Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
ObjectiveTo observe the multimodal imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case study. A total of 52 eyes of 26 patients of AMN associated with COVID-19 diagnosed in Handan Eye Hospital from December 8 to 20, 2022 were included in the study. There were 8 males and 18 females, with the mean age of (33.8±8.1) years. All the patients were bilateral. The time from diagnosis of COVID-19 to the onset of vision loss was 3 to 6 days. All patients underwent the examinations of best corrected visual acuity (BCVA), fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), and optical coherence tomography (OCT). Fluorescein fundus angiography (FFA) combined with indoxine green angiography (ICGA) were performed in 12 eyes, and visual field were performed in 18 eyes. Multimodal image features of the affected eye were retrospectively analyzed. ResultsThe BCVA of the affected eye was 0.25 to 1.0. Round or mottled grayish-white lesions in the macular area were seen in all affected eyes. IR examination showed irregular map-like weak reflex in macular region. AF examination showed speckled fluorescence enhancement in lesion related areas in 3 eyes. FFA combined with ICGA showed weak fluorescence in the macular region in 8 eyes. OCT examination showed patchy strong reflection in the outer plexus layer (OPL) and outer nuclear layer (ONL) of macular area in all affected eyes, and partial absence of outer membrane and ellipsoid band. The en-face OCT showed petal-like intense refleciton between OPL and ONL. Eighteen eyes underwent visual field, and 15 eyes had central dark spots. ConclusionThe characteristic manifestations of AMN associated with COVID-19 are speckled or round-like grayish-white lesions in the macular area, weak reflexes in IR, enhanced OPL and ONL reflexes in OCT, and petal-like intense refleciton changes between OPL and ONL can be seen in en-face OCT.
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.
Objective To investigate the clinical features and multimodal imaging features of eyes with perifoveal exudative vascular anomalous complex (PEVAC). MethodsA retrospective case study. From February 2014 to November 2020, 7 eyes of 7 patients with PEVAC diagnosed by ophthalmology examination in Department of Ophthalmologyof Peking University People's Hospital were included in this study. There were 6 males and 1 female. The age was 60.1±9.1 years. All were monocular. The chief complaints of visual deformation and vision loss were 3 and 1 cases, respectively. All patients underwent best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA). BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. OCT angiography (OCTA) and indocyanine green angiography (ICGA) were performed in 4 and 2 eyes, respectively. Three eyes were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) combined with local laser photocoagulation. Two eyes were treated with laser photocoagulation alone. The follow-up time was 16.7±19.1 months. During follow-up, relevant examinations were performed with the same equipment and methods as at the initial diagnosis. The multimodal imaging characteristics and treatment response of the affected eyes were observed. ResultsThe baseline logMAR BCVA was 0.33±0.19 (0.20-0.80). All eyes showed isolated hemangiomatous lesions in the macular fovea with rigid retinal exudation, and 2 adjacent isolated hemangiomatous lesions were observed in 1 eye. FFA and ICGA examination showed that all eyes with macular hemangiomatous lesions showed clear boundary and strong fluorescence in the early stage. No other retinal or choroidal vascular abnormalities were observed. On OCT examination, circular lumen-like structures with strong reflective wall near the fovea were observed in the macular region of all eyes, accompanied by intraretinal cystic lumen. The macular central retinal thickness (CMT) was 326±125 (207-479) μm. In the four eyes examined by OCTA, blood flow signals were observed in the circular lumenoid structures with strong reflective walls adjacent to the fovea. Blood flow signals were observed in the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina in 3 eyes. SCP showed blood flow signal in 1 eye. In 4 eyes treated with intravitreal injection of anti-VEGF drugs, there was no significant improvement in the intraretinal capsule space after treatment. Subretinal fluid absorption, retinal cystoid edema persisted, and rigid exudation decreased in 1 eye. CMT decreased and BCVA increased in 5 eyes treated with laser photocoagulation or laser photocoagulation alone. At last follow-up, logMAR BCVA was 0.16±0.06 (0.10-0.20) and CMT was 212±34 (154-252) μm. Compared with baseline, the difference of BCVA was statistically significant (t=2.661, P=0.037). ConclusionsThe fundus of PEVAC patients is characterized by solitary or multiple solitary hemangiomatous lesions in the macular fovea. Round lumenoid structures with strong reflective walls, with or without intraretinal cystic lumen, rigid exudate, and subretinal fluid, in which blood flow signals can be seen in OCT.
ObjectiveTo observe the clinical and multimodel imaging characteristics of paracentral acute middle maculopathy (PAMM).MethodsRetrospective case series study. From January 2014 to August 2018, 12 eyes of 12 patients with PAMM diagnosed in Department of Ophthalmology, Peking University People’s Hospital, were included in this study. There were 9 males and 3 females, with the mean age of 57 years. All patients were referred for sudden impaired vision, with or without paracentral scotoma. The patients underwent BCVA, slit lamp examination, fundus photography, FFA and OCT. Simultaneously, OCT angiography (OCTA) was performed in 10 eyes, visual field was performed in 5 eyes, near infrared fundus photography was performed in 1 eye. Clinical and multimodal imaging findings were reviewed and analyzed.ResultsAmong 12 eyes, there were 5 eyes with BCVA 0.05-≤0.1, 4 eyes with BCVA 0.3-0.5, 3 eyes with BCVA 0.6-1.0. There were 1 eye with central rentinal artery obstruction (CRAO), 7 eyes with branch retinal artery obstruction (BRAO). Among them, BRAO with central retinal vein occlusion (CRVO) in 1 eye, with non-arteritic anterior ischemic optic neuropathy in 1 eye, with diabetic retinopathy in 1 eye; old BRAO in 3 eyes; pure BRAO in 1 eye. There were 4 eyes with pure CRVO, including 3 eyes with ischemic CRVO. All eyes demonstrated hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT. En face OCT highlighted the areas with hyperreflectivity corresponding to these lesions. OCTA demonstrated significant deep capillary dropout, abnormal morphology and enlargement of foveal avascular zone.ConclusionHyperreflective band-like lesions at the level of the inner nuclear layer on OCT and middle retinal perivascular hyperreflectivity on en face scan are characteristic in PAMM.
Objective To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC). Methods A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed. Results Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.ConclusionsThe majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
ObjectiveTo observe the multimodal imaging characteristics of choroidal metastasis.MethodsA retrospective clinical observation study. From January 2016 to November 2018, 28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People’s Hospital of Yunnan Province were included in the study. There were 12 males and 16 females, with the mean age of 50.8±6.9 years. There were 18 unilateral patients and 10 bilateral patients. The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes). All patients underwent ultra-wide-angle fundus photography, infrared fundus imaging, fundus autofluorescence, FFA, frequency-domain OCT, and B-ultrasound examinations.ResultsIn the ultra-wide-angle fundus photography, metastatic tumors were located in the posterior or middle part of the retina, of which 26 were isolated lesions and 12 were multifocal. A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes). There were 12 eyes with exudative retinal detachment. Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change, and the infrared photograph of the exudative retinal detachment area was relatively low. Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor, 13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor; 3 eyes of old lesions showed " leopard-like” autofluorescence. Among the 38 eyes in the fluorescein angiography, 32 eyes of the early lesions showed low fluorescence, and the venous phase showed a needle-like high fluorescence point, and the post-leakage fluorescence gradually increased. Two eyes with old lesions showed a " leopard-like” change. In 38 eyes, OCT showed wavy ridges of the choroid and pigment epithelium, and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer. B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo. There were 23 eyes with flat shape, 12 eyes with flat hemisphere, and 3 eyes with irregular shape.ConclusionsColor photography of the fundus showed the size, location, pigmentation and peripheral retinopathy of the metastatic lesions. Infrared photography showed different reflex signals in the tumor, exudation, and atrophy. The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion. In the fluorescein angiography, the fresh tumor showed fluorescence leakage, while the atrophic tumor showed transmitted fluorescenc. OCT reflected the height of the lesion and the change of pigment epithelium.
Objective To observe the multimodal imaging features of retinal diseases associated with COVID-19. MethodsA retrospective case study. Sixteen patients (30 eyes) of retinal diseases associated with COVID-19 admitted to the Ophthalmology Department of the Second People's Hospital of Zhengzhou in December 2022 were included in the study. There were 5 males and 11 females, with the mean age of (26.69±9.88) years; 14 patients were bilateral and 2 patients were unilateral. The time of ocular symptoms after the diagnosis of COVID-19 was (2.63±0.89) days. All patients underwent the examinations of best corrtected visual acuity (BCVA), fundus color photography (FP), infrared fundus photography (IR), optical coherence tomography (OCT). Fluorescein fundus angiography (FFA) was performed in 2 patients (4 eyes). There were 20 eyes with acute macular neuroretinopathy (AMN), including 6 eyes with cotton wool spots; 10 eyes with Purtscher-like retinopathy (PLR). The BCVA of the patients was 0.1-1.0. No obvious abnormality was found in anterior segment examination. The features of FP, IR and OCT were analyzed retrospectively. ResultsIn 20 eyes of AMN, irregular reddish brown lesions in the central or paracentral area of the macula in 14 eyes; FP showed no obvious abnormality in 6 eyes; IR showed irregular map like low reflection in the central or paracentral area of macular in all eyes; OCT showed hyperreflectivity in outer plexiform layer and outer nuclear layer, hyporeflectivity in the ellipsoid zone and photoreceptor layers in all eyes; no abnormal fluorecence was observed in 2 eyes examined by FFA. In 10 eyes with PLR, cotton wool spots and retinal hemorrhage were observed in the posterior pole and/or peripapillary area, and the peripheral retina was generally normal, Purtscher spot was found in 5 eyes and macular edema in 4 eyes; OCT showed strong reflex signal in neuroepithelial layers, edema in neuroepithelial layers in 6 eyes; in the 2 eyes examined by FFA, fluorescein leakage from the retinal vein wall was observed, the posterior pole and peripapillary area retinal arteriole occlusions showed patchy hypofluorescence, the fluorescence was obscured by retinal hemorrhage below at inferior retina. ConclusionsFor AMN associated with COVID-19, IR can show the lesion contour , OCT shows lesions in the outer retina. PLR associated with COVID-19 are usually at the posterior pole and/or peripapillary area in FP, OCT shows neurocortical edema.
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 multi-modal fundus imaging features of subretinal drusenoid deposit (SDD) in age-related macular degeneration (AMD), and observe image features. MethodsA prospective clinical study. From December 2019 to December 2023, 65 patients (104 eyes) with a diagnosis of AMD-SDD by spectral domain optical coherence tomography (SD-OCT) examination in Shandong Eye Hospital were included. All eyes were examined by best corrected visual acuity (BCVA), traditional color fundus photography (CFP), ultra-wide-angle scanning laser fundus imaging (UWF), multicolor scanning laser fundus imaging (MC) and SD-OCT. The standard MC images were obtained by using Spectralis HRA+OCT for MC examination. The multi-mode image characteristics of SDD were analyzed retrospectively. Area under curve (AUC) was used to evaluate the sensitivity and specificity of CFP, MC and UWF in detecting SDD. ResultsAmong 65 patients with SDD, 29 cases of males (52 eyes) and 36 cases of females (52 eyes) was included. There were 26 patients with unilateral SDD and 39 patients with bilateral SDD. The average age was (71.74±10.97) years. The early, middle and late stages of AMD were 31 (29.8%, 31/104), 24 (23.1%, 24/104), 49 (47.1%, 49/104) eyes, respectively. The SDD detected by CFP, MC and UWF was 76 (73.1%, 76/104), 94 (90.4%, 94/104), 96 (92.3%, 96/104) eyes. CFP showed that the edge of SDD in the macular area was blurred. UWF showed that the dot and the ribbon SDD were light yellow pale discrete deposits and light yellow interlaced network deposits respectively. MC showed the dot SDD had a strong yellow-green circular reflection, while the edge of the ribbon SDD was surrounded by a weak reflection, and the boundary was clear. SD-OCT showed that SDD had strong reflection signal, which was located between the retinal pigment epithelium layer and the photoreceptor cell layer. The dot SDD could break through the ellipsoid zone and caused slight uplift or interruption of the external membrane, showing a cone-like strong reflection signal. While the ribbon SDD showed a continuous "hill-like" protrusion, which hardly broke through ellipsoid zone. The sensitivity and specificity of CFP, MC and UWF for SDD were 73.1%, 90.4%, 92.3% and 61.1%, 94.4% and 83.3%, respectively. ConclusionsMC and UWF show high sensitivity and specificity in diagnosing AMD-SDD, which is superior to CFP. SD-OCT can effectively reveal the location and morphoLogical characteristics of SDD under retina.