Parafoveal exudative vascular anomalous complex and its characteristics of multi-modal imaging in 11 cases / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the imaging characteristics of multi-modal imaging in perifoveal exudative vascular anomalous complex(PEVAC).METHODS: A retrospective case analysis. There were 11 patients(11 eyes)diagnosed as PEVAC by multi-modal imaging in our hospital included in this study from February 2021 to February 2022. All patients underwent the examinations of best corrected visual acuity(BCVA), fundus photography, fluorescein fundus angiography(FFA), spectral-domain optical coherence tomography(SD-OCT)and optical coherence tomography angiography(OCTA).RESULTS: On fundus examination, six out of eleven eyes presented as a unilateral and isolated lesion with diameter ≥150μm, five out of eleven eyes presented as multiple lesions(ranging from 2 to 4)and the diameter of each lesion <150μm, seven eyes with retinal edema and/or hard exudation. FFA revealed an oval-like hyper-fluorescent lesion of parafoveal in the late phase with enhancement but no leakage. Late peripheral telangiectasia leakage is seen with oedema. OCTA examination revealed a parafoveal small mass hyper-reflex showed aneurysmal dilation in the superficial and deep capillary, and capillary rarefaction was observed around the lesion. B-scan showed strong blood flow signal inside. Anti-vascular endothelial growth factor(VEGF)therapy was performed in 4 patients with macular edema. However, there was no notable improvement after treatment.CONCLUSION: Multi-modal imaging can help confirm the diagnosis and differential diagnosis of PEVAC, there is a poorly response to anti-VEGF therapy.

Application of multispectral fundus imaging in central serous chorioretinopathy / 中华实验眼科杂志

Objective:To explore the application of multispectral fundus imaging (MSI) in central serous chorioretinopathy (CSC).Methods:A diagnostic test study was conducted.Eighty-five eyes from 69 patients with macular diseases were enrolled in Renmin Hospital of Wuhan University from September 2017 to May 2018.There were 62 males (77 eyes) and 7 females (8 eyes) among the 69 patients with an average age of (48.0±11.2) years.The patients were divided into CSC group (45 cases, 61 eyes) and non-CSC group (24 cases, 24 eyes) according to whether suffering from CSC or not.Color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography, spectral domain-optical coherence tomography and MSI were performed in the two groups and the images were collected.With FFA as the gold standard, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI in the diagnosis of CSC were calculated.Kappa consistency test was used to evaluate the consistency of MSI and FFA in diagnosing CSC, and to evaluate the diagnostic value of MSI in CSC.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). Written informed consent was obtained from each subject prior to any medical examination.Results:The sensitivity, specicity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI for identifying CSC were 88.5%, 91.7%, 8.3%, 11.5%, 96.4% and 75.9%, respectively.The Kappa coefficient of agreement was 0.754.There was no significant difference in the identification of CSC between MSI and FFA ( χ2=1.780, P=0.180). Hyper-reflective signals corresponding to the leakage points were better detected with MSI images at 620-850 nm wavelength.The clear boundary of serous neuroepithelial detachment area was better detected with MSI images at 590-810 nm wavelength.The retinal pigment epithelium damage was better detected with MSI images at 660-850 nm wavelength. Conclusions:There is a good consistency between MSI and FFA.MSI can be an effective noninvasive inspection method for CSC.

Current research status of optical coherence tomography angiography in hereditary retinochoroidal degeneration / 中华眼底病杂志

OCT angiography (OCTA) is a fast,noninvasive and quantifiable new technique,which is especially suitable for long-term follow-up in patients with hereditary retinochoroidal degeneration,such as retinitis pigmentosa,Best vitelliform macular dystrophy,adult onset foveomacular vitelliform dystrophy,doyne honeycomb retinal dystrophy,choroideremia and Stargardt disease.During the follow-up,clinicians can find the subtle signs that explain disease development from the blood flow imaging,quantitatively describe the vascular density,timely detect and treat choroidal neovascularization.It is significant to explore the etiology and monitor the course of these diseases.With the development of more treatments for these diseases,OCTA parameters can also be used as indicators to evaluate and compare different therapeutic effects.In the future,more quantitative indicators of OCTA will be applied to evaluate the course of hereditary retinochoroidal degeneration,and provide valuable basis for early diagnosis and treatment.

The multimodal imaging characteristics of multiple evanescent white dot syndrom / 中华眼底病杂志

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.

Correct understanding the multimodal imaging to improve the diagnosis and treatment of ocular fundus diseases / 中华眼底病杂志

With the rapid development of ophthalmic imaging methods,there are many ways of examination in the diagnosis and treatment of fundus diseases,such as FFA,ICGA,FAF,OCT and emerging blood vessels by OCT angiography in recent years.Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects.A variety of imaging examinations are combined and complemented each other,which makes us have a further understanding of the location and pathological changes of many fundus diseases.But at the same time,the emergence of multi-modal images also brings a series of problems.How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.

The shortcoming and developing perspective of optical coherence tomography angiography in clinical diagnosis and treatment of ocular fundus diseases / 中华眼底病杂志

Optical coherence tomography angiography (OCTA) is a new diagnostic technique in recent years based on the optical coherence tomography.It is one of the fastest developing imaging examinations in ophthalmology.Compared with the classic diagnostic methods of fundus fluorescein angiography and indocyanine green angiography,OCTA show the ability to reveal blood flow non-invasively.With the development of modem medical detection technology,the requirement for ophthalmic diagnosis is raised,and many new measurement methods begin to apply in research and clinical,which makes the detection methods in the field of ophthalmology more accurate and comfortable.OCTA is a novel and noninvasive flow imaging technique,and it has the advantages of high resolution,fast scanning,as w ell as quantifying blood flow.Meanwhile,this technique can not only qualitatively analyze the shape of ocular blood vessels,but also be able to measure the ocular blood vessels and blood flow non-invasively,as well as to assess the depth of lesions.At present,with a wide clinical application in ophthalmology,OCTA still has its own superiority and weakness,but with the development of technology.It is believed that the OCTA will be expected to replace the relevant invasive examination methods and become a new tool for ophthalmic imaging.

The progress in clinical research of retinal angiomatous proliferation / 中华眼底病杂志

Retinal angiomatous proliferation (RAP) is a genetic distinct subgroup of exudative age-related macular degeneration which shows a rapid and severe vision loss and high recurrence rates.The pathophysiological mechanisms of RAP is unclear.Recent histopathologic study and en face optical coherence tomography angiography have furthered our understanding of RAP.Clinical features frequently associated with RAP include bilateral disease,presence of reticular pseudodrusen and pigment epithelial detachments.Indocyanine green angiography is the gold standard diagnostic tool.Recently,more and more accurate optical coherence tomography has improved the acknowledgement of stage and diagnosis of RAP.The treatment efficacy of RAP is highly dependent on the stage.Anti-vascular endothelial growth factor therapy is currently the first line of treatment.Other treatment options including combination of photodynamic therapy with antiangiogenic agent intravitreal injections also achieve a reasonable therapeutic outcome.There remain several important questions such as pathogenesis and treatment regimen,to be answered in future RAP research studies.

Clinical application of ultra-wide field fundus autofluorescence imaging / 中华眼底病杂志

Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.

The imaging features of optical coherence tomography angiography of complex retinal arterial macroaneurysms / 中华眼底病杂志

Objective To observe the imaging features of the optical coherence tomography angiography (OCTA) of complex retinal arterial macroaneurysm (RAM).Methods Nineteen eyes of 19 patients with RAM were enrolled in this retrospective study. There were 1 male (1 eye) and 18 females (18 eyes). The patients aged from 62 to 85 years, with the mean age of 71.3 years. The fundus photography examination revealed the tumors were located in the 1 - 3 branch of the artery, which showed focal spindle-shaped or fusiform angiomatous dilatation. The fundus fluorescein angiography revealed the early uniform fluorescence of the tumor, and the tumor was a high-fluorescence leak in the late period. RAM was divided into exudative type and hemorrhagic type according to the literature and based on the ocular fundus appearance. In 19 eyes, 8 eyes were exudative RAM and 11 eyes were hemorrhagic RAM. All eyes were examined by OCTA, and the retinal blood flow images of 3 mm ×3 mm diameter were routinely collected to observe the OCTA imaging features.Results OCTA examination showed that the superficial RAM of all eyes had strong reflection signal connected with retinal artery. B-scan image showed smaller tumors in the lumen with strong reflection of expansion, or large tumor with peak-like uplift and the blood flow signals in the tumor body were abundant. The enface image clearly showed the three-dimensional shape of the tumor. Tumors with exudation or multi-level bleeding could be clearly documented for their bleeding range and boundary. The white signal co-localized with the superficial retinal blood vessels by the function of multi-color fluoroscopy. The pattern of blood flow density can also clearly show the three-dimensional shape of the tumor.Conclusion The complex RAM is a strong reflection signal in the superficial layer of retina, which is connected with the retinal vessels; B-scan images shows small tumors with a small piece of strong reflection and dilation, or large tumors with mountain-like elevation with abundant blood flow signals. En face image can clearly show the three-dimensional shape of the tumor.

Enhance the quality of image acquisition, reporting and interpreting, and clinical application of optical coherence tomography angiography / 中华眼底病杂志

Optical coherence tomography angiography (OCTA) is a new and noninvasive imaging technique that generates real-time blood flow pattern on chorioretinal vasculature. In order to apply this novel technology in the practice to diagnose and treat ocular fundus diseases, we need to further strengthen the quality of OCTA image acquisition and reporting specifications. We need to understand its technical principle, and multiple factors affecting the OCTA image acquisition and interpretation. Furthermore, In the process of image acquisition, as well as analysis and interpretation, we need to pay attention to the stratification, interpretation of blood flow signals and identification of artifacts of OCTA images.

Benign familial fleck retina: multimodal imaging including optical coherence tomography angiography / Benign familial fleck retina: estudo multimodal incluindo OCT angiography

ABSTRACT This report presents multimodal imaging of a 27-year-old woman diagnosed with benign familial fleck retina (OMIM 228980), an uncommon disorder. Fundus photographs revealed retinal flecks that affected her post-equatorial retina but spared the macular area. Fundus autofluorescence and infrared imaging demonstrated a symmetrical pattern of yellow-white fleck lesions that affected both eyes. Her full-field electroretinogram and electrooculogram were normal. An optical coherence tomography B-scan was performed for both eyes, revealing increased thickness of the retinal pigmented epithelium leading to multiple small pigmented epithelium detachments. The outer retina remained intact in both eyes. Spectral-domain optical coherence tomography angiography with split-spectrum amplitude decorrelation algorithm and 3 × 3 mm structural en face optical coherence tomography did not show macular lesions. Benign familial fleck retina belongs to a heterogenous group of so-called flecked retina syndromes, and should be considered in patients with yellowish-white retinal lesions without involvement of the macula.

RESUMO O objetivo do presente relato é demonstrar um estudo multimodal de um paciente com diagnóstico de Benign Familial Fleck Retina (BFFR) (OMIM 228980), uma alteração retinana muito rara. Retinografia colorida demonstrou "flecks" na retina posterior ao equador, poupando mácula. Tanto autofluorescência quando imagem "infrared," nota-se padrão simétrico de lesões amareladas em ambos os olhos. Eletrorretinograma padrão de campo total e EOG não evidenciaram alterações. SD OCT B-scan demostrou pequenos e múltiplos descolamentos do epitélio pigmentado (EPR), com retina externa intacta em ambos os olhos. Angiografia por OCT com "split-spectrum amplitude decorrelation algorithm" e "structural" "en face" OCT 3 x 3 mm não apontaram anormalidades na mácula. BFFR pertence ao heterogêneo grupo chamado "flecked retina syndromes," devendo ser considerada em pacientes com flecks retinianos poupando mácula.

Paying attention to the clinical application and image interpretation in optical coherence tomography angiography / 中华实验眼科杂志

Optical coherence tomography angiography (OCTA) is a new diagnostic technique in recent years based on the OCT,and it is one of the fastest developing imaging examinations in ophthalmology.At present,the primary diagnostic methods of retinal neovascular diseases are fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA),which can dynamically exhibit the abnormal vessels and provide visible abnormal vascular morphology and useful diagnostic information.However,FFA and ICGA are invasive ways,and these methods are unable to perform layer analysis.Compared with FFA and ICGA,in addition to the features of non-invasive,high-speed scanning and high-resolution,OCTA also shows the ability to reveal blood flow non-invasively.OCTA is not affected by vascular leakage or retinal hemorrhage,and it can give the three dimensionally measuring image and achieve quantitative and enface analysis of lesion.The utility of OCTA technique enriches and accelerates the imaging diagnosis,treatment and exploration of the ocular diseases.However,the measuring procedure and accurate interpretation of OCTA depends on the correct understanding for OCTA principle and tissue structure.Therefore,it is essential for an ophthalmologist to fully study and know its principles and clinical application.

Improve our understanding of ocular fundus diseases with ultra-wide-field fluorescein angiography / 中华眼底病杂志

Ultra-wide-field fluorescein angiography (UWFA) can obtain very wide retinal images (up to 200°), and is a very helpful tool to detect peripheral retinal lesions which cannot be found by other imaging methods. Analyzing the characteristics of the UWFA images may improve our understanding, treatment outcomes and management strategies of ocular fundus diseases. However this technology is still in its premature stage, there is still a lot of work to be done to improve its clinical application and study the characteristics and clinical meanings of these peripheral retinal lesions.

Fundus autofluorescence and its applications in retinal diseases / 中华眼底病杂志

Autofluorescence is produced by lipofuscin in retinal pigment epithelium (RPE) cells which is induced by exciting light and enables the visualization of lipofuscin changes in the RPE cells, thus showing the function of RPE and photoreceptor cells. Fundus autofluorescence (FAF) imaging is a non-invasive imaging technique providing information of RPE and photoreceptor cells, which is not obtainable with other imaging modalities. The scope of applications includes identification of diseased RPE in retinal diseases, elucidating pathophysiological mechanisms, estimating disease progression and prognosis, guiding treatment protocols. Common fundus diseases have different pathological types, levels and causes, so they can cause various damages of RPE and photoreceptor cells which induce complicated FAF. It is worth further observing and investigating the common retinal diseases' FAF characteristics and clinical applications.

Applications of ultra-wide-field fluorescein angiography in the diagnosis and treatment of retinal diseases / 中华眼底病杂志

Ultra-wide-field fluorescein angiography (UWFA) is a novel breakthrough in ocular fundus imaging technology, which can capture a single, high-resolution, 200° wide image of the ocular fundus that traditional fluorescein angiography cannot reach. This technology has important impacts on the screening, diagnosis, staging, treatment and follow-up of vascular diseases involving peripheral retina (such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, uveitis and so on).

Clinical applications of optical coherence tomography angiography / 中华眼底病杂志

Optic coherence tomography (OCT) is one of the most rapid developing technologies in ophthalmology. OCT angiography (OCTA) has been made possible by the development of even faster scanning and sampling techniques, which is the next milestone after stratus OCT and spectral domain OCT. Without the need of injection of the contrast agent, OCTA is capable of providing a three-dimensional reconstruction of the perfused microvasculature within the retina and choroid by detecting the motion of scattering particles such as erythrocytes within sequential OCT cross-sectional scans performed repeatedly at the same location of the eye with different analysis algorithms. Comparing to fundus fluorescein angiography and indocyanine green angiography, with improved OCT technology and understanding, OCTA has showed certain advantages to diagnose retinal and choroidal diseases, especially macular vascular diseases. It is important to establish the contributions that OCTA can make to diagnosing, managing and understanding of ocular fundus diseases.

Analysis the clinical characteristics of unilateral acute idiopathic maculopathy / 中华眼底病杂志

Objective To observe the clinical characteristics and fundus imaging features of unilateral acute idiopathic maculopathy (UAIM).Methods Retrospective cases series.Six eyes of 6 patients with UAIM were included in this study.There were 4 males and 2 females.All patients underwent best corrected visual acuity (BCVA),fundus color photography,spectral domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA) examinations.3 patients underwent indocyanine green angiography (ICGA) examination.No intervention was given in all patients after diagnosis.The mean follow-up was 6.3 months.BCVA,fundus color photography,SD-OCT and FFA were performed in follow-up.Results The ocular symptoms included unilateral sudden decreased vision,metamorphopsia and central scotoma.All patients had a yellow-white lesion involving the macular and irregular small bleeding was seen in 3 eyes.Irregular hyperfluorescence in macular area was seen in all patients,some with the hemorrhages showed blocked fluorescence at the early stage of FFA and fluorescence storage at the late stage.ICGA showed that hypo-fluorescence in macular area continually.SD-OCT showed that subretinal fluid in the macular and lost the ellipsoid zone.During the follow-up period,the subretinal fluid was absorbed spontaneously in one month.The ellipsoid zone structure recovered gradually and the visual acuity were normal.At the time of the latest follow-up,the BCVA was 0.8 in 4 eyes,1.0 in 2 eyes.Conclusions UAIM is featured with a unilateral,acute,transient and exudative lesion in the macular,which can be spontaneously resolved;It mainly affects outer retina.

Towards objective assessment of the inner retinal functions / 中华实验眼科杂志

Retinal anatomic structure and physiology function are very complex.Electroretinogram (ERG) is currently the only objective assessment for retinal function.There are groups of devastating diseases characterized by affecting the inner retinal functions.However,compared with its advantages in evaluating the outer retina function,ERG is less sensitive in judging the inner retinal function.The decrease of sensitivity is mainly associated with the crosstalk between the rod and cone systems in the longer visual signal pathways.In the past twenty years,new recording techniques in ERG analysis including oscillatory potentials,ON-OFF responses,photopic negative responses and scotopic threshold response have been developed.These ERG components are generated from the bipolar cells,amacrine cells or retinal ganglion cells and are becoming novel tools to assess the function of the inner retina.Ophthalmologists should fully understand the clinical significance of these ERG components in assessing inner retinal function to better guide the diagnosis and treatment of retinal diseases.

Better understanding retinal and choroidal vascular diseases with optical coherence tomography angiography / 中华眼底病杂志

Optical coherence tomography angiography (OCTA) is a new and non-invasive imaging technique that is able to detect blood flow signal in the retina and the choroid within seconds.OCTA is different from the traditional angiography methods.The major advantages of OCTA are that it can observe blood flow signal in different layers of the retina and the choroid without injecting any dye,provide blood flow information that traditional angiography cannot provide,and enrich pathophysiological knowledge of the retinal and choroidal vascular diseases.,which help us to make an accurate diagnosis and efficient evaluation of these diseases.However there is a large upgrade potential either on OCTA technique itself or on clinical application of OCTA.We need to fully understand the advantage and disadvantage,and differences of OCTA and traditional angiography.We also need to know how to interpret the result of OCTA.With that we could make a fast diagnosis in a non-invasive way and improve our knowledge of the retinal and choroidal vascular diseases.

Comparison of confocal scanning laser ophthalmoscope and color fundus camera to assess retinal and choroidal disease using / 中华眼底病杂志

Objective To cpmpare the assessment of retinal and choroidal disease using confocal scanning laser ophthalmoscope (cSLO) imaging and color fundus camera.Methods Sixty-seven patients (90 eyes) with fundus diseases were included in this study.There were 35 males (51 eyes) and 32 female (39 eyes),mean age was 51.32 years.All subjects underwent fundus imaging using cSLO technology and traditional color fundus camera,positive numbers of every retinal pathological change were calculated and compared.Spectral domain-optical coherence tomography (SD-OCT) was also done to compare the accordance rate between two modes of fundus imaging (cSLO technology and traditional color fundus camera) and SD-OCT in choroidal changes.Results The positive numbers of retinal microaneurysm (x2 =4.157,P＜ 0.05) and epiretinal membrane (x2 =5.428,P ＜ 0.05) using cSLO fundus imaging were significantly higher than traditional color fundus camera,while the positive numbers of cotton wool spots (x2 =0.523),retinal hemorrhage (x2 =0.117),hard exudates (x2 =0.325) and macular hole (x2 =0.070)were no significant different (P＞ 0.05).The SD-OCT accordance rate of choroidal pathological changes using cSLO technology was higher than traditional color fundus camera (x2 =9.143,P=0.007).Conclusion In retinal and choroidal diseases,the imaging quality of cSLO fundus imaging technology is better than the traditional color fundus camera technology.