Objective To investigate the preoperative design and application of the minimum foveolar translocation distance and angle of macular translocation. Methods The fundus fluorescein and indocyanine green an giographies were performed on 53 eyes of 53 patients with classic subfoveal choroidal neovascularization （SCNV）, including 42 with exudative age-related macular degeneration and 11 with high myopic macular degeneration. The actual area of macular SCNV and the minimum foveolar translocation distance and angle were analyzed. Results The actual area of SCNV was 0.39~18.00 mm2 with the mean of (3.08±3.22) mm2. The designed minimum superior translocation distance was 67~2 240μm with the mean of (845.72±425.23) μm；the minimum designed minimum inferior translocation distance was 53~2 430 μm with the mean of (912.17±547.77) μm. The minimum designed superior translocation angle was 1~32°with the mean of (13.23±6.6 8)°；the minimum designed inferior translocation angle was 1~35°with the mean of (14.06±8.46)°. The individual difference of the minimum designed superior and inferior translocation distance was more than 500 μm in 16 eyes （30.19 % ）, and the difference of translocation angle was more than 10°in 11（20.75%）. Conclusion Preoperative design of minimum translocation distance and angle of macular translocation may be helpful to choose the operation program. (Chin J Ocul Fundus Dis，2004，20：75-77)
Objective To investigate the clinical features, etiological classification and staging of epiretinal macular membrane(MEM)． Methods Clinical materials of 194 cases of MEM diagnosed by fundus fluorescein angiography in outpatient department of eye clinic in this hospital from 1983 to 2000 were retrospectively analyzed． Results There were typical clinical symptoms and signs of MEM in all of this 222 eyes of 194 patients． Etiological classification revealed that 4 cases were congenital(2．12%), 22 cases were secondary(11．34%), and 168 cases were idio pathic(86．60%)． Staging of course of disease indicated that 119 eyes were in early stage(53．60%), 72 eyes were in middle stage(32．43%), and 31 eyes were in late stage(13．96%)． Conclusion MEM may be classified as congenital, secondary and idiopathic type according to its pathogenesis , as early, middle and late stage according to the clinical course of disease．This can be helpful in treating the disease． (Chin J Ocul Fundus Dis, 2001,17:210-213)
ObjectiveTo observe the fundus image characteristics of macular telangiectasia type 2 (MacTel type 2) patients. MethodsA total of 8 patients (16 eyes) diagnosed of MacTel type 2 were included in this study. There were 4 males and 4 females, age ranged from 44 to 69 years old with a median age of (59.88±7.85) years. All patients received examination of best-corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (OCT) and macular pigment optical density (MPOD). Four eyes of 2 patients received OCT angiography examination at the same time. Classification was made according to the Gass and Blodi's criteria. The follow-up time was from 1 to 19 months with the average time of (11.00±8.91) months. The clinical characteristics were observed and analyzed. ResultsThe BCVA was 0.07-0.8. There were 1 eye in stage 1, 1 eye in stage 2, 6 eyes in stage 3, 8 eyes in stage 4. The disease showed a bilateral appearance with a low progression. Fundus features included loss of retinal transparency (14 eyes, 87.5%), blunted retinal venule (15 eyes, 93.75%), pseudo-lamellar hole (5 eyes, 31.25%), pigment proliferation (9 eyes, 56.25%). FFA findings were telangiectatic capillaries predominantly temporal to the foveola in the early phase and a diffuse hyperfluorescence in the late phase. Spectral domain OCT features included depletion of the retinal inner, outer structures, cavity (7 eyes, 43.75%), and atrophy of the neurosensory retina (9 eyes,56.25%). On AF, reduced foveal masking due to loss of macular pigment can be observed. The loss of macular pigment could also be seen on MPOD. OCTA showed the increased intervascular spaces, broken regular network of foveal avascular zone (FAZ), right-angled vessel dipping, dilatations, traction of superficial and deep capillary layers in both the superficial and deep layers, especially in the deep layer. Only one eye of one patient proceeded from stage 4 to stage 5. ConclusionsCharacteristic features of MacTel type 2 included cavities and outer retina atrophy on OCT; loss of MP on MPOD; broken regular network of FAZ, morphological and structural abnormalities of superficial and deep layers of perifoveal capillary network on OCTA.
Objective By using a newly developed animal model of limited macular translocation (LMT) in rabbit eyes, to explore the complications,indications and predictability of LMT. Methods LMT models were performed in 15 rabbit eyes, and were divided into 4.5 mm group and 3.5 mm group by the length of scleral shortening.The effect of retinal translocation (distance and direction) and its complications were analyzed. In a separated group, postoperative corneal astigmatism was studied after release of scleral shortening suture 1 month after LMT. In order to study the impact of neuroretina-retinal pigment epithelium (RPE) adhesion on LMT, retinas and choroids in 4 pigmented rabbit eyes were pretreated with photocoagulation. Results Success rate of LMT was 86.7%. In these cases, retinal translocations were achieved［(distance of 610 to 2690 μm, [AKx-]±s=(1395±636)μm; translocation angle α of 10-38°, [AKx-]±s=(22.7±8.3) °］. The difference in scleral shortening between 4.5 mm and 3.5 mm groups did not significantly influence the final translocation. Major complications of LMT included intraocular bleeding, retinal break, and corneal astigmatism. Release of scleral shortening suture reduced corneal astigmatism and made it more regular, meanwhile, retinal translocation did not regress. The neuroretina-RPE adhesion induced by retinal photocoagulation made neuroretinal hydrodissection difficult, and led to retinal break readily. Conclusion Sufficient LMT models in rabbit eye were obtained with few postoperative complications. Direction of retinal translocation is an important factor influencing the effect of LMT, except for distance. Release of scleral shortening suture can effectively reduce corneal astigmatism without causing regression of retinal translocation. For the patients with a history of macular or para-macular photocoagulation, LMT should be performed carefully. (Chin J Ocul Fundus Dis, 2002, 18: 203-207)
ObjectiveTo observe the changes of retinal thickness in idiopathic macular hole eyes after vitrectomy combined with internal limiting membrane peeling. MethodsThe study included 40 eyes in 40 consecutive patients with idiopathic full-thickness macular holes who underwent vitrectomy and internal limiting membrane peeling. There were 10 males (10 eyes) and 30 female (30 eyes), the average age was (63.60±6.26) years, the average disease duration was (6.00±3.53) months. All patients were examined by spectral-domain optical coherence tomography to measure the foveal retinal thickness, parafoveal retinal thickness and every quadrant in 1, 3, 6 months after surgery. ResultsCompared foveal retinal thickness after 1 month with 3 month, the difference was significant (F=4.527, P=0.013). But foveal retinal thickness were not significantly different in 3 months and 6 months after surgery (F=2.031, P=0.971). The difference of average parafoveal retinal thickness between 1 month, 3 months and 6 months after surgery was not significant (F=2.011, P=0.139). The retinal thickness of the operated eyes were not significantly different from the normal fellow eyes in 1 month after surgery (t=0.651, P=0.519). And the foveal retinal thickness of the operated eyes and the normal fellow eyes are significantly different in 3 months and 6 months after surgery (t=-2.563, -2.524; P=0.015, 0.016). The thickness of temporal were thicker than other quadrant in 1 month, 3months and 6 months after surgery (t=-3.701, -4.612, -4.125; P=0.014, 0.006, 0.009). ConclusionThere is a transient increase in the foveal retinal thickness after macular hole surgery.
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.
Objective To evaluate the effective method for treatment of premacular hemorrhage. Methods In 36 cases (36 eyes) of premacular hemorrhage (2PD),25 cases were treated with medicine, and 11 cases were treated with laser surgery and medicine. Results In 25 patients treated with medicine, the average time of vision recovery was 24 days and the average time of clearance of vitreous hemorrhage was 40 days; in the other 11 patients treated with laser surgery and medicine,10 were treated successfully, and in these 10 patients, the average time of vision recovery were 5 days and the average time of clearance of premacular hemorrhage were 11 days in 10 cases which were operated successfully with laser in 11 cases. Conclusions Laser surgery of inducing preretinal hemorrhage to vitreous body is an effective method for treatment of premacular hemorrhage to relieve the impaired central vision. (Chin J Ocul Fundus Dis, 2002, 18: 199-201)
Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.
Objective To observe the effect of scanning laser ophthalmoscope (SLO) measuring macular light sensibility on evaluating the visual function in idiopathic epiretinal membrane (IERM), and analyze the relationship among the macular light sensibility, central visual acuity, and the thickness of fovea. Methods Procedure of microperimetry of SLO was performed on 44 patients (55 eyes) with IERM diagnosed by indirect and direct ophthalmoscope and optical coherence tomography (OCT). The light sensibility at 10deg;macular central area was measured. The results were compared with 31 healthy control eyes which underwent the same examinations simutaneously. The correlation among the macular light sensibility, the thickness of fovea measured by OCT, and the results of logarithm visual acuity was anaylzed. Results Compared with the control eyes, macular light sensibility decreased in IERM eyes significantly (F=47.265, Plt;0.01), which had the positive correlation with the decrease of visual acuity (r=0.687, P=0.000) and negative correlation with the retinal thickness of macular fovea (r=-0.532,P=0.003). The mean macular light sensitivity in patients with metamorphopsia decreased obviously compared with which in patients without (t=7.039, P=0.000). The mean macular light sensitivity in patients with prolifertive IERM decreased compared with which in patients with dropsical IERM without statistical difference (t=-1.706, P=0.094). Conclusion Microperimetry of SLO may sensitively reflect the macular visual function of eyes with IERM and quantificationally evaluate the changes of macular light sensibility. The changes of macular light sensitivity correlates with the central visual acuity and retinal thickness of macular fovea. (Chin J Ocul Fundus Dis, 2006, 22: 100-102)
ObjectiveTo observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia.MethodsA retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm2 and 0.202±0.03 mm2, respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia.ResultsAt 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm2 and 0.240±0.019 mm2, respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased (F=8.484, 14.346; P＜0.001,＜0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline (F=5.044, 17.763, 13.545; P=0.001,＜0.001,＜0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score (r=－0.816, P＜0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score (r=－0.422, －0.882; P=0.005,＜0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score (r=－0.791,－0.716; P＜0.001,＜0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score (r=－0.343, －0.330, －0.732, －0.694; P=0.026, 0.033,＜0.001,＜0.001).ConclusionsPPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA.