The macular structure and blood flow in familial exudative vitreoretinopathy with inner retinal layer persistence / 中华眼底病杂志

Objective:To compared the changes of macular microvascular architecture in early stage familial exudative vitreoretinopathy (FEVR) patients with inner retinal layer (IRL) persistence and without IRL persistence.Methods:A retrospective clinical study. From 2017 to 2022, 94 patients with stage 1 FEVR with or without IRL residue and 45 age- and sex-matched healthy volunteers with 45 eyes (normal control group) who were confirmed by ophthalmology examination in Hangzhou Hospital of Optometry Affiliated to Wenzhou Medical University and Zhejiang Provincial People's Hospital were included in the study. According to whether there was IRL residue, the patients were divided into IRL group and non-IRL group, with 22 patients (22 eyes) and 72 patients (72 eyes), respectively. Best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were performed in all eyes. Superficial vessel density (SCP) and deep vessel density (DCP) of whole image, fovea and parafovea, the area and perimeter of fovea avascular area (FAZ), A-circularity index (AI, perimeter/standard circle perimeter with equal area) and vessel density around the 300 μm width of the FAZ (FD), central macular thickness (CMT) on macular 3 mm × 3 mm scan on OCTA were measured.Results:SCP and DCP of whole image ( F=10.774, 4.583) and parafovea ( F=10.433, 3.912), CMT ( F=171.940) in IRL group and non-IRL group on macular 3 mm × 3 mm scan on OCTA were significantly lower than that in normal persons ( P<0.05). There were significant differences among three groups of the area of FAZ ( F=4.315), AI ( F=3.413), FD-300 ( F=13.592) ( P<0.05). BCVA were worst in IRL group ( P<0.05). Conclusions:Blood flow density decreased in macular area of FEVR patients. CMT is significantly thicker than normal population. The FAZ area of the foveal IRL residual eyes is small and irregular, with worse BCVA and lower macular blood density.

Changes in the vessel densities of macular and optic nerve head and their relationships with axial length in pathological myopia / 中华眼底病杂志

Objective:To observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM).Methods:A retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL.Results:The perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant ( P<0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant ( P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant ( P<0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL ( P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL ( P<0.05). Conclusion:Compared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.

Macular vessel density and thickness in highly myopic eyes with peripapillary intrachoroidal cavitation / 中华眼底病杂志

Objective:To observe the changes of retinal blood flow density and thickness in the macular region of eyes with high myopia (HM) combined with peripapillary intrachoroidal cavitation (PICC).Methods:A cross-sectional study. From March 2019 to May 2021, 65 patients (65 eyes) diagnosed as PICC (HM+PICC group) in Eye Hospital, China Academy of Chinese Medical Sciences, sex-and age-matched 69 HM patients of 69 eyes (HM group) and 65 healthy people of 65 eyes (control group) were enrolled in this study. The optical coherence tomography angiography was used to scan macular areas in 3 mm×3 mm, and measure the macular fovea and optic disc on superior, inferior, nasal, temporal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density in the foveal and parafoveal region, and macular retinal ganglion cell complex (mGCC) thickness, full retinal thickness. One-way analysis of variance were used to test the difference of the index values among three groups, and then two groups were compared with Bonferroni test. A paired t-test was used to test the difference of the macular vessel density and thickness between the superior and inferior hemifield in three groups. Pearson partial regression analysis was used to calculate the correlations between them at same sites. Results:PICC was located most frequently at the inferior temporal disc border, followed by the inferior nasal region, superior temporal region, and superior nasal region in the HM+PICC group on 57(87.7%, 57/65), 25(38.5%, 25/65), 3(4.6%, 3/65) and 1(1.5%, 1/65 ) eye. There were significant differences in the global and regional full retinal thickness, mGCC thickness, SCP and DCP vessel density among 3 groups ( F=29.097, 51.929, 16.253, 6.135; P<0.001). The macular SCP and DCP vessel density except in the fovea, all regional macular full retinal thickness and mGCC thickness in the HM+PICC group were significantly lower than those in the normal group ( P<0.05). Compared to the HM group, the HM+PICC group had lower all regional mGCC thickness and SCP vessel density, as well as full retinal thickness in the inferior hemifield and DCP vessel density in the foveal region ( P<0.05). Macular vessel density and thickness in the inferior hemifield were significantly lower than those in the superior hemifield ( t=6.356, 11.693, 6.212, 2.936; P<0.01). Pearson partial regression analysis showed the SCP vessel density was positively correlated with corresponding mGCC thickness and full retinal thickness ( r=0.584, 0.534, 0.592, 0.496, 0.485, 0.517; P<0.001). However, there was no significant correlation between the DCP vascular density and mGCC thickness ( P>0.05), and only a weak positive correlation between the DCP vascular density and the full retinal thickness in the inferior hemifield ( r=0.319, P=0.014). However, no association with average and superior full retinal thickness ( r=0.066, 0.002, 0.125, 0.184, 0.016, 0.319; P>0.05). Conclusion:The macular SCP vessel density, mGCC thickness and the full retinal thickness in the inferior hemifield in PICC eyes are lower than those in the HM eyes, especially the mGCC thickness and SCP vessel density in the inferior hemifield, and there is a strong positive correlation between them.

Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye / 中华眼底病杂志

Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.

Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye / 中华眼底病杂志

Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.

Correlation analysis of macular microvascular structure and macular pigment opticaldensity in retinal vein occlusion / 中华眼底病杂志

Objective:To observe the changes of macular microvascular structure and macular pigment density (MPOD) in eyes with macular edema (ME) secondary to retinal vein occlusion (RVO), and preliminarily analyze their correlation.Methods:A prospective clinical study. A total of 62 eyes of 62 patients with monocular RVO secondary ME (RVO-ME) diagnosed in the Ophthalmology Hospital of Xi'an No.1 Hospital from July 2020 to May 2021 were included in this study. There were 33 males with 33 eyes, 29 females with 29 eyes. The age was 58.30±12.15 years. The course of disease from the onset of symptoms to medical treatment was 12.29±7.65 days. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography angiography (OCTA) and MPOD test. BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of minimum angle of resolution (logMAR). The vascular density (VD), vascular skeletal density (SD), foveal avascular area (FAZ) and central macular thickness (CMT) of the superficial retinal capillary plexus (SCP) in the range of 3 mm×3 mm in the macular area of bilateral eyes were measured by OCTA. MPOD was measured by heterochromatic scintillation photometry. Bilateral eyes passed examination in 37 cases. The eyes of 25 patients failed to pass the test. The changes of macular VD, SD, FAZ area, CMT and MPOD between the affected eyes and the contralateral eyes were compared. The MPOD of the affected eye and the contralateral eye was compared by paired t test. FAZ area, CMT, VD, SD, and logMAR BCVA were tested by paired Wilcoxon signed rank sum test. Spearman rank correlation test was used to analyze the correlation between macular blood flow density (VD, SD) and foveal morphology (FAZ area, CMT) with logMAR BCVA and MPOD. Results:Compared with contralateral eyes, VD ( Z=-5.981) and SD ( Z=-6.021) were decreased, FAZ area ( Z=-2.598) and CMT ( Z=-6.206) were increased, and the differences were statistically significant ( P<0.05). In 37 patients who passed MPOD test in bilateral eyes, the MPOD value of the affected eye was lower than that of the contralateral eye, and the difference was statistically significant ( t=-2.930, P<0.05). Compared with the affected eye which failed to pass the MPOD detection, macular VD ( Z=-2.807) and SD ( Z=-2.460) were increased, FAZ area ( Z=-4.297) and CMT ( Z=-3.796) were decreased in the affected eye which passed the MPOD test, and the differences were statistically significant ( P<0.05). Correlation analysis showed that logMAR BCVA in the affected eye was negatively correlated with macular VD and SD ( r=-0.298, -0.461; P<0.05), which was positively correlated with FAZ area and CMT ( r=0.487, 0.789; P<0.05). MPOD in the affected eye was negatively correlated with logMAR BCVA ( r=-0.344, P<0.05). MPOD in the contralateral eye was positively correlated with CMT ( r=0.358, P<0.05). Conclusions:The VD and SD of macular SCP are decreased, FAZ area is enlarged, CMT is thickened, and MPOD is decreased in RVO-ME eyes. MPOD is negatively correlated with logMAR BCVA.

Macular vessel defects for Coats' disease associated with subfoveal fibrotic nodule / 中华眼底病杂志

Objective:To investigate macular microvascular abnormalities in eyes with subfoveal fibrotic nodules secondary to Coats' disease.Methods:A cross-sectional study. From January 1, 2018 to July 30, 2021, 45 eyes of 45 patients diagnosed with Coats' disease with or without subfoveal fibrotic nodules in Eye and ENT Hospital, Shanghai Medical College of Fudan University were included in this study. There were 40 eyes in 40 males and 5 eyes in 5 females. All were under 21 years old. According to the presence or absence of subfoveal fiber nodules, the patients were divided into fibrotic group (26 cases, 26 eyes) and non-fibrotic group (19 cases, 19 eyes). Optical coherence tomography angiography was used to scan 3 mm×3 mm or 6 mm×6 mm macular area of both eyes. The software of the device automatically processed the images. The presence of FAZ edge anastomotic vascular arch ring breakage and abnormal microvascular branch (AMB) in the foveal avascular zone (FAZ) were observed.Results:In 26 eyes of fibrosis group, AMB originating from the parafoveal retinal capillary network was observed, which grew into and destroyed the integrity of the vascular arch ring at the edge of FAZ. AMB was crisscrossing and winding, and its curvature expands. B-scan images showed the blood flow signal in the subfoveal fiber nodule, and the blood flow signal traversed between the inner retina and the fiber nodule in 23 eyes (88.46%, 23/26). In the non-fibrosis group, all the vascular abnormalities were characterized by capillary dilation and defect, and no breakage of FAZ anastomotic vascular arch ring or AMB was observed.Conclusions:In Coats' disease with subfoveal fiber nodules, staggered and dilated AMBs emerge from the parafoveal vascular network, grow into and destroy the integrity of the vascular arch ring at the edge of FAZ, and grow down longitudinally into the fiber nodules.

Multimodal imaging features of tamoxifen retinopathy / 中华眼底病杂志

Objective:To observe the multimodal imaging characteristics of tamoxifen retinopathy.Methods:A retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed.Results:The yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia.Conclusion:Deposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.

Macular morphology and vascular parameters changes following micro-invasive vitrectomy in patients with severe non-proliferative diabetic retinopathy / 中华眼底病杂志

Objective:To observe the changes of macular morphology and blood flow after minimally invasive vitrectomy (PPV) in patients with severe non-proliferative diabetic retinopathy (sNPDR).Methods:A prospective clinical study. From January 2020 to April 2021, 17 consecutive sNPDR patients with 17 eyes who were diagnosed and received PPV treatment at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. There were 12 males with 12 eyes and 5 females with 5 eyes; the average age was 55 years old; the average duration of diabetes was 11 years; the average glycosylated hemoglobin was 7.9%. Before the operation and 1, 3, and 6 months after the operation, all the affected eyes underwent best corrected visual acuity (BCVA), standard 7-field fundus color photography, and optical coherence tomography angiography (OCTA). An OCTA instrument was used to scan the macular area of the affected eye with in the range of 3 mm×3 mm to measure the central subfoveal thickness (CST), the thickness of the ganglion cell complex (GCC) in the macular area, the thickness of the retinal nerve fiber layer (RNFL), and the superficial capillary plexus (SCP) vessel density and perfusion density in the macular area, macular avascular zone (FAZ) area, a-circularity index (AI). Before the operation and 6 months after the operation, the least significant difference test was used for the pairwise comparison.Results:Before the operation, 1, 3, and 6 months after the operation, the FAZ area of the macular area were 0.34±0.14, 0.35±0.10, 0.37±0.10, 0.36±0.13 mm 2, respectively; AI were 0.52±0.13, 0.54±0.11, 0.57±0.10, 0.60±0.11; CST was 282.6±66.7, 290.4±70.9, 287.2±67.5, 273.2± 49.6 μm; GCC thickness were 77.1±15.5, 74.3±13.9, 72.6±16.2, 78.5±18.3 μm; the thickness of RNFL was 97.9±13.8, 101.3±14.6, 97.7±12.0, 96.1±11.4 μm, respectively. The overall blood flow density of SCP in the macula were (16.79±1.43)%, (16.71±1.82)%, (17.30±2.25)%, (17.35±1.22)%; the overall perfusion density were 0.32±0.02, 0.32±0.03, 0.33±0.03, 0.33±0.02, respectively. After the operation, the CST increased first and then decreased; the thickness of RNFL increased 1 month after the operation, and then gradually decreased. Comparison of the parameters before and 6 months after the operation showed that the AI improved, and the difference was statistically significant ( P=0.049); the difference in FAZ area and the thickness of CST, GCC, and RNFL was not statistically significant ( P=0.600, 0.694, 0.802, 0.712); There was no statistically significant difference in the retina SCP blood flow density and perfusion density in the macular area ( P=0.347, 0.361). Conclusion:Compared with before surgery, there is no significant change in macular structure and blood flow density in sNPDR patients within 6 months after minimally invasive PPV.

Correlations between macular microvascular parameters in patients with type 2 diabetes mellitus and urinary albumin creatinine ratio / 中华眼底病杂志

Objective:To observe and analyze the correlation between macular microvascular parameters and urinary albumin to creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study. From October 2017 to April 2018, 100 eyes of 100 patients (T2DM) and 27 eyes of 27 healthy controls (the control group) were enrolled in Xuzhou First People’s Hospital. All subjects underwent anterior segment examination via slit-lamp biomicroscopy, dilated fundus examination, 7-field fundus photographs, OCT angiography (OCTA), the fasting glucose test, glycosylated hemoglobin (HbA1c), urinary albumin, urinary creatinine and UACR levels determination. Height and weight measurement were taken for calculating body mass index (BMI). Diabetic retinopathy was ruled out by fundoscopic examinations and 7-field fundus photographs in T2DM patients. According to the UACR, patients in the T2DM group were subdivided into A1 group (UACR< 30 mg/g), A2 group (UACR 30-300 mg/g), and A3 group (UACR>300 mg/g), with 38 cases and 38 eyes respectively , 40 cases with 40 eyes, 22 cases with 22 eyes. A 6 mm×6 mm scanning area centered on the macular fovea were scanned for right eye using a frequency domain OCTA instrument, which were divided into three concentric circles centered on the macular fovea by the software automatically. The foveal zone was defined as a circular area measuring 1 mm in diameter, the parafoveal zone was described as a middle circle area measuring 1-3 mm in diameter, and the perifoveal zone was an outer circle area measuring 3-6 mm in diameter. The vessel density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular area (FAZ) and perimeter (PERIM), non-circularity index (AI) were measured. The correlation between the macular vessel density, FAZ and UACR was analyzed by Spearman correlation analysis.Results:A1 group, A2 group, A3 group, and normal control group. The macular area SCP and DCP ( F=13.722, 5.644), foveal area ( F=4.607, 4.719), parafoveal area ( H=23.142, F=2.904), the blood flow density of the area around the fovea ( F=12.292, H=10.946), the difference was statistically significant ( P<0.05); with the increase of UACR, the blood flow density of each area of SCP and DCP showed a downward trend. The results of correlation analysis showed that the blood flow density of the whole SCP, parafoveal area, and surrounding area of T2DM patients was negatively correlated with UACR ( r=-0.376, -0.240, -0.364,-0.347, P<0.05). There were no correlation among fasting plasma glucose, HbAlc and UACR ( r=0.179, 0.085, P>0.05). There were no correlation among blood flow density in BMI, SCP foveal area, DCP and UACR (| r|<0.3, P>0.05). Conclusion:The whole, parafovea and perifovea vessel density values of SCP in T2DM eyes without DR are negatively correlated with UACR.

Clinical value of high-frequency color Doppler ultrasound in the detection of axillary lymph node metastasis in breast cancer / 中国基层医药

Objective:To analyze the clinical value of high-frequency color Doppler ultrasound in the detection of axillary lymph node metastasis in breast cancer.Methods:The clinical data of 60 patients with breast cancer who received treatment in Hangzhou Hospital, Zhejiang Medical & Health Group between March 2017 and March 2019 were retrospectively analyzed. Based on pathological results, 34 patients with breast cancer who had axillary lymph node metastasis were included in the observation group, and 26 patients without axillary lymph node metastasis were included in the control group. Both groups of patients underwent high-frequency color Doppler ultrasound examination. Ultrasound image characteristics, distribution of blood flow within the lymph nodes, and grading of blood flow signals were compared between the two groups, and ultrasound diagnosis results were analyzed.Results:Detection rate of cortical thickening, detection rate of lymph node long-diameter to lymph node short-diameter ratio > 2, detection rate of blurred lymph node borders, and detection rate of calcified foci within lymph nodes in the observation group were 55.9% (19/34), 58.8% (20/34), 61.8% (21/34), 52.9% (18/34), respectively, which were significantly higher than those in the control group [11.5% (3/26), 26.9% (7/26), 19.2% (5/26), 7.7% (2/26), χ2 = 12.48, 6.06, 10.85, 13.57, all P < 0.05]. The percentage of peripheral type blood flow distribution in the observation group was significantly higher than that in the control group and the percentage of portal type blood flow distribution in the observation group was significantly lower than that in the control group (both P < 0.05). The percentage of grade 2 blood flow signal in the observation group was significantly lower than that in control group, and the percentage of grade 3 blood flow signal in the observation group was significantly higher than that in the control group (both P < 0.05). The sensitivity, specificity, misdiagnosis rate and missed diagnosis rate of ultrasound in the detection of axillary lymph node metastasis in breast cancer were 88.2% (30/34), 73.1% (19/26), 26.9% (7/26), and 11.8% (4/34), respectively. Conclusion:High-frequency color Doppler ultrasonography in the detection of breast cancer axillary lymph node metastasis has ideal accuracy, and its diagnostic results are of high reference value.

Ultrasonographic features of cervical lymph node metastasis and their relationship with the expression of cell proliferation-associated nuclear antigen / 中国基层医药

Objective:To observe the ultrasonographic features of cervical lymph node metastasis and analyze their relationship with the expression of cell proliferation-associated nuclear antigen (Ki-67).Methods:The clinical data of 92 patients with cervical lymph node metastasis who received treatment in Zhejiang Quhua Hospital, China between June 2017 and July 2019 were retrospectively analyzed. The correlation between ultrasonographic features of cervical lymph node metastasis and Ki-67 expression was analyzed.Results:Among the 92 patients, 158 metastatic lymph nodes were confirmed by pathological examination. The main ultrasonic imaging features were the length ratio of long diameter to short diameter < 2 in 119 (75.32%) lymph nodes, disappearance of portal hyperechoic signal in 127 (80.38%) lymph nodes, punctate hyperechoic signal in 108 (68.35%) lymph nodes, cystic degeneration in 57 (36.08%) lymph nodes, mixed types of peripheral blood flow signal in 124 (78.48%) lymph nodes, microcalcification in 123 (77.85%) lymph nodes. The length ratio of long diameter to short diameter < 2, punctate hyperechoic signal and mixed types of peripheral blood flow signal were correlated with high expression of Ki-67 ( χ2 = 24.252, 15.732, 17.033, all P < 0.05). Conclusion:High expression of Ki-67 is correlated with the length ratio of long diameter to short diameter < 2, punctate hyperechoic signal and mixed types of peripheral blood flow signal in cervical lymph node metastasis.

Quantifying peripapillary vessel density in type 2 diabetic patients without clinically detectable retinopathy using OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To quantify changes in peripapillary vessel density in patients with type 2 diabetic mellitus(DM)without clinical features of diabetic retinopathy(DR)by OCT angiography(OCTA). <p>METHODS:A retrospective clinical study. From January to December 2019, 38 type 2 DM patients without DR(38 eyes, NDR group)and 30 normal subjects(30 eyes, control group)in Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. The optic nerve head was scanned by OCTA with HD 4.5mm×4.5mm imaging scanning mode for all subjects.The software automatically divides the peripapillary region into 8 sectors, designated as nasal superior(NS), nasal inferior(NI), inferior nasal(IN), inferior tempo(IT), tempo inferior(TI), tempo superior(TS), superior tempo(ST)and superior nasal(SN). Radial peripapillary capillaries vessel density(ppVD)and peripapillary retinal nerve fiber layer(pRNFL)thickness of entire peripapillary area and each sector were measured. The discrepancy of ppVD and pRNFL thickness between the two groups was also analyzed. Pearson correlation analysis was used to analyze the correlation between ppVD and pRNFL in each quadrant of NDR group. <p>RESULTS:The mean ppVD value and NS,NI,IN,IT,TI,TS,ST and SN sector values were all significantly lower in NDR group compared to normal controls(all <i>P</i><0.05). The mean and each sector pRNFL thickness was reduced in NDR group compared with the control group, but the difference was not statistically significant(all <i>P</i>>0.05). Pearson correlation analysis showed that the significant positive correlation was found between ppVD and pRNFL thickness in TI, TS, SN, NS and NI sector(<i>r</i>=0.578, 0.427, 0.577, 0.397, 0.317; all <i>P</i><0.05). <p>CONCLUSION: Peripapillary vessel density has decreased in eyes of patients with type 2 DM before clinically detectable retinopathy and OCTA is helpful for early monitoring.

Analysis of the correlation between body mass index and coronary flow reserve in patients with chest pain and no obstructive coronary artery disease / 中华内分泌代谢杂志

Objective:To explore the correlation between body mass index(BMI)and coronary flow reserve(CFR)in patients with chest pain and no obstructive coronary artery disease(NOCA).Methods:This study was a single-center retrospective cross-sectional study. Sixty-six patients with chest pain and NOCA on coronary angiography who underwent PET/CT quantitative myocardial blood flow measurements at TEDA International Cardiovascular Hospital were retrospectively analyzed from August 2018 to October 2019. Pearson correlation analysis and linear regression analysis were used to explore the correlation between BMI and CFR. Patients were divided into 2 groups according to CFR: coronary microvascular dysfunction(CMD)group(CFR<2.5)and control group(CFR≥2.5). Logistic regression analysis was applied to analyze the association of BMI with CMD.Results:The proportions of female, obesity, and overweight plus obesity in CMD group were higher than those in control group( P<0.05). The levels of BMI and low density lipoprotein-cholesterol(LDL-C)were higher in CMD group compared with control group( P<0.05). Pearson correlation analysis showed that CFR was linearly correlated with BMI( r=-0.45, P<0.01), which still existed after adjusted by confounding factors using linear regression model( r=-0.371, P<0.01). Logistic regression analysis showed that BMI was dependently associated with CMD after adjusted by gender, age, hypertension, diabetic mellitus, and LDL-C. The OR value of CMD was 4.46(95% CI 1.47-13.55, P<0.01)with BMI increased by 5 kg/m 2. Conclusion:In patients with chest pain and NOCA, higher BMI is an independent risk factor of CMD.

Advances in the clinical application of optical coherence tomography angiography in glaucoma / 中华眼底病杂志

As a neurodegenerative disease of the retina, glaucoma can cause irreversible vision loss in patients. More and more evidences indicate that systemic blood flow abnormalities, decreased optic nerve blood flow, and retinal microcirculation disorders are related to the mechanism of glaucoma ganglion injury. Optical coherence tomography (OCTA) has the advantages of non-invasive, high resolution, quick inspection, three-dimensional imaging, and quantitative blood flow perfusion. Compared with other blood flow detection methods such as color ultrasound Doppler, laser speckle blood flow imaging, etc. it has higher performance and accuracy, and is easier to be applied in clinical practice. OCTA can not only be used for the early diagnosis and follow-up of glaucoma, but has a strong correlation with retinal nerve fiber layer thickness and visual field parameters; it can also provide objective data for the follow-up of patients with advanced glaucoma to assess the progress of the disease. In the future, OCTA is expected to become a routine detection method and follow-up method for the diagnosis of glaucoma.

Observation of the optic disc vessel density in the affected eye with non-arteritic anterior ischemic optic neuropathy of different stages / 中华眼底病杂志

Objective:To observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease.Methods:A prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; >12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, >24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex.Results:The wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, >24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses ( F=8.939, P<0.001). The average difference of wiVD between 12-24 weeks and >24 weeks in the chronic phase was -0.984, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in diVD of patients with different courses of disease ( F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant ( F=8.816, 6.069, 8.943; P<0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was -0.984, -0.230, -0.198, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease ( F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance ( F=47.122, 14.954; P<0.001, <0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD ( r=-0.225, -0.268; P<0.05), and the average thickness of GCC ( r=0.480, 0.436; P<0.01) were all related. Conclusion:The blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.

Characteristics of highly myopic choroidal neovascularization by optical coherence tomography angiography and analysis of macular choriocapillaris density / 中华眼底病杂志

Objective:To observe the imaging characteristics of optical coherence tomography angiography (OCTA) and the changes of choroidal capillary density (CCD) in the eyes of patients with high myopia choroidal neovascularization (mCNV).Methods:A case-control study. From January 2018 to October 2020, 50 cases of mCNV patients with 50 eyes (mCNV group) were included in the study. There were 18 males and 32 females; their age was 42.11±11.66 years old. Fifty eyes of 50 patients with normal fundus with matching myopia refractive power (≥6.00 D) were selected as the simple high myopia group, and 50 normal volunteers (refractive power -0.25-0.25 D) while 50 eyes were selected as the normal control group. There was no statistically significant difference in age ( F=0.028) and gender composition ratio ( χ2=0.136) among the three groups of patients ( P>0.05); the difference in best corrected visual acuity was statistically significant ( F=14.762, P=0.004). Compared with mCNV group and pure high myopia group, the refractive index ( t=-0.273) and axial length ( t=0.312) of the examined eyes were not statistically significant ( P>0.05). OCTA instrument was used to measure the CCD in the macular area of the examined eye. Analysis of variance was used for comparison of measurement data among the three groups; χ2 test was used for comparison of categorical variables. The paired t test was performed to compare the CCD of the mCNV patient's eye and the contralateral eye. Results:Among the 50 eyes in the mCNV group, Ⅰ , Ⅱ, and mixed choroidal neovascularization (CNV) were 12 (24%, 12/50), 34 (68%, 34/50), and 4 (8%, 4/50) eyes, respectively. Corresponding to the OCTA cross-sectional image of the lesion, there was a clear "flower cluster" -like strong blood flow signal. Among them, the focal shape, the filament shape, and the group net shape were 6 (12%, 6/50), 8 (11%, 8/50), and 36 (72%, 36/50) eyes, respectively. The CCD of the eyes in the mCNV group, the pure high myopia group, and the normal control group were (57.39±3.24)%, (59.33±2.23)%, and (61.87±1.62)%, respectively. The CCD of the eyes in the mCNV group was significantly lower than that of the simple high myopia group ( P=0.030) and the normal control group ( P<0.001). The CCD of the affected eye and the contralateral eye in the mCNV group were (57.39±3.24)% and (59.82±3.94)%, respectively; there was no statistically significant difference between the CCD of the affected eye and the contralateral eye ( t=-0.496, P=0.100). The CCDs of eyes with Ⅰ, Ⅱ and mixed CNV were (57.38±3.31)%, (57.39±2.83)%, and (57.36±4.21)%, respectively. There were no statistically significant differences in CCD ( F=1.476), age ( F=0.274), sex ratio ( χ2=0.825), and diopter ( F=0.348) in different CNV types ( P>0.05). Conclusion:The mCNV is mostly type Ⅱ, and OCTA has a "bloom" appearance of abnormal reticular blood vessels; the CCD is significantly reduced, and it is bilateral.

The role of optical coherence tomography angiography to distinguish ischemic and non-ischemic branch retinal vein occlusion / 中华眼底病杂志

Objective:To observe the value of optical coherence tomography (OCTA) in distinguishing ischemic and non-ischemic branch retinal vein occlusion (BRVO).Methods:A prospective clinical observational study. From January 2020 to January 2021, 44 eyes of 44 patients with BRVO diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, there were 24 eyes of 24 males and 20 eyes of 20 females. The macular edema subsided after three consecutive anti-vascular endothelial growth factor (VEGF) drug treatments. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fluorescein fundus angiography (UWFFA), and OCTA examination. According to the results of UWFFA, the affected eyes were divided into ischemic group and non-ischemic group, with 22 eyes in 22 patients. The macular area of the affected eye with an OCTA instrument were scaned in the range of 3 mm× 3 mm to measure the blood flow density (SVD, DVD), foveal blood flow density (SFVD, DFVD), parafoveal blood flow density (SPFVD, DPFVD), affected hemilateral blood flow density (SHVD, DHVD) and affected quadrant blood flow density (SQVD, DQVD) of the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina, foveal retinal thickness (CRT), fovea avascular zone (FAZ) area, perimeter of FAZ (PERIM), out-of-roundness index (AI), and blood flow density within 300 μm width of FAZ (FD-300). The two-sample independent t test was used to compare the parameters between the ischemic group and the non-ischemic group. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of blood flow density to predict ischemic BRVO, determine the critical value for predicting ischemic BRVO and the corresponding sensitivity and specificity, with AUC> 0.9 as the prediction performance was good. Results:The differences of BCVA ( t=1.544), intraocular pressure ( t=-0.404), SFVD ( t=0.444), DFVD ( t=-0.812), CRT ( t=1.082), FAZ area ( t=-0.785), PERIM ( t=-0.685), AI ( t=1.047) of the eyes in the ischemic group and non-ischemic group were not statistically significant ( P>0.05). The differences of age ( t=2.194), SVD ( t=-3.796), SPFVD ( t=-4.181), SHVD ( t=-4.700), SQVD ( t=-3.594), DVD ( t=-2.324), DPFVD ( t=-2.476), DHVD ( t=-2.118), DQVD ( t=-6.529) and FD-300 ( t=-5.116) of the eyes in the ischemic group and non-ischemic group area were statistically significant ( P<0.05). ROC curve analysis results showed that DQVD predicted the AUC of ischemic BRVO the largest (0.917), the best cut-off value was 33.75%, and the sensitivity and specificity were 90.9% and 81.8%, respectively. Conclusion:OCTA can quantitatively assess the microvascular structure of SCP and DCP in the macular area of BRVO eyes, and contribute to distinguish ischemic and non-ischemic BRVO.

Macular microvascular findings in familial exudative vitreoretinopathy on optical coherence tomography angiography / 中华眼底病杂志

Objective:To evaluate macular microvessel changes in familial exudative vitreoretinopathy (FEVR) by optical coherence tomography angiography.Methods:Cross-sectional clinical case-control study. From November 2019 to November 2020, 21 FEVR patients (41 eyes) from Weifang Eye Hospital were selected; 17 healthy volunteers (28 eyes) with the same age and gender as FEVR group were selected as normal control group. According to the best corrected visual acuity (BCVA) 1.0 and <1.0, FEVR group was divided into normal visual acuity group (27 eyes) and visual acuity decreased group (14 eyes). All enrollees received BCVA and OCTA. BCVA was performed with an international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) vision. The OCTA instrument was used to scan the macular area of all the examined eyes in the range of 3 mm×3 mm, 6 mm×6 mm, and the blood vessel density (VD) and blood perfusion density (PD) within the range of 3 mm×3 mm, 6 mm×6 mm were measured and the area, circumference, and morphological index of the foveal avascular zone (FAZ) within the range of 6 mm×6 mm. Quantitative data were compared between groups by independent sample t test. Statistical data were compared by χ 2 test. The area under curve (AUC) of each index was determined according to receiver operating characteristic curve (ROC curve), and the predictive value of each index was evaluated. Results:In the macular area of 6 mm×6 mm, VD, PD, FAZ area and FAZ perimeter of FEVR group were all lower than those of normal control group, and the differences were statistically significant ( t=-3.350, -2.387, -3.519, -3.029; P<0.05). In macular area of 3 mm×3 mm and 6 mm×6 mm, compared with normal vision group and vision loss group, both VD and PD decreased. The differences were statistically significant ( t=2.088, 2.114, 2.160, 2.545; P<0.05). In the macular area of 6 mm×6 mm , the FAZ morphological index of the two groups was significantly different ( t=2.409, P<0.05). ROC curve analysis showed that all the indicators had low diagnostic value for FEVR (AUC<0.5). Conclusion:There are microvascular abnormalities in macular area in FEVR patients, and the decrease of blood vessels and the change of FAZ shape may be related to the loss of visual acuity.

Observation on the imaging characteristics of optical coherence tomography angiography in eyes with macular telangiectasia type 2 / 中华眼底病杂志

Objective:To observe the imaging characteristics of optical coherence tomography angiography in macular telangiectasia type 2 (Mac-Tel 2).Methods:A retrospective case analysis. From October 2017 to June 2021, 11 patients (22 eyes) diagnosed as Mac-Tel type 2 by multi-modal imaging in Nanjing Medical University Eye Hospital were included in this study. There were 5 males (10 eyes) and 6 females (12 eyes). The age were 41.61±11.32 years old. All patients underwent the examinations of best corrected visual acuity, indirect ophthalmoscope, fundus color photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). The scope of 3 mm × 3 mm in macular area of eyes was scanned by OCTA. After automatic image processing, the system could provide the blood flow image of capillary layer, deep capillary layer, outer retina, choroidal capillary layer, and the B-scan image. The imaging characteristics were observed.Results:Among the 22 eyes, 14 eyes were in the early stage of the disease, and 8 eyes had secondary subretinal neovascularization (SRN) and/or choroidal neovascularization (CNV). FFA examination that in the early stage of the disease, the capillaries near the fovea were dilated, the blood vessels were stretched, and the late fluorescence was mainly stained; high-fluorescence leakage was seen when SRN and CNV were developed. OCTA examination showed that in the early stage of the disease, the temporal capillaries in the macular area were dilated and stretched, especially in the deep layer. The capillary space was enlarged, and the right-angled venules were seen to change and infiltrate into the deep layer; when the lesions invaded the outer retina, flower clusters-like SRN were seen; neovascularization was seen in the outer retina and choroidal capillary layer when CNV was developed. B-scan image showed that in the early stage of the disease, irregular weak reflex cavities and lamellar holes change between the neuroepithelial layers; secondary SRN and CNV showed strong little clumpy reflexes accompanied by abundant blood flow signals.Conclusion:The image characteristics of OCTA in the eyes of Mac-Tel 2 were dilated, stretched superficial and deep temporal capillaries in the macula area and right-angled changes in blood vessels.