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ABSTRACT Purpose: To evaluate using optical coherence tomography angiography the macular and optic nerve head blood flow in pediatric patients with epilepsy treated with levetiracetam for at least 12 months. Methods: This study included 33 pediatric patients with epilepsy and 30 sex- and age-matched healthy volunteer children were included in the study. Optical coherence tomography angiography was used to evaluate the optic nerve head and macular perfusion changes. The mean ocular perfusion pressures were also calculated. Patients who were using multiple antiepileptic drugs or had a prior history of using different drugs were excluded. Results: The choriocapillaris flow area was significantly lower in the Study Group than in the Control Group (p=0.006). However, the foveal avascular zone and vessel densities of the macula in the superficial capillary plexus, deep capillary plexus, and optic nerve head of the study group were not significantly different from those of the control group (p>0.05). Moreover, no significant difference in means of mean ocular perfusion pressure was found between the two groups (p=0.211). No obvious correlation was found between treatment duration and optical coherence tomography angiography parameters or mean ocular perfusion pressure. Conclusion: Choroidal perfusion was reduced in children taking levetiracetam compared with that in the control group, whereas retinal perfusion was not affected in this optical coherence tomography angiography study.
RESUMO Objetivo: Avaliar através de angiotomografia de coerência óptica o fluxo sanguíneo macular e da cabeça do nervo óptico em pacientes pediátricos com epilepsia tratados com levetiracetam por pelo menos 12 meses. Método: Trinta e três pacientes pediátricos com epilepsia e 30 crianças voluntárias saudáveis pareadas por sexo e idade foram incluídos no estudo. A angiotomografia de coerência óptica foi utilizada para avaliar as alterações da perfusão da cabeça do nervo óptico e da macular. As médias das pressões de perfusão ocular também foram calculadas. Pacientes em uso de múltiplas drogas antiepilépticas ou com história prévia de uso de diferentes drogas foram excluídos do estudo. Resultado: A área do fluxo coriocapilar foi significativamente menor no Grupo Estudo do que no Grupo Controle (p=0,006). Entretanto, a zona avascular foveal e as densidades vasculares no plexo capilar superficial e profundo da região macular e na cabeça do nervo óptico não foram significativamente diferentes daquelas de olhos saudáveis (p>0,05). Também não houve diferença significativa entre os dois grupos em relação às médias da pressão de perfusão ocular (p=0,211). Nenhuma correlação aparente foi encontrada entre a duração do tratamento e os parâmetros da angiotomografia de coerência óptica ou a média da pressão de perfusão ocular. Conclusão: Em crianças usando levetiracetam, a perfusão coroidal mostrou-se reduzida em comparação ao grupo controle, enquanto a perfusão retiniana não foi afetada neste estudo com angiotomografia de coerência óptica.
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Purpose: To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods: Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual?Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results: Twenty?eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion: MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low?flow regions, likely because capillary loss is associated with their regression.
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Purpose: To analyze the topographic distribution of neovascularization (NV) and capillary nonperfusion (CNP) using ultra?wide field fluorescein angiography (UWFFA) in patients with proliferative diabetic retinopathy (PDR). Methods: This was a prospective, single?center, observational study in which all patients who presented between March 2019 and December 2020 and satisfied the inclusion criteria were recruited. In our study, patients with treatment?naïve PDR without any fibrovascular proliferation underwent UWFFA. The images were analyzed qualitatively for the topographic distribution of NV and the CNP area was quantified. The number of lesions picked by UWFFA was compared with 7 standard field (7SF) image using overlay of 7SF. The main outcome measure was characteristics of neovascularization, such as the number, location, and area of CNP, measured using UWFFA, which was considered with 95% confidence intervals (CI). Results: Two hundred and fifty?three eyes of 187 patients with a mean age of 56.03 ± 8 years were included. Mean neovascularization elsewhere (NVE) was 2.91 ± 3.43. Maximum NVEs were seen in the superotemporal (ST; 0.9 ± 1.13) quadrant, followed by the inferotemporal (IT; 0.7 ± 1.08), inferonasal (IN; 0.66 ± 1.02) and superonasal (SN; 0.66 ± 1.01) quadrants. Maximum CNP area was seen in the SN (13.75 ± 8.83 disc diameter square [DD2]) quadrant, followed by the IN (13.48 ± 8.59 DD2), IT (11.34 ± 8.37 DD2), and ST (11.3 ± 8.34 DD2) quadrants. Mean CNP area was maximum in patients with only neovascularization of disc (NVD; 64.99 ± 41.47 DD2), followed by both NVD and NVE (61.37 ± 35.61 DD2), and was minimum in patients with only NVE (36.44 ± 22.03 DD2). Eighty?one (32%) eyes out of 253 had NVE and 189 (75%) out of 253 had CNP area outside 7SF (overlay) of Early Treatment Diabetic Retinopathy Study (ETDRS). Conclusion: Diabetic NV lesions and CNP areas are distributed asymmetrically throughout the retina and are not restricted to the posterior pole. Compared to conventional 7SF imaging, UWFFA reveals significantly more retinal vascular pathology in patients with PDR.
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ABSTRACT This is a case report involving a 56-year-old male patient with a history of pars plana vitrectomy due to a rhegmatogenous retinal detachment in the right eye that resulted in the implantation of a drainage device after the patient developed secondary glaucoma. Two years after the device's implantation, the patient was referred to our care as his visual acuity had decreased to 20/200 (1.00 LogMAR). At the fundus evaluation, a choroidal amelanotic elevation was observed at the upper temporal equator, and a potential diagnosis was made of amelanotic choroidal melanoma. The ultrasound exam visualized the patient's implanted superotemporal justabulbar drainage device, which revealed a transscleral communication from the plate fibrocapsular's draining space to the suprachoroidal space (fistula). The ultrasound also revealed a focal pocket of choroidal detachment in the patient's superotemporal region, simulating an amelanotic choroidal melanoma. A new pars plana vitrectomy was performed to remove the internal limiting membrane without repercussions at the fistula site. The patient's recovery progressed well, and he regained a visual acuity of 20/70 (0.55 LogMAR). To the best of our knowledge, this is the first case report of this condition.
RESUMO Relato de caso de paciente 56 anos, sexo masculino, com histórico de vitrectomia via pars plana por descolamento de retina em olho direito e posterior implante de dispositivo de drenagem por glaucoma secundário. Dois anos após o procedimento foi encaminhado ao serviço por baixa de acuidade visual (AV) de 20/200 (1.00 LogMAR). À fundoscopia, observou-se uma elevação amelanótica temporal no equador com hipótese diagnóstica de melanoma de coroide amelanótico. O exame de ultrassom mostrou implante de dispositivo de drenagem justabulbar temporal superior com comunicação transescleral para espaço subcoroidal (fístula), sugerindo bolsão focal de descolamento de coroide em equador temporal superior simulando melanoma de coroide amelanótico. O paciente foi abordado cirurgicamente devido membrana epirretiniana com nova vitrectomia via pars plana para peeling de membrana limitante interna, sem repercussões no local da fístula, evoluindo bem com acuidade visual de 20/70 (0.55 LogMAR). Ao nosso conhecimento, este é o primeiro caso relatado nessa condição.
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Polypoidal choroidal vasculopathy (PCV) is a fundus disease that can cause severe visual impairment. At present, the gold standard for the diagnosis of PCV is indocyanine green angiography (ICGA). Due to its invasiveness and inconvenience in clinical application, researchers are exploring the use of non-invasive optical coherence tomography (OCT) in clinical diagnosis and follow-up of PCV, and non-invasive diagnostic criteria based on OCT are gradually emerging. However, in the clinical application of this technology, there are still some problems, such as poor imaging effect, unclear diagnosis, over-reliance on OCT technology, complex follow-up situations and so on. This paper intends to review the current situation, new diagnostic criteria and related problems of OCT in the clinical diagnosis and treatment of PCV, in order to provide reference for ophthalmologists.
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Retinal vascular bed area(RVBA)is the total area of retinal vasculature segmented by ultra-widefield fluorescein angiography(UWFA)images, and is an objective absolute value in square millimeter. RVBA is mainly affected by the diameter and length of retinal vessels, and whether RVBA increases or decreases depends on the “competition” between ischemia and angiogenesis, indicating subtle changes in retinal vascular morphology. As a new indicator for the study of retinal vascular diseases, RVBA may have higher stability and accuracy than the ischemia index(ISI)and non-perfusion area(NPA). RVBA is currently mainly used to evaluate the progression and prognosis of diabetic retinopathy(DR). It was found that retinal total RVBA in DR eyes was greater than the normal eyes and it decreased in DR eyes after anti-vascular endothelial growth factor(VEGF)treatment. These findings provide favorable support for the study of microvascular lesions in DR. In this article, the application of RVBA in DR was reviewed to provide a reference for the clinical study of RVBA in other retinal vascular diseases such as retinal vein occlusion(RVO).
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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&#x003C;0.05), and there was no statistical significant difference between the control group and the 3h experimental group in the total retinal thickness(P&#x003E;0.05), while the differences between any other two groups were statistically significant(P&#x003C;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&#x003C;0.05), and the mean total retinal thickness and OPL-OS thickness were statistically significant between any two groups(P&#x003C;0.05). The ILM-INL thickness of rats in the control group and 3 and 12h experimental groups was statistically significant(P&#x003C;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&#x003C;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&#x003C;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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With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.
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Objective:To compare the detection rate and time cost of different imaging methods for retinal and optic disc neovascularization in proliferative diabetic retinopathy (PDR).Methods:A cross-sectional study was conducted.Thirty-eight patients (48 eyes) with PDR were enrolled in Henan Eye Hospital from October 2019 to February 2021, including 22 males (28 eyes) and 16 females (20 eyes). The average age of the patients was (51.08±13.35) years.All patients underwent ultra-widefield imaging (UWFI), fundus fluorescein angiography (FFA), optical coherence tomography angiography (OCTA), en face optical coherence tomography (OCT), near-infrared fundus imaging (IR) combined with spectral domain OCT (SD-OCT). Wide field swept-source OCTA (WF-SS-OCTA) was performed in the patients who were unsuitable for FFA.The time required for each examination in one eye and the detection rate of neovascularization at the optic disc (NVD) and retinal neovascularization elsewhere (NVE) were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by Henan Eye Hospital (No.HNEECKY-2021[22]). All patients were informed about the method and purpose of the study and voluntarily signed the informed consent form.Results:The mean monocular examination time costs of UWFI, IR+ SD-OCT, OCTA+ en face OCT, FFA and WF-SS-OCT was (0.51±0.13), (2.08±0.57), (5.79±0.68), (17.66±1.83) and (13.38±1.23)min, respectively.There was a significant overall difference in the mean monocular examination time among the five methods ( F=2 077.960, P<0.001). The detection rates of UWFI, IR+ SD-OCT, OCTA+ en face OCT, FFA+ WF-SS-OCT for NVE and NVD were 52.1%(25/48) and 12.5%(6/48), 81.3%(39/48) and 20.8%(10/48), 83.3%(40/48) and 27.1%(13/48), 93.8%(45/48) and 29.2%(14/48), respectively.There were significant differences in the detection rates of NVE ( χ2=26.460, P<0.001) but not in the detection rates of NVD ( χ2=4.645, P=0.200) among the various methods.Five neovascular buds were detected by OCTA in 3 eyes, but not by FFA. Conclusions:UWFI and IR+ SD-OCT are faster and non-invasive methods for the screening of NVD and NVE in PDR eyes.Compared with FFA, OCTA and en face OCT can show the shape of neovascularization more clearly.FFA provides a wide-range retinal image, but it is time-consuming and invasive.WF-SS-OCTA extends the examination range of OCTA and detects neovascularization non-invasively and faster than FFA.
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Objective:To quantitatively evaluate the retinal ischemia in different retinal regions of diabetic retinopathy (DR) patients in ultra-widefield fluorescein fundus angiography (UWFA) images with ischemic index (ISI), and to explore its correlation with diabetic macular edema (DME).Methods:A cross-sectional study was conducted.Seventy-nine eyes of 79 patients with DR were enrolled in Renmin Hospital of Wuhan University from September 2017 to October 2020, including 44 males (44 eyes) and 35 females (35 eyes) aged 31 to 73 years old, with an average age of (55.95±8.80) years.UWFA and spectral-domain optical coherence tomography (SD-OCT) were performed in all patients.Patients were divided into DME group (37 eyes) and non-DME group (42 eyes) according to the presence or absence of DME in OCT images.The retina in middle phase UWFA images were divided into posterior, middle peripheral and far peripheral regions by ImageJ software, and ISI in each region was calculated.Central macular thickness (CMT) was automatically calculated using the built-in software of the OCT equipment.The correlation between ISI and CMT was analyzed by Spearman rank correlation analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each patient prior to any medical examination.Results:The ISI of the total, posterior, middle peripheral and far peripheral retina was 2.460 (0.603, 5.640)%, 2.670 (1.062, 9.574)%, 1.382 (0.245, 4.378)% and 0.000 (0.000, 1.262)%, respectively, with a statistically significant difference among different regions ( χ2=65.307, P<0.001). There were statistically significant differences in ISI between the total and far peripheral, the posterior and middle peripheral, the posterior and far peripheral, the middle and far peripheral (all at P<0.01). ISI of the total, posterior and middle peripheral retina in DME group were significantly higher than those in non-DME group ( U=424.000, P=0.001; U=403.000, P<0.001, U=493.000, P=0.005), but there was no significant difference in the ISI of the far peripheral region between the two groups ( U=609.000, P=0.061). There was no statistically significant correlation between ISI and CMT in the total, posterior, middle peripheral and far peripheral retina in DME group ( rs=-0.134, -0.018, -0.152, -0.163; all at P>0.05). Conclusions:The retinal non-perfusion area in DR eyes is mainly located in the posterior and middle peripheral retina.The ISI of the posterior and middle peripheral retina in DME eyes is significantly higher than that in eyes without DME.ISI of each retinal region may not be related to the severity of DME.
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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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Purpose: To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management. Methods: Cross?sectional survey conducted in Egypt amongst practicing ophthalmologists. Results: The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non?proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one?year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045. Conclusion: Given that FA detects significantly greater pathology than CI, and that treatment and follow?up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs
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Purpose: To identify and correlate hypopigmented spots on fundoscopy with the leakage points on fluorescein angiography (FA) in patients with central serous chorioretinopathy (CSCR) to provide criteria for FA?free focal laser photocoagulation (FLP). Methods: Fifty consecutive patients of acute CSCR were evaluated between March and October 2019 confirming the inclusion and exclusion criteria. Colocalization of leakage points with discrete hypopigmented spots on clinical fundoscopy was evaluated using FA. Positive predictive value (PPV) was calculated to identify the status of association between these to formulate criteria for FA?free FLP of CSCR patients in future. Results: Out of the 50 eyes, 38 (76%) had a discrete hypopigmented spot on fundoscopy which coincided with the leakage point on FA. The PPV of finding a leakage point at the area of discrete hypopigmented spot is 95%. Colocalization with a pigment epithelial detachment was found in 25 (65.7%) of these 38 eyes. Retinal pigment epithelial irregularities were found associated in all of these 38 eyes. Subretinal homogenously hyperreflective material was found in 8 (21.05%) of 38 eyes. optical coherence tomography following FLP of leakage point in all cases showed complete resolution of CSCR in 47 (94%) eyes. Conclusion: This study demonstrates that hypopigmented spots on clinical fundus examination in CSCR patients, when present, coincide with the leakage point of FA. This may aid to undergo FA?free FLP treatment in CSCR patients
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Objective:To observe the multimodal image features of inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC).Methods:A retrospective clinical analysis. A total of 90 eyes of 46 patients with MFC diagnosed in the Department of Ophthalmology of Yunnan University Affiliated Hospital from May 2017 to April 2021 were included in the study. Among them, there were 21 males and 25 females; the average age was 38.30±8.97 years old. Twenty-nine cases of MFC were diagnosed in the past, and they visited the doctor again due to new symptoms; 17 cases without a clear past medical history were the first visits. All eyes underwent color fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). With reference to the literature and the results of multimodal fundus imaging examinations, MFC lesions were divided into active CNV lesions, inactive CNV lesions, active inflammatory lesions, and inactive inflammatory lesions, with 31 (34.4%, 31/90), 12 (13.3%, 12/90), 26 (28.9%, 26/90), 90 (100.0%, 90/90) eyes. Nineteen eyes were treated with anti-vascular endothelial growth factor drugs. To summarize and analyze the manifestations of inflammatory lesions and CNV lesions in different imaging examinations. The Wilcoxon rank test was used to compare the detection rate of CNV lesions between FFA and OCTA.Results:In eyes with active inflammatory lesions and active CNV lesions, yellow-white lesions, retinal hemorrhage and exudation were seen on fundus color photography; FFA examination showed fluorescein leakage in the lesions; OCT examination showed retinal pigment epithelium (RPE) layer in the lesions was uplifted, the boundary was unclear, combined with subretinal and intraretinal fluid; OCTA examination showed that there was no blood flow signal in each layer of vascular tissue in active inflammatory lesions, and blood flow signals were seen in active CNV lesions. In the eyes of inactive inflammatory lesions and inactive CNV lesions, the fundus color photography showed that the lesions had clear boundaries without bleeding or exudation; FFA examination, the lesions were fluorescently stained, and there was no fluorescein leakage; OCT examination, inactive CNV lesions manifested as raised lesions with clear boundaries, and inactive inflammation manifested as scars formed by mild RPE hyperplasia or depressions in outer structures formed by atrophy; OCTA examination, inactive inflammatory lesions showed patchy loss of blood flow signal or penetrating blood flow signal below, blood flow signal can be seen in inactive CNV lesions.Conclusion:MFC active inflammatory lesions and active CNV lesions are often accompanied by retinal hemorrhage and exudation; FFA shows fluorescein leakage; OCT shows that the boundary of raised lesions is unclear; OCTA can identify the nature of CNV or inflammatory lesions.
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Objective:To observe and analyze the multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia (SO).Methods:A retrospective study. From October 2012 to December 2021, 28 patients (36 eyes) diagnosed SO in the Department of Ophthalmology, Beijing Tongren Hospital were inclued in the study. There were 19 males (25 eyes) and 9 females (11 eyes), with the mean age of 51.61±12.02 years. There were 8 exciting eyes and 28 sympathizing eyes. The time to onset after trauma or surgery was 46.10±107.98 months. All patients underwent examinations including vision test, color fundus photograph, optical coherence tomography (OCT), fundus fluorescence angiography (FFA), indocyanine green angiography (ICGA). Angio-OCT (OCTA) was performed on 3 eyes and fundus autofluorescence (AF) was performed on 8 eyes. The early and late phase were defined respectively as ≤2 months and >2 months. Their multimodal imaging characteristics were summarized.Results:In 8 exciting eyes, subretinal fibrosis with mutifocal retinal atrophy and pigmentation was noted in 5 eyes (62.50%, 5/8), the other 3 eyes showed sunset glow fundus (37.50%, 3/8). In 28 sympathizing eyes, in the early phase, the fundus photograph showed shallow retinal detachment with optic disc edema in 9 eyes (32.14%, 9/28); in the late phase, peripapillary yellowish-white subretinal lesions in 11 eyes (39.29%, 11/28). In the late course of the disease, there were yellow-white lesions around the optic disc (peridisc) and peripheral subretinal area in 11 eyes (39.29%, 11/28). Dalen-Fuchs nodules were found in 10 eyes (35.71%, 10/28). On OCT, multiple serous retinal detachment and irregular choroidal folds were noted in the early phase; hill-like subretinal hyperreflective elevation was noted in peripapillary area and subfovea with presence of cystic spaces in the intraretina in the late phase. FFA examination showed"pinpoint-like" strong fluorescence in the early stage, and "multi-lake-like" fluorescein accumulation and leakage in the late stage; "map-like" weak fluorescence around the disc in the early stage of the disease, dot-like strong fluorescence lesions in each quadrant of the peripheral retina, and fluorescence in the late stage of the disease course. enhanced. ICGA examination showed that the FFA strong fluorescence lesions in the middle and late stages were weak fluorescence. FAF examination, point-like strong and weak autofluorescence lesions with unclear boundaries. Nine sympathizing eyes with subretinal yellow-white lesions has vision without light-0.1 (significantly decreased vison), while 8 eyes with sunset glow fundus was 0.5-1.0 (mildly decreased vison).Conclusions:SO could not only show the semblable features of acute phases of Vogt-Koyanagi-Harada syndrome, but also the yellowish-white lesions in the peripapillary area, macula and periphery. Most of the eyes with peripapillary lesions has a significantly decreased vison, while the eyes with sunset glow fundus has a mildly decreased vison.
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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.
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Objective:To investigate the clinical value of indocyanine green (ICG) staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach in the treament of liver cancer.Methods:The clinical data of 150 patients with primary liver cancer, who received treatment in Yuyao People's Hospital from January 2019 to December 2020, were retrospectively analyzed. Group A ( n = 82) and group B ( n = 68) were designated according to the surgery methods used. The group A was subject to laparoscopic hepatectomy with a Glisson pedicle approach. The group B received ICG staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach. Operation-related conditions, postoperative complications, and the change in liver function indexes after surgery relative to before surgery were compared between the two groups. Results:There were no significant differences in the time taken to first anal exhaust, extubation time, and length of hospital stay between group A and group B (all P > 0.05). Operative time and intraoperative bleeding in the group B were (205.04 ± 35.01) minutes and (230.05 ± 17.53) mL, respectively, which were significantly lower than those in the group A [(228.07 ± 28.05) minutes, (255.07 ± 19.00) mL, t = 4.47, 8.31, both P < 0.05]. R0 resection rate was significantly lower in group B than in group A [85.29% (58/68) vs. 70.73% (58/82), χ2 = 4.50, P < 0.05]. There were no significant differences in postoperative complications between the two groups ( P > 0.05). Before treatment, there were no significant differences in serum levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and total bilirubin between the two groups (all P > 0.05). At 1 day after surgery, serum ALT, AST, and TBil levels in each group were significantly increased compared with before surgery (all P < 0.05). Furthermore, serum levels of ALT, AST and TBil in the group A were (108.51 ± 30.23) U/L, (107.66 ± 26.93) U/L, and (32.16 ± 4.73) μmol/L, respectively, which were significantly higher than those in the group B [(88.38 ± 24.76) U/L, (86.85 ± 19.74) U/L, (27.95 ± 4.31) μmol/L, t = 4.40, 5.30, 5.65, all P < 0.05]. At 3 days after surgery, serum levels of ALT, AST, and TBil in each group were significantly lower than those at 1 day after surgery, but they were still higher than those before surgery. At 3 days after surgery, serum levels of ALT, AST and TBil in group A were (74.20 ± 13.83) U/L, (65.22 ± 9.68) U/L, and (28.18 ± 4.14) μmol/L, respectively, which were significantly higher than those in group B [(54.72 ± 10.31) U/L, (55.41 ± 7.63) U/L, (24.25 ± 3.98) μmol/L, t = 9.61, 6.79, 5.89, all P < 0.05]. Conclusion:Although the ICG staining technique has certain limitations, it can improve the accuracy of hepatectomy to a certain extent. ICG staining technique combined with laparoscopic hepatectomy with the Glisson pedicle approach is a safe and accurate treatment for liver cancer. The combined therapy is worthy of clinical application.
ABSTRACT
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.