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Objective:To investigate the clinical features and multimodal imaging features of eyes with perifoveal exudative vascular anomalous complex (PEVAC).Methods:A retrospective case study. From February 2014 to November 2020, 7 eyes of 7 patients with PEVAC diagnosed by ophthalmology examination in Department of Ophthalmologyof Peking University People's Hospital were included in this study. There were 6 males and 1 female. The age was 60.1±9.1 years. All were monocular. The chief complaints of visual deformation and vision loss were 3 and 1 cases, respectively. All patients underwent best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA). BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. OCT angiography (OCTA) and indocyanine green angiography (ICGA) were performed in 4 and 2 eyes, respectively. Three eyes were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) combined with local laser photocoagulation. Two eyes were treated with laser photocoagulation alone. The follow-up time was 16.7±19.1 months. During follow-up, relevant examinations were performed with the same equipment and methods as at the initial diagnosis. The multimodal imaging characteristics and treatment response of the affected eyes were observed.Results:The baseline logMAR BCVA was 0.33±0.19 (0.20-0.80). All eyes showed isolated hemangiomatous lesions in the macular fovea with rigid retinal exudation, and 2 adjacent isolated hemangiomatous lesions were observed in 1 eye. FFA and ICGA examination showed that all eyes with macular hemangiomatous lesions showed clear boundary and strong fluorescence in the early stage. No other retinal or choroidal vascular abnormalities were observed. On OCT examination, circular lumen-like structures with strong reflective wall near the fovea were observed in the macular region of all eyes, accompanied by intraretinal cystic lumen. The macular central retinal thickness (CMT) was 326±125 (207-479) μm. In the four eyes examined by OCTA, blood flow signals were observed in the circular lumenoid structures with strong reflective walls adjacent to the fovea. Blood flow signals were observed in the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina in 3 eyes. SCP showed blood flow signal in 1 eye. In 4 eyes treated with intravitreal injection of anti-VEGF drugs, there was no significant improvement in the intraretinal capsule space after treatment. Subretinal fluid absorption, retinal cystoid edema persisted, and rigid exudation decreased in 1 eye. CMT decreased and BCVA increased in 5 eyes treated with laser photocoagulation or laser photocoagulation alone. At last follow-up, logMAR BCVA was 0.16±0.06 (0.10-0.20) and CMT was 212±34 (154-252) μm. Compared with baseline, the difference of BCVA was statistically significant ( t=2.661, P=0.037). Conclusions:The fundus of PEVAC patients is characterized by solitary or multiple solitary hemangiomatous lesions in the macular fovea. Round lumenoid structures with strong reflective walls, with or without intraretinal cystic lumen, rigid exudate, and subretinal fluid, in which blood flow signals can be seen in OCT.
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Objective To observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.Methods A retrospective case series.Thirty-one patients (31 eyes) with monocular FCE,first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People's Hospital of Foshan from December 2014 to December 2018,were involved in this study.There were 14 males and 17 females,with the mean age of 45.84± 13.57 years.All patients underwent BCVA,optometry,and SD-OCT examinations.FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications.The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT).The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs.FCE complication group 14 eyes),based on whether complicated by RPE dysfunction.Among 14 eyes of FCE complication group,7 (22.6％) with choroidal neovascularization,4 (12.9％) with central serous chorioretinopathy,1 (3.2％) with polypoidal choroidal vasculopathy,and 2 (6.5％) with RPE detachment.No significant difference was found in the mean age (t=0.87),gender composition (x2=0.06),ocular laterality (x2=2.58),and spherical equivalent (t=-0.81) between two groups,respectively (P＞0.05),except that the BCVA was significantly different (t=-2.11,P＜0.05).The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed.Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.Results Thirty-three excavations were identified in 31 eyes with FCE.The mean SFCT was 167.00± 85.18 μm in FCE alone group vs.228.36± 67.95 μm in FCE complication group,while the excavation width was 645.00 ± 231.93 μm vs.901.00± 420.55 μm and they were both significantly different (P＜0.05).Logistic regression analysis showed the SFCT (OR=1.016,P=0.026) and excavation width (OR=1.004,P=0.034) were risk factors for RPE complications of FCE.EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group,especially at the boundary area of excavation.The RPE damages were located at the boundary area of excavation in 10 eyes (71.4％) of FCE complication group.Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.Conclusions SFCT and excavation width may be risk factors for RPE complications of FCE.Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.
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Objective To observe the multimodal imaging characteristics of combined hamatoma of the retina and retinal pigment epithelium (CHRRPE).Methods A retrospective case study.From January 2013 to December 2017,6 CHRRPE patients (6 eyes) diagnosed in Department of Ophthalmology,Sun Yat-sen Memorial Hospital were included in the study.There were 4 males and 2 females,with the mean age of 12.0±8.10 years.There were 5 eyes with BCVA ≤0.1,1 eye with BCVA＞ 1.0.Corneal fluoroscopy showed 1 eye with an external oblique 15°,and the remaining eye had no abnormalities in the anterior segment.All eyes underwent fundus color photography,FAF,FFA,ICGA,OCT and color Doppler flow imaging (CDFI).The multimodal imaging characteristics were observed.Results All the affected eyes CHRRPE were located in the posterior pole and showed mild elevation.Most of the retinal neuroepithelial layers had different degrees of hyperplasia,vascular tortuosity and retinal folds.Of the 6 eyes,4 eyes (66.7％) involving the macula and optic disc,only 2 eyes (33.3％) involving the macula.OCT showed that the structure of the neuroepithelial layer was unclear and the signal intensity was uneven;it involved 2 eyes of the whole retina (33.3％) and only 4 eyes of the neuroepithelial layer (66.7％).FFA and ICGA showed that the choroidal background fluorescence of the early lesions was weakened,and the lesions showed slightly weak fluorescence;the late telangiectasia fluorescein was obviously leaked,and the lesions were stained with fluorescence.FAF mainly appears as weak autofluorescence with a small amount of strong autofluorescence.CDFI has no characteristic performance.Conclusions CHRRPE is mainly a membrane-like hyperplasia without angiogenesis,involving the retinal neuroepithelial layer,and may also involve the entire retina.OCT is dominated by strong reflection;AF,FFA and ICGA are mainly weak fluorescence.
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Objective To observe the multimodal imaging characteristics of multiple evanescent white dot syndrom (MEWDS).Methods This was a retrospective series case study.Eighteen patients (18 eyes) diagnosed with MEWDS in Eye Center of The Second People's Hospital of Foshan from September 2015 to April 2017 were enrolled in this study.There were 12 females and 6 males,with the mean age of 35.9 years.The disease course ranged from 3 to 90 days,with the mean of 14 days.All the patients underwent BCVA,slit-lamp microscope with +90D preset lens,fundus photography,spectral domain OCT (SD-OCT) and FAF examinations.FFA was simultaneously performed in 6 eyes,FFA and ICGA were simultaneously performed in 12 eyes.Ten patients received the treatment of glucocorticoids and vasodilator substance,and other 8 patients without any treatment.The follow-up duration was 4.5 months.The multimodal imaging characteristics were reviewed and analyzed.Results Fundus color photography showed a variable number of small dots and large spots lesions (14 eyes),and/or fovea granularity (7 eyes) and disk swelling (5 eyes).A variable number of little dots and larger spots lesions showed respectively in FFA,FAF and ICGA were needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent,highly autofluorescence and hypofluoresence.Combined hypofluorescent spots with overlying dots were observed in 10 eyes of the late stages of the ICGA.Black lesions in the gray background show in ICGA were the most obvious and the most extensive,gray-white lesions in the gray-black show in FAF were the second,light gray-black lesions in the gray show in FFA were the least.Gray-white lesions in an orange background show in fundus photography were not obvious and transient.SD-OCT showed disruption of the ellipsoid zone and/or accumulations of hyperreflective material from the ellipsoid layer toward the outer plexiform layer and vitreous cells.During the period of following-up,some patients were prescribed low-dose glucocorticoid and some not,almost all the patients except one patient experienced recovery in BCVA and the lesions in fundus imaging.Conclusions The lesions in MEWDS eyes in modern multimodal imaging modalities among fundus photography (fovea granularity),FFA (needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent),ICGA (flake hypofluorescent) and SD-OCT (disruption of the ellipsoid zone) showed good consistency.Almost eyes were recovery.
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Objective To observe the multimodal imaging characteristics ofchoroidal metastasis.Methods A retrospective clinical observation study.From January 2016 to November 2018,28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People's Hospital of Yunnan Province were included in the study.There were 12 males and 16 females,with the mean age of 50.8±6.9 years.There were 18 unilateral patients and 10 bilateral patients.The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes).All patients underwent ultra-wide-angle fundus photography,infrared fundus imaging,fundus autofluorescence,FFA,frequency-domain OCT,and B-ultrasound examinations.Results In the ultra-wide-angle fundus photography,metastatic tumors were located in the posterior or middle part of the retina,of which 26 were isolated lesions and 12 were multifocal.A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes).There were 12 eyes with exudative retinal detachment.Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change,and the infrared photograph of the exudative retinal detachment area was relatively low.Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor,13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor;3 eyes of old lesions showed "leopard-like" autofluorescence.Among the 38 eyes in the fluorescein angiography,32 eyes of the early lesions showed low fluorescence,and the venous phase showed a needle-like high fluorescence point,and the post-leakage fluorescence gradually increased.Two eyes with old lesions showed a "leopard-like" change.In 38 eyes,OCT showed wavy ridges of the choroid and pigment epithelium,and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer.B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo.There were 23 eyes with flat shape,12 eyes with flat hemisphere,and 3 eyes with irregular shape.Conclusions Color photography of the fundus showed the size,location,pigmentation and peripheral retinopathy of the metastatic lesions.Infrared photography showed different reflex signals in the tumor,exudation,and atrophy.The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion.In the fluorescein angiography,the fresh tumor showed fluorescence leakage,while the atrophic tumor showed transmitted fluorescenc.OCT reflected the height of the lesion and the change of pigment epithelium.
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Objective To observe the clinical and multimodel imaging characteristics ofparacentral acute middle maculopathy (PAMM).Methods Retrospective case series study.From January 2014 to August 2018,12 eyes of 12 patients with PAMM diagnosed in Department of Ophthalmology,Peking University People's Hospital,were included in this study.There were 9 males and 3 females,with the mean age of 57 years.All patients were referred for sudden impaired vision,with or without paracentral scotoma.The patients underwent BCVA,slit lamp examination,fundus photography,FFA and OCT.Simultaneously,OCT angiography (OCTA) was performed in 10 eyes,visual field was performed in 5 eyes,near infrared fundus photography was performed in 1 eye.Clinical and multimodal imaging findings were reviewed and analyzed.Results Among 12 eyes,there were 5 eyes with BCVA 0.05-≤0.1,4 eyes with BCVA 0.3-0.5,3 eyes with BCVA 0.6-1.0.There were 1 eye with central rentinal artery obstruction (CRAO),7 eyes with branch retinal artery obstruction (BRAO).Among them,BRAO with central retinal vein occlusion (CRVO) in 1 eye,with non-arteritic anterior ischemic optic neuropathy in 1 eye,with diabetic retinopathy in 1 eye;old BRAO in 3 eyes;pure BRAO in 1 eye.There were 4 eyes with pure CRVO,including 3 eyes with ischemic CRVO.All eyes demonstrated hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT.En face OCT highlighted the areas with hyperreflectivity corresponding to these lesions.OCTA demonstrated significant deep capillary dropout,abnormal morphology and enlargement of foveal avascular zone.Conclusion Hyperreflective band-like lesions at the level of the inner nuclear layer on OCT and middle retinal perivascular hyperreflectivity on en face scan are characteristic in PAMM.