Diagnosis of lacrimal punctum lesions using optical coherence tomography: a preliminary study

AIM:To study the imaging characteristics of lacrimal punctum lesion with optical coherence tomography(OCT),and provide imaging basis for the diagnosis and treatment of lacrimal punctum diseases.METHODS:A total of 25 patients(28 eyes)with epiphora and lacrimal puncta lesions were enrolled.Lacrimal puncta lesions included:punctum membrane obstruction in 7 cases(9 eyes),punctum agenesis in 1 case(1 eye),a mass protruded from the punctum in 1 case(1 eye),slit puncta in 1 case(1 eye),peri-puncta mass in 2 cases(2 eyes),chronic dacryocystitis in 4 cases(4 eyes),and primary puncta stenosis in 9 cases(10 eyes;3 eyes mild,4 eyes moderate and 3 eyes severe).All patients were examined by slit lamp microscopy and OCT to observe the morphological characteristics of abnormal punctum.RESULTS:Two types of complete membrane obstruction and incomplete membrane obstruction of puncta were observed in OCT images of 7 patients.No lacrimal punctum and lacrimal canalicular cavity were found in 1 case with punctum agenesis.OCT images showed that a narrow lumen remained in the lacrimal puncta in 1 patient with a mass protruded from the punctum.OCT of punctum in a patient with slit punctum after stent placement showed stent and abnormal lacrimal structure.No abnormal intraluminal structure was found in 2 cases of peri-puncta mass after OCT scan,and the lacunar space was narrower than that of the contralateral eye.OCT of puncta in 4 patients with chronic dacryocystitis showed that pus floated in tear with lump-like medium-low reflex.In 9 patients with primary lacrimal puncta stenosis,OCT image could clearly show the changes of puncta lumen in different degrees and shapes.CONCLUSION:OCT is feasible for the examination of pathological punctum,and can provide imaging basis for the diagnosis and treatment of punctum disease.

OPTICAL COHERENCE TOMOGRAPHY FOR BLADDER CANCER DIAGNOSIS:FROM ANIMAL STUDY TO CLINICAL DIAGNOSIS

This paper summarizes the recent technological development in our lab on cystoscopic optical coherence tomography(COCT)by integrating time-domain OCT(TDOCT)and spectral-domain OCT(SDOCT)with advanced MEMS-mirror technology for endoscopic laser scanning imaging.The COCT catheter can be integrated into the instrument channel of a commercial 22Fr rigid cystoscopic sheath for in vivo imaging of human bladder under the cystosocopic visual guidance;the axial/transverse resolutions of the COCT catheter are roughly 9μm and 12μm,respectively,and 2D COCT imaging can be performed with over 110dB dynamic range at 4–8 fps.To examine the utility and potential limitations of OCT for bladder cancer diagnosis,systemic ex vivo rat bladder carcinogenesis studies were performed to follow various morphological changes induced by tumor growth and in vivo porcine study was performed to examine the feasibility of COCT for in vivo imaging.Justified by promising results of the animal studies,preliminary clinical study was conducted on patients scheduled for operating-room cystoscopy for bladder cancers.Double-blind clinical results reveal that COCT can delineate detailed bladder architectures(e.g.,urothelium,lamina propria,muscularis)at high resolution and detect bladder cancers based on enhanced urothelial heterogeneity as a result of excessive growing nature of bladder cancers.The diagnostic sensitivity and specificity can be enhanced to 92%and 85%,respectively.Results also suggest that due to reduced imaging depth of COCT in cancerous lesions,staging of bladder cancers may be limited to Ta or T1 for non-outgrowing cancerous lesions.

Retinoschisis at Macular Area in Highly Myopic Eye by Optic Coherence Tomography

Purpose:To improve our understanding of macular schisis in highly myopic eyes. Methods:From 2002.6-2003.12, the highly myopic eyes(>6D) which has macular schisis found by OCT at our hospital were included in the study. Each eye then received further examinations including visual acuity,refractive error and ultra-sonography. Then the results were analyzed to find the characteristic of the entity. Results:During that period, OCT found macular schisis in 38 highly myopic eyes from 36 patients. Their vision was low, and their average axial length and refractive error were 29.6mm and -10.5D respectively. The appearance and the area of the schisis are different among the eyes. But the schisis can be largely divided into two types: inner and outer schisis. They can exit independently or concurrently in the same eye. And the schisis was often accompanied by other macular findings, like retinal detachment, macular hole. Conclusion:Macular schisis in highly myopic eyes is not uncommon in the clinic. OCT is useful in its diagnosis.

Analysis of Optic Coherence Tomography for Congenital Macular Retinoschisis

Purpose:To investigate the pathological characteristics of congenital macular retinoschisis by optic coherence tomography (OCT).Methods:The data of 7 cases(14 eyes) with congenital macular retinoschisis were collected.Electroretinogram (ERG),fundus fluorecein angiography (FFA) and OCT examination were performed,respectively.Results:The OCT images showed schisis cavity in all eyes.Schisis was confined to the fovea and parafovea in 2 eyes (1 patient).Schisis was involved in entire macular area in 12 eyes (6 patients).Inner nuclear layer (INL) schisis was seen in all eyes.Schisis was located at both INL and outer nuclear layer.(ONL)/outer plexiform layer (OPL) in 2 of the 14 eyes.Besides the schisis cavity,small cysts within ganglion cell layer were found in 3 eyes.The small cysts were confined to parafoveal area.The OCT images of both eyes in one patient were similar but not exactly the same or symmetrical.Conclusion:Morphology,extension and schisis location in congenital macular retinoschisis have respective diversities.

High interpretable machine learning classifier for early glaucoma diagnosis

AIM:To develop a classifier for differentiating between healthy and early stage glaucoma eyes based on peripapillary retinal nerve fiber layer(RNFL)thicknesses measured with optical coherence tomography(OCT),using machine learning algorithms with a high interpretability.METHODS:Ninety patients with early glaucoma and 85 healthy eyes were included.Early glaucoma eyes showed a visual field(VF)defect with mean deviation>-6.00 d B and characteristic glaucomatous morphology.RNFL thickness in every quadrant,clock-hour and average thickness were used to feed machine learning algorithms.Cluster analysis was conducted to detect and exclude outliers.Tree gradient boosting algorithms were used to calculate the importance of parameters on the classifier and to check the relation between their values and its impact on the classifier.Parameters with the lowest importance were excluded and a weighted decision tree analysis was applied to obtain an interpretable classifier.Area under the ROC curve(AUC),accuracy and generalization ability of the model were estimated using cross validation techniques.RESULTS:Average and 7 clock-hour RNFL thicknesses were the parameters with the highest impor tance.Correlation between parameter values and impact on classification displayed a stepped pattern for average thickness.Decision tree model revealed that average thickness lower than 82μm was a high predictor for early glaucoma.Model scores had AUC of 0.953(95%CI:0.903-0998),with an accuracy of 89%.CONCLUSION:Gradient boosting methods provide accurate and highly interpretable classifiers to discriminate between early glaucoma and healthy eyes.Average and 7-hour RNFL thicknesses have the best discriminant power.

X-linked juvenile retinoschisis： phenotypic and genetic characterization

Juvenile X-linked retinoschisis（XLRS, MIM#312700） belongs to a group of the vitreoretinal dystrophies. We aimed to describe the phenotype-genotype correlation of three XLRS cases in juveniles with different novel mutations from the Lithuanian population. The patients demonstrated macular retinoschisis and typical cyst-like cavities on spectral-domain optical coherence tomography（SD-OCT） images. The mean central foveal thickness was 569.7 μm. Two patients presented with peripheral retinoschisis. Flash electroretinogram demonstrated a reduced b/a ratio（〈1.0） in all patients. RS1（NM_000330.3） gene coding exons Sanger sequencing was performed. RS1 c.599 G〉T（p.R200 L） mutation was detected in one case, showing to be pathogenic in silico analysis. c.（92_97） ins C（p.W33 fs） mutation was identified for another patient, indicating the variant is possibly damaging in silico analysis. The third case was identified with a pathogenic mutation c.422 C〉G（p.R141 H）, HGMD CM981753. These are the first cases of XLRS in the Lithuanian population confirmed by molecular genotyping. Presented patients had a different genotype but similar phenotypic traits.

Optic disc coloboma associated with macular retinoschisis:A case report

BACKGROUND To report an unusual case of bilateral optic disc coloboma associated with macular retinoschisis in the left eye.CASE SUMMARY A 37-year-old woman presented with complaints of blurred and distorted vision in her left eye for more than 1 year.Fundus examination demonstrated choroidal atrophy around the optic disc in both eyes,with a cup-to-disc ratio of 0.9.Serous retinal detachment in the macular area of the left eye.Left eye macular blood flow imaging optical coherence tomography(Angio-OCT)showed macular retinal serous cleavage.En-face OCT showed that the canal gully-like structure formed by the defect of the optic disc nerve fiber layer between the optic disc and macula,serous detachment area was connected with the enlarged optic disc coloboma through the canal gully-like structure,and the fluid leaked from the enlarged and thinned optic disc coloboma into the retinal layer of the macular area.Patients with optic disc abnormalities and macular degeneration must be monitored appropriately.During the follow-up period,the use of optic disc stereography and 3D-OCT,en-face,and Angio-OCT imaging can clarify the correlation between macular retinoschisis and optic disc coloboma.CONCLUSION Macular retinoschisis may be owing to the combined force of disc edge loss,enlarged optic disc coloboma,the canal gully-like structure formed by the defect of the nerve fiber layer around the optic disc,and the traction of the posterior vitreous cortex.

超广角光学相干断层扫描血管成像在视网膜静脉阻塞诊断中的应用

目的探讨超广角光学相干断层扫描血管成像(OCTA)在视网膜静脉阻塞(RVO)患者诊断中的价值。方法选取2023年1月至2024年1月在西安爱尔古城眼科医院接受检查并确诊的RVO患者78例(78眼)进行回顾性研究,其中男43例、女35例,年龄(58.7±9.4)岁。所有患者均于2周内分别接受超广角OCTA、荧光素眼底血管造影(FFA)检查,以FFA检查结果作为临床诊断金标准,计算超广角OCTA对视网膜无灌注区的诊断价值。采用配对t检验分析受检者患侧与健侧超广角OCTA检查的视盘区血流密度特征参数差异;采用方差分析法分析FFA与超广角OCTA检查无灌注区面积的差异。结果超广角OCTA检查视网膜层、浅层血管复合体、深层血管复合体无灌注区面积与FFA检出的无灌注区面积比较,差异均无统计学意义(均P>0.05)。视网膜中央静脉阻塞患者患侧视盘区整个图像血管、视盘周血管、整个图像毛细血管、视盘周毛细血管、下方鼻侧、下方颞侧、颞下、颞上、上方颞侧、下方颞侧血流密度均低于健侧[(50.61±4.82)%比(55.17±5.20)%、(51.40±4.77)%比(57.37±5.00)%、(45.68±5.20)%比(48.93±4.88)%、(45.48±5.50)%比(50.30±6.23)%、(43.83±5.50)%比(48.29±7.23)%、(50.90±7.27)%比(57.34±7.86)%、(48.65±6.61)%比(53.43±6.93)%、(49.50±6.14)%比(54.63±7.22)%、(49.33±7.10)%比(55.38±7.50)%、(45.52±6.14)%比(49.58±6.85)%],差异均有统计学意义(均P<0.05)。视网膜分支静脉阻塞患者患侧视盘区整个图像血管、视盘周血管、整个图像毛细血管、视盘周毛细血管、下方鼻侧、下方颞侧、颞下、颞上、上方颞侧、下方颞侧血流密度均低于健侧[(52.33±5.14)%比(55.43±4.88)%、(52.30±5.15)%比(57.43±4.86)%、(46.77±4.98)%比(49.54±5.50)%、(46.13±6.62)%比(50.63±5.87)%、(44.18±5.87)%比(48.43±6.61)%、(51.39±6.98)%比(57.92±6.94)%、(49.66±6.21)%比(53.56±6.60)%、(49.50±6.33)%比(54.81±6.87)%、(49.89±7.09)%比(56.12±7.28)%、(45.83±5.81)%比(50.75±6.43)%],差异均有统计学意义(均P<0.05)。超广角OCTA检查诊断视网膜中央静脉阻塞及视网膜分支静脉阻塞患者无灌注区的灵敏度分别为100.0%(35/35)、81.4%(35/43),特异度分别为86.0%(37/43)、100.0%(35/35)。结论超广角OCTA可检查RVO患眼视盘区血流密度特征,对RVO无灌注的诊断价值较高,且与FFA相比具有无创优势。

扫频源光学相干断层扫描血管成像在眼科临床中的应用进展

扫频源光学相干断层扫描血管成像(SS-OCTA)检查是近几年提出的一种新型血管成像技术,具有非侵入性、快速、高分辨率、自动化血管分层成像等优势,在眼科相关疾病的早期诊断、疗效评估及监测疾病进展等方面具有很高的价值。基于OCTA的基础,SS-OCTA采用快速调谐的激光器和1050 nm的波长,穿透力更强,对视网膜和脉络膜微血管系统进行无创深度分辨成像,加深了对多种眼部疾病(眼底病变、青光眼、神经退行性疾病等)特征的认识。此外,SS-OCTA也可用于研究眼前节结构,如角膜新生血管的深度和密度、虹膜新生血管治疗前后的变化等。该技术为眼科临床实践提供了一种新的手段。本文就SS-OCTA技术在眼科临床的应用进展进行综述。

人工智能在OCTA图像分析和眼部疾病诊断中的应用指南(2024)

光学相干断层扫描血管成像(OCTA)是一种无创成像技术,可提供三维、信息丰富的血管图像。大量研究表明,OCTA技术在影像生物标志物量化、诊断和监测方面具有独特的优势,因此在实验及临床研究中得到了迅速的应用。图像分析工具可快速、准确地量化OCTA的血管和病理特征,从而大大提高了OCTA成像的价值。近年来,人工智能(AI)已成为最强大的图像分析方法,特别是基于深度学习的图像分析可提供各种情况下的精确测量,包括不同的疾病和眼部区域。在此,中国医药教育协会眼科影像与智能医疗分会和国际转化医学会眼科专业委员会组织专家总结了国内外AI在OCTA图像分析和疾病诊断中的应用,其中包括脉络膜新生血管等病变的准确检测、视网膜灌注的精确量化以及可靠的疾病诊断,并分析目前面临的挑战和发展方向,经过多轮讨论和修改,形成了AI在OCTA图像分析和眼部疾病诊断中的应用指南,该指南旨在为临床提供新的见解和参考。

基于视网膜结构改变的机器学习对早期帕金森病诊断的预测价值研究

背景帕金森病(PD)的诊断主要以临床症状为主,缺乏正确诊断的客观方法。目前已有关于视网膜结构改变作为PD早期诊断的生物标志的研究,但基于视网膜结构改变的机器学习对预测早期PD的研究尚少。目的基于视网膜结构改变的特征构建机器学习模型,探索其在早期PD诊断中的预测价值,及探讨不同机器学习算法对PD早期诊断的准确性。方法选取2021年10月—2022年9月在河南省人民医院神经内科门诊就诊和住院治疗的年龄40~70岁的PD患者49例(PD组),并选取来医院体检的年龄及性别相匹配的39名健康者(健康对照组)为研究对象。所有研究对象行扫频源光学相关断层扫描和扫频源光学相干断层扫描血流成像检查,并定量分析黄斑区视网膜的厚度和血管密度。将88例受试者按7∶3的比例随机分为训练集62例和验证集26例,选择PD组与健康对照组差异有统计学意义的变量作为纳入机器学习模型的特征变量,并在训练集中分别构建Logistic回归(LR)、K-近邻算法(KNN)、决策树(DT)、随机森林(RF)和极端梯度提升(XGboost)模型。采用受试者工作特征(ROC)曲线下面积(AUC)、准确度、灵敏度和特异度评价基于视网膜改变的机器学习模型对早期PD诊断的预测价值。结果与健康对照组相比,PD组患者浅层毛细血管的上方外圈(A6)、颞侧外圈(A7)、下方外圈(A8)以及鼻侧外圈(A9)密度减少,视网膜层的上方内圈(A2)、颞侧内圈(A3)、下方内圈(A4)、鼻侧内圈(A5)、A6~A9厚度,节细胞复合体层的A9厚度,神经纤维层的A7厚度,视网膜外层的A2和A4~A9厚度变薄(P<0.05)。视网膜层A2厚度(OR=0.781,95%CI=0.659~0.926)、视网膜层A3厚度(OR=1.190,95%CI=1.019~1.390)、视网膜外层A2厚度(OR=0.748,95%CI=0.603~0.929)、视网膜外层A6厚度(OR=2.264,95%CI=1.469~3.490)、视网膜外层A8厚度(OR=0.723,95%CI=0.576~0.906)以及神经纤维层A7厚度变薄(OR=0.592,95%CI=0.454~0.773)及浅层毛细血管A7密度减少(OR=1.966,95%CI=1.399~2.765)为早期PD发生的独立危险因素(P<0.05)。将上述变量纳入并构建机器学习模型,结果显示,构建的5个模型中,LR模型整体性能最高,其AUC为0.841,而DT模型的准确度最高,其准确度为0.846。结论基于视网膜特征的机器学习模型可准确的预测早期PD,其中,DT模型对早期PD诊断具有较高的准确度。

CSC继发脉络膜新生血管研究进展

中心性浆液性脉络膜视网膜病变(CSC)是一类以黄斑区视网膜神经上皮层浆液性脱离为特征的自限性疾病。CSC可继发脉络膜新生血管(CNV),造成视力预后不良。近年来研究表明,病程是CSC继发CNV主要的危险因素,其发生机制尚未完全阐明,可能涉及脉络膜局部缺血缺氧及视网膜屏障功能受损等多种病理机制。多模态影像技术有助于诊断CSC继发的CNV,光学相干断层扫描示高反射扁平不规则色素上皮脱离需要高度警惕继发CNV的可能。虽然尚未有统一标准的治疗方案,大量研究提示光动力疗法和玻璃体腔注射抗血管内皮生长因子药物可改善此类患者视力预后。本文综述了CSC继发CNV的危险因素、发病机制、多模态影像诊断模式、治疗等方面的研究进展,以期为临床早期诊断和治疗提供参考。

继发性牙根纵裂诊断的研究进展

牙根纵裂是一种源自牙根的纵向裂纹,可发生在活髓牙和根管治疗后牙齿,是病因复杂、预后较差的牙体硬组织疾病。发生于牙髓治疗后的牙根纵裂称为继发性牙根纵裂(secondary vertical root fracture,SVRF),对SVRF的诊断,应结合临床体征(如疼痛、肿胀、牙齿松动、位于牙龈边缘附近的窦道和深而窄的孤立牙周袋)和根尖片(如牙周膜增宽、垂直骨丧失和根周骨丧失、根周“晕圈状”或“J”形的透射影)进行综合判断。对疑似牙根纵裂的牙齿,应通过锥形束CT(cone⁃beam computed tomography,CBCT)等三维影像学辅助诊断,如CBCT显示牙根上的折裂线以及颊侧或舌侧骨板缺损;优化设置CBCT参数,如选用小视野CBCT、增强染料辅助的应用、使用金属伪影还原工具(metal artifact reduction,MAR)等方法提高CBCT诊断SVRF的精确度。使用多种影像技术可对不同宽度的裂纹进行检测,如核磁共振成像(magnetic resonance imaging,MRI)中表现为异常的高强度信号;使用数字减影技术(digital subtraction radiography,DSR)进行图像处理后出现的黑色线状区域;不同宽度的裂纹在光学相干断层扫描(optical coherence tomography,OCT)可表现为高亮度线或暗区。人工智能(artificial intelligence,AI)诊断技术和预测模型也是SVRF诊断的辅助手段。通过各种无创手段仍然无法确诊的SVRF病例,可通过根管内直视和翻瓣手术中直视发现SVRF。

SD-OCT在真假视乳头水肿鉴别诊断中的应用

视乳头水肿是由于颅内压升高导致视盘神经纤维轴浆流障碍,视盘水肿、抬高,并向前隆起。假性视乳头水肿多为视盘形态异常,如视盘玻璃疣、视盘倾斜等,眼底照相可见视盘边界模糊。临床上难以鉴别视乳头水肿和假性视乳头水肿,谱域光学相干断层扫描(SD-OCT)提供了一种无创、易获取、高分辨率的成像技术,通过测量视盘周围神经纤维层厚度、视盘体积和总视网膜厚度等定量指标或观察视盘周围形状和移位、视网膜皱褶等定性指标,可提高诊断准确性。本文主要讨论SD-OCT在鉴别视乳头水肿和假性视乳头水肿中的应用价值。

近视病人青光眼诊断的研究进展

近视是青光眼发病的高危因素,且研究表明近视程度越高,患青光眼的可能性就越大。近视病人青光眼诊断是一个特殊问题,这可能因为早期青光眼与近视的表现相似,所以许多近视病人因青光眼而使视力受到损害,但未引起临床医生考虑青光眼的可能性。近年来随着眼科影像技术的发展,尤其是光学相干断层扫描与共焦激光眼底扫描红外成像及无赤光眼底照相技术的结合、光学相干断层扫描离散傅里叶变换分析与视野的结合,光学相干断层扫描血流成像的快速革新,临床医生可以从多方面了解近视与青光眼的发生发展,为早期诊断近视眼青光眼,及时干预治疗,从而为提高近视病人的视觉生活质量提供坚实的基础。

急性视网膜坏死综合征二例误诊分析

目的 分析急性视网膜坏死综合征(ARNS)的临床特点及容易引起误诊的原因,并总结防范误诊措施,以提高早期诊断正确率。方法 回顾分析2021年3月至2023年9月收治的一度误诊为青光眼、眼内炎的ARNS 2例病例资料。结果 1例以右眼视物不清3月余就诊,1例因左眼红、眼痛4 d急性发病入院。就诊初期一度误诊为青光眼、眼内炎,予相应治疗效果不佳,后经手术及眼底检查、光学相干断层成像检查,明确诊断为ARNS。误诊时间4 d至2个半月。确诊后经抗病毒药物、糖皮质激素等治疗出院,预后尚可。结论 ARNS病情进展较迅速且预后较差,是严重的致盲性眼病,而早期临床表现缺乏特异性,易误诊;加强对ARNS的认识,提高警惕性,仔细鉴别诊断,及时行相关医技检查,全面分析病情,避免早期误诊。

Impact of OCT scan-patterns in identifying morphological features of lamellar macular holes and macular pseudoholes

AIM:To evaluate the impact of the optical coherence tomography(OCT)scan patterns on the detection of the features associated with lamellar macular hole(LMH)and macular pseudohole(MPH).METHODS:This is a retrospective analysis of 100 consecutive eyes with LMH(n=41)and MPH(n=59)having at least three of the following OCT features,which include mandatory criteria for the diagnosis of LMH and MPH:Epiretinal membrane,epiretinal proliferation,verticalization,intraretinal cystoid spaces,foveoschisis,irregular foveal contour,foveal cavity with undermined edges,and ellipsoid line disruption.Primary outcome measurement was the detection frequency of the features in three different OCT scan patterns:1)volume scan;2)six radial scans(R6);and 3)vertical and horizontal radial scans(R2).RESULTS:Of the total eight features,the maximal detection frequency was found as 4.45±1.45,4.35±1.47,and 3.70±1.59,by the volume,R6 and R2,respectively.R2 was inferior to the other patterns in detection of the total features(P<0.001),whereas R6 and volume patterns were found comparable(P=0.312).CONCLUSION:The physician should be aware that the selection of the OCT-scan pattern may influence the detection of mandatory morphological criteria for the diagnosis of LMH and MPH.

Monocular posterior scleritis presenting as acute conjunctivitis:A case report

BACKGROUND Posterior scleritis is a rare inflammatory ocular disease,characterized by severe and painful inflammation of the sclera.It is often misdiagnosed or underdiagnosed,due to its general and varying clinical presentation profile,which primarily involves pain and visual impairment but which can include eyelid edema,choroidal folds,serous retinal detachment,disc edema,hard exudates in fovea and subretinal mass.We report here a case of posterior scleritis,with symptoms of eye pain and red eye,initially misdiagnosed as acute conjunctivitis.CASE SUMMARY A 56-year-old man presented to a local hospital with complaint of pain and redness in the right eye.The initial diagnosis was acute conjunctivitis and he was given antibiotic eyedrops.Upon week-long continuance of the symptoms despite treatment,he presented to our hospital.Initial examination revealed a shallow anterior chamber in the right eye and vision reduction to 0.6.Further testing by optical coherence tomography,ultrasound biomicroscopy,and fundus photography indicated diagnosis of posterior scleritis.The patient was given methylprednisolone(oral)on a tapered reduction schedule(starting with 70 mg/d).According to the peaks and troughs of symptoms,compound betamethasone injection was administered into the bulb,culminating in discontinuation of the oral corticosteroid.Subsequent optical coherence tomography showed the subretinal fluid near the optic disc to be completely absorbed after treatment.CONCLUSION Posterior scleritis should be among the differential diagnosis of eye pain and redness,and diagnosis requires further ophthalmic accessory examination,such as by optical coherence tomography.

Peripapillary and macular vascular densities in healthy,ocular hypertensive,and different stages of glaucomatous eyes

AIM:To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography(OCTA)in the early diagnosis of glaucoma.METHODS:Glaucoma patients and healthy controls(n=29 eyes)were investigated in this cross-sectional comparative study.Glaucoma patients were grouped as ocular hypertension(n=44 eyes),preperimetric glaucoma(PPG;n=32 eyes),early glaucoma(EG;n=35 eyes),moderate stage glaucoma(MG;n=36 eyes),and advanced glaucoma(AG;n=35 eyes).Peripapillary and macular vascular densities(VDs)of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness(RNFLT),ganglion cell analysis(GCA),and visual field(VF)tests were evaluated.Area under the receiver operation characteristic curves(AUC)of the peripapillary and macular VD parameters were obtained.RESULTS:VD values decreased with the progression of glaucoma.Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls(P<0.001).There was no significant difference in RNFLT between the PPG and EG groups,but most peripapillary and macular VDs were found to be lower in EG group than in PPG group(P<0.05).In most disease group,VDs were significantly correlated with OCT parameters(P<0.001)and VF index(P<0.05).There were no significant correlations between VF and RNFLT indices in the AG group,but significant correlations were found between VF and VD values(P<0.05).AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD(AUC:0.865,0.929,and 0.986,respectively in EG,MG,and AG groups).CONCLUSION:OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease.In cases where limitations or suspicions in structural and functional tests are present,OCTA can be used as a supportive diagnostic test,both in EG and AG.

Bilateral posterior scleritis presenting as acute primary angle closure:A case report

BACKGROUND Scleritis is a rare disease and the incidence of bilateral posterior scleritis is even rarer.Unfortunately,misdiagnosis of the latter is common due to its insidious onset,atypical symptoms,and varied manifestations.We report here a case of bilateral posterior scleritis that presented with acute eye pain and intraocular hypertension,and was initially misdiagnosed as acute primary angle closure.Expanding the literature on such cases will not only increase physicians’awareness but also help to improve accurate diagnosis.CASE SUMMARY A 53-year-old man was referred to our hospital to address a 4-d history of bilateral acute eye pain,headache,and loss of vision,after initial presentation to a local hospital 3 d prior.Our initial examination revealed bilateral cornea edema accompanied by a shallow anterior chamber and visual acuity reduction,with left-eye amblyopia(>30 years).There was bilateral hypertension(by intraocular pressure:28 mmHg in right,34 mmHg in left)and normal fundi.Accordingly,acute primary angle closure was diagnosed.Miotics and ocular hypotensive drugs were prescribed,but the symptoms continued to worsen over the 3-d treatment course.Further imaging examinations(i.e.,anterior segment photography and ultrasonography)indicated a diagnosis of bilateral posterior scleritis.Methylprednisolone,topical atropine,and steroid eye drops were prescribed along with intraocular pressure-lowering agents.Subsequent optical coherence tomography(OCT)showed gradual improvements in subretinal fluid under the sensory retina,thickened sclera,and ciliary body detachment.CONCLUSION Bilateral posterior scleritis can lead to secondary acute angle closure.Diagnosis requires ophthalmic accessory examinations(i.e.,ultrasound biomicroscopy,Bscan,and OCT).