Idiopathic intracranial hypertension (IIH) is a neurological disease, characterized by increased intracranial pressure and papilledema, and often associated with headache, transient loss of vision and pulsatile tinnitus. IIH typically occurs in women of childbearing age. Over 90.0% of patients are with obesity or over weighted. Loss of sensory visual function is the major morbidity associated with IIH and some patients even develop into blindness. Most patients will have varied degrees of visual impairment, or even a few become blind. Frisén grading system, visual field examination and spectral-domain optical coherence tomography can be used to evaluate and monitor the IIH papilledema functionally and morphologically. In recent years, IIH treatment trials in other countries confirmed that, weight loss and low-salt diet combined with acetazolamide treatment has a clear improvement for IIH patients with mild visual impairment. In-depth understanding of the etiology, clinical manifestations, diagnostic criteria and the main treatment has important clinical significance for IIH patients
ObjectiveTo observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.MethodsA retrospective case series. Thirty-one patients (31 eyes) with monocular FCE, first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People’s Hospital of Foshan from December 2014 to December 2018, were involved in this study. There were 14 males and 17 females, with the mean age of 45.84±13.57 years. All patients underwent BCVA, optometry, and SD-OCT examinations. FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications. The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT). The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs. FCE complication group 14 eyes), based on whether complicated by RPE dysfunction. Among 14 eyes of FCE complication group, 7 (22.6%) with choroidal neovascularization, 4 (12.9%) with central serous chorioretinopathy, 1 (3.2%) with polypoidal choroidal vasculopathy, and 2 (6.5%) with RPE detachment. No significant difference was found in the mean age (t=0.87), gender composition (χ2=0.06), ocular laterality (χ2=2.58), and spherical equivalent (t=?0.81) between two groups, respectively (P＞0.05), except that the BCVA was significantly different (t=?2.11, P＜0.05). The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed. Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.ResultsThirty-three excavations were identified in 31 eyes with FCE. The mean SFCT was 167.00±85.18 μm in FCE alone group vs. 228.36±67.95 μm in FCE complication group, while the excavation width was 645.00±231.93 μm vs. 901.00±420.55 μm and they were both significantly different (P＜0.05). Logistic regression analysis showed the SFCT (OR=1.016, P=0.026) and excavation width (OR=1.004, P=0.034) were risk factors for RPE complications of FCE. EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group, especially at the boundary area of excavation. The RPE damages were located at the boundary area of excavation in 10 eyes (71.4%) of FCE complication group. Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.ConclusionsSFCT and excavation width may be risk factors for RPE complications of FCE. Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.
ObjectiveTo observe the characteristic of optical coherence tomography (OCT) and subfoveal choroidal thickness(SFCT) in patients with multiple evanescent white dot syndrome (MEWDS). MethodsThe clinical data of 10 patients (10 eyes)with MEWDS were included in the study. 10 normal subjects with matched age, gender and ocular refractive status was selected as control. The patients including 9 females (9 eyes) and 1 male (1 eye), with the average age of (27±8) years. The onset time ranged from 5 to 14 days. The patients were in acute phase if it was in 2 weeks after onset, or convalescent phase if onset was 8 weeks ago. The corrected vision, slit lamp biomicroscopy, ophthalmoscope, fundus photography, fundus fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT) were performed alone or combined in all patients. The SFCT between the acute and convalescent phases were measured using enhanced depth imaging OCT. The average follow-up was 5 months. The OCT characteristics of affected eyes between acute and convalescent phase were compared. The SFCT of the affected eyes and fellow eye were compared. ResultsThe foveal inner segment-outer segment (IS/OS) was disrupted, thin, irregular in the acute phase, and restored in the convalescent phase. The SFCT of patients in the acute phase was (239±140.7) μm, in the convalescent phase was (189.9±115.6) μm. The SFCT in the acute phase was more thicker than the convalescent phase (t=5.287, P < 0.05). The SFCT of fellow eyes in the acute phase was (214.6±127.2) μm, in the convalescent phase was (186.5±108.6) μm, the difference was significant(t=3.553, P < 0.05).The SFCT in the control subject was (155.5±83.5) μm. The SFCT in the acute phase was thicker than the control(Z=-2.117, P < 0.05). ConclusionsIn the acute phase of MEWDS, the foveal IS/OS was disrupted, thin and irregular in OCT scan. The choroid is thicker in the acute phase than in the convalescent phase in both eyes, and thicker than controls.
ObjectiveTo investigate the clinical characteristics of 40 patients with ocular toxocariasis (OT) on the first attendance. MethodsA total of 40 consecutive patients who were clinically and serologically diagnosed with OT were retrospectively reviewed. ResultsThe mean age of patients was (12.12±10.42) years. There were 29 males and 11 females. 29 cases presented with decreased vision, 4 children with leukocoria, 2 cases with strabismus and 5 cases was found abnormal during regular eye examination. Initially 8 eyes (20%) were misdiagnosed as retinoblastoma (1 eye), Coat's disease(1 eye), cataract (2 eyes), iridocyclitis (2 eyes) and retinal detachment (2 eyes). 23 eyes had retinal detachment, 19 eyes had cataract. OT was the initial diagnosis for 15 patients (37.5%). The best corrected visual acuity (BCVA) were NLP to 0.7. Ultrasound biomicroscopy (UBM) were performed in 29 eyes, and identified peripheral granulomas in 23 eyes and adjacent tractional retinal detachment in 12 eyes. We also identified 17 cases (68.0%) with elevated IgE level among 25 patients with positive serological antibody test. ConclusionsTractional retinal detachment, vitreous opacities and cataract are the common clinical findings at the first attendance of OT patients. The adjunctive test of serum total IgE level may be helpful for the diagnosis. The application of UBM and specific IgG detection in serum and intraocular fluid, can also improve the diagnosis.
Objective To evaluate the long-term result of vitrectomy for macular epiretinal membranes(ERM) and the relationship between bestcorrected visual acuity(VA) and macular thickness. Methods In a retrospective consecutive series, twenty-two eyes(17eyes of idiopathic（77％） and 5 of secondary ERM（23％）) of 2 2 patients with macular ERM who underwent pars plana vitrectomy and membrane peeling which had more than 1 yearprime;s (12.40 months，mean(23plusmn;8)months)follow up were included. All the patients were examined by VA, fundus color photography, fluo rescein fundus angiography (FFA) optical coherence tomography (OCT) before and after treatment. VA was adopted 5 points record; FFA and OCT were underway as common way. The mean of VA was (4.25plusmn;0.36), the mean of macular thickness was (4.99 plusmn;114) mu;m. Compared the VA, appearance of fundus photography, fluorescein angio graphy and optical coherence tomography (OCT) before and after surgery. Results Visual improvement was achieved in 13 eyes (59%), meanwhile, 6 eyes (27%) were s table and 3 eyes (14%) were worse; VA of 15 eyes (66%) was more than 4.5 at last follow-up. The mean VA increased from (4.25plusmn;0.36) to (457plusmn;031) postope rative ly, the difference was statistically significant (P＜0.05). Mean macular thi cknes s decreased from (499plusmn;114) mu;m (317-774 mu;m) to (286plusmn;104) mu;m (150-597 mu;m) (P＜0.05) postoperatively, the difference was statistically significant (P＜0.05), but still different to the opposite eyesprime;((184plusmn;37) mu;m)(P＜0.05).VA correlated with macular thickness preoperatively (r=-0.64,P=0.001)and postoperat ively(r=-0.58, P=0.01) except the patients with cataract improvement without therapy. 6 eyes(27%) had retinal hemorrhage and 2 eyes(9%) had peripheral retinal breaks intraoperati vely; 5 eyes(23%) had secondary higher intraocular pressure, 1 eye(5%) had macul a hole and 8 eyes(36%) had cataract improvement postoperatively. Conclusions Surgery is successful in treating ERM. It can relieve macular edema and improve visual acuity. （Chin J Ocul Fundus Dis，2008，24：206-209）
Objective To detect the apoptosis of vascular endothelial cells and retinal pigment epithelial (RPE) cells in vitro induced by verteporfin-photodynamic therapy. Methods Cultured vascular endothelial cells and human RPE cells were incubated with verteporfin at a concentration of 1.0 mu;g/ml which was equivalent to the initial plasma level of verteporfin in clinical therapy. Each kind of cells were divided into 6 groups according to different time of incubation: 0, 5, 15, 30, 60, and 120 minutes group. After incubated, the cells were illuminated by the laser light with the maximum wavelength of absorption of verteporfin (wavelength: 689 nm, power density: 600 mW/cm2) with the power of 2.4 J/cm 2for 83 seconds. The percentage of cellular apoptosis was measured by flow cytometry 3 hours after PDT, and the measurement was repeated thrice. Results The proportion of cellular apoptosis 3 hours after PDT were 0.01plusmn;0.01, 0.25plusmn;0.02, 0.32plusmn;0.02, 0.41plusmn;0.04, 0.49plusmn;0.03 and 0.61plusmn;0.02, respectively in 0-120 minutes group of vascular endothelial cells; and 0.02plusmn;0.01, 0.22plusmn;0.01, 0.31plusmn;0.02, 0.38plusmn;0.03, 0.47plusmn;0.05 and 0.58plusmn;0.03 respectively in 0-120 minutes group of RPE cells. The proportion of cellular apoptosis of both kinds of the cells increased as the incubation time was prolonged. There was no significant difference of the percentage of cellular apoptosis between the accordant time groups in the two kinds of cells (P＞0.05). Conclusions Cellular apoptosis can be quickly induced by verteporfin-PDT both in human vascular endothelial cells and RPE cells; under the same condition in vitro, PDT has no obvious selection for the apoptosis of the two kinds of cells. (Chin J Ocul Fundus Dis, 2006, 22: 253-255)
ObjectiveTo evaluate the 3-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). MethodsThis is a retrospective, uncontrolled case series study. Thirty-two eyes of 29 patients with PCV were enrolled. All patients were primarily treated with the first conventional PDT. For the eye with active polypoida, residual or exudative lesions in 6 month after PDT, PDT combined with intravitreal anti vascular endothelial growth factor (VEGF)or simple vitreous injection of anti VEGF therapy were used. All the patients were followed up for at least 3 years with the mean follow-up duration of 43.64±10.84 months. The best-corrected visual acuity (BCVA) in 1, 3, 6, 12, 24 and 36 months after the primary PDT, PCV recurrence rates and number of treatments were followed and analyzed. The BCVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. ResultsDuring the 1, 3, 6, 12 months after the primary PDT, the mean BCVA were all improved with statistically significant difference(t=2.27, 4.57, 3.77, 2.37; P<0.05). During the 24 and 36 months after PDT, the mean BCVA was decreased without statistically significant difference(t=-1.29, -0.81; P>0.05). On the final evaluation at 36 months, the mean BCVA was improved in 6 eyes(18.75%), stable in 14 eyes(43.75%), and decreased in 12 eyes(37.50%). During the follow-up time, recurrence of PCV in 24 eyes (75.00%), no recurrence in 8 eyes (25.00%). There was 1 recurrence in 12 eyes (50.00%), 2 recurrences in 9 eyes (37.50%), 3 recurrences in 3 eyes (12.50%). Initial recurrences were noted in 4 eyes (16.67%) within 12 months of baseline PDT treatment; in 11 eyes (45.83%) between 13 and 24 months; in 9 eyes (37.50%) between 25 and 36 months. The mean number of PDT and anti-VEGF was 1.86±1.04 and 4.95±3.92 in all patients, respectively. ConclusionThe 3-year efficacy of PDT in patients with PCV was poor with low improvement of visual acuity and high recurrence rate of PCV.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
The randomized controlled trial is the best evidence in the evidence-based medicine. The cardiovascular disease internal department is the typical example of the evidence-based medicine. A serial large-scale randomized controlled trials provided the evidence and improved clinical treatment level. For normal development of a large-scale randomized controlled trials need to enhance the standard management.
There are various examination methods for cardiovascular diseases. Non-invasive diagnosis and prognostic information acquisition are the current research hotspots of related imaging examinations. Positron emission tomography (PET)/magnetic resonance imaging (MRI) is a new advanced fusion imaging technology that combines the molecular imaging of PET with the soft tissue contrast function of MRI to achieve their complementary advantages. This article briefly introduces several major aspects of cardiac PET/MRI in the diagnosis of cardiovascular disease, including atherosclerosis, ischemic cardiomyopathy, nodular heart disease, and myocardial amyloidosis, in order to promote cardiac PET/MRI to be more widely used in precision medicine in this field.