or more PVA lesions, the difference was statistically significant (χ2=30.535, P＜0.001). Compared with the inner MRS group and mixed MRS group, the age of the simple PVA group was younger, and the age of the outer MRS group was older, and the differences were statistically significant (P＜0.05). Compared with the inner MRS group and the outer MRS group, the simple PVA group had short AL, less myopia and better optimal corrected visual acuity (BCVA), while the mixed MRS group had long AL, more myopia and worse BCVA, and the differences were statistically significant (P＜0.05). Compared with the PVA group and the inner MRS group, the fovea was more involved in the outer MRS group and the mixed MRS group, and the difference was statistically significant (χ2=3.906, 10.836; P＜0.05). Those with MRS involved in fovea were older, AL was longer, myopia was more severe, and BCVA was worse (P＜0.001). DSM-associated splits were less likely to involve macula (P＜0.001). ConclusionPVA and MRS exhibit a variety of presentations, and their imaging features correlate with clinical features.