ABSTRACT
Autoimmune retinopathy (AIR) is a group of immune-mediated retinopathies that usually results in severe loss of vision and visual field defects.AIR mainly includes paraneoplastic and non-paraneoplastic syndromes.One main feature of AIR is the presence of circulating anti-retinal antibodies (ARAs) in peripheral blood, which are produced through anti-tumor responses, anti-microbial responses, and immune responses induced by autoantigen fragments following retinal injury, and mainly attack retinal photoreceptor cells.ARAs are important for the diagnosis, progression assessment and treatment outcome of AIR.These ARAs often appear before the diagnosis of cancer and can be helpful for the early detection of malignant tumors.The mechanism of ARAs production, its pathological role in AIR, and its significance in clinical practice were reviewed in this article.
ABSTRACT
Objective:To investigate the clinical features and multimodal imaging features of eyes with perifoveal exudative vascular anomalous complex (PEVAC).Methods:A retrospective case study. From February 2014 to November 2020, 7 eyes of 7 patients with PEVAC diagnosed by ophthalmology examination in Department of Ophthalmologyof Peking University People's Hospital were included in this study. There were 6 males and 1 female. The age was 60.1±9.1 years. All were monocular. The chief complaints of visual deformation and vision loss were 3 and 1 cases, respectively. All patients underwent best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA). BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. OCT angiography (OCTA) and indocyanine green angiography (ICGA) were performed in 4 and 2 eyes, respectively. Three eyes were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) combined with local laser photocoagulation. Two eyes were treated with laser photocoagulation alone. The follow-up time was 16.7±19.1 months. During follow-up, relevant examinations were performed with the same equipment and methods as at the initial diagnosis. The multimodal imaging characteristics and treatment response of the affected eyes were observed.Results:The baseline logMAR BCVA was 0.33±0.19 (0.20-0.80). All eyes showed isolated hemangiomatous lesions in the macular fovea with rigid retinal exudation, and 2 adjacent isolated hemangiomatous lesions were observed in 1 eye. FFA and ICGA examination showed that all eyes with macular hemangiomatous lesions showed clear boundary and strong fluorescence in the early stage. No other retinal or choroidal vascular abnormalities were observed. On OCT examination, circular lumen-like structures with strong reflective wall near the fovea were observed in the macular region of all eyes, accompanied by intraretinal cystic lumen. The macular central retinal thickness (CMT) was 326±125 (207-479) μm. In the four eyes examined by OCTA, blood flow signals were observed in the circular lumenoid structures with strong reflective walls adjacent to the fovea. Blood flow signals were observed in the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina in 3 eyes. SCP showed blood flow signal in 1 eye. In 4 eyes treated with intravitreal injection of anti-VEGF drugs, there was no significant improvement in the intraretinal capsule space after treatment. Subretinal fluid absorption, retinal cystoid edema persisted, and rigid exudation decreased in 1 eye. CMT decreased and BCVA increased in 5 eyes treated with laser photocoagulation or laser photocoagulation alone. At last follow-up, logMAR BCVA was 0.16±0.06 (0.10-0.20) and CMT was 212±34 (154-252) μm. Compared with baseline, the difference of BCVA was statistically significant ( t=2.661, P=0.037). Conclusions:The fundus of PEVAC patients is characterized by solitary or multiple solitary hemangiomatous lesions in the macular fovea. Round lumenoid structures with strong reflective walls, with or without intraretinal cystic lumen, rigid exudate, and subretinal fluid, in which blood flow signals can be seen in OCT.
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Background Branch retinal vein occlusion (BRVO)often leads to macular edema as the result of elevating intravitreal VEGF level,and avastin,a anti-VEGF drug,show a good effectiveness on macular edema secondary to BRVO.ObjectiveThis study attempts to evaluate the clinical efficacy of avastin on macular edema induced by BRVO.MethodsThis is a retrospective case-observation study.The clinical data of 39 eyes from 39 patients with macular edema induced by BRVO were included in this analysis.All of the patients received intravitreal injection of 1.25mg (0.05mL)avastin without other any therapy prior to the injection of avastin.This procedure followed the Declaration of Helsinki,and written informed consent was obtained from all the patients before and initial of any management.Clinical indexes included best-corrected visual acuity(BCVA),slit-lamp examination,intraocular pressure and stereoscopic biomicroscopy examination before injection and 3,6 and 12 weeks after initial injection.Optical coherence tomography (OCT),fundus photography,fluorescein fundus angiography(FFA)were performed prior to injection and 6,12 weeks after initial injection.The follow-up period was 3-20 months.ResultsThe mean BCVA was significantly improved at 3,6,12 weeks after injection in comparison with before injection (t=-6.039,-6.182,-4.189,all P=0.000).The mean CMT showed a statistically significantly decline at 6,12 weeks after injection in comparison with before injection(t=8.684,5.019,all P=0.000).No ocular or systemic adverse events were found after intravitreal injection of avastin during the follow-up duration.The numbers of visual acuity-improved eyes were significantly increased in the patients with disease course ≤1 month duration in comparison to ones with the course ≥1 month (P<0.05)in 3 weeks after injection.CMT was obviously decreased in 12 weeks after injection in comparison to before injection between with and without macular perfusion eyes (P<0.05).ConclusionIntravitreal injection of avastin is safe and effective for macular edema induced by BRVO,especially the patients with shorter course of disease.
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Objective To compare the clinical results of photodynamic therapy(PDT) and transpupillary thermotherapy (TTT) for patients with choroidal neovascularization caused by exudative age-related macular degeneration. Methods Seventy cases (82 eyes) with exudative AMD were divided into PDT and TTT groups. Thirty-five cases (42 eyes) were treated with PDT. Nineteen eyes had occult or predominantly occult CNV. Twenty-three eyes had classic or predominantly classic CNV. Thirty-five cases (40 eyes) were treated with TTT. Twenty-five eyes had occult or predominantly occult CNV. Fifteen eyes had classic or predominantly classic CNV. Visual acuity, FFA, ICGA and OCT were evaluated before and after treatment. All cases were subfoveal or juxtafoveal CNV. The follow-up was (3-6 months.) Results Visual acuity in 3 eyes (15.8%) of PDT group and 1 eye (4.0%) in TTT group increased at least 2 lines. The difference was no significant(P=0.1778), FFA showed cessation or reduction of fluorescein leakage from CNV in 15 eyes(78.9%) in PDT group and 13 eyes(52.0%) in TTT group. The difference was not significant (P=0.0657). Three months after treatment, The visual acuity of 2 eyes(10.5%) in PDT group and 2 eyes (8.0%) in TTT group increased at least 2 lines. The difference was not significant (P=0.7728). FFA showed cessation or reduction of fluorescein leakage from CNV in 8 eyes(42.1%) in PDT group and 21 eyes(84.0%) in TTT group. The difference was significant (P=0.0037). Conclusion For classic CNV, the short-term effect of PDT is better than TTT concerning visual acuity. The effect of PDT is apparently better than TTT in cessation or reduction of fluorescein leakage one month after treatment. But there was no significant difference between PDT and TTT in cessation or reduction of fluorescein leakage three month after treatment. For occult CNV, there is no significant short-term difference between PDT and TTT concerning visual acuity. There was no significant difference between PDT and TTT in cessatin or reduction of fluorescein leakage one month after treatment. But three month after treatment TTT is apparently better than PDT in cessation or reduction of fluorescein leakage. We need more cases and longer follow -up to evaluate these two kinds of treatments in treating exudative age-related macular degeneration.