Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME). Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study. The patients included 12 males and eight females, with a mean age of (47.3plusmn;10.2) years. All the patients were examined documenting best corrected visual acuity (BCVA), spectraldomain optical coherence tomography (OCT) and ophthalmological examination. According to OCT DME morphology, samples are divided into diffuse macular edema, cystoid macular edema, serous retinal detachment and hard exudate groups. The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84plusmn;28.80) mu;m of same age group. Correlation between SFCT and age, diopter, diabetic duration, fasting blood glucose, BCVA and central retinal thickness were analyzed by Pearson Analysis. SFCT of different DME types were analyzed by ANOVA Analysis. Results The mean SFCT of 32 eyes was (223.81plusmn;43.74) mu;m (ranging from 120.50 to 361.50 mu;m), which was lower by 63.03 mu;m (95% confidence interval, -78.80 to -47.26 mu;m, P＜0.01) from normal SFCT. SFCT was independent of age (r=0.124), diopter (r=0.277), diabetic duration (r=0.286), fasting blood glucose (r=0.408), BCVA (r=0.087), and central retinal thickness (r=0.036). There was no significant difference of SFCT between different DME types (F=0.042，P＞0.05). Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.
Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent microinvasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. The central foveal thicknesses (CFT) were measured after surgery by spectral domainoptical coherence tomography (SD-OCT). The median follow-up time was (12.81plusmn;8.22) months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema (ME), epiretinal membrane (ERM), interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed. The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstructure were analyzed. Results The CFT was ranged from 103.00 mu;m to 498.00 mu;m,with the mean of（251.12plusmn;90.23） mu;m. Macular abnormalities were observed in 37 eyes (69.8%), and normal macula in 16 eyes (30.2%). Among 37 eyes with macular abnormalities, there were 20 eyes (37.7%) with ME, 12 eyes (22.6%) with ERM, 33 eyes (62.3%) with interrupted IS/OS, and 20 eyes (37.7%) with interrupted ELM. The BCVA of ME eyes decreased significantly than that in nonME eyes （t=-2.09，P＜0.05). The difference of BCVA in ERM and nonERM eyes was not statistically significant (t=-1.10,P＞0.05). The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=-4.33,P＜0.05). The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58, P＜0.05). The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not (r=7.65, 8.21, 4.99; P＜0.05), but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01, 0.82; P＞0.05). Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT，the status of IS/OS junction, whether ME or not, but not related to integrity of the ELM or whether ERM or not.
Optical coherence tomography (OCT) can depict mild papilledema and slight changes in the internal segment and external segment; measure thickness of the retinal nerve fiber layer, retinal thickness and macular volume; detect missing axons and damage to the macular ganglion cell complex. Thus, OCT has important application values and widespread prospects in diagnosis and differential diagnosis of glaucoma and nonglaucoma optic neuropathy, optic nerve diseases and macular diseases, outer and inner retinopathy as well as evaluation of curative effects, followup observation, prognosis and mechanisms in neuroophthalmological diseases. Neuro-ophthalmologists should pay more attention to the exploration and application of OCT in the field of neuro-ophthalmology.
Objective To investigate the relationship of choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment (RRD) in eyes without high myopia. Methods Fifty-three eyes of 53 patients with RRD and without highly myopic eyes after anatomically successful surgical repair were enrolled in this study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. Spectral domain-optical coherence tomography (OCT) was used to assess the postoperative foveal structure, central foveal thicknesses (CFT) and choroidal thickness. The correlation between the postoperative BCVA and abnormality of the fovea, CFT and choroidal thickness was evaluated. According to the postoperative thickness of the choroid, the patients were divided into le;150.00 mu;m group and ＞150.00 mu;m group; the improvement of postoperative BCVA in the two groups was analyzed. The state of inside and outside section (IS/OS) and the external limiting membrane (ELM) was divided into reconstructed and un-reconstructed categories. The postoperative BCVA, CFT and choroidal thickness of two types were comparatively analyzed. Results At the last time of follow up, the mean BCVA was 0.52plusmn;0.47. The results of spectral domain OCT showed that the mean CFT was (207.45plusmn;63.63) and mean choroidal thickness was (175.46plusmn;62.68) mu;m. The postoperative BCVA correlated positively with IS/OS junction and choroidal thickness (r=4.92, 4.63; P＜0.05), but was insignificantly associated with ELM junction, whether subretinal fluids were present or not, whether epiretinal membrane was affected or not, whether there was macular edema or not and CFT (r=0.24, 1.20, 0.30, 0.03, 0.14; P＞0.05). Two weeks to three months after surgery, the improvement of BCVA in ＞150.00 mu;m group was significantly higher than that in le;150.00 mu;m group (t=-2.318, P＜0.05). Compared the reconstructed with un-reconstructed IS/OS eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.253, 2.396; P＜0.05). The difference of mean CFT was not statistically significant (t=1.454，P＞0.05). Compared the reconstructed with un-reconstructed ELM eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.940, 3.563;P＜0.05). The difference of mean CFT was not statistically significant (t=1.117, P＞0.05). Conclusion The choroidal thickness has a significant correlation with visual acuity after successful repair of RRD in eyes without high myopia.
Objective To investigate the risk factors associated with visual acuity after minimally invasive vitrectomy of idiopathic macular hole (IMH). Methods Forty-six IMH patients (50 eyes) who underwent minimally invasive vitrectomy were enrolled in this prospective clinical study. The patients included eight males (nine eyes) and 38 females (41 eyes), with a mean age of (60.7plusmn;9.6) years. All the patients were examined for Snellen corrected visual acuity (CVA), optometry, slit lamp microscope and preset lens, as well as spectral domain optical coherence tomography (SD-OCT). The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The mean logMAR CVA was 0.95plusmn;0.29 (CVA ranged from 0.02 - 0.6). The mean duration was (11.1plusmn;7.8) months. The mean breaking length of inner segment/outer segment (IS/OS) junction was (1566.9plusmn;830.5) mu;m. The mean maximum diameter of the bottom of macular hole was (914.0plusmn;484.8) mu;m. There were 10, 19, 21 eyes with stage two, three and four IMH, respectively. The therapeutic effects were evaluated at three months after surgery. The relationship between visual acuity after surgery and age, duration, visual acuity before surgery, stage of IMH, breaking length of IS/OS before and after surgery, the maximum diameter of the bottom of macular hole, thickness of photoreceptors after surgery were analyzed. The safety of minimally invasive vitrectomy for IMH was observed. Results Three months after surgery, the closure rate of macular hole was 100.0%. The mean logMAR CVA was 0.45plusmn;0.25. The mean thickness of photoreceptors and breaking length of IS/OS were (183.8plusmn;62.6), (477.5plusmn;341.9) mu;m respectively. The mean breaking length of IS/OS after surgery was significantly shorter than before surgery (t=12.679, P＜0.001). The difference of logMAR CVA before and after surgery was statistically significant (Z=6.571, P＜0.001). The logMAR CVA before surgery (r=0.569), duration (r=0.465), breaking length of IS/OS before (r=0.574) and after surgery (r=0.564) had a positive correlation with logMAR CVA after surgery (P＜0.001). The logMAR CVA after surgery was independent of age, the maximum diameter of the bottom of macular hole and thickness of photoreceptors after surgery (r=0.546, 0.361, -0.441; P＞0.05). The logMAR CVA after surgery in eyes with stage four IMH was significant decreased than that in eyes with stage two and three IMH (Z=0.455, 2.556; P＜0.05). Except 17 eyes with complicated cataract and eight eyes with macular epiretinal membrane, there were no other surgery-related serious complications. The cataract eyes had improved visual acuity after phacoemulsification. Conclusion The visual acuity before surgery, duration and breaking length of IS/OS are main influence factors of visual acuity after surgery.
Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.
Objective To observe the image characteristics of eyes with choroidal osteoma using enhanced spectral domain optical Cirrus coherence tomography （SD-OCT）, and to explore their relationship with visual acuity. Methods The records and SD-OCT images of 14 patients（18 eyes） diagnosed with choroidal osteoma at this hospital were reviewed retrospectively. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, fundus fluorescein angiography, B scan and/or computerized tomography. Subtle structure changes of the retina and choroidal osteoma were observed by four lines of the horizontal, the vertical scanning lines through the foveal and the tumor basal diameter under the model of five Line Raster．The correlation between the retinal and choroidal morphology and visual acuity was evaluated. Results The choroidal features of SD-OCT image of choroidal osteoma can be categorized into hyper-reflective in six eyes (33.3%), isoreflective in five eyes (27.8%), hypo-reflective in three eyes (16.7%) and mixing-reflective in four eyes (22.2%). The foveal thickness ranged from 50.2 to 245.1μm, and the average foveal thickness was (130.2±58.3) μm. The horizontal and vertical diameters of choroidal osteoma ranged from 5.6 to 15.8 mm and 4.6 to 12.8 mm respectively. The average horizontal and vertical diameters of choroidal osteoma were (7.8±2.9) mm and (6.5±2.5) mm respectively. The statistical analysis revealed that BCVA was not related to the horizontal, vertical diameters of choroidal osteoma or the foveal thickness （r=0.262, 0.229, 0.137; P=0.284, 0.294, 0.362）. BCVA was related to the involvement of fovea and the integrity of photoreceptor inner/outer segment junction (IS/OS) （r=-3.838,-4.559; P=0.0015, 0.0003），but not related to macular choroidal neovascularization (CNV) or serous retinal detachment （r=-0.144, 0.411; P=0.684, 0.687）. Conclusions The main SD-OCT image characteristics of eyes with choroidal osteoma was hyper-reflective and isoreflective. BCVA was not related to the horizontal, the vertical diameters of choroidal osteoma, the foveal thickness, macular CNV or serous retinal detachment. It was related to the involvement of fovea and the integrity of IS/OS.
Objective To investigate the clinical manifestations and spectral-domain optical coherence tomography (SD-OCT) imaging features of acute zonal occult outer retinopahy (AZOOR) and to explore the role of SD-OCT in the diagnosis and follow-up of AZOOR. Methods Retrospective analysis of clinical data of 52 cases (66 eyes) who were diagnosed through comprehensive eye examinations including best corrected visual acuity, fundus exam, OCT, electroretinogram (ERG), fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Results A total of 52 cases of AZOOR (66 eyes) were collected. The majority of patients complained of blurred vision, photopsia and acute onset of a scotoma. In this group, 24 cases (28 eyes) with normal fundus were defined as AZOOR typeⅠ, while the other 28 cases (38 eyes) with fundus changes were AZOOR type Ⅱ, including 9 eyes of multiple evanescent white dot syndrome (MEWDS), 25 eyes of punctate inner choroidopathy (PIC),4 eyes of multifocal choroiditis (MC). All typeⅠcases went through visual field, ERG and OCT tests. The most common visual field defect was central and paracentral scotoma, which was seen in 15 eyes (53.6%). Nine eyes (32.1%) presented with blind spot enlargement or even associated with other visual field defects. Four eyes (14.3%) showed scattered scotoma. In the series of 24 typeⅠcases （28 eyes）, 12 eyes (42.9%) demonstrated depressed scotopic and photopic amplitudes, and nine eyes only yielded reduced scotopic amplitudes, while seven eyes showed normal. All OCT showed an absence of both the inner and outer segment (IS/OS) line, and (or) the cone outer segment tip (COST) line between the IS/OS line and RPE. Many grey-white or yellowish white punctuate lesion of different sizes were found in posterior pole of the fundus in all of type Ⅱ AZOOR which were more obvious in FFA. The manifestations of OCT showed IS/OS irregularity or absence in the area corresponding to the lesions. At final follow up from 15 days to two years, the IS/OS line became discernible in 13 of 24 typeⅠcases got discernible IS/OS line, while it was still absent in the other 11 case. During one to two month follow up period, nine eyes of MEWDS and four eyes of MC showed the presence of the a continuous IS/OS line in their OCT images after treatment, but there is no significant change for 25 eyes of PIC. ConclusionsOCT showed abnormalities in the microstructures of the outer retina, e.g., IS/OS line. The high resolution of OCT images has allowed better evaluations of the intraretinal IS/OS line in AZOOR, which presented a significant correlation with different stage in the course of AZOOR. In conclusions, OCT plays an important role in the diagnosis and follow up in AZOOR.
Objective To compare the findings of posterior vitreous detachment (PVD) with B-mode ultrasonography and spectral-domain optical coherence tomography (SD-OCT), and to find the best way for clinical diagnosis of PVD. Methods This is a prospective case series study based at our hospital between May and September 2012. Patients aged 50 years or older with no obvious ocular pathology, no history of intraocular operation and refractive power within ±3 Diopter were recruited and examined with B-mode ultrasonography and SD-OCT. Posterior hyaloid status were assessed by two experienced technicians respectively. Patients with idiopathic macular pucker and macular hole indicated for vitrectomy were also included, and preoperative findings of posterior vitreous cortex status were compared with intraoperative findings. SPSS software was used for statistical analyses. Results Two hundreds and four eyes of 102 patients met the criteria were examined, in which 10 eyes of 10 patients received 23G vitrectomy. There were 31 males and 71 females. Mean age was (63.2±7.2) years old (ranged from 50 to 80 years old). Status of posterior vitreous cortex were measured by SD-OCT in 70 eyes (34.3%), 56 eyes (27.5%) of which manifested different stages of PVD and 14 eyes (6.8%) with attached posterior vitreous cortex (N-PVD). The other 134 eyes (65.7%) had no findings of posterior vitreous cortex with SD-OCT. B-mode ultrasonography showed 98 eyes (48.0%) with C-PVD. Combining the results detected by both ultrasound and SD-OCT, altogether 145 eyes (71.1%) were found with different stages of PVD. Comparison of B-mode ultrasonography and SD-OCT to intraoperative findings in 10 operated eyes showed that: seven eyes with no findings in SD-OCT actually had C-PVD; three eyes with PVD in SD-OCT were proved having PVD during operation; five eyes manifested N-PVD in B-mode ultrasonography, only one of which was proved having N-PVD; five eyes with C-PVD in B-scan were observed having C-PVD. Only one eye had a matched result of C-PVD with three detecting ways. Conclusions B-mode ultrasonography provides a significant higher detection rate of PVD than SD-OCT; SD-OCT has more advantages than ultrasound in detecting the earlier stage of PVD. Combining Bmode ultrasonography and SD-OCT can significantly improve the PVD detection rate and provide considerably more information of PVD.
Objective To observe the characteristics of optical coherence tomography (OCT) of the macular in uveitis patients. Methods A total of 51 cases (78 eyes) of uveitis admitted to affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from May 2011 to May 2012 were reviewed retrospectively. All patients were underwent OCT examination and classified according to characteristics of OCT. Results The characteristics of OCT in uveitis were classified into six groups. Macular edema including cystoid macular edema and diffuse edema was detected in 48 eyes (61.5%). Macular epiretinal membrane was found in 22 eyes (28.2%). Choroidal neovascularization and macular hole was found in 4 eyes (5.1%), respectively. Ten eyes (12.8%) showed macular atrophy and 22 eyes (28.2%) showed serous neuroepithelium detachment. Conclusions Macular OCT in uveitis patients displayed different morphological characteristics.