ObjectiveTo observe the changes of blood flow density in the macular area of normal eyes, and to analyze its correlation with age. MethodsA cross-sectional study. Two hundred and fifty normal healthy subjects (125 males and 125 females, aged 44.76±14.77) in routine ophthalmologic examination at the Department of Ophtalmology of Guangdong Provincial People’s Hospital during June 2017 to June 2018 were enrolled. Among them, 20 to 29, 30 to 39, 40 to 49, 50 to 59, and ≥ 60 years old were 50 subjects (50 eyes) in each. BCVA, slit lamp microscope, indirect ophthalmoscope, OCT angiography (OCTA) examinations were conducted for all eyes. The subjects were examined by both eyes, and the data of 1 eye was selected by EXCEL to generate random numbers, including 126 right eyes and 124 left eyes. The range of 6 mm × 6 mm in the macular area was scanned using a frequency domain OCTA instrument. The software automatically divides it into three concentric circles centered on the macular fovea, which were foveal area with a diameter of 1 mm, parafoveal area of 1 to 3 mm, and foveal peripheral area of 3 to 6 mm. The blood flow density of superficial capillary vessel, deep capillary vessel and foveal avascular area (FAZ) within a 300 μm width (FD-300), FAZ area, perimeter (PERIM), non-circularity index, center retinal thickness (CRT) were measured. The relationship between the blood flow density in macula, CRT, FAZ and age was analyzed by Pearson correlation analysis. ResultsThe mean blood flow density of superficial capillary vessel and deep capillary vessel were (51.61±2.54)% and (54.04±5.46)%, respectively. The average FD-300, CRT, PERIM and non-circularity index were (285.55±12.13) μm, (2.150±0.367) mm, 1.10±0.04, respectively. The relevance of the results showed that the age was negatively correlated with the blood flow density of whole area (r=−0.335, −0.279; P＜0.01), parafoveal area (r=−0.255, −0.368; P＜0.01), foveal peripheral area (r=−0.330, −0.269; P＜0.01) in superficial capillary vessel and deep capillary vessel as well as FD-300 (r=−0.311, P＜0.01), but not correlated with the blood flow density of foveal area (r=−0.071, −0.118; P=0.264, 0.064). There was no relationship between the age and the FAZ area, PERIM, non-circularity index (r=−0.070, −0.055, 0.074; P=0.267, 0.385, 0.142). The age was negatively correlated with the average CRT (r=−0.217, P＜0.01), but not correlated with the CRT in foveal area (r=0.115, P=0.068). The CRT was positively correlated with the blood flow density of superficial capillary vessel and deep capillary vessel in foveal area (r=0.715, 0.653; P＜0.01), but negatively correlated with the FAZ area (r=−0.669, P＜0.01). ConclusionThe capillary blood flow density of macular area in the normal eyes decreases with age.
ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.
ObjectiveTo assess changes of blood flow density of idiopathic choroidal neovascularization (ICNV) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF).MethodsRetrospective case analysis. Sixteen eyes of 16 patients with ICNV diagnosed with FFA and OCT were included in this study. Among them, 12 were female and 4 were male. The mean age was 33.94±9.83 years. The mean course of diseases was 5.13±4.44 weeks. The BCVA, indirect ophthalmoscope, OCT and OCT angiography (OCTA) were performed at the first diagnosis in all patients. The BCVA was converted to logMAR. The macular fovea retinal thickness (CMT) was measured by OCT, and the selected area of CNV (CSA) and flow area of CNV (CFA) were measured by OCTA. The mean logMAR BCVA, CMT, CSA and CFA were 0.336±0.163, 268.500±57.927 μm, 0.651±0.521 mm2, 0.327±0.278 mm2 , respectively. All patients were treated with intravitreal ranibizumab (IVR, 10 mg/ml, 0.05 ml). Follow-up results including the BCVA, fundus color photography, OCT and OCTA were obtained 1 month after treatment. To compare the changes of BCVA, CMT, CSA, CFA of ICNV treated with anti-VEGF. Pearson method was used to analyze the correlation between logMAR BCVA and CMT, CSA and CFA before and after the treatment.ResultsOne month after treatment, the average logMAR BCVA, CMT, CSA and CFA were 0.176±0.111, 232.500±18.910 μm, 0.420±0.439 mm2, 0.215±0.274 mm2. The mean logMAR BCVA (t=5.471, P＜0.001), CMT (t=2.527, P=0.023), CSA (t=4.039, P=0.001), CFA (t=4.214, P=0.001) significantly decreased at 1 month after injection compared to baseline, and the difference had statistical significance. The results of correlation analysis showed that the post-logMAR BCVA was moderately positively correlated with pre-CSA and post-CSA (r=0.553, 0.560; P=0.026, 0.024), and strongly correlated with pre-CFA and post-CFA (r=0.669, 0.606; P=0.005, 0.013), but not correlated with pre-CMT and post-CMT (r=0.553, 0.560; P=0.026, 0.024).ConclusionThe blood flow density of ICNV measured by OCTA were significantly decreased in the treatment of anti-VEGF drugs.
ObjectiveTo compare the choriocapillaris flow density and choroidal vessel volume (CVV) of acute and chronic central serous chorioretinopathy (CSC).MethodsA cross-sectional observational clinical study. A total of 64 eyes of 64 patients (CSC group) diagnosed with CSC at Department of Ophthalmology of West China Hospital of Sichuan University from May 2019 to October 2020, and a total of 64 eyes of 64 age and gender matched healthy volunteers (control group) during the same period were included in this study. In the CSC group, there were 34 patients with acute CSC (acute CSC group) and 30 patients with chronic CSC (chronic CSC group). There was no significant difference in age (t=－0.041) and sex composition ratio (χ2=0.191) between CSC group and control group (P＞0.05). There were statistically significant differences in age (t=－1.872) and sex composition ratio (χ2=8.778) between acute CSC group and chronic CSC group (P＜0.05). Swept source optical coherence tomography angiography (SS-OCTA) was performed using VG200D. The scanning mode was 512×512 and scannig range was 12 mm × 12 mm. The choriocapillaris flow density of the 3 mm, 6 mm, 12 mm circular area and 1-3 mm ring, 3-6 mm ring, and 6-12 mm ring, and the CVV of the of the 3 mm, 6 mm, 12 mm circular area was automatically generated by the built-in software (v1.28.6). The age, choriocapillaris flow density and CVV were compared between two groups using independent sample t test.ResultsCompared with the control group, the choriocapillaris flow density decreased in the CSC group, and there were statistically significant differences in the 3 mm, 6 mm circular area (t=－7.210, －4.040; P＜0.001). There were statistically significant differences between CSC group and control group in the 3 mm, 6 mm, 12 mm circular area (t=1.460, 12.270, 11.250; P＜0.05). Compared with the acute CSC group, the choriocapillaris flow density decreased in the chronic CSC group, and there were statistically significant differences (P＜0.05) in the 3 mm, 6 mm circular area (t=3.230, 2.330), the total and four quadrants of 1-3 mm ring (t=2.780, 2.060, 2.140, 2.620, 3.770), the superior quadrants of the 3-6 mm ring (t=2.550), and the superior and temporal of 6-12 mm ring (t=3.070, 2.610). There was no significant difference of CVV in the 3 mm, 6 mm and 12 mm circular area between the acute CSC group and the chronic CSC group (t=0.250, 0.070, －0.110; P＞0.05).ConclusionCompared with acute CSC, chronic CSC exhibits significant decreased choriocapillaris flow density and no change in CVV.
ObjectiveTo observe the changes of macular blood flow density in patients of macular telangiectasis type 1 (Mac-Tel type 1) with macular edema before and after the treatment of anti-VEGF.MethodsA retrospective clinical study. From January 2016 to December 2017, 14 Mac-Tel type 1 patients (14 eyes) diagnosed in Nanjing Medical University Eye Hospital were included in the study. There were 6 males (6 eyes) and 8 females (8 eyes), with the mean age of 35.3±9.3 years. All patients underwent BCVA and OCT angiography examinations. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. All the patients were received anti-VEGF injection treatment once a month for 3 consecutive months. The OCTA scanning region in the macular area was 3 mm × 3 mm. Macular blood flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the vessel density within a 300 μm width ring surrounding the foveal avascular area (FD-300) and central macular thickness (CMT) were measured in all eyes. Paired samples t-test and Pearson correlation analysis were used in this study.ResultsAt the baseline, logMAR BCVA was 0.69±0.07, CMT was 468.43±26.59 μm, SCP blood flow density was (50.99±1.19)%, DCP blood flow density was (43.79±1.44)%, FD-300 was (50.73±1.16)%. Compared with the baseline, there were significant differences between logMAR BCVA, CMT, DCP blood flow density and FD-300 in 1 week, 1 month, 3 months after treatment and 2 months after cessation of treatment (logMAR BCVA: t=6.77, 13.30, 16.99, 9.51; P=0.00, 0.01, 0.00, 0.01. CMT: t=6.99, 15.88, 26.10, 6.50; P=0.00, 0.01, 0.01, 0.00. DCP: t=6.75, 8.61, 15.12, 7.63; P=0.00, 0.01, 0.01, 0.00. FD-300: t=11.86, 13.08, 14.36, 4.41; P=0.00, 0.01, 0.01, 0.03). There was no significant difference in blood flow density of SCP between baseline and 2 months after cessation of treatment (t=1.36, P=0.19), but there was significant difference at the other time points after treatment (t=5.50, 6.84, 6.27; P=0.00, 0.01, 0.01). The Pearson's correlation analysis showed that there was a significant positive correlation between FD-300 and CMT (r2=0.54, P=0.04).ConclusionsThere is no significant change in the SCP blood flow density in the patients of Mac-Tel type 1 with macular edema, while the DCP blood flow density decreased and FD-300 increased. After anti-VEGF treatment, DCP blood flow density increased and FD-300 decreased. FD-300 is positively correlated with CMT.
ObjectiveTo observe the changes of macular vascular density of hypertensive patients without obvious hypertensive retinopathy (HRP).MethodsTwenty-three patients (hypertension group) diagnosed as grade 2 or grade 3 essential hypertension in Cardiology Department of Renmin Hospital of Wuhan University from January to April 2019 were enrolled in the study. Among them, there were 13 males and 10 females. The mean age was 61.6 ± 5.6 years, and the mean BCVA was 0.74 ± 0.16. The course of hypertension was more than 7 years; Keith Wagener (K-W) grade was 0 or 1. Fifteen age-matched people without hypertension were selected as the control group, among which included 8 males and 7 females. Their average age was 59.7 ± 4.4 years and the average BCVA was 0.79 ± 0.17, the K-W grades were 0. There was no significant difference (P=0.265, 1.000, 0.563) between the two groups in age (t=1.739), sex ratio (χ2=0.036) or BCVA (t=0.585). All subjects were examined by BCVA, fundus photography and OCTA. OCTA scanned the macular area in the range of 3 mm × 3 mm. The software automatically divided the image into two concentric circles with the macular fovea as the center, which are the inner ring with a diameter of 1 mm (foveal area) and the outer ring with a diameter of 1-3 mm. The blood flow density of the whole, temporal, upper, nasal and lower capillary layers within 3 mm of the macular area, and foveal avascular zone (FAZ) area, central foveal retinal thickness (CFT) were measured.ResultsSignificant differences were observed in the vascular densities of total, temporal, nasal and inferior area of maculas (t=2.188, 2.472, 5.105, 2.734; P=0.037, 0.020, 0.000, 0.010) between the two groups, while no significant differences were evidenced in foveal vascular densities and superior vascular densities (t=0.575, 0.140; P=0.570, 0.889). There was no significant difference in FAZ area or CFT between the two groups (t=0.367, 0.753; P=0.714, 0.457). Macular arches were intact in all hypertension patients.ConclusionsThe vascular densities of total, temporal, nasal and inferior area of maculas in the hypertension patients without HRP decreased. The area of FAZ did not expand, and the structures of macular arch ring were normal.
ObjectiveTo observe the changes of macular microvessels in patients with retinal vein occlusion (RVO) and macular edema (ME) after intravitreal injection of aflibercept (IVA), and analyze its correlation with best corrected visual acuity (BCVA).MethodsA retrospective case study. Thirty patients (30 eyes) with monocular RVO with ME (RVO-ME) who were diagnosed in the clinical examination of Tianjin Eye Hospital from April 2019 to February 2020 were included in the study. Among them, there were 12 males (12 eyes) and 18 females(18 eyes); the average age was 54.30±13.17 years. The average course of disease was 3.43±1.97 months. Both eyes were examined by BCVA and optical coherence tomography (OCTA). The on-demand injection was adopted after the first injection in IVA treatment regimen. The macular area 6 mm×6 mm in both eyes was scanned with an OCTA instrument, and the area of the foveal avascular area (FAZ), FAZ circumference (PERIM), and out-of-roundness were measured at baseline and 1, 3, and 6 months after treatment. Index (AI), blood flow density within 300 μm width of FAZ (FD-300), foveal retinal thickness (CMT), superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) blood flow density. The paired t test was used to compare the quantitative parameters of the affected eye and the contralateral healthy eye at baseline; the changes of the quantitative parameters at baseline and 1, 3, and 6 months after treatment were analyzed by repeated measures analysis of variance. Pearson correlation analysis was used to analyze the correlation between BCVA, retinal perfusion, and macular blood supply parameters at 6 months after IVA treatment.ResultsAt baseline, compared with the contralateral healthy eye, the FAZ area (t=−4.091), PERIM (t=−5.098) and AI (t=−9.093) of the RVO-ME eye were enlarged, and FD-300 (t=7.237) and overall SCP and DCP blood flow density (t=8.735, 9.897) decreased, the difference was statistically significant (P＜0.001). Six months after treatment, the BCVA of RVO-ME eyes was significantly increased, CMT decreased, FAZ area expanded, and AI decreased (t=8.566, 16.739, −6.469, 9.719; P＜0.001), the difference was statistically significant. There was no significant change in the blood flow density of FD-300 and overall SCP and DCP, and the difference was not statistically significant (t=1.017, 1.197, 0.987; P＞0.05). Compared with baseline, the FAZ area of RVO-ME eyes gradually expanded at 3 and 6 months after treatment, and the difference was statistically significant (F=21.979, P＜0.001). Correlation analysis results showed that BCVA at 6 months after treatment was positively correlated with the overall SCP and DCP blood flow density at baseline and 6 months after treatment (r=−0.538, −0.484, −0.879, −0.854; P＜0.05). There was a negative correlation with the area of FAZ 6 months after treatment (r=0.544, P=0.001). The number of ME recurrences was negatively correlated with BCVA and overall SCP and DCP blood flow density 6 months after treatment (r=0.604, −0.462, −0.528; P＜0.05), it was positively correlated with FAZ area (r=0.379, P=0.043).ConclusionWithin 6 months of IVA treatment in RVO-ME eyes, ME is significantly reduced and visual acuity is improved; SCP blood flow density decreases, and FAZ area expands.
As a neurodegenerative disease of the retina, glaucoma can cause irreversible vision loss in patients. More and more evidences indicate that systemic blood flow abnormalities, decreased optic nerve blood flow, and retinal microcirculation disorders are related to the mechanism of glaucoma ganglion injury. Optical coherence tomography (OCTA) has the advantages of non-invasive, high resolution, quick inspection, three-dimensional imaging, and quantitative blood flow perfusion. Compared with other blood flow detection methods such as color ultrasound Doppler, laser speckle blood flow imaging, etc. it has higher performance and accuracy, and is easier to be applied in clinical practice. OCTA can not only be used for the early diagnosis and follow-up of glaucoma, but has a strong correlation with retinal nerve fiber layer thickness and visual field parameters; it can also provide objective data for the follow-up of patients with advanced glaucoma to assess the progress of the disease. In the future, OCTA is expected to become a routine detection method and follow-up method for the diagnosis of glaucoma.
ObjectiveTo investigate macular microvascular abnormalities in eyes with subfoveal fibrotic nodules secondary to Coats' disease. MethodsA cross-sectional study. From January 1, 2018 to July 30, 2021, 45 eyes of 45 patients diagnosed with Coats' disease with or without subfoveal fibrotic nodules in Eye and ENT Hospital, Shanghai Medical College of Fudan University were included in this study. There were 40 eyes in 40 males and 5 eyes in 5 females. All were under 21 years old. According to the presence or absence of subfoveal fiber nodules, the patients were divided into fibrotic group (26 cases, 26 eyes) and non-fibrotic group (19 cases, 19 eyes). Optical coherence tomography angiography was used to scan 3 mm×3 mm or 6 mm×6 mm macular area of both eyes. The software of the device automatically processed the images. The presence of FAZ edge anastomotic vascular arch ring breakage and abnormal microvascular branch (AMB) in the foveal avascular zone (FAZ) were observed. ResultsIn 26 eyes of fibrosis group, AMB originating from the parafoveal retinal capillary network was observed, which grew into and destroyed the integrity of the vascular arch ring at the edge of FAZ. AMB was crisscrossing and winding, and its curvature expands. B-scan images showed the blood flow signal in the subfoveal fiber nodule, and the blood flow signal traversed between the inner retina and the fiber nodule in 23 eyes (88.46%, 23/26). In the non-fibrosis group, all the vascular abnormalities were characterized by capillary dilation and defect, and no breakage of FAZ anastomotic vascular arch ring or AMB was observed. ConclusionsIn Coats' disease with subfoveal fiber nodules, staggered and dilated AMBs emerge from the parafoveal vascular network, grow into and destroy the integrity of the vascular arch ring at the edge of FAZ, and grow down longitudinally into the fiber nodules.
ObjectiveTo compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.MethodsThirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender, age, axial length matched healthy volunteers (control group) were enrolled in this study. For each subject, macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured. Then 3.0 mm×3.0 mm macular scan with SS-OCT angiography was performed, and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane. The grayscale images were then binarized for the analysis of FBFD.ResultsThe SCT in ECS group was (394.7±77.7) μm, which was significantly thicker than (332.1±68.1) μm in control group (t=2.923, P=0.008). The FBFD of intermediate choroid in ECS group were (76.35±14.46)%, which were significantly greater than (63.57±13.42)% in control group (t=2.775, P=0.01).ConclusionECS patients had increased FBFD at intermediate choroid level compared with healthy controls.