Outer retinopathy does not refer to a specific type of retinal disease. Patients with outer retinopathy often have abnormal vision symptoms, however, no positive signs can be found with conventional routine eye examination. And the diseases are often labeled “occult”. In recent years, optical coherence tomography (OCT) has been widely used in clinical practice. It has been found that many so-called “occult” diseases are actually caused by structural abnormalities of the outer retina. The causes of structural abnormalities are diverse, and the treatments and disease outcomes are also different. Therefore, it is necessary for clinical ophthalmologists to get detailed medical history, make diagnosis and differential diagnosis based on multi-model imaging, rather than roughly name it as “outer retinopathy”. With the development of OCT imaging technology, higher resolution images reveal the finer structure of retinal tissue, allowing us to have a deep understanding of the disease, thus improving diagnosis and treatment in clinical practice.
Objective To evaluate the changes of optic nerve head (ONH) and the thickness of peripapillary retinal nerve fiber layer (RNFL) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography (OCT). Methods Circular and cross-sectional OCT scans of an area with a diameter of 3.38 mm surrounding the optic disc were performed for 108 eyes (96 cases) with NAION, including 96 eyes (96 cases) in acute edema phase and 41 eyes (37 cases) in resolving phase. Follow-up period was 2 weeks to 24 months, with an average of 6 months. Results The RNFL was thickener with shallow cup or small cups in the acute edema phase. Comparing with the RNFL in the ischemic sector, the thickness of peripapillary RNFL in the nonischemic sector was greater in 59 eyes (59 cases, 61%), lesser in 26 eyes (26 cases, 27%) and no difference in 11 eyes (11 cases, 12%). During the treatment NAION eyes were dynamically observed by OCT. While ischemic edema of the optic disc resolved in about two weeks, non-ischemic edema subsided in 3-6 weeks. After 1 month in the resolving phase, the thickness of peripapillary RNFL in the ischemic sector of 35 cases (95%) was thinner than the thickness of non-ischemic sector and fellow normal controls. After 3 month in the resolving phase, 26 cases (70%) showed thinner RNFL of whole optic disc. Conclusion The thickness of RNFL in NAION patients in acute edema phase is thicker than that in the fellow normal eyes, and is also thicker in ischemic sector than that in non-ischemic sector. In resolving phase, the thickness of RNFL is thinner in NAION eyes than that in the fellow normal eyes.
Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion （RVO）, and to explore the application value of Fourier-domain (FD) OCT in RVO macular edema.Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity （BCVA）, direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients （60 eyes）also underwent fundus fluorescein angiography. There were 35 patients （35 eyes）with central retinal vein occlusion （CRVO） and 56 patients（57 eyes）with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema,characteristics of OCT images and the relationship between the different type of the edema and vision.Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (spongelike thickening of the retina with reduced reflectivity) 12 patients （12 eyes, 13.0%), cystoid edema (multicystlike space in the neuroretina separated by tissue column) 21 patients （21 eyes, 22.8%) and serous retinal detachment (separation of neuroretina and retinal pigment epithelium by space with low reflectivity) 37 patients （37 eyes, 40.2%) and mixed edema（mix of the above several edema form）58 patients （59 eyes, 64.1%）. The edema can happen at different layers of the neuroretina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients （92 eyes, 100.0%), inner nuclear layer (INL) in 68 patients （68 eyes, 74.2%）and ganglion cell layer (GCL) in 23 patients （23 eyes, 25.0%）.Statistic analysis revealed that BCVA was related to the integrity of IS/OS （r=3.778 6, P=0.000）, ELM （r=4.462 2,P=0.000）and FT (r=-0.4513, P=0.000 ), but not related to CFT （r=0.269 7, P=0.121）, V（r=0.0528, P=0.054）and AT (r=0.060 8,P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.
ObjectiveTo determine the retinal thickness of normal children 3-6 years old and its relationship with the age and gender. MethodsIn a cross-sectional study, 480 eyes of 240 normal preschool children including 115 male and 125 female, ages 3 to 6 years in the urban of Beijing, China were included. The average age was (4.93±0.77) years old. The visual acuity, slit-lamp microscopy and frequency domain optical coherence tomography (FD-OCT, Optvue, Inc. USA) were examined. The retinal thickness of the macular fovea and 500, 750, 1500 μm from temporal and nasal side around the fovea were measured. 32 eyes were excluded from the study because they couldn't cooperate. Pearson correlation analysis was used to determine the correlation between age and macular retinal thickness. Independent samples group t-test was used to compare the differences between boys and girls. ResultsThe mean thickness of macular fovea was (169.10±20.587) μm. The mean macular thickness of boys was significantly higher than girls (t=-4.549, -6.167, -5.492, -5.163, -6.749, -7.494, -6.874; P≤0.001). The mean thickness of 500 μm and 750 μm from nasal side of macular fovea were significantly higher than temporal side (t=5.594, 15.778, 7.678, 18.180; P < 0.001). There was no significant relevance between macular thickness and age. ConclusionsThe mean macular thickness of boys is significantly higher than girls in normal children in the urban of Beijing. There is no significant relevance between macular thickness and age.
Objective To observe the image characteristics of eyes with choroidal osteoma using enhanced spectral domain optical Cirrus coherence tomography （SD-OCT）, and to explore their relationship with visual acuity. Methods The records and SD-OCT images of 14 patients（18 eyes） diagnosed with choroidal osteoma at this hospital were reviewed retrospectively. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, fundus fluorescein angiography, B scan and/or computerized tomography. Subtle structure changes of the retina and choroidal osteoma were observed by four lines of the horizontal, the vertical scanning lines through the foveal and the tumor basal diameter under the model of five Line Raster．The correlation between the retinal and choroidal morphology and visual acuity was evaluated. Results The choroidal features of SD-OCT image of choroidal osteoma can be categorized into hyper-reflective in six eyes (33.3%), isoreflective in five eyes (27.8%), hypo-reflective in three eyes (16.7%) and mixing-reflective in four eyes (22.2%). The foveal thickness ranged from 50.2 to 245.1μm, and the average foveal thickness was (130.2±58.3) μm. The horizontal and vertical diameters of choroidal osteoma ranged from 5.6 to 15.8 mm and 4.6 to 12.8 mm respectively. The average horizontal and vertical diameters of choroidal osteoma were (7.8±2.9) mm and (6.5±2.5) mm respectively. The statistical analysis revealed that BCVA was not related to the horizontal, vertical diameters of choroidal osteoma or the foveal thickness （r=0.262, 0.229, 0.137; P=0.284, 0.294, 0.362）. BCVA was related to the involvement of fovea and the integrity of photoreceptor inner/outer segment junction (IS/OS) （r=-3.838,-4.559; P=0.0015, 0.0003），but not related to macular choroidal neovascularization (CNV) or serous retinal detachment （r=-0.144, 0.411; P=0.684, 0.687）. Conclusions The main SD-OCT image characteristics of eyes with choroidal osteoma was hyper-reflective and isoreflective. BCVA was not related to the horizontal, the vertical diameters of choroidal osteoma, the foveal thickness, macular CNV or serous retinal detachment. It was related to the involvement of fovea and the integrity of IS/OS.
Objective To observe the Fourierdomain optical coherence tomography（FD-OCT）characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s,area of 6.0 mmtimes;6.0 mm, and mode of 512times;128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings: no traction (9.48%), tangential traction (84.48%) and tangential traction with anteriorposterior traction (6.04%). A total of 97 eyes (83.62%) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL) . A total of 14 eyes (12.07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment junction (IS/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis (Pgt;0.05), but was related with CFT(Plt;0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients' visual acuity.
ObjectiveTo assess the occurrence of CNV in patients presenting with flat irregular pigment epithelial detachments (FIPED). MethodsForty-five patients (49 eyes) with FIPED on OCT were enrolled in this retrospective study. There were 25 males (28 eyes) and 20 females (21 eyes). The mean age was 61.022±9.292 years. FFA, ICGA, spectral domain OCT and OCT angiography (OCTA) were performed in all patients during the same period. The FIPED was defined as an irregular elevation of the RPE allowing distinct visualization of Bruch’s membrane on OCT B-scan. The abnormal vascular signals from the deep retinal layer to the choroid layer on OCTA was defined as CNV. The CNV was classified into a type 1 CNV and a type 2 CNV according to the OCT characteristics. The CNV was classified into a typical and occult CNV according to the characteristics of the FFA image. Of all 49 eyes, fundus angiography revealed 18 eyes (36.7%) with CNV, and 31 eyes (63.3%) with no characteristic signs of CNV. FFA examination found that CNV in 8 eyes (classic CNV in 1 eyes, occult CNV in 7 eyes), which confirmed by OCT were type 1 CNV; transmitted fluorescence in 41 eyes. ICGA examination showed that CNV-like hyperfluorescence spots in 18 eyes, suspicious hyperfluorescence spots in late stage in 20 eyes, and choroidal high permeability in 11 eyes, respectively; and 18 CNV eyes were confirmed to be type 1 CNV by OCT. To compare the detection of CNV by OCTA and fundus angiography. ResultsOf the 49 eyes with FIPED, OCTA detected 36 eyes (73.5%) of type 1 CNV, and full or partial strong reflex signals were seen in FIPED; 13 eyes (26.5%) were not associated with CNV, and some strong reflection signals were found in FIPED in 9 eyes, 4 eyes with weak reflection signal. The FFA was examined for 1, 7 eyes of the classic and occult CNV, which confirmed to be type 1 CNV by OCTA. Among the 18 eyes with CNV which detected by ICGA, OCTA also found type 1 CNV. Among the 20 eyes with ICGA’s late suspicious strong fluorescent spots, OCTA showed 17 eyes of type 1 CNV; in 11 eyes with high choroidal permeability, OCTA showed type 1 CNV in 1 eye. Among the 36 eyes with CNV which detected by OCT, there were SRD in 32 eyes, no SRD in 2 eyes and retinal interlamellar cavities in 2 eyes. ConclusionOCTA can detect 73.5% of FIPED eyes with CNV. Compared with traditional fundus angiography, OCTA has a higher detection rate of CNV under FIPED. The FIPED of the internal strong reflection signal has a certain diagnostic value for the type 1 CNV.
ObjectiveTo compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.MethodsThirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender, age, axial length matched healthy volunteers (control group) were enrolled in this study. For each subject, macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured. Then 3.0 mm×3.0 mm macular scan with SS-OCT angiography was performed, and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane. The grayscale images were then binarized for the analysis of FBFD.ResultsThe SCT in ECS group was (394.7±77.7) μm, which was significantly thicker than (332.1±68.1) μm in control group (t=2.923, P=0.008). The FBFD of intermediate choroid in ECS group were (76.35±14.46)%, which were significantly greater than (63.57±13.42)% in control group (t=2.775, P=0.01).ConclusionECS patients had increased FBFD at intermediate choroid level compared with healthy controls.
Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography (OCT) images: outer layer retinoschisis, outer + middle layer retinoschisis, outer + inner layer retinoschisis and multilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane (ILM) around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on multilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.
ObjectiveTo observe the clinical features of nine foveal hypoplasia (FVH) patients in a family. MethodsA retrospective clinical study. In August 2018, nine patients with FVH from a family diagnosed in Qilu Hospital of Shandong University (Qingdao) were included in this study. Detailed medical history of the proband was collected. Best corrected visual acuity (BCVA), slit-lamp, cycloplegic refraction, fundus color photography, optical coherence tomography (OCT) and OCT angiography (OCTA) were performed on the proband. The peripheral venous blood of V7 (family member), the proband and the proband's parents were collected for DNA extraction, and gene detection was performed. ResultsThe proband, a four-year-old girl, had poor vision with BCVA of 0.4 in both eyes. OCT showed absence of foveal pit, absence of outer segment lengthening, absence of outer nuclear layer widening and incursion of inner retinal layers. The proband's mother was 32 years old, and macular foveal reflection was not observed in her eyes. OCT and OCTA examination showed no foveal pit and foveal avascular zone in both eyes. Both eyes of the proband and her mother were diagnosed with Thomas grade 4 FVH. The other seven patients also had no foveal pit, and could be categorized into Thomas grade 3 or 4. No significant pathogenic genes and mutation sites were detected in the proband through whole genome sequencing, and no copy number variation or chromosomal abnormality associated with the phenotype of the proband was detected. After seven months of amblyopia treatment, the proband's BCVA had improved to 0.5 in the right eye and 0.6 in the left eye, while the BCVA did not change after 2 years of follow-up. ConclusionNine FVH patients in this family had no foveal pit with similar OCT images, and their visual acuity was affected from lightly to severely. Early amblyopia training is helpful to improve the visual acuity of child patients.