Objective To observe multimodality imaging features of different properties in multifocal choroiditis (MFC). Methods Twenty-eight patients (51 eyes) with MFC were enrolled in this study. There were 10 males and 18 females. The patients aged from 31 to 49 years, with the mean age of (41.5±0.8) years. There were 23 bilateral patients and 5 unilateral patients. All patients underwent best corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, infrared fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) examinations. The lesions were classified as active inflammatory lesion, inactive inflammatory lesion, active choroidal neovascularization (CNV) and inactive CNV. The multimodality imaging features of different properties in MFC was observed. Results In fundus colour photography, the boundaries of active inflammatory lesions were blurry, while inactive inflammatory lesions had relatively clear boundaries. Secondary active CNV showed mild uplift and surrounding retinal edema; Secondary active CNV lesions showed mild uplift, retinal edema around the lesion; Secondary non-active CNV had no retinal exudate edema lesions, but had lesions fibrosis and varying degrees of pigmentation. Infrared fundus examination revealed that both active and inactive inflammatory lesions showed a uniform punctate or sheet-like fluorescence. The fluorescence of CNV lesions was not uniform; there was a bright ring around the strong fluorescence. FAF found that active inflammatory lesions showed weak autofluorescence (AF), surrounded by a strong fluorescence ring; inactive inflammatory lesions showed AF loss. Secondary active CNV lesions showed strong AF with a bright ring along the edge, and obscured fluorescence for co-occurred hemorrhagic edema; secondary non-active CNV lesions were strong AF, surrounded by a weak AF ring. FFA revealed that active inflammatory lesions showed weak fluorescence in the early stage, and fluorescence gradually increased in the late stage with slight leakage. Inactive inflammatory lesions showed typical transmitted fluorescence. Fluorescein leakage secondary to active CNV was significant; lesions secondary to inactive CNV showed scar staining. In OCT, the active inflammatory lesions showed moderately weak reflex signals in the protruding lesions under the retinal pigment epithelium (RPE). The inactive inflammatory lesions showed penetrable RPE defects or choroidal scar, it also showed clear RPE uplift lesions with a strong reflection signal. Secondary active CNV showed subretinal fluid retention; secondary non-active CNV showed RPE defects and choroidal scarring. Conclusions Active inflammatory lesions in MFC have blurred boundary, retinal edema and fluorescein leakage in FFA; inactive inflammatory lesions have clear boundary and typical transmitted fluorescence in FFA, and no retinal edema. Secondary active CNV showed subretinal fluid in OCT; and secondary non-active CNV showed RPE defects and choroidal scarring.
ObjectiveTo observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).MethodsA retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.ResultsThe postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=−11.66, −7.52, −4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,ConclusionsThe macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
Objective To investigate the CT imaging features of pancreatic fatty replacement and its clinical significance. Methods Three patients with pancreatic fatty replacement detected by CT were retrospectively analyzed. CT examination included plain scan and contrast-enhanced scanning at the arterial and portal venous phases. The shape, size, density, pancreatic lobulation and interlobular spaces, course of the pancreatic duct were carefully observed. The clinic and laboratory data were also analyzed to determine the clinical significance of pancreatic fatty replacement. Results ①Imaging features: Two patients had complete fatty replacement involving the entire pancreas, another one had most fatty replacement sparing the posterior aspect of head and tail. Two patients had regular configuration of pancreas. The size of pancreas was slightly enlarged in 2 patients. Lobular atrophy and widening of interlobular spaces were present in all 3 patients. The pancreatic duct was normal in 3 patients. ②Clinic findings: Chronic diarrhea was present in 3 patients. Two patiens had diabetes （one had chronic cholangitis with choledochal lithiasis）， another one had small stone in the common bile duct. Serum lipase was low in 3 patients, of which one had low serum amylase. Conclusion Pancreatic fatty replacement demonstrates certain characteristic CT appearances, and is usually associated with disturbances of both the endocrine and exocrine functions of the pancreas.
ObjectiveTo explore the etiology, clinical manifestation, computed tomography (CT) manifestations, pathological character, diagnosis, differential diagnosis, and treatment of fibrous mediastinitis in China.MethodsThe clinical data of a patient with fibrous mediastinitis admitted to Hospital of Sichuan Provincial Armed Police Force were retrospectively analyzed and the related literature was reviewed. A literature research was performed with " fibrous mediastinitis, mediastinal fibrosis, sclerosing mediastinitis, chronic mediastinitis ”as the Chinese key word in WanFang database and China national knowledge internet, and " fibrous mediastinitis, mediastinal fibrosis, fibrosis of mediastinum, fibrosing mediastinitis, sclerosing mediastinitis, chronic mediastinitis” as English key words in PubMed database. The time interval was from January 1980 to December 2016.ResultsThe patient was a 59 year old male, whose chest CT scan showed soft tissue density in pulmonary hilar and mediastina, with bronchus truncation and obvious stenosis of pulmonary artery in hilar. Literature review found 12 related articles reporting 37 cases of fibrous mediastinitis in China. Fifteen cases were caused by tuberculosis infection presumably, and 9 cases were idiopathic mediastinal fibrosis. The common clinical manifestations were cough, dyspnea, chest tightness and pain, fever, and edema. CT manifested soft tissue density in pulmonary hilar and mediastina, which were diffuse in 32 cases. Trachea and bronchus were involved in 26 cases, while pulmonary artery in 29 cases, pulmonary vein in 13 cases, plural effusion in 16 cases, and vena cava and its branch in 8 cases. Other involved regions were described in 18 cases, including aorta and its branch in 4 cases, esophagus in 1 case, and there were pericardial effusion in 6 cases. Fourteen cases had pathology results.ConclusionsThe most common etiological factor of fibrous mediastinitis in China is tuberculosis infection, secondly idiopathic mediastinal fibrosis. Clinical manifestation is nonspecific. mostly diffuse, surrounding bronchus, esophagus and blood vessels in hilar and mediastina, and sometimes infiltrating into pericardium and pleurae. Its pathological character is proliferation of fibrous tissue, with proliferation of lymphocytes, and without envelope. The diagnosis depends on CT and pathology. Corticosteroid is considered to treat idiopathic mediastinal fibrosis, while surgery and vascular interventional therapy may improve symptoms of vascular compression in mediastina.
Optical coherence tomography angiography (OCTA) is a new and non-invasive imaging technique that is able to detect blood flow signal in the retina and the choroid within seconds. OCTA is different from the traditional angiography methods. The major advantages of OCTA are that it can observe blood flow signal in different layers of the retina and the choroid without injecting any dye, provide blood flow information that traditional angiography cannot provide, and enrich pathophysiological knowledge of the retinal and choroidal vascular diseases., which help us to make an accurate diagnosis and efficient evaluation of these diseases. However there is a large upgrade potential either on OCTA technique itself or on clinical application of OCTA. We need to fully understand the advantage and disadvantage, and differences of OCTA and traditional angiography. We also need to know how to interpret the result of OCTA. With that we could make a fast diagnosis in a non-invasive way and improve our knowledge of the retinal and choroidal vascular diseases.
Peripapillary intrachoroidal cavitation (PICC) is a common pathological change observed in high myopia. The exact pathogenesis of PICC is still unclear. Expansion and mechanical stretching of the peripapillary sclera, breakage and defect in the retina near the border of the myopic conus and communication between intrachoroidal cavity and the vitreous space may be important segments during the development of PICC. Color fundus photography shows a localized and well-circumscribed peripapillary lesion with yellow-orange colour, often accompanied by fundus changes, such as myopic conus excavation, optic disc tilting and inferotemporal retinal vein bending at the transition from the PICC to the myopic conus. However, the PICC lesion is not easy to be recognized in the fundus photography. Fluorescein angiography shows early hypofluorescence and later progressively staining in the lesion. Indocyanine green angiography shows hypofluorescence throughout the examination. Optical coherence tomography (OCT) is vital in diagnosing PICC. Hyporeflective cavities inside the choroid, sometimes communicating with the vitreous chamber, can be observed in OCT images. OCT angiography indicates lower vessel density or even absence of choriocapillary network inside or around PICC lesions.
ObjectiveTo observe the imaging features of branching vascular network (BVN) in polypoidal choroidal vasculopathy (PCV). MethodsEighty PCV patients (90 eyes) were enrolled in this study. The patients included 58 males and 22 females. The age was ranged from 49 to 85 years, with a mean age of 61.4 years. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The fibrovascular retinal pigment epithelium detachment (PED) was defined as a well-demarcated subretinal heterogeneous plaque with increasing fluorescence on FFA. The late lichenoid hyperfluorescent plaque was defined as a well-demarcated lichenoid hyperfluorescent plaque on late phase ICGA. The double-layer sign on OCT was defined as a wide range of shallow PED from Bruch membrane. ResultsBVN were found on early ICGA in 76 eyes among the 90 eyes (84.4%). Among these 76 eyes, 18 eyes (23.7%) demonstrated the subretinal reddish-orange branches corresponding to BVN. Fifty-six eyes (73.7%) demonstrated all or part of the BVN on early FFA. Three eyes (3.9%) demonstrated branching transmitted fluorescence corresponding to BVN throughout the FFA. Seventy-three eyes (96.1%) were manifested by occult choroidal vascularization on FFA, and 21 eyes (27.6%) of them were fibrovascular PED. Among the 76 eyes with BVN, all BVN appeared earlier than polypoidal lesions on ICGA. Polypoidal lesions located on the terminal of BVN in 62 eyes (81.6%). Sixty-nine eyes (90.8%) on ICGA demonstrated the late lichenoid hyperfluorescent plaque, whose area was equal to or greater than the area of BVN shown on early ICGA. Seventy-two eyes (94.7%) had the double-layer sign. Among these 72 eyes, 15 eyes (20.8%) had lumen-like structure within the double-layer sign. Sixty-five eyes (90.3%) had punctate and linear hyper-reflectance within the double-layer sign. Two eyes (2.8%) demonstrated a hyporeflective short segment and a gap of Bruch membrane on OCT corresponding to the origin of the BVN. Sixty-three eyes (87.5%) had an area of double-layer sign that matched the area of late lichenoid hyperfluorescent plaque on ICGA. ConclusionsBVN in PCV can be noted as reddish-orange branches on fundus examination. Most of the BVN are shown as early branching transmitted fluorescence but collectively an occult choroidal vascularization on FFA, as lichenoid hyperfluorescent plaque on late ICGA, and as double-layer sign on OCT whose area matches late lichenoid hyperfluorescent plaque.
ObjectiveTo observe the imaging characteristics of optical coherence tomography angiography (OCTA) and the changes of choroidal capillary density (CCD) in the eyes of patients with high myopia choroidal neovascularization (mCNV). MethodsA case-control study. From January 2018 to October 2020, 50 cases of mCNV patients with 50 eyes (mCNV group) were included in the study. There were 18 males and 32 females; their age was 42.11±11.66 years old. Fifty eyes of 50 patients with normal fundus with matching myopia refractive power (≥6.00 D) were selected as the simple high myopia group, and 50 normal volunteers (refractive power －0.25-0.25 D) while 50 eyes were selected as the normal control group. There was no statistically significant difference in age (F=0.028) and gender composition ratio (χ2=0.136) among the three groups of patients (P＞0.05); the difference in best corrected visual acuity was statistically significant (F=14.762, P=0.004). Compared with mCNV group and pure high myopia group, the refractive index (t=－0.273) and axial length (t=0.312) of the examined eyes were not statistically significant (P＞0.05). OCTA instrument was used to measure the CCD in the macular area of the examined eye. Analysis of variance was used for comparison of measurement data among the three groups; χ2 test was used for comparison of categorical variables. The paired t test was performed to compare the CCD of the mCNV patient's eye and the contralateral eye. ResultsAmong the 50 eyes in the mCNV group, Ⅰ, Ⅱ, and mixed choroidal neovascularization (CNV) were 12 (24%, 12/50), 34 (68%, 34/50), and 4 (8%, 4/50) eyes, respectively. Corresponding to the OCTA cross-sectional image of the lesion, there was a clear “flower cluster”-like strong blood flow signal. Among them, the focal shape, the filament shape, and the group net shape were 6 (12%, 6/50), 8 (11%, 8/50), and 36 (72%, 36/50) eyes, respectively. The CCD of the eyes in the mCNV group, the pure high myopia group, and the normal control group were (57.39±3.24)%, (59.33±2.23)%, and (61.87±1.62)%, respectively. The CCD of the eyes in the mCNV group was significantly lower than that of the simple high myopia group (P=0.030) and the normal control group (P＜0.001). The CCD of the affected eye and the contralateral eye in the mCNV group were (57.39±3.24)% and (59.82±3.94)%, respectively; there was no statistically significant difference between the CCD of the affected eye and the contralateral eye (t=－0.496, P=0.100). The CCDs of eyes with Ⅰ, Ⅱ and mixed CNV were (57.38±3.31)%, (57.39±2.83)%, and (57.36±4.21)%, respectively. There were no statistically significant differences in CCD (F=1.476), age (F=0.274), sex ratio (χ2=0.825), and diopter (F=0.348) in different CNV types (P＞0.05). ConclusionThe mCNV is mostly type Ⅱ, and OCTA has a "bloom" appearance of abnormal reticular blood vessels; the CCD is significantly reduced, and it is bilateral.
Thinning and atrophy of sclerotic tissues play an important role in the development of high myopia. High myopic eyes had the thickest sclera at the posterior pole and the thinnest sclera at the equator. Most clinical studies found that scleral thickness was negatively correlative with the axial length. Patients complicated with posterior staphyloma had even thinner sclera, and its height was negatively related with the scleral thickness. At present, the main measurement methods for scleral thickness of high myopic eyes include histological measurement, enhanced depth imaging optical coherence tomography (OCT), and swept-source OCT. Following the development of OCT technique, it gradually becomes feasible to carry out studies on sclera thickness in mildly and moderately myopic populations, which is helpful to illuminate the mechanism of action of sclera on the onset and progression of high myopia.
Objective To compare the macular imaging and measurements of patients with idiopathic epiretinal membranes (ERM) by stratus optical coherence tomography (OCT) and two different types of spectral-domain OCT. Methods Forty-six consecutive patients (46 eyes) diagnosed as idiopathic ERM in the period of August 2008 to October 2008 were enrolled in this study. The patients included 11 males and 35 females, with a mean age of (61.04plusmn;10.13) years. Twenty-one age- and sex- matched normal subjects (21 eyes) were enrolled in this study as control group. All the subjects underwent stratus OCT, cirrus OCT and 3D OCT-1000 examinations. The macular area was divided into three concentric circles which including central region with 1 mm diameter, inner area with ＞1 mm but le;3 mm diameter, and outer ring area with ＞3 mm but le;6 mm diameter. The inner area and outer ring area were divided into superior, nasal, inferior and temporal quadrants by two radioactive rays. The characteristics of OCT images and the quantitative measurements were compared among these three machines. The macular thickness of ERM group and control group was also compared. And the correlation of visual acuity and the macular thickness in idiopathic ERM patients was evaluated. Results The increased macular retinal thickness, disorder structure of inner retina, uneven surface and proliferative inner and outer plexiform layer were observed in ERM group by stratus and spectral-domain OCT. But the minor pathological changes on inner retina structure and internal surface proliferation could be observed more clearly by spectral-domain OCT than those by stratus OCT.The macular thicknesses of all the subjects measured by Cirrus OCT and 3D OCT-1000 were thicker than those measured by Stratus OCT (t=7.445-11.253,P=0.000). The correlations of measurements between three OCTs were good (r＞0.9). The flatted or disappeared fovea of ERM patient group was observed by all three OCTs. The macular thicknesses on different subfields of patients in ERM group were thicker than those in control group, especially in the 1-3 mm inner ring (t=2.477-10.139,P＜0.05). Moderate negative correlations were shown on the macular thickness and visual acuity in ERM group (r=-0.216-0.517). Conclusions Spectral domain OCT yields better visualization of the intraretinal layers than time domain OCT. The images in spectral domain OCT are more clear and fine compared to stratus OCT. Stratus OCT correlates with spectral domain OCT, but they are different, and cannot be replaced by each other.