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.
Optical imaging technology of ocular fundus, including fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and fundus autofluorescence (FAF), is growing at an unprecedented speed and scale and is integrating into the routine clinical management of ocular fundus diseases, such as diagnosis, treatment, and mechanism study. While FFA allow us to observe the retinal and choroidal blood circulation, OCT and FAF are non-invasive, fast and quantifiable measurement; such techniques show even more unique advantages and are favored tools. All these retinal imaging technologies, together with a variety of retinal function assessments, bring us into the era of big data of ocular fundus diseases. All of these developments are the challenges and opportunities for the operator and user of these fundus optics imaging technologies. In order to improve its clinical applications and allocate resources rationally, we need to understand the optical properties of these retinal imaging technologies, and standardize diagnosis behavior. This is a continuous learning process needs to continue to explore.
Optical coherence tomography angiography (OCTA) is an noninvasive, rapid and reproducible technology which can provide high resolution view of the vascular structures and quantifies the vessel densities in retina and choroid. Myopia can be divided into simple myopia and pathologic myopia. The mechanism of myopia is not clear while it is closely related to the vessel density. For simple myopia, OCTA can monitor the course and deepen the understanding of myopia by quantifying the vessel densities in each layers and sectors and the foveal avascular zone. For pathologic myopia, OCTA has an advantage of observing the choroidal neovascularization, chorioretinal atrophy and Zinn-Haller arterial circle which can contribute to the early diagnosis and management and follow-up to estimate the prognosis. However, there are several limitations of OCTA which need to be improved, including in the process of acquiring high-quality images, accurate layering and dynamic observation.
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.
ObjectiveTo observe the macular capillary morphology in diabetic patients.MethodsA total of 61 patients (104 eyes) with diabetes mellitus (DM group) and 31 healthy controls (41 eyes) were enrolled in the study. According to the degree of diabetic retinopathy (DR), the DM group was divided into non-DR (NDR) group, non-proliferative DR (NPDR) group, and proliferative DR (PDR) group. There were 13 patients (23 eyes), 21 patients (34 eyes) and 27 patients (47 eyes) in each group, respectively. According to whether there was diabetic macular edema (DME), the DM patients were divided into DME group and non-DME group, each had 20 patients (28 eyes) and 41 patients (76 eyes), respectively. The age (F=2.045) and sex (χ2=2.589) between the control group, the NDR group, the NPDR group and PDR group were not statistically significant (P=0.908, 0.374). The 3 mm × 3 mm region in macula was scanned by optical coherence tomography angiography (OCTA), and the retinal capillary morphological changes of superficial capillary layer (SCL) and deep capillary layer (DCL) were observed. Chi-square test and t test were used to compare data among different groups.ResultsThere was no abnormal change of retinal capillary morphology in control group. Microaneurysms and foveal avascular zone (FAZ) integrity erosion can be found in NDR group. There were microaneurysms, FAZ integrity erosion, vascular tortuosity bending, capillary non-perfusion and venous beading in NPDR and PDR groups. The microaneurysms of DCL were significantly more than that of the SCL (t=4.759, P＜0.001). The eyes with microaneurysms in NDR group, NPDR group, and PDR group showed significant differences (χ2=44.071, P＜0.001), and the eyes with FAZ integrity erosion among these three groups also showed significant differences (χ2=30.759, P＜0.001). Compared with NPDR group and PDR group, there were significant differences in vascular tortuosity bending and capillary non-perfusion (vascular tortuosity bending: OR=0.213, 95%CI 0.070−0.648, P=0.004; capillary non-perfusion: OR=0.073, 95%CI 0.022−0.251, P＜0.001), and there was no significant difference in venous beading (OR=0.415, 95%CI 0.143−1.208, P=0.102). SCL blood flow density in the 4 groups (control, NDR, NPDR and PDR group) was 49.233±1.694, 48.453±2.581, 45.020±4.685 and 40.667±4.516, respectively. While the difference between the control and NDR group was not significant, the differences between other pairs (control vs NPDR/PDR, NDR vs NPDR/PDR, NPDR vs PDR) were significant. The ratio of FAZ integrity erosion and non-perfusion of DME group was significantly higher than those of non-DME group (vascular tortuosity bending: OR=7.719, 95%CI 1.645−36.228, P=0.004; capillary non-perfusion: OR=14.560, 95%CI 3.134−67.646, P＜0.001).ConclusionsOCTA can distinctively detect the abnormal retinal capillary changes of SCL and DCL in diabetic patients. Even in DM patients without diabetic retinopathy, OCTA can detect abnormal blood vessels.
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.
ObjectiveTo comparatively observe features of choroidal osteoma by multimodal fundus imaging methods. MethodsThis is a retrospective case study. Sixteen patients (16 eyes) with choroidal osteoma were enrolled in this study. The patients included 6 males (6 eyes) and 10 females (10 eyes), with an average age of (30.5±2.4) years. All patients received examination of best-corrected visual acuity, slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (SD-OCT). The tumors were classified as fresh lesion (clear boundary and rosy tumor with smooth surface) and obsolete lesions (pale and flat tumor with obvious patches). The tumor features of color fundus photography, AF, FFA and SD-OCT were comparatively observed. ResultsThere were 5 fresh lesions and 11 obsolete lesions. Color fundus photography showed the tumor color was orange-red or yellow-white with clear boundary and retinal blood vessels on the surface of the tumor. The color of fresh lesion was rosy. In general, choroidal osteoma shown weak AF, however AF of fresh tumor was slightly stronger than the obsolete tumor, and retinal detachment region showed relatively stronger AF. FFA of fresh tumor indicated uniform intense fluorescence with clear boundary at late stage, much stronger than obsolete tumor. SD-OCT showed mesh-like reflected signal in the choroidal layer, but different from the surrounding choroidal vascular structures. ConclusionsThe tumor color is orange-red or yellow-white in color funds photography, which shown weak AF. FFA showed mottled hyperfluorescence in the early stage and tissue staining at the late stage. SD-OCT showed mesh-like reflected signal in the choroidal layer.