Objective To observe the multimodal imaging features of retinal diseases associated with COVID-19. MethodsA retrospective case study. Sixteen patients (30 eyes) of retinal diseases associated with COVID-19 admitted to the Ophthalmology Department of the Second People's Hospital of Zhengzhou in December 2022 were included in the study. There were 5 males and 11 females, with the mean age of (26.69±9.88) years; 14 patients were bilateral and 2 patients were unilateral. The time of ocular symptoms after the diagnosis of COVID-19 was (2.63±0.89) days. All patients underwent the examinations of best corrtected visual acuity (BCVA), fundus color photography (FP), infrared fundus photography (IR), optical coherence tomography (OCT). Fluorescein fundus angiography (FFA) was performed in 2 patients (4 eyes). There were 20 eyes with acute macular neuroretinopathy (AMN), including 6 eyes with cotton wool spots; 10 eyes with Purtscher-like retinopathy (PLR). The BCVA of the patients was 0.1-1.0. No obvious abnormality was found in anterior segment examination. The features of FP, IR and OCT were analyzed retrospectively. ResultsIn 20 eyes of AMN, irregular reddish brown lesions in the central or paracentral area of the macula in 14 eyes; FP showed no obvious abnormality in 6 eyes; IR showed irregular map like low reflection in the central or paracentral area of macular in all eyes; OCT showed hyperreflectivity in outer plexiform layer and outer nuclear layer, hyporeflectivity in the ellipsoid zone and photoreceptor layers in all eyes; no abnormal fluorecence was observed in 2 eyes examined by FFA. In 10 eyes with PLR, cotton wool spots and retinal hemorrhage were observed in the posterior pole and/or peripapillary area, and the peripheral retina was generally normal, Purtscher spot was found in 5 eyes and macular edema in 4 eyes; OCT showed strong reflex signal in neuroepithelial layers, edema in neuroepithelial layers in 6 eyes; in the 2 eyes examined by FFA, fluorescein leakage from the retinal vein wall was observed, the posterior pole and peripapillary area retinal arteriole occlusions showed patchy hypofluorescence, the fluorescence was obscured by retinal hemorrhage below at inferior retina. ConclusionsFor AMN associated with COVID-19, IR can show the lesion contour , OCT shows lesions in the outer retina. PLR associated with COVID-19 are usually at the posterior pole and/or peripapillary area in FP, OCT shows neurocortical edema.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
The update of the cognition of fundus diseases is inseparable from the rapid development of fundus multimodal imaging. Especially in recent years, the application of wide and ultra-wide fundus photography, ultra-wide fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography angiography contribute to observe the peripheral retinopathy more directly. The application of adaptive optics and fluorescence lifetime imaging ophthalmoscopy contribute to have a further understanding of fundus diseases at the cellular and metabolic level. Multimodal imageing reflect the pathological characteristics of the diseases from different angles and levels. At the same time, the digitization and intelligence of fundus images are also developing rapidly. However, there are some problems that the ophthalmologists needs to consider further, such as the correctly understanding the use of multimodal imaging, the application of artificial intelligence, and how to sum up from the images.
Objective To investigate the clinical features and multimodal imaging features of eyes with perifoveal exudative vascular anomalous complex (PEVAC). MethodsA retrospective case study. From February 2014 to November 2020, 7 eyes of 7 patients with PEVAC diagnosed by ophthalmology examination in Department of Ophthalmologyof Peking University People's Hospital were included in this study. There were 6 males and 1 female. The age was 60.1±9.1 years. All were monocular. The chief complaints of visual deformation and vision loss were 3 and 1 cases, respectively. All patients underwent best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA). BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. OCT angiography (OCTA) and indocyanine green angiography (ICGA) were performed in 4 and 2 eyes, respectively. Three eyes were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) combined with local laser photocoagulation. Two eyes were treated with laser photocoagulation alone. The follow-up time was 16.7±19.1 months. During follow-up, relevant examinations were performed with the same equipment and methods as at the initial diagnosis. The multimodal imaging characteristics and treatment response of the affected eyes were observed. ResultsThe baseline logMAR BCVA was 0.33±0.19 (0.20-0.80). All eyes showed isolated hemangiomatous lesions in the macular fovea with rigid retinal exudation, and 2 adjacent isolated hemangiomatous lesions were observed in 1 eye. FFA and ICGA examination showed that all eyes with macular hemangiomatous lesions showed clear boundary and strong fluorescence in the early stage. No other retinal or choroidal vascular abnormalities were observed. On OCT examination, circular lumen-like structures with strong reflective wall near the fovea were observed in the macular region of all eyes, accompanied by intraretinal cystic lumen. The macular central retinal thickness (CMT) was 326±125 (207-479) μm. In the four eyes examined by OCTA, blood flow signals were observed in the circular lumenoid structures with strong reflective walls adjacent to the fovea. Blood flow signals were observed in the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina in 3 eyes. SCP showed blood flow signal in 1 eye. In 4 eyes treated with intravitreal injection of anti-VEGF drugs, there was no significant improvement in the intraretinal capsule space after treatment. Subretinal fluid absorption, retinal cystoid edema persisted, and rigid exudation decreased in 1 eye. CMT decreased and BCVA increased in 5 eyes treated with laser photocoagulation or laser photocoagulation alone. At last follow-up, logMAR BCVA was 0.16±0.06 (0.10-0.20) and CMT was 212±34 (154-252) μm. Compared with baseline, the difference of BCVA was statistically significant (t=2.661, P=0.037). ConclusionsThe fundus of PEVAC patients is characterized by solitary or multiple solitary hemangiomatous lesions in the macular fovea. Round lumenoid structures with strong reflective walls, with or without intraretinal cystic lumen, rigid exudate, and subretinal fluid, in which blood flow signals can be seen in OCT.
Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
Objective To observe the clinical and multimodel image features in patients of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsClinical data and multimodal imaging results in 12 patients (24 eyes) of AMN associated with COVID-19 which were diagnosed in our Department of Ophthalmology, The Second Hospital of The Army Medical University ranging from December 2022 to January 2023 were included. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), visual field tests, high-resolution computed tomography of the lungs and inflammation-related laboratory tests. After diagnosis, patients were reveived methylcobalamin and Ginaton therapy, 6 patients receiced intravenous dripping of dexamethasone. The follow-up time of this study was 4 weeks. ResultsThere were 1 male (2 eyes) and 11 females (22 eyes), with the mean age of (29.00±5.17) years. For all cases, decreased vision presented 1 to 2 days after patients being suffered from several flu-like symptoms of COVID-19. Ten eyes in 5 patients were at the acute phrase of AMN, which the vision decrease occurred 1-5 days after they were diagnosed with COVID-19; 14 eyes in 7 patients were at the progressive stage of AMN, which they were diagnosed with COVID-19 for more than 5 days. The BCVA of patients were 0.02-0.9, in company with one or more central/pericentral scotoma. Fundus ophthalmoscopy revealed reddish-brown lesion around macula, IR imaging demonstrated localized areas of hypo-shape lesions in the macula. For 16 eyes, their OCTA revealed a decreased density of blood flow in the deep layer of retinal capillary plexus, and OCT revealed that high reflex bands existed in the outer nuclear layer (ONL) and outer plexiform layer of the retina at the acute phrase of AMN, in accompany with hypo-reflection in ellipsoid zone (EZ) and interdigitation zone (IZ); for retina at the progressive stage of AMN, ONL became thinner in some cases and the continuation interruption occurred in EZ and IZ. For en-face OCT, high reflex bands with clear edges existed in the ONL and EZ layer of the retina at the acute phrase of AMN, but no high reflex bands existed in the ONL and EZ layers of the retina at the progressive stage of AMN. Instead, hypo-reflection with similar shape occurred in the EZ and IZ layers at the progressive stage of AMN. During treatment, 5 patients at the acute phrase reported a shrinking central scotomas and raised BCVA, otherwise the BCVA of 7 patients at the progressive stage changed slightly. For 10 eyes at the acute phrase of AMN, OCT revealed that the high reflex bands of ONL and OPL missed within 1 week. En-face OCT revealed the hyper-reflection in the ONL and EZ layers of retina in the acute phrase of AMN receded within 1 week, but hypo-reflection of ONL and EZ still presented. ConclusionsFor AMN associated with COVID-19, IR imaging demonstrated localized areas of hypo-shape lesions in the macula. OCT revealed high reflex bands in ONL and OPL of the retina at the acute phrase of AMN, but hypo-reflection of ONL and EZ still presented. The continuation interruption occurred in EZ and IZ at the progressive phrase. En-face OCT revealed hyper-reflection in ONL and EZ of the retina at the acute phrase which receded within 1 week, and hypo-reflection in EZ and IZ of the retina presented at all phrases during AMN progression.
ObjectiveTo observe and analyze the clinical and imaging features of eyes with cystoid macular degeneration (CMD) secondary to chronic central serous chorioretinopathy (cCSC). MethodsA retrospective clinical study. From February 2018 to June 2023, 9 patients of 15 eyes with cCSC secondary CMD diagnosed by ophthalmology examination in Yunnan University Affiliated Hospital were included in the study. All patients were male. The age was (53.67±3.83) years. The cases of binocular and monocular were 6 and 3 respectively. The visual acuity of the affected eye ranges from 0.02 to 0.1, which cannot be corrected. Visual acuity decreased and the duration of shadow occlusion was ＞1 year. Half dose photodynamic therapy (PDT) was performed on 8 eyes. All the patients underwent the best corrected visual acuity, posterior mydriatic fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and multi-wavelength dazzling imaging (MC). The patients who received half dose PDT were followed up until 3 months after treatment. Patients who did not receive treatment were followed up to 2 years after the first diagnosis. ResultsThe light reflection in macular area decreased or disappeared in all eyes, and abnormal macular pigmentation was observed in 12 eyes. IR examination showed diffuse patchy weak fluorescence in the macular area in all affected eyes, and dotted strong fluorescence in the periphery. Fundus AF examination showed disc-like weak AF in the macular area, and scattered small amounts of strong AF in the middle and margins, among which the retinal pigment epithelium (RPE) atrophy trace in the macular area was observed in 7 eyes. By MC examination, the green signal in the macular area of the posterior pole of all affected eyes was uneven and mottled. FFA examination showed that no abnormal fluorescein leakage was observed in 15 eyes and 8 eyes showed strong fluorescence caused by diffuse permeation fluorescence. A small amount of active fluorescein was found in 7 eyes. OCT examination showed that there were several cystic cavities of different sizes in all the affected eyes, RPE atrophied to different degrees, and RPE cell compensatory ridges and tubular structures in the outer retina were seen in 6 eyes; 7 eyes with CMD and active leakage showed signs of subcortical fluid accumulation. Choroidal hypertrophy was seen in all affected eyes, with significant expansion of the great vascular layer and compression of the middle vascular layer and capillary layer. In 8 eyes treated with half-dose PDT, 6 eyes were ineffective at 3 months after treatment. The treatment was effective in 2 eyes. In 7 eyes that did not receive half-dose PDT, CMD structure did not improve significantly after 2 years of follow-up. The visual acuity decreased with the prolongation of the disease. ConclusionsCMD is more common in cCSC with a long course of disease, which has significant effects on vision and poor prognosis. Fundus color photography shows that the reflection in the macular area of the pole is weakened or disappeared, which may be combined with macular abnormal pigmentation. IR and AF examination show uneven fluorescence in macular area. The green signal in macular area is not uniform according to MC inspection. FFA shows strong fluorescence caused by diffuse permeable fluorescence and fluorescein leakage in active lesions. OCT examination shows that multiple small sacs or connections between sacs were broken and fused, and RPE atrophied to varying degrees.