ObjectiveTo investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment. MethodsRetrospective case series study. Eleven eyes of 11 patients with bullous retinal detachment diagnosed in Department of Ophthalmology, Peking University People's Hospital from July 2015 to September 2021 were enrolled. There were 10 males and 1 female, with the mean age of (39.27±6.81) years. All patients had monocular bullous retinal detachment, with mean duration ranged from 3 months to 14 years. The basic information and medical history of all patients were collected. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan ultrasonography. BCVA was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The clinical data and imaging features of BCVA, OCT, FFA and ICGA were retrospectively analyzed and summarized. ResultsThe mean logMAR BCVA of the 11 eyes was 0.91±0.45. Nine patients had bilateral disease, but bullous retinal detachment occurred in only 1 eye, and CSC manifestations were present in the contralateral eye. Six patients had received systemic or topical hormone therapy prior to onset. Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes. OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes, and a few granular hyperreflective substances in the neuroretina in 6 eyes. Neuroretina cystoid degeneration was observed in 6 eyes, adhesion between the detached neuroretina and retinal pigment epithelial (RPE) was observed in 6 eyes, RPE tear was observed in 6 eyes, and different forms of retinal pigment epithelial detachment (PED) were observed in 6 eyes. FFA showed multiple fluorescence leakage spots in 10 eyes, and the average number of fluorescence leakage spots in all eyes was 3.82±2.44. There were multiple diffuse RPE lesions in 9 eyes. The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes. B-scan ultrasonography examination of all affected eyes showed retinal detachment. Retinal reattachment can be achieved at (2.0±1.0) months after photodynamic therapy (PDT), while SRF can be completely absorbed at (2.36±0.81) months. The mean logMAR BCVA can be improved to 0.50±0.33, and no recurrence was found in the follow-up period up to 6 months. ConclusionsBullous retinal detachment is often associated with the use of hormones, while yellow-white material in the subretina and hyperreflective material in the OCT are common. It is characterized by neuroretina cystoid degeneration in the macular area, adhesion between the neuroretina and RPE, RPE tear and PED, with multiple fluorescence leakage spots and diffuse RPE lesions. PDT is an effective treatment for bullous retinal detachment.
ObjectiveTo observe the safety and effectiveness of targeted navigation laser with continuous wave threshold power in the treatment of chronic central serous chorioretinopathy (CCSC).MethodsA retrospective clinical study. From November 2018 to June 2020, 28 eyes of 28 patients with CCSC diagnosed in the Eye Hospital of Nanjing Medical University were included in the study. Among them, there were 17 males with 17 eyes and 11 females with 11 eyes; all of them had a monocular disease. The average age of the patients was 36.24±5.14 years, and the average course of the diseases was 4.7±1.3 months. All affected eyes underwent best corrected visual acuity (BCVA), fluorescein fundus angiography, fundus autofluorescence, frequency domain optical coherence tomography and angiography, multifocal electroretinogram (mf-ERG) and micro field inspection. BCVA was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. A targeted navigation laser system was used for continuous wave power therapy under the threshold. Two weeks and 1, 3 months after treatment, the same equipment and methods as before treatment were used to perform related examinations to observe the BCVA, subfoveal choroidal thickness (SFCT), foveal retinal thickness (CMT), the mean light sensitivity (MS) in the 10° range of the macular center, and the amplitude density of P1 wave at ring 1 and 2. The t test was used to compare CMT, SFCT, retinal amplitude density and MS before and after treatment.ResultsBefore treatment and 2 weeks, 1 and 3 months after treatment, the average logMAR BCVA of the eyes were 0.74±0.16, 0.57±0.16, 0.22±0.05, 0.21±0.06, and the average CMT was 512.33±31.56, 350.40±36.61, 256.49±22.38, 253.45±23.65 μm respectively, the average SFCT was 462.82±25.38, 462.37±39.54, 461.51±29.36, 461.25±34.55 μm, the average MS was 16.32±5.41, 17.53±4.23, 19.52±4.12, 21.35±2.77 dB respectively. At different times before and after treatment, BCVA (t=6.52, 5.71, 6.01; P=0.00, 0.00, 0.00), CMT (t=3.08, 6.57, 4.90; P=0.01, 0.00, 0.00), SFCT (t=7.01, 6.54, 4.85; P=0.08, 0.07, 0.17), MS (t=6.17, 4.25, 5.46; P=0.02, 0.00, 0.00), the difference was statistically significant. The amplitude density of P1 wave at ring 1 in the affected eye was 64.37±18.25, 85.31±13.98, 98.35±14.52, 98.40±22.17 nV/deg2, and the amplitude density of P1 wave at ring2 was 36.12±18.32, 44.02±17.15, 62.35±14.85, 63.17±15.79 nV/deg2. The amplitude density of P1 wave at ring 1 (t=5.11, 9.03, 4.27; P=0.03, 0.00, 0.00) and ring 2 (t=5.11, 9.03, 4.27; P=0.03, 0.00, 0.00) before and after treatment showed statistical significance.ConclusionTargeted navigation laser continuous wave threshold power treatment for CCSC can increase the BCVA, macular retinal amplitude density and macular foveal MS, and reduce CMT and SFCT.
ObjectiveTo observe the clinical manifestations of a Wagner syndrome (WS) family. MethodsA retrospective clinical study. Four patients (the proband, his father, sister, and brother) and one family member (the proband's mother) from a WS family diagnosed by clinical examination in Chengdu Aidi Eye Hospital in June 2023 were included in the study. The proband's medical history was examined in detail, followed by best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), and OCT angiography (OCTA). The proband underwent full field electroretinogram (ERG) examination. The proband and his sister and brother underwent blood glucose, blood pressure, hearing, face, joint, exercise and general physical examination at the same time. Peripheral venous blood was collected from the proband and 4 other family members. The proband extracts genomic DNA samples, conducts target region capture, library construction and high-throughput sequencing after qualified quality control. The suspected pathogenic mutation sites were verified by Sanger. According to the selected mutation sites, other family members in this family were co-isolated and verified. The pathogenicity of the mutation site was analyzed using the guidelines of the American College of Medical Genetics and Genomics (ACMG). ResultsProband (Ⅱ-1) was 23 years old female. Both eyes BCVA were 0.1. The waveforms of ERG in both eyes were basically normal, and some amplitudes were reduced. Sister of the proband (Ⅱ-2) was 20 years old. Both eyes BCVA 1.0. Fundus examination showed no obvious abnormality. Brother of the proband (Ⅱ-3) was 19 years old. The left eye underwent pars plana vitrectomy combined with silicone oil filling 2 years ago due to retinal detachment and severe vitreous hyperplasia. BCVA light sensitivity, complicated cataract, and fundus opacity were observed. Right eye BCVA was 0.1. The lenses of the proband and his younger sister and brother were pointed and wedged, and the younger brother was heavier. Vitreous cavity of lens. The retina color of both eyes and the right eye of the younger brother of the protor was dark, with flaky dark areas on the side of the nose and the posterior pole, and the symmetrical retinal veil membrane hyperplasia and pulling on the periphery, showing small retinal splits. The choroidal retina showed focal and segmental symmetrically large atrophy. The optic disc was tilted. By OCT examination, the ellipsoid band was partially missing and broken, and the thickness of the choroid layer was reduced. Retinal cortical atrophy in 1 eye (younger brother of proband). By OCTA examination, the mesovascular layer of choroid was atrophied seriously and the blood density decreased. The results of laboratory and general examination of the three siblings showed no obvious abnormalities. The results of genetic testing showed that the proband, his father (Ⅱ-1), his sister and his brother carried a heterozygous mutation of the VCAN gene c.9264A>G (p.Pro3088=). According to ACMG guidelines, the pathogenicity of this variant was unknown. The mother of proband (Ⅰ-2) was wild type. ConclusionsThe abnormal manifestations of WS eyes are diverse, and both anterior and posterior segments could be involved. The pathogenicity of the heterozygous variation of VCAN gene c.9264A>G (P.RO3088 =) in this family is unknown.