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AIM: To observe the structural and functional changes of retinal tissue in rats after different duration of intense blue light irradiation.METHODS: A total of 48 healthy 8-week-old SD male rats were selected and randomly divided into the control group(n=12)and 3, 6 and 12h experimental groups(n=36). The rats in the control group received natural light, and the rats in the experimental groups received blue light with a wavelength of 465±5nm and the illumination of 1000±100lx for 3, 6, and 12h each day. Optical coherence tomography(OCT), fundus fluorescein angiography(FFA)and haematoxylin-eosin(HE)staining of paraffin pathological section were used to observe the changes of the retinal thickness, retinal tissue structure and the function in different directions and layers.RESULTS: The OCT results showed that the retinal thickness in the superior, inferior, nasal, and temporal sides of rats in different groups was statistically significant(P<0.05), and there was no statistical significant difference between the control group and the 3h experimental group in the total retinal thickness(P>0.05), while the differences between any other two groups were statistically significant(P<0.05); The mean total retinal thickness, internal limiting membrane(ILM)-inner nuclear layer(INL)thickness, outer plexiform layer(OPL)-outer segment(OS)thickness and retinal pigment epithelium(RPE)of rats in each group were statistically significant(P<0.05), and the mean total retinal thickness and OPL-OS thickness were statistically significant between any two groups(P<0.05). The ILM-INL thickness of rats in the control group and 3 and 12h experimental groups was statistically significant(P<0.05), and the thickness of RPE layer in the 12h experimental group was statistically different from that of the 3 and 6h experimental groups(P<0.05). FFA results showed that there was no obvious fluorescence leakage in the fundus of rats in the control group and the 3h experimental group, while there was obvious fluorescence leakage and hyperfluorescence in the retina of the 6 and 12h experimental groups, and the background fluorescence of choroid was enhanced. HE staining showed the atrophy and apoptosis of cells in the optic cell layer, and some lightly stained nucleus. In addition, RPE layer showed atrophy and thinned with the increase of light time, and there was significant difference in the number of the optic cells between the control group and experimental group(P<0.05).CONCLUSION: The intense blue light irradiation could cause thinning of the retina in rats, with varying degrees of thinning in different layers of the retina. It could also led to decrease and even disappearance of the number of cells in the visual cell layer, the focal atrophy of the RPE layer, and the change of vascular permeability. With the extension of the light time, the structural and functional changes in retinal tissue became more obvious.
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Retinal arterial macroaneurysm(RAM)is a kind of acquired retinal vascular disorder. The pathogenesis of RAM is not yet clear, and it is associated with some systemic conditions, including hypertension, arteriosclerosis and hyperlipidemia. RAM is prone to exudation or bleeding, leading to some other complications in the condition of hypertension due to the weak tube wall, and its clinical manifestations are complex and diverse, which makes it difficult to diagnose. RAM itself has a tendency of self-degeneration, and the prognosis of visual acuity is good if the lesion doesn't involve the macular area. However, when the macula is affected by exudation and/or bleeding, the vision is severely affected and some feasible treatments are needed. Understanding the typical imaging manifestations of RAM is helpful to make a definite diagnosis and give corresponding treatment measures. In this paper, the manifestations of RAM by various examination methods are reviewed and the corresponding treatments of different types of RAM are summarized, aiming to provide reference for the early diagnosis and treatment of RAM in the future.
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Fundus fluorescein angiography (FFA) is usually performed intravenously through injection of sodium fluorescein dye. This procedure is difficult to perform in children and patients who are afraid of intravenous needles. Oral FFA can serve as a useful alternative to intravenous FFA in many cases and gives reliable results. We describe the recommended protocol and technique for doing oral FFA in adults and children
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AIM: To observe the macular retina vascular density of patients with acute central retinal artery occlusion(CRAO)by optical coherence tomography angiography(OCTA)and to analyze the relationship with retinal circulation time of these patients on fundus fluorescein angiography(FFA).METHODS: Retrospective case analysis. A total of 43 patients(43 eyes)from January 2019 to March 2021 admitted to Shaanxi Eye Hospital with clinical diagnosis of acute CRAO(course of disease ≤7d)were included. All patients underwent FFA, OCTA, best corrected visual acuity(BCVA)examination and thrombolytic therapy. The patients with enhanced or unchanged retinal blood flow signal in the affected eye showed on OCTA before treatment compared with the contralateral healthy eye were assigned to group A, and the patients with retinal blood flow signal of the affected eye was lower than that in the contralateral healthy eye by OCTA were assigned to group B. Image J software was used for OCTA image processing to evaluate the macular retina vascular density before treatment, and FFA examination was performed to record the affected retinal circulation time before treatment.RESULTS: The retinal vascular density of patients in the affected eye and the contralateral healthy eye in group A was higher than that in group B(25.08%±4.40% vs 12.24%±3.41%, 25.72%±2.70% vs 17.89%±4.55%, all P<0.001), the filling time(FT)of retinal artery trunk to terminal in group B [96(20.50, 193.50)s] was longer than that in group A [11(5.00, 19.50)s](P<0.001). The course of disease, the retinal vascular density of contralateral healthy eye and FT were related factors of retinal vascular density of the affected eye(all P<0.05), and the influence strength order was FT, course of disease and the retinal vascular density of contralateral healthy eye, in which the course of disease and FT was negatively correlated with the retinal vascular density.CONCLUSION: OCTA retinal vascular density was correlated with FFA retinal circulation time in CRAO patients.
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Central retinal vein occlusion(CRVO)is a common retinal vascular disease that severely affects visual acuity. Currently, ranibizumab, aflibercept and dexamethasone implant have been successful in treating macular edema associated with CRVO. However, there were still 1/3 patients with no significant improvement in vision after treatment, 30.7% patients with macular edema subsiding after treatment but recurring, and 28.1% patients with macular edema persisting after treatment. How to determine the prognosis of patients by their different clinical manifestations at the early stage of disease onset can help clinicians to better select treatment options for patients according to their specific disease conditions. Recent studies on the prognosis of CRVO treatment have focused on imaging markers including disorganization of retinal inner layers, retinal hyperreflective foci, subretinal fluid, ischemic index, leakage index, and biomarkers including VEGF, interleukin(IL)-6, IL-8, etc. This article reviews the progress of research on factors related to the prognosis of CRVO, with the aim of treating, managing and monitoring patients with CRVO more precisely and effectively.
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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.
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【Objective】 To investigate the imaging features of weak response after anti-vascular endothelial growth factor (VEGF) treatment for refractory diabetic macular edema (DME) with vesicles. 【Methods】 We made a retrospective analysis of the clinical data of 120 patients with DME (120 eyes) who received anti-VEGF therapy in Ophthalmology Department of The Second Affiliated Hospital of Xi’an Jiaotong University from March 2018 to September 2019 and the same anti-VEGF medicine with the therapeutic regimen of 3+PRN. Of the 50 patients with cystoid macular edema (CME), 40 of them had a significant response and 10 had a weak response. The characteristics of optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) for the patients with weak response after anti-VEGF therapy were comparatively analyzed. 【Results】 Eyes with vesicular DME that responded weakly to anti-VEGF treatment had similar imaging characteristics. The OCT images showed impurity-independent vesicles located in the inner layer of the retina. Compared with the obvious response group, the reflection signal of the vesicle area was significantly enhanced. In early images of FFA, micro-angiomas related to vesicle formation were seen in both groups. However, in the late FFA image, the leakage intensity of vesicles in the weak response group was significantly lower than that in the obvious response group. 【Conclusion】 Vesicular DME with poor anti-VEGF treatment has the characteristics of high reflection in OCT and weak fluorescence leakage in FFA. This study is helpful for preoperative evaluation of anti-VEGF treatment.
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A 35-year-old male, a case of Takayasu arteritis on treatment with oral prednisolone and methotrexate, revealed novel ultrawide field fluorescein angiographic features in bilateral eyes. The typical features of delayed arm-retina circulation time, lobulated areas of nonperfusion in choroid, cattle trucking of red blood cells in veins, and delayed arteriovenous transit time were nicely captured. Additionally, we noted peripheral perivascular hyperfluorescence and disc hyperfluorescence. We believe these findings could possibly be used as markers of disease activity. Lack of marked capillary nonperfusion areas and marked perivascular leakage probably signifies modulation of disease activity by the immunosuppressants.
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Purpose: Retinal hemangioblastomas (RHs) are characteristic of von Hippel-Lindau (VHL) disease. Early diagnosis of retinal lesions may aid in systemic diagnosis. Early identification of VHL is life-saving and also prevents vision loss. Fundus fluorescein angiography (FFA) is a useful tool in the diagnosis and management of RHs. The aim of this study is to report FFA features of RH using ultra-widefield (UWF) imaging. Methods: A retrospective cross-sectional study of consecutive patients of RH who underwent UWF FFA at a tertiary eye care center. Images were analyzed and assessed by authors. The main outcome measures were (a) the number and size of RH in each eye and (b) vascular characteristics of the retina. UWF-FFA characteristics in each eye were tabulated. The number of clock hours involved by these characteristics and their correlation with the number and size of RH were analyzed. Results: The study evaluated 24 eyes of 13 patients. The mean age was 28.4 years. The median number of RHs in an eye was 3.5 (range 1�16), and the size of RHs varied from 0.1 to 4 disc diameters. Novel UWF-FFA findings noted in this study were the presence of abnormal capillary network in 22 of 24 eyes (91.7%), capillary leakage in 15 of 24 eyes (62.5%), and capillary telangiectasia in 7 of 24 eyes (29.2%). In addition, feeder arterioles and venules showed bulbous projections in 8 of 24 eyes (33.3%). Conclusion: The UWF-FFA characteristics of RH, which have not been described before, were identified. These add to our understanding of the pathogenesis of the disease and may pave the way for future therapeutic targets.
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Background: Central Serous chorioretinopathy (CSCR) is one of the common causes of visual handicap affecting young people of highly intellectual professionals at the peak of their career which can lead to irrecoverable loss of vision.Methods: The present prospective observational population-based study was conducted in the Department of Ophthalmology, S.C.B. Medical College, Cuttack, Odisha from October 2013 to September 2015. The total number of patients attended the Outpatient Department (OPD) during the study period were 1,83,199. Amongst which 123 patients diagnosed to have CSCR were selected for the present study.Results: Incidence of CSCR during in this study period was 0.06%. The age group most commonly affected was 31 to 40 years. Males were affected 7 times more commonly than females. Increased incidence was noticed in bank employees (21.1 %) and IT professionals (17.8%).Conclusions: There was increased incidence of the disease in people under stressful life condition.
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@#AIM:To observe the clinical value of digital nonmydriatic funds photography in screening diabetic retinopathy and early intervention of hospitalized diabetic patients. <p>METHODS: Totally 130 diabetic patients hospitalized in Department of Endocrinology of our hospital were selected from January 2015 to December 2016. All patients were underwent non-mydriatic digital fundus photography and fundus fluorescein angiography(FFA). <p>RESULTS: There were 82 eyes diagnosed as non-proliferative diabetic retinopathy(NPDR)and 28 eyes as proliferative diabetic retinopathy(PDR)by non-mydriatic digital fundus photography. There were 89 eyes diagnosed as NPDR and 29 eyes as PDR by FFA. Compared with the result of the gold standard, the Kappa value of non-mydriatic digital fundus photography was 0.87(>0.61), and the test was consistency. There was no significant difference between the two methods in the detection of diabetic retinopathy in different stages(<i>P</i>>0.05). The positive rate of diabetic retinopathy was significantly higher in patients with diabetes mellitus over 10a(<i>P</i><0.05). <p>CONCLUSION: Digital fundus photography is an effective method for early detection of DR in hospitalized diabetic patients. It is of great significance to reduce the blindness rate of diabetic retinopathy.
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@#Serpiginous choroiditis(SC)is a rare, chronic-idiopathic inflammatory disease mainly involving choriocapillaris and the retinal pigment epithelium(RPE), characterized by grayish yellow geographic lesions. Pathogenesis is unclear, the choriocapillaris is a main pathology of SC. Based on clinical presentation, it can be classified into peripapillary, macular, and ampiginoustype. The clinical appearance of SC is varied and similar to those of acute posterior multifocal placoid pigment epitheliopathy(APMPPE), tuberculosis, toxoplasmosis and choroidal ischemia. So, it is still difficult to diagnose SC without typical fundus symptoms.With the development of science and technology, multimode imaging such asfundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography are helpful for the diagnosis of SC, assessment of lesion extent, activity, and complications. Besides, it's very important to avoid unnecessary drug use.
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We report a case of 22-year-old young male who presented with a 3-month history of gradual and painless decrease of vision in his right eye (RE). On ophthalmological examination, best-corrected visual acuity in his RE was counting finger close to the face. Left eye ophthalmic examination was unremarkable. RE indirect ophthalmoscopy revealed multiple telangiectatic vessels, aneurysmal dilations, extensive yellow (lipid) exudation over the posterior pole along with perivascular exudation, and multiple sclerosed vessels in peripheral retina. Fluorescein angiography also revealed progressive leakage from telangiectasias, multiple aneurysmal outpouchings, extensive capillary dropouts, and vascular communicating channels in all quadrants. Spectral-domain-optical coherence tomography of macula demonstrated marked intraretinal fluid. Based on the above findings, a diagnosis of healed retinal vasculitis with Coats'-like response was made. The patient received 4-weekly two intravitreal bevacizumab injections which resulted in stabilization of the retinal findings and improvement in visual acuity.
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The aim of this study is to compare the optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) features of retinal capillary hemangioblastoma (RCH). This is an observational case series of three patients with von Hippel朙indau (VHL) disease and one patient with juxtapapillary RCH. All patients underwent FFA with a mydriatic fundus camera and OCTA with swept-source angio OCT. The FFA and OCTA characteristics of tumors were compared. In our series, FFA could identify tumors as small as the width of a third-order retinal artery, which was missed on clinical examination. OCTA identified these tiny tumors, but only those closer to the posterior pole. Both FFA and OCTA could identify the intrinsic vasculature and feeder vessel in juxtapapillary RCH. On OCTA, the tumors were better defined than in FFA. The depth of the lesion can be identified on OCTA. Feeder and the draining vessels could be identified precisely in OCTA than FFA, particularly in small tumors. OCTA can identify tumors in VHL missed on clinical examination. It can identify the feeder vessel and intrinsic vasculature of sessile juxtapapillary RCH and aids in its diagnosis. Tumors are better defined in OCTA than FFA due to the absence of leakage. However, FFA can identify nearly all the early tumors, but OCTA fails to image the peripheral tumors due to its smaller field and prolonged acquisition time. Technological advances and the development of wide-field OCTA in the future can be helpful in identifying all the unsuspected tumors in VHL disease.
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@#AIM: To research and discuss the value and features of fluorescence fundus angiography(FFA)in patients with diabetic retinopathy. <p>METHODS: We selected 130 hospitalized diabetic patients suspected with diabetic retinopathy from January 2014 to February 2018 in our hospital. All patients underwent fundus photography and FFA examination. We analyzed the detected retinopathy. The reference was the clinical diagnosis, to calculate the sensitivity, specificity and accuracy of fundus photography and FFA in diagnosis of diabetic retinopathy and to compare the diagnostic accuracy of fundus photography and FFA for different degrees of diabetic retinopathy. The FFA characteristics of diabetic retinopathy was analyzed. Kappa consistency test was used to analyze the consistency between the two diagnostic methods and the clinical diagnosis results. <p>RESULTS: The sensitivity, specificity and accuracy of FFA on diabetic retinopathy were 96.8%, 97.1%, 96.9%, all of which were above the fundus photography(<i>P</i><0.05). The diagnostic accuracy of FFA in mild, moderate, severe diabetic retinopathy were 97.1%, 97.0%, 96.4%, all above the fundus photography without significance(<i>P</i>>0.05). The Kappa consistency test showed the consistency between the diagnosis results of FFA and clinical was good; and the consistency between the results of the clinical and fundus photography was only moderate. FFA test results showed that diabetic retinopathy were more visible in nasal retinal lesions and in the peripheral part from the optic disc, and intraretinal microvascular abnormalitie could be seen. In diabetic retinopathy, the number and distribution of retinal microangiomas, hemorrhagic spots, vein beads, and capillary non-perfusion zone were different. Some patients, before the formation of retinal microangiomas and hemorrhagic spots, had increased foveal thickness, focal cotton-wool spot and focal capillary non-perfusion zone. <p>CONCLUSION: FFA has high sensitivity, specificity and accuracy in the diagnosis of diabetic retinopathy. The consistency between FFA diagnosis and clinical diagnosis is strong. FFA has accurate diagnosis for suspected changes in fundus photography.