High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis

OBJECTIVES

Optic nerve head edema (ONHE) detected by fundoscopy is observed in one-third of patients presenting optic neuritis (ON). While ONHE is an important semiological feature, the correlation between ONHE and optic nerve head MRI abnormalities (ONHMA), sometimes called "optic nerve head swelling," remains unknown. Our study aimed to assess the diagnostic accuracy of T2 fluid-attenuated inversion recovery (FLAIR) MRI sequence in detecting ONHE in patients with acute ON.

METHODS

In the present single-center study, data were extracted from two prospective cohort studies that consecutively included adults with a first episode of acute ON treated between 2015 and 2020. Two experienced readers blinded to study data independently analyzed imaging. A senior neuroradiologist resolved any discrepancies. The primary judgment criterion of ONHMA was assessed as optic nerve head high signal intensity on gadolinium-enhanced T2FLAIR MRI sequence. Its diagnostic accuracy was evaluated with both the gold standard of ONHE on fundus photography (FP) and peripapillary retinal nerve fiber layer thickening on optic coherence tomography (OCT).

RESULTS

A total of 102 patients were included, providing 110 affected and 94 unaffected optic nerves. Agreement was high between the different modalities: 92% between MRI and FP (k = 0.77, 95% CI: 0.67-0.88) and 93% between MRI and OCT (k = 0.77, 95% CI: 0.67-0.87). MRI sensitivity was 0.84 (95% CI: 0.70-0.93) and specificity was 0.94 (95% CI: 0.89-0.97) when compared with the FP.

CONCLUSION

Optic nerve head high T2FLAIR signal intensity corresponds indeed to the optic nerve head edema diagnosed by the ophthalmologists. MRI is a sensitive tool for detecting ONHE in patients presenting acute ON.

CLINICAL RELEVANCE STATEMENT

In patients with optic neuritis the high T2FLAIR (fluid-attenuated inversion recovery) signal intensity of the optic nerve head corresponds indeed to optic nerve head edema, which is a useful feature in optic neuritis etiological evaluation and treatment.

KEY POINTS

Optic nerve head edema is a prominent clinical feature of acute optic neuritis and is usually diagnosed during dilated or non-dilated eye fundus examination. Agreement was high between magnetic resonance imaging, fundus photography, and optical coherence tomography. Optic nerve head high T2 fluid attenuation inversion recovery signal intensity is a promising detection tool for optic nerve head edema in patients presenting acute optic neuritis.

Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study

BACKGROUND

Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool.

OBJECTIVE

To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis.

METHODS

175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined.

RESULTS

The mean CCET value was 58.06±3.1μm in the mild group, 60.10±5.0μm in the moderate group, 65.75±6.3μm in the severe group and 56.16±3.1μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p=0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<0.001). There was a strong positive correlation between PASI score and CCET (p<0.001, r=0.519).

STUDY LIMITATIONS

Cross-sectional design and a relatively small number of participants.

CONCLUSIONS

There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.

Freedom From Stent Fracture-Related Complications of Vascular Longitudinal Remodeling in a Patient With Heart Failure and a Degraded Bioresorbable Vascular Scaffold

Because vascular geometric change during the long-term process of cardiac chamber remodeling in heart failure is usually unpredictable after coronary stenting, the risk of acquired metallic stent fracture can persist. This rare but possible complication could be minimized with the implantation of bioresorbable vascular scaffold because of its unique properties. Here, the authors report on 1 patient with heart failure who received optical coherence tomography evaluation between 3 and 3.5 years after bioresorbable vascular scaffold implantation. Measurement of the discernible struts of bioresorbable vascular scaffold provided evidence of coronary longitudinal remodeling without serious risk of complications related to metallic stent fracture resulting from cardiac remodeling.

Correlation between intraoperative and postoperative vaulting of the EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system

Background

Implantable Collamer lens (ICL) vaulting is one of the most important parameters for the safety, aqueous humor circulation, and lens transparency after ICL implantation. This study aimed to investigate the factors associated with the actual vaulting after refractive EVO-ICL surgery.

Methods

This retrospective study included patients who underwent EVO-ICL surgery at a tertiary eye hospital between October and December 2019. A RESCAN 700 was used for the intraoperative and CIRRUS HD-OCT was used for postoperative observation of vaulting. Subjective and objective refractions, anterior ocular segment, corneal morphology, intraocular pressure (IOP), anterior chamber volume (ACV), crystalline lens rise (CLR), white-to-white distance (WTW), anterior chamber depth (ACD), axial length, corneal endothelial cell density (ECD), and fundoscopy were examined. A multivariable analysis was performed to determine the factors independently associated with 1-month postoperative vaulting.

Results

Fifty-one patients (102 eyes) were included. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P = 0.039), lower preoperative corrected visual acuity (P = 0.006), lower preoperative IOP (P = 0.029), higher preoperative ACD (P = 0.004), lower preoperative CLR (P = 0.046), higher ICL spherical equivalent (P = 0.030), higher intraoperative vaulting (P < 0.001), and lower IOP at 1 month (P = 0.045). The multivariable analysis showed that the only factor independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio = 1.005, 95% confidence interval: 1.002–1.007, P < 0.001). The intraoperative and 1-month postoperative vaulting values were positively correlated (R² = 0.562).

Conclusions

The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value of ICL at 1 month.

[Comparison of corneal refractive power and astigmatism measured by the new anterior segment optical coherence tomographic device and Scheimpflug imaging device in age-related cataract patients]

Objective: To compare the difference and agreement of corneal refractive power and astigmatism measured by the new swept-source anterior segment optical coherence tomography (SS-AS-OCT) device (CASIA2) and Scheimpflug imaging device (Pentacam) in age-related cataract patients. Methods: In this cross-sectional study, 112 eyes of 112 patients with age-related cataract were examined before phacoemulsification in the Tianjin Medical University Eye Hospital from April to May 2020. The steep keratometry (Ks), flat keratometry (Kf), mean keratometry (Km), degree and axis of astigmatism of the corneal anterior and posterior surfaces and the total cornea were recorded. The difference in astigmatism was analyzed by the arithmetic method and the vector method. The difference of data was evaluated using Paired t test or Wilcoxon test. The agreement of data was evaluated using Bland-Altman plots. Results: The patients were 44 males and 68 females with an average age of (67±10) years. There were no statistically differences in the Ks and Km values of the corneal anterior surface between the Pentacam and the CASIA2 (both P>0.05). There was significant difference in the Kf values of the corneal anterior surface between the Pentacam and the CASIA2 [(44.24±1.73) D vs. (44.14±1.64) D; t=2.278; P<0.05]. The Ks, Kf, and Km values of the posterior surface of the cornea measured by the Pentacam and the CASIA2 were (-6.60±0.29) D vs. (-6.45±0.28) D, (-6.34±0.27) D vs. (-6.17±0.25) D, and (-6.47±0.26) D vs. (-6.31±0.25) D, respectively. The Ks, Kf, and Km values of the total cornea measured by the two instruments were (45.08±1.84) D vs. (43.94±1.64) D, (44.18±1.85) D vs. (43.02±1.64) D, and (44.63±1.82) D vs. (43.48±1.60) D, respectively. There were significant differences in the Ks, Kf, and Km values of the posterior surface of the cornea and the total cornea (t=-14.440, -13.522, -17.186, 21.016, 21.819, 22.981; all P<0.01). The degree and axis of astigmatism of the corneal anterior and posterior surfaces and the total cornea showed no statistically significant difference (all P>0.05). Vector operation results showed that the astigmatism difference vector (DV) of the Pentacam and the CASIA2 on the anterior surface of the cornea was 0.06 D@57°±0.64 D,>0.50 D in 47 eyes (41.96%). The astigmatism DV on the posterior surface of the cornea was 0.07 D@174°±0.21 D, >0.50 D in 2 eyes (1.79%). The astigmatism DV on the total cornea was 0.13 D@3°±0.69 D,>0.50 D in 59 eyes (52.68%). The results of the two devices were positively correlated (r values of the Ks, Kf, Km, and astigmatism degree on the anterior surface of the cornea were 0.970, 0.968, 0.976, and 0.697, respectively, on the posterior surface of the cornea were 0.918, 0.875, 0.925, and 0.517, respectively, and on the total cornea were 0.951, 0.955, 0.959, and 0.622, respectively; all P<0.01). Bland-Altman analysis showed that the Ks, Kf, Km, and astigmatism degree of the corneal anterior and posterior surfaces measured by the two devices were consistent, with 2.68% to 8.04% of the measured values outside 95% limits of agreement (95%LoA). The 95%LoA of the total corneal Ks, Kf, and Km between the two devices was 0.01 to 2.28 D, 0.06 to 2.27 D, and 0.10 to 2.20 D, respectively, with a wide 95%LoA range and poor consistency. Conclusions: The corneal refractive power and astigmatism measured by the CASIA2 and the Pentacam shows little difference on the anterior surface of the cornea, with good agreement. However, the refractive power results of the posterior surface of the cornea and the total cornea show great difference, suggesting that these two instruments cannot be used interchangeably in clinical practice. (Chin J Ophthalmol, 2021, 57: 48-55).

[The application and progress of optical coherence topography angiography in polypoidal choroidal vasculopathy]

Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging technology, which could acquire volumetric angiographic information. Numerous studies have reported the potential clinical use of OCTA in a variety of common retinal disorders. Polypoidal choroidal vasculopathy (PCV) is characterized by the formation of branching choroidal vascular networks (BVN) with terminal dilatations (polyps). Indocyanine green angiography (ICGA) remains the golden diagnostic standard for PCV. The clinical application of OCTA in PCV is also widely investigated recent years. But the results are controversially interpreted. In addition to various diagnostic accuracy of PCV from different studies, the clinical application of OCTA in PCV is limited. With the constant innovation of fundus imaging techniques, OCTA is reaching greater investigation depth and become more accurate at picking up blood flow signals, which also improves the diagnostic accuracy of PCV. In this paper, we reviewed the clinical application and research progress of OCTA in PCV, in order to provide some assistant for clinical practice and correct interpretation of the reports. (Chin J Ophthalmol, 2020, 56:950-955).

[Fundus imaging features of purified protein derivative and T-spot positive tubercular serpiginous-like choroiditis]

Objective: To summarize the clinical and fundus imaging features of purified protein derivative and T-spot positive tubercular serpiginous-like choroiditis (PTP-SLC) patients. Methods: This retrospective study consecutively enrolled 13 PTP-SLC patients (21 eyes) in Beijing Tongren Hospital from November 2015 to November 2017. There were 8 males and 5 females with an average age of (45.2±12.1) years. Medical history and results of systemic and ophthalmological examinations, such us fundus autofluorescence photography, optical coherence tomography (OCT), fluorescein fundus angiography (FFA) and indocyanine green angiography, were evaluated. Results: Eight patients had binocular disease with an average interval time of (8.4±7.9) years. The average visual acuity of all patients was 0.3, and 4 patients had a clear history of exposure to tuberculosis. The active lesions in the PTP-SLC patients were homogeneous and creamish-yellow with unclear boundaries. Fundus autofluorescence showed an ill-defined, diffuse hyperautofluorescent zone. OCT showed punctate hyperreflexes between the choroidal stroma, destruction of the outer retinal structure with intraretinal edema and discrete vitreal hyper-reflective spots. FFA showed hypofluorescence in the active lesion at early stage and diffuse hyperfluorescence with leakage. Indocyanine green angiography showed persistent hypofluorescence. Conclusions: PTP-SLC fundus lesions are mainly manifested as homogeneous creamish-yellow lesions with unclear boundaries and high in autofluorescence. The involvement of the choroid and the outer layer of the retina can be observed on OCT. FFA can find more retinal vascular inflammatory changes. It is difficult to distinguish PTP-SLC from serpiginous choroiditis simply based on clinical and epidemiological characteristics. The pathogenic examination of tuberculosis is still the key to differential diagnosis (Chin J Ophthalmol, 2020, 56: 914-919).

[Peripapillary and macular vessel density in eyes with different phases of thyroid-associated ophthalmopathy]

Objective: To analyze the characteristics of vessel density in the optic disc and macular area of patients with different phases of thyroid-associated ophthalmopathy (TAO) and their correlation with visual function. Methods: This case-control study was conducted at the Department of Ophthalmology of Peking Union Medical College Hospital between June 2019 and September 2019. TAO patients and healthy volunteers were included in the study. Patients with a clinical activity score greater than or equal to 3 points were categorized as active TAO. Dysthyroid optic neuropathy (DON) patients with a course less than 6 months were categorized as acute phase of DON, and those more than 6 months were in the chronic group. Healthy volunteers were in the control group. Each group included 12 subjects, with right eyes for analysis. There were 6 males and 6 females in each group. All participants underwent comprehensive ophthalmic examination including best corrected visual acuity and visual field examination for the mean defect (MD). Best corrected visual acuity was subsequently converted to logarithm of minimum angle of resolution (logMAR). Optical coherence tomography was used to measure the thickness of the retinal nerve fiber layer (RNFL) and retinal ganglion cell complex (GCC). Optical coherence tomography angiography was used to the peripapillary and macular vessel density. The differences in the vessel densities in the optic disc and macular area between groups and their correlation with different factors were analyzed. Analysis of variance, non-parametric Mann-Whitney U test and Spearman coefficient were conducted for statistical analysis. Results: There was no significant difference in age among the four groups (P>0.05). The logMAR of the acute DON group was 0.1 (0.0, 0.2), worse than the control group, which was 0.0 (0.0, 0.0) (U=114.000, P<0.05). The overall vessel densities of the optic disc in acute DON and chronic DON were significantly lower than the control group (54.70%±2.31% and 54.31%±3.65% vs. 57.54%±2.17%; t=3.104, 2.636; both P<0.05). The overall superficial vessel densities of the macular area in active TAO, acute DON and chronic DON were significantly lower than the control group (46.07%±3.06% and 42.26%±5.05% and 45.63%±3.87% vs. 49.34%±3.08%), and the differences were statistically significant (t=2.614, 4.147, 2.603; all P<0.05). There was no statistically significant difference in the size of the foveal avascular zone or the density of deep blood vessels in the macular area among the four groups (all P>0.05). In the active TAO period, there was no correlation between the MD value, RNFL thickness, GCC thickness and the vessel densities of the optic disc and macular area (all P>0.05). The vascular density of the whole layer of the optic disc in acute DON was negatively correlated with the MD value (r=-0.591, P<0.05) and positively correlated with the RNFL thickness and GCC thickness (r=0.595, 0.693; both P<0.05). In chronic DON, the overall capillary density of the optic disc was negatively correlated with the MD value (r=-0.673, P<0.05); the superficial overall blood vessel density of the macular area was positively correlated with the thickness of RNFL and GCC (r=0.732, 0.712;both P<0.01). Conclusions: In active TAO, only the blood supply to the superficial layer of the macular area is decreased. In the acute and chronic phases of DON, the blood supply to the superficial layer of the macular area and the optic disc is both reduced; the smaller the blood vessel density, the more severe the visual field defect, and the thinner the RNFL and GCC. (Chin J Ophthalmol, 2020, 56:824-831).

[Progress of ocular motor and structures in multiple sclerosis patients]

Multiple sclerosis (MS) is a demyelinating disease of central nervous system, which often affects ocular region and causes structural and functional changes of eyes. Therefore, there have been plenty of researches on the alteration of motor and structures of eyes by MS. This paper reviews and summarizes the progress of MS-related changes of ocular motor, cornea, structure and blood flow of retina, and optic nerve, and may provide a new insight for related clinical researches. (Chin J Ophthalmol, 2020, 56: 711-715).

[A comparative study of retinal nerve fiber layer thickness in AIDS patients with different fundus diseases]

Objective: To investigate the characteristics of retinal nerve fiber layer (RNFL) thickness in AIDS patients with normal fundus, HIV-related microvascular retinopathy (MVR), and cytomegalovirus retinitis (CMVR). Methods: In this cross-sectional study, 111 patients were diagnosed with AIDS from 2012 to 2017 by infectious disease physicians in Beijing You'an Hospital. There were 105 males and 6 females, aged 20-65 years. According to the results of ophthalmic examination, the patients were divided into three groups: 31 patients in the active-stage CMVR group, 47 patients in the MVR group, and 33 patients with normal fundus in the control group. RNFL thickness was measured by optical coherence tomography in all patients. At the same time, visual acuity, intraocular pressure, and fundus were examined, and AIDS-related systemic examination (CD4(+) T lymphocyte count, HAART treatment status, and blood cytomegalovirus DNA level) was performed. The measurement data were compared by t-test, variance analysis or rank sum test. The counting data were compared by chi square test or Fisher exact probability method. Results: In the control group, the thickness of RNFL in the superior quadrant in the left and right eyes was 145 (79, 231) μm and 142 (46, 179) μm, respectively; the difference was statistically significant (Z=-2.481, P=0.013). The RNFL thickness of the diseased and healthy eyes in the MVR group was 116 (91, 138) μm and 122 (82, 192) μm, respectively, with no significant difference (Z=-0.861, P=0.389); the best corrected visual acuity was 0.0 (0.0, 0.2) and 0.0 (0.0, 0.2), respectively, with no significant difference (Z=-0.378, P=0.705). In the CMVR group, the best corrected visual acuity of the diseased and healthy eyes was (0.23±0.48) and (0.02±0.82), respectively, and the difference was statistically significant (t=-2.944, P=0.003); the RNFL thickness was 133 (61, 219) μm and 121 (69, 146), respectively, in the whole optic disc, with statistically significant difference (Z=-2.385, P=0.017), 104 (41, 374) μm and 82 (55, 121) μm, respectively, in the nasal quadrant, and 99 (14, 173) μm and 72 (36, 111) μm, respectively, in the temporal quadrant, with statistically significant difference (Z=-2.045, -2.543; P=0.041, 0.011). The RNFL thickness in the CMVR group, the MVR group, and the control group was 149 (61, 350) μm, 126 (71, 304) μm, and 113 (87, 149) μm, respectively, with statistically significant difference (H=20.908, P=0.000). Conclusions: The fundus of AIDS patients had different characteristics on optical coherence tomography. In active CMVR patients, the thickness of RNFL was generally thickened. In MVR patients, the average thickness of RNFL was thicker than that in the normal control group.(Chin J Ophthalmol, 2020, 56:258-265).

Optical coherence tomography features of neovascularization in proliferative diabetic retinopathy: a systematic review

Background

Diabetic retinopathy (DR) is a leading cause of blindness due to diabetic macular edema (DME) or complications of proliferative diabetic retinopathy (PDR). Optical coherence tomography (OCT) is a noninvasive imaging technique well established for DME but less used to assess neovascularization in PDR. Developments in OCT imaging and the introduction of OCT angiography (OCTA) have shown significant potential in PDR.

Objectives

To describe the tomographic features of PDR, namely of neovascularization, both of the optic disc (NVD) and elsewhere (NVE), intraretinal microvascular abnormalities (IRMA), retinal nonperfusion areas (NPA), status of the posterior vitreous, vitreoschisis and vitreous and subhyaloid/sub-ILM hemorrhages.

Data sources

Electronic database search on PubMed and EMBASE, last run on December 19th 2019.

Study eligibility criteria, participants and interventions

Publications assessing OCT and/or OCTA findings in PDR patients. All study designs were allowed except for case-reports, conference proceedings and letters.

Study appraisal

Newcastle–Ottawa Scale for observational studies was used for purposes of risk of bias assessment.

Results

From the 1300 studies identified, 283 proceeded to full-text assessment and 60 were included in this comprehensive review. OCT was useful in detecting NVD and NVE, such as in characterizing disease activity and response to laser and/or anti-VEGF therapies. The absence of posterior vitreous detachment seemed determinant for neovascular growth, with the posterior hyaloid acting as a scaffold. OCTA allowed a more detailed characterization of the neovascular complexes, associated NPA and disease activity, allowing the quantification of neovessel area and flow index. However, changes in OCTA blood flow signal following local therapies did not necessarily correlate with structural regression. Widefield and ultra-widefield OCTA were highly sensitive in the detection of PDR, adding value to disease staging and monitoring. Compared to fluorescein angiography, OCTA was more sensitive in detecting microvascular changes indicating disease progression.

Limitations

Publication languages were restricted. Most included studies were observational and non-comparative. Risk of bias regarding case representativeness.

Conclusions

OCT-based retinal imaging technologies are advancing rapidly and the trend is to be noninvasive and wide-field. OCT has proven invaluable in diagnosing, staging and management of proliferative diabetic disease with daily application in clinical and surgical practices.

[The fundus autofluorescence of retinal astrocytic hamartomas in tuberous sclerosis complex]

Objective: To investigate the autofluorescence findings of retinal astrocytic hamartoma (RAH) in patients with tuberous sclerosis complex (TSC). Methods: It was a retrospective case series study. Twenty-three patients (35 eyes) who were referred to Department of Internal Medicine and Department of Ophthalmology, Peking Union Medical College Hospital between November 2012 and June 2018 with established TSC-associated RAH diagnosis were included. The findings of fundus autofluorescence, fundus photos and spectral-domain optical coherence tomography (SD-OCT) were retrospectively reviewed. RAH lesions were classified into three types based on the morphology shown in fundus photos. The fundus autofluorescence features of TSC-associated RAH were described. The Welch's test and Fisher's exact test were used for statistical analysis. Results: The patients were 8 males and 15 females aged (28±9) years old (range, 15-55 years). Seventy-two RAH lesions were examined, including 59 type 1 RAHs, 7 type 2 RAHs and 6 type 3 RAHs. According to fundus autofluorescence, type 1 RAHs could be further divided into reduced, speckled and background autofluorescence patterns, among which the hypoautofluorescence pattern accounted for the majority (69.5%, 41/59), while the speckled pattern was usually accompanied by outer retinal disorganization and discontinuation of photoreceptor outer segment as revealed by SD-OCT. No significant difference was revealed in tumor thickness for reduced, speckled and background autofluorescence patterns of type 1 RAHs [(490.2±97.9) vs. (589.2±221.6) vs. (463.0±76.2) μm respectively, F=1.426, P=0.283]. Among type 1 RAHs, the number of reduced autofluorescence pattern lesions found in perifoveal, peripapillary, inferonasal, inferotemporal, superonasal, superotemporal quadrants were 9, 4, 4, 7, 4, 13 respectively, while that of speckled autofluorescence pattern lesions were 3, 0, 3, 2, 3, 2 and background autoflurorescence pattern lesions 3, 0, 1, 1, 0, 0. No significant difference was revealed in location distribution (P=0.452) either. Type 2 RAHs featured numerous hyperautofluorescent spots or plaques, and calcification in type 2 RAHs varied in autofluorescence intensity. Type 3 RAHs, combining the features of type 1 and 2 RAHs, were characterized by central hyperautofluorescent spots and hypoautoflurescent rim, but the area of hyperautofluorescence was smaller than that of calcification as shown in fundus photos. Conclusions: In TSC, the fundus autofluorescence of RAHs varies from hypoautofluorescence to hyperautofluorescence patterns according to RAH types. The retinal involvement and calcification degree of TSC-associated RAHs could be reflected on the autofluorescence, which was beneficial to the full assessment. (Chin J Ophthalmol, 2020, 56: 211-216).

[Changes of retinal structure after systemic immunosuppressive treatment in eyes with Vogt-Koyanagi-Harada disease]

Objective: To assess structural changes in retina after systemic immunosuppressive treatment in Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT). Methods: The clinical data of 17 VKH cases (34 eyes) who consecutively attended the Beijing Tongren Hospital between December 2015 and December 2019 were retrospectively reviewed. All the patients had acute or subacute onset, and underwent high-dose systemic corticosteroid and/or immunosuppressive treatment, with a followed-up time of at least 6 months. At the end of follow-up, the intraocular inflammation was controlled, and oral prednisone was withdrawn or being adjusted to less than 10 mg/day. The SD-OCT features of the included eyes were analyzed before treatment, 1 week, 1 month and 3 months after treatment, and at the last visit. Results: A total of 17 cases (34 eyes; 6 males and 11 females) were included, with an age of (42.2±10.6) years, and were followed up for (9.4±3.3) months. At 1 week after initiating treatment, the percentage of the eyes with extensive/multiple or multifocal retinal detachment in the macular region, membranous structures and intraretinal cysts, and undulations and bumps of retinal pigment epithelium (RPE) decreased (5.9% vs 100%, 2.9% vs 47.1%, 5.9% vs 70.6%, 11.8% vs 58.8%, respectively, all P<0.001). There was statistical significant difference of the percentage of ellipsoid zone and external limiting membrane (ELM) disruptions before treatment, at 3 months and the last visit (100% vs 35.3%, 64.7% vs 52.9%, 41.2% vs 26.5%, respectively, all P<0.001). At the last visit, there were statistical significant differences of the best corrected vision acuity (BCVA) between the intact ellipsoid zone group (20 eyes) and the discontinuous group (14 eyes), as well as between the intact ELM group (25 eyes) and the discontinuous group (9 eyes), respectively [0 (0, 0.05) vs 0.10 (0.03, 0.33) (log MAR), P=0.004; 0 (0, 0.07) vs 0.22 (0.05, 0.40) (log MAR), P=0.005]. Conclusions: The edema of choroid and retina subsided obviously at 1 week after initiating treatment. The extent of damage and recovery ability of ellipsoid zone and ELM were different before treatment, at 3 months and the last visit. At the last visit, the outer retinal layers failed to recover completely in some patients, and were related to the BCVA.

Optical coherent tomography to evaluate the degree of inflammation in a mouse model of colitis

Background

There is an urgent need to develop a noninvasive imaging technique for the diagnosis of early inflammatory lesions or early and real-time microscopic assessment before selecting the most representative biopsy sites.

Methods

In this study, a dextran sulfate sodium colitis model was developed, and intestinal histological damage scores measured the degree of inflammation in colitis. According to these scores, 6 parameters were designed for hematoxylin and eosin (HE) sections based on morphological changes, and 2 parameters were designed for optical coherence tomography (OCT) images to measure submucosal edema by morphological changes to evaluate inflammation degrees in the colon. Spearman's rank correlation method was used to compare the correlation between the submucosal morphological changes and the different degrees of inflammation. One-way analysis of variance (ANOVA) was used for comparisons among groups, while receiver operating characteristic (ROC) curves of the indicators in HE sections and OCT images were plotted.

Results

In HE sections, angle of mucosal folds (r=0.853, P<0.01), length of basilar parts (r=0.915, P<0.01), submucosal area (r=0.819, P<0.01), and height between submucosal and muscular layers (r=0.451, P=0.001) were correlated with the degree of inflammation in colitis. In OCT images, length of basilar parts (r=0.800, P<0.01) and height of submucosa + thickness of muscularis (r=0.648, P=0.001) were correlated with the degree of inflammation and aided the measurement of inflammation in the colon.

Conclusions

Parameters based on morphological changes in OCT images and HE sections were significant indexes for evaluating the degree of inflammation in colitis. OCT images have advantages for future clinical applications in situ, including noninvasiveness and real-time imaging.

[Research progress of outer retinal tabulation]

The outer retinal tubular structure (ORT) indicates a round or oval-shaped structure with a highly reflective border and a relatively low reflective lumen on spectrum-domain coherence tomography. ORTs are located in the outer nuclear layer accompanied by disruption and curling of the external limiting membrane and retinal pigment epithelial atrophy. Histopathological researches have revealed that ORTs are some kind of remodeling of the outer retina especially photoreceptors under pathological conditions, representing an advanced damage to the outer retina and a common final pathway of various retinal degenerative diseases. ORTs are common in neovascular age-related macular degeneration. They show some similarities in morphology with inter retinal fluid or cystoid edema on spectrum-domain coherence tomography, but they are not an indication for neovascular activity and retreatment. Their response to anti-vascular endothelial growth factor is poor, and the visual prognosis is not optimistic. Therefore, raising awareness of ORTs is very important for guiding clinical treatment and judging prognosis. (Chin J Ophthalmol, 2020, 56: 149-154).

[Optic nerve morphology and vessel density in eyes with different phases of non-arteritic anterior ischemic optic neuropathy]

Objective: To compare the blood flow around the optic disc and related factors in patients with acute and chronic non-arteritic anterior ischemic optic neuropathy (NAION) and healthy volunteers with small disc cups under the same anatomical structure. Methods: This was a prospective case-control study. NAION patients with unilateral onset and healthy volunteers of the same phase were included in the study conducted at the Department of Ophthalmology of Peking Union Medical College Hospital between February 2017 and September 2018. Patients with a course of ≤ 3 months were categorized in the acute phase of NAION, and those with a course of >3 months were in the chronic phase of NAION. Healthy volunteers were in the control group. All subjects underwent the examination of best corrected visual acuity converted to logarithm of the minimum angle of resolution (LogMAR), measurement of non-contact intraocular pressure, slit lamp examination, small pupil fundus examination, and axial measurement. Optical coherence tomography was used to measure the thickness of retinal nerve fiber layers (RNFL) and retinal ganglion cell complex (GCC). Optical coherence tomography angiography was used to measure the vessel density around the optic disc. NAION patients underwent the visual field examination. Analysis of variance, non-parametric Mann-Whitney U test and Spearman coefficient was used for statistical analysis. Results: This study included 16 patients with acute phase of NAION, aged (57±9) years, 6 males and 10 females. There were 17 patients with chronic disease, aged (56±10) years, 7 males and 10 females. There were 15 healthy controls, aged (57±10) years old, 6 males and 9 females. There were no significant differences in age and gender between the groups (both P>0.05). The RNFL and the GCC in the NAION chronic phase group were significantly thinner than those in the acute phase group [(78±38) μm vs. (191±99) μm, (75±19) μm vs. (98±28) μm; t=4.389, 2.758; both P<0.05]. The cup/disc area ratio, cup/disc vertical diameter ratio and cup/disc horizontal diameter ratio in the chronic phase group were larger than those in the acute phase group [0.18 (0.11, 0.31) vs. 0.05 (0.01, 0.18), 0.45 (0.39, 0.56) vs. 0.22 (0.11, 0.41), 0.39 (0.28, 0.54) vs. 0.20 (0.07, 0.42)], and the difference was statistically significant (U=212.000, 208.000, 205.000; all P<0.05). Compared with the optic disc vessel density in the control group (53%±6%), there was a significant decrease in the acute phase group and the chronic phase group (45%±7%, 41%±8%; t=3.705, 4.940; both P<0.01). The blood vessel density in the nasal inferior of the chronic phase group was significantly lower than that in the acute phase group (36%±8% vs. 42%±7%, P=0.039), other sections didn't have significant difference (all P>0.05). There were tortuous capillaries in 8/16 of the acute phase cases, with a low blood flow density and visual field defect in relative positions. Correlation analysis showed that the whole density and peripapillary density in the NAION patients were negatively correlated with LogMAR, mean visual field defect, cup/disc area ratio, focal loss of volume of GCC and general loss of volume of GCC (r=-0.510, -0.733, -0.372, -0.532, -0.648; all P<0.01), but positively correlated with GCC and RNFL thickness (r=0.604, 0.508; both P<0.01). Conclusions: The optic disc vessel density in the acute phase and chronic phase of NAION is significantly reduced. The vessel density in the nasal area of the chronic phase is significantly reduced compared with the acute phase. The vessel density is correlated with visual acuity, visual field defect, disc indexes, thickness of RNFL and GCC. (Chin J Ophthalmol, 2019, 55: 677-686).

[A preliminary study on optical coherence tomography of the lacrimal punctum in normal adults]

Objective: To study the imaging characteristics and accumulate data of optical coherence tomography (OCT) of the lacrimal punctum in normal adults. Methods: From September to November 2018, 59 healthy adults (90 eyes) with normal lacrimal punctum structure were enrolled in this cross-sectional study conducted at the Lacrimal Center of Ophthalmology, Third Medical Center of PLA General Hospital, including 21 males (34 eyes) and 38 females (56 eyes), aged 18-65 years. All the subjects were examined by slit lamp microscopy to measure the maximum transverse diameter. OCT was performed to observe the inferior lacrimal punctum, including the external punctal diameter, the punctal diameter at 100 μm and 200 μm depth. The difference in the diameter of different parts of the punctum was analyzed. Independent sample t test and single factor analysis of variance were used for statistical analysis. Results: In normal adults, the maximum transverse diameter under a slit lamp was (545.6±149.3) μm, the external punctal diameter on OCT images was (548.4±130.5) μm, and the punctal width at 100 μm and 200 μm depth on OCT images was (262.8±120.8) μm and (179.2±110.0) μm, respectively. There was no significant difference between the maximum transverse diameter of the punctum under a slit lamp microscope and the OCT outer diameter of the punctum (t=0.133, P=0.894). There were significant differences between the diameter of the lacrimal punctum in the different scanning sites of the OCT (F=213.237, P<0.01). There was significant difference between the punctal width at 100 μm and the external punctal diameter on OCT images (t=15.229, P<0.01). There was significant difference between the punctal width at 200 μm and the external punctal diameter on OCT images (t=20.517, P<0.01). There was significant difference between the punctal width at 100 μm and 200 μm depth on OCT images (t=4.855, P<0.01). Conclusion: The width of different parts of the lacrimal punctum in healthy adults is different on OCT images, and the punctal width at 200 μm depth is the narrowest. (Chin J Ophthalmol, 2019, 55: 695-699).

[Correlation of capillary plexus with visual acuity in idiopathic macular epiretinal membrane eyes using optical coherence tomography angiography]

Objective: To observe changes in foveal avascular zone(FAZ) and capillary plexus in idiopathic macular epiretinal membrane (IMEM) in optical coherence tomography angiography (OCTA) and analyze their correlation with the visual acuity. Methods: Cross-sectional study. 42 patients (15 Males and 27 females, age 64.8) from the Eye Hospital of Wenzhou Medical University were included with 51 eyes diagnosed as IMEM (IMEM group), and 23 normal eyes (9 Males and 14 females, control group). All patients received the examination of fissure lamp combined with fundus pre-set lens, best corrected visual acuity (BCVA), OCT angiography (OCTA) and fundus photo. OCTA was performed on 3 mm× 3 mm sections centred on the fovea. The software automatically measured the superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density(VD) and retinal thickness(RT) and FAZ area. The IMEM eyes were compared with the normal eyes and correlation between the parameters of OCTA and BCVA was analyzed in IMEM. Independent-sample t test and MannWhitney test were used for comparison between groups, and Spearman test was used for correlation analysis. Results: LogMAR BCVA in the IMEM group was 0.40(0.15, 0.70), in the control group was 0.10(0.05, 0.22). FAZ area of IMEM group was (0.09±0.05) mm(2), while that of control group was (0.34±0.13)mm(2).Compared with the control group, in IMEM group, the BCVA was worse (Z=-4.443, P<0.001), FAZ area was smaller (t=-9.198, P<0.001), RT was increased (P<0.001), The foveal DCP and SCP vessel density was increased (t=4.280, 9.079, P<0.01), The parafoveal DCP vessel density was decreased (P<0.05), The parafoveal SCP vessel density was decreased in superior, inferior and nasal side (t=-2.759, Z=-3.998, Z=-2.108; P<0.05). The BCVA was negatively correlated with FAZ area (r=-0.337, P=0.017), positively correlated with center macular thickness (r=0.324, P=0.020). The BCVA was no correlated with foveal VD and parafoveal DCP vessel density (P>0.05), but correlated with SCP vessel density(P<0.05). Conclusions: In the IMEM eyes the BCVA was worse, FAZ area was smaller, foveal vessel density was increased and the parafoveal vessel density was decreased compared with the normal eyes. The smaller the FAZ area, the smaller foveal SCP vessel density, the poorer BCVA. There was no correlation between BCVA and DCP vessel density. Changes in VD in IMEM eyes may lead to changes in vision. (Chin J Ophthalmol, 2019, 55:757-762).

Relationship between neointimal strut bridge and jailed side-branch ostial area

BACKGROUND

Our study analyzed the relationship between the neointimal strut bridge and jailed side-branch (SB) ostial area in patients with coronary heart disease (CHD) who had a single drug-eluting stent (DES) crossover of the left anterior descending coronary artery (LAD)/diagonal branch (D) bifurcation.

PATIENTS AND METHODS

A total of 64 CHD patients with an LAD/D bifurcation treated by optical coherence tomography (OCT)-guided single-DES implantation and followed up at 1 year after primary percutaneous intervention (pPCI) were enrolled in our study. According to the two-dimensional OCT results, patients were divided into a non-neointimal bridge group (n = 44) and a neointimal bridge group (n = 20). Basic clinical, angiographic, 2D and 3D OCT, and DES results were analyzed.

RESULTS

The blood lipid levels of the two groups after the 1‑year follow-up were lower than the levels 1 year earlier (p < 0.05). There was a notable decrease in the SB ostial minimum lumen diameter and area directly after pPCI vs. before pPCI in both groups. The diameter stenosis directly after pPCI showed a clear increase compared with the pre-pPCI value in both groups (p < 0.05 or p < 0.01, respectively). The strut distance of the neointimal bridges in the neointimal bridge group was greater than in the non-neointimal bridge group (p < 0.05). A clearly short strut distance of the neointimal bridge was observed compared with the strut distance of the non-neointimal bridge in the neointimal bridge group (p < 0.05). A larger neointimal bridge area and a smaller SB ostial area were found in the neointimal bridge group compared with the non-neointimal bridge group (p < 0.05 or p < 0.01, respectively).

CONCLUSION

A short strut distance facilitated formation of a neointimal bridge, which significantly influenced the SB ostial area after single crossover stenting of the SB orifice at the 1‑year follow-up.

[Comparison of biometry with the Pentacam AXL, IOLMaster 700 and IOLMaster 500 in cataract patients]

Objective: To compare biometry with new biometers of Pentacam AXL and IOLMaster 700 and the widely used biometer of IOLMaster 500 in cataract patients. Methods: Cross-sectional study. A total of 223 eyes of 147 cataract patients from Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University during 4-8 December 2017 were recruited. There were 67 males and 80 females with an age of (64±11) years.The axial length (AL), mean keratometry (Km), anterior chamber depth (ACD) and white-to-white corneal diameter (WTW) from each device were recorded. The difference and agreement between the measurements were evaluated by ANOVA, LSD test, intraclass correlation coefficient and Bland-Altman analysis. Results: The success rate of AL measurement was 85.2% (190/223) with the Pentacam AXL, 96.9% (216/223) with the IOLMaster 700 and 90.6% (202/223) with the IOLMaster 500. There was no difference among devices in measuring the AL, Km and ACD (all P>0.05). Significant difference was found in WTW [(11.36±0.42) vs. (11.69±0.45) vs. (11.45±0.42) mm; F=34.696, P=0.000]. Intraclass correlation coefficient was 0.859-1.000, and Bland-Altman analysis showed good agreement among three devices. Conclusions: The new biometers of Pentacam AXL and IOLMaster 700 and the widely used IOLMaster 500 show no difference in measuring AL, Km and ACD. All three devices show good agreement in biometry of cataract patients. (Chin J Ophthalmol, 2019, 55: 515-521).

Intravascular imaging analysis of a drug-eluting balloon followed by a bare metal stent compared to a drug-eluting stent for treatment of de novo lesions

BACKGROUND/AIMS

After a study comparing drug-eluting stents (DESs) to sequential treatment with drug-eluting balloons (DEBs) and bare metal stents (BMSs), we retrospectively analysed strut malapposition and neointimal hyperplasia in de novo coronary lesions using optical coherence tomography (OCT) or intravascular ultrasonography (IVUS).

METHODS

We obtained OCT data from 16 patients (eight per group) and IVUS data from 40 patients (20 per group). OCT or IVUS was performed after the index procedure and after 9 months. Parameters including obstruction volume due to neointimal hyperplasia (neointimal hyperplasia volume/stent volume, %), strut malapposition (% of malapposed struts), and intra-individual inhomogeneity of in-stent restenosis were compared.

RESULTS

Although obstruction volume due to neointimal hyperplasia was significantly higher in the DEB-BMS group (14.90 ± 15.36 vs. DES 7.03 ± 11.39, p = 0.025), there was no difference in strut malapposition between the two groups (DEB-BMS 1.99 ± 5.37 vs. DES 0.88 ± 2.22, p = 0.856). The DEB-BMS group showed greater intra-individual inhomogeneity of in-stent restenosis pattern than the DES group.

CONCLUSION

Treatment with DEB followed by BMS failed to improve strut malapposition despite higher in-stent neointimal growth, probably because of the inhomogeneous inhibition of in-stent neointimal hyperplasia by DEB. DEB technology should be improved to obtain even drug delivery to the vessel wall and homogeneous prevention of neointimal growth comparable to contemporary DES.

[The relationship between optical coherence tomography performance and visual acuity of acute retinal necrosis]

Objective: To analyze the relationship between optical coherence tomography(OCT) performance and visual acuity of patients with acute retinal necrosis (ARN). Methods: Retrospective analysis was performed on the patients diagnosed with ARN at the ophthalmology department of Peking union hospital during October 2011 and May 2016. Fourteen patients (15 eyes), 9 males and 5 females, whose anterior and posterior inflammation disappeared and the retinal necrosis lesion in the fundus of the eye subsided were included. The mean age was (41.6±12.2) years. All patients underwent careful examinations including best corrected visual acuity (BCVA), slit-lamp microscope, indirect ophthalmoscope, color fundus picture, fundus fluorescein angiography (FFA) and OCT (results of their last consultations). Results: BCVA: 8 eyes were increased, 2 eyes were unchanged and 5 eyes were decreased at the last visit; light perception (LP) 1 eye, finger count (FC) 1 eye, 3 eyes of 0.01 to 0.1, 6 eyes of 0.15 to 0.25. The inflammatory reaction in the anterior segment of 14 eyes disappeared, while the inflammatory reaction of the remaining 1 eye was relieved. The fundus lesions of all 15 eyes disappeared. According to OCT results: five eyes (5/15) exhibited normal macula area, among the 5 eyes, 4 eyes are of 0.15 to 0.25 visual acuity, and 1 eye is of 0.5 visual acuity;macular epiretinal membrane is present in three eyes (3/15), of which the visual acuity is 0.02, 0.25 and 0.3 respectively macula edema is present in three eyes (3/15), among the 3 eyes, 1 eye (visual acuity of 0.01)showed thickening of neurosensory retina, cystoid change of fovea and several fluid dark areas, the other 2 eyes (visual acuity of 0.02 and 0.5 respectively) showed small diffuse fluid dark area in the neurosensory retina;atrophy of neurosensory retina and absence of IS/OS was found in four eyes (4/15), among the 4 eyes, the visual acuity of 3 is below 0.01, and the other 1 eye is of 0.08 visual acuity. Conclusions: The OCT performance of stationary phase of ARN tends to be positively correlated with the visual acuity of patients. The prognosis of visual acuity of the patients whose OCT results showed atrophy of neurosensory retina and absence of IS/OS is poor. (Chin J Ophthalmol, 2018, 54: 369-374).

[Optical coherence tomography angiography of acute Vogt-Koyanagi-Harada disease]

Objective: To measure vascular density in retinal and choroidal capillary layers by optical coherence tomography angiography (OCTA) and to explore their potential clinical values in Vogt-Koyanagi-Harada disease (VKH). Methods: This is a cross-sectional case-control study. Twenty-one acute VKH cases presented to Peking Union Medical College Hospital between April 2015 and July 2015 and 49 healthy controls were enrolled in this study. OCTA was performed with a split-spectrum amplitude-decorrelation angiography-optical coherence tomography (SSADA-OCT) system borrowed from Optovue Inc. Vascular densities of the capillary layers were analyzed by the built-in software. Bilateral independent sample t-test was used to compare retinal and choroidal vascular density of eyes in acute phase VKH with healthy controls. Spearman correlation test was used to analyze the correlation between the vascular density of retina and choroid in acute phase VKH and LogMAR best corrected visual acuity (BCVA). Results: Mean vascular density of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in eyes of the acute VKH group were statistically lower than those of healthy control group (51.56%±2.88%, 56.51%±2.31%, 58.14%±2.10% vs. 53.55%±2.51%, 58.14%±2.10%, 58.14%±2.10%, t=-3.890, 3.910,-6.554, all 3 P values were<0.01). In VKH patients, eyes with retinal detachment (RD) had statistically lower mean vascular density in the CC layer than those without (NRD) (63.46%±2.19% vs. 65.85%±1.79%, t=3.890, P<0.01), while no statistically significant differences were found in vascular densities of SCP and DCP layers between RD and NRD eyes. Spearman's correlation test revealed a negative correlation between vascular density of the CC layer and logMAR BCVA(r=-0.437, P<0.01), while no statistically significant associations were found between logMAR BCVA and vascular densities of SCP and DCP. Conclusions: OCTA can be used for quantitative detection of vascular density of retina and choroidal capillary in acute VKH. There is circulatory disturbance in SCP, DCP and CC of acute VKH. Vascular density of CC is associated with visual acuity and retinal detachment. (Chin J Ophthalmol, 2017, 53: 735-739).

[Spontaneous focal lamina cribrosa defect in glaucoma and its relationship with nonprogressive glaucomatous neuropathy]

Objective: To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG). Methods: Case-control study. The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University. Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed. Intraocular pressure, mean defects of visual field, central corneal thickness and axis length were recorded in the follow-up duration. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated by χ(2) or Fisher's test, mixed-effect model analysis and multivariate Logistical regression analysis. Results: A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47±14) years, the group consisted of 17 males and 15 females. Fourty-five eyes showed nonprogressive VFD. LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (χ(2)=6.896, P=0.009). Eyes with nonprogressive VFD showed longer axis length[(26.82±1.34) mm vs. (25.79±1.44) mm; t=6.589, P=0.013] and wider LC defects diameter[211 (165-326) μm vs. 114 (106-156) μm; Z=4.797, P=0.042]. Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217, P=0.012). There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7, P=0.002). There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 μm) than that in the contralateral eyes with stable VFD (269 μm). Conclusions: LC defects are more common in eyes with nonprogressive VFD. Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG. (Chin J Ophthalmol, 2019, 55:338-346).

[The presentations of uveitis on OCTA images and interpretations]

Optical coherence tomography angiography (OCTA) can reflect the vascular morphological changes of various types of uveitis, including flow void, hypoperfusion, capillary abnormalities, capillary network disorders and choroidal neovascularization. Moreover, OCTA is featured of particular quantification functions, such as measurement of the areas of foveal avascular zone, choroidal neovascularization, vascular density and flow index. Despite certain limitations, its characteristics of non-invasiveness and capabilities of depicting vascular details are helpful to the observation and follow-up of uveitis. As current interpretation of the OCTA images for uveitis is not thorough enough, hence further analysis of the images is needed to improve its application on uveitis. (Chin J Ophthalmol, 2019, 55: 392-396).

[The clinical characteristics and pathologic mechanisms of acute macular neuroretinopathy]

Acute macular neuroretinopathy (AMN) is a rare macular disorder. The clinical diagnosis of AMN is difficult and complicated since the retinal symptoms of patients with AMN are usually unclear or untypical. Spectral domain optical coherence tomography (SD-OCT) is a reliable examination for imaging the retinal structure, which improved the insight of AMN in etiology and pathogenesis. This review summarizes and analyzes the recent clinical reports and research progress, in an effort to present a more accurate clinical recognition of AMN. (Chin J Ophthalmol, 2019, 55:311-315).

[Application of optical coherence tomography angiography in evaluation of retinal microvascular changes in patients with obstructive sleep apnea syndrome]

Objective: To assess the changes of retinal microvasculature in patients with obstructive sleep apnea syndrome (OSAS) evaluated by optical coherence tomography (OCTA). Methods: Adult OSAS patients who visited Beijing Tongren Hospital from Jan 2016 to Apr 2016 and complained of snoring were included in this study. The patients' general information, results of polysomnography, and OCTA parameters were collected. Patients were divided into three groups according to their apnea hypopnea index (AHI) results: Mild-moderate group, AHI≤30/h; Severe group, 30/h<AHI≤60/h; Extremely severe group, AHI>60/h, and clinical characteristics, polysomnography and OCTA parameters among the three groups were compared. Results: A total of 27 patients were included in this study with 21 males (77.8%) and 6 females (22.2%). Mean age was (41.7±10.0) years, and the mean body mass index was (27.9±4.5) kg/m(2;) Neck circumference was 31-48 cm, mean (39.8±4.3) cm; 8 patients (29.6%) suffered from hypertension that could be controlled; Epworth sleepiness scale scored 1-18 points and mean (8.5±4.4) scores; AHI ranged between 5.5 and 92.1/h with a mean of (46.4±28.6)/h. There were 9 (33.3%), 7 (25.9%), and 11 (40.7%) patients in mild-moderate group, severe group, and extremely severe group, respectively. Compared with severe group, the optic nerve head and radial peripapillary capillaries (RPC) peripapillary vascular density in extremely severe group were significantly decreased (62.4%±1.9% vs 60.3%±1.9%, P=0.041; 64.7%±1.7% vs 62.2%±2.3%, P=0.036). Conclusions: OCTA has rapid, safe, and objective characteristics in assessing the retinal microvascular changes in OSAS patients. Retinal microvascular damage in patients with OSAS is associated with the disease severity. Reduction of retinal microvascular density in patients with OSAS may be associated with intermittent hypoxia.

[The status of the application of optical coherence tomography angiography in nonarteritic ischemic optic neuropathy]

Optical coherence tomography angiography (OCTA) is a new technology of angiography which features multiple advantages over the traditional ones. It can provide a rapid and noninvasive approach to observing the vascular morphology and blood vessel density of the optic disc, peripapillary and macular area. Nonarteritic ischemic optic neuropathy (NAION) is an acute optic neuropathy characterized by a sudden, painless decrease in vision and a typical visual field defect. It has been widely accepted that the circulatory insufficiency of the optic nerve head (ONH) mainly supplied by the posterior ciliary arteries (PCA) results in ischemic damage. Relevant researches are necessary for exploring the pathogenesis, diagnosis and treatment of NAION, and this review summarizes the results of recent studies on application of OCTA in analyzing the blood flow in the optic and macular area in NAION patients. (Chin J Ophthalmol, 2019, 55:306-310).

[Quantification of optical coherence tomographic angiography images in type 2 diabetic patients]

Objective: To quantify optical coherence tomographic angiography (OCTA) images and to explore potential clinical values of each parameter in diabetic patients. Methods: A case-control and cross-sectional study of diabetic (129 eyes) and healthy (32 eyes) subjects was conducted. 3-mm OCTA scan, fundus photography and best corrected visual acuity measurement were performed. Image-pro plus was used to calculate microvascular and foveal avascular indices in nonsegmented and segmented OCTA images. Intraclass correlation coefficient and relative standard deviation were used to examine the reliability, reproducibility and accuracy. Correlation of each parameter was calculated, and so was the area under the receiver operating characteristic curve. Results: Vessel density (VD) of diabetic patients measured in the nonsegmented retinal layer (RL) and superficial retinal layer (SRL) was 49.146%±6.097%, 44.038%±5.641%, respectively, significantly lower than healthy subjects 52.212%±6.250%, 46.698%±5.417% (t=2.534, 2.405; P=0.012, 0.017), and vessel length (VL) was (19.905±2.285)mm, (17.596±2.149)mm, (14.479±2.091)mm in the three layers, which was significantly shorter than that in the healthy control group (21.037±2.185)mm, (18.739±1.994)mm, (15.343±2.266)mm (t=2.529, 2.731, 2.059; P=0.012, 0.007, 0.041). Compared with non-diabetes, foveal avascular zone (FAZ) in diabetes was (0.441±0.167)mm(2), larger compared to health eyes 0.352±0.109mm(2) (t=-2.831, P=0.005). FAZ demonstrated a negative correlation with VD and VL in RL or SRL(r=-0.227, -0.338; P<0.05) (r=-0.241, -0.332; P<0.05), while best corrected visual acuity showed a negative correlation with VL in each layer (r=-0.225, -0.201, -0.250; P=0.01, 0.022, 0.004), and VD in DRL (r=-0.197, P=0.026). All parameters showed high reproducibility between graders(intraclass correlation coefficient>0.965), while relative standard deviation was greater than 3.049%. AR had the highest area under the receiver operating characteristic curve (0.737), compared with AI (0.724). Conclusions: Our study demonstrates good reliability, reproducibility and accuracy of quantification of OCTA images and reveals changes of VD, VL and FAZ in diabetes, which may occur earlier than vision impairment. AR and AL may have great values in prompting early diabetic retinopathy in diabetic patients. (Chin J Ophthalmol, 2019, 55:273-279).

[The importance of combined application of visual electrophysiology examination and OCT in optic neuropathy]

This article briefly analyzes the advantages and limitations of visual electrophysiology and OCT, and explains the complementarity of visual electrophysiology and OCT and the advantages of combined application in typical optic neuropathy, so as to provide guidance on how to combine the functional and morphological inspections in the clinical diagnosis and treatment of optic neuropathy. (Chin J Ophthalmol, 2019, 55: 161-163).

[Vessel density and structure in the macular region of non-arteritic anterior ischemic optic neuropathy patients]

Objective: To explore the correlation between the vessel density and the structure and visual function in patients with non-arteritic anterior ischemic optic neuropathy (NAION) in different stages. Methods: This case-control study included 25 NAION patients (28 eyes)of Peking Union Medical College Hospital from November 2017 to May 2018 and 25 healthy controls(HC) (25 eyes) of matched age and gender. General eye examination, visual field examination, and optical coherence tomography angiography were performed to obtain data of blood flow in the macular area and structure such as ganglion cell complex (GCC) and gross loss of volume (GLV), and focal loss of volume (FLV). All affected eyes were divided into the acute group (≤3 weeks), sub-acute group (4 to 12 weeks), and chronic group (>12 weeks) in line with the course of the disease. The group and regional analyses were made to carry out overall differences of blood flows and structures and the correlations with visual function. Results: There were 25 NAION patients with 28 eyes, 16 males and 9 females, aged (55±9) years. The acute group included 8 patients (8 eyes), and the sub-acute group included 10 patients (10 eyes), while the chronic group comprised 7 patients (10 eyes). The overall macular superficial vessel density of patients with NAION was significantly reduced compared with the HC(42.03%±5.70% vs.49.01%±3.34%, t=-5.546, P<0.01), but the deep vessel density was not significantly reduced (P>0.05). The superficial vessel density of the acute group, sub-acute group, and chronic group was significantly decreased(47.41%±3.51% vs. 41.68%±3.09% vs.38.06%±5.93%, all P<0.05). The GCC thickness in patients with NAION were significantly lower than the HC [(88.5±18.2) μm vs. (102.9±5.4)μm, P<0.05]. The GLV and FLV in patients with NAION were significantly higher than the HC (12.733%±11.216% vs. 0.941%±0.852%, 6.295%±4.291% vs. 0.596%±0.460%, both P<0.05). There was a correlation between the macular superficial vessel density and GCC thickness (r=0.606, P=0.001), FLV(r=-0.552, P=0.002), GLV (r=-0.685, P=0.000) and mean sensitivity (r=0.493, P=0.023). Conclusion: Compared with healthy controls, the macular superficial vessel density in NAION patients decreas along with the course of the disease, and its correlation with structural and visual function is revealed. (Chin J Ophthalmol, 2019, 55:195-202).

[Choroidal thickness in preschool children]

Objective: To estimate the choroidal thickness (CT) in healthy children aged 2-6 years old and its relation to axial length, age and gender. Methods: Cross-sectional study. CT was assessed using spectral domain optical coherence tomography (OCT) in 126 children aged 2 to 6 years. CT was measured at nine locations, including the subfovea and 1 mm and 3 mm nasal, temporal, superior and inferior to the fovea. Results: Mean subfoveal choroidal thickness (SFCT) was 331.56±62.03 μm. The choroid was thickest at the subfoveal and 1 mm temporal area, and thinner nasally compared to temporally, superiorly and inferiorly. No statistical significance of SFCT between male and female was noted. Stepwise multiple regression analysis revealed that axial length and age were associated significantly with SFCT (P=0.00), while there was no detectable effect of sex on SFCT (P=0.94). Conclusions: Choroidal thickness was negatively correlated to axial length and positively correlated to age in preschool children. The development of the choroid in early childhood offset the effect of the expansion of eyes. Gender played a minor role in the choroidal development in early childhood. (Chin J Ophthalmol, 2019, 55:111-114).

[Characteristics, multimodality imaging and treatment of macular telangiectasia type 2]

Macular telangiectasia type 2 (MacTel 2) is an idiopathic entity which is characterized by dilated capillary network near, or around, the fovea of the macula. The spectrums secondary to macular retinal vascular inflammation or obstruction are excluded. It is a binocular disease in general. MacTel 2 is now widely recognized as a macular neurodegenerative disease rather than a simple vascular disease. This article reviews the epidemiological features, clinical features, staging, special examinations, pathogenesis and treatment of MacTel 2. (Chin J Ophthalmol, 2019, 55:68-73).

Choroidal Thickness Analysis in Patients with Erectile Dysfunction

Purpose

To investigate the morphological features of choroidal vasculature in patients with erectile dysfunction (ED) by analyzing choroidal thickness using optical coherence tomography.

Materials and Methods

We enrolled 39 patients with ED and 19 controls. ED was defined as an erectile function domain score <26 on the International Index of Erectile Function (IIEF) questionnaire. Small-choroidal-vessel-layer (SCVL) thickness was calculated by subtracting large-choroidal-vessel-layer (which corresponded to Haller's layer) thickness from total choroidal thickness. Choroidal thickness was compared between the ED and control groups.

Results

SCVL thickness was lesser in the ED group than in the control group (control, 69.8±24.3 µm vs. ED, 55.1±19.9 µm; p=0.017). Among patients without diabetes, the ED group showed significantly lesser SCVL thickness than did the control group (control, 77.1±22.7 µm vs. ED, 56.5±20.9 µm; p=0.021). However, among patients with diabetes, choroidal thickness showed no significant intergroup difference. Multiple linear regression analysis revealed that spherical equivalent (standardized coefficient β=0.294; p=0.019) and the IIEF erectile function score (standardized coefficient β=0.315; p=0.012) were significantly associated with SCVL thickness.

Conclusions

SCVL thickness, including the choriocapillaris layer and medium-sized choroidal vascular layer, decreased in proportion to ED severity, suggesting that microvascular changes in choroidal vessels may occur before specific ocular diseases in patients with ED.

[Cyclopexy on cyclodialysis cleft guided by anterior segment optic coherence tomography]

Objective: To analyze the accuracy of cyclopexy on traumatic cyclodialysis cleft guided by anterior segment optic coherence tomography (AS-OCT). Methods: Fifty-six eyes of 56 consecutive patients[41 males, 15 females, with a mean age of (43.14±13.85) years]who diagnosed with traumatic cyclodialysis cleft confirmed by ultrasound biomicroscopy (UBM) and underwent cyclopexy surgery at Shanxi Eye Hosiptal from July 2013 to February 2016 were included in the study. Patients were measured with the AS-OCT system before cyclopexy. AS-OCT findings of the cyclodialysis clefts were recorded. Localizing and suturing the clefts was guided by AS-OCT imaging. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP) and anterior chamber depth (ACD) were recorded and analyzed. Results: Imaging of preoperative AS-OCT of the 56 eyes showed an annular ciliary body detachment, a cyclodialysis cleft and shallow anterior chamber. The ciliary body detachment detected by AS-OCT showed an echo free zone between the annular ciliary body and the sclera. The cyclodialysis cleft showed a new pathway between the anterior chamber and the suprachoroidal space. AS-OCT imaging showed that the extent of cyclodialysis clefts ranged from 30 degrees to 240 degrees, which had a 0 degree to 20 degrees difference compared with UBM imaging. Localizing and suturing of the cyclodialysis clefts was guided by AS-OCT imaging. The best corrected visual acuity (BCVA) was 0.21±0.17 at baseline and 0.29±0.21 at five days postoperatively. The initial and final BCVA showed a remarkable difference after treatment (t=-4.98, P<0.01). The mean intra-ocular pressure (IOP) was (8.33±2.29) mmHg before surgery and (15.40±2.34) mmHg at five days postoperatively. There was a significant difference of IOP between preoperative and postoperative period (t=-16.590, P<0.01). The mean ACD was (1.94±0.45) mm preoperatively and (2.69±0.44) mm at five days postoperatively. There was also a significant difference of ACD between preoperative and postoperative period (t=-10.276, P<0.01). The postoperative reexamination found that ciliary body detachment or cyclodialysis clefts was not observed in the 56 eyes by AS-OCT. Conclusions: As a non-invasive method, AS-OCT is accurate, correlating well with UBM in the examination of cyclodialysis cleft, and can localize the extent of clefts before cyclopexy.

POSTOPERATIVE THINNING OF LAMELLAR DONOR GRAFT AFTER CONVENTIONAL DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY

- The purpose of this study was to evaluate postoperative deturgescence of lamellar donor graft after conventional Descemet's stripping automated endothelial keratoplasty (DSAEK). It was a prospective study that included 55 eyes of patients (mean age 70.9±9.4 years; female 61.8%, male 38.2%). Preoperative thickness of lamella was compared with postoperative thickness six months after surgery. Central lamellar graft thickness decreased from 142±27 µm preoperatively to 124±20 µm 6 months postoperatively (p<0.01). After performing conventional DSAEK corneal transplantation, surgeons should expect deturgescence of corneal graft and reduction in thickness of lamellae by about 12% of initial thickness according to our results. We found this information important for better planning of surgical procedures and knowing what to expect after surgery, as well as for better cooperation with eye banks when ordering pre-cut corneal tissue.

[Rational application of optical coherence tomography in examining glaucomatous optic neuropathy]

Glaucoma-related retinal imaging using frequency domain optical coherence tomography (OCT) has become an important but not the only basis for the diagnosis and follow-up of glaucoma. The circumpapillary retinal nerve fiber layer thickness and the macular ganglion cell thickness are two commonly used structural parameters in glaucoma. Their diagnostic efficacy is similar, but each has different influencing factors. Clinically, these two parameters should be analyzed together to improve the specificity and sensitivity for detecting glaucomatous optic nerve damage. Recently, there have been quite a few clinical studies on new OCT technologies and concepts related to glaucoma, but it is still necessary to further confirm the application value. Ophthalmologists should master the principle of glaucoma-related OCT retinal imaging, combining with other clinical evaluation methods, to improve early diagnosis and timely detection of glaucomatous progression.(Chin J Ophthalmol, 2018, 54: 801-805).

[Comparison of swept source anterior segment optical coherence tomography and ultrasound biomicroscopy in measurement of anterior chamber depth and anterior chamber angle data in age-related cataract patients]

Objective: To explore the difference and agreement in the measurement of anterior chamber depth (ACD) and anterior chamber angle data in age-related cataract patients between swept source anterior segment optical coherence tomography (SS-AS-OCT) and ultrasound biomicroscopy (UBM). Methods: A prospective study. Forty-five eyes from 45 age-related cataract patients were selected at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from November to December 2016. There were 23 males and 22 females aged (51±19) years. SS-AS-OCT and UBM were used to measure the ACD, angle opening distance (AOD 500) and trabecular-iris angle (TIA 500). The paired samples t-test and Pearson linear correlation were used for statistical analysis, and the Bland-Altman analysis was used to evaluate the measurement consistency of the two tools. Results: The ACD measured by SS-AS-OCT and UBM was (2.750±0.544) mm and (2.775±0.531) mm, respectively, the difference was statistically significant (t=2.109, P=0.040), and the measurement results were positively correlated (r=0.989, P<0.001). In the nasal, temporal, upper and lower positions, the AOD 500 and TIA 500 values measured by SS-AS-OCT and UBM had a significant difference [AOD 500: (0.451±0.201) mm vs.(0.421±0.194) mm, (0.499±0.229) mm vs. (0.465±0.207) mm, (0.390±0.215) mm vs. (0.355±0.208) mm, (0.441±0.226) mm vs. (0.423±0.215) mm, t=4.262, 4.350, 5.355, 4.415; TIA 500: 39.587°±14.698°vs. 36.944°±13.790°, 42.149°±14.138°vs. 40.289°±13.041°, 36.482°±15.887°vs. 35.600°±15.215°, 38.504°±14.805°vs. 36.818°±14.931°, t=5.131, 4.658, 4.174, 5.731; all P<0.001] and a significant linear correlation (AOD 500: r=0.971, 0.975, 0.979, 0.973; TIA 500: r=0.972, 0.957, 0.956, 0.970; all P<0.001). The Bland-Altman method showed that the two modalities had comparable results for the ACD, AOD 500 and TIA 500 (2.22%-6.67% of the measured value outside the 95% consistency boundaries). Conclusion: SS-OCT and UBM show a good agreement in the measurement of ACD and anterior chamber angle data in age-related cataract patients, though there is difference between them in measurement results. (Chin J Ophthalmol, 2018, 54: 678-682).

[A study on observing the central macular choroidal thickness of thyroid-associated ophthalmopathy patients with spectral-domain optical coherence tomography]

Objective: To compare the differences in the central macular choroidal thickness (CMCT) between thyroid-associated ophthalmopathy (TAO) patients in active and inactive stages, and the healthy subjects used spectral-domain optical coherence tomography (SD-OCT) and assess the potential of using CMCT as an indicator for follow-up of TAO patients. Methods: Cross-sectional study. Eleven active stage TAO patients (22 eyes, active TAO group) and 21 inactive stage TAO patients (42 eyes, inactive TAO group) who received treatment at the Department of Ophthalmology, First People's Hospital of Nantong during January 2015 and December 2017 were enrolled. Twenty-three healthy subjects (46 eyes) with comparable ages to the two TAO groups were enrolled in the healthy control group. TAO activity was assessed using the TAO clinical activity score (CAS) system. All subjects underwent best corrected visual acuity, slit lamp examination, Goldmann tonometer for intraocular pressure measurement, direct ophthalmoscopy, A-superelocular measurement, ocular protrusion measurement, and SD-OCT detection of CMCT. The variance analysis was used to compare the differences of intraocular pressure, eyeball protrusion and CMCT between the three groups. The correlation between CMCT and various clinical indicators was analyzed by univariate linear regression analysis and multivariate linear regression analysis. Results: The intraocular pressure and eyeball protrusion indicators of the active TAO group, the inactive TAO group, and the control group were (20.16±3.49) mmHg (1 mmHg=0.133 kPa) and (18.68±1.64) mm, (15.42±2.49) mmHg and (15.64±1.01) mm, (15.72±2.38) mmHg and (12.02±0.83) mm, respectively. The intraocular pressure and ocular protrusion of the active TAO group were higher than those of the inactive TAO group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). The CMCT value of the active TAO group, the inactive TAO group and the healthy control group were (391.27±33.89) μm, (317.31±29.62) μm, and (304.26±42.26) μm, respectively. The CMCT of the active TAO group was significantly higher than the inactive group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). Based on univariate analysis, thicker CMCT was significantly associated with intraocular pressure (t=4.600, P<0.001); after correction of intraocular pressure, thicker CMCT was significantly associated with CAS (β=0.848, 95%CI 15.608-21.499, P<0.001). Multivariate analysis showed a correlation between thicker CMCT and CAS scores (P<0.001), thyroid function (P<0.001), and intraocular pressure(P=0.039). Conclusions: The CMCT in the eyes of active TAO patients is higher than that of the inactive TAO patients and healthy people. The CMCT examination is of referential value, and may be used as a tool for assessing the activity of lesions in patients with TAO and clinical follow-up. (Chin J Ophthalmol, 2018, 54: 688-693).

[Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane]

Objective: To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients. Methods: Retrospective case series study. The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients, 43 male patients, aged 68.1±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed. Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation. All eyes underwent vitecrtomy and macular epiretinal membrane peeling. During the 12 months follow up, the preoperative and postoperative data including best corrected visual acuity (BCVA), foveal thickness, changes of morphology in ellipsoid zone were observed and analyzed. All the patients were divided into two groups, continuous group (52 patients) and discontinuous group (22 patients), based on the preoperative continuity status of ellipsoid zone. The data of preoperative macular retinal thickness, the relationship between age and course of the disease, preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method. The postoperative BCVA were analyzed statistically with t test mtehod, based on the different grouping of continuity status of ellipsoid zone. Results: The preoperative LogMar BCVA, and the postoperative LogMAR BCVA of 1 month, 3 month, 6 month and 12 month after operation were 0.59±0.26, 0.63±0.34, 0.46±0.22, 0.45±0.23, 0.41±0.23 (F=25.122, P<0.05) respectively. The preoperative foveal thickness, and the postoperative foveal thickness of 1 month, 3 month, 6 month and 12 month after operation were (468.12±73.07), (371.57±57.09), (320.57±65.88), (294.85±69.36), (283.5±66.56)μm (F=8.802, P<0.05), the difference between the figures are of statistical significance. The postoperative BCVA of continuous group (0.34±0.27) improved significantly, as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209, P<0.05). There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015, P> 0.015). Seven patients still have macular edema one year after surgery. Conclusion: The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea, and has positive correlation with continuity of ellipsoid zone. (Chin J Ophthalmol, 2018, 54: 258-262).

[Analysis on the clinical and retinal imaging characteristics of autosomal recessive bestrophinopathy]

Objective: To study the clinical and imaging features of autosomal recessive bestrophinopathy (ARB). Methods: Retrospective study. The clinical and imaging data of 14 participants were analyzed in using autofluorescence (AF), fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT). Ten patients were screened for mutations in BEST1 gene. Results: Retinopathy of ARB were shown as bilaterally and circularly distributed yellow subretinal deposits in the mid-peripheral and posterior retina, which was observed more clearly by AF and FA. The abnormalities were observed as hyperreflection between the sub-retinal pigment epithelium space as well as the subretinal space by SD-OCT imaging. All of the patients showed serous retinal detachment, and 4 of them were found to have intraretinal schisis. Other ocular complications include choroidal neovascularization (CNV) and angle closure glaucoma (ACG) were also found in the patients. Genetic examinations showed that the mutations are compound heterozygous in five patients, homozygous in one patient and heterozygous in only one of the rest 4 patients. Conclusions: The combination of clinical and retinal imaging data may facilitate the diagnosis of ARB. Physicians should be cautious of the vision-threatening complications of the disease. (Chin J Ophthalmol, 2018, 54: 263-269).

Optical coherence tomography in neuromyelitis optica spectrum disorders: potential advantages for individualized monitoring of progression and therapy

Neuromyelitis optica spectrum disorders (NMOSD) are mostly relapsing inflammatory disorders of the central nervous system (CNS). Optic neuritis (ON) is the first NMOSD-related clinical event in 55% of the patients, which causes damage to the optic nerve and leads to visual impairment. Retinal optical coherence tomography (OCT) has emerged as a promising method for diagnosis of NMOSD and potential individual monitoring of disease course and severity. OCT not only detects damage to the afferent visual system caused by ON but potentially also NMOSD-specific intraretinal pathology, i.e. astrocytopathy. This article summarizes retinal involvement in NMOSD and reviews OCT methods that could be used now and in the future, for differential diagnosis, for monitoring of disease course, and in clinical trials.

[Optical coherence tomographic analysis of in-stent neoatherosclerosis in lesions with restenosis after drug-eluting stent implantation]

Objective: To explore the imaging characteristics and related influencing factors of in-stent neoatherosclerosis (ISNA) in patients with restenosis after drug-eluting stent(DES) implantation with optical coherence tomography(OCT). Methods: A total of 25 cases of coronary heart disease patients(DES placement time ≥8 months) with coronary artery angiography showing DES in-stent restenosis (ISR) in Zunyi medical college affiliated hospital from July 2013 to December 2015 were included in this study and patient's data were retrospectively analyzed.In these patients with ISR, OCT images were acquired before percutaneous coronary intervention. Patients were divided into the ISNA group (12 patients and 12 lesions) and non-ISNA group(13 patients and 13 lesions) according to the result of OCT. ISNA on OCT was defined as neointima formation with the presence of lipids or calcification. Results: (1) The incidence of chronic kidney disease and increased low-density lipoprotein cholesterol level in ISNA group were significant higher than that in non-ISNA group(all P<0.05). The stent implantation time in ISNA group was longer than that in the non-ISNA group(53.0(14.0, 81.0) months vs. 15.0(8.5, 32.5) months, P<0.01). In addition, clinical manifestation of acute coronary syndrome was present in 8 out of 12 patientsin ISNA group, and stable angina pectoris was found in 10 out of 13 casesin non-ISNA group(P<0.01). (2) Quantitative analysis of OCT showed that the lumen area was less in ISNA group than in non-ISNA group((3.45±1.82)mm(2) vs. (4.17±1.68)mm(2), P<0.01), and neointimal area(3.89(2.26, 5.52)mm(2) vs. 2.96(1.99, 4.22)mm(2), P<0.01), neointimal load (53.15(40.18, 67.30)% vs. 41.54(32.08, 56.91)%, P<0.01), neointimal thickness(0.98(0.63, 1.36)μm vs. 0.72(0.51, 1.03)μm, P<0.01) were higher in ISNA group than in non-ISNA group.(3)Qualitative analysis of OCT showed that the prevalence of homogeneous intima was less in the ISNA group than in the non-ISNA group ((41.42±22.56)% vs.(72.06±18.68)%, P<0.05), on the contrary, the heterogeneous intima was more common in the ISNA group ((58.57±22.56)% vs. (27.94±18.68)%, P<0.05). There was no significant difference between two groups in the peri-stentmicrovessels (9/12 vs. 5/13,P>0.05), and prevalence of intraintimalmicrovessels was higher in the ISNA group than in non-ISNA group (7/12 vs. 2/13, P<0.05). In addition, thin cap fibrous plaque(7/12 vs. 0, P<0.01), disrupted intima with visible cavity (7/12 vs. 1/13, P<0.05),andintraluminal red thrombus(7/12 vs. 1/13, P<0.05) were significantly higher in ISNA group than in non-ISNA group. Conclusions: Results of OCT show that ISNA occurs frequently in patients with ISR after DES implantation. The stent implantation time, incidence of chronic kidney disease and higher low-density lipoprotein cholesterol level are associated with the formation of ISNA in these patients.

[Clinical observation on the evolution process of macular ganglion cell complex and peripapillary retinal nerve fiber layer of neuritis patients]

Objective: To discuss the dynamic changes and correlation of macular ganglion cell (mGCC) and peripapillary retinal nerve fiber layer (pRNFL) of neuritis patients through optical coherence tomography (OCT). Methods: A retrospective case series study. Eleven eyes from 11 patients who have been diagnosed with neuritis and received regular follow-up during June 2013 through June 2015 were included. The dynamic characteristic changes of mGCC and pRNFL over the course of disease, as well as their correlations between best visual acuity and visual field have been analyzed based on OCT measurements. Results: According to the observation on the 11 eyes of the 11 patients, patients showed symptoms of decreased vision, abnormal visual field, swollen mGCC and pRNFL with normal or increased thickness during the subnormal period. During the advance-separation period (around 3 weeks), the thickness of mGCC decreased resulting from atrophy while pRNFL was still swollen. Druing the late period (usually 6-8 weeks after onset of the disease), both mGCC and pRNFL were getting thinner due to atrophy. Vision acuity and visual field of the patients improved after treatment, however, they were still not comparable with the normal level before the disease. Conclusions: The thickness changes of mGCC and pRNFL differs in neuritis patients over time. OCT can help us in detecting these changes, thus provide a foundation for us to further explore the treatment and anatomical changes of neuritis patients. (Chin J Ophthalmol, 2018, 54: 62-68).

[Development of en face optical coherence tomography and its application in ocular fundus diseases]

Optical coherence tomography (OCT) is able to obtain the cross-sectional image of the fundus noninvasively and quickly. The cross-sectional image in vivo almost matches the histological section of the retina. OCT has become the most important imaging tool in ophthalmology. Based on the latest OCT technology, en face OCT is a new imaging technique that reveals the structure of retinal and choroidal sections approximately paralleled to the retina surface. Compared to the conventional OCT, en face OCT provides more comprehensive information and makes more accurate diagnosis and assessment of the prognosis. En face OCT is widely used in ocular fundus diseases, such as macular epiretinal membrane, macular hole, macular edema, age-related macular degeneration and retinal vascular disease, glaucoma and neuro-ophthalmology. This article reviews the related concepts, principles and clinical applications of en face OCT. (Chin J Ophthalmol, 2017, 53: 956-960).

Self-perception and determinants of color vision in Parkinson's disease

Visual dysfunction is common in patients with Parkinson's disease (PD). The objective of this study was to investigate the perceived impact of visual dysfunction and especially color vision loss on PD patients, and to identify retinal and disease factors associated with color vision. Thirty PD patients and thirty-four healthy controls were included. Participants performed the Farnsworth-Munsell Hue-100 test (FMT). Patients answered the National Eye Institute Visual Function Questionnaire (NEI-VFQ), Unified Parkinson's Disease Rating Scale (UPDRS) assessment, and underwent optical coherence tomography with measurement of retinal nerve fiber layer, ganglion cell layer + inner plexiform layer (GCIPL), and outer nuclear and photoreceptor layer. Dopaminergic treatment was assessed as levodopa equivalent dose (LED). Vision domains significantly worse in PD patients compared to normative data were General Vision, Near Activities, Distance Activities, Vision-Specific Dependency, Driving, and Peripheral Vision. Worse NEI-VFQ total scores were associated with worse UPDRS, higher LED, and higher age, but not with FMT, visual acuity, or OCT measures. Only two patients (7%) reported problems with color vision. In contrast, patients performed significantly worse in the FMT than healthy controls and 17 (56.7%) patients were outside the 95th percentile of normative data. In multiple regression analyses, lower LED and higher age were associated with worse color vision in the FMT. PD patients are not aware of color vision deficits. Given the impact of color vision loss on everyday tasks in other conditions, future research should investigate the impact of vision deficits on disease burden in PD.

[The clinical manifestations and imaging characteristics of acute syphilitic posterior placoid chorioretinitis]

Objective: To investigate the clinical manifestations and imaging characteristics of acute syphilitic posterior placoid chorioretinitis (ASPPC). Methods: Retrospective study of 10 patients diagnosed ASPPC in the Department of Ophthalmology, Beijing Tongren Hospital from 2011 to 2016, including 6 males (10 eyes involved) and 4 females (8 eyes involved) with an age of (43.4±11.6) years (range, 26-60 years). Their clinical manifestations and imaging characteristics were summarized. Results: All 10 ASPPC patients complained about the reduction of visual acuity, and the majority of them had both eyes involved. The initial visual acuity ranged from finger count to 0.8, with an average of 0.4 and a median visual acuity of 0.3. The intraocular pressure was in the normal range. The inflammation of anterior chamber occurred in only one patient (1/10). The lesions were located at the posterior pole as shown on fundus photographs. There are six placoid lesions, four yellowish massive lesions and seven mixed lesions (placoid and yellowish massive lesions). Partial or whole disappearance, abnormality and opacity of the ellipsoid layer, retinal pigment epithelial (RPE) nodules, and cells in the vitreous body were observed by optical coherence tomography. There were partial detachment between the neuronal retina and RPE layer with fine-sand like hypereflective dots. The lesion size and morphology on autofluorescence (AF), fundus fluorescence angiography (FFA) and indocyanine green angiography (ICG) were almost consistent with those on fundus photography. The lesions were hyperautofluorescent in a placoid or massive shape. The lesions on FFA showed slight hyperfluorescence with unclear edges from the venous phase, and the fluorescence increased with the time and leaked in the late phase. Vascular walls showed blood staining in the late phase. The lesions on ICG showed hypofluorescence with hyperfluorescence and hypofluorescence dots like fine needles in the middle and late phases. Conclusion: ASPPC mainly occurs among the young adults without gender difference. The characteristic is the contradiction between sever clinical symptoms and slight signs on the fundus. The lesion area shown on fundus photography, FFA, ICG and AF is consistent, as well as injuries of the ellipsoid layer, RPE nodules and cells in the vitreous body. The above manifestations and imaging characteristics of ASPPC are significant for the diagnosis and differential diagnosis. (Chin J Ophthalmol, 2017, 53:352-357).

[Study of retinal microvascular perfusion alteration and structural damage at macular region in primary open-angle glaucoma patients]

Objective: To investigate the alteration of retinal microcirculation and structural damage at macular region and evaluate their associations in primary open angle glaucoma (POAG) eyes. Methods: Cross-sectional study. Fifty-nine POAG patients (male/femal=35/24) were recruited from July 2015 to December 2015 in Eye, Ear, Nose and Throat Hospital of Fudan University. Twenty-eight eyes of early-stage POAG group (EG), 11 eyes of moderate-stage POAG group (MG) and 20 eyes of severe-stage POAG group (SG) were enrolled in this study. All patients underwent complete ophthalmological examinations and the general information was collected. The macular perfusion parameters (flow index & vessel area density) and the global/hemimacular retina thickness were derived from the 3D angio-retina and retina map procedures in the single optic coherence tomography (OCT) system with split-spectrum amplitude decorrelation angiography (SSADA) algorithm, respectively. One-way ANOVA analysis was conducted to compare the macular perfusion parameters, retinal thickness and visual field defects among three groups. Pearson partial regression analysis was used to calculate the correlations between different variables. Results: The mean flow index and vessel area density of MG eyes were 0.05±0.01 and 60.8%±7.9%, which were significantly lower than those indexes (0.06±0.01; 71.9%±4.6%) in EG eyes (t=5.11, P=0.001; t=5.05, P<0.01). The full and inner retinal layer thicknesses of MG eyes were (270.3±24.6) μm and (98.4±13.3) μm, which were obviously thinner than those indexes (293.0±12.0 μm, 113.0±7.4 μm) in EG eyes (t=3.60, P<0.01; t=4.06, P<0.01). However, there was no significant alteration of macular perfusion parameters and retinal thickness between MG and SG eyes. Furthermore, there was a significantly positive correlation between macular perfusion (flow index/vessel area density) and the macular retina thickness (full/inner thickness) (R=0.35-0.71, All P<0.01). Conclusions: The microvascular perfusion and retinal thickness in MG eyes were lower than those in EG eyes. There was significant positive association between the retinal microvascular perfusion and structural damage. Furthermore, the association between microvascular perfusion and inner inferior retinal thickness is the strongest. (Chin J Ophthalmol, 2017, 53: 98-103).

Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema

INTRODUCTION

A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan.

METHODS

This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy.

RESULTS

A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%.

CONCLUSION

The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.

[Relationship between carotid plaque and diabetic retinopathy in type 2 diabetes mellitus patients]

Objective: To analyze the relevant factors for diabetic retinopathy. Methods: The data of type 2 diabetes mellitus patients undergoing general examination and ophthalmology specialist consultation were collected from the inpatients of Department of Endocrinology in Beijing Airport Hospital between 2013 and 2016, and the relevant factors of diabetic retinopathy were retrospectively analyzed. Results: A total of 432 cases were analyzed, including 168 cases of non-diabetic retinopathy and 264 cases of diabetic retinopathy. In the non-diabetic retinopathy group, there were 88 cases of male and 80 cases of female, with an mean age of (57.0± 13.6) years old. Meanwhile, the diabetic group had 142 cases of male and 122 cases of female, with an mean age of (62.7±10.4) years old. Univariate logistic regression analysis showed that age and glycosylated hemoglobin value were significantly higher in the diabetic retinopathy group than those of the non-diabetic retinopathy group, and the incidence of diabetic peripheral neuropathy, carotid plaque and central retinal thickness was significantly higher than that of the non-diabetic retinopathy group. Multivariate logistic regression analysis displayed that carotid plaque (OR=9.922, 95%CI: 3.700-26.603, P<0.001) and thinning of central retinal thickness (OR=9.639, 95%CI: 3.604-25.781, P<0.001) were independently associated with diabetic retinopathy. Conclusions: Carotid plaque is an independent risk factor for diabetic retinopathy, and thinning of central retinal thickness may indicate the progression of retinopathy. Therefore, patients with these two signs need to be observed more closely in clinical practice.