Physiological characteristics of the choroid and its association with myopia in children and adolescents / 中国学校卫生

Abstract@#The choroid is a multifunctional dynamic structure located between the sclera and the Bruch membrane, which may be involved in the regulation of eye growth and the development of myopia. Choroidal thickness may serve as an important biomarker for predicting the development of myopia and the effectiveness of myopia control treatments in children and adolescents. The study reviews and summarizes the physiological structure and measuring methods of the choroid, and discusses its influencing factors including age, physiological changes, refractive status, axial length, drug effects, optical environment and so on. The review points out the potential applications of choroidal thickness in myopia research among children and adolescents.

Research progress in assisting in the diagnosis of early Alzheimer's disease through eye structure / 国际眼科杂志(Guoji Yanke Zazhi)

Alzheimer's disease(AD)is a common degenerative disease of the central nervous system in which neuropathological changes precede cognitive dysfunction and behavioral impairment. Currently, early diagnosis of AD is based on invasive and expensive testing techniques that are difficult to use widely in the clinical setting. Therefore, there is an urgent need for new markers to detect AD at an early stage. The eye, as an extension of the brain, has been found to show earlier onset of ocular pathologic changes in patients with AD compared to brain pathologic changes, such as retinal structural abnormalities, visual dysfunction, retinal abnormal protein accumulation, choroidal thickness changes, decreased corneal nerve fiber density, deposition of abnormal Aβ proteins in the lens, and pupillary light decreased sensitivity of response, etc. This article reviews the ocular pathologic changes in AD patients in recent years to provide new ideas for the early clinical diagnosis of AD.

Unusual ocular manifestations of ethomoidal mucocele: a case report / Manifestações oculares incomuns de mucocele etmoidal: relato de caso

ABSTRACT A 42-year-old female patient had vision loss and chronic epiphora in her left eye. Her best-corrected visual acuity was 10/10 in the right eye and 0.3/10 in the left eye. The anterior segment examination results were normal. In fundus examination, choroidal folds were detected. Optical coherence tomography showed elevation on the macula and choroidal folds. Ultrasonography revealed a T-sign. Magnetic resonance imaging revealed an ethmoidal mucocele that compresses the orbital tissues. Surgical treatment was performed in the otorhinolaryngology department. Postoperatively, choroidal folds recovered, and the best-corrected visual acuity improved, but subretinal fluid accumulated. During the follow-up period without any treatment, subretinal fluid totally disappeared.

RESUMO Paciente do sexo feminino, 42 anos, com perda visual e epífora crônica no olho esquerdo. Sua acuidade visual melhor corrigida foi de 10/10 no olho direito e 0,3/10 no olho esquerdo. O exame do segmento anterior foi normal. No exame de fundo de olho, foram detectadas pregas coroidais. A tomografia de coerência óptica revelou elevação na mácula e pregas coroidais. A ultrassonografia revelou sinal T. A imagem de ressonância magnética mostrou mucocele etmoidal que comprime os tecidos orbitários. O Departamento de Otorrinolaringologia realizou o tratamento cirúrgico. No pós-operatório, as dobras coroidais se recuperaram, a acuidade visual melhor corrigida foi melhorada, mas ocorreu líquido sub-retiniano. Durante o período de acompanhamento sem qualquer tratamento, o líquido sub-retiniano recuperou-se totalmente.

Pseudomelanomas at a referral ocular oncology center in Brazil / Pseudomelanomas em um centro de referência em oncologia ocular no Brasil

ABSTRACT Objective: To evaluate the epidemiological, clinical, and imaging profile of lesions that mimic choroidal melanoma. Methods: Retrospective study of medical records of suspected choroidal melanoma lesions referred to the Ocular Oncology Service from the Universidade Federal de São Paulo, from 2014 to 2020. Demographic data, clinical history, and exams were evaluated. Results: A total of 104 patients (mean age: 65.57 ± 13.18; 49.04% female) were referred to our service with suspected choroidal melanoma. Of these, 32 (30.77%) were classified as pseudomelanoma, while 72 (69.23%) had a confirmed diagnosis of choroidal melanoma. Pseudomelanoma cases manifested in older individuals (p < 0.001), with smaller lesions in height (p < 0.001), anteroposterior diameter (p = 0.008), and lateral diameter (p = 0.003) on ultrasound. Pseudomelanoma cases were associated with higher frequencies of vitreous hemorrhage (p = 0.014) and lower rates of the presence of a mass (p = 0.001) and retinal detachment (p < 0.001). The main diagnoses of pseudomelanoma cases were choroidal nevus (40.63%), subretinal hemorrhage (18.75%) and choroidal neovascular membrane (18.75%). Conclusion: Almost one third of the cases referred with suspected choroidal melanoma were pseudomelanomas, which demonstrates that there is still a considerable path to improve the ability of general ophthalmologists to clinically discriminate melanoma from other conditions that can mimic it.

RESUMO Objetivo: Avaliar a frequência e o perfil epidemiológico, clínico e de imagem das lesões que simulam o melanoma de coroide. Métodos: Trata-se de estudo de revisão retrospectiva de prontuários de suspeita de lesões de melanoma de coroide de 2014 a 2020 no Setor de Oncologia Ocular da Universidade Federal de São Paulo. Foram avaliados dados demográficos, dados clínicos e exames complementares. Resultados: Um total de 104 pacientes (média de idade: 65,57 ± 13,18; 49,04% do sexo feminino) foram encaminhados ao nosso serviço com suspeita de melanoma de coroide. Destes, 32 (30,77%) foram classificados como pseudomelanoma, enquanto 72 (69,23%) tiveram diagnóstico confirmado de melanoma de coroide. Os casos de pseudomelanoma manifestaram-se em indivíduos mais velhos (p < 0,001) e apresentaram lesões menores em altura (p < 0,001), diâmetro anteroposterior (p = 0,008) e diâmetro lateral (p = 0,003) na ultrassonografia. Os casos de pseudomelanoma estão associados a maiores frequências de hemorragia vítrea (p = 0,014) e menores taxas de presença de massa (p = 0,001) e descolamento de retina (p < 0,001). Os principais diagnósticos dos casos de pseudomelanoma foram nevo (40,63%), hemorragia sub-retiniana (18,75%) e membrana neovascular coroidal (18,75%). Conclusão: Quase um terço dos casos encaminhados com suspeita de melanoma de coroide foram pseudomelanomas, o que demonstra que ainda há um caminho considerável para melhorar a habilidade do oftalmologista geral em discriminar clinicamente o melanoma de outras condições que o simulam.

Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

ABSTRACT Follicular thyroid cancers account for 15%-20% of all thyroid tumors. Choroidal metastases secondary to follicular thyroid cancer rarely occur. Herein, we report the case of an 85-year-old woman who presented choroidal metastasis from a follicular thyroid carcinoma in the right eye 7 years after total thyroidectomy and underwent enucleation. To confirm the diagnosis and primary tumor site, histopathological, and immunohistochemical examinations were performed. One year later, she presented metastasis in the contralateral eye. Few similar cases have been described in the literature.

Choroidal macrovascular and capillary alterations in eyes with idiopathic epiretinal membranes

ABSTRACT Purpose: To evaluate the choroidal vascular alterations and effect of surgical treatment in the setting of idiopathic epiretinal membranes. Methods: The structure of the choroid was studied in 33 patients with unilateral idiopathic epiretinal membrane using optical coherence tomography with enhanced depth imaging and optical coherence tomography angiography. Eyes with epiretinal membrane underwent 25-gauge vitrectomy with epiretinal membrane and internal limiting membrane peeling. The choroidal vascularity index, Haller layer/choroidal thickness ratio, and choriocapillaris flow density were used to evaluate changes in choroidal structure after surgery and compare with the healthy fellow eyes. Results: The choroidal vascularity index and Haller layer/choroidal thickness ratio of the eyes with epiretinal membrane were higher than those of the fellow eyes at baseline (p=0.009 and p=0.04, respectively) and decreased postoperatively compared with preoperative values (p=0.009 and p=0.001, respectively). The choriocapillaris flow of eyes with epiretinal membrane was lower than that of the fellow eyes at baseline (p=0.001) and increased after surgery compared with the preoperative value (p=0.04). The choroidal vascularity index, Haller layer/choroidal thickness ratio, and choriocapillaris flow values of the healthy fellow eyes were comparable at baseline and final visit. In eyes with epiretinal membrane, the final choroidal vascularity index correlated with the final choriocapillaris flow (r=-0.749, p=0.008) in the multivariate analysis. Conclusion: Idiopathic epiretinal membrane appears to affect the choroidal structure with increased choroidal vascularity index and Haller layer/choroidal thickness ratio and decreased choriocapillaris flow. These macrovascular (choroidal vascularity index and Haller layer/choroidal thickness) and microvascular (choriocapillaris flow) alterations appear to be relieved by surgical treatment of the epiretinal membranes.

Thinning of the retinal nerve fiber and choroidal layers in adolescents with anorexia nervosa: A controlled study

ABSTRACT Purpose: We aimed to evaluate retinal nerve fiber and choroidal layer alterations in adolescents with anorexia nervosa using spectral-domain optical coherence tomography. Methods: Thirty patients with anorexia nervosa and 30 healthy adolescents aged 12-18 years were included in this study. Their age, sex, body mass index, anorexia nervosa type, disease duration, and spectral-domain optical coherence tomography data were recorded. Results: Central macular thickness and retinal nerve fiber layer thickness in the temporal and inferior regions were significantly lesser in patients with anorexia than in healthy controls (p<0.05). Moreover, significant choroidal thinning around the foveal and subfoveal regions in patients with anorexia was observed (p<0.05). In addition, a statistically significant relation between the increase in disease duration and the thinning of the inferior retinal nerve fiber layer was detected (p<0.05). Conclusion: The retinal nerve fiber layer and choroidal layer thicknesses were lesser in patients with anorexia than in healthy controls. Screening for retinal indices might prevent the development of irreversible retinal pathologies in adolescents with anorexia nervosa. In addition, thinning of the retinal nerve fiber and choroidal layers could reflect structural or functional changes in the brain of adolescents with anorexia nervosa.

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review / Papiloma de plexo coroide na fossa posterior na população pediátrica: série de casos e revisão da literatura

Abstract Choroid plexus papillomas (CPPs) are rare benign neoplasms which are particularly uncommon in the posterior fossa in children. We herein present a case series of five patients treated at a tertiary care hospital. A comprehensive literature review was also carried out. The patients treated at the tertiary care hospital were aged between 4 and 16 years. Gross total resection (GTR) was initially achieved in two patients. All patients showed clinical improvement. Moreover, 27 articles published between 1975 and 2021 were selected for the literature review, totaling 46 patients; with the 5 patients previously described, the total sample was composed of 51 cases, With a mean age was 8.2 years. The lesions were located either in the fourth ventricle (65.3%) or the cerebellopontine angle (34.7%). Hydrocephalus was present preoperatively in 66.7% of the patients, and a permanent shunt was required in 31.6% of the cases. The GTR procedure was feasible in 64.5%, and 93.8% showed clinical improvement. For CPPs, GTR is the gold standard treatment and should be attempted whenever feasible, especially because the role of the adjuvant treatment remains controversial. Neuromonitoring is a valuable tool to achieve maximal safe resection. Hydrocephalus is common and must be recognized and promptly treated. Most patients will need a permanent shunt. Though there is still controversy on its efficacy, endoscopic third ventriculostomy is a safe procedure, and was the authors' first choice to treat hydrocephalus.

Resumo Os papilomas do plexo coroide (PPCs) são neoplasias benignas raras e, na população pediátrica, são particularmente incomuns na fossa posterior. Apresentamos uma série de casos de cinco pacientes atendidos em um hospital terciário. Além disso, foi realizada uma ampla revisão da literatura. Os pacientes atendidos no hospital terciário tinham entre 4 e 16 anos. Ressecção macroscópica total (RMT) foi inicialmente realizada em dois pacientes. Todos os pacientes apresentaram melhora clínica. Além disso, 27 artigos publicados entre 1975 e 2021 foram selecionados para a revisão da literatura, totalizando 46 pacientes. Somados à série de casos atuais, encontramos 51 pacientes, com média de idade de 8,2 anos. As lesões localizavam-se no quarto ventrículo (65,3%) ou no ângulo pontocerebelar (34,7%). Hidrocefalia estava presente no pré-operatório em 66,7% dos pacientes, e derivação ventricular permanente foi necessária em 31,6% dos casos. A RMT foi possível em 64,5%, e 93,8% tiveram melhora clínica. Para os CPPs, a RMT é o tratamento padrão-ouro e deve ser tentado sempre que possível, especialmente porque ainda existem controvérsias quanto ao papel do tratamento adjuvante. A neuromonitorização é uma ferramenta importante para se atingir a máxima ressecção segura. A hidrocefalia é comumente vista nesses pacientes e deve ser identificada e tratada. A maioria dos pacientes irá precisar de uma derivação permanente. Apesar de persistirem controvérsias sobre sua eficácia, a terceiro-ventriculostomia endoscópica foi a primeira escolha para tratar a hidrocefalia na experiência dos autores e é uma opção segura.

Choroid plexus papilloma in a mature cystic teratoma of ovary: A rare case report

Mature cystic teratoma of the ovary is the most common type of germ cell tumor. It constitutes approximately 20% of all ovarian neoplasms. As a rare occurrence, however, several types of benign and malignant tumours developing secondarily in dermoid cysts have been reported. Those of central nervous origin are almost exclusively gliomas of astrocytic, ependymal or oligodendroglial lineage. Choroid plexus tumors are unusual intracranial tumors which comprised of only 0.4?0.6% of all brain tumors. These are neuroectodermal in origin and similar in structure to a normal choroid plexus in the form of multiple papillary fronds mounted on a well vascularized connective tissue stroma. The present case report highlights the presence of a choroid plexus tumor in a mature cystic teratoma of the ovary in a 27?year?old woman who came for safe confinement and cesarean section.

Real-world outcomes and complications of different surgical approaches for significant submacular haemorrhages

Purpose: To evaluate the outcomes and complications after different surgical management of cases with significant sumacular hemorrhage (SMH) of size more than 4 disc diameter (DD). Methods: It was a retrospective interventional study. All consecutive 103 cases of significant SMHs were treated by vitrectomy and divided into three groups. In Group A (<4 weeks, confined to the macula or extending inferiorly, n = 62), vitrectomy, subretinal cocktail of tissue plasminogen activator (tPA), antivascular endothelial growth factor, and air with SF6 gas; in Group B (4–8 weeks, extending beyond macula, n = 31), subretinal tPA followed by SMH drainage either by retinotomy (Group B?1, n = 17) or by temporal 180?degree retinectomy (Group B?2, n = 14) with silicone oil (SO) tamponade; and in Group C (>8 weeks, extending beyond macula, n = 10), SMH removal with autologous retinal pigment epithelium (RPE)?Choroid patch graft transplantations with SO tamponade were performed. Parameters evaluated were best corrected visual acuity (BCVA), Optos, optical computerized tomography, and ultrasonography as required. Results: Significant visual improvement was seen from mean preoperative to mean postoperative BCVA in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.001). Postoperative complications were recurrent SMH (4.84% vs 12.90% vs 10%), vitreous hemorrhage (6.45%, GroupA), hyphema (4.84% vs 12.90% vs 10%), hypotony (nil vs 3.23% vs 20%), macular hole formation (6.45%, Group A), epiretinal membrane (16.13%, Group B), and retinal detachment (3.23%, Group A and 10%, Group C). Conclusion: Surgical approaches for significant submacular hemorrhage are visually awarding, though certain specific complications may arise

Choroidal metastasis: Radiation and bevacizumab at presentation

Purpose: To reveal early intervention outcomes for patients describing with choroidal metastasis. Methods: A retrospective interventional case series on 27 eyes of 22 patients treated for choroidal metastasis with external beam radiation therapy (EBRT) With and without intravitreal injections. The prescribed radiation dose was a mean and median 30 Gy (range of 30–40 Gy in 180–200 cGy daily fractions). Outcome measures included change in tumor thickness, subretinal fluid, visual acuity, radiation oculopathy, and survival. Results: Decreased vision was the most common presenting symptom (n = 20/27, 74%). Pre?treatment vision for subfoveal lesions was a mean 20/400, median 20/200, and range 20/40 to hand motions (HM). Pre?treatment vision for extrafoveal tumors were a mean 20/40, median 20/25, range 20/20 to counting fingers (CF) which improved to a mean 20/32, median 20/20, range 20/12.5 to 20/200. Local control, with ultrasonographic height regression (44.5%; mean: 2.7–1.5 mm), was observed in all eyes at mean follow?up of 16 months (range: 1–72 months). Intravitreal anti?vascular endothelial growth factor (anti?VEGF) was given in nine cases (n = 9/27, 33%) to slow the growth of the metastasis and suppress their exudative detachments and to treat radiation maculopathy in 10 cases (n = 10/27, 37%). Late radiation complications included keratoconjunctivitis sicca in four cases (n = 4/27, 15%), exposure keratopathy in two cases (n = 2/27, 7%), and radiation retinopathy in 10 cases (n = 10/27, 37%). Of the 23 phakic eyes, four (n = 4, 17%) developed cataract. Conclusion: Radiation therapy with or without intravitreal anti?VEGF injections was a safe and effective treatment for choroidal metastasis. It was associated with local tumor control, reduction of secondary retinal detachments, and vision preservation.

Metastatic and aggressive renal cell carcinoma mimicking a unilateral choroidal tuberculoma / Carcinoma de células renais metastático grave mimetizando tuberculoma de coroide unilateral

ABSTRACT Ocular metastases from systemic tumors are uncommon. The choroid is the most frequent target, with a preference for elderly individuals. Lung cancer is the predominant primary tumor that metastasizes to the eyes in males, although other ocular conditions such as uveitis and retinal lesions can mimic secondary tumor implants in ocular tissues. On fundoscopy, choroidal metastasis resembles other infectious processes, especially choroidal tuberculoma. Therefore, patients presenting with choroidal masses should undergo detailed clinical examinations, especially if the mass is the first manifestation of a systemic and severe disease. In this report, we describe a young man with a metastatic choroidal tumor secondary to papillary renal cell carcinoma mimicking a unilateral choroidal tuberculoma.

RESUMO A disseminação metastática ocular de tumores sistêmicos é incomum, ocorrendo principalmente na coroide e em pacientes idosos. O câncer de pulmão é considerado o principal tumor metastático ocular em homens, contudo, outras doenças oculares, como as uveítes e lesões retinianas, podem mimetizar os implantes secundários tumorais nos tecidos oculares. O aspecto fundoscópico das neoplasias da coroide pode apresentar similaridade com outros processos infecciosos, especialmente o tuberculoma de coroide. Dessa forma, a investigação clínica detalhada é de grande importância no diagnóstico de pacientes com massas coroideanas, especialmente quando configuram a primeira manifestação de uma doença sistêmica e grave. Relatamos um caso raro de metástase coroideana como primeira manifestação clínica do carcinoma de células renais em um homem jovem, mimetizando um tuberculoma de coroide.

Choroidal thickness changes in post-COVID-19 cases / Mudanças de espessura da coroide após COVID19

ABSTRACT Purpose: The current study aimed to evaluate the effects of the coronavirus disease 2019 (COVID-19) on choroidal thickness using enhanced depth imaging optical coherence tomography. Methods: This study evaluated the right eyes from 41 post-COVID-19 cases (Group 1) and 41 healthy subjects (Group 2). Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. Post-COVID-19 cases were evaluated within 1 month after a diagnosis of COVID-19. Two experienced ophthalmologists measured the choroidal thickness at the subfovea, temporal, and nasal quadrants at 500-μm intervals up to 1500 μm from the fovea at seven different points. Moreover, central macular thickness and ganglion cell layer thickness were measured via OCT, after which both two groups were compared. Results: Group 1 showed a significantly thicker choroid compared to Group 2 at the subfovea, 500 μm temporal to the fovea, 500 and 1000 μm nasal to the fovea (p=0.011, p=0.043, p=0.009, and p=0.019, respectively). Although other areas measured were also thicker in Group 1, the difference was not significant (p>0.05). Moreover, no significant difference in the central macular thickness and ganglion cell layer thickness were observed between the groups (p>0.05). Conclusion: Choroidal thickness was increased in post-COVID-19 patients, which might be related to inflammation associated with the pathogenesis of COVID-19.

RESUMO Objetivo: Avaliar o efeito da doença por coronavírus de 2019 (COVID19) na espessura da coroide usando tomografia de coerência óptica com profundidade de imagem aprimorada. Métodos: Este estudo consistiu em 41 casos pós-COVID19 (Grupo 1) e 41 indivíduos saudáveis (Grupo 2). Apenas os olhos direitos dos participantes foram incluídos no estudo. A espessura da coroide foi medida usando tomografia de coerência óptica com profundidade de imagem aprimorada. Nos casos pós-COVID19, as medições foram realizadas dentro de 1 mês da doença. A espessura da coroide foi medida por dois oftalmologistas experientes nos quadrantes subfoveal, temporal e nasal, em sete pontos diferentes, a intervalos de 500 a 1500 μm da fóvea. Além disso, a espessura macular central e a espessura da camada de células ganglionares foram medidas com OCT e os dois Grupos foram comparados. Resultados: As espessuras coroidais foram estatisticamente mais espessas no Grupo 1 que no Grupo 2, com 500 μm no quadrante subfoveal, 500 Symbol (OTF)m no temporal e 1000 μm no nasal (p=0,011, p=0,043, p=0,009 e p=0,019, respectivamente). Embora outras medidas tenham se mostrado mais espessas no Grupo 1, elas não foram estatisticamente significativas (p>0,05). Também não houve diferenças significativas entre os Grupos quanto à espessura macular central e à espessura da camada de células ganglionares (p>0,05). Conclusão: A espessura da coroide mostrou-se aumentada em pacientes pós-COVID19. Isso pode estar relacionado à inflamação que faz parte da patogênese do COVID19.

Infratentorial atypical choroid plexus papilloma in an adult: A case report and literature review

Atypical choroid plexus papilloma is classified as WHO (World Health Organization) Grade II subtype of choroid plexus tumor, and it has intermediate pathological features, prognosis, and clinical outcome rates between choroid plexus papilloma and choroid plexus carcinoma. These tumors are more common in children compared with adults and are usually located in the lateral ventricles. We present a case of an adult with atypical choroid plexus papilloma located in the infratentorial region. A 41?year?old woman underwent evaluation for headache and dull aching neck pain. Magnetic resonance imaging (MRI) of the brain revealed a well?defined intraventricular mass lesion in the fourth ventricle and foramen of Luschka. She underwent craniotomy and gross total excision of the lesion. Histopathological and immunohistochemical findings confirmed the diagnosis of atypical choroid plexus papilloma (WHO Grade II). We discuss the various treatment options for this condition and review the relevant literature.

The relationship between reduced choroidal thickness due to high plasma asymmetrical dimethylarginine level and increased severity of diabetic retinopathy / Altos níveis de dimetil-arginina assimétrica no plasma podem aumentar a gravidade da retinopatia diabética através da redução da espessura da coroide

ABSTRACT Purpose: To evaluate the relationship between subfoveal choroidal thickness and plasma asymmetrical dimethylarginine level and the severity of diabetic retinopathy in patients with type 2 diabetes mellitus. Methods: A total of 68 cases, including 15 patients without diabetic retinopathy, 17 patients with nonproliferative diabetic retinopathy, 16 patients with type 2 diabetes mellitus and proliferative diabetic retinopathy, and 20 healthy patients (control group), were enrolled in this study. Subfoveal choroidal thickness was measured manually using the enhanced depth imaging optical coherence tomography scanning program, and plasma asymmetrical dimethylarginine level was measured using a commercial micro enzyme-linked immunosorbent assay kit. Results: The subfoveal choroidal thickness values and plasma asymmetrical dimethylarginine levels were significantly different between the four groups (p<0.001 and p<0.001). The subfoveal choroidal thickness values were significantly lower in the proliferative diabetic retinopathy group than in the other three groups (no diabetic retinopathy, nonproliferative diabetic retinopathy, and control groups; p<0.001, p=0.045, and p<0.001, respectively). The plasma asymmetrical dimethylarginine levels were significantly higher in the proliferative diabetic retinopathy group than in the other three groups (p<0.001, p<0.04, and p<0.001, respectively). In addition, a significant negative correlation was also found between plasma asymmetrical dimethylarginine level and subfoveal choroidal thickness (p<0.001, r=-0.479). Conclusion: Asymmetrical dimethylarginine is an important marker of endothelial dysfunction and endogenous endothelial nitric oxide synthase inhibitor. The severity of diabetic retinopathy was related to increased plasma asymmetrical dimethylarginine level and reduced subfoveal choroidal thickness in type 2 diabetic patients with diabetic retinopathy.

RESUMO Objetivo: Avaliar a relação da espessura subfoveal da coroide e dos níveis plasmáticos de dimetil-arginina assimétrica com a gravidade da retinopatia diabética em pacientes com diabetes mellitus tipo 2. Métodos: Foram incluídos 68 casos, compreendendo 15 pacientes sem retinopatia diabética, 17 pacientes com retinopatia diabética não proliferativa, 16 pacientes com retinopatia diabética proliferativa, e 20 casos saudáveis (grupo de controle). A espessura subfoveal da coroide foi medida manualmente, usando o programa de varredura com tomografia computadorizada óptica com imagem profunda aprimorada, e os níveis plasmáticos de dimetil-arginina assimétrica foram medidos usando um kit microELISA comercial. Resultados: Os valores da espessura subfoveal da coroide e os níveis plasmáticos de dimetil-arginina assimétrica foram significativamente diferentes nos quatro grupos (p<0,001 para ambos os parâmetros). Os valores da espessura subfoveal da coroide foram significativamente menores no grupo com retinopatia diabética proliferativa do que nos outros três grupos (sem retinopatia diabética, retinopatia diabética não proliferativa e grupo de controle, com p<0,001, p=0,045 e p<0,001, respectivamente). Já os níveis plasmáticos de dimetil-arginina assimétrica foram significativamente maiores no grupo com retinopatia diabética proliferativa do que nos outros três grupos (p<0,001, p=0,04 e p<0,001, respectivamente). Além disso, também foi encontrada uma correlação negativa significativa entre os níveis plasmáticos de dimetil-arginina assimétrica e a espessura subfoveal da coroide (p<0,001, r=-0,479). Conclusão: A dimetil-arginina assimétrica é um importante marcador de disfunção endotelial e um inibidor endógeno da óxido nítrico sintase. Foi encontrada uma relação da gravidade da retinopatia diabética e de níveis elevados de dimetil-arginina assimétrica no plasma com a redução da espessura subfoveal da coroide em pacientes diabéticos tipo 2 com retinopatia diabética.

Within-day changes in luminal, stromal choroidal thickness, and choroidal vascularity index in healthy adults

Purpose: To investigate topographical and within?day changes in the choroidal vascularity index and its association with choroidal thickness parameters (total, luminal, and stromal thickness) among young adults. Methods: Choroidal thickness and vascularity index were measured in 28 healthy young adults (age mean ± standard deviation [SD]: 25 ± 3.0) using spectral?domain optical coherence tomography. Participants were divided into three refractive groups: emmetropes, myopes, and high myopes. Choroidal parameters were evaluated in the macular and peripheral regions in the superior and inferior regions at two time points during the day; in the morning (at 7 am) and in the afternoon (at 1 pm). Results: All investigated choroidal thickness parameters showed a significant topographical variation across the vertical meridian, between the foveal (270 ± 89 ?m, 170 ± 45 ?m, and 111 ± 47 ?m, respectively) and peripheral (246 ± 68 ?m, 160 ± 39 ?m, 86 ± 36 ?m, respectively). The superior choroid was thicker in all thickness parameters compared to the inferior choroid. A significant increase in the vascularity percentage was seen from the fovea (61.8 ± 7%) toward the periphery (66.4 ± 7%). Thinner choroidal parameters were associated with high myopia, whereas an increase in the vascularity index was observed in high myopes. Significant within?day changes were observed in all choroidal thickness parameters, which were slightly reduced in the afternoon. The choroidal vascularity index (CVI) increased from 61.3 ± 5.3% in the morning and 63.2 ± 5.8% in the afternoon. High myopes exhibited reduced within?day amplitude in stromal thickness. Conclusion: All parameters showed significant regional variations. Myopia is associated with greater thinning in stromal thickness rather than vascular thickness. Only high myopes experienced reduced within?day change amplitudes in stromal choroidal thickness that was more predominant in the foveal and parafoveal regions.

Research progress of optical coherence tomography angiography in detecting retinal and choroidal thickness and blood flow in patients with high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

High myopia is a state of refractive error with myopia over -6.00D. High myopia is typically accompanied by multiple fundus lesions, thus making patients with high myopia suffer from varying degrees of impairment in visual function. As an emerging auxiliary way in ophthalmology, optical coherence tomography angiography(OCTA)can efficiently and non-invasively obtain microvascular stratified images of the retina and choroid and quantitatively analyze blood flow signals. Since the advent of OCTA, there have been numerous studies observing fundus changes in those with high myopia through OCTA. In this paper, some studies in which OCTA is applied to obtain retinal and choroidal thickness from patients with high myopia are reviewed, with a view to revealing the correlation between high myopia and the parameters such as retinal thickness, choroidal thickness, vessel density and the area of the foveal avascular zone and providing novel ideas to deeply investigate the mechanism of high myopia and delay the occurrence and development of high myopia.

Research progress on the relationship between ciliary muscle and myopia / 国际眼科杂志(Guoji Yanke Zazhi)

As a key ocular structure, ciliary muscle has a major role in accommodating both eye and aqueous humor drainage. Recent studies have found that the position and shape of ciliary muscles in myopia are significantly different from those in emmetropia or hyperopia, and the differences of ciliary muscle may affect the progress of myopia by altering ocular accommodation, choroidal tension and intraocular pressure. The present evidence indicating that the thickening of posterior ciliary muscle was associated with the development of myopia, but the mechanism has not been clearly confirmed. This paper summarizes the relationship between the differences of ciliary muscle and myopia, and the possible mechanism of myopia changes affected by ciliary muscle, so as to provide reference for follow-up research.

Effect of orbital decompression on choroidal thickness in patients with thyroid associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of orbital decompression on the central macular choroidal thickness(CMCT)in patients with thyroid-associated ophthalmopathy(TAO).METHOD: Prospective clinical studies. A total of 29 TAO patients(42 eyes)treated in our department from January 2021 to January 2022 were analyzed, and they were divided into 20 cases(30 eyes)in the moderate and severe group and 9 cases(12 eyes)in the extremely severe group. Both groups of patients received orbital decompression, and the changes of CMCT, visual acuity, intraocular pressure, exophthalmos, and clinical activity score(CAS)at 3 and 6mo before and after surgery were compared between the two groups.RESULTS: All patients completed follow-up. The CMCT, exophthalmos, intraocular pressure, and CAS of the extremely severe group at 3 and 6mo were 355.13±15.59 and 339.61±13.17μm, 19.33±2.23 and 17.83±1.70mm, 18.86±3.05 and 18.09±1.37mmHg, 3.75±0.87 and 2.42±1.00 points, respectively. The moderate and severe group was 325.00±10.48 and 321.04±11.34μm, 16.07±1.74 and 15.6±1.98mm, 16.65±2.04 and 16.03±2.3mmHg, 1.50±0.51 and 1.43±0.50 points, and there was differences with those before operation(extremely severe group: 396.46±17.61μm, 22.00±2.3mm, 21.85±2.82mmHg, 5.33±1.44 points; moderate and severe group: 335.77±11.60μm, 19.07±1.84mm, 18.89±3.06mmHg, 1.63±0.49 points; all P&#x003C;0.001). The best corrected visual acuity(LogMAR)before surgery was 0.64±0.22 in the extremely severe group, and 0.43±0.20 and 0.34±0.15 at 3 and 6mo after operation, respectively, which were different from those before surgery(all P&#x003C;0.001)CONCLUSION: Orbital decompression can effectively reduce CMCT, intraocular pressure and exophthalmos in TAO patients, relieve orbital vein stasis, and effectively improve vision and reduce mobility in patients with extremely severe disease.

Correlation between blood biochemical parameters and choroidal thickness in patients with nonproliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the relationship between blood biochemical parameters and choroidal thickness(CT)in na&#x0026;#xEF;ve-treatment of patients with nonproliferative diabetic retinopathy(NPDR).METHODS: Prospective cross-sectional study. A total of 92 patients(92 eyes)with na&#x0026;#xEF;ve-treated NPDR were selected in the Affiliated Eye Hospital of Nanchang University from July 2021 to July 2022. All of the patients included in this study were subjected to ophthalmologic examination including enhanced depth imaging optical coherence tomography(EDI-OCT), best corrected visual acuity(BCVA), fundus fluorescence angiography, intraocular pressure, slit lamp and fundus examination. At the same time, they were also underwent hematological examination including blood glucose, glycosylated hemoglobin(HbA1c), serum creatinine, uric acid, urea, β2 microglobulin, high density lipoprotein(HDL), low density lipoprotein(LDL), serum calcium, serum potassium and other tests. According to the glomerular filtration rate(eGFR)and CT, the patients were divided into normal, mild and moderate to severe renal function group, pachychoroid group and the leptochoroid group. The blood biochemical indexes, CT differences and theirs correlation were analyzed in na&#x0026;#xEF;ve-treated NPDR patients.RESULTS: A total of 92 cases(92 eyes)were included in this study, with 51 males(51 eyes), 41 females(41 eyes), 45 right eyes and 47 left eyes. There was no significant difference in age, axial length and disease duration among the three groups(all P&#x003E;0.05). There were significant differences in nasal 0.5, 1.5mm, subfoveal and temporal 0.5, 1.5mm CT among three groups(all P&#x003C;0.05). There was no statistical significance in age, axial length and the course of disease between the pachychoroid and leptochoroid groups(all P&#x003E;0.05). There were significant differences in creatinine, eGFR, uric acid, urea, potassium and β2-microglobulin between the pachychoroid group and the leptochoroid group(all P&#x003C;0.05). There were no significant differences in total cholesterol, triglyceride, HDL, LDL, HbA1c, serum calcium and glucose between the two groups(all P&#x003E;0.05). CT was negatively correlated with creatinine, urea, uric acid and β2-microglobulin, and positively correlated with eGFR. Multiple regression analysis showed that the thicker the nasal 0.5mm CT, the higher the eGFR(B=0.292, P&#x003C;0.001). CT affected creatinine, eGFR, urea, uric acid and β2-microglobulin(B=16.5, 64.6, 24.1, 18.1, 20.3; P=0.008, &#x003C;0.001, &#x003C;0.001, 0.004, 0.001), while there were no significant effects on total cholesterol, triglyceride, glucose, serum calcium, HDL and LDL(all P&#x003E;0.05).CONCLUSION: In patients with na&#x0026;#xEF;ve-treated NPDR, the thicker the CT, the better the renal function. The decrease of CT in newly diagnosed NPDR patients is an important hint to pay attention to the renal function.