ObjectiveTo observe the changes of blood flow density in the macular area of normal eyes, and to analyze its correlation with age. MethodsA cross-sectional study. Two hundred and fifty normal healthy subjects (125 males and 125 females, aged 44.76±14.77) in routine ophthalmologic examination at the Department of Ophtalmology of Guangdong Provincial People’s Hospital during June 2017 to June 2018 were enrolled. Among them, 20 to 29, 30 to 39, 40 to 49, 50 to 59, and ≥ 60 years old were 50 subjects (50 eyes) in each. BCVA, slit lamp microscope, indirect ophthalmoscope, OCT angiography (OCTA) examinations were conducted for all eyes. The subjects were examined by both eyes, and the data of 1 eye was selected by EXCEL to generate random numbers, including 126 right eyes and 124 left eyes. The range of 6 mm × 6 mm in the macular area was scanned using a frequency domain OCTA instrument. The software automatically divides it into three concentric circles centered on the macular fovea, which were foveal area with a diameter of 1 mm, parafoveal area of 1 to 3 mm, and foveal peripheral area of 3 to 6 mm. The blood flow density of superficial capillary vessel, deep capillary vessel and foveal avascular area (FAZ) within a 300 μm width (FD-300), FAZ area, perimeter (PERIM), non-circularity index, center retinal thickness (CRT) were measured. The relationship between the blood flow density in macula, CRT, FAZ and age was analyzed by Pearson correlation analysis. ResultsThe mean blood flow density of superficial capillary vessel and deep capillary vessel were (51.61±2.54)% and (54.04±5.46)%, respectively. The average FD-300, CRT, PERIM and non-circularity index were (285.55±12.13) μm, (2.150±0.367) mm, 1.10±0.04, respectively. The relevance of the results showed that the age was negatively correlated with the blood flow density of whole area (r=−0.335, −0.279; P＜0.01), parafoveal area (r=−0.255, −0.368; P＜0.01), foveal peripheral area (r=−0.330, −0.269; P＜0.01) in superficial capillary vessel and deep capillary vessel as well as FD-300 (r=−0.311, P＜0.01), but not correlated with the blood flow density of foveal area (r=−0.071, −0.118; P=0.264, 0.064). There was no relationship between the age and the FAZ area, PERIM, non-circularity index (r=−0.070, −0.055, 0.074; P=0.267, 0.385, 0.142). The age was negatively correlated with the average CRT (r=−0.217, P＜0.01), but not correlated with the CRT in foveal area (r=0.115, P=0.068). The CRT was positively correlated with the blood flow density of superficial capillary vessel and deep capillary vessel in foveal area (r=0.715, 0.653; P＜0.01), but negatively correlated with the FAZ area (r=−0.669, P＜0.01). ConclusionThe capillary blood flow density of macular area in the normal eyes decreases with age.
ObjectiveTo observe the changes of choriocapillary blood flow area (CBFA) and diameter of ellipsoid zone absence (DEZA) of eyes with idiopathic macular hole (IMH) before and after surgery and its correlation with visual function.MethodsA prospective study. From May 2019 to January 2020, 23 IMH patients (IMH group and fellow eyes group) diagnosed in the Department of Opthalmology of The First Affiliated Hospital of Bengbu Medical College, and 30 age and gender-matched normal controls (30 eyes, control group) were included in this study. All patients were examined the best corrected visual acuity (BCVA) before and after surgery. The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. CBFA and DEZA were obtained by optical coherence tomography angiography (OCTA). CBFA was measured on the choriocapillary with a circle of 1.0 mm radius centered in the fovea. DEZA was the diameter of ellipsoid zone absence horizontally. The differences of CBFA and logMAR BCVA in the three groups, and the changes of CBFA, DEZA, logMAR BCVA in IMH group before and after surgery were analyzed. The measurement data between the three groups were compared by one-way analysis of variance, and the independent samples t test was used for the comparison between the two groups. Pearson correlation analysis was used for the correlation between the index, multiple linear regression analysis were performed between postoperative visual acuity and preoperative parameters.ResultsBefore and 6 months after surgery, the logMAR BCVA in IMH group were 1.26±0.7 and 0.48±0.22, CBFA were 1.49±0.30 and 1.92±0.17 mm2, DEZA were 1 080.22±576.98 and 433.78±423.04 μm, respectively. Compared with those before surgery, BCVA and CBFA were significantly improved, DEZA obviously decreased and the differences were statistically significant (t=5.53, 7.77, 6.58; P＜0.01). CBFA in IMH group was lower than fellow eyes group and control group, the difference was statistically significant (F=14.13, P＜0.01). After surgery, CBFA in IMH group increased similar to that of fellow eyes group (t=4.32, P=0.37), but lower than that of control group with the significant difference (t=4.07, P＜0.01). The results of Pearson correlation analysis showed that logMAR BCVA and DEZA were positively correlated (r=0.69, 0.75; P＜0.01), CBFA and DEZA were negatively correlated (r=−0.49, −0.89; P＜0.05) before and after surgery. Multivariate linear regression analysis showed that the postoperative logMAR BCVA was positively correlated with DEZA (t=2.32, P=0.02).ConclusionsAfter surgery, BCVA and CBFA of IMH eyes are significantly increased, DEZA is obviously reduced. Before and after surgery, logMAR BCVA is positively correlated with DEZA, and CBFA is negatively correlated with DEZA.
Non-arteritic ischemic optic neuropathy (NAION) is a neurological disease due to poor perfusion in optic disk. It causes severe visual function impairment, characterized by loss of vision and visual field defect. Optical coherence tomography (OCT) is vital for detecting anterior laminar depth, peripapillary nerve fiber layer thickness, ganglion cell complex thickness and peripapillary choroid thickness change in eyes with NAION at different course of the disease. In addition, OCT features are in accordance with visual function impairment. OCT angiography (OCTA) reveals retinal and choroidal vasculature networks in optic and macular area. OCTA revealed vasculature perfusion decline in eyes with NAION, even if their visual sensitivity and visual evoked potential were normal. Studying OCT and OCTA features is vital for exploring the pathogenesis and prognosis of NAION.
ObjectiveTo observe the imaging characteristics of optical coherence tomography angiography in macular telangiectasia type 2 (Mac-Tel 2). MethodsA retrospective case analysis. From October 2017 to June 2021, 11 patients (22 eyes) diagnosed as Mac-Tel type 2 by multi-modal imaging in Nanjing Medical University Eye Hospital were included in this study. There were 5 males (10 eyes) and 6 females (12 eyes). The age were 41.61±11.32 years old. All patients underwent the examinations of best corrected visual acuity, indirect ophthalmoscope, fundus color photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). The scope of 3 mm × 3 mm in macular area of eyes was scanned by OCTA. After automatic image processing, the system could provide the blood flow image of capillary layer, deep capillary layer, outer retina, choroidal capillary layer, and the B-scan image. The imaging characteristics were observed. ResultsAmong the 22 eyes, 14 eyes were in the early stage of the disease, and 8 eyes had secondary subretinal neovascularization (SRN) and/or choroidal neovascularization (CNV). FFA examination that in the early stage of the disease, the capillaries near the fovea were dilated, the blood vessels were stretched, and the late fluorescence was mainly stained; high-fluorescence leakage was seen when SRN and CNV were developed. OCTA examination showed that in the early stage of the disease, the temporal capillaries in the macular area were dilated and stretched, especially in the deep layer. The capillary space was enlarged, and the right-angled venules were seen to change and infiltrate into the deep layer; when the lesions invaded the outer retina, flower clusters-like SRN were seen; neovascularization was seen in the outer retina and choroidal capillary layer when CNV was developed. B-scan image showed that in the early stage of the disease, irregular weak reflex cavities and lamellar holes change between the neuroepithelial layers; secondary SRN and CNV showed strong little clumpy reflexes accompanied by abundant blood flow signals. ConclusionThe image characteristics of OCTA in the eyes of Mac-Tel 2 were dilated, stretched superficial and deep temporal capillaries in the macula area and right-angled changes in blood vessels.
Objective To compared the changes of macular microvascular architecture in early stage familial exudative vitreoretinopathy (FEVR) patients with inner retinal layer (IRL) persistence and without IRL persistence. MethodsA retrospective clinical study. From 2017 to 2022, 94 patients with stage 1 FEVR with or without IRL residue and 45 age- and sex-matched healthy volunteers with 45 eyes (normal control group) who were confirmed by ophthalmology examination in Hangzhou Hospital of Optometry Affiliated to Wenzhou Medical University and Zhejiang Provincial People's Hospital were included in the study. According to whether there was IRL residue, the patients were divided into IRL group and non-IRL group, with 22 patients (22 eyes) and 72 patients (72 eyes), respectively. Best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were performed in all eyes. Superficial vessel density (SCP) and deep vessel density (DCP) of whole image, fovea and parafovea, the area and perimeter of fovea avascular area (FAZ), A-circularity index (AI, perimeter/standard circle perimeter with equal area) and vessel density around the 300 μm width of the FAZ (FD), central macular thickness (CMT) on macular 3 mm × 3 mm scan on OCTA were measured. ResultsSCP and DCP of whole image (F=10.774, 4.583) and parafovea (F=10.433, 3.912), CMT (F=171.940) in IRL group and non-IRL group on macular 3 mm × 3 mm scan on OCTA were significantly lower than that in normal persons (P＜0.05). There were significant differences among three groups of the area of FAZ (F=4.315), AI (F=3.413), FD-300 (F=13.592) (P＜0.05). BCVA were worst in IRL group (P＜0.05). ConclusionsBlood flow density decreased in macular area of FEVR patients. CMT is significantly thicker than normal population. The FAZ area of the foveal IRL residual eyes is small and irregular, with worse BCVA and lower macular blood density.
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.
ObjectiveTo observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease. MethodsA prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; ＞12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, ＞24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex. ResultsThe wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, ＞24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses (F=8.939, P＜0.001). The average difference of wiVD between 12-24 weeks and ＞24 weeks in the chronic phase was －0.984, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in diVD of patients with different courses of disease (F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant (F=8.816, 6.069, 8.943; P＜0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was －0.984, －0.230, －0.198, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease (F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance (F=47.122, 14.954; P＜0.001, ＜0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD (r=－0.225, －0.268; P＜0.05), and the average thickness of GCC (r=0.480, 0.436; P＜0.01) were all related. ConclusionThe blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.
ObjectiveTo observe and analyze the correlation between macular microvascular parameters and urinary albumin to creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM). MethodsA cross-sectional study. From October 2017 to April 2018, 100 eyes of 100 patients (T2DM) and 27 eyes of 27 healthy controls (the control group) were enrolled in Xuzhou First People’s Hospital. All subjects underwent anterior segment examination via slit-lamp biomicroscopy, dilated fundus examination, 7-field fundus photographs, OCT angiography (OCTA), the fasting glucose test, glycosylated hemoglobin (HbA1c), urinary albumin, urinary creatinine and UACR levels determination. Height and weight measurement were taken for calculating body mass index (BMI). Diabetic retinopathy was ruled out by fundoscopic examinations and 7-field fundus photographs in T2DM patients. According to the UACR, patients in the T2DM group were subdivided into A1 group (UACR< 30 mg/g), A2 group (UACR 30-300 mg/g), and A3 group (UACR>300 mg/g), with 38 cases and 38 eyes respectively , 40 cases with 40 eyes, 22 cases with 22 eyes. A 6 mm×6 mm scanning area centered on the macular fovea were scanned for right eye using a frequency domain OCTA instrument, which were divided into three concentric circles centered on the macular fovea by the software automatically. The foveal zone was defined as a circular area measuring 1 mm in diameter, the parafoveal zone was described as a middle circle area measuring 1-3 mm in diameter, and the perifoveal zone was an outer circle area measuring 3-6 mm in diameter. The vessel density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular area (FAZ) and perimeter (PERIM), non-circularity index (AI) were measured. The correlation between the macular vessel density, FAZ and UACR was analyzed by Spearman correlation analysis. ResultsA1 group, A2 group, A3 group, and normal control group. The macular area SCP and DCP (F=13.722, 5.644), foveal area (F=4.607, 4.719), parafoveal area (H=23.142, F=2.904), the blood flow density of the area around the fovea (F=12.292, H=10.946), the difference was statistically significant (P＜0.05); with the increase of UACR, the blood flow density of each area of SCP and DCP showed a downward trend. The results of correlation analysis showed that the blood flow density of the whole SCP, parafoveal area, and surrounding area of T2DM patients was negatively correlated with UACR (r=－0.376, －0.240, －0.364, －0.347, P＜0.05). There were no correlation among fasting plasma glucose, HbAlc and UACR (r=0.179, 0.085, P＞0.05). There were no correlation among blood flow density in BMI, SCP foveal area, DCP and UACR (|r|＜0.3, P＞0.05). ConclusionThe whole, parafovea and perifovea vessel density values of SCP in T2DM eyes without DR are negatively correlated with UACR.
ObjectiveTo observe the correlation analysis between the deep-superficial flow-density ratio (DSFR) and treatment response of macular edema secondary to branch retinal vein occlusion (BRVO).MethodsForty-eight patients（48 eyes）with macular edema secondary to BRVO from December 2018 to December 2019 in the Department of Ophthalmology of Beijing Hospital were enrolled in this study. There were 29 males (29 eyes) and 19 females (19 eyes), with the mean age of 58.77±10.88 years. All eyes were treated with intravitreal injection of ranibizuma once a month for 3 months, and then treated as needed. According to the central retinal thickness (CRT) 12 months after treatment, the patients were divided into good response group (CRT≤250 μm) and refractory group (CRT＞250 μm). The flow density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of all subjects was measured by optical coherence tomography angiography. The flow density of DCP and SCP measured at 3 follow-up times was selected and DSFR was calculated. The DSFR was recorded by the Study for the Treatment of Diabetic Retinopathy (ETDRS) -grid and Nine-grid. The flow density of DCP, SCP and DSFR were compared between the two groups by paired t test. At 3 months post-treatment, the efficacy of DSFR in ME treatment response was evaluated according to area under curve (AUC) of receiver operating characteristic. Univariate and multivariate binary logistic regression were used to analyze the factors affecting the response to ME treatment.ResultsAt 12 months after treatment, there were 27 eyes in good response group and 21 eyes in refractory group. There was no statistical significance in the flow density of DCP (t=1.804, 1.064, 0.660) and SCP (t=0.581, 0.641, 0.167) and DSFR (t=0.393、－0.553、0.474) in all area of response group and refractory group using ETDRS-GRID recording method (P＞0.05). The SCP, DCP and DSFR of the most severe non-perfusion area were (27.10±5.70) %, (28.33±8.95) %, 1.35±0.54 and (27.54±6.70) %, (29.11±0.42) %, 1.01±0.40 in the response group and refractory group, respectively. There was no significant difference in the flow density of DCP and SCP between the two groups (t=－0.237, －0.340; P＞0.05). The difference of DSFR between two groups was statistically significant (t=2.288, P=0.024). Univariate and multivariate binary logistic regression analysis showed that DSFR in the most severe non-perfusion area was associated with ME response (odds ratio=0.212, 0.085; P=0.027, 0.024). The AUC was used to evaluate the efficacy of DSFR in ME treatment response, the results showed that the AUC was 0.800, P=0.001, Youden index was 1.348, sensitivity was 67.7%, and specificity was 86.7%.ConclusionsDSFR reduction is more common in BRVO secondary to ME patients. DSFR correlates with ME treatment response.
ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.