Objective To observe the imaging features of ultra-wide field short wave fundus autofluorescence (SW-FAF) in eyes with multiple evanescent white dot syndrome (MEWDS), and analysis the correspondence to conventional images. Methods It was a retrospective case series study. Thirteen patients (14 eyes) diagnosed with MEWDS were enrolled. There were 12 females and 1 male, aged from 22 to 57 years, mean age was 34.5 years. All the eyes underwent fundus color photography, optical coherence tomography (OCT) and ultra-wide field autofluorescence (FAF). Simultaneous fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed in 6 eyes. The characteristic changes of SW-FAF in studied eyes were observed and compared with the images of FFA and ICGA. All the eyes were followed up every 1 to 2 weeks, with an average of 16.7 weeks. The characteristic images of SW-FAF and corresponding OCT were studied during follow up. Results MEWDS presented with numerous multiple hyper-autofluorescent spots, sized from 50-500 μm, with a vague boundary in ultra-wide field SW-FAF. These spots located mainly at the peripapillary area and the posterior pole with a confluent pattern. The lesions extended to the mid-peripheral retina as well and became more scattered. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to that of the greyish-white spots seen in color photograph and the hyper-fluorescent spots detected by FFA. It was consistent with the distribution of hypo-fluorescent spots in late-phase ICGA as well. But the number of the spot showed in FAF is much more than that in FFA, and slightly less than that in ICGA. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina. After the recovery, the hyper-autofluorescent spots disappeared with the outer retina structure repaired completely. Conclusions MEWDS presented with numerous multiple hyper-autofluorescent spots which located mainly at the peripapillary area in ultra-wide field SW-FAF. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to color photograph, FFA and ICGA in late-phase. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina.
ObjectiveTo measure the macular retinal thickness of middle-aged and elderly myopic patients and examine the correlations between the macular retinal thickness and the axial length (AL), diopter, corrected visual acuity and gender. Methods Eight-five middle-aged and elderly myopic patients (96 eyes), including 43 females (52 eyes) and 42 males (44 eyes), with an average age of 63±6 years, were enrolled in this study. All subjects underwent a full ophthalmic examination including visual acuity, intraocular pressure, slit lamp, indirect ophthalmoscopy, OCT, refraction and diopter and A-scan ultrasound biometry. The patients were divided into three groups according to the AL and spherical equivalent degree (SED) that stands for diopter, including low and intermediate myopia group, high myopia group and super high myopia group. There were no significant differences in age (χ2=1.875), gender (χ2=0.667) and right/left eye distribution (χ2=0.375) among the 3 groups (P > 0.05), and significant differences were found in the AL (F=345.75), SED (F=239.05) and corrected visual acuity (F=3.679) among the 3 groups of patients (P < 0.05). SD-OCT was used to measure the total average macular thickness (TR), central subfield thickness, and the retina thickness in 4 quadrants of the inner and outer ring (IR/OR) of macular. Correlation between AL, SED, and corrected visual acuity with macular TR was analyzed by Pearson correlation analysis. Independent-Sample Test was used in TR comparison in different sex-group and macular retina area. ResultsThe retinal thickness of all the macular regions, except those at inferior and superior inner ring of macular, was significantly different among the 3 groups (F=6.794, 10.155, 5.861, 6.692, 12.081, 10.729, 5.137; P < 0.05).The retinal thickness of IR, OR and TR was significantly different among the 3 groups(F=7.370, 17.939, 15.553; P < 0.05). Superior inner macular thickness had no correlations with both AL and SED (r=-0.103, -0.098; P > 0.05). Inferior inner macular thickness had no correlations with AL, but had negative correlations with SED (r=-0.203, P < 0.05). The central subfield thickness (t=-2.082), temporal inner macular thickness (t=-2.564), superior inner thickness (t=-2.958), average inner macular thickness (t=-2.777) and TR (t=-2.400) was lower in females compared to males, and significant differences were existed (P < 0.05). ConclusionsIn our study, middle-aged and elderly myopic patients featured generally thinner macular retinal thickness, and the central subfield thickness, temporary and nasal inner macular thickness and all the quadrants of outer macular thickness was decreased significantly. Females are characterized by thinner central subfield thickness, inner macular thickness and total average macular thickness compared to males.
Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure. Methods Prospective clinical case-control study. A total of 26 patients (30 eyes) with acute primary angle-closure glaucoma (APACG) were in the APACG group, whose intraocular pressure were control after a single episode acute primary angle closure; 30 age-and sex-matched healthy subjects (30 eyes) in the control group. All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm×6 mm macular scanning. The parameters included average thickness of entire CP-RNFL, thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The foveal retinal thickness, center retinal thickness (≤1 mm from the fovea), 4 quadrants of macular inner-ring ( > 1 mm but≤3 mm from the fovea) retinal thickness, 4 quadrants of macular outer-ring ( > 3 mm but≤6 mm from the fovea) retinal thickness, average thickness of macular retinal thickness and macular volume were measured and analyzed. Results The disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22, 4.12, 3.90, 3.00, 3.23; P < 0.05), rim area was smaller than the control group (t=-2.63, P < 0.05). The average thickness (t=-6.68) and the thickness of superior (t=-5.90), temporal (t=-11.64) and inferior (t=-5.06) quadrants of CP-RNFL, center retinal thickness (t=-2.50), 4 quadrants of macular inner-ring retinal thickness (t=-4.91, -4.88, -2.83, -3.59), nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outer-ring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P < 0.05), and the macular volume (t=-2.69) was significantly smaller than the control group (P < 0.05). There was no statistically difference at nasal CP-RNFL (t=-0.11), foveal retinal thickness (t=-0.59), temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P > 0.05). Conclusions In comparison with the healthy subjects, the disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio, C/D vertical diameter ratio in APACG eyes were bigger, while rim area was smaller; the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL, fovea, temporal and inferior quadrants of macular outer-ring retinal.
Using optical imaging equipment with different wavelength and computer technology, fundus optical imaging diagnostic techniques can record fundus reflected light, auto fluorescence and emitted light after excitation by external light source in order to observe and analyze the structure and pathological process of retina and choroid. Advances in fundus optical image capture technology (including laser, confocal laser, spontaneous auto-fluorescence, multispectral imaging) and storage and analysis technology, promote this field into a high-definition digital imaging era, with features of rapid, non-invasive, wide-angle three-dimensional multi-level integration, dynamic automatic navigation location tracking and combined application of a variety of optical imaging diagnostic techniques. In order to promote clinical and scientific research of ocular fundus diseases, we need to understand the development trend of optical imaging diagnostic technique, interpret the fundus imaging features appropriately, reasonably chose different inspection techniques, establish standardized diagnosis criteria and continue to expand clinical applications.
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
ObjectiveTo observe the characteristics of indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA) in polypoidal choroidal vasculopathy (PCV). Methods17 patients (17 eyes) with PCV referred to Peking Union Medical College Hospital from November 2014 to February 2015 were included in this cross-sectional study. There were 9 males (9 eyes) and 8 females (8 eyes), aged from 55 to 79 years, with the mean of (68.24±6.80) years. There were 10 right eyes and 7 left eyes. All patients were examined by fundus fluorescein angiography combined with ICGA, and OCTA was performed within 1 hour. ResultsICGA showed 5 eyes with branching vascular network (BVN), 7 eyes with polyps, only 1 eye with both BVN and polyps. 4 eyes showed no positive findings, 3 of them with large hemorrhage. 5 eyes with BVN shared the similar location and range of the lesions in ICGA and OCTA. 7 eyes with polyps showed hot spot in OCTA, 5 of them shared the similar lesions with ICGA, the other 2 eyes showed slightly different in ICGA and OCTA. 1 eye showed both BVN and polyps, OCTA and ICGA were consistent for this. In the 3 eyes with large hemorrhage, 2 of them showed hot spot below pigment epithelial detachment, 1 eye show no positive findings in both ICGA and OCTA. ConclusionsPCV patients with BVN shared similar findings in ICGA and OCTA, PCV patients with polyps showed highlight spot in OCTA. OCTA can visualize BNV and polyps of choroidal capillary, and it can showed the similar site and range of lesions in ICGA.
ObjectiveTo observe the characteristics of macular optical coherence tomography (OCT) changes before and after silicone oil removal in patients who had undergone pars plana vitrectomy with silicone oil tamponade for macula-off rhegmatogenous retinal detachment (RRD). MethodsThirty-nine eyes that underwent silicone oil removal were enrolled in this retrospective study. The patients included 24 males and 15 females, with an average age of (53.05±4.03) years, the duration of silicone oil tamponade ranged from 3 to 7 months. Best-corrected visual acuity, intraocular pressure, slit lamp microscope and pre-lens, indirect ophthalmoscopy and fourier domain OCT were measured for all patients before and at months 1, 3 and 6 after silicone oil removal. The macular microstructure were observed before and after silicone oil removal. ResultsSubmacular fluid was detected in 6 eyes (15.38%), at the last time of follow-up, submacular fluid resolved completely in 2 eyes with disrupted ellipsoid zone, and resolved partly in 2 eyes. Disrupted ellipsoid zone were observed before silicone oil removal in 16 eyes (41.02%), 6 eyes showed simultaneous disrupted ellipsoid zone and disrupted external limiting membrane, and there were 2 eyes that external limiting membrane was not identified, at the last time of follow-up, disrupted ellipsoid zone restored in 2 eyes and the extent of disrupted ellipsoid zone became reduced in 4 eyes. Cystoids macular edema were found in 2 eyes (5.12%), it resolved completely in 1 eye and resolved partly in 1 eye at the last time of follow-up. Macular epiretinal membrane was detected in 10 eyes (25.64%), and macular epiretinal membrane was found before silicone oil removal in 5 eyes, at the last time of follow-up, the membrane became thickened in 2 eye; 5 eyes developed macular epiretinal membrane after silicone oil removal, at the last time of follow-up, the membrane became thickened in 1 eye. Secondary macular hole were noted in 2 eyes. Microcystic macular changes were observed in 9 eyes (23.07%), it was observed in 7 eyes before silicone oil removal, and was observed in 2 eyes after silicone oil removal, at the last time of follow-up, the cysts reduced in 1 eye. ConclusionSubmacular fluid, disrupted ellipsoid zone and microcystic macular are the main macular ultrastructural changes that developed in patients with RRD before and after silicone oil removal.