Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P＜0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P＜0.01) and the last follow-up (r=−0.768, P＜0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P＜0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P＞0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
Objective To assess the value of fluorine-18 fluorodeoxyglucose （18 F-FDG） positron emission tomography （PET） in patients with pulmonary tuberculosis. Methods Fifty-three patients with pulmonary tuberculosis were imaged with 18SF-FDG-PET. 18F-FDG-PET data were analyzed retrospectively with visual method and semiquantitative method. When pulmonary tuberculosis with abnormal 18F-FDG uptake appeared in PET scans confirmed by visual method, their maximum standard uptake value （SUVmax）, mean standard uptake value （SUVmean） and standard uptake value of normal lung （SUVlung） were measured using semiquantitative method. Results Thirty-six pulmonary tuberculous nodules could be detected by 18SF- FDG-PET, and were diagnosed active tuberculosis with visual method. SUVmax（2. 77±1. 20） and SUV mean（2.15±0.86） were higher than SUVlung（0.41± 0.09, Z=-5. 232, P〈0.01 ; Z=- 5. 232, P〈0.01）. Correlations were not found between SUVmax ,SUVmax and nodule size （Dmax, Dmin）, SUVlung, age, blood glucose level in these 36 patients （P〉0.05）. Seventeen fibrosis and calcification cases without caseous necrosis were not found abnormal in 18F-FDG-PET. Conclusion 18F- FDG- PET is useful in diagnosing active tuberculosis , extent of tuberculosis and guiding therapeutic regimen.
Objective To cpmpare the assessment of retinal and choroidal disease using confocal scanning laser ophthalmoscope (cSLO) imaging and color fundus camera. Methods Sixty-seven patients (90 eyes) with fundus diseases were included in this study. There were 35 males (51 eyes) and 32 female (39 eyes), mean age was 51.32 years. All subjects underwent fundus imaging using cSLO technology and traditional color fundus camera, positive numbers of every retinal pathological change were calculated and compared. Spectral domain-optical coherence tomography (SD-OCT) was also done to compare the accordance rate between two modes of fundus imaging (cSLO technology and traditional color fundus camera) and SD-OCT in choroidal changes. Results The positive numbers of retinal microaneurysm (χ2=4.157, P < 0.05) and epiretinal membrane (χ2=5.428, P < 0.05) using cSLO fundus imaging were significantly higher than traditional color fundus camera, while the positive numbers of cotton wool spots (χ2=0.523), retinal hemorrhage (χ2=0.117), hard exudates (χ2=0.325) and macular hole (χ2=0.070) were no significant different (P > 0.05). The SD-OCT accordance rate of choroidal pathological changes using cSLO technology was higher than traditional color fundus camera (χ2=9.143, P=0.007). Conclusion In retinal and choroidal diseases, the imaging quality of cSLO fundus imaging technology is better than the traditional color fundus camera technology.
ObjectiveTo observe the image characteristics of multispectral scanning laser imaging (MSLI) and OCT in patients with pregnancy induced hypertension syndrome (PIHS).MethodsA total of 112 patients (224 eyes) of PIHS patients diagnosed in Obstetrics Department of Tianjin First Central Hospital from May 2016 to May 2017 were included in this study. The average age of the patients was 27.00±2.14 years. The average course of the disease was 15.00±8.27 days. There were 174 eyes in 87 patients of blurred vision, dazzling and visual fatigue consciously. All patients performed BCVA, direct ophthalmoscope, B ultrasound, confocal scanning laser Ophthalmoscope (cSLO) and spectral-domain OCT (SD-OCT). SD-OCT was performed with Spectralis HRA+OCT from Heidelberg Company in Germany to acquire tomographic images. Using Herdelberg's colorful program (MultiColor) based on cSLO and operating in accordance with standard methods, one scan simultaneously obtained blue light reflection based on 488 nm, green light reflection based on 515 nm, and infrared reflection based on 820 nm, synthesis to MSLI. Fundus abnormalities were classified into arterial spasm (stage Ⅰ), arteriosclerosis (stage Ⅱ), and retinopathy (stage Ⅲ). OCT examination was divided into normal and abnormal cases according to the abnormality of retinal morphology and thickness.ResultsOf the 224 eyes, 68 eyes (30.36%) showed normal fundus examination and 156 eyes (69.64%) showed abnormal fundus performance. Among them, 28 eyes were stage Ⅰ (17.95%); 40 eyes were stage Ⅱ (25.64%); 88 eyes were stage Ⅲ (56.41%). Thirty-six eyes (16.07%) showed normal fundus and 188 eyes (83.93%) showed abnormal performance with OCT. Of the 188 eyes with abnormal fundus performance, 86 eyes (45.74%) had retinal neuroepithelial serous detachment; 56 eyes (29.79%) had RPE detachment; optic disc edema, bulge, and local reflexes in the retinal nerve fiber layer were enhanced and/or the thickness increased in 46 eyes (24.47%). In MSLI, 48 eyes (21.43%) showed normal fundus; 176 eyes (78.57%) showed abnormal performance. Retinal edema was showed in green on MSLI, serous retinal neuroepithelial layer detachment, RPE layer detachment, retinal nerve fiber layer thickening, accompanied by changes in local retinal structure. The higher the degree of bulge, the darker the color. Consistent with the range of retinal edema revealed by SD-OCT.ConclusionsMSLI and SD-OCT images show highly consistent lesions in PIHS patients. MSLI can more clearly show superficial and deep retinal lesions.
Non-arteritic ischemic optic neuropathy (NAION) is a neurological disease due to poor perfusion in optic disk. It causes severe visual function impairment, characterized by loss of vision and visual field defect. Optical coherence tomography (OCT) is vital for detecting anterior laminar depth, peripapillary nerve fiber layer thickness, ganglion cell complex thickness and peripapillary choroid thickness change in eyes with NAION at different course of the disease. In addition, OCT features are in accordance with visual function impairment. OCT angiography (OCTA) reveals retinal and choroidal vasculature networks in optic and macular area. OCTA revealed vasculature perfusion decline in eyes with NAION, even if their visual sensitivity and visual evoked potential were normal. Studying OCT and OCTA features is vital for exploring the pathogenesis and prognosis of NAION.
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
With the renovations of modern retinal imaging modality, such as video ophthalmoscopy, fundus photography, fundus fluorescein angiograph and spectral domain optical coherence tomography, it is possible to get high resolution and reproducible in vivo imaging of retina from neonates to improve the diagnosis and treatment of pediatric retinal disease. Now we have a better tool to investigate the early development of human retina, the pathogenesis and progression of pediatric retinal diseases, and to monitor the treatment efficacy and prognosis of these diseases. To expand these technologies in the diagnosis and treatment of pediatric retinal disease, we need simple, safe, comprehensive and objective applications which can only be achieved through multi-disciplinary cooperation.
ObjectiveTo observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).MethodsA retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.ResultsThe fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P＜0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.Conclusions3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
Objective To measure the changes of eye shape and axial length of the eyeball before and after removing the scleral encircling buckles.Methods This is a prospective and controlled study. Twenty eyes (20 patients) with rhegmatogenous retinal detachment and the fellow eyes were enrolled in this study. All patients underwent scleral encircling buckling, and the buckles were removed 2.0-3.5 years after the surgery. The eye shape and axial length of both eyes were measured by three-dimensional computed tomography (3D-CT) before and one,three,six months after the removing surgery. The axial length was also measured by intraocular lens (IOL) Master.Results 3D-CT showed that buckled eyeball depressed at the equator, resulting in a gourd-shaped eyeball. One month after removing the encircling buckle the depression disappeared. By 3D-CT scanning, the axial lengths of buckled eyes were (27.65plusmn;1.22), (27.3plusmn;1.56), (27.29plusmn;1.46) and (27.12plusmn;1.49) mm before and one, three, six months after the removing surgery respectively. The difference between before and after removing surgery was not statistically significant (t=2.89,P=0.723). By IOLMaster, the axial length of operated eyes were (28.32plusmn;1.94), (28.17plusmn;1.87), (28.21plusmn;1.94), (28.25plusmn;1.93） mm respectively. The difference between before and after removing the encircling band was not statistically significant (t=3.304, P=0.93). There was no significant difference in these two measuring modes (t=3.705,P=0.847).Conclusions Encircling buckling can cause eyeball indentation, removing the encircling band can rescue the indentation. There are no changes in the axial length before and after removing the encircling buckles.
ObjectiveTo evaluate the associated factors for predicting anatomical outcomes of idiopathic macular hole (IMH) after vitrectomy. MethodsThis is a retrospective study. A total of 165 eyes in 164 IMH patients underwent a successful vitrectomy and ILM peeling surgery were included in this study.The patients included 43 males and 121 females, with the mean age of (64.0±6.7) years. The corrected vision acuity of logarithm of the minimum angle of resolution (logMAR), indirect ophthalmoscope and spectral domain optical coherence tomography (SD-OCT) were measured for all patients. The mean logMAR corrected vision acuity was 1.0. The duration of disease was (8.7±14.9) months. The minimum diameter (MIN), base diameter (BASE) and height (H) were 521, 1010, 406 μm respectively. The macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI) and macular hole closure index (MHCI) were 0.43, 0.82, 0.57, 0.92 respectively. Anatomical outcomes were divided into 3 levels. A: bridge-shaped healing; B: good healing; C: poor healing. The mean follow-up was (3.6±3.2) months. The multiple factors related with prognosis including age, sex, duration of disease, preoperative logMAR corrected vision acuity, MIN, BASE and H, MHI, THI, DHI, MHCI were analyzed. ResultsDuration of disease (r=0.141), preoperative logMAR corrected vision acuity (r=0.082), age (r=0.044), sex (r=0.109) was independent of anatomical prognosis (P > 0.05). MIN (r=0.397), BASE (r=0.276), H (r=-0.240), MHI (r=-0.363), THI (r=-0.432), DHI (r=0.272) was weak correlation to anatomical prognosis (P < 0.05). MHCI correlated significantly with anatomical outcomes (r=-0.543, P=0.000). The median MHCI of A, B and C were 1.07, 0.91, 0.56 respectively. There were significant difference of MHCI among the three levels (H=52.857, P < 0.05). ConclusionsMHCI has the best correlation with anatomical outcomes. It can be considered a key factor for predicting anatomical outcomes of IMH after vitrectomy.