Fractal evaluation in retinographies of individuals with different grades of diabetic retinopathy / Avaliação fractal de retinografias de indivíduos com diferentes graus de retinopatia diabética

ABSTRACT Purpose To evaluate the retinal blood vascular network of the retinographies of patients with different grades of diabetic retinopathy. Methods Ninety Retinographies (MESSIDOR database) were used, with different grades of diabetic retinopathy divided into 4 groups: no retinopathy (n=23), grade one (n=20), grade two (n=20) and grade three (n=27) diabetic retinopathy. The grades of diabetic retinopathy were classified according to the number of microaneurysms, number of hemorrhages and the presence of neovascularization. The images were skeletonized and quantified by fractal methods: dimension of box-counting (Dbc) and information (Dinf). Results The means of Dbc values of groups were around 1.25, without statistically significant difference in the dimension values between groups for whole retina. There was also no statistical difference in Dinf values between groups, whose means ranged between 1.294 ± 0.013 (group of grade 1) and 1.3 ± 0.017 (group of grade 3). The retinographies were divided into regions of equal areas. The fractal values of some retinal regions showed statistical differences, but these differences were not enough to show the sensitivity of fractal methods in identifying diabetic retinopathy. Conclusion The fractal methods were not able to identify the different grades of diabetic retinopathy in retinographies.

RESUMO Objetivo Avaliar a rede vascular sanguínea da retina a partir de retinografias de pacientes com diferentes graus de retinopatia diabética. Métodos Foram utilizadas 90 retinografias (banco de dados MESSIDOR), com diferentes graus de retinopatia diabética divididas em quatro grupos: sem retinopatia (n=23), retinopatia diabética de grau um (n=20), grau dois (n=20) e grau três (n=27). Os graus de retinopatia foram classificados conforme o número de microaneurismas, número de hemorragias e presença de neovascularização. As imagens foram esqueletizadas e quantificadas pelos métodos fractais: dimensão da contagem de caixas e informação. Resultados As médias dos valores das dimensões de contagem de caixas para todos os grupos foram próximas a 1,25, sem diferença estatisticamente significativa nos valores das dimensões entre os grupos para retina inteira. Também não houve diferença estatística nos valores da dimensão de informação entre os grupos, cujas médias variaram entre 1,294 ± 0,013 (grupo do grau 1) e 1,3 ± 0,017 (grupo do grau 3). As imagens retinianas foram divididas em regiões de áreas iguais. Os valores fractais de algumas regiões retinais mostraram diferenças estatísticas, mas estas não foram suficientes para mostrar a sensibilidade dos métodos fractais na identificação da retinopatia diabética. Conclusão Os métodos fractais não foram capazes de identificar os diferentes graus de retinopatia diabética em retinografias.

Lateral elongation of flat irregular pigment epithelial detachment: A novel optical coherence tomography biomarker in polypoidal choroidal vasculopathy

Purpose: To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV). Methods: This retrospective cohort study included 76 treatment na飗e fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period. Results: 11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 � 376u and the mean expansion of FIPED at SRF formation was 461 � 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED. Conclusion: Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.

Spectral domain OCT for the differentiation of polypoidal choroidal vasculopathy from wet age-related macular degeneration / 中华实验眼科杂志

Objective To evaluate the sensitivity and specificity of spectral domain optical coherence tomography (SD-OCT) for the differentiation of PCV from wet age-related macular degeneration (wAMD).Methods A cross-sectional study was conducted from Jun 2014 to Apr 2016 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV:double layer sign,pigment epithelium detachment (PED),a sharp PED peak,a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined by κ analyses.Results One hundred and twenty-six patients (132 eyes) with PCV or wAMD were enrolled in the study.In PCV patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 38,35,48,40 and 46,accounting for 67.9％,62.5％,85.7％,71.4％ and 82.1％,respectively.In wAMD patients,PED notch,a hyporeflective lumen representing polypoidal lesion,PED peak,double layer sign and PED were 12,3,11,8 and 26,accounting for 14.5％,10.5％,34.2％,15.8％ and 3.9％,respectively,which were all lower than PCV,with statistically significant differences (all at P＜0.001).SD-OCT detected PCV in 49 of 56 eyes and 10 PCV patients were misdiagnosed as wAMD.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 87.5％ and 86.8％,respectively.The consistence between SD-OCT and imdocyanine green angiography (ICGA) was moderate (κ:=0.738,P＜0.001).Conclusions SD-OCT exhibits high sensitivity and specificity in PCV diagnosis.The presence of DLS,PED,a sharp PED peak,a PED notch,and a hyporeflective lumen representing polypoidal lesion is suggested to be a new diagnostic strategy for PCV.

Spectral domain OCT for the differentiation of polypoidal choroidal vasculopathy from wet age-related macular degeneration / 中华实验眼科杂志

Objective@#To evaluate the sensitivity and specificity of spectral domain optical coherence tomography (SD-OCT) for the differentiation of PCV from wet age-related macular degeneration (wAMD).@*Methods@#A cross-sectional study was conducted from Jun 2014 to Apr 2016 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV: double layer sign, pigment epithelium detachment (PED), a sharp PED peak, a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined by κ analyses.@*Results@#One hundred and twenty-six patients (132 eyes) with PCV or wAMD were enrolled in the study.In PCV patients, PED notch, a hyporeflective lumen representing polypoidal lesion, PED peak, double layer sign and PED were 38, 35, 48, 40 and 46, accounting for 67.9%, 62.5%, 85.7%, 71.4% and 82.1%, respectively.In wAMD patients, PED notch, a hyporeflective lumen representing polypoidal lesion, PED peak, double layer sign and PED were 12, 3, 11, 8 and 26, accounting for 14.5%, 10.5%, 34.2%, 15.8% and 3.9%, respectively, which were all lower than PCV, with statistically significant differences (all at P<0.001). SD-OCT detected PCV in 49 of 56 eyes and 10 PCV patients were misdiagnosed as wAMD.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 87.5% and 86.8%, respectively.The consistence between SD-OCT and imdocyanine green angiography (ICGA) was moderate (κ=0.738, P<0.001).@*Conclusions@#SD-OCT exhibits high sensitivity and specificity in PCV diagnosis.The presence of DLS, PED, a sharp PED peak, a PED notch, and a hyporeflective lumen representing polypoidal lesion is suggested to be a new diagnostic strategy for PCV.

OCT and OCTA observation of polypoidal choroidal vasculopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare and observe the image characteristics of polypoidal choroidal vasculopathy(PCV)with frequency domain optical coherence tomography(OCT)andoptical coherence tomography angiographyoptical(OCTA).<p>METHODS: Totally 25 eyes of 25 patients diagnosed with PCV in our hospital from March 2018 to December 2018 were included in the study. All the patients were examined by fluorescein fundus angiography(FFA)and /or indocyanine green angiography(ICGA)and OCT and OCTA were performed at the same time. Their similarities and differences between OCT and OCTA were compared.<p>RESULTS: OCT examination showed 14 eyes with serous and hemorrhagic pigment epithelial detachment(PED)in 25 eyes. OCTA lesions were in dark areas with low signal and 9 eyes showed strong signal points beside. OCTA showed branch vascular network(BVN)of reticular structure in 11 eyes with double layer sign. In 12 eyes with polyps lensions, OCTA showed strong or low signal areas.<p>CONCLUSION: OCTA is more intuitive to BVN in eyes with PCV. Polyps show strong or weak signals. Serous and hemorrhagic PED, OCT and OCTA images all showed low reflection or low singial dark ares,without characteristic. The lesion location and morphology of the two showed similarities, but also differences.

”Double-layer sign” on spectral domain optical coherence tomography in pachychoroid spectrum disease

Purpose: The “double-layer sign (DLS)” describes the shallow and irregular elevation of the retinal pigment epithelium from the underlying intact Bruch's membrane visualized on the spectral domain optical coherence tomography. In this study, we evaluated the frequency, characteristics of the space within the double layer and other features in the pachychoroid spectrum to aid the clinical diagnosis of these variants. Methods: This retrospective study evaluated the features of the DLS on multimodal imaging in consecutive patients with a clinical diagnosis of one of the four variants of pachychoroid: pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PCN), chronic central serous chorioretinopathy (CCSCR), and polypoidal choroidal vasculopathy (PCV). The features of the DLS were graded by two masked graders. Results: Overall, 102 eyes of 79 consecutive patients with pachychoroid spectrum were identified for grading. Sixteen eyes with PPE did not show any evidence of DLS. The DLS was identified in 15/16 (93.75%) eyes with PCN, 11/35 (31.43%) with CCSCR, and 32/35 (91.43%) with PCV (P < 0.001). The space within the DLS showed moderate hyperreflectivity in all eyes with PCV and PCN, while the space in the DLS in CCSCR showed uniform hyporeflectivity in 10/11 (%) eyes. Conclusion: The DLS sign was most frequent in polypoidal vasculopathy and PCN. A hyporeflective gap within the DLS favored the diagnosis of CCSCR.

Polypoidal choroidal vasculopathy: Pearls in diagnosis and management

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.

The application of subdermal vascular network skin graft in severed finger reunion with small area skin defects / 中国医师进修杂志

Objective To explore the application of subdermal vascular network skin graft in severed finger reunion with small area skin defects.Methods Modified subdermal vascular network,which was inversion thin and middle thick,was used to repair defect of severed finger reunion without exposure of blood vessel.There were 10 patients and 14 fingers,including 7 patients and 10 fingers injured in the dorsal sid with 5 fingers' extensor tendon exposed,and 3 patients and 4 fingers injured in the palmar side with 2 patients' flexor tendon exposed.The defect area was ranged from 1.0 cm × 0.8 cm to 3.0 cm × 1.5 cm.Results In 6 larger subdermal vascular network,skin's edge became blue and blister appeared in the middle.The others was good with skin texture and aspect.Conclusions Modified subdermal vascular network skin graft is safe and effective choose to solve severed finger reunion with smnall area skin defects.

Repair of skin and soft tissue defects of the extremity by transplantation of a U-shaped trimmed ilioinguinal flap / 中华显微外科杂志

Objective To explore the efficacy of transplantation of a U-shaped ilioinguinal flap in the re pair of skin and soft tissue defects of the extremity.An axial flap based on the superficial iliac circumflex artery and trimmed to a subdermal vascular network flap was used for the procedures.Methods Seven patients with skin and soft tissue defects treated between June,2009 and May,2014 were studied.The patients were 22-45 years of age (mean,32 years),and included 5 males and 2 females.Four patients had punch-press injuries,1 patient had a hot-crush injury,and the remaining 2 patients were injured in the accidents.The wound sizes were 14.0 cm × 10.0 cm to 6.0 cm × 5.0 cm,with a varying extent of exposed tendons and bones.Repairs were performed using free ilioinguinal flaps,which were 15.0 cm × 11.0 cm to 7.0 cm × 5.0 cm in size.The axial flap was trimmed to a U-shaped subdermal vascular network flap and transplanted to the recipient site with anastomosis of blood vessels.Results All transplanted flaps survived.Four patients were followed for 1-6 months,with a mean duration of follow-up of 4 months.The trimmed flaps showed gradual reddening immediately after surgery,and the capillaries were recovered with a flat surface.Re-examination 3 months after surgery showed that the flaps were thin and flexible and met the aesthetic demand.No obvious pigmentation occurred,and the donor site was sutured directly,leaving only linear scars.Conclusion Repair of skin and soft tissue defects of the extremity using a U-shaped trimmed ilioinguinal flap has the advantages of a hidden donor site,small scar,and conformity to aesthetic requirements.The trimmed flaps are preferred over untrimmed flaps in terms of color and texture.The former flap is thinner,meets the aesthetic demand,and achieves a better efficacy.

A Study of the Vascular Network of the Iris Using Flat Preparation

PURPOSE: This study was performed to examine the vascular network of the human iris using flat preparation. METHODS: The ciliary body-iris structures were separated from human eyeballs, and a portion of the irises were treated with trypsin to remove the pigment granules. These iris tissues were unfolded and placed onto glass slides using flat preparation, and the vascular network of each iris was examined by fluorescein microscopy. The ciliary body-iris structures separated from the remaining eyes were stained with hematoxylin-eosin without trypsin treatment and were examined by light microscopy. RESULTS: The long posterior ciliary artery formed several branches before entering the iris root, and such branches formed the major arterial circle of the iris with diverse diameters in the vicinity of the iris root and the ciliary process. In the pupillary margin, the iris vasculature network formed a cone shape and then formed an arcade by connecting to adjacent vasculatures. In the vicinity of the collarette, the iris vasculature network formed the minor arterial circle of the iris with diverse diameters perpendicular to the arcade of the iris network located in the pupillary margin. In the pupillary margin, the capillaries were somewhat thick and connected to the irregular traveling iris vein. CONCLUSIONS: The above findings explain the human iris vascular network and provide a theoretical basis for the sectoral filling of the iris vasculature seen in fluorescein iris angiography.

Changes of Network Vessels after Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate whether the branching vascular network component of polypoidal choroidal vasculopathy (PCV) could be occluded after photodynamic therapy (PDT). METHODS: A retrospective clinical study based upon indocyanine green angiogram was performed in 26 eyes of 26 patients having PCV and treated with PDT. RESULTS: Of the 19 eyes which received a single session of PDT, none showed complete occlusion of the vascular network and 16 (84%) showed, at least in part, a persisting vascular network. Of the 7 eyes which had two session of PDT, 1 (14%) showed complete occlusion of the vascular network, and 3 (43%) showed, at least in part, a persisting vascular network. Changes in the vascular network could not be evaluated with exactness in 6 eyes. Of the 18 eyes achieving clinical improvement after single PDT, 3 had recurrence of hemorrhagic or exudative changes from new polypoidal lesions which originated from the persisting vascular network. CONCLUSIONS: It is difficult to expect complete occlusion of branching vascular network after PDT, which means future recurrence may not be prevented even though occlusion of polyps accompanied with clinical improvement can be achieved with PDT.

Effectiveness of Vascular Network Including Angular Artery in Inner Canthal Region for Mid-facial Reconstruction

Angular artery as a terminal branch of facial artery ends at inner canthal region and anastomoses with adjacent arteries to form the vascular network in this region. Flaps using this network have been widely used to reconstruct the mid-facial defects. This study was designed to investigate the anatomical basis of theses arteries, especially angular artery which is known to have variable courses, and to demonstrate safety and effectiveness of flaps using this network. The authors reviewed several textbooks of anatomy and reported literatures through MEDLINE search about anatomy of angular artery and its anastomosis. To document clinical application, the authors also analyzed clinical experiences of 19 patients for recent 6 years who were undergone the reconstructive flap surgeries for mid-facial defects using forehead, dorsal nasal and retroangular flaps based on anastomosed vascular network in inner canthal region. As a result of review, the authors could not get an exact conclusion, although there were numerous opinions about anatomical variations of facial and angular artery. However, robust network composed of anastomotic arteries in inner canthal region seems to give high viability to flaps due to rich blood supply regardless of variation. Clinical experiences also showed excellent flap viability without any complication and satisfactory results functionally and cosmetically. In conclusion, flaps using vascular network in inner canthal region should be suggested as safe and effective methods for mid-facial reconstruction.

Changes of DNA content in the fibroblasts of narrow pedicled subdermal vascular network flap during its surviving / 中华医学美学美容杂志

Objective To study the dynamic changes of DNA content of the fibroblasts in narrow pedicle subdermal vascular network flap (SVNP) during their surviving. Methods Eighteen pieces of surviving skin in pig back with size of 16 cm?8 cm and pedicle wideness of 4 cm were stained with acridine orange, and their DNA contents were measured with the adherent cell analysis and sorting cytometer 570. The tissue samples were taken at 3, 4 ,5 ,and 7 days after operation from different parts of the flap.Results The DNA content of fibroblast in the proximal part of the flap was slightly changed, those in the middle portion increased from 3rd to 5th day and became normal at 7th day, and in the distal portion progressively increased after operation. The results suggested that the transitional part of the flap and skin graft in the middle portion was most active in function and metabolism, and well survived, but the distal portion of the graft was poor in surviving and had a long repairing period. These indicated that local tissue hypoxia stimulated proliferation of fibroblasts and synthesis of the DNA in a short time, but as time wert by, the proliferative speed and DNA synthesis in the individual cell were heterogeneous, probably because of the degeneration or necrosis of some epidermal cells in the graft. Conclusion The wideness and length of the pedicle as well as its vascular anastomoses should be readjusted to promote the blood circulation of the distal skin graft tissues.

A clinical anatomic study on the subdermal vascular network skin flap in antebrachial region / 中华创伤骨科杂志

Objective To investigate the vascular architecture of subdermal vascular network in antebrachial region, and provide anatomic basis for designing the subdermal vascular network skin flap in the antebrachial region. Methods Anatomical observation and measurement of the blood supply, arterial architecture and venous return of the subdermal vascular network skin flap in anterior antebrachial region were performed on 8 fresh adult specimens perfused with latex and black ink. Results It was found that 4～15 or more fine perforators derived from each the terminal end of the brachial artery and radial or ulnar arteries in anterior antebrachial region, and their diameters were between 0.2～0.9 mm. The anatomical studies showed that the fasciocutaneous perforators supplying the in anterior antebrachial region were found to form rich "spider nevus"arterial networks on the subdermal layer. Moreover, the subdermal vascular networks were also found to give off fine arterial branches into papillary and superficial fascia layers, respectively, to form papillary vascular plexus and superficial fascia vascular network, and all of the vascular networks were anastomosed densely each other. The subdermal venous networks were also anastomosized in plexus and drained into the deep vein. Conclusion Either a random or an axial subdermal vascular network skin flap of the anterior arm can be designed according to the need of recipient defect, and the latter may also be designed as a transfer or a free subdermal vascular network skin flap according to the size of the arterial diameter in the pedicle of skin flap.

Free Skin Graft with Subcutaneous Vascular Network / 대한피부과학회지

BACKGROUND: Full-thickness skin graft(FTSG) for deep skin defects often results in poor contour cosmetically due to insufficient thickness and does not take on defects with exposed bone or cartilage. These lesions may require more difficult methods such as skin flaps. OBJECTIVE: To describe the usefulness of free skin graft(FSG) with some fat and vascular network on the underside, and therefore thicker than FTSG, for repairing deep cutaneous defects on the nose. METHODS: Five patients, four with skin cancers and one with a combined nevus, were treated with FSG harvested from the postauricular area as the donor site. RESULTS: These grafts provided excellent cosmetic and functional results in all patients without complications. CONCLUSION: FSG with subcutaneous vascular network is useful in reconstruction of deep skin defects instead of complex, multistaged skin flaps. Moreover, its cosmetic outcome is superior to FTSG.