Ophthalmic imaging including radiographic imaging, acoustic imaging and optical imaging, as a branch of medical imaging has developed rapidly. Optical imaging is very suitable for fundus examination because of the physiological characteristics of the eye. Ophthalmoscope and fundus fluorescein angiography are two historical stages of fundus optical imaging, which become an independent new discipline now, including infrared fundus photography, fundus autofluorescence, fundus fluorescein and indocyanine green angiography and optical coherence tomography. Comprehensive optical imaging plays an irreplaceable role in the diagnosis and treatment evaluation of ocular fundus diseases. Appropriate understanding the principles and significance of various optical imaging methods is very important for their clinical applications.
ObjectiveTo observe the changes of macular structure and choroidal capillary blood flow density in patients with acute central serous chorioretinopathy (CSC).MethodsProspective cross-sectional study. A total of 24 eyes of 24 patients with monocular acute CSC (case group) diagnosed by clinical examination from Shanxi Eye Hospital during January and March 2018 were included in the study. The eyes (24 eyes) and contralateral eyes (24 eyes) of the patients in the case group were set to CSC group and contralateral eye group, respectively. Twenty-one eyes of 21 healthy volunteers with age and gender matching were selected as normal control group. The macular structure of the eyes were observed by OCT and OCT angiography (OCTA), and the blood vessel density of choroidal capillary layer in the circular area of the macular area with a radius of 1 mm was measured. The paired t-test was used to compare the differences in blood flow density in the choroidal capillaries between the three groups.ResultsThe results of OCT showed that the serous neuroepithelial detachment in the macular area was observed in all eyes of the CSC group, with or without RPE detachment being 20 or 4 eyes, respectively. Of the 24 eyes in the contralateral eye group, 13 eyes (54.2%) had thick choroidal RPE lesions (PPE). There was no abnormality in the retina and choroidal structure in the macular area of the normal control group. The results of OCTA showed that the blood flow density of choroidal capillaries in the CSC group, the contralateral eye group and the normal control group were 1.759±0.132, 1.924±0.463, and 1.940±0.033, respectively. Compared with the eyes of the contralateral eye group and the normal control group, the blood flow density of choroidal capillaries in the CSC group was significantly lower (t=6.611, 6.474; P=0.000, 0.000). There was no significant difference in the blood flow density of choroidal capillary layer between the contralateral eye group and the normal control group (t=1.328, P＞0.05). In the contralateral eye group, there was no significant difference in the blood flow density of choroidal capillary layer between PPE eyes and no RPE eyes (t=0.806, P＞0.05).ConclusionsThere is 54.2% of the contralateral eyes in the monocular acute CSC patients with PPE. The choroidal capillary layer blood flow density is lower than that of the contralateral and normal eyes.
ObjectiveTo observe the imaging features of branching vascular network (BVN) in polypoidal choroidal vasculopathy (PCV). MethodsEighty PCV patients (90 eyes) were enrolled in this study. The patients included 58 males and 22 females. The age was ranged from 49 to 85 years, with a mean age of 61.4 years. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The fibrovascular retinal pigment epithelium detachment (PED) was defined as a well-demarcated subretinal heterogeneous plaque with increasing fluorescence on FFA. The late lichenoid hyperfluorescent plaque was defined as a well-demarcated lichenoid hyperfluorescent plaque on late phase ICGA. The double-layer sign on OCT was defined as a wide range of shallow PED from Bruch membrane. ResultsBVN were found on early ICGA in 76 eyes among the 90 eyes (84.4%). Among these 76 eyes, 18 eyes (23.7%) demonstrated the subretinal reddish-orange branches corresponding to BVN. Fifty-six eyes (73.7%) demonstrated all or part of the BVN on early FFA. Three eyes (3.9%) demonstrated branching transmitted fluorescence corresponding to BVN throughout the FFA. Seventy-three eyes (96.1%) were manifested by occult choroidal vascularization on FFA, and 21 eyes (27.6%) of them were fibrovascular PED. Among the 76 eyes with BVN, all BVN appeared earlier than polypoidal lesions on ICGA. Polypoidal lesions located on the terminal of BVN in 62 eyes (81.6%). Sixty-nine eyes (90.8%) on ICGA demonstrated the late lichenoid hyperfluorescent plaque, whose area was equal to or greater than the area of BVN shown on early ICGA. Seventy-two eyes (94.7%) had the double-layer sign. Among these 72 eyes, 15 eyes (20.8%) had lumen-like structure within the double-layer sign. Sixty-five eyes (90.3%) had punctate and linear hyper-reflectance within the double-layer sign. Two eyes (2.8%) demonstrated a hyporeflective short segment and a gap of Bruch membrane on OCT corresponding to the origin of the BVN. Sixty-three eyes (87.5%) had an area of double-layer sign that matched the area of late lichenoid hyperfluorescent plaque on ICGA. ConclusionsBVN in PCV can be noted as reddish-orange branches on fundus examination. Most of the BVN are shown as early branching transmitted fluorescence but collectively an occult choroidal vascularization on FFA, as lichenoid hyperfluorescent plaque on late ICGA, and as double-layer sign on OCT whose area matches late lichenoid hyperfluorescent plaque.
Objective To observe the choroidal thickness of patients with chronic central serous chorioretinopathy (CSC) in affected eyes and unaffected fellow eyes.Methods Forty-five chronic CSC patients diagnosed by fundus pre-set lens, fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study. The patients included 36 males and nine females, with a mean age of (46.18plusmn;8.20) years, with a mean duration of (16.34plusmn;7.23) months. Thirty-six patients were affected unilaterally and nine patients affected bilaterally. The patients were divided into affected eyes group (group A, 51 eyes) and unaffected fellow eyes group (group B,39 eyes). Fifty age-, sex- and diopter- matched normal subjects (50 eyes) were enrolled in this study as control group (group C). Enhanced depth imaging (EDI) choroidal scans were obtained in all eyes by using spectral-domain optical coherence tomography. Subfoveal choroidal thickness (SFCT) and choroidal thickness at 3 mm nasal (NCT3 mm), temporal (TCT3 mm), superior (SCT3 mm), inferior (ICT3 mm) to the fovea were measured.Results The mean SFCT of group A, B and C were (436.76plusmn;87.01), (394.71plusmn;61.63), (294.86plusmn;75.30) mu;m respectively. The mean SFCT of group A and B were thicker than group C, the difference was significant among three groups (F=44.791,P＜0.001). There were difference between group A, B, C in NCT3 mm, TCT3 mm, SCT3 mm and ICT3 mm (F=15.816, 22.823, 15.147, 11.527;P＜0.001). The mean SFCT in affected eyes of unilateral patients was (416.34plusmn;79.44) mu;m, which was thicker than that in unaffected fellow eyes (t=2.897, P=0.007). Conclusion Choroidal thickness increased significantly in affected eyes and unaffected fellow eyes in patients with chronic CSC.
Objective To asses the potential of a new imaging technique,opticl coherence tomography(OCT),for diagnosis and monitoring of central serous choroidoretinopathy(CSC). Methods Thirty cases (32eyes) with CSC were examined by ophthalmoscopy, fundus fluorescein angiography and OCT. Some patients were monitored by OCT. Results Among images of OCT in 32 eyes with CSC, 27 eyes showed serous neurosensory detachement,2 eyes appeared retinal pigment epithelial detachement and 3 eyes combined neurosensory detachement with pigment epithelial detachement.Monitoring images of OCT in ll eyes revealed absorption of serous fluid and decrease of neurosensory detachment． Conclusions OCT is potentially useful as a new and noninvasive diagnostic technique for quantitative examination of patients with CSC and objectively monitoring the clinical course of the serous retinal detachement in this disease. (Chin J Ocul Fundus Dis, 1999, 15: 131-134)
ObjectiveTo observe the morphologic characteristics of drusen in atrophic age-related macular degeneration (AMD) by spectral domain optical coherence tomography (SD-OCT). MethodsFifty-four patients (84 eyes) with macular drusen and atrophic AMD, and 56 age-matched control patients (56 eyes) with cataract were included in this study. Atrophic AMD patients were divided into two groups: D1 group with drusen involving the fovea (42 eyes) and D2 group with drusen not involving the fovea (42 eyes). The SD-OCT images in macular (6 mm×6 mm scans) were acquired, and the foveal retinal thickness (FRT) was measured. The size, morphology, inner reflection, homogeneity of drusen and its relationship with surrounding tissues were analyzed. ResultsThe FRT of D1 group, D2 group and control group were (160.90±38.47), (194.21±26.11), (222.42±19.29) μm respectively. The FRT of D1 group and D2 group were thinner than that of control group (F=57.08, P=0.00). Totally 1124 drusen were found by SD-OCT images in 84 eyes, with an average of 10.84 drusen in each eye. 3.0%, 12.5% and 84.5% of all 1124 drusen were small, medium and large sized respectively. 56.6%, 14.2%, 20.4% and 8.8% of all drusen were dome, pointed, saw-toothed and basal-shaped respectively. 17.1%, 57.5% and 25.4% of all drusen had low, medium and high internal reflectivity respectively. The internal reflectivity of 65.6%, 2.8% and 31.7% of all drusen were homogeneous, nonhomogeneous with core, and nonhomogeneous without core respectively. Overlying retinal pigment epithelium (RPE) damage and photoreceptor inner segment/outer segment (IS/OS) junction damage were presented in 34.5% and 24.8% drusen respectively. The most common type of drusen was dome-shape, homogeneous, with medium internal reflectivity, and without overlying RPE or IS/OS junction damage (81.0%). ConclusionsThe FRT becomes thinner in patients with drusen. The most common drusen types are dome-shaped, homogeneous, with medium internal reflectivity, and without overlying RPE or IS/OS junction damage.
ObjectiveTo observe the pathological changes of central retinal artery occlusion (CRAO) by optical coherence tomography (OCT).MethodsFifty-three eyes of 53 patients who were diagnosed as CRAO in our center between January 2001 to January 2004 underwent the examination by OCT. The intervals between the disease onset and OCT examination were less than 2 weeks. The scan modes of OCT were horizontal or vertical line scan. The locations of scanning were macular, posterior pole of retina, optical papilla and the focus of bleeding or exudation.ResultsThe OCT pathological changes of CRAO in vivo includes increase of retinal thickness and reflex of retina, width of dark layer of photoreceptor (edema), edema or cystoid edema of fovea, retinal bleeding, cotton-wool spot and papilla edema. Four patients who had ciliary retinal artery showed normal retinal structure in the supply region of ciliary retinal artery.ConclusionOCT can display the pathological changes of retinal tissues in CRAO in vivo, especially on the old patients or the patients with systemic disease who were contraindicated by FFA. The unique OCT image of pathological changes of CRAO supply the objective signs for the instant clinical diagnosis.(Chin J Ocul Fundus Dis, 2005,21:74-78)
ObjectiveTo observe the image features of eyes with indirect choroidal rupture on optical coherence tomography (OCT). MethodsFifteen patients (16 eyes) with indirect choroidal rupture were included in this study. There were 11 males (12 eyes) and 4 females (4 eyes). The mean age was (37.5±11.6) years old with a range from 19 to 57 years old. The disease course was ranged from 2 days to 43 years. One patient had bilateral lesions and 14 patients had unilateral lesions. Six patients (6 eyes) were in the acute stage, and 9 patients (10 eyes) were in the recovery stage. Average course of disease was (7.17±4.62) years in acute stage, and (7.93±13.64) years in recovery stage. Choroidal rupture locations of all the 16 eyes were in the posterior pole. Among them, 13 eyes involved foveal area, and 4 eyes with multiple fractures. OCT was used to measure the integrity of the reflective band on the photoreceptor inner segment/outer segment (IS/OS) junction layer as well as the retinal pigment epithelium (RPE), and the blood capillary complex in choroid and RPE for all patients. According to the literature, OCT reflection bands of the RPE and choriocapillaris complex can bent inward (type Ⅰ) or outward (type Ⅱ) to the center of the eyeballs with choroidal rupture. ResultsFor the 6 eyes in acute stage, 4 eyes were typeⅠ (66.67%) and 5 eyes were typeⅡ (83.33%). Three eyes (50.00%) had both typeⅠand typeⅡ OCT features. All 6 eyes (100.00%) had fuzzy or disappeared IS/OS reflective band, 5 eyes (83.33%) showed interrupted RPE reflection band, 4 eyes (66.67%) showed focal choroidal thinning. Two eyes were accompanied with macular hole and 2 eyes were with neural epithelium separated from the macular area. Among the 10 eyes during the recovery stage, 2 eyes (20.00%) were typeⅠand 8 eyes (80.00%) were type Ⅱ. Seven eyes (70.00%) had fuzzy or disappeared IS/OS reflective band, 1 eye (10.00%) showed interrupted RPE reflection band, 7 eyes (70.00%) showed focal choroidal thinning. One eye had secondary choroidal neovascularization, 2 eyes had macular hole, and 3 eyes had neural epithelium shrinkage. The proportion of typeⅠwas significantly higher in the acute stage than that in the recovery stage, and the difference was significant (P=0.001). The proportion of interrupted RPE reflection band in acute stage was also significantly higher than that of the recovery stage, and the difference was statistically significant (P=0.002). ConclusionInjury eyes with indirect choroidal rupture mainly showed RPE choroid blood capillary complex extruding inward or outward the eyeball, fuzzy or disappeared IS/OS reflective band, RPE reflective band interruption or reduced, and focal choroidal thinning.
Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000A scan/s, area was 6.0 mmtimes;6.0 mm, and the mode was 512times;128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean logMAR was 0.99plusmn;0.44 (ranged from 0.15 to 2.00),the mean diameter of macular holes was (942.0plusmn;348.4) mu;m(ranged from 171 to 1491 mu;m), and the mean diameter of IS/OS disruption was (1870.3plusmn;673.2) mu;m(range from 463 to 3176 mu;m). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and logMAR in IMH (P＝0.038, 0.002, 0.000）. In eyes with closed macular hole after surgery, the logMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the ISOS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the macular hole closure surgery.
ObjectiveTo systematically review the overall diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI in differentiating dysplastic nodules (DNs) and hepatocellular carcinoma (HCC), exploring whether the hepatobiliary phase can effectively improve diagnostic accuracy. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data, and CBM databases were searched from January 1998 to March 2023 to identify original studies on Gd-EOB-DTPA-enhanced MRI for the differential diagnosis of DNs and HCC. Two investigators independently performed literature screening, extraction of data features and quality assessment. Meta-analysis was performed using Stata 17.0 and Meta-disc1.4 software. ResultsA total of 14 papers were included in this meta-analysis, including 375 DNs and 653 HCC. The results of meta-analysis showed that, in the multiparametric diagnostic sequence, the pooled Sen, Spe, PLR, NLR and AUC were 0.95 (95%CI 0.87 to 0.98), 0.95 (95%CI 0.91 to 0.97), 18.57 (95%CI 9.64 to 35.78), 0.06 (95%CI 0.02 to 0.14) and 0.98 (95%CI 0.97 to 0.99), respectively. ConclusionGd-EOB-DTPA-enhanced MRI has a good differential diagnostic value for DNs and HCC. Hepatobiliary phase imaging also greatly compensates for the diagnostic deficiency of dynamic enhancement with low sensitivity for early HCC.