ObjectiveTo observe the changes of the inner-retinal irregularity index (IRII) of eyes with idiopathic macular epiretinal membrane (IMEM) before and after surgery and its correlation with visual function.Methodsretrospective series of studies. From March 2017 to May 2018, 46 IMEM patients (46 eyes) diagnosed in the Department of Ophthalmology of Central Theater Command General Hospital were included in the study. BCVA, visual deformation degree (M), OCT inspection with swept source were all performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logMAR visual acuity for record. The average IRII was 1.255±0.048, the average logMAR BCVA was 0.63±0.21, the average M value was 0.68±0.38, the average of central macular thickness (CMT) was 353.57±73.92 μm, the average inner retinal layer thickness (IRT) was 181.50±40.91 μm. The complete and incomplete ellipsoid zone (EZ) were 17 and 29 eyes, respectively. All eyes underwent a 25G three-incision closed vitrectomy through the flat part of the ciliary body, and the epiretinal membrane and inner limiting membrane were removed at the same time. The changes of IRII, M value, BCVA, CMT, IRT and EZ were observed at 1, 3, 6, and 12 months after surgery, and the correlation were analyzed between IRII and M value and BCVA before and after surgery. Single-factor repeated measurement data analysis of variance was used for the comparison of BCVA, M value, CMT, and IRT before and after surgery. Spearman rank correlation analysis were adopted for the correlation analysis between IRII and BCVA, M value, CMT, IRT and EZ integrity before and after surgery.ResultsTwelve months after surgery, the average IRII and logMAR BCVA were 1.175±0.032 and 0.47±0.16, respectively. Compared with those before surgery, they were significantly improved, and the difference was statistically significant (F=22.273, 5.453; P＜0.001, ＜0.001). The average M value (F=20.109), CMT (F=14.273), IRN (F=13.665) were significantly lower than those before the operation, and the difference was statistically significant (P＜0.001, 0.001, ＜0.001). The integrity of EZ was significantly improved compared with that before surgery, and the difference was statistically significant (χ2=12.715, P＜0.001). The results of correlation analysis showed that preoperative IRII was positively correlated with preoperative M value and CMT (r=0.951, 0.701; P＜0.001, ＜0.001). It was positively correlated with postoperative M value, logMAR BCVA, CMT and EZ integrity (r=0.650, 0.369, 0.720, 0.293; P＜0.001, ＜0.001, P=0.048). It was not correlated with preoperative logMAR BCVA and EZ integrity (r=0.283, 0.001; P=0.056, 0.996).ConclusionThe IRII of IMEM eyes before surgery is significantly correlated with the BCVA and M values after surgery.
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.
Objective To observe the image features of high myopia with retinoschisis by spectraldomain optical coherence tomography (SD-OCT). Methods The clinical data of eight patients (eight eyes) of high myopia with retinoschisis were retrospective analyzed. All patients were diagnosed by SD-OCT (Topcon 3D-OCT 1000), had no macular holes and underwent vitrectomy including internal limiting membrane (ILM) peeling and gas tamponade. All patients also underwent visual acuity, refraction, premirror fundus examination and A/B mode ultrasound examination. Visual acuity and SD-OCT were followed up at one, three and six months after surgery. Before surgery, premirror fundus examination revealed shallow foveal detachment in 3/8 eyes, posterior scleral staphyloma in 7/8 eyes. SD-OCT showed concave arc stripes in 7/8 eyes, and outer retinoschisis in 8/8 eyes, middle or inner retinoschisis in 5/8 eyes and foveal detachment in 5/8 eyes. Results Six months after surgery, posterior retinoschisis disappeared in six eyes, foveal detachment still presented in one eye and parafoveal hole occurred in one eye. The corrected visual acuity improved from the 0.15 to 0.8 in one eye which had a restored continuous inner segment/outer segmen (IS/OS) line by SD-OCT. The corrected visual acuity improved from 0.01 to 0.1 in one eye, from 0.05 to 0.15 in one eye, not changed in five eyes. There was no continuous IS/OS line in those patients by SD-OCT. Conclusions SD-OCT shows a variety of morphological features of myopic retinoschisis which could be cured anatomically and functionally by vitrectomy combined ILM peeling. The continuity of IS/OS layer from SD-OCT could help to interpret the vision recovery after the operation.
Objective To investigate the CT imaging features of pancreatic fatty replacement and its clinical significance. Methods Three patients with pancreatic fatty replacement detected by CT were retrospectively analyzed. CT examination included plain scan and contrast-enhanced scanning at the arterial and portal venous phases. The shape, size, density, pancreatic lobulation and interlobular spaces, course of the pancreatic duct were carefully observed. The clinic and laboratory data were also analyzed to determine the clinical significance of pancreatic fatty replacement. Results ①Imaging features: Two patients had complete fatty replacement involving the entire pancreas, another one had most fatty replacement sparing the posterior aspect of head and tail. Two patients had regular configuration of pancreas. The size of pancreas was slightly enlarged in 2 patients. Lobular atrophy and widening of interlobular spaces were present in all 3 patients. The pancreatic duct was normal in 3 patients. ②Clinic findings: Chronic diarrhea was present in 3 patients. Two patiens had diabetes （one had chronic cholangitis with choledochal lithiasis）， another one had small stone in the common bile duct. Serum lipase was low in 3 patients, of which one had low serum amylase. Conclusion Pancreatic fatty replacement demonstrates certain characteristic CT appearances, and is usually associated with disturbances of both the endocrine and exocrine functions of the pancreas.
Objective To investigate the imaging features of intestinal volvulus on multi-detector row spiral CT (MDCT). MethodsThirty-one patients with surgically confirmed intestinal volvulus were included in this study. Nine patients received MDCT plain scan, 22 received contrast enhanced MDCT scan and 5 of them had additional CT angiography. Two abdominal radiologists analyzed the MDCT imaging features of intestinal volvulus observed, such as the location, direction of rotation, degree of volvulus, appearance rate of the “whirl sign” and the “beak sign”, bowel wall thickening and ascites and the possible causes of volvulus, which were recorded with review of surgical findings. Results The location of volvulus included duodenum (1 case), jejunum (23 cases), ileum (3 cases), entire small intestine (2 cases) and sigmoid colon (2 cases). The location of volvulus was correctly diagnosed based on MDCT findings in 27 patients (27/31; 87.0%). The direction of volvulus was correctly diagnosed for all patients based on MDCT findings (clockwise in 11 cases and counterclockwise in 20 cases). The degrees of volvulus assessed on MDCT findings were respectively 180° in 13 cases, 360° in 12 cases, 540° in 2 cases, 720° in 2 cases and 900° in 2 cases, as compared with surgical findings of 180° in 17 cases, 360° in 10 cases, 540° in 1 case, and 720° in 3 cases. The diagnostic accuracy of MDCT for assessing the degree of volvulus was 74.2%. The “whirl sign” and “beak sign” appeared in 18 and 20 patients, respectively. Bowel wall thickening and ascites were showed in 9 patients. In 5 patients with reconstructed images, the images obtained by maximum intensity projection (MIP) and volume rendering (VR) techniques showed the abnormality of mesenteric vessels in all patients, and the multi-planar reconstruction (MPR) image of one patient showed the “whirl sign” and the “beak sign”. The causes of intestinal volvulus were identified on MDCT in 10 patients. Conclusion The “whirl sign” and the “beak sign” are the characteristic images of intestinal volvulus on MDCT. Bowel wall thickening and ascites may indicate the hemody-namic images impairment of volvulus. MDCT plays valuable role in the diagnosis of intestinal volvulus.
ObjectiveTo study changes in choroidal thickness(CT) with intravitreal injections of ranibizumab treatment. MethodsThis is a prospective, uncontrolled, open-label study. A total of 31 eyes of 31 patients diagnosed with wet age-related macular degeneration (AMD) and 33 eyes of 33 patients diagnosed with choroidal neovascularization (CNV) secondary to pathological myopia (PM) were included in the study. All affected eyes were treated with intravitreal ranibizumab 0.05 ml (10 mg/ml) and followed up monthly until 6 months. Enhanced depth imaging on Cirrus spectral-domain optical coherence tomography was used to measure the CT. The initial CT was compared with the data at 1, 3 and 6 month after treatment, and the correlation between of the decrease of CT at the 6 month and the number of injection times was analyzed. ResultsIn AMD group, the average CT respectively decreased by (9.68±11.02), (12.58±11.04), (13.84±11.67)μm at 1, 3 and 6 month, and the differences were significant(t=4.89, 6.34, 6.60;P < 0.001). In PM group, the average CT respectively decreased by (2.06±10.92), (3.64±8.78), (3.27±7.20)μm at 1, 3 and 6 month. The difference at 1 month was not significant (t=1.08, P=0.287). While after 3 months and 6 months, the differences were significant(t=2.38, 2.61;P=0.024, 0.014). The injection times were not correlated with the CT decreases at 6 month in both groups(r=0.04, 0.30;P=0.815, 0.099). ConclusionIntravitreal injections of ranibizumab can induce choroidal thickness reduction for wet age-related macular degeneration and choroidal neovascularization secondary to pathologic myopia.
Objective To observe the optical coherence tomography (OCT) features of Best vitelliform macular dystrophy (BVMD) at different stages.Methods Twenty-eight BVMD patients (56 eyes) were enrolled in this study. All the patients were examined for visual acuity, slit-lamp microscopy, direct ophthalmoscope, fundus photography, electrooculogram, fundus fluorescein angiography (FFA) and OCT. Fifty-six eyes were classified into stage 0 (eight eyes)、Ⅰ (two eyes)、Ⅱ(10 eyes)、Ⅱa （12 eyes）、Ⅲ (six eyes) 、Ⅳa (six eyes)、Ⅳb (five eyes) and Ⅳc (seven eyes) accordingly. The OCT features of BVMD at different stages were observed.Results The OCT results showed that the macular area was normal in eyes of stage 0; disturbance of retinal pigment epithelium (RPE) and subretinal hyporeflective area were found in eyes of stage I; the location of the yellowish material between RPE and the inner segment and outer segment (IS/OS) with normal appearance in RPE and IS/OS interface were found in eyes of stage Ⅱ. In all the other progressing stages from Ⅱa、Ⅲ and Ⅳ, the vitelliform material appeared as a thicker highly reflective lesion located between the outer nuclear layer and RPE layer, usually accompanied by optical hyporeflective lesion. Images of stage Ⅳc were in similar appearance besides edema of retina. OCT images of Ⅳb stage were demonstrated atrophy of retinal layer and IS/OS loss with fibrosis. Conclusions OCT demonstrated the location of the yellowish material between RPE and IS/OS. Optical hyporeflective lesion between the outer nuclear layer and RPE layer accompanied thicker highly reflected lesion might be the characteristic image in stages II a to IV of BVMD.
ObjectiveTo analyze the diagnostic value of multicolor scanning laser imaging (confocal scanning laser ophthalmoscopy, cSLO) combined with swept-source optical coherence tomography (SS-OCT) for lacquer cracks (LC) and myopia stretch lines (MSL) of pathological myopia.MethodsA observational study. A total of 83 eyes of 58 patients with pathological myopia were recruited from May 2017 to January 2018 in Department of Ophthalmology of The First People’s Hospital Affiliated to Shanghai Jiao Tong University. Among 58 patients, 20 were males (30 eyes) and 38 were females (53 eyes). The mean age was 50.65±12.02 (range from 24 to 70) years old; the average BCVA was 0.37±0.32; the average diopter was ?11.38±4.96 D; and the average axial length was 28.91±2.15 mm. All participants underwent FFA and ICGA examination to obtain FFA, ICGA, infrared light reflection (IR) and autofluorescence (AF) images. SS-OCT was applied for scanning macular and optic disc at 9 mm × 9 mm range. cSLO was performed with macular as the center. All images were inspected carefully by three independent observers and the consistency test was detect. LC were diagnosed as hyperreflective line in FFA and hypofluorescent linear lesions in late ICGA. MSL were defined as both hypofluorescent linear lesions in FFA and late ICGA. The accuracy of each inspection item in the diagnosis of LC was detected. The optimal technique was applied with SS-OCT to further explore the detection rate of LC.ResultsThe intra-observer reproducibility was good to excellent for all measurements (Kappa=0.938, P＜0.01). The positive detection rate of LC and MSL was highest in the standard images of cSLO (77.1%), followed by SS-OCT red free (73.1%), fundus photography (72.3%), IR (72.3%) and AF (49.4%). The cSLO was optimal in the test consistency (Kappa=0.520, P＜0.01) and accuracy (the area under the receiver operating characteristic was 0.750). SS-OCT and cSLO were jointly applied to diagnosis of LC and MSL in high myopia. The positive detection rate of LC, MSL and LC+MSL were 91.7%, 91.2% and 93.3% respectively. The characteristics of LC in SS-OCT were irregularities and discontinuous of the RPE-Bruch membrane line, discontinuous inner ellipsoid zone, thinner choroid, an increased light penetrance into deeper tissues, and RPE fracture in severe cases. MSL was mainly manifested as RPE clumps, visible large choroidal vessels protruding and pushing the overlying RPE toward the vitreous.ConclusionsThe diagnosis rate of LC in pathological myopia by cSLO is 77.1%. The standard images of cSLO combined with SS-OCT can diagnose LC, MSL and LC+MSL at rates of 91.7%, 91.2% and 93.3% respectively.
Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME). Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study. The patients included 12 males and eight females, with a mean age of (47.3plusmn;10.2) years. All the patients were examined documenting best corrected visual acuity (BCVA), spectraldomain optical coherence tomography (OCT) and ophthalmological examination. According to OCT DME morphology, samples are divided into diffuse macular edema, cystoid macular edema, serous retinal detachment and hard exudate groups. The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84plusmn;28.80) mu;m of same age group. Correlation between SFCT and age, diopter, diabetic duration, fasting blood glucose, BCVA and central retinal thickness were analyzed by Pearson Analysis. SFCT of different DME types were analyzed by ANOVA Analysis. Results The mean SFCT of 32 eyes was (223.81plusmn;43.74) mu;m (ranging from 120.50 to 361.50 mu;m), which was lower by 63.03 mu;m (95% confidence interval, -78.80 to -47.26 mu;m, P＜0.01) from normal SFCT. SFCT was independent of age (r=0.124), diopter (r=0.277), diabetic duration (r=0.286), fasting blood glucose (r=0.408), BCVA (r=0.087), and central retinal thickness (r=0.036). There was no significant difference of SFCT between different DME types (F=0.042，P＞0.05). Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.
ObjectiveTo observe the correlation between the changes of area foveal avascular zone (FAZ), central foveal thickness (CFT), the thickness of the macular ganglion cell-inner plexiform layer (GCIPL) and the BCVA in type 2 diabetic mellitus patients with different fundus lesions.MethodsA prospective clinical study. Eighty-three eyes of 51 patients with type 2 diabetic mellitus were collected in Shengjing Hospital of China Medical University from January 2018 to January 2019, including 31 males and 20 females. The average age was 53.4±7.8 years. According to the diabetic retinopathy international clinical staging criteria, the patients were divided into the non-diabetic retinopathy (NDR) group with 17 patients (31 eyes), and the non-proliferative diabetic retinopathy (NPDR) group with 34 patients (52 eyes). And 13 control eyes of 8 age- and sex-matched healthy physical examination subjects (control group) were selected in this study. The BCVA examination was performed using the international standard visual acuity chart, which was converted into IogMAR visual acuity. OCT was used to measure the CFT, the mean and the minimum thickness of GCIPL. OCT angiography (OCTA) examination was applied to obtain blood flow density scan images in macular area of 3 mm × 3 mm size. The superficial FAZ area was measured by Photoshop software. The differences of the superficial FAZ area, BCVA, CFT, the mean and the minimum thickness of GCIPL in each group were statistically analyzed, and to explore the correlation between the parameters. Analysis of variance was used to compare measurement data among three groups, and chi-square test was used for the comparison of counting data among three groups. The statistical correlation was evaluated using Pearson’s correlation coefficient.ResultsThe average area of superficial FAZ area in the control group, NDR group and NPDR group were 0.314±0.103, 0.349±0.102, 0.416±0.148 mm2; the mean logMAR BCVA were 0.015±0.038, 0.029±0.059, 0.129±0.133; the mean CFT were 247.46±13.35, 244.13±25.09, 263.12±24.96 μm; the mean GCIPL thickness were 89.00±4.98, 86.06±4.43, 82.61±14.32 μm; the mean minimum GCIPL thickness were 84.85±3.18, 80.68±5.39, 71.19±19.94 μm, respectively. The superficial FAZ area, logMAR BCVA, CFT and the minimum thickness of GCIPL showed significant differences (F=4.660, 11.708, 6.891, 6.333; P=0.012, 0.000, 0.002, 0.003) among these three groups. Correlation analysis showed that the logMAR BCVA was positively correlated with the superficial FAZ area (r=0.335, P=0.001), negatively correlated with the mean GCIPL thickness (r=－0.348, P=0.001) and the minimum GCIPL thickness (r=－0.416, P=0.000), no significant correlated with the CFT (r=0.171, P=0.095). The superficial FAZ area was negatively correlated with the CFT (r=－0.262, P=0.010) and the minimum GCIPL thickness (r=－0.213, P=0.037), no significant correlated with the mean GCIPL thickness (r=－0.179, P=0.081).ConclusionsWith the aggravation of fundus lesions in patients with type 2 diabetic mellitus, the superficial FAZ area gradually expands, the minimum GCIPL thickness gradually becomes thinner and the BCVA gradually decreases. Both the superficial FAZ area and the GCIPL thickness are correlated with BCVA. The superficial FAZ area is correlated with CFT and the minimum GCIPL thickness.