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ObjectiveTo compare the changes of retinal microcirculation indexes in the anterior and posterior macular areas of the eyes used at close range and to explore the possible causes of myopia affected by near work. MethodsWatching mobile phone video for 1 hour at close range was used as the method of defining near work. The OCTA technology was used to measure the superficial retinal microcirculation indexes within 6 by 6 mm macular area before and after near work， including the superficial retinal VLD from the nerve fiber layer to the inner boundary of the outer plexiform layer， the VPD， nonperfusion area of FAZ， FAZ-P and FAZ circulation，. The FAZ was divided int center， inner layer， outer layer and overall according to the region， and 11 microcirculation indexes were obtained to compare the differences between before and after near work. ResultsThe indexes of superficial retinal microcirculation in the macular area generally decreased after near work， except for FAZ-A and FAZ-P（P = 0.148， 0.975）. The largest differences among both VLD and VPD occurred between the central and inner layer（Difference = 1.00， 0.80， 0.02， 0.02，P = 0.001， 0.008， 0.001， 0.008）. No differences in microcirculation indexs were observed in the macular area after near work with different diopters and axial lengths. ConclusionNear work may affect the occurrence and development of myopia by affecting the changes of retinal microcirculation in the superficial layer of macula， leading to ischemia and hypoxia.
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Objective:To explore the relationship between preoperative level of glycosylated hemoglobin (HbA 1c) and changes in structure and function of macular area in patients with type 2 diabetes mellitus (T2DM) after phacoemulsification. Methods:A total of 118 patients with T2DM and monocular cataract undergoing phacoemulsification in Hefei First People′s Hospital, were enrolled between January 2018 and June 2021. According to preoperative HbA 1c level, they were divided into high HbA 1c group (HbA 1c >7.0%, 55 cases) and normal HbA 1c group (HbA 1c ≤7.0%, 63 cases). The central macular thickness (CST), central volume (CV), subfoveal choroidal thickness (SFCT) and incidence of postoperative cystoid macular edema (PCME) between the two groups were compared. The risk factors of PCME were analyzed. Results:At 1 week, 1 month and 3 months after phacoemulsification, CST level in high HbA 1c group was significantly higher than that in normal HbA 1c group: (256.21±19.27) μm vs. (242.33 ± 14.63) μm, (277.41 ± 16.39) μm vs. (248.12 ± 11.54) μm, (242.51 ± 11.52) μm vs. (234.87 ± 9.34) μm, and there was statistical difference ( P<0.05). At 3 months after phacoemulsification, CV level in high HbA 1c group was significantly higher than that in normal HbA 1c group: (10.40 ± 0.51) mm 2 vs. (10.17 ± 0.47) mm 2 ( P<0.05). The incidence of PCME in high HbA 1c group was significantly higher than that in normal HbA 1c group: 25.45% (14/55) vs. 7.94% (5/63) ( P<0.05). Preoperative HbA 1c>7.0% and retinopathy were independent risk factors of PCME ( P<0.05). Conclusions:The preoperative HbA 1c level will affect retina and choroid structures in macular area of patients with T2DM and cataract after phacoemulsification. The risk of PCME is higher in patients with preoperative HbA 1c>7.0%.
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@#AIM:To explore the relationship between the parameters of macular integrity assessment(MAIA), best corrected visual acuity(BCVA)and macular morphology in patients with diabetic macular edema. <p>METHODS: From March 2018 to January 2020, a total of 43 patients(74 eyes)with diabetic macular edema were randomly selected for treatment in the department of ophthalmology in our hospital.To compare the relationship between MAIA micro field meter parameters and the integrity of macular external membrane, junction of inner and outer photoreceptors(IS/OS)layer and hard exudation. Pearson correlation test was used to analyze the relationship between retinal thickness and retinal sensitivity. Pearson correlation test was used to analyze the correlation between retinal thickness, retinal sensitivity and BCVA in the intact and defect groups of IS/OS layer.<p>RESULTS: Compared with the IS/OS layer defect group, the levels of BCVA(LogMAR), central retinal thickness(CRT), elliptical area of binary contour 63(BCEA63), elliptical area of binary contour 95(BCEA95)and macular integrity index(MI)in the IS/OS layer intact group were lower, and the levels of average threshold(AT)and P2 were higher(all <i>P</i><0.01), but there was no significant difference in the levels of central retinal volume(CRV)and P1 between the two groups(all <i>P</i>>0.05). Compared with the external membrane defect group, the levels of BCVA(LogMAR), CRT and MI in the external membrane intact group were lower(all <i>P</i><0.05), but there was no significant difference in the levels of CRV, AT, P1, P2, BCEA63 and BCEA95 between the two groups(all <i>P</i>>0.05). Compare the group with and without hard exudation, there was no significant difference in eye parameters between the two groups(<i>P</i>>0.05).There was a significant negative correlation between retinal thickness and sensitivity in temporal, central and nasal sides of fovea(<i>P</i><0.05), but no significant correlation in the upper and lower parts of fovea(<i>P</i>>0.05). In the complete group of IS/OS layer, AT was significantly negatively correlated with CRT and BCVA, while CRT was significantly positively correlated with BCVA(all <i>P</i><0.05). In the IS/OS layer defect group, there was a significant negative correlation between AT and BCVA(<i>P</i><0.05).<p>CONCLUSION:MAIA in the diabetic macular edema is closely related to the morphology and structure of macular area, especially the integrity of IS/OS layer and outer membrane. MAIA may be an important index to evaluate the visual function of patients with diabetic macular edema.
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@#AIM: To analyze the changes of the epiretinal membrane(ERM)stage, macular status and best corrected visual acuity(BCVA, LogMAR)in cataract patients with idiopathic macular epiretinal membrane(IERM)before and after cataract surgery.METHODS:We conducted a single center retrospective observational case series of patients that underwent sequential cataract and idiopatic ERM surgeries from March 2016 to May 2019 in Anyang Eye Hospital. Full data were obtained for 51 patients(54 eyes).Preoperative and postoperative 1mo ERM stage, central macular edema(CME), central macular thickness(CMT), macular volume(MV), ellipsoid zone disruption, occurrence of neurosensory detachment(NSD)and BCVA were analyzed.RESULTS:In this group of patients, 5 eyes(9%)had ERM grade 1, 23 eyes(43%)had ERM grade 2, 21 eyes(39%)had ERM grade 3, and 5 eyes(9%)had ERM grade 4 before surgery; ERM graded 1mo after surgery were keeping steady. Compared with before operation(0.45±0.16),there was no significant change in BCVA(0.47±0.17)at 1mo after operation(<i>P</i>>0.05), but the incidence of CME, ellipsoid band interruption and NSD were significantly higher than those before operation(<i>P</i><0.05). CONCLUSION: We suggest that phacoemulsification did not significantly accelerate ERM progression and affect BCVA, but patients underwent cataract surgery in the presence of epiretinal membranes need tight follow up to treat and control eventual macular infammatory changes and eventual prompt vitrectomy if BCVA was threatened.
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@#AIM:To provide a clinical reference for the design of personalized surgical parameters for cataract, swept source optic coherence tomography angiography(SS-OCTA)was applied to comparatively study the blood flow of the macular area before operation in patients with different intraocular pressure during cataract surgery.METHODS: Prospective randomized controlled study. A total of 61 patients(77 eyes)who underwent cataract surgery in Sichuan Provincial People's Hospital from January to April 2021 were collected and divided into group A(37 eyes)and group B(40 eyes)for the study using a random number table. Group A and group B received the height of 75 and 90cm perfusion bottles with intraoperative,corresponding to 55.5 and 66.6mmHg intraoperative mean intraocular pressure,respectively. All patients were examined with SS-OCTA in macula area before and 1,7 and 30d after surgery, except routine ophthalmologic examination, the macular retinal thickness, the perfusion area and vessel density of the radial perioptic capillary plexus(RPCP)layer, superficial vascular plexus(SVP)layer, intermediate vascular plexus(IVP)layer and deep vascular plexus(DVP)layer were observed.RESULTS: There were no significant differences in the best corrected visual acuity(BCVA), intraocular pressure, foveal avascular zone(FAZ), macular retinal thickness, perfusion area and vascular density between the two groups at each time point before and after surgery(all <i>P</i>>0.05),but there were differences in time(all <i>P</i><0.05). In both groups, BCVA improved significantly from preoperative values at all time points after surgery, intraocular pressure and FAZ decreased compared with preoperative values(all <i>P</i><0.05), and macular retinal thickness, perfusion area in all layers, and blood flow density were increased compared with preoperative values.CONCLUSION:The macular retinal thickness, blood flow density and perfusion area of all layers increased,and the FAZ area decreased after cataract surgery, which may help to promote the recovery of visual acuity after surgery. At different intraocular pressures of 55.5 and 66.6mmHg intraoperatively, there was no significant difference in the patients'postoperative fundus blood flow changes, therefore, intraocular pressure can be flexibly selected during the operation to provide patients with personalized surgical design.
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@#AIM: To explore the effects of different intensity aerobic exercises on macular retinal vascular density in patients with primary open angle glaucoma(POAG). <p>METHODS: Prospective case-control study, 88 eyes of 48 patients with POAG diagnosed in our hospital from January 2019 to April 2021 were included(POAG group), 43 cases(86 eyes)were included in the normal control group(control group). The fundus photographic examination without mydriasis was performed with a mydriatic fundus camera, and the operation and film reading were carried out by a special ophthalmologist. Macular vascular density was measured by macular vascular segmentation method. According to macular vascular density, 48 patients with POAG were divided into low vascular density group and high vascular density group, with 24 cases in each group. 48 patients with POAG were instructed to perform treadmill load exercise to compare the vascular density levels in macular area of patients with high intensity(76%-87% HRmax), moderate intensity(64%-75% HRmax)and low intensity(52%-63% HRmax).<p>RESULTS: The vascular density in macular area of control group was significantly higher than that of POAG group; Compared with the high vascular density group, the age and systolic blood pressure were significantly higher in the low vascular density group, and the body weight was significantly lower; In both low and high vascular density groups, the retinal vascular density of macular area under moderate intensity aerobic exercise was significantly higher than that of low intensity and high intensity aerobic exercise; Systolic blood pressure and aerobic exercise were the influencing factors of vascular density in macular area; the above results showed statistically significant differences(<i>P</i><0.05).<p>CONCLUSION: Systolic blood pressure and aerobic exercise are factors affecting macular vascular density, and moderate intensity aerobic exercise can significantly increase macular vascular density.
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@#AIM: To quantitatively analyze the macular area blood perfusion and retinal thickness of school-age children in each ametropia group by using OCT angiography technology, in order to evaluate the effect of the changes of refractive state on the macular area blood perfusion and retinal thickness during the growth and development of school-age children.<p>METHODS: In this study, 174 eyes were randomly selected from school-age children who were treated in the ophthalmic clinic from July 2018 to March 2019. The superficial retinal capillary of vessel density(SCPVD), deep retinal capillary of vessel density(DCPVD), central retinal thickness(CRT)and average retinal thickness(ART)were quantitatively analyzed using by OCT angiography technology. Additionally, the correlation between blood vessel density in macular area and retinal thickness was analyzed.<p>RESULTS: After quantitatively analysis, compared with emmetropia group, the SCPVD value of the high myopia group was decreased(<i>P</i><0.001). The DCPVD value of the hyperopia group was increased(<i>P</i>=0.004). The ART value of high myopia group was decreased(<i>P</i><0.001).There was no significant difference in CRT values between the ametropia group and the emmetropia group(<i>P</i>>0.05). SCPVD was positively correlated with ART as an independent factor(<i>r</i>=0.274, <i>P</i><0.01).<p>CONCLUSION:In the process of refractive development, SCPVD of children with high myopia decreases and ART becomes thinner. Moreover, SCPVD can be an independent factor positively correlated with ART during the whole refractive development. This suggests that the retina of school-age children with high myopia has presented pathological changes.
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Objective To analyze the clinical features of paracentral acute middle maculopathy(PAMM).Methods A retrospective series case observation was carried out.Clinical data of 11 eyes from 11 patients with PAMM were included in this study from January 2016 to December 2017 in Henan Eye Hospital.All of the patients received general information inquiry,regular ophthalmic examination,color fundus photography,fundus infrared imaging (IR),spectral-domain optical coherence tomography (SD-OCT),OCT angiography (OCTA),fundus fluorescence angiography(FFA),visual field examination and multifocal electroretinography.Results The ages of the patients ranged from 50 to 71 years old,with the average age of 60 years old.There were 9 males and 2 females,including hypertension in 3 patients,hypertension carotid atherosclerotic plaque in 1 patientd,diabetes with carotid stenosis in 2 patients,hypertension with diabetes in 2 patients,only carotid atherosclerotic plaque in 2 patients and chest trauma in 1 patient.The symptoms of PAMM were central or paracentral scotoma within 1 week.The best corrected visual acuity(BCVA) of the patients ranged from 0.6 to 1.0.All of the patients had central or paracentral scotoma or decrease of visual sensitivities.Mf-ERG showed that amplitude density of P1 waves was reduced in 8 eyes.With subtle-white lesion was seen in fundus of 8 eyes and no obvious symptom in 3 eyes.IR imaging demonstrated hypo-reflection in paracentral macula area in all eyes,and their FFA imaging seemed normal.SD-OCT scanning across lesion area revealed hyper-reflection in inner nuclear layer (INL).OCTA demonstrated perfusion deficit in deep capillary plexuses(DCP).After treatment,there was no improvement in BCVA for all the eyes but scotomas were lessened.Conclusions PAMM easily occurs in older males with systemic diseases.PAMM lesson is a occult paramacular middle layer of retinopathy.The combination examination of morphological and functional methods is avaiable for diagnosis.
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PURPOSE: We report a case of branch retinal artery occlusion (BRAO) interconnected with the perifoveal capillaries in a healthy young female. CASE SUMMARY: A 16-year-old female presented with sudden loss of vision in her left eye. Upon initial examination, her left visual acuity was 0.02 and intraocular pressure was 31 mm Hg. Fundus examination revealed pallid retinal edema of the inferior posterior pole and retinal hemorrhage below optic disc. Ocular massage followed by anterior chamber paracentesis was performed for 30 minutes within 4 hours after the onset of vision loss. Fluorescein angiography (FAG) showed a very slow blood flow in the superotemporal and inferotemporal retinal arteries and a delay in retinal arteriovenous transit time. We performed hemodynamic tests such as blood pressure, echocardiography, and the hematologic test for thrombogenicity and all tests were normal. At three weeks after treatment, vision in the left eye was 0.7 and FAG revealed normal retinal arterial circulation and venous drainage time. CONCLUSIONS: This is the first report regarding acute BRAO in a healthy Korean child without any detectable systemic disorder. Prompt treatment can prevent permanent visual loss in BRAO involving the macular area.