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1.
Article in Chinese | WPRIM | ID: wpr-934284

ABSTRACT

Objective:To apply the multi-modal deep learning model to automatically classify the ultra-widefield fluorescein angiography (UWFA) images of diabetic retinopathy (DR).Methods:A retrospective study. From 2015 to 2020, 798 images of 297 DR patients with 399 eyes who were admitted to Eye Center of Renmin Hospital of Wuhan University and were examined by UWFA were used as the training set and test set of the model. Among them, 119, 171, and 109 eyes had no retinopathy, non-proliferative DR (NPDR), and proliferative DR (PDR), respectively. Localization and assessment of fluorescein leakage and non-perfusion regions in early and late orthotopic images of UWFA in DR-affected eyes by jointly optimizing CycleGAN and a convolutional neural network (CNN) classifier, an image-level supervised deep learning model. The abnormal images with lesions were converted into normal images with lesions removed using the improved CycleGAN, and the difference images containing the lesion areas were obtained; the difference images were classified by the CNN classifier to obtain the prediction results. A five-fold cross-test was used to evaluate the classification accuracy of the model. Quantitative analysis of the marker area displayed by the differential images was performed to observe the correlation between the ischemia index and leakage index and the severity of DR.Results:The generated fake normal image basically removed all the lesion areas while retaining the normal vascular structure; the difference images intuitively revealed the distribution of biomarkers; the heat icon showed the leakage area, and the location was basically the same as the lesion area in the original image. The results of the five-fold cross-check showed that the average classification accuracy of the model was 0.983. Further quantitative analysis of the marker area showed that the ischemia index and leakage index were significantly positively correlated with the severity of DR ( β=6.088, 10.850; P<0.001). Conclusion:The constructed multimodal joint optimization model can accurately classify NPDR and PDR and precisely locate potential biomarkers.

2.
Article in Chinese | WPRIM | ID: wpr-934283

ABSTRACT

Objective:To build a small-sample ultra-widefield fundus images (UWFI) multi-disease classification artificial intelligence model, and initially explore the ability of artificial intelligence to classify UWFI multi-disease tasks.Methods:A retrospective study. From 2016 to 2021, 1 608 images from 1 123 patients who attended the Eye Center of the Renmin Hospital of Wuhan University and underwent UWFI examination were used for UWFI multi-disease classification artificial intelligence model construction. Among them, 320, 330, 319, 268, and 371 images were used for diabetic retinopathy (DR), retinal vein occlusion (RVO), pathological myopia (PM), retinal detachment (RD), and normal fundus images, respectively. 135 images from 106 patients at the Tianjin Medical University Eye Hospital were used as the external test set. EfficientNet-B7 was selected as the backbone network for classification analysis of the included UWFI images. The performance of the UWFI multi-task classification model was assessed using the receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, and accuracy. All data were expressed using numerical values and 95% confidence intervals ( CI). The datasets were trained on the network models ResNet50 and ResNet101 and tested on an external test set to compare and observe the performance of EfficientNet with the 2 models mentioned above. Results:The overall classification accuracy of the UWFI multi-disease classification artificial intelligence model on the internal and external test sets was 92.57% (95% CI 91.13%-92.92%) and 88.89% (95% CI 88.11%-90.02%), respectively. These were 96.62% and 92.59% for normal fundus, 95.95% and 95.56% for DR, 96.62% and 98.52% for RVO, 98.65% and 97.04% for PM, and 97.30% and 94.07% for RD, respectively. The mean AUC on the internal and external test sets was 0.993 and 0.983, respectively, with 0.994 and 0.939 for normal fundus, 0.999 and 0.995 for DR, 0.985 and 1.000 for RVO, 0.991 and 0.993 for PM and 0.995 and 0.990 for RD, respectively. EfficientNet performed better than the ResNet50 and ResNet101 models on both the internal and external test sets. Conclusion:The preliminary UWFI multi-disease classification artificial intelligence model using small samples constructed in this study is able to achieve a high accuracy rate, and the model may have some value in assisting clinical screening and diagnosis.

3.
Article in Chinese | WPRIM | ID: wpr-912413

ABSTRACT

Leber hereditary optic neuropathy (LHON) is a blinding disease caused by mutations in mitochondrial DNA. It is a classic disease model for studying mitochondrial abnormalities. Its main mutation sites are m11778G.A, m.3460G.A and m.14484T.C. LHON cell models are mainly produced by lymphoblasts, fibroblasts, cell hybrids and induced pluripotent stem cells, while LHON animal models are mainly mice, which are produced by rotenone and ND4 mutants. Although the research on the LHON model has achieved good results, there are still many difficulties in constructing an ideal experimental model, which severely limit the exploring to the pathogenesis and therapeutic drugs of LHON. A detailed understanding of the application and characteristics of existing models in LHON will help improve experimental design and construct new models.

4.
Article in Chinese | WPRIM | ID: wpr-912412

ABSTRACT

Leber hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disease. It is clinically recognizable by painless, bilateral loss of vision, and the prognosis of vision is generally poor. In recent years, the information provided by optical coherence tomography (OCT) and OCT angiography (OCTA) has greatly improved people's understanding of LHON, and new progress has been made in the intervention and treatment of LHON. A detailed understanding of the structural changes of retina and choroid under OCT and OCTA of the natural course and after treatment of LHON, may provide reference for revealing the pathogenesis, prediction of onset time, differential diagnosis, follow-up of treatment effect and prognosis of LHON.

5.
Article in Chinese | WPRIM | ID: wpr-912407

ABSTRACT

Objective:To observe and preliminarily discuss the distribution characteristics of the non-perfusion area (NP) of the retina in different stages of diabetic retinopathy (DR) and its changes with the progression of DR.Methods:A retrospective clinical study. From October 2018 to December 2020, 118 cases of 175 eyes of DR patients diagnosed in Eye Center of Renmin Hospital of Wuhan University were included in the study. Among them, there were 64 males with 93 eyes and 54 females with 82 eyes; the average age was 56.61±8.99 years old. There were 95 eyes of non-proliferative DR (NPDR), of which 25, 47, and 23 eyes were mild, moderate, and severe; 80 eyes were proliferative DR (PDR). Ultra-wide-angle fluorescein fundus angiography was performed with the British Optos 200Tx imaging system, and the fundus image was divided into posterior, middle, and distal parts with Image J software, and the ischemic index (ISI) was calculated. The difference of the retina in different DR staging groups and the difference of ISI were compared in the same area. The Kruskal-Wallis test was used to compare the ISI between the different DR staging groups and the Kruskal-Wallis one-way analysis of variance was used for the pairwise comparison between the groups.Results:The ISI of the posterior pole of the eyes in the moderate NPDR group, severe NPDR group, and PDR group were significantly greater than that in the distal periphery, and the difference was statistically significant ( χ 2=6.551, 3.540, 6.614; P=0.000, 0.002, 0.000). In severe NPDR group and PDR group, the ISI of the middle and peripheral parts of the eyes was significantly greater than that of the distal parts, and the difference was statistically significant ( χ 2=3.027, 3.429; P=0.015, 0.004). In the moderate NPDR group, there was no significant difference in ISI between the peripheral and distal parts of the eye ( χ 2=2.597, P=0.057). The ISI of the posterior pole of the eyes in the moderate NPDR group and the PDR group was significantly greater than that in the middle periphery, and the difference was statistically significant ( χ 2=3.955, 3.184; P=0.000, 0.009). In the severe NPDR group, there was no significant difference in ISI between the posterior pole and the middle periphery of the eye ( χ 2=0.514, P=1.000). Compared with the mild NPDR group and the moderate NPDR group, the ISI of the whole retina, posterior pole, middle and distal parts of the PDR group was larger, and the difference was statistically significant ( χ 2=-7.064, -6.349,-6.999, -5.869, -6.695, -6.723, -3.459, -4.098; P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000, 0.003, 0.000). Conclusion:The NP of the eyes with different DR stages is mainly distributed in the posterior pole and the middle periphery. The higher the severity of DR, the greater the NP in the posterior and middle periphery.

6.
Article in Chinese | WPRIM | ID: wpr-885858

ABSTRACT

Objective:To observe the changes of vision and visual evoked potentials (VEP) in patients with Leber hereditary optic neuropathy (LHON) before and after gene therapy.Methods:A retrospective cohort study. From December 2017 to October 2018, 35 cases of 70 eyes of m11778G.A/MT-ND4 mutant LHON patients who were diagnosed in the Tongji Hospital of Huazhong University of Science and Technology and received gene therapy were included in the study. There were 30 males (87.71%) and 5 females (12.29%), with the mean age of 23.31±6.72 years. The gene therapy method was intravitreal injection of rAAV2-ND4 (recombinant adeno-associated virus carrying NADH-ubiquinone oxidoreductase subunit 4 gene) into one eye. The eye with poor visual acuity was chosen as the injection eye. If both eyes had the same visual acuity, the right eye was designated as the injection eye. Seventy eyes were divided into the injected eye group and the non-injected eye group, in which were both 35 eyes. The best corrected visual acuity (BCVA) and pattern VEP (PVEP) examinations were performed in the injected eye group and the non-injected eye group before treatment (baseline), 1, 3, and 6 months after injection. Compare the changes of BCVA and PVEP between the injected eye group and the non-injected eye group at baseline, 1 month, 3 months, and 6 months after injection. Independent sample t test, paired sample t test or two independent sample nonparametric test were performed to compare the two groups. Results:Compared with baseline, 1, 3, and 6 months after treatment, the BCVA of the injected eye group ( t=3.530, 4.962, 5.281; P=0.001, 0.000, 0.000) and the non-injected eye group ( t=3.288, 2.620, 2.252; P=0.002, 0.013, 0.031) increased, and the difference was statistically significant; there was no statistically significant difference between VEP IT ( tinjected eye group=-0.158, 1.046, -1.134; Pinjected eye group = 0.875, 0.303, 0.190; tnon-injected eye group=0.773, -0.607, -0.944; Pnon-injected eye group = 0.445, 0.548, 0.352) and VEP A ( Zinjected eye group=-0.504, -0.934, -1.065; Pinjected eye group = 0.614, 0.351, 0.287; Znon-injected eye group=-0.521, -0.115, -0.491; Pnon-injected eye group = 0.602, 0.909, 0.623). Conclusion:After gene therapy, the visual acuity of the injected and non-injected eyes of LHON patients improved; PVEP did not change significantly, and remained stable compared with baseline.

7.
Article in Chinese | WPRIM | ID: wpr-883291

ABSTRACT

Diabetic retinopathy (DR) is a common ocular complication in patients with diabetes, and diabetic macular edema (DME) is the main cause of vision loss in patients with DR, so the early diagnosis and treatment of DME is of an important clinical significance.Optical coherence tomography (OCT) can provide high-quality imaging of retina and choroid.It has been widely used in clinical practice and can be used for long-term follow-up of the diagnosis and treatment of DME.Recent studies have found various characteristic changes in retina and choroidal layer of DME on OCT, including vitreomacular interface abnormalities, disorganization of retinal inner layers, inner segment-outer segment (IS-OS) continuity destruction, external limiting membrane continuity destruction, outer retinal tubulations, hyperreflective foci, intraretinal cystic fluid, subfoveal neuroretinal detachment, low optical reflectivity, subfoveal choroidal thickness change, and choroidal vascularity index change, etc.These changes are related to the prognosis of DME, so they can be used as biomarkers of DME.This paper reviews the research progress in this field.

8.
Article in Chinese | WPRIM | ID: wpr-908633

ABSTRACT

Objective:To explore the application of multispectral fundus imaging (MSI) in central serous chorioretinopathy (CSC).Methods:A diagnostic test study was conducted.Eighty-five eyes from 69 patients with macular diseases were enrolled in Renmin Hospital of Wuhan University from September 2017 to May 2018.There were 62 males (77 eyes) and 7 females (8 eyes) among the 69 patients with an average age of (48.0±11.2) years.The patients were divided into CSC group (45 cases, 61 eyes) and non-CSC group (24 cases, 24 eyes) according to whether suffering from CSC or not.Color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography, spectral domain-optical coherence tomography and MSI were performed in the two groups and the images were collected.With FFA as the gold standard, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI in the diagnosis of CSC were calculated.Kappa consistency test was used to evaluate the consistency of MSI and FFA in diagnosing CSC, and to evaluate the diagnostic value of MSI in CSC.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each subject prior to any medical examination.Results:The sensitivity, specicity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI for identifying CSC were 88.5%, 91.7%, 8.3%, 11.5%, 96.4% and 75.9%, respectively.The Kappa coefficient of agreement was 0.754.There was no significant difference in the identification of CSC between MSI and FFA ( χ2=1.780, P=0.180). Hyper-reflective signals corresponding to the leakage points were better detected with MSI images at 620-850 nm wavelength.The clear boundary of serous neuroepithelial detachment area was better detected with MSI images at 590-810 nm wavelength.The retinal pigment epithelium damage was better detected with MSI images at 660-850 nm wavelength. Conclusions:There is a good consistency between MSI and FFA.MSI can be an effective noninvasive inspection method for CSC.

9.
Article in Chinese | WPRIM | ID: wpr-908620

ABSTRACT

Objective:To investigate the features of multicolor imaging in the macular region of central serous chorioretinopathy (CSC) patients.Methods:A cross-sectional study was conducted.Thirty-four acute CSC patients (34 eyes) treated in Renmin Hospital of Wuhan University from August 2017 to January 2018 were enrolled.Among the 34 subjects, there were 21 males (21 eyes) and 13 females (13 eyes). The subjects were 26 to 61 years old, with an average age of (37.41±9.35) years.The course of the disease was 5 to 45 days, with an average course of (12.00±2.29) days.All the subjects were examined by color fundus photography, fluorescein angiography (FFA), indocyanine green angiography (ICGA), multicolor imaging, spectral-domain optical coherence tomography (SD-OCT). The image features of each patient were compared and analyzed.The diagnostic accordance rate for leakage point and serous retinal neuroepithelial detachment of multicolor imaging and color fundus photography was calculated according to FFA/ICGA and OCT.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037).Results:The serous retinal detachment region showed green light reflection area with clear boundary in 33 eyes (97.06%) in the standard as well as blue and green enhanced multicolor image, with not clear boundary in 1 eye (2.94%). The serous retinal detachment region showed weakly reflective area in 17 eyes (50%) in blue reflectance image, showed weak reflection with clear boundary in 32 eyes (94.11%) in green reflectance image, showed weakly reflection with clear boundary in 33 eyes (97.06%) in infrared reflectance image.The fluorescein leakage point in FFA image was found micro retinal pigment epithelium detachment (PED) in 19 eyes (55.88%), rough light band of retinal pigment epithelium (RPE) in 12 eyes (35.29%), and large PED in 3 eyes (8.82%) in SD-OCT image.The RPE leakage showed red mottled changes in the area of neuroepithelial detachment in 29 eyes (85.29%) in the standard as well as blue and green enhanced multicolor images, presented strong reflection spots in blue reflectance images in 2 eyes (5.88%), showed strong reflective spots in green reflectance in 5 eyes (14.70%), showed strong reflection spot in the weakly reflective area in 33 eyes (97.06%) in infrared reflectance images.Taking FFA/ICGA and OCT as the gold standard, the diagnostic accordance rate of standard multicolor, blue and green enhanced multicolor and infrared reflectance images for serous retinal neuroepithelial detachment and leakage points was higher than that of color fundus photography, and the differences were statistically significant (all at P<0.05). Conclusions:Standard multicolor, blue and green enhanced multicolor and infrared reflectance images can reflect the leakage point and retinal neuroepithelial detachment of acute CSC.Green reflectance image can show serous retinal neuroepithelial detachment of acute CSC.Multicolor imaging can be used as the auxiliary diagnosis method of acute CSC.

10.
Article in Chinese | WPRIM | ID: wpr-908564

ABSTRACT

Nonarteritic anterior ischemic optic neuropathy (NAION) is a common type of acute optic neuropathy in elderly, characterized by optic disc edema and visual field defect.At present, there is no generally accepted treatment, and the treatment of NAION is to control systemic disease and other risk factors, reduce optic disc edema, nurture nerve and improve microcirculation.In recent years, intravitreal drug injection has been used as a new therapy of NAION.It can make drug reach the target issue in the eye rapidly and maintain a relatively high concentration, which can enhance the efficacy without causing severe systemic complication.In this article, the effect of intravitreal injection of anti-vascular endothelial growth factor, triamcinolone acetonide, and erythropoietin in NAION was reviewed.

11.
Article in Chinese | WPRIM | ID: wpr-908559

ABSTRACT

Objective:To analyze the peripheral retinal fluorescence characteristics of normal fundus on ultra-wide field fluorescein angiography (UWFA) images.Methods:A cross-sectional study was conducted.Ninety-five patients (190 eyes) who underwent normal UWFA in Renmin Hospital of Wuhan University from July 2016 to January 2019 were enrolled.There were 94 (49.47%) male eyes and 96 (50.53%) female eyes.Among them, there were 72 (37.89%) mild cataract eyes, 60 (31.58%) moderate and low myopia eyes and 58 (30.53%) subjective blurred vision eyes.The peripheral retinal fluorescence characteristics were divided into vascular-associated feature or non-vascular feature according to whether the retinal vessel involved or not.The subjects were divided into ≤40 years old group and >40 years old group, and the differences in various features between the two groups were compared and analyzed.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each patient prior to any examination.Results:Four non-vascular and five vascular-associated fluorescence features were found in normal peripheral retina.Non-vascular features contained glass hyperfluorescence in 158 (83.16%) eyes, far peripheral retina with mottled florescent band in 82 (43.16%) eyes, granular ground hyperfluorescence in 24 (12.63%) eyes and local mottled fluorescence in 21 (11.05%) eyes.Vascular-associated fluorescence features included peripheral avascular area in 92 (48.42%) eyes, vessels passing through the ora serrata in 66 (34.74%) eyes, microaneurysm in 60 (31.58%) eyes, slight leakage within 10 minutes after angiography in 56 (29.47%) eyes and angiotelectasis in 30 (15.79%) eyes.There were 19.61% (20/102) of eyes with peripheral retinal vessels passing through the ora serrata and 43.10% (44/102) of eyes with microaneurysm and 19.61% (20/102) of eyes with angiotelectasis in >40 years old group, and there were 52.27% (46/88), 18.23% (16/88) and 11.36% (10/88) correspondingly in ≤40 years old group, and the differences were statistically significant ( χ2=22.235, 10.451, 9.259; all at P<0.01). Conclusions:UWFA reveals four non-vascular and five vascular-associated fluorescence characteristics of normal fundus and age might be associated with the distribution of microaneurysm and angiotelectasis.

12.
Article in Chinese | WPRIM | ID: wpr-871848

ABSTRACT

The choroidal vascular index (CVI) is the ratio of the luminal area to the total choroidal area. It can not only reflect the changes in the vascular composition of the choroid, but also serve as an observation index for follow-up treatment effects. CVI is a new biometric tool, which is gradually applied to the observation of choroidal structure in various eye diseases. It has great application prospects in the study of pathophysiological mechanisms, disease process monitoring and efficacy evaluation such as central serous chorioretinopathy, polypoid choroidal vascular disease, age-related macular degeneration, diabetic retinopathy,etc. Understanding the research progress of CVI in various eye diseases can provide reference for clinical research of CVI.

13.
Article in Chinese | WPRIM | ID: wpr-871705

ABSTRACT

Autosomal recessive Best disease (ARB) is a rare clinical fundus disease caused by BEST1 mutation.The critical features of ARB are the presence of multifocal subretinal yellowish lesions,which corresponding to the hyperfluorescent spots on FAF,scattered over the posterior pole of the retina,absent of typical vitelliform lesions in the macula.Imaging of OCT is often manifested as subretinal or intraretinal fluid,and cystoid macular edema,and hypereflective focus at RPE level.EOG shows an absent or severely reduced light rise (decreased value of Arden),which often accompanied by reduction and delay of the rod and cone ERG.Some patients with ARB show hyperopia,short axial length and shallow anterior chambers,with a corresponding high incidence of angle-closure glaucoma.Though there isn't any effective therapeutic methods of ARB at present,prevention and treatment for its complications such as angle-closure glaucoma and choroidal neovascularization should be considered.Present study about ARB mainly focus on some retrospective cases,and ARB is often misdiagnosed with Best vitelliform macular dystrophy,central serous chorioretinopathy and other fundus diseases in clinic.A detailed understanding of the clinical features and genetic characteristics of ARB might be helpful in clinical diagnosis and treatment.Research with larger sample size are expected to further investigate the different stages of ARB and its developing process,the potential pathological mechanism,the relationship between genotype and phenotype,so as to improve the understanding of the disease.

14.
Article in Chinese | WPRIM | ID: wpr-871697

ABSTRACT

Objective To observe the imaging features of cystoid macular edema (CME) in multicolor imaging (MC),and to evaluate the value of MC in the diagnosis of CME.Methods Descriptive case series study.From August 2017 to June 2018,42 eyes of 37 patients with CME diagnosed in the people's Hospital of Wuhan University were included in the study.Among them,there were 24 males and 13 females,with an average age of 48.51 ± 10.29 years.There were 14 eyes with diabetic retinopathy,14 eyes with central retinal vein occlusion,8 eyes with branch retinal vein occlusion,4 eyes with uveitis,and 2 eyes with Eales disease.The macular color fundus photography (CFP) was performed with Visucam 200 non-mydriatic fundus camera of Zeiss company in Germany.MC,frequnce domainoptical OCT (SD-OCT) and FFA were examined by Spectralis HRA2 + OCT of Heidelberg company in Germany.According to the MC standard method,five images,including 488 nm blue reflection (BR),515 nm green reflection (GR),820 nm infrared reflection (IR) imaging and standard MC and blue-green enhancement (BG),were obtained at the same time.Compared with SD-OCT,CFP and MC images were scored.Friedman M test and Wilcoxon signed rank test were used for statistical analysis.Results The standard MC and BG images showed blue-green uplift area or petal-shaped appearance,surrounded by green reflection areas with clear boundaries.BR image can be seen in the low reflexes area.On the GR image,there were patches or cystic low reflection areas,surrounded by a slightly high reflection.On the IR image,patches or cystoid high reflexes can be seen,surrounded by low reflection dark areas with clear boundaries.The average scores of CFP,standard MC,GB,IR,GR and BR were 1.20± 0.94,3.05± 0.99,2.90± 1.04,2.55± 1.27,2.00± 0.94,0.51 ± 0.85 respectively,and the differences were statistically significant (χ2=151.61,P=0.000).The score of CFP were significantly lower than that of standard MC (Z=-5.421),BG (Z=-5.354),IR (Z=-4.714),GR (Z=-4.438) and higher than that of BR (Z=-3.435).The differences were statistically significant (P=0.000,0.000,0.000,0.000,0.001).Conclusions The quality of MC imaging is better than that of CFP.Combined with SD-OCT,it can be used as an assistant method to diagnose CME.

15.
Article in Chinese | WPRIM | ID: wpr-865318

ABSTRACT

Ultra-wide field fluorescein angiography (UWFFA) is a new technique emerging in recent years.UWFFA can observe the fluorescence signs of wide areas of retina beyond the traditional 7-field of vision.UWFFA has obvious advantages in peripheral retina of vascular diseases, such as diabetic retinopathy (DR) , retinal vein occlusion (RVO) and familial exudative retinopathy.Traditional fundus fluorescein angiography (FFA) has accumulated much experience in normal fluorescence and abnormal fluorescence, but little is known about the fluorescence characteristics of normal eye periphery.Periphery fluorescence performance is different from posterior pole and equator.It is necessary to consider the distribution of retinal pigment epithelium (RPE) , pigmentation, vascular development and posterior vitreous cortex.At the same time, more attention should be paid to the influence of age and systemic metabolic diseases on some fluorescence.Light performance also needs dynamic whole-course analysis, combined with color fundus photography and anterior endoscopy analysis.Defining normal fluorescence of different parts of retina at different times is the premise of judging abnormal fluorescence.In clinic, it is necessary to carefully interpret the peripheral fluorescence signs of UWFFA, especially in diagnosis of vascular diseases, such as RVO and DR.It is essential to continuously accumulate experience in interpreting fluorescence signs of normal and abnormal peripheral retina, and further improve the application of UWFFA technology.

16.
Article in Chinese | WPRIM | ID: wpr-865259

ABSTRACT

China is currently in a critical stage of controlling the outbreak of novel coronavirus pneumonia (COVID-19). As ophthalmologists working in the center of Wuhan city, the virus’s front line, we recently found conjunctivitis in five COVID-19 patients of a total of 92 COVID-19 patients.One of these five patients had conjunctivitis as the first symptom and was then diagnosed with COVID-19.These observations suggest: the mechanism and pathway of transmission of the novel coronavirus need to be further clarified; the symptoms of conjunctivitis accompanying novel coronavirus infection and conjunctiva as an important entrance point of the virus need to be further verified; early diagnosis, implementation of medical isolation, and giving appropriate treatment to patients with asymptomatic and mild-symptom conjunctivitis are essential to prevent the spread of the epidemic; those with conjunctivitis symptoms should be distinguished from other types of viral conjunctivitis; strict personal protection measures should be taken; and more sensitive techniques should be developed as soon as possible for virus detection in tear and conjunctiva swabs.

17.
Article in Chinese | WPRIM | ID: wpr-746217

ABSTRACT

Objective To observe the blood perfusion changes ofperipapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).Methods Retrospective cohort study.Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People's Hospital of Wuhan University from November 2017 to January 2019 were included in this study.There were 1 0 males and 9 females,with the mean age of 55.05 ± 7.11 years.Forty eyes of 20 normal subjects matched with NAION patients were included as controls.BCVA,fundus color photography,SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks,1-2 months,3-5 months intervals.OCT quantitative measurements:average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL),average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC).OCTA quantitative measurements:average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC),average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD),average vascular density of deep layer retina (aDVD),areas of foveal avascular zone (FAZ).The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed.Independent sample t test,paired sample t test or nonparametric rank sum test were performed for comparison among three groups.Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC,GCC and SVD,RNFL and GCC,RPC and SVD.Results At baseline,the aRNFL,aRPC and aDVD of NAION patients were significantly higher than those of normal controls.Compared with the fellow eyes,the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes.The overall differences of aRNFL,aRPC,aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P<0.05).The average sRNFL,sRPC,sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL,iRPC,iGCC and iSVD (P<0.05).Correlation analysis:at 1-2 months interval,aGCC was positively correlated with aSVD (r=0.482,P=0.037);at 3-5 months interval,aRNFL was positively correlated with aRPC (r=0.631,P=0.037).Conclusion There is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.

18.
Article in Chinese | WPRIM | ID: wpr-746184

ABSTRACT

Objective To assess changes of blood flow density of idiopathic choroidal neovascularization (ICNV) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF).Methods Retrospective case analysis.Sixteen eyes of 16 patients with ICNV diagnosed with FFA and OCT were included in this study.Among them,12 were female and 4 were male.The mean age was 33.94±9.83 years.The mean course of diseases was 5.13 ±4.44 weeks.The BCVA,indirect ophthalmoscope,OCT and OCT angiography (OCTA) were performed at the first diagnosis in all patients.The BCVA was converted to logMAR.The macular fovea retinal thickness (CMT) was measured by OCT,and the selected area of CNV (CSA) and flow area of CNV (CFA) were measured by OCTA.The mean logMAR BCVA,CMT,CSA and CFA were 0.336±0.163,268.500±57.927 μm,0.651 ±0.521 mm2,0.327±0.278 mm2,respectively.All patients were treated with intravitreal ranibizumab (IVR,10 mg/ml,0.05 ml).Follow-up results including the BCVA,fundus color photography,OCT and OCTA were obtained 1 month after treatment.To compare the changes ofBCVA,CMT,CSA,CFA of ICNV treated with anti-VEGF.Pearson method was used to analyze the correlation between logMAR BCVA and CMT,CSA and CFA before and after the treatment.Results One month after treatment,the average logMAR BCVA,CMT,CSA and CFA were 0.176±0.111,232.500± 18.910 μm,0.420±0.439 mm2,0.215 ± 0.274 mm2.The mean logMAR BCVA (t=5.471,P< 0.001),CMT (t=2.527,P=0.023),CSA (t=4.039,P=0.001),CFA (t=4.214,P=0.001) significantly decreased at 1 month after injection compared to baseline,and the difference had statistical significance.The results of correlation analysis showed that the post-logMAR BCVA was moderately positively correlated with pre-CSA and post-CSA (r=0.553,0.560;P=0.026,0.024),and strongly correlated with pre-CFA and post-CFA (r=0.669,0.606;P=0.005,0.013),but not correlated with preCMT and post-CMT (r=0.553,0.560;P=0.026,0.024).Conclusion The blood flow density of ICNV measured by OCTA were significantly decreased in the treatment of anti-VEGF drugs.

19.
Article in Chinese | WPRIM | ID: wpr-756411

ABSTRACT

Objective To quantitatively analyze the changes ofchoroidal capillaries in chronic central serous chorioretinopathy (CCSC) before and after half-dose photodynamic therapy (PDT).Methods A retrospective cohort study.Nineteen patients (21 eyes) with CCSC were enrolled in this study from November 2017 to September 2018 in People's Hospital of Wuhan University.Among them,there were 14 males (15 eyes) and 5 females (6 eyes),with diseases course over than 6 months.All patients underwent half-dose PDT.Twenty normal subjects (40 eyes) matched with age and sex in CCSC group were taken as controls.The subfoveal choroidal thickness (SFCT) was measured by Heidelberg depth enhanced imaging-OCT before and after PDT treatment in CCSC patients and in normal subjects.Spectral-domain OCT (Retina map) and Angio-OCT angiography (3 mm × 3 mm) were arranged for all subjects at the same time.Macular fovea retinal thickness (CMT) was recorded under OCT-Retina map mode,and Angio-OCT 3 mm × 3 mm choroidal capillary images were binarized using Image J software,and calculating the area ratio of low pixel area as flow signal void (FSV).BCVA,spectral-domain OCT and Angio-OCT were performed 1 week and 1,3 months after PDT with the same equipment and methods before PDT.The changes of CMT,SFCT,FSV and BCVA in CCSC patients before and after PDT treatment were compared.Pearson correlation analysis was used to analyze the correlation between FSV and SFCT,age.Results The average CMT,SFCT and FSV in CCSC patients increased significantly compared with the controls (P<0.05).The average SFCT and FSV in CCSC patients 3 months after treatment were higher and the average CMT decreased compared with the controls (P=0.000,0.000,0.000).Comparison before and after PDT in CCSC patients:there were significant differences in average CMT,SFCT and FSV before and after PDT (P=0.000,0.000,0.000).Post Hoc multiple comparisons showed that the average CMT (P=0.000,0.000,0.000,0.000,0.000) and FSV (P=0.010,0.000,0.000,0.001,0.000) decreased significantly in all time points except for 1 month and 3 months after treatment,so as the average FSV (P=0.788,0.702).The average SFCT decreased 1 month and 3 months after treatment compared with the baseline (P=0.024,0.008),and there was no significant difference between before treatment and 1 week after treatment (P=0.162),and between 1 month and 3 months after treatment (P=0.687).The correlation analysis showed that there was no correlation between FSV and age in CCSC patients (r=0.052,P=0.822),but there was a correlation between FSV and age in controls (r=0.716,P=0.000).Conclusion Quantitative analysis of OCTA showes the degree of choriocapillary ischemia in the form of FSV in CCSC patients decreased after PDT treatment,however,which is still higher than normal controls.

20.
Article in Chinese | WPRIM | ID: wpr-753212

ABSTRACT

Objective To evaluate the application value of an intelligent fundus assisted diagnosis system for detecting retinopathy of prematurity ( ROP) based on deep learning. Methods A total of 38895 fundus images for premature infants screening were collected from Renmin Hospital of Wuhan University Eye Center and were labeled by 10 licensed ophthalmologists. A deep learning network model was established to acquire automatic classification of disease stages and plus disease. The accuracy,sensitivity and specificity of the algorithm were calculated to evaluate the performance of the artificial intelligence system for ROP automatic diagnosis. This study protocol was approved by Ethic Committee of Renmin Hospital of Wuhan University ( No. WDRY2019-K032 ) . Written informed consent was obtained from the guardians of the children before entering the study cohort. Results The intelligent system achieved an accuracy of 0. 931. Specifically,the accuracies in detecting demarcation line (stageⅠ) was 0. 876,ridge (stage Ⅱ) was 0. 942,ridge with extra retinal fibrovascular (stageⅢ) was 0. 968,subtotal retinal detachment (stageⅣ) was 0. 998,total retinal detachment (stage Ⅴ) was 0. 999,vascular tortuosity and dilatation (plus disease) was 0. 896,optic disc was 0. 954,macular was 0. 781,and laser scars were 0. 974,respectively. Conclusions Deep learning algorithm can detect the stages and plus disease of ROP with excellent accuracy,and it provides the feasibility of applying the algorithm for ROP automated screening in clinical.

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