ObjectiveTo observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC), and to compare the stability and consistency of the two methods of measurement.MethodsA retrospective study. Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st, 2016 to Mar 18th, 2018 were included in the study. Thirty-one healthy age-matched subjects were enrolled as controls. All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT. The image was binarized and then the CVI of a 1500 μm range below fovea was calculated, i.e. the ratio of vascular (or lumen) area to total choroidal area. CVI and SFCT were compared among CSC eyes, fellow eyes and healthy eyes by variance analysis. Intra-group correlation coefficient (ICC), Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability, consistency and stability of CVI and SFCT; and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods.ResultsThere were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470, 2.844; P=0.001, 0.006), CSC affected eyes and healthy eyes (t=6.977, 6.277; P＜0.001,＜0.001), fellow eyes and healthy eyes (t=3.508, 3.433; P=0.001, 0.001). Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively, and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively. The consistency of CVI and of SFCT was very good. The ICC value of CVI was slightly higher than that of SFCT. The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller, and the difference between the two SFCT measurements was larger. And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5% and 25.3% respectively. CVI has smaller CV than SFCT.ConclusionsCompared with healthy eyes, CVI and SFCT are increased in CSC affected eyes and fellow eyes. And compared with SFCT, CVI has better consistency, repeatability and stability.
ObjectiveTo comparatively observe features of choroidal osteoma by multimodal fundus imaging methods. MethodsThis is a retrospective case study. Sixteen patients (16 eyes) with choroidal osteoma were enrolled in this study. The patients included 6 males (6 eyes) and 10 females (10 eyes), with an average age of (30.5±2.4) years. All patients received examination of best-corrected visual acuity, slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (SD-OCT). The tumors were classified as fresh lesion (clear boundary and rosy tumor with smooth surface) and obsolete lesions (pale and flat tumor with obvious patches). The tumor features of color fundus photography, AF, FFA and SD-OCT were comparatively observed. ResultsThere were 5 fresh lesions and 11 obsolete lesions. Color fundus photography showed the tumor color was orange-red or yellow-white with clear boundary and retinal blood vessels on the surface of the tumor. The color of fresh lesion was rosy. In general, choroidal osteoma shown weak AF, however AF of fresh tumor was slightly stronger than the obsolete tumor, and retinal detachment region showed relatively stronger AF. FFA of fresh tumor indicated uniform intense fluorescence with clear boundary at late stage, much stronger than obsolete tumor. SD-OCT showed mesh-like reflected signal in the choroidal layer, but different from the surrounding choroidal vascular structures. ConclusionsThe tumor color is orange-red or yellow-white in color funds photography, which shown weak AF. FFA showed mottled hyperfluorescence in the early stage and tissue staining at the late stage. SD-OCT showed mesh-like reflected signal in the choroidal layer.
Objective To investigate the correlation of microperimetric parameters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME) eyes. Methods It is a prospective, no controlled, open study. Twenty-four consecutive patients (40 eyes) with DME were included. There were 10 males (18 eyes),14 females (22 eyes); aged from 41 to 79 years, with the mean age of (56.84±8.96) years. All the patients were type 2 diabetes, the average duration of diabetes was 8 years. BCVA was evaluated using the international Snellen E vision test chart, and then recorded as logarithm of the minimum angle of resolution (logMAR). CRT was measured by Cirrus HD-OCT4000. MAIA microperimetric parameters were evaluated, including average threshold (AT) of retinal sensitivity, macular integrity index (MI), fixating points within a circle of 1° (P1) and 2° of radius (P2), bivariate contour ellipse area (BCEA) considering 63% and 95% of fixating points (A63,A95), and horizontal and vertical axes of that ellipse (H63,H95,V63,V95). Pearson correlation analysis was performed to evaluate the association between these variables. The independent factor influenced the type of fixation was analyzed by multiple linear regression analysis. Results Strong correlations of logMAR BCVA with CRT (r=0.58,P=0.000), V63 (r=0.44,P=0.004), V95 (r=0.41,P=0.008), MI (r=0.36,P=0.024), AT (r=?0.61,P=0.000), P1 (r=?0.41,P=0.009), P2 (r=?0.38,P=0.015) were found. AT was correlations with P1 (r=0.53,P=0.000), P2 (r=0.51,P=0.001), A63 (r=?0.39,P=0.012), A95 (r=?0.40,P=0.012), V63 (r=?0.53,P=0.000), V95 (r=?0.46,P=0.003), MI (r=?0.50,P=0.001). There was no correlation between AT and CRT (r=?0.21,P=0.190). Forty eyes were included in this study, 8 eyes (20%) had stable fixation,14 eyes (35%) had relatively unstable fixation,18 eyes (45%) had unstable fixation. Multiple linear regression analysis showed that fixation classification was independently affected by P1. Conclusions In DME eyes, logMAR BCVA was positively correlated with CRT, negatively correlated with AT, P1 and P2. There is no correlation between AT and CRT. The fixation classification was independently affected by P1.
Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=（M+N）/BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=?0.665, ?0.691; P＜0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery.
ObjectiveTo determine the retinal nerve fiber layer thickness (RNFLT) of chronic progressive external ophthalmoplegia (CPEO) and kearns-sayre syndrome (KSS) patients using spectral-domain optical coherence tomography (SD-OCT) and to analyze the potential influence factors for RNFLT of these patients. Methods18 CPEO and 4 KSS (CPEO with retinitis pigmentosa and cardiac block) patients, all were muscle biopsy confirmed, were included in this study. There were 7 males and 15 females, the average age was (29.09±13.40) years, the average onset age was (16.4±10.7) years and the average disease duration was (11.30±7.30) years. All the patients underwent SD-OCT examination for the left eye, the peripapillary RNFL thickness was measured using the Spectralis 3.45 mm circle scan protocol. 8 quadrants were scanned including superior temporal (ST), temporal upper (TU), temporal lower (TL), inferior temporal (IT), inferior nasal (IN), nasal lower (NL), nasal upper (NU) and superior nasal (SN). The relationship between RNFLT and onset time, disease duration was analyzed by Pearson correlation analysis. ResultsThe average RNFLT of ST, TU, TL, IT, IN, NL, NU, SN in the 22 patients were (136.3±24.1), (85.4±25.7), (68.2±11.7), (128.2±28.7), (127.3±29.5), (66.7±16.8), (70.1±17.6) μm, respectively. The circumferential average RNFLT was (101.5±14.4) μm. There was no significant difference between the KSS group and CPEO group (P>0.05). The decrease of the circumferential RNFLT had no relationship with the onset age (r=-0.306, P=0.11), but a negative relationship with the disease course (r=-0.518, P=0.03). There were negative relationships between the disease course and RNFLT of 4 nasal quadrants (IN:r=-0.555, P=0.01, NL: r=-0.630, P=0.00, NU: r=-0.559, P=0.01, SN: r=-0.557, P=0.01). ConclusionThere is no difference in RNFLT of patients with CPEO and KSS. There is a negative relation between RNFLT (especially RNFLT of 4 nasal quadrants) and disease course.
Macular edema is an important cause of visual impairment in many eye diseases such as diabetic retinopathy, retinal vein occlusion and uveitis. Optical coherence tomography (OCT) provides high-resolution image of retinal microstructures in a non-contact and rapid manner, which greatly improves the ability of diagnosis and follow-up to macular edema patients. OCT has been widely used in the clinical detection of patients with macular edema. No matter what the cause of macular edema is, it can be observed in OCT images that there are spot-like deposits with strong reflection signals in the retina, which are mostly distributed discretely or partially convergent, and are called hyperreflective foci. At present, the nature or source of hyperreflective foci is not clear, however, may involve the destruction of the blood retina barrier, retinal inflammatory reaction, neurocellular degeneration, and so on. These mechanisms are also the key physiological mechanisms in the development of macular edema. The clinical research on hyperreflective foci provides a new direction for understanding the pathogenesis of macular edema and predicting the prognosis of macular edema. The distribution and quantity characteristics of hyperreflective foci may be an important biological marker to predict the prognosis of macular edema.nosis of macular edema. foci provides a new direction for understanding the pathogenesis of macular edema and predicting the prognosis of macular edema. The distribution and quantity characteristics of HRF may be an important biological marker to predict the prognosis of macular edema.
Leber hereditary optic neuropathy is an optic neuropathy associated with mitochondrial DNA. The disease affects young men mainly, which is considered to be due to denaturation of the retinal nerve ganglion cell and axonal loss of optic nerve, leading to optic atrophy. Nowadays, there are some development in studying Leber hereditary optic neuropathy by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). It is great help to know the disease, forecast the progression of disease, and take action on intervention. In addition, there is a lack of in-depth study on OCT and OCTA characteristics among different mutation sites of LHON, different genders of the same site, different families of the same site or even different branches of the same family. It is expected to be improved in the future work.
Objective To compare changes in retinal and choroidal blood flow in the macular area of eyes with idiopathic macular hole (IMH), fellow eyes, and normal eyes. Additionally, the correlation between these blood flow changes and the occurrence and development of IMH. Methods A cross-sectional study. From January 2023 to January 2024, 47 patients (47 eyes) diagnosed with IMH (IMH group) in Department of Ophthalmology of The Second Hospital of Hebei Medical University were included in the study. The contralateral eye of IMH eyes was assigned to the contralateral eye group. Healthy volunteers with matched gender and age were selected as the normal control group. Swept-source optical coherence tomography angiography was used to acquire the vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the areas within 0-1 mm and 1-6 mm around the fovea, including the superior, temporal, inferior, and nasal regions. Additionally, the choroidal blood flow area (CBFA) and three-dimensional choroidal vascular index (3D-CVI) were measured. The minimum linear diameter (MLD) and base diameter (BD) of the IMH were manually measured. Spearman correlation analysis was performed to evaluate the correlation between the size of the IMH and the various vascular parameters. ResultsCompared with the normal control group, the SCP-VD in the 3rd stage (t=1.298, P=0.009) and 4th stage (t=1.264, P＜0.000) eyes in the IMH group was significantly decreased, with statistical significance; the DCP-VD (t=1.958, 2.150, 1.712, 1.667; P=0.027, ＜0.000, ＜0.000, ＜0.000) and 3D-CVI (t=0.027, 0.030, 0.024, 0.023; P=0.005, 0.003, ＜0.000, ＜0.000) in eyes of all stages were significantly decreased, with statistical significance; the CBFA in eyes of stages 2-4 was significantly decreased, with statistical significance (t=0.027, 0.022, 0.021; P=0.028, 0.002, 0.002). Compared with the contralateral eye group, the DCP-VD and 3D-CVI in the IMH group were significantly reduced, with statistical significance (Z=?3.289, ?2.704; P=0.001, 0.007). Pairwise comparisons between eyes of different stages in the IMH group showed that SCP-VD was significantly different between stage 2 and stage 4 (t=1.776, P=0.008); DCP-VD was significantly different between stage 1 and stage 3, and stage 1 and stage 4 (t=1.685, 1.661; P=0.002, 0.000). Correlation analysis showed that SCP-VD was negatively correlated with MLD and BD (r=?0.508, ?0.408; P=0.002, 0.014); DCP-VD was negatively correlated with BD (r=?0.410, P=0.013). Compared with the normal control group, the nasal CBFA in stage 3 and 4 IMH eyes (t=0.149, 0.145; P=0.005, 0.002), and the nasal 3D-CVI in stage 1 and 3 IMH eyes (t=0.030, 0.027; P=0.002, ＜0.000) were significantly decreased, with statistical significance. ConclusionsThe SCP-VD, DCP-VD, CBFA, and 3D-CVI in IMH eyes were significantly reduced. SCP-VD showed a negative correlation with MLD and BD, while DCP-VD was only negatively correlated with BD.
ObjectiveTo evaluate the spectral domain optical coherence tomography (SD-OCT) characteristics of polypoidal choroidal vasculopathy (PCV) and its correlation with the visual acuity after photodynamic therapy (PDT) combined with intravitreal ranibizumab. MethodsTwenty-six eyes of 26 patients with PCV diagnosed by indocyanine green angiography (ICGA) were enrolled in this study. All the patients were examined for best corrected visual acuity (BCVA), slit lamp microscope, SD-OCT, fundus fluorescein angiography (FFA) and ICGA before and 1, 3 months after treatment. The mean baseline BCVA was (31.46±16.87) letters, mean central retinal thickness (CRT) was (581.19±309.05) μm, and mean subfoveal choroidal thickness (SFCT) was (248.92±95.45) μm. Patients were divided into 2 groups according to the final visual improvement after 6 month of treatment: GR or sensitive Group (17 eyes) and PR or non-sensitive Group (9 eyes). GR group included 12 males and 5 females, with a mean age of (65.24±7.03) years, a mean CRT of (619.06±335.07) μm and a mean SFCT of (271.24±106.61) μm. There were 4 eyes with subretinal hemorrhage (SRH), 2 eyes with interface retinal fluid (IRF), 13 eyes with subretinal fluids (SRF) and 15 eyes with pigment epithelial detachment (PED). PR group included 8 males and 1female, with a mean age of (64.00±7.02) years, a mean CRT of (509.67±255.21) μm and a mean SFCT of (271.24±106.61) μm. There were 6 eyes with subretinal hemorrhage (SRH), 5 eyes with interface retinal fluid (IRF), 6 eyes with subretinal fluids (SRF) and 8 eyes with pigment epithelial detachment (PED). The difference of sex, age, CRT and SFCT between these two groups was not significant (P>0.05). The relationship of baseline SD-OCT and post-treatment BCVA was analyzed. ResultsOn 1, 2, 3, 6 months after treatment, the BCVA were (38.46±19.81), (40.04±20.80), (42.96±21.63), (43.77±20.91) letters respectively. On 6 months after treatment, the mean CRT in GR and PR group were (360.71±276.54), (341.44±193.68) μm respectively (P>0.05). 64.71% (11/17) eyes in GR group and 22.22% (2/9) eyes in PR group had a SFCT thicker than 263μm. The difference was statistical significant between two groups [odds ratio (OR):0.052, 95% confidence interval (CI):0.005-0.533; P=0.013]. Logistic regression analysis showed that existence of IRF (OR=9.375, 95% CI: 1.299-67.645; P=0.026) or SRH (OR=6.500, 95% CI: 1.094-38.633; P=0.040) at baseline was negative prognostic factor to treatment. ConclusionThick SFCT is a protective factor, however, existence of IRF or SRH at baseline is negative prognostic factor of final visual improvement.