Leber hereditary optic neuropathy is an optic neuropathy associated with mitochondrial DNA. The disease affects young men mainly, which is considered to be due to denaturation of the retinal nerve ganglion cell and axonal loss of optic nerve, leading to optic atrophy. Nowadays, there are some development in studying Leber hereditary optic neuropathy by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). It is great help to know the disease, forecast the progression of disease, and take action on intervention. In addition, there is a lack of in-depth study on OCT and OCTA characteristics among different mutation sites of LHON, different genders of the same site, different families of the same site or even different branches of the same family. It is expected to be improved in the future work.
ObjectiveTo observe the positional relationship between the central fixation point of the retina and the fovea in normal adults.MethodsA retrospective clinical study. From August 2019 to January 2020, 100 eyes of 100 normal adults who underwent physical examination at the Fourth People's Hospital of Shenyang were included in the study. All patients underwent BCVA, diopter, microfield, OCT examination, and axial length (AL) measurement. There were 42 males and 58 females with the average age was 46.4±14.7 years. The average diopter was －1.02±1.99 D, the average AL was 23.22±0.47 mm, the average foveal avascular zone (FAZ) area was 0.38±0.13 mm2. The MP-3 microperimetry was used for central fixation examination. After the examination, high-definition fundus images were automatically taken and the central fixation point of the retina were automatically calculated by the equipment. The Nidek Overlay functional multi-mode imaging platform was used to superimpose the images containing the central fixation point of the retina and the macular fovea, the positional relationship between the two was observed, and the distance between the two was measured. Pearson correlation analysis was performed on the distance between the fixation point of the center of the retina and the center of the fovea, age, diopter, and FAZ area of the macula.ResultsThe fixation point of the retinal center of all tested eyes was within the range of the macular fovea, which did not coincide with the center of the macular fovea. Among 100 eyes, the fixation point of the center of the retina were 53, 23, 15, and 9 eyes at the nose, lower, temporal, and upper sides, respectively. The average distance between the fixation point of the center of the retina and the center of the fovea was 158.31±71.56 μm. The distance between the fixation point of the retinal center and the center of the macular fovea and age (r=0.140), diopter (r=－0.009), FAZ area ( r=0.038) were not correlated (P=0.165, 0.932, 0.707) in correlation analysis.ConclusionThe central fixation point of normal adult retina is more common on the fovea nasal side.
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.
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.
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.
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.
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)