Dome-shaped macula (DSM) of high myopia has been described as an inward convexity or bulge of the macular within the concavity of the posterior staphyloma in highly myopic eyes, with the bulge height over than 50 μm, which can be observed by optical coherence tomography. There are three patterns of DSM, including the typical round dome, the horizontally oriented oval-shaped dome and the vertically oriented oval-shaped dome. The pathogenesis of DSM development remains unclear, several hypotheses have been suggested, such as localized choroidal thickening in the macular area, relatively localized thickness variation of the sclera under the macula, resistance to deformation of sclera staphyloma, ocular hypotony and tangential vitreoretinal traction. Vision-threatening macular complications of DSM including serous retinal detachment, choroidal neovascularization, foveoschisis and retinal pigment epithelial atrophy. Clinically, asymptomatic patients with DSM mainly take regular follow-up observation. Appears serous retinal detachment and significant visual impairment, treatment with half-dose photodynamic therapy, supplementary of laser photocoagulation or oral spironolactone may have a beneficial effect. However, more large clinical studies are required to confirm the exact efficacy of these treatments.
ObjectiveTo observe the changes of glaucoma optic nerve head (ONH) parameters and macular ganglion cell complex (GCC) structure in preperimetric glaucoma (PPG) patients. Methods Eighteen PPG patients (18 eyes, PPG group), 22 primary open-angle glaucoma (POAG) patients (22 eyes, POAG group), and 20 patients (20 eyes) with physiologic large optic cup (physiological big optic cup group) were included in this study. Seventeen healthy volunteers (17 eyes) were the normal control. The optic nerve head and macular was scanned by fourier-domain optic coherence tomography (FD-OCT) for all subjects. The following 15 parameters, including nerve fiber layer thickness (RNFL), the optic disk rim volume (RV), optic nerve head volume (NHV), optic disc area (ODA), rim area (RA), cup volume (CV), cup/disc area ratio (CDAR), vertical cup/disc ratio (VCDR), horizontal cup/disc ratio (HCDR) and optic cup area (CA), macular GCC, superior GCC, inferior GCC thickness, focal loss of volume (FLV) and global loss of volume (GLV), were measured at 10 different quadrants. The relationship between macular GCC thickness or optic disc RNFL thickness and RA was analyzed by simple linear regression analysis. ResultsThe RNFL thickness of PPG patients was (99.29±19.93) μm (superior quadrant), (97.29±22.86) μm (inferior), (114.61±15.64) μm (superior temporal, ST), (119.22±26.19) μm (inferior temporal, IT), (116.11±39.32) μm (superior nasal, SN), (111.33±37.65) μm (inferior nasal, IN), (77.56±17.22) μm (temporal upper, TU), (76.78±10.34) μm (temporal lower, TL), (88.94± 42.54) μm (nasal upper, NU), and (82.33±43.83) μm (nasal lower, NL) respectively, which was thinner than normal control group and physiologic large cup group, but thicker than POAG patients. Compared to normal controls and physiologic large cup patients, PPG patients also had 4 parameters reduced (RV, NHV, ODA and RA), and 5 parameters increased (CV, CDAR, VCDR, HCDR and CA), the differences are statistically significant (P < 0.05). However, these parameters were similar to POAG patients (P > 0.05). For macular GCC parameters, PPG patients also had 3 parameters reduced (average GCC, superior and inferior GCC thickness), and 2 parameters increased (GLV and FLV) compared to normal control group and physiologic large cup patients (P < 0.05). However, these parameters were similar to POAG patients (P > 0.05).Simple linear regression analysis showed that, with the GCC macular thinning, reducing the number of ganglion cells reduced, optic disc RNFL thickness became thinner (regression coefficient=1.25, P=0.00) and RV reduced (regression coefficient=0.037, P=0.00). ConclusionsPPG patients and normal control had a similar distribution of optic disc RNFL. Five parameters (RV, NHV, ODA, RA, macular GCC thickness) were less than normal control and physiological big optic cup group, but had no significant differences compared with POAG group.
Diabetic macular edema is the leading cause of central vision loss and even blindness in diabetic retinopathy. Compared to FFA, OCT can obtain the high-resolution 3D image quickly, easily to reflect the details of the tissue and realize the quantitative measurement. As a novel technology, OCT angiography (OCTA) can display microvascular structure from different layers of retina and choroid, having its advantage of quantifying the vessel density and the lesion area. By detecting fundus morphology, quantifying and quantitating the retinal vessels and vessel density, the combination of OCT and OCTA could play a guiding role in diagnosis, classification, treatment and prognosis of diabetic macular edema.
ObjectiveTo observe the changes in choroidal thickness in type 2 diabetes patients with diabetic retinopathy (DR). MethodsA total of 227 eyes from 150 type 2 diabetes patients were enrolled in this study. The patients included 67 males (89 eyes) and 83 females (138 eyes). The mean age was (65.6±8.0) years, and the mean diabetes duration was (12.4±6.5) years. All the patients were examined for best corrected visual acuity (BCVA), diopter, slit lamp ophthalmoscopy, indirect ophthalmoscopy and spectral domain optical coherence tomography (SD-OCT) examination. The patients were divided into non-DR (NDR group, 99 eyes), non-proliferative DR (PDR) without macular edema (ME) group (NPDR/ME-group, 64 eyes), non-PDR with ME group (NPDR/ME+ group, 5 eyes), PDR without ME group (PDR/ME-group, 25 eyes), PDR with ME group (PDR/ME+ group, 5 eyes) according to the Early Treatment Diabetic Retinopathy Study. The ones having a history of pan-retinal photocoagulation (PRP) were classified as PRP-DR. Age-matched normal subjects were enrolled as the control group. Sub-foveal choroidal thickness (SFCT) was measured by SD-OCT with enhanced depth imaging (EDI). ResultsMean SFCT was (310.2±54.8), (251.1±81.4), (262.5±83.2), (286.2±76.8) and (327.4±83.1) μm respectively in control, NDR, NPDR/ME-, PDR/ME-and PRP-DR groups. Mean SFCT decreased significantly in NDR and NPDR/ME-group (t=2.754, 2.140; P < 0.05). Mean SFCT in PDR/ME-group was thicker than that in NDR (t=-2.114, P < 0.05). Mean SFCT in PRP-DR group was thicker than that in PDR/ME-group (U=271.500, P < 0.05). ConclusionSFCT decreased during the early course of diabetics and increased significantly as the severity worsened from NDR to PDR, and increased in the early duration after PRP treatment.
Objective To observe the degree of choriocapillary ectasia (CCE) and sub-foveal choroidal thickness (SFCT) in central serous chorioretinopathy (CSC) with different activity and discuss their relations. Methods Forty eyes of 40 CSC patients were recruited. The activity of CSC was determinate by fundus fluorescein angiography (FFA). There were 23 eyes with active CSC (active-CSC group), and 17 eyes with inactive CSC (inactive-CSC group). All eyes in both groups were examined with optical coherence tomography angiography(OCTA), and the CCE area of the choriocapillary layer was measured within a 3 mm×3 mm zone centered on the central fovea of macula. Ectasia was classified based on CCE area, more than 66% of examination area was high ectasia, and 33%-66% as medium ectasia, below 33% as low ectasia. SFCT was measured with frequency domain optical coherence tomography. The relationship between CCE degree, SFCT and CSC group was analyzed. Results Among the 23 eyes of active-CSC group, there were 5 eyes of low ectasia, 12 eyes of medium ectasia, 6 eyes of high ectasia. Among 17 eyes of inactive-CSC group, there were 11, 4, 2 eyes of low, medium and high ectasia respectively. Active-CSC group had more advanced degree of ectasia than that in inactive-CSC group(Z=-2.472, P=0.013).SFCT of active-CSC group and inactive-CSC group were (418.13±126.15), (429.76±105.80) μm respectively, the difference was not significant (t=-0.308, P=0.760). SFCT in eyes with low ectasia, medium ectasia, high ectasia were (419.13±105.60), (381.00±125.12), (515.13±67.68) μm respectively. The difference among the three group was statistical significant (F=4.106, P=0.025). SFCT in eyes of high ectasia was obviously thicker than low ectasia and medium ectasia, the difference was statistical significant (P=0.007, 0.048);the SFCT difference between low ectasia and medium ectasia did not appear statistical significance (P=0.326). There was no linear relation between SFCT and CCE degree (r=0.247, P=0.124). Conclusions Active-CSC eyes has more advanced CCE degree than inactive-CSC eyes, but SFCT is the same between the two groups. High ectasia eyes have thicker SFCT.
Objective To observe the macular morphological changes of choroidal melanoma with coherence tomography (OCT) after plaque radiotherapy (PRT). Methods A total of 48 patients (48 eyes) with choroidal melanoma who underwent125I PRT were enrolled in this study. All the patients were examined documenting OCT to get the image of macula. The macula of all the patients was not involved. The median visual acuity was 0.4plusmn;0.2, which ranged from 0.02 to 1.0. There were 18 eyes (37.5%) with retinal detachment, 12 eyes (25.0%) with retinal pigment epithelium (RPE) changes, seven eyes (14.6%) with macular edema, epimacular membrane, detachment combined with edema, exudation and RPE changes, 11 eyes (22.9%) with normal macular structure. The median follow-up time was (10.4plusmn;5.9) months, which ranged from one to 24 months. The tumor control situation and visual acuity were observed in follow-up period. The same equipment and methods of OCT were used to return visit in follow-up period. The macular morphological changes at the final visit and its relationship with PRT and visual acuity were contrastively analyzed. Results All the patients had good control of tumor. The vision acuity improved in two eyes (4.2%), unchanged in 10 eyes (20.8%), and decreased in 36 eyes (75.0%). The differences of the visual acuity was statistically significant between before and after treatment (Z=-3.778,P＜0.05). There were 13 eyes (27.1%) with retinal detachment; nine eyes (18.8%) with RPE changes; 17 eyes (35.4%) with macular edema, detachment combined with edema, exudation and RPE changes; six eyes (12.5%) with proliferation, atrophy, detachment combined with edema, exudation and epimacular membrane;three eyes (6.3%) with normal macular structure. There were 15 patients (31.3%) with two or more abnormal macular morphology after PRT. Conclusions Retinal detachment, RPE changes, macular edema and exudation are common abnormal macular morphology after PRT. The incidence rate of abnormal macular morphology is increased. There are 31.3% patients with two or more abnormal macular morphology.