Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Spectral domain optical coherence tomography crosssectional image of optic nerve head during intraocular pressure elevation

AIM: To analyze changes of the optic nerve head(ONH) and peripapillary region during intraocular pressure(IOP) elevation in patients using spectral domain optical coherence tomography(SD-OCT).METHODS: Both an optic disc 200×200 cube scan and a high-definition 5-line raster scan were obtained from open angle glaucoma patients presented with monocular elevation of IOP(≥30 mm Hg) using SD-OCT. Additional baseline characteristics included age, gender, diagnosis,best-corrected visual acuity, refractive error, findings of slit lamp biomicroscopy, findings of dilated stereoscopic examination of the ONH and fundus, IOP, pachymetry findings, and the results of visual field.RESULTS: The 24 patients were selected and divided into two groups: group 1 patients had no history of IOP elevation or glaucoma(n =14), and group 2 patients did have history of IOP elevation or glaucoma(n =10). In each patient, the study eye with elevated IOP was classified into group H(high), and the fellow eye was classified into group L(low). The mean deviation(MD)differed significantly between groups H and L when all eyes were considered(P =0.047) and in group 2(P =0.042), not in group 1(P =0.893). Retinal nerve fiber layer(RNFL) average thickness(P =0.050), rim area(P =0.015),vertical cup/disc ratio(P =0.011), cup volume(P =0.028),inferior quadrant RNFL thickness(P =0.017), and clockhour(1, 5, and 6) RNFL thicknesses(P =0.050, 0.012, and0.018, respectively), cup depth(P =0.008), central prelaminar layer thickness(P =0.023), mid-inferior prelaminar layer thickness(P =0.023), and nasal retinal slope(P =0.034)were significantly different between the eyes with groups H and L.CONCLUSION:RNFLaveragethickness,rim area,vertical cup/disc ratio, cup volume, inferior quadrant RNFL thickness, and clock-hour(1, 5, and 6) RNFL thicknesses significantly changed during acute IOP elevation.

Systematic review of macular ganglion cell complex analysis using spectral domain optical coherence tomography for glaucoma assessment

AIM: To review the use of spectral domain optical coherence tomography(SD-OCT) for macular retinal ganglion cells(RGC) and ganglion cell complex(GCC) measurement in glaucoma assessment, specifically for early detection and detection of disease progression. METHODS: A systematic review was performed by searching Pub Med, Medline, and Web of Science for articles published in English through July 2014 describing the various macular SD-OCT scanning strategies developed for glaucoma assessment. The review focused on papers evaluating the use of macular RGC/GCC SDOCT to detect early glaucoma and its progression. The search included keywords corresponding to the index test(macular ganglion cell/RGC/GCC/Spectral domain OCT), the target condition(glaucoma), and diagnostic performance. The RGC/GCC SD-OCT scanning strategies used to assess glaucoma of most commonly used SD-OCT instruments were described and compared. These included the Cirrus high definition-OCT(Carl Zeiss Meditec, Inc., Dublin, CA, United States), RTVue(Optovue, Inc., Fremont, CA, United States), Spectralis(Heidelberg Engineering, Heidelberg, Germany) and the 3D OCT 2000(Topcon Corporation, Tokyo, Japan). Studies focusing on the ability of RGC/GCC SD-OCT to detect early glaucomatous damage and on the correlation between glaucomatous progression and RGC/GCC measurement by SD-OCT were reviewed.RESULTS: According to the literature, macular RGC/GCC SD-OCT has high diagnostic power of preperimetric glaucoma, reliable discrimination ability to differentiate between healthy eyes and glaucomatous eyes, with good correlation with visual filed damage. The current data suggests that it may serve as a sensitive detection tool for glaucomatous structural progression even with mild functional progression as the rate of change of RGC/GCC thickness was found to be significantly higher in progressing than in stable eyes. Glaucoma assessment with RGC/GCC SD-OCT was comparable with and sometimes better than circumpapillary retinal nerve fiber layer thickness measurement.CONCLUSION: An increasing body of evidence supports using macular RGC/GCC thickness as an indicator for early glaucoma. This might be a useful tool for monitoring disease progression.

Microperimetry and spectral domain optical coherence tomography in myelinated retinal nerve fibers

Dear Sir,I write to present the correlation between microperimetric （MP） values and the density of myelinated retinal nerve fibers （MNFs） in optical coherence tomography （OCT） imaging.

Comment on “The diurnal variation pattern of choroidal thickness in macular region of young healthy female individuals using spectral domain optical coherence tomography”

Dear Editor,We have read and reviewed the article entitled＂The diurnal variation pattern of choroidal thickness in macular region of young healthy female individuals using spectral domain optical coherence tomography＂by Zhao et al^（[1]）with great interest.

Comparison of Ziemer FEMTO LDV "Classic" and " Crystal Line" femtosecond laser flap quality by Fourierdomain optical coherence tomography

AIM:To compare the regularity and accuracy of laser in situ keratomileusis(LASIK) flaps created by the Ziemer FEMTO LDV 'Classic'(Ziemer 'Classic') and Ziemer FEMTO LDV Crystal Line femtosecond laser(Ziemer Crystal Line). METHODS:Fourier-domain optical coherence tomography(RTVue OCT) was used to measure the morphology of 200 LASIK flaps of 100 consecutive patients created with the Ziemer Classic(100 flaps) or the Ziemer Crystal Line(100 flaps) at one week postoperatively.Flap thickness was evaluated at 36 specified measurement points on each flap.For all procedures with both lasers,the nominal flap thickness was 110μm.RESULTS:The mean flap thickness of the Ziemer Crystal Line group(102.49±2.68μm) was thinner than that of the Ziemer Classic group(107.65±5.09μm)(P【0.01).Average thickness of all flaps was uniform within 4μm at all measurement points.The flaps in the Ziemer Crystal Line group were more regular than those in the Ziemer Classic group when measured from the center to the periphery.The maximum deviation from the nominal 110μm of 36 measurements was 8μm in the Ziemer Classic group,while in the Ziemer Crystal Line group it was 9μm.Within the 3 600 measurements on the 100 eyes,differences greater than 20μm were observed 0.14% in the Ziemer Classic group,and 0.04% in the Ziemer Crystal Line group. CONCLUSION:The flaps created with the Ziemer FEMTO LDV Crystal Line femtosecond laser are more uniform and thinner than those created by the Ziemer FEMTO LDV Classic femtosecond laser.

Comparison of central macular thickness between two spectral-domain optical coherence tomography in elderly non-mydriatic eyes

AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS: Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired- t test The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P <0.05. The main outcome measures included CMT. RESULTS: When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83 mu m at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient =0.516, P=0.001; beta coefficient=0.453, P =0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P =0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION: Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.

Choroidal Analysis of Polypoidal Choroidal Vasculopathy by Spectral Domain Optical Coherence Tomography

Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness(SFCT) and choroidal maximal vessel diameter(MVD) of the affected and unaffected fellow eyes in patients with polypoidal choroidal vasculopathy(PCV) and compare them to healthy controls.Methods: In this cross-sectional observational clinical study,SFCT and MVD were measured in both eyes of 53 patients with unilateral PCV. PCV eyes were subgrouped into group A and unaffected fellow eyes into group B. All patients were diagnosed with PCV by fundus fluorescein angiography.(FFA)and indocyanine green angiography.(ICGA). Sixty age- and gender-matched healthy subjects were enrolled in the control group(group C).Results: No statistical difference was observed among groups in age and gender. Overall, SFCT was correlated with MVD in all subjects(P <0.001; correlation coefficient: 0.759). P values were < 0.001 with a correlation coefficient of 0.686,0.801, and 0.808 in groups A, B, and C, respectively. No statistical significance was noted in SFCT among groups A(266.45±99.51 μm),B(269.57 ± 105.10 μm),and C(243.83±99.68 μm)(P =0.335). However, the MVD in group A was(202.55±72.45 μm), significantly larger than that in group C(166.45 ±56.18 μm,P =0.008), while the MVD in group B(194.75±85.27 μm) was equally significantly greater than that in group C(166.45 ± 56.18 μm)(P=0.038).Conclusion: For both PCV patients and healthy subjects,SFCT was positively correlated with MVD. No statistical significance was noted in SFCT between PCV eyes and unaffected fellow / normal eyes. However, MVD was significantly larger in the PCV affected eyes than in unaffected fellow or normal control eyes, suggesting that MVD could be considered as a sensitive indicator to evaluate choroidal perfusion in PCV patients.

1310 nm Source Spectral-Domain Optical Coherence Tomography for Chinese Pigment and Jadeite Research

Optical Coherence Tomography (OCT) technique is a nondestructive optical detection technology based on low-coherence interferometer and it has become an attractive cultural heritage research method. A 1310 nm source spectral-domain optical coherence tomography (SD-OCT) system based on optical fiber Michelson interferometer and optical spectrum analyzer is proposed and demonstrated for Chinese cultural heritage research. The cross-section OCT images of Chinese pigment samples and jadeite samples can provide a lot of valuable microstructure information for the Chinese cultural heritage research and identification works.

BINARY TISSUE CLASSIFICATION STUDIES ON RESECTED HUMAN BREAST TISSUES USING OPTICAL COHERENCE TOMOGRAPHY IMAGES

We report the results of a comparative study of Fourier domain analysis(FDA)and texture analysis(TA)of optical coherence tomography(OCT)images of resected human breast tissues for binary classification between normal
abnormal classes and benign
malignant classes.With the incorporation of Fisher linear discriminant analysis(FLDA)in TA for feature extraction,the TA-based algorithm provided improved diagnostic performance as compared to the FDAbased algorithm in discriminating OCT images corresponding to breast tissues with three different pathologies.The specificity and sensitivity values obtained for normal
abnormal classification were both 100%,whereas they were 90% and 85%,respectively for benign
malignant classification.

Renal function and choroidal thickness using swept-source optical coherence tomography in diabetic patients

AIM: To assess the relationship between choroidal thickness and renal function in diabetic patients. METHODS: Cross-sectional retrospective clinical study of 42 eyes of 21 ocular treatment-na?ve diabetic patients. Demographic data included: age, sex, type and course of diabetes. Ocular data included: severity of diabetic retinopathy;retinal thickness at the central macular region, as well as choroidal thickness at the central and paracentral quadrants, using automatically generated maps by swept-source optical coherence tomography;presence of cystic macular edema;and ocular axial length(AXL). Lab-test parameters included: glycated hemoglobin(HbA1c), albuminuria, albumin/creatinine ratio in urine, and glomerular filtration rate. RESULTS: A significant negative correlation was mainly observed between several choroidal thicknesses, age(P<0.020) and ocular AXL(P<0.030). On the contrary, a significant positive correlation was found between all choroidal thicknesses, HbA1 c(P<0.035) and albuminuria(P<0.040). CONCLUSION: Choroidal thickness can represent an additional tool to help clinicians predicting the renal status in ocular treatment-na?ve diabetic patients.

Diagnostic capability of Fourier-Domain optical coherence tomography in early primary open angle glaucoma

Background Optical coherence tomography （OCT） is a high resolution noncontact imaging modality which can quantitatively detect the optic disc and retinal structure.This study was designed to evaluate the diagnostic capability of parameters of the optic disc, retinal nerve fiber layer thickness, and ganglion cell complex （GCC） using a new technology called Fourier-domain OCT （FD-OCT） for early primary open angle glaucoma （POAG） patients.Methods Two groups of patients, early perimetric damage POAG and normal subjects were included in this observational cross-sectional study.All patients underwent FD-OCT and visual field examination in addition to full ophthalmic examinations.Receiver operating characteristic curves （ROC） were studied for all parameters.The sensitivity and specificity for distinguishing between normal and early glaucomatous eyes, the areas under the receiver operating characteristic curves （AROC） and positive, negative likelihood ratios were evaluated for all the single parameters and selected combined parameters using arbitrary cutoffs.Results Thirty-four eyes of 34 early POAG patients and 42 eyes of 42 normal subjects were analyzed.Cup/disc （C/D）vertical ratio presented the best sensitivity and positive likelihood ratio for selected specificities （95% and 85%） which were 79.4% and 88.2%, 33.4 and 7.4, respectively.Among all single parameters, the C/D vertical ratio demonstrated the highest AROC which was at 0.930.The average thickness of circumpapillary RNFL on 3.45 mm showed the highest AROC among all of the peripapillary RNFL parameters.The sensitivity at selected specificity and AROC of GCC were not as high as C/D vertical ratio and RNFL AT on 3.45 mm.When the C/D vertical ratio, RNFL AT on 3.45 mm, and rim area were combined using a logistical diagnostic model, the AROC was raised to 0.949 but not significantly different from the top single parameter, C/D vertical ratio.Conclusions The key parameters obtained by FD-OCT were able to show the significant differences of optic discs,thickness of RNFL and GCC between POAG patients and normal subjects.According to sensitivity, specificity, likelihood ratio and AROC, the top three parameters from FD-OCT for early diagnosis of POAG were C/D vertical ratio, RNFL AT on 3.45 mm, and the rim area.

Angle-to-angle and spur-to-spur distance analysis with high-resolution optical coherence tomography

Background:To measure angle-to-angle(ATA)and spur-to-spur(STS)distances along six meridians using highresolution swept-source optical coherence tomography(SS-OCT)and to compare those values with horizontal white-to-white(WTW)distance.Methods:Sixty-eight eyes from 68 patients were quantitatively assessed with the Anterion SS-OCT(Heidelberg Engineering,Heidelberg,Germany).ATA and STS distances were measured with the SS-OCT B-scan in six cross-sectional images corresponding to the vertical(6-12 o'clock),1-7 o'clock,2-8 o'clock,horizontal(3-9 o'clock),4-10 o'clock and 5-11 o'clock meridians.WTW was measured horizontally with the device's infrared camera.A Pearson correlation analysis was carried out to compare ATA and STS distances with WTW.Results:The largest values were found for the vertical meridian and the shortest for the 2-8 o'clock meridian,both for ATA and STS distances.No statistically significant differences were found between WTW,ATA and STS along the horizontal meridian(P>0.1).However,ATA and STS showed statistically significant differences elsewhere,except for the horizontal and the 2-8 o'clock meridians(P>0.05).Moreover,we found that ATA and STS varied significantly depending on the meridian being assessed,except for ATA at 4-10 versus 3-9 o'clock and for STS at 4-10 versus 3-9 o'clock and at 3-9 versus 2-8 o'clock(P>0.1).R2 values ranged from 0.49 to 0.75 for ATA and STS at the different meridians,showing the best correlation at 3-9 o'clock meridian(0.64 and 0.75,respectively)and the worst at 6-12 o'clock meridian(R2=0.49 for both ATA and STS).Conclusions:ATA and STS distances vary radially,thus showing that the anterior chamber is vertically oval.Therefore,it is advisable to measure these two distances along the meridian to be used.

Comparing imaging capabilities of spectral domain and swept source optical coherence tomography angiography in healthy subjects and central serous retinopathy

Background:There are two forms of system implementation of optical coherence tomography angiography(OCTA)in ophthalmic imaging,i.e.,spectral domain(SD-)and swept source OCTA(SS-OCTA).The purpose of this paper is to compare the SD-OCTA and SS-OCTA for elucidating structural and vascular features associated with central serous retinopathy(CSR),and to evaluate the effects of CSR on SD-and SS-OCTA’s imaging capabilities.Methods:Normal subjects and CSR patients were imaged by SD-and SS-OCTA using 3×3 mm and 6×6 mm scan patterns.OCT signal strengths at the superficial retina,deep retina,Sattler’s layer and Haller’s layer were used to compare the ability of SD-and SS-OCTA to image structural features.In addition,the ability to acquire angiograms were discussed by evaluating retinal vessel density.Central serous volume(CSV)was measured and it was correlated with difference in signal strengths(ΔS)between two OCTA devices.Results:Seven normal eyes and seven diseased eyes were recruited.Results showed no significant differences between SD-and SS-OCT in detecting structural features of the retinal layer according to the paired t-test.However,when imaging the Sattler’s layer for normal eyes,a significant difference is found between SD-and SS-OCT(p<0.0001 for 3×3 mm scan,and p=0.0002 for 6×6 mm);while for CSR eyes,the corresponding values were p<0.0001 and p=0.0003,respectively.At Haller’s layer for normal eyes,the corresponding values were p=0.0004 and p=0.0014;and for CSR eyes,p=0.0004 and p<0.0001,respectively.A strong correlation betweenΔS and CSV was observed in the Sattler’s layer(3×3 mm–p=0.0031 and R^(2)=0.951;6×6 mm–p=0.0075 and R^(2)=0.911)and Haller’s layer(3×3 mm–p=0.0026 and R^(2)=0.955;6×6 mm–p=0.0013 and R^(2)=0.972).Conclusions:The results suggest no differences between SD-and SS-OCTA for imaging the retinal layers however,when imaging beyond retinal layers,SS-OCTA appears advantageous in detecting returning signals.In CSR cases,the CSV may have an impact on sub-CSR tissue imaging and appears to have more impact on SD-than SS-OCTA.

Numerical Study on Spectral Domain Optical Coherence Tomography Spectral Calibration and Re-Sampling Importance

A spectral calibration technique, a data processing method and the importance of calibration and re-sampling methods for the spectral domain optical coherence tomography system were numerically studied, targeted to optical coherence tomography （OCT） signal processing implementation under graphics processing unit （GPU） architecture. Accurately, assigning the wavelength to each pixel of the detector is of paramount importance to obtain high quality images and increase signal to noise ratio （SNR）. High quality imaging can be achieved by proper calibration methods, here performed by phase calibration and interpolation. SNR was assessed employing two approaches, single spectrum moving window averaging and consecutive spectra data averaging, to investigate the optimized method and factor for background noise reduction. It was demonstrated that the consecutive spectra averaging had better SNR performance.

Angle-to-angle and spur-to-spur distance analysis with high-resolution optical coherence tomography

Background:To measure angle-to-angle(ATA)and spur-to-spur(STS)distances along six meridians using highresolution swept-source optical coherence tomography(SS-OCT)and to compare those values with horizontal white-to-white(WTW)distance.Methods:68 eyes from 68 patients were quantitatively assessed with the Anterion SS-OCT(Heidelberg Engineering,Heidelberg,Germany).ATA and STS distances were measured with the SS-OCT’s B-Scan in six cross-sectional images corresponding to the vertical(6-12 o’clock),1-7 o’clock,2-8 o’clock,horizontal(3-9 o’clock),4-10 o’clock and 5-11 o’clock meridians.WTW was measured horizontally with the device’s infrared camera.A Pearson correlation analysis was carried out to compare ATA and STS distances with WTW.Results:The largest values were found for the vertical meridian and the shortest for the 2-8 o’clock meridian,both for ATA and STS distances.No statistically significant differences were found between WTW,ATA and STS along the horizontal meridian(p>0.1).However,ATA and STS showed statistically significant differences elsewhere,except for the horizontal and the 2-8 o’clock meridians(p>0.05).Moreover,we found that ATA and STS varied significantly depending on the meridian being assessed,except for ATA at 4-10 versus 3-9 o’clock and for STS at 4-10 versus 3-9 o’clock and at 3-9 versus 2-8 o’clock(p>0.1).R^(2) values ranged from 0.49 to 0.75 for ATA and STS at the different meridians,showing the best correlation at 3-9 o’clock meridian(0.64 and 0.75,respectively)and the worst at 6-12 o’clock meridian(R^(2)=0.49 for both ATA and STS).Conclusions:ATA and STS distances vary radially,thus showing that the anterior chamber is vertically oval.Therefore,it is advisable to measure these two distances along the meridian to be used.

扫频源光学相干断层扫描和时域光学相干断层扫描对近视患者房角参数测量的一致性分析

目的:探讨扫频源光学相干断层扫描(SS-OCT)和时域光学相干断层扫描(TD-OCT)在近视患者前房角测量的一致性。方法:回顾性选择2023年1-5月在陆军军医大学大坪医院眼科就诊的46(92眼)近视患者,所有患者均使用SS-OCT和TD-OCT分别对房角参数进行测量,对比分析SS-OCT和TD-OCT两种扫描方法测量中央前房深度(ACD)、房角开放距离(AOD500、AOD750)、巩膜突角度(SSA)、小梁网虹膜面积(TISA500、TISA750)等参数的差异;采用Pearson相关性分析法和Bland-Altman检验,分析测量的相关性和一致性。结果:两种扫描方法测量房角参数ACD比较差异均有统计学意义(t=-6.83,P<0.001);且AOD500、AOD750、SSA500、TISA500和TISA750的鼻侧测量数据差异均有统计学意义(t=-5.16、5.51、-6.51、-4.75、-5.69,P<0.001);颞侧测量数据差异均有统计学意义(t=-5.04、-4.8、-6.06、-3.84、-4.02,P<0.001)。两种扫描方法测量结果呈正相关(r=0.71~0.92),Bland-Altman分析显示2.1%~8.9%测量值在95%一致性界限外。结论:SS-OCT和TD-OCT在近视患者房角参数测量中存在差异,测量结果呈正相关。

Scansys、Pentacam、CASIA和Arcscan测量近视眼ICL植入术后拱高比较

目的评估国产三维眼前节分析系统Scansys、Pentacam三维眼前节全景分析仪、频域眼前节光学相干断层扫描仪(CASIA SS-1000)和新型超高频数字超声扫描系统(Arcscan Insight100)测量近视眼有晶状体眼后房型人工晶状体(ICL)植入术后中央拱高的差异及一致性。方法采用诊断试验研究方法,纳入2019年6—12月于河南省人民医院眼科行ICL V4c植入术的近视患者56例56眼,术后同时应用Scansys、Pentacam、CASIA和Arcsan测量中央拱高。比较4种仪器拱高测量值的差异;4种仪器拱高测量值的相关性采用Pearson相关性分析,一致性比较采用Bland-Altman法分析。结果Scansys、Pentacam、CASIA和Arcscan拱高测量值分别为(481.8±191.6)、(476.4±190.6)、(619.3±207.5)和(534.0±221.2)μm,总体比较差异有统计学意义(F=143.301,P<0.001),其中Scansys和Pentacam拱高测量值明显低于CASIA和Arcscan,Arcscan拱高测量值低于CASIA,差异均有统计学意义(均P<0.001)。Arcscan-CASIA、Arcscan-Pentacam、Arcscan-Scansys、CASIA-Pentacam、CASIA-Scansys、Pentacam-Scansys拱高测量值均呈强正相关(r=0.982、0.933、0.931、0.942、0.941、0.989,均P<0.001)。Scansys、Pentacam、CASIA和Arcscan拱高测量值组内相关系数分别为0.985、0.975、0.998、0.992;CASIA和Arcscan、CASIA和Scansys、CASIA和Pantacam、Arcscan和Scansys、Arcscan和Pantacam拱高测量值差值95%一致性界限分别为-170~0、0~280、0~280、-110~210、-100~220μm,差值的绝对值最大值超出临床的可接受范围,一致性欠佳;Scansys和Pentacam拱高测量值差值95%一致性界限为-60~50μm,一致性良好。结论4种仪器测量近视眼ICL V4c植入术后拱高重复性均良好,其中,Scansys和Pentacam的拱高测量值偏小,两者一致性良好,结果可以互相替代;而CASIA拱高测量值最大,其次为Arcscan,彼此差异较大,测量结果不能相互替代,在临床工作中应结合实际情况综合分析。

Macular ganglion cell complex injury in different stages of anterior ischemic optic neuropathy

BACKGROUND Anterior ischemic optic neuropathy(AION)is a group of ophthalmic diseases in which the optic nerve is injured causing blindness.However,the pathogenesis,clinical manifestations,and clinical treatments of AION are yet elusive.Only a few related experimental or clinical reports are available on the disease.In this study,spectral domain optical coherence tomography(SD-OCT)was used to examine the morphology of thickness swelling and atrophic changes of macular ganglion cell complex(mGCC)in the different stages of AION that were then compared with the visual fields.Thus,the clinical value of mGCC examination was alleged to be similar to that of the visual field.AIM To explore the mGCC injury at different stages in AION and the clinical significance.METHODS Cases with AION were analyzed in a retrospective study.SD-OCT was used to analyze the correlation between mGCC and peripapillary retinal nerve fiber layer thicknesses at different stages of AION and the changes in the corresponding stages of visual fields.RESULTS A total of 21 cases(28 eyes)presented AION.The onset time of AION was defined as early stage(within 3 wk of onset),middle stage(from 3 wk to 2 mo),and late stage(disease span>2 mo).In the early stage,the mGCC thickness of SD-OCT was within the normal high limit,and the perioptic nerve fibers thickness was more than the normal.The changes in the visual field in early stage were not consistent with the swelling changes in mGCC and peri-disc nerve fibers.In addition,atrophy and thinning appeared in mGCC,and the perioptic nerve fibers were swollen.However,the thickness was lower in the middle period than that in the early stage.The change in visual field was consistent with that of mGCC in this period.In the late stage,mGCC shrank and thinned,and the thickness of the nerve fibers around the optic disc in the corresponding region shrank and thinned.CONCLUSION The changes in mGCC thickness in patients with AION showed early,middle,and late stages of development by SD-OCT.Although the early stage visual field changes of AION were not consistent with the swelling changes of mGCC,the horizontal delimitation or annular atrophy of mGCC was consistent with that in the middle and late stage of the disease.The atrophy of peripheral nerve fibers was later than that of the mGCC atrophy.

Importance of 3-D image reconstruction of spectraldomain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema

AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.