OBJCTIVE :To investigate the fundus ocu]i changes in hypnxie isehemic encepbalnpa ally(HIE)of new[x,rns. METHODS:One hundred and two newblt;~rns suffered from HIE were investi- gated to observe lhe pathological neular fundus changes by di~et ophthabnoseopy after mydria~s. RE- SULTS:Seventy seven ca.~s(154 eyes)were found to have ophthalmoscopic changes in the ~ular fundi including papilledema .white retina vaseolar abnormality and hemorrhage. CONCLUSIONS:In clinical view .the severity of HIE depends on the pathological ebanges of the brain .and ftmdus ahnormalby will be very often in middle and .~vere sufforers of HIE.
Chronic disease is a major threat to human health. Fundus disease has become a major ophthalmic disease affecting daily life. Although great breakthroughs have been made in the treatment, compared with other chronic disease management, the management of patients with fundus disease is still in its infancy. To strengthen the management exploration of patients with fundus diseases, establish a management model of fundus diseases and strive to improve patients' awareness of fundus diseases and adherence to treatment and follow-up are the great challenges at present. All ophthalmic centers should strengthen patient education, establish a regional cooperation network, support the construction of grassroots medical capacity, cultivate talents, enhance training, promote the standardized treatment of fundus diseases, standardize fundus imaging inspection and diagnosis, and promote the homogeneous construction of diagnosis and treatment of chronic fundus diseases. We will accelerate the construction of a hierarchical diagnosis and treatment system and the ability to link consultation and referral. Through systematic management and intervention of fundus diseases, a large number of patients with fundus diseases will receive early screening, diagnosis, standardized continuous treatment and systematic management, and improve the quality of life of patients with fundus diseases.
Objective To detect the value of three-dimensional (3D) ultrasound diagnosis in common ocular fundus diseases. Methods Two-dimensional (2D) images of 38 patients with common ocular fundus diseases were three-dimensionally reconstructed via 3D ultrasound workstation. The 3D images reflecting the ocular diseases were analyzed. Result In 38 patients with common ocular fundus diseases, there was vitreous hemorrhage in 16 patients, retinal detachment in 12, choroidal detachment in 5, and intraocular space occupying lesion in 5. Compared with the 2D images, 3D reconstructed images reflect the lesions more intuitionistically, displayed the relationship between the lesions and the peripheral tissues more clearly, and revealed the blood flow more specifically. During a scanning examination, 3D reconstructed technology provided the diagnostic information of section of X, Y and Z axises simultaneously which shortened the time of examination; the condition of any point of lesions and the relation between the lesion and the peripheral tissues could be gotten by the tools like cut and chop provided by 3D imaging software itself, which avoided detecting the same lesion with different angles and lays and proved the diagnostic efficacy. Conclusions 3D ultrasound diagnosis is better than 2D in diagnosis of vitreous, retina, choroid, and intraocular space occupying lesion. 3D ultrasound diagnosis is a complementarity for the 2D one, and the Z axis changes the former observational angles which may provide the new way of precise diagnosis. (Chin J Ocul Fundus Dis, 2005, 21: 381-383)
Objective To compare the characteristics of the results of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) in patients with classic choroidal neovasculazation (CNV). Methods The data of FFA and ICGA of 34 patients (36 eyes) with classic CNV were analyzed retrospectively and the results of the two examinations were analyzed contrastively. Results The results of FFA revealed the clew or cartheel-tike configuration of classic CNV at the early phase in 3 out of 15 eyes (20%) with age-related macular degeneration (AMD); in 5 out of 7 eyes with pathological myopia(71.4%); and in 9 out of 14 eyes with central exudative chorioretinopathy (CEC),(64.3%),In 36 eyes with classic CNV, the images of ICGA indicated CNV distinctly in 20 (55.6%) and indistinctly in 15 (41.6%); CNV was not detected by ICGA in 1 eye (2.8%); feeding blood vessels in 6 eyes (16.7%) were detected by ICGA but none by FFA. Conclusions At the early phase of FFA, the configuration of classic CNV is clew-like in eyes with pathological myopia and CEC, and erose in eyes with AMD. The image of ICGA which indicated the outline of classic CNV is not as clear as the one of FFA, but it can reveal the feeding vessels which FFA can not. (Chin J Ocul Fundus Dis, 2006, 22: 217-209)
ObjectiveTo observe the clinical characteristics and risk factors associated with pachydrusen in eyes affected by central serous chorioretinopathy (CSC). MethodsA retrospective clinical study. From July 2021 to June 2024, 144 cases and 158 eyes of CSC patients diagnosed through ophthalmological examination at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included. All affected eyes underwent a series of assessments, including refraction, intraocular pressure measurement, fundus color photography, fluorescein fundus angiography (FFA), and swept-source optical coherence tomography (OCT). Additionally, 58 eyes underwent indocyanine green angiography (ICGA). Cross-sectional (en-face) OCT was utilized to observe the colocalization of pachydrusen with areas of dilation of large choroidal vessels and attenuation of the choriocapillaris layer. The device was used for OCT included software for calculating subfoveal choroidal thickness (SFCT). FFA fluorescein leakage was categorized into “ink stain”, “cooking smoke”, and “diffuse point leakage”. Patients were classified into groups of CSC patients complicated by pachydrusen and groups of CSC patients without pachydrusen. Comparisons between the groups were performed using the χ2 test, and factors associated with the presence of pachydrusen were analyzed using logistic regression. ResultsAmong 158 eyes, 72 eyes (45.6%, 72/158) were complicated by pachydrusen. In en-face OCT images, pachydrusen were co-located with dilated large choroidal vessels in 59 eyes (81.94%, 59/72) and corresponded to choroidal capillary layer blood flow holes in 61 eyes (84.72%, 61/72). Among the 58 eyes that underwent ICGA examination, pachydrusen corresponded to punctate strong fluorescence in 46 eyes (79.31%, 46/58) and were located in areas of choroidal hyperpermeability in 43 eyes (74.14%, 43/58). Compared with the CSC group without pachydrusen, the incidence of choroidal neovascularization, flat irregular pigment epithelial detachment, diffuse punctal leakage and multiple leakage points increased in the CSC group, and the differences were statistically significant (χ2=6.217, 8.455, 5.363, 17.749; P＜0.05). Logistic regression analysis indicated that age [odds ratio (OR)=1.116, 95% confidence interval (CI) 1.060-1.176, P＜0.001], chronic CSC [OR=2.628, 95%CI 1.250-5.526, P=0.011] were independent risk factors for the occurrence of pachydrusen. ConclusionsThe incidence of pachydrusen in eyes with CSC is 45.6%, with age and chronic CSC identified as independent risk factors for their occurrence. Pachydrusen correspond to dilated choroidal vessels and areas of choroidal hyperpermeability, which may serve as potential risk factors for CSC activity or development.
ObjectiveTo deeply explore the clinical features and gene mutations of Waardenburg syndrome (WS) by tested of the eyes and genes of three patients. MethodsA Case series study. From 2019 to 2021, 3 children with WS who were diagnosed at Department of Ophthalmology, West China Hospital of Sichuan University were included in the study. Among them, there were 2 males and 1 female; the ages were 3, 4, and 12 months, respectively. All children underwent external eye, anterior segment, fundus and fluorescein fundus angiography, the clinical features of the eyes were observed. The peripheral venous blood of 3 children was collected, and the whole genome DNA was extracted for whole exome sequencing to analyze the gene mutation sites. ResultsAll children had different degrees of iris heterochromia and fundus pigment abnormalities, and were accompanied by sensorineural hearing impairment. Case 1 had dystopia canthorum; case 2 had macular fovea hypoplasia. The sequencing results of case 1 showed that there were large fragments of heterozygous deletion in exons 2-8 of the Paired box 3 (PAX3) gene, who was diagnosed as WS Ⅰ type. The sequencing results of of case 2 showed heterozygous mutation in exon 9 of Microphthalmia-associated transcription factor (MITF) gene (c.1066 C＞T), combined with heterozygous mutation in exon 1 of HPS6 gene (c.1417 G＞T), who was diagnosed as WS Ⅱ type. The sequencing result of case 3 showed that the exon 3 of SOX10 gene had loss of heterozygosity (c.497_500 delAAGA), who was diagnosed as WS Ⅳ type. Both PAX3 and SOX10 gene mutations were newly discovered mutations. ConclusionsThe ocular clinical features of Waardenburg syndrome include hypopigmentation of the iris and choroid, and dystopia canthorum, etc. Early screening of the eye and hearing will help to better diagnose the disease. The large fragments of heterozygous deletion in exons 2-8 of the PAX3 gene, the heterozygous mutation in exon 9 of MITF gene (c.1066 C＞T), and the loss of heterozygosity in exon 3 of SOX10 gene are pathogenic genetic variations of 3 children.
ObjectiveTo comparatively analyze for the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR) between first-visit and non-first-visit in ophthalmology.MethodsA retrospective study was performed for 22 patients (41 eyes) diagnosed as CMVR with AIDS by ophthalmology in the Affiliated Municipal Hospital of Xuzhou Medical University from July 2004 to September 2017. The patients were divided into two groups: one with the first-visit in ophthalmology (FVO) and the other with the first-visit in non-ophthalmology (FVNO). All patients underwent visual acuity, intraocular pressure, slit lamp microscope and indirect ophthalmoscope examinations. Thirty-nine eyes of 21 patients with clear refractive media were examined by color fundus photography, of which 5 patients were examined by FFA. Five patients examined by OCT and B-mode ultrasound. The CMVR were characterized as fulminant type or indolent type. All the 22 patients (41 eyes) except 2 patients (4 eyes) accepted highly active antiroviral therapy, and all patients were treated with ganciclovir intravenously. Nine patients (12 eyes) received intravitreal injection of ganciclovir, 7 patients (10 eyes) underwent vitrectomy because of retinal detachment, 6 patients (7 eyes) gave up surgery because of extensive retinal detachment, and the other 12 eyes did not undergo any eye surgery. All patients were followed for 6-58 months (average 23±39 months). The incidences and fundus characteristics of the patients with fulminant or indolent CMVR were compared and analyzed. Between the two groups, the difference of visual acuity and CD4+T cell count at the first vist and the last follow-up were analyzed by a t-test, and the macular involvement and spread of the two groups were compared by a chi-square test.ResultsFulminant CMVR showed dense yellow-white necrotic lesions along the great vessels with or without satellite lesions, while indolent CMVR showed sparse yellow-white granular lesions with a little bleeding. The concomitant signs included frost-like dendritic vascular sheath, retinal artery occlusion and optic disc edema. Fourteen eyes of 7 patients in FVO group were fulminant, including 2 patients (2 eyes) with retinal artery occlusion and 1 patient (two eyes) with optic disc edema. In FVNO group, there were 27 eyes of 15 patients, including 21 eyes of 13 cases identified as fulminant type and 6 eyes of 4 patients as indolent type. In the fulminant type, there were 4 patients (6 eyes) with frost-like dendritic vascular sheath, 10 patients (12 eyes) with retinal artery occlusion and 4 patients (4 eyes) with optic disc edema. There was no significant difference in initial visual acuity (t=－1.534, P=0.133), but there was a significant difference in visual acuity at the last follow-up (t=－3.420, P=0.001). There was no significant difference in CD4+ T cells between the two groups at the first visit (t=－0.902, P=0.378). The proportions of macular involvement and 3-4 quadrant involvement in FVO group were significantly higher than those in FVNO group (χ2=7.552, 7.865; P=0.006, 0.005).ConclusionFor AIDS patients with CMVR, the first-visit in ophthalmology showed more dense necrotic lesions involving macular and a wider range of lesions than the first-visit in non-ophthalmology.
Objective To discuss the image of indocyanine green angiography (ICGA) about high myopia． Methods Tweenty-seven patients (54 eyes) with high myopia underwent ocular examination, funduscolorphotography, simultaneous ICGA and fluorescein angiograp hy (FFA) with theconfocalscanning laser ophthalmoscope．The findings for the two modes of amgiographies were compared． Results Lacquer crack was evident on ICGA in 19 eyes among which the focal, plaque choroidal neovascularization (CNV) were apparent in the middle part of lacquer cracks in 10 eyes (52．6%) ．In comparison the lacquer cracks were seen in only 7 eyes on FFA． Choroidal capillary atrophy was seen on ICGA and FFA in 14 eyes and ICGA shew thick choroidal vessels in 3 eyes． Conclusion ICGA is superior to FFA for showing choroidoretinal degeneration and atrophy,lacquer crack and CNV in high myopic eyes, and conduce to evaluating prognosis． (Chin J Ocul Fundus Dis, 2001,17:201-203
Objective To assess the consistency of diagnostic results using optical coherence tomography angiography(OCTA) and fundus fluorescein angiography(FFA) in the central retinal vein occlusion(CRVO). Methods A retrospective case series of 26 eyes of 26 patients with CRVO. Simultaneous OCTA and FFA were performed in all patients by using 7-standard field of ETDRS to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weightedKappa statistic values.Kappa≥0.75, consistency is excellent; 0.60≤Kappa＜0.75, consistency is good; 0.40≤Kappa＜0.60, consistency is general;Kappa＜0.40, consistency is poor. Results Examined by OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21eyes. Performed with FFA, 23 eyes were diagnosed to have microaneurysms, 16 eyes have nonperfused, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms(Kappa=0.772，P<0.01) and optical disc/retinal neovascularization(Kappa=0.766，P<0.01), good for nonperfused areas (Kappa=0.703，P<0.01) and macular edema(Kappa=0.60，P<0.01). Conclusion There is high consistency between OCTA and FFA in the diagnosis of CRVO, OCTA is an effective method in the examination of CRVO.
Based on the current situation of patients with retinal diseases in China and the clear requirements of the "14th Five-Year Plan for Eye Health (2021-2025)" to strengthen the construction of the prevention and control system for retinal diseases, experts in the field of retinal diseases in China have conducted in-depth and comprehensive thematic discussions, and used the modified Delphi method for collective decision-making and opinion solicitation, ultimately forming consensus and consistent guidance suggestions for the management of chronic diseases of retinal diseases that are in line with China's national conditions. This consensus includes key content such as definitions, treatment plans, and follow-up frequency for the management of chronic diseases of the fundus. It clearly proposes relevant measures to improve the management process of chronic diseases of the fundus, and elaborates on the advantages and feasibility of establishing an online remote platform for the management of chronic diseases of the fundus, in order to assist doctors in formulating personalized treatment plans and ensure that patients receive standardized treatment and follow-up. This consensus will provide guidance and reference for the management of chronic diseases and long-term standardized diagnosis and treatment of major fundus diseases in China.