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.
Objective To observe the autofluorescence of dated fundus hemorrhage excited by the excitaton light with different wavelength. Methods A total of 23 patients (23 eyes) with dated fundus hemorrhage were observed. The blue light under the fundus fluorescence angiography (FFA) mode of Topcon 50IA fundus camera was the excitation light, and the whiteandblack images of 4 patients and colorized images of 16 patients were collected, respectively. The autofluorescence of dated fundus hemorrhage in other 3 patients was observed by excitation of scanning laser with the wavelength of 488 nm and 795 nm emitted from Heidelberg retina angiography apparatus (HRA2). Results The black and white images showed the b red autofuorescence of dated fundus hemorrhage in 4 patients, while the colorized ones revealed the red autofluorescence in 16 patients. The hemorrhage autofluorescence could be also excited by blue laser (488 nm) and infrared laser (795 nm) using HRA2, but with different extent and intensity. Conclusions Due to the complex composition of dated fundus hemorrhage, different excitation light can excite the autofuorescence with different wavelength.
Objective To investigate the characteristics of congenital retinoschisis of optical coherence tomography(OCT) and its clinical application. Methods Eight cases(15 eyes) which were diagnosed as or suspected to retinoschisis in clinic were examined by OCT,direct ophthalmoscopy and color fundus photograph.Three cases(6 eyes) were examined by electroretinogram(ERG) and fundus fluorescein angiography(FFA). Results The typical characteristic OCT images of congenital retinoschisis were cystic maculopathy with tilted and vertical connective filaments,typical split in innner retinal layers in posterior retina and thickening of neurosensory retina with the split of outer retinal layers in membranous remnants. Conclusions OCT can display the characteristics of congenital retinoschisis．It is potentially useful as a new technique for the diagnosis of congenital retinoschisis. (Chin J Ocul Fundus Dis, 1999, 15: 209-211)
Objective To observe the characteristics of multiple evanescent white dot syndrome (MEWDS) with modern multimodal imaging modalities. Methods This was a retrospective case study. Eleven patients (11 eyes) diagnosed with MEWDS were enrolled. There were 10 females and 1 male, mean age was 27.6 years (range 15-41 years). The period between disease onset and visiting to the hospital was between 2 to 13 days, the average time was 4.7 days. All the patients underwent examinations of best corrected visual acuity, slit-lamp biomicroscope, indirect ophthalmoscope, fundus color photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT). The mean follow up duration was 3.2 months. The imaging characteristics were compared. Results Fundus color photography showed foveal orange-red granularity in all eyes. FAF showed strong autofluorescence with a vague boundary. FFA showed a variable number of highly fluorescent fine needle-like dots arranged in a ring in the early stage, and fluorescence remained in the late stage. ICGA showed advanced lesions of vague boundary merged into a large plaque of deep retinal hypofluorescence. SD-OCT showed the hyperreflectant material deposit over the retinal pigment epithelium and extending anteriorly through the interdigitation zone, ellipsoid layer, and toward the external limiting membrane. At the site of extrafoveal lesions, SD-OCT revealed the presence of discontinuities or disruptions centered on the ellipsoid zone to include the interdigitation. Conclusions In MEWDS patients, fundus photography showed foveal orange-red granularity; FFA showed early fluorescent dots distributed in a ring pattern; ICGA showed hypofluorescent lesions in the later stage; SD-OCT showed disruption of the interdigitation zone and ellipsoid zone and accumulations of hyperreflective material that was of variable size and shape; FAF showed strong autofluoresce areas that correlated to spots observed with FFA and ICGA.
Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation. According to its fundus feature, lesion location, imaging feature and disease progression, PCV can be divided into different types or stages. It can be divided into hemorrhage and exudation PCV according to the fundus features, into macular, peripapillary, periphery and mixed types according to the lesion locations. It can also be divided into type 1 and 2 according to the ICGA (indocyanine green angiography) manifestations, and can be classified as early stage and late stage according to disease progression. There were different correlations between different types of PCV and some risk genetic loci, such as ARMS2 (age-related macular degeneration factor 2)/ HTRA1 (high temperature essential protein A1) , C2, complement factor B, complement factor H, and elastin genes. The response to therapy and prognosis are also different between different types. It is important to further study the clinical classification of PCV, to explore the genetic characteristics, influencing factors and treatment or prognosis features of different types of PCV. The results will improve the differential diagnosis of PCV, and the effectiveness of individualized treatment.
ObjectiveTo observe the clinical characterisitics of choroidal excavation in the macula. MethodsA total of 22 patients (22 eyes) with choroidal excavation diagnosed by spectral domain high definition optical coherence tomography (HD-OCT) were enrolled in this study. The patients included 12 males (54.50%) and 57 females (45.50%). The age was ranged from 21 to 82 years old, with an average of (41.44±13.17) years. All the patients were affected unilaterally, including 9 right eyes and 13 left eyes. The corrected vision, slit lamp microscope with preset lens, fundus photography, HD-OCT and fluorescence fundus angiography (FFA)were measured for all patients. The clinical characterisitics and concomitant diseases were observed. Seventeen eyes were followed for a period between 3 to 12 months. The lesions change were evaluated by HD-OCT. ResultsThere were 18 eyes (81.8%) with symptoms of micropsia and metamorphopsia, 4 eyes (18.2%) without symptoms. The corrected vision was ranged from 0.3 to 1.2, 12 eyes (54.54%) with moderate or high myopia. Fundus examination presents yellowish-white exudation in 12 eyes (54.54%), yellowish-white exudation accompanied with hemorrhage in 9 eyes (40.91%), grayish yellow reflex halo in 1 eye (4.55%). HD-OCT showed that the retinal pigment epithelium (RPE) layer was involved in the excavation, and the photoreceptor outer segment and pigment junction (OPR) layer was disappeared in all eyes. The external limiting membrane and the photoreceptor inner segment/outer segment junction layer were preserved in 13 eyes (59.09%) and disappeared in 9 eyes (40.91%). There were 10 eyes (18.18%) with a single lesion, 4 eyes (18.18%) with idiopathic choroidal neovascularization, 4 eyes (18.18%) with punctate inner choroidopathy, 1 eye (4.55%) with polypoidal choroidal vasculopathy, 1 eye (4.55%) with macular preretinal menbrance, 1 eye (4.55%) with central serous chorioretinopathy. FFA showed hypofluorescence in early phase, hyperfluorescence in late phase, without obvious leakage. There was no noticeable changes in size and morphological changes in the follow-up period. ConclusionsChoroidal excavation in the macula occurs mostly in middle-aged people with myopia. It can be associated with many fundus diseases. The excavation is located in RPE layer, and OPR layer disappeared. Choroidal excavation in the macula develops slowly.
Optic coherence tomography (OCT) is one of the most rapid developing technologies in ophthalmology. OCT angiography (OCTA) has been made possible by the development of even faster scanning and sampling techniques, which is the next milestone after stratus OCT and spectral domain OCT. Without the need of injection of the contrast agent, OCTA is capable of providing a three-dimensional reconstruction of the perfused microvasculature within the retina and choroid by detecting the motion of scattering particles such as erythrocytes within sequential OCT cross-sectional scans performed repeatedly at the same location of the eye with different analysis algorithms. Comparing to fundus fluorescein angiography and indocyanine green angiography, with improved OCT technology and understanding, OCTA has showed certain advantages to diagnose retinal and choroidal diseases, especially macular vascular diseases. It is important to establish the contributions that OCTA can make to diagnosing, managing and understanding of ocular fundus diseases.
ObjectiveTo observe the characteristics of indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA) in polypoidal choroidal vasculopathy (PCV). Methods17 patients (17 eyes) with PCV referred to Peking Union Medical College Hospital from November 2014 to February 2015 were included in this cross-sectional study. There were 9 males (9 eyes) and 8 females (8 eyes), aged from 55 to 79 years, with the mean of (68.24±6.80) years. There were 10 right eyes and 7 left eyes. All patients were examined by fundus fluorescein angiography combined with ICGA, and OCTA was performed within 1 hour. ResultsICGA showed 5 eyes with branching vascular network (BVN), 7 eyes with polyps, only 1 eye with both BVN and polyps. 4 eyes showed no positive findings, 3 of them with large hemorrhage. 5 eyes with BVN shared the similar location and range of the lesions in ICGA and OCTA. 7 eyes with polyps showed hot spot in OCTA, 5 of them shared the similar lesions with ICGA, the other 2 eyes showed slightly different in ICGA and OCTA. 1 eye showed both BVN and polyps, OCTA and ICGA were consistent for this. In the 3 eyes with large hemorrhage, 2 of them showed hot spot below pigment epithelial detachment, 1 eye show no positive findings in both ICGA and OCTA. ConclusionsPCV patients with BVN shared similar findings in ICGA and OCTA, PCV patients with polyps showed highlight spot in OCTA. OCTA can visualize BNV and polyps of choroidal capillary, and it can showed the similar site and range of lesions in ICGA.
Objective To observe the prognosis of visual acuity (VA) of patients with different classification of polypoidal choroidal vasculopathy (PCV). Methods Sixty-seven PCV patients (68 eyes) diagnosed by fundus photography, fundus fluorescein angiography, indocyanine green angiography (ICGA) and ocular coherence tomography were enrolled in this retrospective study. The patients were classified into static, exudative, small hemorrhage and large hemorrhage according to activity and pathological characteristics of lesions. The patients were classified into aciniform, single or several single, combined branching choroidal vascular network (BVN) according to morphological characteristics and combination with BVN of lesions on ICGA. The patients also were classified into macular, vascular arcade, peripapillary and mixing zone according to distribution of lesions. The VA of all the types were observed. Results There were 16, 19, 19, 14 eyes in the type of static, exudative, small hemorrhage and large hemorrhage PCV, which with logMAR VA of 0.34plusmn;0.52, 0.70plusmn;0.98, 0.60plusmn;0.50, 0.91plusmn;0.75 respectively. The VA of static PCV patients was better than that in exudative, small hemorrhage and large hemorrhage PCV patients (q=4.75, 4.26, 5.13; P＜0.05). There was no significant difference of VA between exudative and small hemorrhage PCV patients (q=0.98, P＞0.05). There were 22, 38 and eight eyes in the type of aciniform, single or several single, combined BVN PCV, which with logMAR VA of 0.52plusmn;0.55, 0.59plusmn;0.43, 0.80plusmn;0.95 respectively. The VA of combined BVN PCV patients was worse than that in aciniform and single or several single PCV patients (q=3.81, 3.02;P＜0.05). There were 34, 13, 8 and 13 eyes in the type of macular, vascular arcade, peripapillary and mixing zone PCV, which with logMAR VA of 0.78plusmn;0.43, 0.57plusmn;0.37, 0.38plusmn;0.27, 0.74plusmn;0.41 respectively. The VA of macular PCV patients was less than that in vascular arcade and peripapillary PCV patients (q=4.61,5.11;P＜0.05). There was no significant difference of VA between macula and mixing zone PCV patients (q=0.73,P＞0.05). Conclusions The VA of PCV patients is variable.It is related to activity and pathological characteristics of lesions, morphological characteristics and combination with BVN of lesions on ICGA, and distribution of lesions.
Multicolor imaging (MCI) based on confocal scanning laser ophthalmoscopy can gather more diagnostic information than traditional fundus photographs through utilizing three wavelengths of laser to scan posterior retina, which gain different layer reflected signal since the depth of penetration into retina is different for each wavelength. Currently, it provides important information and reference value for diagnose of different layer diseases on retina or choroid combining MCI with OCT, FAF, FFA and so on. However, there are still misunderstandings in the diagnosis of retinal diseases with MCI. Careful observation of retinal details in MCI, CFP and other imaging methods is more conducive to the correct diagnosis of fundus ophthalmopathy.