Diabetic retinopathy (DR) is one of the most common causes of visual impairment and blindness in diabetic patients. It is particularly important to set up simpler, safer, non-invasive and highly effective methods for diagnosis as well as monitoring DR. A variety of new fundus imaging techniques show great advantages in early diagnosis, treatment and monitoring of DR in recent years. The main characteristics of wide-field scanning laser imaging system is achieving a large range of retinal image in a single photograph and without mydriasis. It provides several options for color images, FFA and FAF, which satisfy to detect the retina, choroid and vascular structure. Multi spectral fundus imaging system is suitable for DR screening, because it is able to recognize the typical characteristics of DR, such as microaneurysms, hemorrhage and exudation, and is non-invasive and convenient. OCT angiography is a quantitative examination that provides foveal avascular zone area, macular blood flow density, which provides strong evidence for DR diagnosis. The improvement of these new techniques will help us to build up a personalized evaluation system of DR.
ObjectiveTo observe the application value of RetCam Ⅲ in the diagnosis of retinoblastoma (RB). MethodsThe clinical data of 125 eyes from 94 patients with RB were retrospectively analyzed. According to the International Intraocular Retinoblastoma Classification, the results of binocular indirect ophthalmoscope and RetCam Ⅲ was compared. The consistency between RetCam Ⅲ and binocular indirect ophthalmoscope was analyzed by Kappa test. The detectable rates of tumor between binocular indirect ophthalmoscope, RetCam Ⅲand B scan ultrasound were comparatively analyzed. ResultsBy binocular indirect ophthalmoscope, there were 18 eyes (14.4%) in stage A, 15 eyes (12.0%) in stage B, 10 eyes (8.0%) in stage C, 28 eyes (22.4%) in stage D, and 54 eyes (43.2%) in stage E. Using RetCam Ⅲ, the classification was 18 eyes (14.4%) in stage A, 16 eyes (12.8%) in stage B, 11 eyes (8.8%) in stage C, 27 eyes (21.6%) in stage D, and 53 eyes (42.4%) in stage E. The RB classification of RetCam Ⅲ was quite consistent with binocular indirect ophthalmoscope (Weighted Kappa Coefficient=0.979 8, 95% confidence interval=0.960 1-0.999 5). A total of 150 tumors from stage A-D were observed by binocular indirect ophthalmoscope. In which, 147 tumors (98.0%) were found by RetCam Ⅲ, 122 tumors (81.3%) were found by B scan ultrasound. No serious complication was found in these patients. ConclusionsRetCam Ⅲ can detect RB of different stage in clinic. It is quite consistent with binocular indirect ophthalmoscope.
Fundus photograph, angiography, optical coherence tomography, ultrasonography and other image technology and visual electrophysiology can provide a wealth of information for the diagnosis and treatment of pediatric retinal diseases. However, it put forward higher requirements on pediatric retinal imaging equipment and techniques which will be quite different from adult, because of pediatric retinal disease has its own characteristics, such as disease spectrum, pathogenesis, and pathophysiology. The principles and methods of image results interpretation on adult were not quite ready for children. It is necessary to further study the fundus imaging techniques suitable for children, gradually establish standardized examination procedures and clinical interpretation system, to promote the diagnosis of retinopathy in children.
ObjectiveTo study the effects and outcomes of green diode laser therapy under indirect ophthalmoscope in the treatment of juvenile Coats disease. MethodsNineteen juvenile Coats disease patients (19 eyes) well enrolled in this study. Average age at presentation was 73.5 months (27-146 months). Best corrected visual acuity (BCVA) was ≥0.1 in 7 eyes; 0.01 to 0.09 in 8 eyes; counting finger in 3 eyes and light perception in 1 eye. The macular of all eyes was involved. There were 3 eyes with macular exudative retinal detachment, 4 eyes with sub-macular fibrosis, 1 eye with macular atrophy. Exudative area was more than two quadrants in 17 eyes, and less than two quadrants in 2 eyes. The abnormal blood vessels located in the superior or nasal-superior retina (2 eyes) or inferior or temple-inferior area (17 eyes). Exudative retinal detachment occurred in 13 eyes, in which macular was not involved in 10 eyes, and macular was involved in 3 eyes. All patients were treated with green diode laser (532 nm) ablation therapy under general anesthesia and indirect ophthalmoscope to areas of the retina telangiectasia. 3 patients received a single intravitreal 2 mg triamcinolone injection (IVTA). Average follow-up was 18.5 months (6-51 months). Main outcome measures included visual acuity, retinal vascular abnormalities, subretinal exudates and exudative retinal detachment. ResultsAmong 3 patients treated with IVTA, one needed cataract extraction and one needed pre-retinal membrane peeling surgery. After laser photocoagulation, resolution of telangiectasia lesions was achieved in all patients at the end of follow-up. Exudation was resolved in 8 eyes, reduced in 9 patients and no change in 2 eyes. Exudative detachment was resolved in 8/13 eyes, reduced in area in 3/13 eyes and no change in 2 eyes. There were 9 eyes with sub-macular fibrosis and 3 eyes with macular atrophy at the end of follow-up. The visual acuity was stable in most cases. BCVA was ≥0.1 in 6 eyes; 0.01 to 0.09 in 11 eyes; counting finger in 1 eyes and light perception in 1 eye. Compared to the normal eyes, eyes with Coats disease tended to be more hyperopic (t=3.6,P=0.003) and astigmatic (t=3.6, P=0.004), but no correction were needed for these refractive errors. ConclusionsGreen diode laser therapy under indirect ophthalmoscope can be an effective treatment for juvenile Coats disease with little complications. IVTA can be helpful, but must be used with cautions as it can induce some complications.
Illumimaton intensities of 6 indirect opthalmoscopes and 5 slit lamps were measured and calculated. The results showed the retinal irradiance from these instruments is quite high with dilated pupils ahd clear media. Although such illuminating intensity is a potential risk factor for the human retina, with careful use and reduced intensity, they are relatively safe. We suggest that ophthalmologists try their best to avoid using brighter source beyond useful illumination and unnecessary wide slit. （Chin J Ocul Fundus Dis,1992,8:133-137）
With the renovations of modern retinal imaging modality, such as video ophthalmoscopy, fundus photography, fundus fluorescein angiograph and spectral domain optical coherence tomography, it is possible to get high resolution and reproducible in vivo imaging of retina from neonates to improve the diagnosis and treatment of pediatric retinal disease. Now we have a better tool to investigate the early development of human retina, the pathogenesis and progression of pediatric retinal diseases, and to monitor the treatment efficacy and prognosis of these diseases. To expand these technologies in the diagnosis and treatment of pediatric retinal disease, we need simple, safe, comprehensive and objective applications which can only be achieved through multi-disciplinary cooperation.
Objective To observe the characteristics of morphological development of premature retina at 33-46 weeks of gestational corrected age (GCA). Methods A total of 268 premature infants were divided into 7 groups according to the GCA (33-34，35-36，37-38，39-40，41-42，43-44 and 45-46 weeks). The ocular fundus of those infants were recorded and analyzed by an indirect ophthalmoscopelinked imaging system. Results As GCA increases, noticeable macular morphological changes occurred and recorded in 96% of infant at 45-46 weeks of GCA. Retinas were gradually vascularized at 41-42 weeks (nasal retina) or 43-44 weeks (area Ⅲ,temporal retina), and pigmented in 84% of infant at 45-46 weeks of GCA. Conclusion Macular morphological patterns, retinal blood vessels and pigments continue to develop in postnatal premature infants.
Objective To investigate the incidence, risk factors and relationship with intraocular hemorrhage of Tersonprime;s syndrome among patients with spontaneous subarachnoid hemorrhage (SSAH) after emergency admission. Methods Seventy-four consecutive patients with SSAH from June 2010 to September 2011 were prospectively examined. A direct ophthalmoscope examination was performed in all participants within three hours after emergency admission. If circumstances permit, fundus photos were taken. When initial fundus examination was conducted, the Hunt-Hess grade was classified by the brain surgeon. The fundus examination was taken on the 1st, 3rd, and 7th day, 2 weeks, 1 month, and 3 months after emergency admission. The details were recorded, including sex, age, bleeding patterns, Hunt-Hess grade and death. The incidence of Tersonprime;s syndrome was analyzed and correlated with sex, age and Hunt-Hess grade. The relationship between intraocular hemorrhage and Hunt-Hess grade and mortality was analyzed. Results Among the 74 patients, 19 were suffering from Tersonprime;s syndrome, 31 eyes involved. The incidence of Tersonprime;s syndrome was 25.7%. Statistical analysis demonstrated that the sex of the patient was randomly distributed (chi;2=0.071,P=0.790), and the age components were also randomly distributed (Fisherprime;s exact test.P=0.203). The Hunt-Hess grade components were nonrandomly distributed (Fisherprime;s exact test，P=0.000). Among the patients with preretinal hemorrhage and vitreous hemorrhage, Hunt-Hess grade Ⅴ was in 76.9% patients; among inte-retinal hemorrhage, Hunt-Hess grade was in 16.7% of patients. The distribution was non-random (Fisherprime;s exact test.P=0.041). All intraocular hemorrhages were found at the time of first fundus examination. The mortality from Tersonprime;s syndrome was 68.4% (13/19) according to the follow-up investigation. The mortality in patients with vitreous hemorrhage and preretinal hemorrhage was statistically different (Fisherprime;s exact test.P=0.046) from patients with inter-retinal hemorrhage. Among the six recovered Tersonprime;s syndrome patients, two of them were recovered from vitrectomy, and the other four were recovered from selfabsorption. Conclusions A higher frequency (25.7%) of Tersonprime;s syndrome was observed in patients with SSAH. The incidence is highly related to the general condition of the patient but not to the sex or age. Intraocular hemorrhage is more likely to happen in the early time of SSAH. People with more severe intraocular hemorrhage may have worse general condition or higher mortality.