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Objective:To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC).Methods:A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed.Results:Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.Conclusions:The majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
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Objective:To observe the clinical and multimodal imaging characteristics of eyes with acute macular neuroretinopathy (AMN) associated with COVID-19.Methods:A retrospective clinical study. From December 18 to 26, 2022, 16 eyes of 8 patients with AMN associated with COVID-19 were included in the study. There were 4 males and 4 females; all cases were bilateral. The age was (31.5±9.6) years old. The time from fever to decreased vision was (3.75±1.04) days. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundus microscopy, fundus color photography, and optical coherence tomography (OCT) were performed in all patients. Infrared fundus photography (IR), OCT angiography (OCTA) and fluorescein fundus angiography (FFA) were performed in 14, 6 and 4 eyes respectively. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistics. The clinical data, IR, OCT and OCTA imaging features of the patients were retrospectively analyzed.Results:The logMAR BCVA of AMN eyes was 4.21±0.74, intraocular pressure was (14.87±1.50) mm Hg (1 mm Hg=0.133 kPa). Fundus color photography showed that multiple gray-white petal-shaped lesions were arranged around the macular fovea in 2 eyes; no obvious abnormality was found in the macular area in 14 eyes. Of the 14 eyes examined by IR, 6 eyes had irregular weak reflective lesions around the macular fovea. OCT showed strong reflex in the outer nuclear layer and outer plexiform layer of all eyes, including 15 eyes with elliptical zone injury. In 6 eyes examined by OCTA, the blood flow density of the superficial and deep capillary plexus (DCP) of retina decreased, and the blood flow density of DCP decreased significantly. The en-face image of DCP showed the wedge-shaped strong reflective lesion area with the tip pointing to the central fovea in 2 eyes. No abnormal fluorescence was observed in FFA.Conclusions:The characteristic manifestation of AMN associated with COVID-19 is weak reflex focus in IR; OCT shows strong reflection in outer core layer and outer plexiform layer; OCTA showed that retinal DCP blood flow density decreased.
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Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50–91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT);OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%);CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89, Kappa value=0.796, P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV;the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82, Kappa value=0.753, P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.
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Objective To observe the characteristics of macular optical coherence tomography (OCT) changes before and after silicone oil removal in patients who had undergone pars plana vitrectomy with silicone oil tamponade for macula-off rhegmatogenous retinal detachment (RRD).Methods Thirty-nine eyes that underwent silicone oil removal were enrolled in this retrospective study.The patients included 24 males and 15 females,with an average age of (53.05±4.03) years,the duration of silicone oil tamponade ranged from 3 to 7 months.Best-corrected visual acuity,intraocular pressure,slit lamp microscope and prelens,indirect ophthalmoscopy and fourier domain OCT were measured for all patients before and at months 1,3 and 6 after silicone oil removal.The macular microstructure were observed before and after silicone oil removal.Results Submacular fluid was detected in 6 eyes (15.38％),at the last time of follow-up,submacular fluid resolved completely in 2 eyes with disrupted ellipsoid zone,and resolved partly in 2 eyes.Disrupted ellipsoid zone were observed before silicone oil removal in 16 eyes (41.02％),6 eyes showed simultaneous disrupted ellipsoid zone and disrupted external limiting membrane,and there were 2 eyes that external limiting membrane was not identified,at the last time of follow-up,disrupted ellipsoid zone restored in 2 eyes and the extent of disrupted ellipsoid zone became reduced in 4 eyes.Cystoids macular edema were found in 2 eyes (5.12％),it resolved completely in 1 eye and resolved partly in 1 eye at the last time of follow-up.Macular epiretinal membrane was detected in 10 eyes (25.64％),and macular epiretinal membrane was found before silicone oil removal in 5 eyes,at the last time of follow-up,the membrane became thickened in 2 eye;5 eyes developed macular epiretinal membrane after silicone oil removal,at the last time of follow-up,the membrane became thickened in 1 eye.Secondary macular hole were noted in 2 eyes.Microcystic macular changes were observed in 9 eyes (23.07％),it was observed in 7 eyes before silicone oil removal,and was observed in 2 eyes after silicone oil removal,at the last time of follow-up,the cysts reduced in 1 eye.Conclusion Submacular fluid,disrupted ellipsoid zone and microcystic macular are the main macular ultrastructural changes that developed in patients with RRD before and after silicone oil removal.
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Background Central retinal vein occlusion (CRVO) is a common retinal vascular disease.Intravitreal injection of ranibizumab, a vascular endothelial growth factor (VEGF) antibody, is being a useful approach to the treatment of macular edema secondary to CRVO.However,little literature about choroidal thickness variations following intravitreal injection of ranibizumab for CRVO is published up to now.Objective This study was to observe the dynamic changes of macular choroidal thickness after intravitreal injection of ranibizumab in CRVO eyes.Methods A self-controlled series cases study was designed.Thirty-one eyes of 31 CRVO patients were included in Tianjin Eye Hospital from June 2013 to November 2014,with the males 19 and females 12 and mean age of (51.13±16.65) years.Ranibizumab (5 mg,5 ml) was intravitreally injected in the CRVO eyes once per month for 3 times by the same operator.A enhanced depth image (EDI) mode of spectral-domain OCT system was employed to measure the choroidal thickness at subfoveal, 1 mm from fovea nasal and 1 mm from fovea temporal before and 1 month,2,3 months after first injection in both CRVO eyes and contralateral healthy eyes, respectively.The best LogMAR vision was recored.This research protocol was approved by the Ethic Committee of this hospital, and written informed consent was obtained from each individual prior to any medical examination.Results Retinal bleeding was exhibited in the CRVO eyes in color photography,and fundus fluorescein angiography showed the fluorescine leakege in the early phase and fluorescine accummulation in the late phase.The mean choroidal theckness value was (325.32±83.04) , (294.83±80.61), (315.95±90.77) and (314.81±84.98) μm before injection and 1,2,3 months after injection,respectively,showing a significantly difference among various time points (F =7.96,P =0.00) , and the choroidal theckness values were evidently reduced in various time points after injection in comparison with before injection (P =0.01,0.01,0.00).The choroidal thickness value at foveal was (314.81±84.98) μm in the CRVO eyes 3 months after injection,and that in the fellow eyes was (260.47±55.90) ,with significant difference between them (t =2.95, P =0.01).The LogMAR vision was 0.17±0.09,0.37±0.23,0.42±0.26 and 0.49±0.21 before and 1,2,3 months after injection,with the significant difference among various time points (F =21.50, P =0.00) and showed considerable improvement after intravitreal injection of ranibizumab(all at P＜0.01).The mean retinal thickness value was (244.14-±23.28) μm in the fellow eyes, and those in 1 month, 2,3 months after injection were (523.81 ± 147.61), (352.13 ± 166.71),(376.39±209.46) and (369.00±225.61) μm in the CRVO eyes, showing obvious reduce after intravitreal injection, with significant difference among different time points (F =7.09, P＜0.01).Conclusions Choroidal thickness at macular fovea is obviously increased in CRVO eyes compared with the contralateral healthy eyes.Intravitreal injection of ranibizumab can reduce choroidal thickness and therefore improve vision.EDI OCT is available in the evaluation of dynamic change of choroidal thickness.Macular choroidal thickness could be used as a predictor of CRVO prognosis following intravitreal ranibizumab.
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Objective To observe the characteristic variation of the patients' inner and outer retina who had chronic central serous chorioretinopathy (CSC) after being treated of photodynamic therapy (PDT).Methods Nineteen patients with chronic CSC were recruited,including 15 eye of men and 4 eye of women,logMAR BCVA was 0.1-1.0,0.39 ± 0.30.Meanwhile,24 healthy people were located in the control group.All the patients received PDT for the first time.All subjects including 24 healthy people underwent fourier domain optical coherence tomography (FD-OCT).Retinal thickness were investigated before PDT and 1,4,12,20 weeks after PDT respectively.Data were recorded including inner layer and outer layer.Retinal thickness were compared in fovea (1 mm),parafovea (3 mm)and perifovea(5 mm).Paired-samples t test was used to compare retinal thickness before and after PDT.The statistical differences of patients and control group were evaluated by independent-samples t test.The correlations between the best logMAR corrected visual acuity (BCVA) was analyzed by Pearson statistical analyses.Results The inner(F=13.814,10.095,4.689) and outer(F＝ 9.354,5.878,3.978) layer fovea thickness of CSC subjects in 1,4,12 week was thinner,the difference was statistically significant (P＜0.05).The outer layer fovea thickness at P12 (t =-3.725),parafovea of inner and outer retinal (t =-3.198,-2.722) was reduced when compared with control group,and differences have statistical sense,respectively (P＜0.05).There was correlation between logMAR BCVA and outer retinal thickness in fovea and parafovea (r =0.465,-0.728,-0.687; P＜0.05).Conclusion In our study,the inner and outer layer retinal thickness decreased generally after the first time PDT in CSC patients.
