Comparison of 24×20 mm^(2) swept-source OCTA and fluorescein angiography for the evaluation of lesions in diabetic retinopathy

AIM: To compare ultra-widefield(24×20 mm^(2)) sweptsource optical coherence tomography angiography(SSOCTA) and fluorescein angiography(FA) in the evaluation of diabetic retinopathy(DR) lesions. METHODS: Forty-six eyes of 23 patients with treatmentna?ve DR were included at Peking University People’s Hospital from September 1, 2021, until December 31, 2021, as well as 23 age and gender matched healthy controls. Quantitative assessments of DR lesions on FA and SS-OCTA(superficial capillary plexus, SCP, 24×20 mm^(2)) were performed.RESULTS: Area of fovea avascular zone(FAZ) was larger in DR cases than controls(0.34±0.069 mm^(2) vs 0.287±0.108 mm^(2), P=0.006). In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm^(2) on SS-OCTA and FA, respectively(P=0.428), while the median FAZ perimeter was 2.382(IQR, 2.201-2.59) and 2.333(IQR, 2.138-2.6) mm on SS-OCTA and FA images(P=0.733). There was no significant difference in the size of the non-perfusion area(NPA) between the images on SS-OCTA and FA(12.389, IQR 4.96-28.3 and 11.125, IQR 5-28.31 mm^(2), P=0.197). The median total microaneurysm(MA) count was 35(IQR, 19-46) and 73(IQR, 43-93) on SS-OCTA and FA(P<0.001), respectively. No significant difference in intra-retinal microvascular abnormality(IRMA) and neovascularization (NV) count was found between the two techniques. The intraclass coefficient(ICCs) of all the parameters above indicated stable repeatability.CONCLUSION: Ultra-widefield SS-OCTA represents a reliable, noninvasive, and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.

Association between endogenous cortisol level and the risk of central serous chorioretinopathy:a Meta-analysis

AIM： To assess the association between endogenous cortisol level and the risk of central serous chorioretinopathy（CSC）.METHODS： Case-control studies were systematically searched on PubM ed, Embase, Cochrane, China National Knowledge Infrastructure（CNKI） for publishes between January 1990 and July 2017 to assess the association between endogenous cortisol level and CSC. The main endpoints were serum cortisol level at 8 a.m. and 24-hour urine 17-hydroxysteroids level. We assessed pooled data using a random-effects model.RESULTS： Of 86 identified studies, 5 were eligible included in our analysis. The 5 studies included a total of 315 participants, of whom 187 had CSC. Statistically significant association was observed between serum cortisol level（summary SMD=0.77, 95%CI=0.55-0.99）, 24-hour urine 17-hydroxysteroids level（summary SMD=0.95, 95%CI=0.61-1.30）, and the risk of CSC.CONCLUSION： Endogenous cortisol level is associated with an increased risk of CSC. Combined treatment targeting the serum cortisol level at 8 a.m. and 24-hour urine 17-hydroxysteroids level can be a potential preventive strategy for individuals who are at risk of CSC and therapeutic strategy for patients with CSC.

A novel mutation of CYP4V2 gene associated with Bietti crystalline dystrophy complicated by choroidal neovascularization

AIM: To investigate the clinical characteristics and genetic features of a Bietti crystalline dystrophy(BCD) proband in a Chinese family.METHODS: A Chinese female diagnosed with BCD complicated by bilateral choroidal neovascularization(CNV) and her parents underwent complete ophthalmic examinations, including fundus autofluorescence(AF), fundus photography(FP), fundus fluorescein angiography(FFA), visual field testing, full-field electroretinography(ERG), optical coherence tomography(OCT) and optical coherence tomography angiography(OCTA). The sequencing of the CYP4 V2 gene was performed to the whole family.RESULTS: Bilateral tiny glittering crystal-like deposits and differing extent of atrophy of the retinal pigment epithelium(RPE) were found in the posterior pole of her fundus. The diffuse hypo-fluorescence shown on AF images and window defects shown on FFA both indicated the atrophy of the RPE and choriocapillaris. OCT showed the thinning of the RPE and choriocapillaris layer, ellipsoid zone(EZ) band defect and CNV in both eyes. OCTA images proofed bilateral type 2 CNV. The visual field test showed central and paracentral scotoma. ERG showed a slightly decreased b-wave in scotopic ERG. Gene sequencing identified three mutations of the CYP4 V2 gene, c.802_807 del, c.810 del T, and c.1388 G>A. The mutation c.1388 G>A was a novel substitution mutation.CONCLUSION: The novel mutation c.1388 G>A may be a possible cause that could induce the clinical phenotype of BCD.

Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

Background：Polypoidal choroidal vasculopathy （PCV） is characterized by the presence of polyps with or without a branching vascular network and more prevalent among Asians.The aim of this study was to compare the outcomes of conbercept therapy between two different angiographic subtypes of PCV.Methods：Fifty-eight patients of PCV were classified into two phenotypes according to indocyanine green angiography （ICGA）.In Type 1,both feeder and draining vessels are visible on ICGA and network vessels are numerous.In Type 2,neither feeder nor draining vessels are detectable,and the number of network vessels is small.The patients were treated with intravitreal conbercept （IVC） for 3 months.Additional 1VC was given at subsequent monthly visits,if needed.The patients were followed up for 12 months,and changes in mean best-corrected visual acuity （BCVA）,central retinal thickness （CRT）,subretinal fluid （SRF） thickness,pigmented epithelial detachment （PED）,hemorrhage,and number of polypoidal lesions were evaluated.Results：The mean BCVA in Type 2 PCV （15.92 ± 9.76 letters） achieved a significantly greater improvement than that in the Type 1 （14.10± 9.07 letters） at month 12 （t=2.37,P〈 0.01）.Moreover,the mean CRTdecrease was numerically greater in Type 2 （120.44± 73.81μm） compared with Type 1 （106.48 ± 72.33 μm） at month 6 （t =4.31,P 〈 0.01）,and greater in Type 2 （130.21 ± 76.28 μm） compared with Type 1 （111.67 ± 79.57μm） at month 9 （t =1.87,P 〈 0.0l）.There was no significant difference between the two types for the decrease in SRF thickness,PED height,and regression of polyps from month 3 to 12 （t =2.97,P〉 0.05）.Conclusion：Classification systems for PCV will show differences in presentation,natural history,or response to anti-vascular endothelial growth factor treatment and might,therefore,provide a new key to the choice of treatment for the disease.