ObjectiveTo observe the imaging features of branching vascular network (BVN) in polypoidal choroidal vasculopathy (PCV). MethodsEighty PCV patients (90 eyes) were enrolled in this study. The patients included 58 males and 22 females. The age was ranged from 49 to 85 years, with a mean age of 61.4 years. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The fibrovascular retinal pigment epithelium detachment (PED) was defined as a well-demarcated subretinal heterogeneous plaque with increasing fluorescence on FFA. The late lichenoid hyperfluorescent plaque was defined as a well-demarcated lichenoid hyperfluorescent plaque on late phase ICGA. The double-layer sign on OCT was defined as a wide range of shallow PED from Bruch membrane. ResultsBVN were found on early ICGA in 76 eyes among the 90 eyes (84.4%). Among these 76 eyes, 18 eyes (23.7%) demonstrated the subretinal reddish-orange branches corresponding to BVN. Fifty-six eyes (73.7%) demonstrated all or part of the BVN on early FFA. Three eyes (3.9%) demonstrated branching transmitted fluorescence corresponding to BVN throughout the FFA. Seventy-three eyes (96.1%) were manifested by occult choroidal vascularization on FFA, and 21 eyes (27.6%) of them were fibrovascular PED. Among the 76 eyes with BVN, all BVN appeared earlier than polypoidal lesions on ICGA. Polypoidal lesions located on the terminal of BVN in 62 eyes (81.6%). Sixty-nine eyes (90.8%) on ICGA demonstrated the late lichenoid hyperfluorescent plaque, whose area was equal to or greater than the area of BVN shown on early ICGA. Seventy-two eyes (94.7%) had the double-layer sign. Among these 72 eyes, 15 eyes (20.8%) had lumen-like structure within the double-layer sign. Sixty-five eyes (90.3%) had punctate and linear hyper-reflectance within the double-layer sign. Two eyes (2.8%) demonstrated a hyporeflective short segment and a gap of Bruch membrane on OCT corresponding to the origin of the BVN. Sixty-three eyes (87.5%) had an area of double-layer sign that matched the area of late lichenoid hyperfluorescent plaque on ICGA. ConclusionsBVN in PCV can be noted as reddish-orange branches on fundus examination. Most of the BVN are shown as early branching transmitted fluorescence but collectively an occult choroidal vascularization on FFA, as lichenoid hyperfluorescent plaque on late ICGA, and as double-layer sign on OCT whose area matches late lichenoid hyperfluorescent plaque.
ObjectiveTo observe the pathological changes of central retinal artery occlusion (CRAO) by optical coherence tomography (OCT).MethodsFifty-three eyes of 53 patients who were diagnosed as CRAO in our center between January 2001 to January 2004 underwent the examination by OCT. The intervals between the disease onset and OCT examination were less than 2 weeks. The scan modes of OCT were horizontal or vertical line scan. The locations of scanning were macular, posterior pole of retina, optical papilla and the focus of bleeding or exudation.ResultsThe OCT pathological changes of CRAO in vivo includes increase of retinal thickness and reflex of retina, width of dark layer of photoreceptor (edema), edema or cystoid edema of fovea, retinal bleeding, cotton-wool spot and papilla edema. Four patients who had ciliary retinal artery showed normal retinal structure in the supply region of ciliary retinal artery.ConclusionOCT can display the pathological changes of retinal tissues in CRAO in vivo, especially on the old patients or the patients with systemic disease who were contraindicated by FFA. The unique OCT image of pathological changes of CRAO supply the objective signs for the instant clinical diagnosis.(Chin J Ocul Fundus Dis, 2005,21:74-78)
Objective To compare the macular imaging and measurements of patients with idiopathic epiretinal membranes (ERM) by stratus optical coherence tomography (OCT) and two different types of spectral-domain OCT. Methods Forty-six consecutive patients (46 eyes) diagnosed as idiopathic ERM in the period of August 2008 to October 2008 were enrolled in this study. The patients included 11 males and 35 females, with a mean age of (61.04plusmn;10.13) years. Twenty-one age- and sex- matched normal subjects (21 eyes) were enrolled in this study as control group. All the subjects underwent stratus OCT, cirrus OCT and 3D OCT-1000 examinations. The macular area was divided into three concentric circles which including central region with 1 mm diameter, inner area with ＞1 mm but le;3 mm diameter, and outer ring area with ＞3 mm but le;6 mm diameter. The inner area and outer ring area were divided into superior, nasal, inferior and temporal quadrants by two radioactive rays. The characteristics of OCT images and the quantitative measurements were compared among these three machines. The macular thickness of ERM group and control group was also compared. And the correlation of visual acuity and the macular thickness in idiopathic ERM patients was evaluated. Results The increased macular retinal thickness, disorder structure of inner retina, uneven surface and proliferative inner and outer plexiform layer were observed in ERM group by stratus and spectral-domain OCT. But the minor pathological changes on inner retina structure and internal surface proliferation could be observed more clearly by spectral-domain OCT than those by stratus OCT.The macular thicknesses of all the subjects measured by Cirrus OCT and 3D OCT-1000 were thicker than those measured by Stratus OCT (t=7.445-11.253,P=0.000). The correlations of measurements between three OCTs were good (r＞0.9). The flatted or disappeared fovea of ERM patient group was observed by all three OCTs. The macular thicknesses on different subfields of patients in ERM group were thicker than those in control group, especially in the 1-3 mm inner ring (t=2.477-10.139,P＜0.05). Moderate negative correlations were shown on the macular thickness and visual acuity in ERM group (r=-0.216-0.517). Conclusions Spectral domain OCT yields better visualization of the intraretinal layers than time domain OCT. The images in spectral domain OCT are more clear and fine compared to stratus OCT. Stratus OCT correlates with spectral domain OCT, but they are different, and cannot be replaced by each other.
Optical coherence tomography (OCT) can depict mild papilledema and slight changes in the internal segment and external segment; measure thickness of the retinal nerve fiber layer, retinal thickness and macular volume; detect missing axons and damage to the macular ganglion cell complex. Thus, OCT has important application values and widespread prospects in diagnosis and differential diagnosis of glaucoma and nonglaucoma optic neuropathy, optic nerve diseases and macular diseases, outer and inner retinopathy as well as evaluation of curative effects, followup observation, prognosis and mechanisms in neuroophthalmological diseases. Neuro-ophthalmologists should pay more attention to the exploration and application of OCT in the field of neuro-ophthalmology.
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 evaluate the diagnostic value of Heidelberg retinal angiography(HRA) combined with optical coherence tomography (OCT) to detect neovascularization (CNV) in exudative agerelated macular degeneration (AMD) patients. Methods This is a cross-sectional study of a series of clinical cases. AMD diagnosis was established by international standard vision chart, Slit lamp microscope, direct or indirect ophthalmoscope examination. A total of 50 eyes (42 cases) of exudative AMD received HRA and frequency domain OCT scan. All 50 eyes received fundus fluorescein angiography (FFA) and frequency domain OCT simultaneously, and among them 15 eyes also received indocyanine green angiography (ICGA) at the same time. FFA and ICGA were carried out by conventional methods, CNV was localized by real-time localization technology of frequency domain OCT. In the radial and grid-like section from the areas with b fluorescence, image acquisition settings are 7 mu;m fault for each frame, 30 deg; intervals for radial section, 10 vertical and 10 horizontal scan lines for gridlike section. CNV can be divided into 4 types (typical CNV, partial typical CNV, occult CNV, CNV scarring) according to their boundaries demonstrated in FFA. Based on the features of the OCT images, there were 3 types of integrated image (sub-RPE type, sub-retinal type and mixed type). Results CNV was detected in all 50 eyes. There were 4 eyes (8%) of typical CNV, 11 eyes (22%) of partial typical CNV, 32 eyes (64%, including 27 eyes of RPE detachment and 5 eyes of passive late leakage) of occult CNV and 3 eyes (6%) of CNV scarring. There were 4 eyes (8%) of subRPE type (CNV under the RPE light band) , 16 eyes (32%) of subretinal type(interrupted light band of RPE and choroid capillary layer) and 30 eyes (60%) of mixed type of integrated image. Conclusion The image integration technology of the HRA and frequency domain OCT system provide a valuable tool to classify and measure CNV, which will benefit the clinical treatment of AMD patients.
Objective To observe the Fourierdomain optical coherence tomography（FD-OCT）characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s,area of 6.0 mmtimes;6.0 mm, and mode of 512times;128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings: no traction (9.48%), tangential traction (84.48%) and tangential traction with anteriorposterior traction (6.04%). A total of 97 eyes (83.62%) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL) . A total of 14 eyes (12.07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment junction (IS/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis (Pgt;0.05), but was related with CFT(Plt;0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients' visual acuity.
Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000A scan/s, area was 6.0 mmtimes;6.0 mm, and the mode was 512times;128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean logMAR was 0.99plusmn;0.44 (ranged from 0.15 to 2.00),the mean diameter of macular holes was (942.0plusmn;348.4) mu;m(ranged from 171 to 1491 mu;m), and the mean diameter of IS/OS disruption was (1870.3plusmn;673.2) mu;m(range from 463 to 3176 mu;m). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and logMAR in IMH (P＝0.038, 0.002, 0.000）. In eyes with closed macular hole after surgery, the logMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the ISOS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the macular hole closure surgery.
ObjectiveTo evaluate the spectral domain optical coherence tomography (SD-OCT) characteristics of polypoidal choroidal vasculopathy (PCV) and its correlation with the visual acuity after photodynamic therapy (PDT) combined with intravitreal ranibizumab. MethodsTwenty-six eyes of 26 patients with PCV diagnosed by indocyanine green angiography (ICGA) were enrolled in this study. All the patients were examined for best corrected visual acuity (BCVA), slit lamp microscope, SD-OCT, fundus fluorescein angiography (FFA) and ICGA before and 1, 3 months after treatment. The mean baseline BCVA was (31.46±16.87) letters, mean central retinal thickness (CRT) was (581.19±309.05) μm, and mean subfoveal choroidal thickness (SFCT) was (248.92±95.45) μm. Patients were divided into 2 groups according to the final visual improvement after 6 month of treatment: GR or sensitive Group (17 eyes) and PR or non-sensitive Group (9 eyes). GR group included 12 males and 5 females, with a mean age of (65.24±7.03) years, a mean CRT of (619.06±335.07) μm and a mean SFCT of (271.24±106.61) μm. There were 4 eyes with subretinal hemorrhage (SRH), 2 eyes with interface retinal fluid (IRF), 13 eyes with subretinal fluids (SRF) and 15 eyes with pigment epithelial detachment (PED). PR group included 8 males and 1female, with a mean age of (64.00±7.02) years, a mean CRT of (509.67±255.21) μm and a mean SFCT of (271.24±106.61) μm. There were 6 eyes with subretinal hemorrhage (SRH), 5 eyes with interface retinal fluid (IRF), 6 eyes with subretinal fluids (SRF) and 8 eyes with pigment epithelial detachment (PED). The difference of sex, age, CRT and SFCT between these two groups was not significant (P>0.05). The relationship of baseline SD-OCT and post-treatment BCVA was analyzed. ResultsOn 1, 2, 3, 6 months after treatment, the BCVA were (38.46±19.81), (40.04±20.80), (42.96±21.63), (43.77±20.91) letters respectively. On 6 months after treatment, the mean CRT in GR and PR group were (360.71±276.54), (341.44±193.68) μm respectively (P>0.05). 64.71% (11/17) eyes in GR group and 22.22% (2/9) eyes in PR group had a SFCT thicker than 263μm. The difference was statistical significant between two groups [odds ratio (OR):0.052, 95% confidence interval (CI):0.005-0.533; P=0.013]. Logistic regression analysis showed that existence of IRF (OR=9.375, 95% CI: 1.299-67.645; P=0.026) or SRH (OR=6.500, 95% CI: 1.094-38.633; P=0.040) at baseline was negative prognostic factor to treatment. ConclusionThick SFCT is a protective factor, however, existence of IRF or SRH at baseline is negative prognostic factor of final visual improvement.
ObjectiveTo systematically review the overall diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI in differentiating dysplastic nodules (DNs) and hepatocellular carcinoma (HCC), exploring whether the hepatobiliary phase can effectively improve diagnostic accuracy. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data, and CBM databases were searched from January 1998 to March 2023 to identify original studies on Gd-EOB-DTPA-enhanced MRI for the differential diagnosis of DNs and HCC. Two investigators independently performed literature screening, extraction of data features and quality assessment. Meta-analysis was performed using Stata 17.0 and Meta-disc1.4 software. ResultsA total of 14 papers were included in this meta-analysis, including 375 DNs and 653 HCC. The results of meta-analysis showed that, in the multiparametric diagnostic sequence, the pooled Sen, Spe, PLR, NLR and AUC were 0.95 (95%CI 0.87 to 0.98), 0.95 (95%CI 0.91 to 0.97), 18.57 (95%CI 9.64 to 35.78), 0.06 (95%CI 0.02 to 0.14) and 0.98 (95%CI 0.97 to 0.99), respectively. ConclusionGd-EOB-DTPA-enhanced MRI has a good differential diagnostic value for DNs and HCC. Hepatobiliary phase imaging also greatly compensates for the diagnostic deficiency of dynamic enhancement with low sensitivity for early HCC.