With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.
Objective To evaluate the clinical features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case series studies. A total of 12 eyes of 8 patients diagnosed of AMN associated with COVID-19 at Peking University People’s Hospital from December 5, 2022 to January 5, 2023 were included. Of the 8 patients, 2 were male (4 eyes) and 6 were female (8 eyes), with an average age of (29.38±8.60) years. All patients underwent best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (OCT), and infra-red fundus photography (IR). After definite diagnosis, the patients were given symptomatic treatment such as local vasodilation, anti-inflammatory and systemic circulation improvement and nutritional nerve. Follow-up time was 21-30 days weeks. Clinical manifestations, OCT and IR image characteristics, and treatment outcomes were retrospectively analyzed. ResultsThe time from diagnosis of COVID-19 to the onset of ocular symptoms was (3.00±0.93) days. Among 12 eyes, 6 had complaints of paracentral scotoma, with 2 of them accompanied by visual acuity loss; and 6 had complaints of dark shadows in the vision, with 2 of them accompanied by visual acuity loss. At the initial examination, 2 eyes had a BCVA of less than 0.05, 2 eyes had a BCVA between 0.4 and 0.6, and 8 eyes had a BCVA between 0.8 and 1.0. At the last follow-up, visual symptoms improved in 7 eyes and remained unchanged in 5 eyes. Fundus color photography showed reddish-brown lesions in the macular area. Spectral-domain OCT revealed localized thickening and strong reflection of the outer plexiform layer (OPL) in the macular area, patchy strong reflections in the outer nuclear layer (ONL), and varying degrees of local discontinuity in the adjacent external limiting membrane, ellipsoid zone/interdigitation zone (EZ/IZ), with reduced local reflection in the adjacent retinal pigment epithelium layer in 2 eyes. The strong reflection area of the ONL on corresponding structural OCT was observed more clearly as a lesion range with strong reflection on en-face OCT. The incomplete structure of the EZ/IZ band was observed more clearly as a lesion range with weak reflection on en-face OCT. IR showed several clear-bordered and weakly reflecting lesions at the center of the macula, with the tip pointing to the fovea. ConclusionsAMN associated with COVID-19 tends to occur in young females. The OCT findings of AMN are characterized by strong reflections in the OPL and ONL, and lesion ranges can be observed more clearly at different levels using en-face OCT. The lesions on IR appear as weak reflections.
Macular choroidal macrovessel (MCM) is a recently reported rare choroidal vascular abnormality, characterized by a distinctly thickened choroidal vessel extending from the macular area to the temporal periphery area in fundus examinations. MCM may be an abnormal dilatation of the posterior ciliary artery. The diagnosis of MCM relies on multimodal imaging examinations, with indocyanine green angiography and optical coherence tomography being particularly critical, while optical coherence tomography angiography serves as an essential supplementary and non-invasive alternative. Due to its rarity, ophthalmologists generally have limited awareness of MCM. In clinical practice, it is essential to be familiar with the clinical manifestations and imaging characteristics of MCM, to improve diagnostic levels, enhance differentiation capabilities, and minimize the occurrence of misdiagnosis.
ObjectiveTo observe the clinical and fundus imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case study. A total of 32 eyes of 18 patients diagnosed of AMN associated with COVID-19 at Chengdu Aidi Eye Hospital from December 2022 to February 2023 were included. All patients had a history of fever 1 to 5 days prior to ocular onset and tested positive for SARS CoV-2 antigen. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, scanning laser ophthalmoscope (SLO), infrared fundus photography (IR), and optical coherence tomography (OCT); OCT angiography, visual field and multifocal electroretinogram (mf-ERG) were performed in 6 patients (11 eyes), 3 patients (6 eyes) and 1 patient (2 eyes), respectively. Follow-up time was 8-10 weeks. The clinical and fundus imaging features were observed and analyzed.ResultsThere were 6 males (12 eyes) and 12 females (20 eyes), aged from 15 to 36 years, with the mean age of (28.00±5.86) years. Fourteen patients were bilateral and 4 patients were unilateral. The time from the onset of eye symptoms to seeing a doctor was ranged from 1 day to 8 weeks. Among them, 6 patients (10 eyes) visited the doctor within 3 days of onset, while 12 patients (22 eyes) visited the doctor after 3 days of onset. The BCVA was 0.80±0.29. Fundus color photography and SLO examination showed that only 2 patients (4 eyes) showed sheet or petal-like dark red lesions in the macular area, and no obvious abnormal changes were observed in other patients. No obvious abnormalities were found in AF examination of all patients. IR examination showed no significant abnormality in 6 cases which came to hospital within 3 days after the onset, but irregular hyporeflective dark shadow lesions in the macular region of patients with more than 3-day course of disease was observed. OCT examinations of all eyes showed hyperreflective band or patchy lesion on the outer plexiform layer (OPL) and outer nuclear layer (ONL) and affect the ellipsoid zone (EZ) and interdigitation zone (IZ). In 11 eyes of 6 patients undergoing OCTA examination, the blood flow density of the choroidal capillary layer in the focal area decreased. In 6 eyes of 3 patients who underwent visual field examination, the physiologic scotoma was slightly enlarged. One patient (2 eyes) receiving mf-ERG showed a concave reduction in macular center amplitude. The hyperreflective band lesion on OPL and ONL disappear rapidly within 2 weeks, while the continuity of EZ recovered slowly, and the disruption of IZ kept existing for more than 10 weeks. ConclusionsMost AMN associated with COVID-19 are young women; IR showed irregular weak reflex in the lesion area. OCT showed strong OPL and ONL reflection. OCTA was characterized by decreased blood flow density in the choroidal capillary layer of the focal area.
ObjectiveTo observe the clinical and multimodel imaging characteristics of paracentral acute middle maculopathy (PAMM).MethodsRetrospective case series study. From January 2014 to August 2018, 12 eyes of 12 patients with PAMM diagnosed in Department of Ophthalmology, Peking University People’s Hospital, were included in this study. There were 9 males and 3 females, with the mean age of 57 years. All patients were referred for sudden impaired vision, with or without paracentral scotoma. The patients underwent BCVA, slit lamp examination, fundus photography, FFA and OCT. Simultaneously, OCT angiography (OCTA) was performed in 10 eyes, visual field was performed in 5 eyes, near infrared fundus photography was performed in 1 eye. Clinical and multimodal imaging findings were reviewed and analyzed.ResultsAmong 12 eyes, there were 5 eyes with BCVA 0.05-≤0.1, 4 eyes with BCVA 0.3-0.5, 3 eyes with BCVA 0.6-1.0. There were 1 eye with central rentinal artery obstruction (CRAO), 7 eyes with branch retinal artery obstruction (BRAO). Among them, BRAO with central retinal vein occlusion (CRVO) in 1 eye, with non-arteritic anterior ischemic optic neuropathy in 1 eye, with diabetic retinopathy in 1 eye; old BRAO in 3 eyes; pure BRAO in 1 eye. There were 4 eyes with pure CRVO, including 3 eyes with ischemic CRVO. All eyes demonstrated hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT. En face OCT highlighted the areas with hyperreflectivity corresponding to these lesions. OCTA demonstrated significant deep capillary dropout, abnormal morphology and enlargement of foveal avascular zone.ConclusionHyperreflective band-like lesions at the level of the inner nuclear layer on OCT and middle retinal perivascular hyperreflectivity on en face scan are characteristic in PAMM.
Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
ObjectiveTo observe the clinical and imaging characteristics of acute idiopathic macular degeneration (AIM).MethodsA retrospective clinical study. From March 2016 to January 2018, 5 eyes (5 AIM patients) in The Second People's Hospital of Yunnan Province were included in the study. Among them, there were 4 males (4 eyes) and 1 female (1 eye); all patients were monocular with the average age of 34.2 years. The course of illness from onset of symptoms to treatment was 4-22 days. All affected eyes were examined by BCVA, fundus color photography, OCT, FAF, and FFA. Among 5 eyes, 1 eye with optic disc vasculitis was given oral glucocorticoid treatment; 4 eyes were not interfered after the diagnosis. ResultsThe follow-up time was 6 months. During follow-up, BCVA, fundus color photography, and OCT examination were performed. The results were all a sudden decrease in monocular vision, accompanied by visual distortion or central dark spots. At the first visit, the BCVA was 0.1, 0.2, 0.2, 0.05, and 0.5; at the last follow-up, the BCVA of the affected eye was 0.8, 0.6, 0.5, 0.5, and 1.0, respectively. Fundus color photography showed that at the first diagnosis, all the affected eyes showed irregular round yellow-white lesions in the macular area, including 1 eye with small patches of hemorrhage and 1 eye with pseudopyous changes in the macular area. Two to three weeks after the initial diagnosis, the yellowish-white lesions and bleeding in the macular area were basically absorbed. The center of the lesion showed weak pseudopod-like fluorescence, and the surrounding area was surrounded by strong fluorescence in FAF examination. The irregular and strong fluorescence in the early macular area and accumulation of late fluorescein in FFA examination. One eye was receivied glucocorticoid therapy. The upper layer of the retinal nerve in the macular area was detached, and the inferior space showed focal strong reflective material in 3 eyes in OCT examination. At the first diagnosis, the retinal neuroepithelial layer was detached, the top of the RPE layer was irregular with strong reflective material, and the structure of the ellipsoid zone and the chimera zone was unclear; as the course of the disease prolonged, the outer retinal structure recovered.ConclusionsAIM is characterized by inflammatory exudative changes in the outer layer of the retina in the macular area; FFA is characterized by strong subretinal disc-like fluorescence or multifocal weak fluorescence in the macular area; OCT mainly manifests as neuroepithelial detachment and changes in the outer retina and RPE, The structure can be restored by itself.
Objective To observe the multimodal image features of inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC). MethodsA retrospective clinical analysis. A total of 90 eyes of 46 patients with MFC diagnosed in the Department of Ophthalmology of Yunnan University Affiliated Hospital from May 2017 to April 2021 were included in the study. Among them, there were 21 males and 25 females; the average age was 38.30±8.97 years old. Twenty-nine cases of MFC were diagnosed in the past, and they visited the doctor again due to new symptoms; 17 cases without a clear past medical history were the first visits. All eyes underwent color fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). With reference to the literature and the results of multimodal fundus imaging examinations, MFC lesions were divided into active CNV lesions, inactive CNV lesions, active inflammatory lesions, and inactive inflammatory lesions, with 31 (34.4%, 31/90), 12 (13.3%, 12/90), 26 (28.9%, 26/90), 90 (100.0%, 90/90) eyes. Nineteen eyes were treated with anti-vascular endothelial growth factor drugs. To summarize and analyze the manifestations of inflammatory lesions and CNV lesions in different imaging examinations. The Wilcoxon rank test was used to compare the detection rate of CNV lesions between FFA and OCTA. ResultsIn eyes with active inflammatory lesions and active CNV lesions, yellow-white lesions, retinal hemorrhage and exudation were seen on fundus color photography; FFA examination showed fluorescein leakage in the lesions; OCT examination showed retinal pigment epithelium (RPE) layer in the lesions was uplifted, the boundary was unclear, combined with subretinal and intraretinal fluid; OCTA examination showed that there was no blood flow signal in each layer of vascular tissue in active inflammatory lesions, and blood flow signals were seen in active CNV lesions. In the eyes of inactive inflammatory lesions and inactive CNV lesions, the fundus color photography showed that the lesions had clear boundaries without bleeding or exudation; FFA examination, the lesions were fluorescently stained, and there was no fluorescein leakage; OCT examination, inactive CNV lesions manifested as raised lesions with clear boundaries, and inactive inflammation manifested as scars formed by mild RPE hyperplasia or depressions in outer structures formed by atrophy; OCTA examination, inactive inflammatory lesions showed patchy loss of blood flow signal or penetrating blood flow signal below, blood flow signal can be seen in inactive CNV lesions. ConclusionMFC active inflammatory lesions and active CNV lesions are often accompanied by retinal hemorrhage and exudation; FFA shows fluorescein leakage; OCT shows that the boundary of raised lesions is unclear; OCTA can identify the nature of CNV or inflammatory lesions.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
ObjectiveTo observe the multimodal imaging characteristics of tamoxifen retinopathy. MethodsA retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed. ResultsThe yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia. ConclusionDeposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.