ABSTRACT
Objective:To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC).Methods:A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed.Results:Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.Conclusions:The majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
ABSTRACT
Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50–91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT);OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%);CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89, Kappa value=0.796, P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV;the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82, Kappa value=0.753, P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.
ABSTRACT
Background Optic neuritis is one of the common clinical neuro-ophthalmic diseases.Spectraldomain OCT (SD-OCT) is a valuable tool in assessing the thickness changes of retina,while enhanced depth imaging (EDI) OCT can further quantitatively and morphologically evaluate the changes of retina and choroid.The pathological mechanism of optic neuritis is unclear now.Objective This study was to quantitatively measure the retinal and choroidal thickness in early optic neuritis eyes by SD-OCT and EDI OCT.Methods A prospective cohort study was carried out in Tianjin Eye Hospital from July 2015 to May 2016.Twenty eyes of 20 patients with acute optic neuritis were enrolled as optic neuritis group and 22 eyes of 20 healthy subjects with matched age and gender were included in the normal control group.The mean thickness of retinal nerve fiber layer (RNFL) and choriod in superior,inferior,nasal and temporal quadrants at 3.4 mm around optic disc was measured,and the mean thickness of RNFL,ganglion cell layer (GCL),inner plexiform layer (IPL),inner nuclear layer (INL),outer plexiform layer (OPL),outer nuclear layer (ONL) and photoreceptor layer also was measured by EDI OCT.Pattern visual evoked potential (P-VEP) and visual field were examined in all the individuals,the correlations of mean defect (MD) with the thickness of RNFL,choroid and the thickness of RNFL,GCL,IPL,INL,OPL,ONL,photoreceptor layer at macular area were evaluated.Results The RNFL thickness values were (424.00±160.30),(428.40±169.83) and (108.15 ±50.66) μm in superior,inferior,nasal quadrants at 3.4 mm arear around optic disc in the optic neuritis group,which were significantly higher than (265.68±26.25),(283.27±52.81) and (72.68± 12.01) μm in the normal control group (t=4.571,3.814,3.190,all at P＜0.01),and there was no significant difference between the two groups (t =0.849,P =0.401),and no significant differences were found in choroidal thickness of 4 quadrants between the two groups (all at P＞0.05).The thickness of RNFL,GCL and IPL at 1 mm area around macula and the thickness of GCL,IPL,INL at 3 mm area around macula were evidently thining in the optic neuritis group compared with the normal control group (all at P＜0.05).The latency of P100 wave was (133.15±11.11) seconds in the optic neuritis group and that in the control group was (94.59 ±4.38) seconds,showing a significnat difference between them (t =15.058,P＜0.05).Positive correlations were found between MD and the RNFL thickess in superior,inferior,nasal quadrants at 3.4 mm arear around optic disc (r =0.649,0.649,0.635,all at P＜0.05),however,no evidentlylinear correlations were found between MD and choroidal thickness in 4 quadrands (r =-0.120,-0.102,-0.415,0.120,all at P＞0.05),and the thickness of RNFL,GCL,IPL,INL,OPL,ONL,photoreceptor layer at macular area was significantly linear correlated with MD.Conclusions EDI OCT can reflect the RNFL edema around optic disc and thining of various layers of retina at macular area in acuter optic neuritis eyes,however,the choroidal thickess is unchanged.EDI OCT is a useful tool in quantitative evaluation of retinal and choroidal thickness of early optic neuritis.