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.
Objective To evaluate the application value of optical coherence tomography angiography (OCTA) in obstructive sleep apnea syndrome (OSAS). Methods A comprehensive search of both domestic and international databases was conducted to identify clinical studies on the use of OCTA in OSAS, from the establishment of the databases to May 2024. A meta-analysis was performed using Revman 5.4 software. Results A total of 134 studies were initially identified, with 14 studies meeting the inclusion criteria, encompassing 999 subjects (739 in the OSAS group and 260 in the healthy group). Meta-analysis results indicated that the superficial capillary plexus (SCP) density in the fovea (MD=–2.05, 95%CI –3.75 to –0.35, P=0.02) and parafovea (MD=–1.56, 95%CI –2.44 to –0.68, P=0.000 5) was significantly lower in the OSAS group compared with the healthy group. In the mild to moderate OSAS group, SCP density was significantly lower in the fovea (MD=–2.41, 95%CI –4.32 to –0.49, P=0.01), parafovea (MD=–1.17, 95%CI –2.01 to –0.32, P=0.007), and perifovea (MD=–1.73, 95%CI –2.69 to –0.77, P=0.000 4) compared with the healthy group. In the severe OSAS group, SCP density in the perifovea (MD=–1.33, 95%CI –2.53 to –0.13, P=0.03) was significantly lower than that of the healthy group. SCP density in the whole area (MD=0.36, 95%CI 0.05 to 0.68, P=0.02) was significantly higher in the mild to moderate OSAS group compared with the severe OSAS group. In the deep capillary plexus (DCP) density, the OSAS group showed significantly lower densities in the whole area (MD=–2.16, 95%CI –3.51 to –0.81, P=0.002), fovea (MD=–2.38, 95%CI –4.38 to –0.37, P=0.02), and parafovea (MD=–2.33, 95%CI –3.93 to –0.73, P=0.004) compared with the healthy group. The mild to moderate OSAS group also showed significantly lower densities in the whole area (MD=–2.02, 95%CI –3.33 to –0.72, P=0.002) and parafovea (MD=–1.65, 95%CI –3.04 to –0.26, P=0.02) compared with the healthy group. The severe OSAS group had significantly lower DCP density in the whole area (MD=–2.26, 95%CI –3.85 to –0.66, P=0.006) and parafovea (MD=–1.47, 95%CI –2.31 to –0.62, P=0.000 7) compared with the healthy group. DCP density in the whole area (MD=0.54, 95%CI 0.02 to 1.07, P=0.04) was significantly higher in the mild to moderate OSAS group compared with the severe OSAS group. Regarding the retinal nerve fiber layer (RNFL) thickness, the inferior quadrant (MD=4.01, 95%CI 0.69 to 7.32, P=0.02) and temporal quadrant (MD=4.35, 95%CI 1.88 to 6.82, P=0.000 6) were significantly thicker in the mild to moderate OSAS group compared with the severe OSAS group. In terms of the foveal avascular zone (FAZ) area, the severe OSAS group showed a significantly larger FAZ area (MD=0.06, 95%CI 0.03 to 0.08, P<0.000 01) compared with the healthy group. Conclusion OCTA-related ocular biomarkers may be associated with the occurrence and progression of OSAS and have potential applications in the diagnosis and treatment of OSAS.
Objective To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis. MethodsClinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ2 inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. ResultsCompared with the control group, the CVI (t=3.133, 4.814), CVV (t=7.504, 9.248), and CT (t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA (t=－8.206, －5.065) significantly decreased, with statistically significant differences (P＜0.05); CVI (t=7.129), CVV (t=10.020), and CT (t=10.488) significantly increased within 6 mm of the central fovea, while CFA (t=－2.548) significantly decreased, with statistically significant differences (P＜0.05). The CVI (t=4.980, 4.201, 4.716, 8.491), CVV (t=9.014, 7.156, 7.719, 10.730), and CT (t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences (P＜0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm3, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. ConclusionChoroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.
ObjectiveTo analyze the associations between the choroidal vasculature and submacular fluid (SMF) in central serous chorioretinopathy (CSC). MethodsA retrospective study. A total of 29 CSC patients (31 eyes) with complete records who visited the Department of Ophthalmology in Peking University People's Hospital from August 1, 2021 to March 1, 2023 were included in this study. The patients were divided into complete absorption and incomplete absorption groups according to the status of SMF in the last visit. All the patients underwent ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA) with a scanning range of 24 mm × 20 mm. The UWF SS-OCTA images were automatically analyzed in 9 regions (superotemporal, superior, superonasal, temporal, central, nasal, inferotemporal, inferior, and inferonasal). Alterations of choroidal vasculature in the nine subfields after SMF absorption were described, including choroidal thickness (CT), flow density of choriocapillaris layer, vessel density of large choroidal vessel layer, three-dimensional choroidal vascularity index (CVI), the mean choroidal vessel volume (mCVV), and the mean choroidal stroma volume (mCSV). The relevant factors affecting the complete absorption of SMF were additionally evaluated. ResultsAt baseline, CT (Z=2.859, P=0.004), mCVV (t=2.514, P=0.018), and mCSV (Z=2.958, P=0.003) in the superotemporal region of the affected eyes in the incomplete absorption group were significantly higher than those in the complete absorption group. Compared with baseline, at the last visit, the proportion of asymmetric vortex veins in the complete absorption group was significantly decreased (χ2=6.000, P=0.014), CVI in the superotemporal, superonasal, temporal, central, nasal, inferotemporal, and inferonasal regions (t=－4.125, t=－3.247, Z=－3.213, t=－2.994, t=－3.417, t=－3.733, t=－3.795; P=0.001, 0.006, 0.001, 0.010, 0.005, 0.003, 0.002), the mCVV of 9 regions (t=－2.959, t=－2.537, t=－2.235, t=－3.260, t=－3.022, t=－2.796, t=－2.747, Z=－2.107, t=－2.935; P=0.011, 0.025, 0.044, 0.006, 0.010, 0.015, 0.017, 0.035, 0.012) were significantly decreased. Compared to the complete absorption group, the choroidal blood flow changes in the non-complete absorption group were more limited, and CT in the upper region increased significantly at the last follow-up (t=2.272, P=0.037). Multivariate logistic regression analysis revealed that baseline CT in the superotemporal region may be an independent risk factor affecting the complete absorption of SMF (odds ratio=0.981, 95% confidential interval 0.965-0.997, P=0.021). ConclusionsIn the process of SMF absorption in CSC, significant reductions of choroidal blood flow were found in the large choroidal vessel layer, and there may be a locally compensatory increase in CT. In addition, baseline CT in superotemporal region is an independent risk factor affecting SMF absorption.
Objective To explore the application value of time of flight magnetic resonance angiography (TOF-MRA) in target bypass surgery for moyamoya disease. Methods The data of patients with moyamoya disease in Affiliated Drum Tower Hospital, Medical College, Nanjing University between May 1 and August 30, 2020 were retrospectively analyzed. Patients were divided into navigation group and control group according to whether navigation technology was used during operation. All patients completed TOF-MRA evaluation before operation, and all patients completed surgical treatment. One week after operation, TOF-MRA was reviewed to evaluate the patency of anastomotic stoma. The intraoperative and postoperative conditions of the two groups were compared. Results Finally, 48 patients with moyamoya disease were included. 22 patients who used intraoperative navigation were included in the navigation group, and 26 patients with moyamoya disease who did not use intraoperative navigation in the same period were included in the control group. There was no significant difference between the two groups in gender, age, Suzuki stage before operation, proportion of posterior circulation involvement, proportion of bleeding type, proportion of hypertension and proportion of diabetes (P>0.05). The operation duration [(3.3±0.4) vs. (3.6±0.6) h] and postoperative hospital stay [(7.3±1.9) vs. (8.8±2.7) d] in the navigation group were shorter than those in the control group (P<0.05). There was no significant difference between the two groups in the proportion of patients who completed bypass surgery, the proportion of middle meningeal artery retained, the postoperative patency rate, the proportion of temporary dysfunction, and the proportion of serious complications (P>0.05). Conclusion TOF-MRA sequence combined with navigation technology can effectively guide the surgical scheme design and postoperative evaluation of moyamoya disease.
ObjectiveTo evaluate the CT features of coronary artery aneurysm by coronary artery imaging on 128 slice CT and dual source CT (CTCA). MethodsA total of 1 108 cases were prospectively examined using CTCA between March 2011 and April 2014. With volume rendering, maximum intensity projection, multiplanar reconstruction and surface reconstruction, we observed the coronary artery morphology and vascular wall condition. ResultsThree cases of coronary artery aneurysm were found. In case one, the anterior descending branch (LAD) had grape-like prominency segmentally; in case two, LAD and left coronary circumflex branch (LCX) and right coronary artery (RCA) had diffuse dilation with local shuttle expansion; in case three, left main, LAD and LCX and RCA had diffuse expansion. ConclusionCTCA is a noninvasive, simple and effective method for the diagnosis of coronary artery aneurysm, and it can be the first choice for the high risk population with coronary artery aneurysm.
Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50 – 91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT); OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%); CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89,Kappa value=0.796,P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV; the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82,Kappa value=0.753,P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.
ObjectiveTo observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH). MethodsA retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. ResultsIn the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant (t=10.832, P＜0.01). Before operation, the area of cyst was (1.04±0.55) mm2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole (r=0.50, P=0.010) and BCVA before operation (r=0.57, P＜0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area (r=－0.53, －0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS (r=－0.65,－0.76; P=0.020, 0.030). There was no correlation with BCVA (r=0.23, P=0.470). ConclusionsRetinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.
Thoracoscopic pulmonary segmentectomy is one of the important treatment methods for early lung cancer. Only the premise of surgical precision can make the radical resection of lesions and maximum reservation of healthy lung tissue be simultaneously guaranteed. As a representative of the precise lung operation, the " cone-shaped lung segmentectomy” focuses on the lesion, and combines the anatomical characteristic of the patient to design individualized operation scheme. The technological core consists of three parts, three dimensional-computed tomography bronchography and angiography (3D-CTBA) surgery path planning, accurate definition of intersegmental demarcation and anatomic dissection of intersegmental borders along the demarcation. This paper aims to explore the technical process and quality control of the key techniques of thoracoscopic precise segmentectomy, so as to standardize the segmentectomy procedure under the principle of radical and minimally invasive therapy.
目的 提高對先天性腹主動脈瘤（AAA）的認識。 方法 報道2012年11月1日先天性AAA 1 例，回顧國內外報道的24 例先天性AAA的臨床資料。 結果 患兒男，2歲，以肉眼血尿起病，伴高血壓、蛋白尿和反復血小板降低；多層螺旋CT血管成像（MSCTA）見AAA伴左腎動脈狹窄；彩色多普勒超聲見AAA累及雙側髂總動脈伴動脈壁間血栓及鈣化，左腎萎縮；保守治療7個月后猝死，臨終前頭顱CT見腦梗死。回顧分析24例先天性AAA，包括腎下型AAA 15 例，腎上型AAA 5例，胸腹部AAA 2例，未具體指明類型2例；產前診斷6例，出生后診斷18例（其中包括新生兒5例和1個月～3歲嬰幼兒8例）；以腹部搏動性包塊起病8 例，嘔吐4 例，呼吸困難2例，腰部疼痛1例，因其他疾病就診3例；采用血管超聲21例，MSCTA 16例，磁共振血管造影9例；13例腎下型AAA接受手術治療；死于AAA破裂5例，死于心力衰竭2例。 結論 先天性AAA以腎下型為主，多為嬰幼兒，常表現為腹部腫塊，確診該病首選MSCTA，主張行早期個體化手術。