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.
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.
ObjectiveTo investigate the characteristics of microcirculation parameter changes in the deep capillary plexus (DCP) of the macular region in patients with type 2 diabetes mellitus (T2DM) and to analyze their correlation with diabetic kidney disease (DKD). MethodsThis cross-sectional study included 133 eyes of 133 T2DM patients who visited Shanxi Eye Hospital from March 2022 to May 2024. According to the presence of DKD, the patients were divided into a DKD group (49 eyes of 49 patients) and a non-DKD group (84 eyes of 84 patients). All eyes underwent swept-source optical coherence tomography angiography examination, and 6 mm × 6 mm macular images were acquired. Microcirculation parameters of the superficial capillary plexus (SCP) and DCP were quantitatively analyzed, including vessel diameter (VD), vessel area density (VAD), vessel skeleton density (VSD), and non-perfusion area (NPA). The area of the foveal avascular zone (FAZ) was also measured. Intergroup comparisons were performed using the independent samples t-test or Mann-Whitney U test. Multivariate logistic regression was employed to analyze the independent association between microcirculation parameters of SCP and DCP and DKD after adjusting for diabetic retinopathy (DR) status. ResultsCompared with the non-DKD group, the DKD group showed significantly increased VD (Z=?3.885) and NPA (Z=?4.268), and significantly decreased VAD (t=2.883) and VSD (t=3.866) in the DCP layer (P＜0.05). No statistically significant differences were observed between the two groups in VD, VAD, VSD, NPA of the SCP layer, or the FAZ area (P＞0.05). After adjusting for DR, multivariate logistic regression analysis indicated that VD [odds ratio (OR)=2.513, 95% confidence interval (CI) 1.445-4.370] and NPA (OR=2.079, 95%CI 1.375-3.143) of the DCP were independent risk factors for DKD in T2DM patients (P＜0.05), whereas VAD (OR=0.810, 95%CI 0.696-0.943) and VSD (OR=0.433, 95%CI 0.271-0.691) of the DCP were protective factors (P＜0.05). ConclusionsIn T2DM patients, those with DKD exhibit characteristic microcirculatory alterations in the macular DCP, specifically increased VD and NPA, along with decreased VAD and VSD. These abnormalities in DCP microcirculation parameters are independently associated with the occurrence of DKD, suggesting their potential as imaging biomarkers for assessing renal complications in T2DM.
Objective To compared the changes of macular microvascular architecture in early stage familial exudative vitreoretinopathy (FEVR) patients with inner retinal layer (IRL) persistence and without IRL persistence. MethodsA retrospective clinical study. From 2017 to 2022, 94 patients with stage 1 FEVR with or without IRL residue and 45 age- and sex-matched healthy volunteers with 45 eyes (normal control group) who were confirmed by ophthalmology examination in Hangzhou Hospital of Optometry Affiliated to Wenzhou Medical University and Zhejiang Provincial People's Hospital were included in the study. According to whether there was IRL residue, the patients were divided into IRL group and non-IRL group, with 22 patients (22 eyes) and 72 patients (72 eyes), respectively. Best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were performed in all eyes. Superficial vessel density (SCP) and deep vessel density (DCP) of whole image, fovea and parafovea, the area and perimeter of fovea avascular area (FAZ), A-circularity index (AI, perimeter/standard circle perimeter with equal area) and vessel density around the 300 μm width of the FAZ (FD), central macular thickness (CMT) on macular 3 mm × 3 mm scan on OCTA were measured. ResultsSCP and DCP of whole image (F=10.774, 4.583) and parafovea (F=10.433, 3.912), CMT (F=171.940) in IRL group and non-IRL group on macular 3 mm × 3 mm scan on OCTA were significantly lower than that in normal persons (P＜0.05). There were significant differences among three groups of the area of FAZ (F=4.315), AI (F=3.413), FD-300 (F=13.592) (P＜0.05). BCVA were worst in IRL group (P＜0.05). ConclusionsBlood flow density decreased in macular area of FEVR patients. CMT is significantly thicker than normal population. The FAZ area of the foveal IRL residual eyes is small and irregular, with worse BCVA and lower macular blood density.
ObjectiveTo observe the clinical features of collateral circulation in different types of retinal vein occlusion. MethodsA retrospective clinical study. A total of 360 patients with monocular retinal vein occlusion diagnosed by ophthalmic examination in Department of Ophthalmology of Yunnan University Affiliated Hospital from December 2021 to December 2023 were included in the study. Among them, 157 males had 157 eyes and 203 females had 203 eyes. Age were (61.0±5.9) years. The duration of the disease from the onset of symptoms to the time of treatment was 3 days to 6 months. Macular branch vein occlusion (MBRVO), retinal branch vein occlusion (BRVO) and central retinal vein occlusion (CRVO) were observed in 67, 187 and 106 eyes, respectively. 210 eyes were with macular edema. All patients with macular edema were treated with anti-vascular endothelial growth factor (VEGF) by intravitreal injection. All eyes were examined by scanning source optical coherence tomography. The incidence, location, morphological characteristics, formation time of retinal collateral circulation and the effect of anti-VEGF drug on the formation of collateral circulation were observed. A short circuit in which blood vessels originating from the optic disc in the form of a blood loop return to the optic disc after the disc has been deformed for some time is defined as a short-circuited collateral circulation of the ciliary vessels of the optic disc. ResultsAfter 1 week of disease course, MBRVO and collateral circulation of BRVO affected eye were established. By 1 to 2 months, a relatively abundant and stable collateral circulation had been established. In the course of 2 to 3 months, the short-circuit collateral circulation of ciliary vessels in the optic disc of the affected eye gradually formed. At 6 months, collateral circulation was established in 36 eyes (53.7%, 36/67) in 67 MBRVO patients. Collateral circulation was observed in 187 eyes of BRVO patients (100.0%, 187/187). In 106 eyes with CRVO, collateral circulation was established in 29 eyes (18.1%, 29/106). In 36 eyes with MBRVO, collateral circulation was established at the vertical horizontal slit between the blocked area and the non-blocked area. In 187 eyes of BRVO patients, collateral circulation was established in the vertical horizontal slit between the blocked and non-blocked areas in 102 eyes; 54 eyes were blocked the most central bypass to the collateral circulation on normal blood vessels. The collateral circulation of 19 eyes was established through nasal and temporal side. Collateral circulation through the fovea was established in 12 eyes. Its morphology is straight out of shape, spiral sinuous and flower cluster. CRVO established collateral circulation in 29 eyes, all of which had short-circuit collateral circulation of ciliary vessels. In 210 eyes treated with anti-VEGF drugs, collateral circulation was established in 160 eyes. Among them, 32 eyes were MBRVO (50.7%, 32/63), BRVO 119 eyes (100.0%, 119/119), CRVO 9 eyes (32.1%, 9/28). ConclusionsThe incidence of collateral circulation of MBRVO, BRVO and CRVO is 53.7%, 100.0% and 18.1%, respectively. The forms of MBRVO were varied and the course of disease is about 2 months. Anti-VEGF therapy did not inhibit the establishment of collateral circulation.
Objective To observe the signal intensity and homogeneity of subretinal hyperreflective material (SHRM) in neovascular age-related macular degeneration (nAMD) and preliminarily analyze its relationship with macular neovascularization (MNV) morphology. MethodsA prospective cross-sectional observational study. Forty-six eyes of 46 nAMD patients with SHRM who initially visited Zhongshan Ophthalmic Center, Sun Yat-sen University from January 1, 2022 to March 31, 2023 were enrolled. Optical coherence tomography (OCT) examination was performed according to a standardized protocol, and 3D Slicer software was used for three-dimensional reconstruction of SHRM lesions. Signal intensity was represented by the mean gray value (mGV) of the three-dimensional lesion area, and homogeneity was represented by the standard deviation of gray values (GV-SD). OCT angiography (OCTA) was used to scan the 6 mm×6 mm area of the macula. FIJI and Angio Tool software were used to measure MNV vascular network total area, perimeter, maximum and minimum diameters, maximum vessel diameter, vascular component area, total number of vascular network junctions and endpoints, vessel dispersion, and mean lacunarity. The ratio of maximum to minimum diameter of the vascular network, average vessel length, vessel density, and vessel fractal index were calculated. Using the mean mGV of the total sample as the standard, the eyes were divided into low-density SHRM group (20 eyes) and high-density SHRM group (26 eyes); using the mean GV-SD of the total sample as the standard, the eyes were divided into homogeneous SHRM group (29 eyes) and non-homogeneous SHRM group (17 eyes). The morphological characteristics of MNV between groups were compared. Independent samples t-test or Mann-Whitney U test was used for between-group comparisons; a multivariate regression model was established to analyze independent factors affecting SHRM signal characteristics. ResultsAmong the 46 eyes of 46 patients, there were 26 eyes of 26 males (56.52%, 26/46) and 20 eyes of 20 females (43.48%, 20/26). The mean age was (65.61±7.50) years. The average vessel length and vessel dispersion in the high-density SHRM group and low-density SHRM group were (6.88±4.56), (11.30±6.31) mm?1 and 41.30±67.26, 13.22±11.34, respectively. Compared with the low-density SHRM group, the high-density SHRM group had significantly lower average vessel length (t=2.645) and higher vessel dispersion (t=?2.090), with statistically significant differences (P=0.012, 0.046). Compared with the homogeneous SHRM group, the non-homogeneous SHRM group had significantly higher total area (t=?2.338), maximum diameter (t=?3.137), and minimum diameter (t=?2.173), with statistically significant differences (P＜0.05). The total number of vascular network junctions in the non-homogeneous SHRM group and homogeneous SHRM group were (90.71±67.34) and (49.34±41.91), respectively; the non-homogeneous SHRM group had significantly more junctions than the homogeneous SHRM group, with a statistically significant difference (t=?2.286, P=0.032). Multivariate regression analysis showed that average vessel length was an independent factor affecting SHRM intensity (odds ratio=0.819, 95% confidence interval 0.705-0.951, P=0.009); there were no independent vascular indicators affecting SHRM reflectivity homogeneity (P＞0.05). ConclusionIn nAMD, compared with low-density SHRM, high-density SHRM has significantly lower average vessel length and higher vessel dispersion; compared with homogeneous SHRM, non-homogeneous SHRM has a larger spatial dimension of the vascular network.
ObjectiveTo observe the changes of macular structure and microvessels in eyes with diabetes macular ischemia (DMI). MethodsA retrospective case study. From January 2023 to July 2023, 23 patients of 31 eyes diagnosed with DMI at Tangshan Ophthalmological Hospital were included in this study. Among them, there were 14 males with 23 eyes; Female cases with 8 eyes. Age were (59.5±4.6) years old. According to the DMI grading standard formulated by the research group for early treatment of diabetes retinopathy, the patients were divided into mild DMI group, moderate DMI group, and severe DMI group, with 8, 12, and 11 eyes respectively. The blood flow density (VD), perfusion area (FA), small vessel VD (SVD), inner retinal capillary plexus VD, FA, and outer retinal, choroidal, and ganglion cell complex (GCC) thickness within 1 mm of the macular fovea in retinal superficial vascular plexus (SVP)were measured using a scanning frequency light source optical coherence tomography instrument. The changes in macular structure and microvasculature in the affected eyes of different degrees of DMI groups were compared and observed. Inter group comparisons were conducted using one-way ANOVA or Kruskal Wallis H-test. Spearman correlation analysis was used to analyze the correlation between DMI severity and GCC, outer retina, choroid thickness, VD, FA and SVP VD, SVD and FA in inner retina. ResultsThe GCC (F=70.670), outer retinal thickness (H=12.393), VD (F=105.506), SVD (H=25.300), FA (F=107.655), and VD (H=24.098) and FA (H=25.300) of the retinal SVP in the mild, moderate, and severe DMI groups were compared, and the differences were statistically significant (P＜0.05). There was no statistically significant difference in choroidal thickness (H=2.441, P＞0.05). Pairwise comparison between groups: VD, SVD, FA of GCC thickness and SVP, and VD of inner retina were statistically significant between severe DMI group and moderate DMI group, and between moderate DMI group and mild DMI group (P＜0.05). The thickness of outer retina was statistically significant between severe DMI group and moderate DMI group (P＜0.05). Inner retinal FA: there were statistically significant differences between severe DMI group, moderate DMI group and mild DMI group (P＜0.05). The correlation analysis results showed that GCC (rs=－0.918), outer retinal thickness (rs=－0.448), and inner retinal VD (rs=－0.894) and FA (rs=－0.918), as well as VD (rs=－0.919), SVD (rs=－0.924), and FA (rs=－0.939) of retinal SVP, were all negatively correlated with the degree of DMI (P＜0.05). There was no correlation between choroidal thickness and degree of DMI (rs=－0.081, P＞0.05). ConclusionThe thickness of GCC, outer retina and choroid, the VD, SVD, and FA of the retinal SVP, the VD and FA of inner retina are all reduced in eyes with different degrees of DMI, while all of them are negatively correlated with the degree of DMI, except for choroid thickness.
Optic nerve diseases seriously affect visual function, and early accurate diagnosis and effective follow-up are very important for treatment and prognosis. Optical coherence tomography (OCT) and OCT angiography (OCTA) are non-invasive and high-resolution imaging techniques, which play increasingly important roles in the diagnosis and treatment of optic nerve diseases. OCT can visually display the structure of retinal nerve fiber layer and macular area, accurately measure the thickness of nerve fiber layer and structural parameters of macular area. OCTA can clearly display the changes of microblood flow around optic disc and retinal blood vessels. The combined use of these two technologies will not only help diagnose and monitor optic nerve diseases, but also deepen our understanding of the pathogenesis of optic nerve diseases. In view of the fact that the application of OCT and OCTA in neuro-ophthalmic diseases involving the optic nerve is still in the development stage in the domestic medical community, it is urgent to formulate a guiding document to regulate and promote the application of these two technologies. To this end, based on a systematic literature review and combined with the current clinical practice of OCT and OCTA in China, we formulated the Expert consensus on the clinical application of optical coherence tomography and angiography in optic nerve diseases. This consensus comprehensively expounds the technical principles and main measurement indicators of OCT and OCTA, the specific application, examination specifications and limitations of OCT and OCTA in clinical diagnosis and follow-up of neuroophthalmic diseases involving optic nerve, aiming to improve the application level of OCT and OCTA by doctors, especially neuroophthalmologists, and better play the role of this advanced imaging technology in neuroophthalmology.
ObjectiveTo observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy (AMN) associated with the coronavirus disease 2019 (COVID-19). MethodsA retrospective study. From December 20, 2022 to January 17, 2023, a total of 29 patients (58 eyes) with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital, Shanghai Medical College were included in the study. All the affected eyes underwent the best corrected visual acuity, color fundus photography, infrared fundus photography (IR), short-wavelength autofluorescence (SW-AF), near-infrared autofluorescence (NIL-AF), optical coherence tomography (OCT), and OCT angiography (OCTA). All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy. Follow-ups were conducted 1 to 3 months after the initial diagnosis, with a total of 19 cases (38 eyes) completing the one-month follow-up. ResultsOut of the 29 cases, there were 9 males (18 eyes) and 20 females (40 eyes), all of whom experienced bilateral eye involvement. The age of the patients ranged from 12 to 47 years, with an average age of (29.9±9.5) years. The time from the onset of fever to the appearance of ocular symptoms was (2.52±2.01) days. Among the 58 affected eyes, there were 5 cases with retinal cotton wool spots, 2 cases with optic disc edema, and 1 case with parafoveal branch retinal vein occlusion. All affected eyes exhibited deep reddish-brown macular dark spots. IR revealed wedge-shaped, wedge-like, or "petaloid-like" dark areas involving the fovea and parafovea. SW-AF examination showed no obvious abnormality in 39 eyes. Weak autofluorescence dark area were consistent with IR in 19 eyes. NIR-AF examination showed spot-like or flaky self-fluorescent dark areas. OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium (RPE) layer in the macular area in the acute stage, showing typical "bean seedling" sign. OCTA revealed reduced blood flow density in the deep capillary plexus (DCP) of 50 eyes. En-face OCT displayed lesion areas that corresponded to the dark areas seen in IR. One month after the initial diagnosis, the condition improved in 18 eyes (47.4%, 18/38). Among the 5 eyes with cotton wool spots, regression of these spots was accompanied by loss of nerve fiber layer in 4 eyes. In cases with optic disc edema, the edema subsided. The "bean sprout" sign disappeared in all affected eyes, and the lesions became localized. The ellipsoid zone and/or interdigitation zone in the lesion areas were discontinuous. ConclusionsCOVID-19-related AMN is characterized by distinctive features. IR fundus reveals wedge-shaped, wedge-like, or petaloid dark areas involving the fovea and parafovea. OCT displays strongly reflective lesions with vertical spread above the RPE. OCTA shows reduced blood flow density in the DCP of the retina.
Objective To assess the consistency of diagnostic results using optical coherence tomography angiography(OCTA) and fundus fluorescein angiography(FFA) in the central retinal vein occlusion(CRVO). Methods A retrospective case series of 26 eyes of 26 patients with CRVO. Simultaneous OCTA and FFA were performed in all patients by using 7-standard field of ETDRS to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weightedKappa statistic values.Kappa≥0.75, consistency is excellent; 0.60≤Kappa＜0.75, consistency is good; 0.40≤Kappa＜0.60, consistency is general;Kappa＜0.40, consistency is poor. Results Examined by OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21eyes. Performed with FFA, 23 eyes were diagnosed to have microaneurysms, 16 eyes have nonperfused, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms(Kappa=0.772，P<0.01) and optical disc/retinal neovascularization(Kappa=0.766，P<0.01), good for nonperfused areas (Kappa=0.703，P<0.01) and macular edema(Kappa=0.60，P<0.01). Conclusion There is high consistency between OCTA and FFA in the diagnosis of CRVO, OCTA is an effective method in the examination of CRVO.