Objective To observe the characteristics of spectraldomain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) in acute and chronic central serous chorioretinopathy (CSC).Methods Seven-three eyes of 67 patients with CSC diagnosed by slit-lamp microscopy, fundus photochromy, fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study. All the patients were examined for FAF and SD-OCT. The patients were divided into acute CSC group (37 patients, 37 eyes) and chronic CSC group (30 patients,36 eyes) according to the clinical features and FFA images. According to the OCT feature in retinal detachment area, they were divided into three categories, which including intact, non-intact and atrophy outer segment, respectively. According to the FAF characteristics, they were divided into hyper-FAF, hypo-FAF and mixed type, respectively. The characteristics of SD-OCT and FAF of both acute and chronic CSC patients were evaluated and analyzed. Results In acute CSC group, 19 eyes (51.35%) were hypo-FAF, 18 eyes (48.65%) were hyper-FAF. In chronic CSC group, two eyes (5.56%) were hypo-FAF, 16 eyes (44.44%) were hyper-FAF, and 18 eyes (50.00%) were mixed type. There was significant difference between both groups (chi;2=31.872,P=0.000). The SD-OCT results showed that in acute group, 15 eyes (40.54%) were intact outer segment, 18 eyes (48.65%) were non-intact outer segment, and four eyes (10.81%) were atrophy outer segment. In chronic group, five eyes (13.89%) were intact outer segment, 17 eyes (47.22%) were non-intact outer segment, and 14 eyes (38.89%) were atrophy outer segment. There was significant difference between both groups (chi;2=10.572,P=0.005). Conclusions The FAF characteristics of acute and chronic CSC mainly manifests hypo-FAF and mixed type, respectively. The OCT characteristics of acute CSC mainly manifests intact outer segment and non-intact outer segment, but non-intact outer segment and atrophy outer segment in chronic CSC.
Objective To investigate the characteristics of indocyanine green angiography(ICGA) in central serous chorioretinopathy(CSC) Methods The simultanous fundus fluorescein angiography(FFA) and ICGA were performed on 79 eyes of 70 consecutive patients with Heidelberg Retina Angiography. Results Seventy-nine eyes in FFA revealed RPE leakages.The changes of ICGA showed a small localized delay of filling of choroid vessels during the early phase of angiography in 23 eyes,choroidal capillary congestion in 79 eyes,the choriodal capillary hyperpermeability in the area of RPE leakage in 78 eyes,pigment epithelial detachment in 25 eyes and RPE atrophy in 21 eyes． Conclusion The findings in this research indicate that the choroidal abnormalities are the basic characteristics of ICGA in CSC. (Chin J Ocul Fundus Dis,20000,16:14-16)
ObjectiveTo observe the clinical characterisitics of choroidal excavation in the macula. MethodsA total of 22 patients (22 eyes) with choroidal excavation diagnosed by spectral domain high definition optical coherence tomography (HD-OCT) were enrolled in this study. The patients included 12 males (54.50%) and 57 females (45.50%). The age was ranged from 21 to 82 years old, with an average of (41.44±13.17) years. All the patients were affected unilaterally, including 9 right eyes and 13 left eyes. The corrected vision, slit lamp microscope with preset lens, fundus photography, HD-OCT and fluorescence fundus angiography (FFA)were measured for all patients. The clinical characterisitics and concomitant diseases were observed. Seventeen eyes were followed for a period between 3 to 12 months. The lesions change were evaluated by HD-OCT. ResultsThere were 18 eyes (81.8%) with symptoms of micropsia and metamorphopsia, 4 eyes (18.2%) without symptoms. The corrected vision was ranged from 0.3 to 1.2, 12 eyes (54.54%) with moderate or high myopia. Fundus examination presents yellowish-white exudation in 12 eyes (54.54%), yellowish-white exudation accompanied with hemorrhage in 9 eyes (40.91%), grayish yellow reflex halo in 1 eye (4.55%). HD-OCT showed that the retinal pigment epithelium (RPE) layer was involved in the excavation, and the photoreceptor outer segment and pigment junction (OPR) layer was disappeared in all eyes. The external limiting membrane and the photoreceptor inner segment/outer segment junction layer were preserved in 13 eyes (59.09%) and disappeared in 9 eyes (40.91%). There were 10 eyes (18.18%) with a single lesion, 4 eyes (18.18%) with idiopathic choroidal neovascularization, 4 eyes (18.18%) with punctate inner choroidopathy, 1 eye (4.55%) with polypoidal choroidal vasculopathy, 1 eye (4.55%) with macular preretinal menbrance, 1 eye (4.55%) with central serous chorioretinopathy. FFA showed hypofluorescence in early phase, hyperfluorescence in late phase, without obvious leakage. There was no noticeable changes in size and morphological changes in the follow-up period. ConclusionsChoroidal excavation in the macula occurs mostly in middle-aged people with myopia. It can be associated with many fundus diseases. The excavation is located in RPE layer, and OPR layer disappeared. Choroidal excavation in the macula develops slowly.
Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation. According to its fundus feature, lesion location, imaging feature and disease progression, PCV can be divided into different types or stages. It can be divided into hemorrhage and exudation PCV according to the fundus features, into macular, peripapillary, periphery and mixed types according to the lesion locations. It can also be divided into type 1 and 2 according to the ICGA (indocyanine green angiography) manifestations, and can be classified as early stage and late stage according to disease progression. There were different correlations between different types of PCV and some risk genetic loci, such as ARMS2 (age-related macular degeneration factor 2)/ HTRA1 (high temperature essential protein A1) , C2, complement factor B, complement factor H, and elastin genes. The response to therapy and prognosis are also different between different types. It is important to further study the clinical classification of PCV, to explore the genetic characteristics, influencing factors and treatment or prognosis features of different types of PCV. The results will improve the differential diagnosis of PCV, and the effectiveness of individualized treatment.
Purpose To define the morphometric characteristic s and the implication of simultaneous fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) in traumatic choroidal rupture. Methods Simultaneous FFA and ICGA were carried out in 17 patient s (17 eyes) with traumatic choroidal rupture. Results Choroidal ruptures were shown as hyperfluorescence region in the early pha se of FFA,and as hyperfluorescence in the late phase of FFA but in ICGA were shown as hypofluorescence region in both early and late phases.The rupture regions in ICG A were longer than that in FFA in 5 patients (5 eyes).The rupture regions in 6 patients (6 eyes) with hemorrhage could be shown in ICGA,but couldn't be shown in FFA . Conclusion ICGA is helpful in diagnosing minor choroidal ruptures,in defining the extent of traumatic choroidal ruptures,and in further understanding the pathological changes of choroidal ruptures. (Chin J Ocul Fundus Dis, 2001,17:30-32)
Objective To observe the clinical features, phenotypes and genotypes in a Chinese family with choroideremia (CHM). Methods A Chinese four-generation family (15 members) with CHM, including 5 patients (4 males/1 female), 2 female carriers and 8 healthy members, was enrolled in this study. Initially all family members underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), visual field and full view electroretinogram (ERG). BCVA was followed up for 3 years. Venous blood samples were collected, and all of the 15 coding exons and flanking intron regions were amplified in the proband by polymerase chain reaction followed by direct sequencing. Protein structure was modeled based on the protein data bank and mutations in DeepView v4.0.1 to predict the effect of the mutations. A total of 180 healthy volunteers were enrolled as control group to matching CHM gene sequences. Results The visual acuity (VA) of 3/4 adult male patients began to decrease at less than 10, 10 and 30 years old, the average BCVA was 0.43. There were characteristic signs and symptoms of CHM including narrow visual field, extinguished rod and cone response in ERG, disappeared junction line and intermediate line of photoreceptor inner segment/outer segment on OCT. After 3 years, the mean BCVA decreased to 0.11. The BCVA of one young male patient was 1.0 in both eyes with minor changes fundus and visual field. The VA of the female patient began to decrease at 50 years old, her BCVA of two eyes were 0.5 and 0.25, respectively. The fundus changes were typical of CHM, with relative scotomas in the peripheral visual field of OD, and big scotomas in the OS. After 3 years, her mean BCVA decreased to 0.2. Of 2 female carriers, one had minor fundus changes (patches of pigmentary deposits, atrophy spots of retinal pigment epithelium cells), and the other was normal. A novel heterozygous c.1837G＞A mutation in exon 15 of CHM was detected in the proband, which resulted in the substitution of serine by proline at codon 613 (p.D613N). Based on molecular modeling, the misfolded protein caused by the mutation might destabilize the structure of the helix that potentially could affect the global stability of the Rep-1 protein. Conclusions A novel c.1837G＞A (p.D613N) mutation may be the causative mutation for CHM in this family. Female CHM carriers may have some signs and symptoms.
Optical coherence tomography angiography (OCTA) is a new and noninvasive imaging technique that generates real-time blood flow pattern on chorioretinal vasculature. In order to apply this novel technology in the practice to diagnose and treat ocular fundus diseases, we need to further strengthen the quality of OCTA image acquisition and reporting specifications. We need to understand its technical principle, and multiple factors affecting the OCTA image acquisition and interpretation. Furthermore, In the process of image acquisition, as well as analysis and interpretation, we need to pay attention to the stratification, interpretation of blood flow signals and identification of artifacts of OCTA images.
Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.
Multicolor imaging (MCI) based on confocal scanning laser ophthalmoscopy can gather more diagnostic information than traditional fundus photographs through utilizing three wavelengths of laser to scan posterior retina, which gain different layer reflected signal since the depth of penetration into retina is different for each wavelength. Currently, it provides important information and reference value for diagnose of different layer diseases on retina or choroid combining MCI with OCT, FAF, FFA and so on. However, there are still misunderstandings in the diagnosis of retinal diseases with MCI. Careful observation of retinal details in MCI, CFP and other imaging methods is more conducive to the correct diagnosis of fundus ophthalmopathy.
Objective To observe ophthalmoscopic image characteristics of central serous chorioretinopathy (CSC). Methods Twenty-one eyes of the 18 patients diagnosed with CSC were enrolled in this study．The patients included 12 males (14 eyes) and six females (seven eyes)．The patients ages ranged from 26 to 47 years，with a mean age of (39.1plusmn;5.4) years. There were nine patients (11 eyes) with acute CSC, seven patients (seven eyes) with chronic CSC, and two patients (three eyes) with recurrent CSC. All the patients were examined using color fundus photography including infrared (IR), auto-fluorescence (AF), near infrared ray-auto-fluorescence (NIR-AF), fluorescein angiography (FA) and indocyanine green angiography (ICGA) photography. The ophthalmoscopic image characteristics of CSC were comparared. Results The circular serous retinal detachments of 21 eyes were depicted in color images of the ocular fundus, which in the IR showed the hypo-fluorescence. Ten eyes displayed mottled hyper-fluorescent spots associated with serous retinal detachments corresponding to the leakage points. The serous retinal detachments of 15 eyes in the AF images showed hypo-fluorescence, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo-or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. In addition, three eyes with acute CSC showed many scattered hyper-fluorescent spots, which showed hypo-fluorescence in the ICGA. The serous retinal detachment of 15 eyes exhibited hypo-fluorescence in the NIR-AF images, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo- or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. Twenty-one eyes in FA identified the leakage. Eight eyes showed regional choroidal delayed filling, 13 eyes exhibited regional choriocapillary dilatation during 1-5 minutes after injection of ICGA. During 1-5 minutes after injection of ICGA, six eyes showed more lesions than FA, three eyes showed obvious patchy hypo-fluorescence whereas the FA were normal. Conclusions CSC has its own characteristic fundus images in the IR, FA and NIR-A. FA is still the photographic method of choice, but ICGA can reveal lesions of the choroid in CSC. IR, FA and NIR-AF are not as good as FA and ICGA for detecting of leakage points.