应用扫频源光学相干断层扫描成像分析后皮质前玻璃体囊袋的形态

目的：应用扫频源光学相干断层扫描成像(SS-OCT)观察并分析后皮质前玻璃体囊袋(PPVP)的形态学特点。

方法：前瞻性研究。纳入2019-03/06于河南省立眼科医院行SS-OCT检查发现PPVP的受检者91例138眼。观察PPVP的SS-OCT形态学特点,比较不同性别、年龄、等效球镜受检者的PPVP的宽度和高度的差异。

结果：纳入91例138眼中112眼(81.2%)PPVP形态为船形,19眼(13.8%)为椭圆形,7眼(5.1%)为对勾形。99眼(71.7%)PPVP与Martegiani区连通。138眼的PPVP的平均宽度为6248.82±1117.87μm,平均高度为562.12±476.94μm。不同性别受检者的PPVP的平均宽度和高度比较无差异(P>0.05),PPVP的宽度与年龄呈正相关(r=0.32,P<0.01),低度近视组受检者PPVP的高度低于非近视组和中度近视组(P=0.01、0.03)。

结论：PPVP多为黄斑前船形液体腔隙,多与玻璃体管(Cloquet管)连通,其宽度与年龄相关,PPVP的存在可能影响PVD的形成与进展。     

黄斑囊样水肿患眼多波长炫彩成像影像特征和定量分析

目的观察黄斑囊样水肿(CME)患眼多波长炫彩成像(MC)的影像特征,初步评估MC在CME诊断中的应用价值。方法描述性研究。2017年8月至2018年6月在武汉大学人民医院眼科检查确诊的CME患者37例42只眼纳入研究。其中,男性24例,女性13例;平均年龄(48.51±10.29)岁。糖尿病视网膜病变14只眼,视网膜中央静脉阻塞14只眼,视网膜分支静脉阻塞8只眼,葡萄膜炎4只眼,Eales病2只眼。采用德国Zeiss公司Visucam 200免散瞳眼底照相机行眼底彩色照相(CFP)检查。采用德国Heidelberg公司Spectralis HRA2+OCT行MC、频域OCT(SD-OCT)、FFA检查。按MC标准方法,1次扫描同时获得基于488 nm的蓝光反射(BR)、515 nm的绿光反射(GR)、820 nm的红外光反射(IR)成像及标准MC和蓝绿加强(BG)等5个图像。参照SD-OCT图像,对CFP、MC图像进行评分。采用Friedman M检验和Wilcoxon符号秩和检验进行统计学处理。结果标准MC、BG像可见黄斑区片状蓝绿色隆起或花瓣状外观,周围环绕绿色隆起反射,边界清晰。BR像可见水肿区呈弱反射。GR像上可见黄斑区片状或囊样弱反射暗区,周围环绕稍强反射区。IR像可见黄斑区片状或囊样强反射,周围环绕弱反射暗区,边界清晰。CFP、标准MC、GB、IR、GR、BR像评分平均值分别为(1.20±0.94)、(3.05±0.99)、(2.90±1.04)、(2.55±1.27)、(2.00±0.94)、(0.51±0.85)分;不同成像间评分比较,差异有统计学意义(χ^2=151.61,P=0.000)。CFP评分显著低于标准MC(Z=-5.421)、BG(Z=-5.354)、IR(Z=-4.714)、GR(Z=-4.538)成像,高于BR成像(Z=-3.435),差异均有统计学意义(P=0.000、0.000、0.000、0.000、0.001)。结论MC质量明显优于CFP,结合SD-OCT可作为辅助诊断CME的手段。     

B型超声和频域光相干断层扫描在玻璃体后脱离临床诊断中的作用

目的 比较B型超声和频域光相干断层扫描(SD-OCT)检查在玻璃体后脱离(PVD)临床诊断中的作用.方法 前瞻性研究.50岁以上、无明显内眼疾患和手术史、屈光度在±3D以下的患者102例204只眼纳入研究.受检者均行眼科常规检查及B型超声、SD-OCT检查.其中10例患者10只眼接受了玻璃体切割手术治疗.对比观察不同检查方法的PVD检测结果,并将接受玻璃体切割手术患者10例10只眼手术中观察的PVD情况与手术前的B型超声、SD-OCT检查结果进行对比.结果 204只眼中,OCT检查结果显示,不同分期的PVD 56只眼,占27.5％;B型超声检查结果显示,98只眼有PVD,占48.0％;B型超声联合SD-OCT检查发现,145只眼显示不同分期的PVD,占71.1％.接受玻璃体切割手术的患者中,7只眼手术前SD-OCT检查没有显示玻璃体后皮质信息,手术中证实有完全PVD;3只眼手术前SD-OCT检查显示PVD,手术中得到证实.5只眼手术前B型超声检查未发现PVD,4只眼手术中发现有PVD,1只眼手术证实无PVD;5只眼B型超声显示PVD,手术中均得到证实有PVD;其中1只眼手术前B型超声、SD-OCT及手术中结果一致显示PVD存在.结论 B型超声检查对PVD的检出率明显高于SD-OCT检查;SD-OCT检查对早期PVD的显示明显优于B型超声检查.联合B型超声和SD-OCT检查可以显著提高PVD的临床检出率.     

高度近视眼中心凹脱离伴视网膜劈裂的形态学观察

目的观察高度近视眼中心凹脱离伴视网膜劈裂的形态学特征,并探讨高度近视眼玻璃体、黄斑及后巩膜葡萄肿三者间的关系。设计回顾性病例系列。研究对象29例(38眼)高度近视眼中心凹脱离伴视网膜劈裂的患者。方法所有患者均进行裂隙灯前置镜、三面镜、直接或间接检眼镜、B超及相干光断层扫描(OCT)检查,观察黄斑中心凹脱离及视网膜劈裂的形态及其与玻璃体以及后巩膜葡萄肿的关系。其中10眼行玻璃体手术。主要指标形态学特征。结果裂隙灯前置镜、三面镜检查见视网膜成微囊样改变并浅脱离,未见黄斑裂孔。B超显示后极部视网膜水肿或浅脱离0.5~2.0mm。所有38眼的OCT扫描均显示黄斑区神经上皮脱离;未显示黄斑裂孔;神经上皮层劈裂,表现为内层劈裂、外层劈裂和双层劈裂,劈裂的内外层视网膜之间可见桥柱样连接;3眼黄斑区未见劈裂,扫描至后巩膜葡萄肿边缘附近见视网膜劈裂;视网膜前存在低反射细光带(玻璃体后皮质),且与视网膜间存在点、线及片状粘连,相应粘连处视网膜被牵引。10眼玻璃体手术中见玻璃体液化、不完全后脱离,后极部玻璃体后皮质与视网膜粘连紧密,尽量剥除后皮质,术后视网膜均复位。结论OCT可清晰显示高度近视眼中心凹脱离伴视网膜劈裂的形态特征,来自玻璃体皮质的牵引及后巩膜葡萄肿因素是导致视网膜劈裂的主要原因。     

获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎患眼光相干断层扫描图像特征

目的观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒视网膜炎(CMVR)患眼OCT图像特征。方法2015年1月至2017年12月在首都医科大学附属北京地坛医院眼科检查确诊的AIDS合并后极部CMVR患者26例39只眼纳入研究。患者均为男性,平均年龄(33.12±9.87)岁。采用德国Heidelberg公司Spectralis HRA+OCT设备行频域OCT检査。扫描区域包括视盘、黄斑区以及病变区域及邻近视网膜。典型图像存盘分析。结果所有患眼病变中心区视网膜增厚,反射增强;病变累及区域以及病变外周区域椭圆体带(EZ)缺失或结构改变。39只眼中,病变周边视网膜外层点状强反射6只眼(15.38%),视网膜全层点状强反射31只眼(79.49%);病变累及黄斑区25只眼(64.10%);可见玻璃体细胞34只眼(87.17%)。结论AIDS合并CMVR患眼OCT图像特征为病变累及视网膜全层;病变累及区域以及病变外周区域可见EZ缺失或结构改变。     

扫频光学相干断层扫描在眼科的应用进展

精准定性、定量评估眼前节及后节的影像学技术,不仅对多种眼病的准确诊断至关重要,同时也可为治疗方案、手术方式以及随访提供重要参考依据.作为一种分辨率高、非接触无创的成像技术,光学相干断层扫描(optical coherence tomography,OCT)已成为玻璃体视网膜相关疾病必不可少的辅助检查工具.近几年提出的扫频光学相干断层扫描成像(swept-source OCT,SS-OCT)技术,具备扫描速度提高及穿透深度加深的优点,同时运用不同成像系统可获得眼部不同层次结构精准的成像.新型的SS-OCT成像技术可用于评估眼前节结构,如角膜移植术后角膜瓣、前房参数等检查,也加深了对玻璃体视网膜相关疾病如糖尿病性黄斑病变、眼底新生血管的转归和黄斑毛细血管扩张等疾病病理形态改变的认识.同时,运用玻璃体增强成像(enhanced vitreous visualization,EVV)、分层扫描(En face SS-OCT)和SS-OCT血管造影等成像系统,可为眼底相关疾病,如玻璃体后脱离、视网膜前膜、视网膜脱离、糖尿病牵拉性视网膜脱离等手术适应证制定最佳的治疗方案并协助术后随访.此外,该技术还为多种眼部疾病如青光眼、眼肿瘤的病理形态学观察提供精准的微结构成像图.本文主要对SS-OCT的技术原理及临床应用进展等方面进行综述.     

相干光断层成像对病理性近视黄斑区的临床观察

目的探讨相干光断层成像（OCT）在观察高度近视患者黄斑区视网膜各层次结构变化的临床意义。方法对45例（66只眼）诊断为病理性近视的患者进行回顾性研究。全部病例均采用OCT进行扫描,详细分析患者黄斑区的结构变化。结果本组66只眼患者中继发性视网膜劈裂、脉络膜新生血管29只眼,单纯视网膜下出血5只眼,黄斑裂孔6只眼,视网膜前膜6只眼,玻璃体黄斑牵引5只眼,瘢痕16只眼。结论 OCT在观察病理性近视患者黄斑区结构变化中,有着独特的、不可或缺的作用。     

玻璃体视网膜手术治疗糖尿病性黄斑水肿的疗效观察

目的探讨玻璃体视网膜手术治疗糖尿病性黄斑水肿的疗效。方法对连续21例(12只眼)反复光凝无效的糖尿病性黄斑水肿患眼行玻璃体手术,手术前后分别进行光学相关断层成像术(OCT)和多焦视网膜电图(mf-ERG)检查。结果21例(21只眼)手术后最佳矫正视力、黄斑区mf-ERG和中心凹厚度较术前明显改善( P<0.05)。结论玻璃体视网膜手术是治疗难治性糖尿病性黄斑水肿的有效方法,OCT和mf-ERG可以精确的评价术后黄斑区解剖和功能的恢复情况。     

应用SS-OCT观察全身化疗后脉络膜转移癌退行一例

患者女性,53岁。因右眼上方视物遮挡1.5个月,于2019年6月3日就诊于北京同仁医院。2个月前患者诊断肺癌,病理结果示腺癌（非小细胞肺癌）,目前行全身化疗（培美曲塞+卡铂）。眼部检查：最佳矫正视力：右眼：眼前指数,左眼：1.0;眼压：右眼：10 mmHg,左眼：11 mmHg。右眼相对性传入性瞳孔障碍（relative afferent pupillary defect,RAPD）阳性,双眼眼前节未见明显异常。检眼镜下可见右眼中心凹反光消失,黄斑区少量渗出,颞侧赤道后视网膜下不规则的黄白色隆起病灶,周围可见色素沉着,下方周边视网膜脱离（图1A）,左眼未见明显异常。频域相干光断层扫描（SD-OCT）：右眼黄斑区及病灶视网膜外界膜不连续,椭圆体区、嵌合体区消失,外核层下可见大量颗粒状高反射,视网膜神经上皮脱离（图2A）;病灶表面脉络膜呈波浪状隆起,下方遮蔽（图2B、C）。应用扫频源OCT（SS-OCT）扫描病灶,除上述特征外还观察到：脉络膜毛细血管区消失,病变呈中度反射略低于正常脉络膜反射,其间可见类团块状或不规则高反射信号（图1C）。B超可见右眼眼球后壁扁平的实性占位病变,病变最大横径7.1 mm,厚度2.1 mm,内部呈中低回声,未见挖空征及脉络膜凹。荧光素眼底血管造影（FFA）示：病灶早期低荧光,很快出现点状高荧光,荧光渗漏,晚期荧光积存。吲哚菁绿血管造影（ICGA）示：早期病灶呈低背景荧光,可以透见下方脉络膜大血管（图3）,随后出现点片状中等荧光,晚期病灶周围荧光增强,荧光积存。眼眶MRI：右眼眼球后壁可见短T1,短T2信号影,边缘清晰,眼球壁完整,眼眶壁完整,视神经眶内段、管内段及眼内段信号未见明显异常。拟诊右眼脉络膜转移癌,右眼渗出性视网膜脱离。建议患者继续全身化疗,眼部病变观察。1个月后患者门诊复查,诉右眼视力较前好转。查体：右眼最佳矫正视力0.3,检眼镜下可见右眼颞侧病灶扁平,周围色素沉着,视网膜平伏（图1B）。SS-OCT扫描病灶：可见脉络膜隆起高度较前明显减低,病灶内类团块状高反射消失,仅见少量点状高反射（图1D）。SD-OCT示：视网膜下液明显减少,外核层下方粗颗粒样高反射明显减少。未见黄斑区神经上皮脱离（图2D）。B超提示病变厚度1.0 mm,较前减低,病变横径无明显改变。随访至2019年9月2日,患者右眼最佳矫正视力0.4。右眼病灶较前未见明显变化;左眼未见明显异常。OCT扫描黄斑及病灶区视网膜下液完全吸收,余未见明显变化。  讨论 脉络膜转移癌（choroidal metastasis,CM）是成年人眼内最常见的恶性肿瘤。随着癌症患者生存时间延长,CM发病率增加。CM原发肿瘤最常见的是乳腺癌[1-2],其次是肺癌[2-3]。55%~70%患者主诉视物模糊[4],少部分患者诉眼球疼痛[3-4]。该患者右眼RAPD阳性,FFA及MRI均未见视盘及视神经明显异常,不考虑CM侵犯可能,与右眼黄斑区局限性神经上皮脱离及下方周边视网膜脱离导致视网膜感光传入系统异常相关。 CM患者OCT具有典型特征[5-6]：脉络膜及视网膜色素上皮（retinal pigment epithelium, RPE）波浪状隆起,视网膜下液,椭圆体区及嵌合体区不连续甚至消失,外核层下颗粒状高反射。既往因为SD-OCT对脉络膜结构显示欠佳,国内文献仅对CM视网膜OCT特征进行归纳总结,缺乏脉络膜相关描述。SS-OCT较SD-OCT相比,扫描光源波长更长,能够穿过RPE层进行更深层次的扫描,更能清晰地显示脉络膜结构。同时SS-OCT扫描速度快,成像质量高[7]。ICGA早期病灶呈低荧光,既往考虑与肿瘤遮蔽下方脉络膜相关,但是无法解释透见的脉络膜大血管。应用SS-OCT观察到脉络膜毛细血管层消失,能够解释ICGA 早期表现。推测癌细胞可能侵袭并破坏脉络膜毛细血管,使脉络膜萎缩,此猜想能够被组织病理学证实[8]。SS-OCT观察到病灶内部类团块状或不规则高反射,在全身化疗后该结构消失,仅见内部点状高反射。推测病灶内部类团块状高反射是转移癌的腺体结构。有文献表明,不同的肿瘤,病理类型不同,OCT特征不同[9]。但是原发于肺腺癌的脉络膜转移癌SS-OCT特征尚需更多病例来证实。 B超的分辨率约为50~200 000 μm[10],对于监测大肿瘤的厚度及直径变化有重要意义。然而,分辨小肿瘤瘤体与正常脉络膜结构可能具有挑战性,在这种情况下,OCT检查尤其重要,因为OCT分辨率约为5 μm。本例患者脉络膜病灶大小约7.1 mm×2.1 mm,B超能够很好监测病灶变化。但是B超对于病灶内部细节分辨不够。考虑本例患者病灶厚度薄且位置靠近视网膜,更适合用OCT观察病灶内部结构。 经过3个月随访本例患者确诊右眼脉络膜转移癌,通过眼底像、OCT及B超评估病灶变化,尤其是SS-OCT,在分辨脉络膜结构层次具有显著优势。目前,这是国内首例应用SS-OCT观察的脉络膜转移癌,引发笔者对脉络膜转移癌发病机制的思考,但是该猜想及脉络膜转移癌退行后特征仍需更多病例证实     

应用光学相干断层扫描观察玻璃体牵拉视网膜的特征

用光学相干断层扫描 (OCT)描述玻璃体牵拉视网膜不同时期的特征。方法 :对 12 1例 ,14 7眼 ,诊断为视网膜前膜或有玻璃体视网膜牵拉者行OCT检查。每眼均行四个方向放射状线性扫描。结果 :OCT证实 112例 (83 % ) ,13 8眼 (94% )符合玻璃体牵拉视网膜的各种特征。黄斑部视网膜厚度增至 3 44 8± 13 5 1um ,范围为 13 8～ 865um。 49眼有玻璃体后脱离、 5 5眼有部分玻璃体后脱离的高反光带。 5 6眼有程度不同的视网膜囊样水肿 ,OCT表现为视网膜增厚伴有低反射腔隙。 2 4眼为Ⅱ期以上黄斑孔。 2 6例双眼受累。平均视力为 0 45 8± 0 3 2 ,范围为 0 0 1～ 1 2。结论 :OCT可帮助发现玻璃体牵拉视网膜发展至黄斑裂孔的全过程 ,且助于及早采取治疗措施     

Comparison of spectral domain and swept-source optical coherence tomography in pathological myopia

Purpose

To compare optical coherence tomography (OCT) images obtained with swept-source OCT (SS-OCT) and spectral domain OCT (SD-OCT) in pathological myopia.

Methods

This is a comparative observational cases series. Five patients with pathological myopia underwent SD-OCT and SS-OCT imaging. SS-OCT was performed using a prototype system (Topcon Medical Systems). SD-OCT was performed using enhanced depth imaging on the Heidelberg Spectralis OCT. The closest corresponding scans from the central subfield were compared.

Results

Eight eyes of five patients with pathological myopia were included (mean spherical equivalent: −16.00±4.70 D). Overall, SS-OCT better visualized retino-choroidal structures. The choroid, inner segment (IS)/outer segment (OS) line, and external limiting membrane (ELM) were clearly seen in a higher proportion of SS-OCT than SD-OCT scans, (P<0.01 for all) whereas visualization of the sclera and retinal pigment epithelium (RPE) were similar. SS-OCT demonstrated foveoschisis in four eyes, with one of these not visible on SD-OCT. The wider SS-OCT scan revealed additional pathology not visible using SD-OCT along the staphyloma walls in 4/8 images. These included incomplete posterior vitreous detachment in one eye and peripheral retinoschisis in 3/8 eyes. Vitreoschisis was visible in 3/8 SS-OCT images but not in the SD-OCT images.

Conclusion

SS-OCT is useful for imaging the posterior staphyloma of pathological myopia, providing greater detail than SD-OCT.     

Vitreous and macular diseases

We investigated the vitreous in its origin, morphology, metabolism and regeneration, and its role in various vitreomacular diseases. Focal vitreous liquefaction developed anterior to a laser induced chorioretinal scar in rabbit eyes, which suggested that a normal retina is necessary to maintain the integrity of the vitreous. We measured levels of hyaluronic acid and of the precursor of type II collagen in vitreous samples obtained by vitrectomy. Those levels declined with age in women. The precursor of type II collagen was at the same level in the samples from vitrectomy and those obtained by fluid air exchange, which suggested a persistent secretion of type II collagen into the vitreous cavity even after vitrectomy. We found a posterior precortical vitreous pocket in human autopsied eyes whose vitreous was stained with fluorescein. Using the same methods, we confirmed the presence of intravitreal fibrous membranes in the "tractus" in the anterior vitreous. In clinical studies using biomicroscopy, observations during surgery, scanning laser ophthalmoscopy, and optical coherence tomography (OCT), we clarified the role of premacular vitreous cortex which forms the posterior wall of the "pocket" in the premacular membrane and macular hole. The premacular vitreous cortex seems to be the main structure of the premacular membrane and its contraction may cause macular hole. Ring-shaped proliferation tends to develop along the outer margin of the "pocket". OCT demonstrated that some diabetic macular edema is caused by traction of the premacular vitreous cortex. Vitrectomy appear to be effective for diabetic macular edema by eliminating vitreous traction and the accumulated cytokine in the "pocket". The retina appears to have a program for vitreous metabolism throughout life, including the premacular pocket formation.     

Depiction of the vitreous pocket by optical coherence tomography

The reported shape and size of the vitreous pocket vary depending on the method of visualization. We used spectral domain optical coherence tomography (SD-OCT) to clarify the structure of the normal vitreous pocket. The macular retina of 20 consecutive non-highly myopic eyes of 10 healthy young adults (aged 22−27 years) was examined using spectral SD-OCT. The premacular vitreous pocket and the pre-papillary Cloquet’s canal were observed in a scan area 9 mm in transverse diameter and 6 mm in longitudinal diameter. On SD-OCT, the vitreous pocket was observed in all the eyes, anterior to the macula as a flat dish-like structure measuring 7.5 ± 0.6 mm in transverse diameter, 5.2 ± 0.3 mm in longitudinal diameter, and 0.3 ± 0.5 mm in thickness. The boundary of the vitreous pocket was clear, the central portion was thin, and the peripheral portion protruded anteriorly. The posterior wall of the vitreous pocket which can be observed at the macular region was a thin layer of vitreous cortex. Mildly reflective dots were observed inside the vitreous pocket. A thin wall was observed between the vitreous pocket and the pre-papillary Cloquet’s canal. On SD-OCT, the vitreous pocket of healthy young adults was visualized as a liquefied lacuna with a clear boundary measuring approximately 7.5 × 5.2 × 0.3 mm, with the posterior wall composed of a layer of vitreous cortex and separated from the pre-papillary Cloquet’s canal by a thin wall.     

Enhanced vitreous imaging optical coherence tomography in primary macular holes

The aim of the current pilot study is to investigate the efficacy of a novel enhanced vitreous imaging (EVI) in primary macular holes (MHs) using a spectral-domain optical coherence tomography (SD-OCT). Thirty-four eyes of 32 consecutive patients with a MH were examined in one time cross-sectional study. The vitreomacular interface was assessed using SD-OCT with conventional and EVI technique. Twenty-three of the 34 eyes did not show a Weiss ring, and in 22 of those, we observed a MH with an open roof or operculum and a detached posterior vitreous cortex with conventional vitreous imaging. Using EVI-OCT, we visualized the reflection of the posterior vitreous with a vitreopapillary attachment. One of the 23 eyes without a Weiss ring had a central round retinal defect without an operculum, and the conventional SD-OCT showed an empty vitreous, suggesting a complete posterior vitreous detachment. However, the EVI-OCT revealed the reflection of the posterior vitreous, and the cortex appeared to still be completely attached. In all the 23 eyes without a Weiss ring, EVI-OCT detected the reflection of the posterior vitreous and vitreopapillary attachment. In all 11 eyes with a Weiss ring (stage 4 hole), EVI-OCT showed an optically empty space in the posterior vitreous cavity without a vitreopapillary attachment. EVI-OCT may be a new reliable method for preoperative evaluations to determine the presence or absence of a complete posterior vitreous detachment in macular diseases with an indistinct Weiss ring.     

Age-dependent changes in the basal retinovitreous adhesion

PURPOSE: To determine the width of the posterior vitreous base in human eyes of different ages and to clarify the nature of the postoral retinovitreous adhesion that underlies the development of juxtabasal retinal tears and retinal detachment after posterior vitreous detachment (PVD). METHODS: The posterior limit of the vitreous base was delineated with indocyanine green after mechanical peeling of the postbasal vitreous cortex from the retina in 58 pairs of donor eyes. The area of residual retinovitreous adhesion was measured by image analysis. Scanning electron microscopy was performed on the undersurface (or retinal aspect) of the inner limiting lamina (ILL) after trypsin digestion of the peripheral retina. RESULTS: An age-dependent increase in the anteroposterior dimension of the posterior vitreous base was revealed that became progressively wider in eyes of male donors than in those of female donors and in the nasal half compared with the temporal half of the globe. Ultrastructural studies showed progressive invasion of the innermost peripheral retina by bundles of collagen fibrils, initially in the form of characteristic braids splaying out beneath the ILL and eventually as a dense sublaminar mat in the elderly. The collagen fibrils penetrated the ILL through localized defects and intertwined with those in the basal gel. CONCLUSIONS: With aging, the posterior border of the vitreous base migrates posteriorly so that an annular band of firm adhesion eventually straddles the ora serrata eccentrically. Intraretinal synthesis of collagen fibrils, their penetration of the ILL, and their splicing with cortical vitreous fibrils, underlie the slowly evolving retinovitreous adhesion.     

Anatomical findings of vitreoretinal interface in eyes with asteroid hyalosis

Purpose  To investigate the anatomical features of vitreoretinal interface in eyes with asteroid hyalosis (AH) with optical coherence tomography (OCT) and intravitreal triamcinolone acetonide (TA) during vitreous surgery. Methods  This study was an interventional clinical case series. Records relating to ten eyes from ten patients who underwent a TA-assisted vitrectomy for the treatment of diverse vitreoretinal diseases complicated with AH. The posterior vitreoretinal interface was examined by preoperative OCT and by intraoperative visualization of posterior vitreous cortex utilizing TA. Results  In eight of ten AH eyes, preoperative OCT revealed abnormal vitreoretinal adhesions. In four of these eight eyes, posterior vitreoschisis could be seen on OCT. In the other four of these eight eyes, a clear no posterior vitreous detachment (PVD) pattern could be seen on OCT. Although posterior vitreous cortex could not be clearly identified with preoperative OCT in two of ten AH eyes, a complete PVD was refuted by intraoperative visualization of the posterior vitreous cortex with TA identical to the other eight eyes. Conclusion  These results indicate that complete PVD appears to be unlikely to occur in eyes with AH. In addition, spontaneous PVD in eyes with AH might lead to vitreoschisis or residual whole layer or posterior vitreous cortex, possibly due to anomalous vitreoretinal adhesion.     

Dome-shaped detachment of premacular vitreous cortex in macular hole development

PURPOSE: To clarify the role of the posterior vitreous cortex in macular hole development, we evaluated the follow-up findings of clinical observations and optical coherence tomography (OCT) images of macular holes in early stage. METHODS: The vitreoretinal tomography was examined and followed in eyes with stage 1 and 2 macular holes with OCT. RESULTS: The posterior cortical vitreous was identified in 12 of 17 eyes with early-stage macular holes by OCT (71%). In these eyes, the detached posterior vitreous appeared to be merged to the fovea and the disc. The vitreoretinal separations showed typically dome-shaped. A long scan along the papillomacular axis also delineated the posterior vitreous face as dome-shaped perifoveal vitreous detachment with adhesion to the fovea and disc. Repetitive OCT examinations clearly demonstrated the course of development of the macular hole. CONCLUSIONS: The dome-shaped vitreoretinal separation seen with OCT gives rise to an idea that the posterior vitreous cortex may not be taut but slack, and would not cause a continuous tractional force even in early-stage macular holes. This finding brings us an idea that the tangential traction at the fovea may be generated by fluid movements, rather than by contraction of the cortical vitreous.     

Evaluation of congenital excavated optic disc anomalies with spectral-domain and swept-source optical coherence tomography

Purpose

To investigate the anatomic characteristics of congenital excavated optic disc anomalies by using fundus photography, spectral-domain optical coherence tomography (SD-OCT), and swept-source optical coherence tomography (SS-OCT).

Methods

Fourteen eyes from 13 patients with congenital excavated optic disc anomalies underwent a complete ophthalmologic examination that included best-corrected visual acuity evaluation, fundus photography, and SD-OCT. SS-OCT was performed in cases of peripapillary staphyloma cases in which the excavation depth could not be detected with SD-OCT. On the basis of the funduscopic and OCT findings, patients were classified as morning glory syndrome, optic disc coloboma, or peripapillary staphyloma.

Results

Seven eyes with morning glory syndrome were characterized by the presence of the preretinal tractional membrane in front of the excavated optic disc and could be divided into two groups: three eyes without retinal excavation, and four eyes with retinal excavation. Four eyes with optic disc coloboma showed inferiorly decentered scleral excavations with shallow optic disc excavation detectable by SD-OCT. Three eyes with peripapillary staphyloma showed deep excavation, the depth of which could not be detected by SD-OCT. SS-OCT and enhanced depth imaging SD-OCT images focused on the bottom revealed membranous structure at the bottom of the excavation in two cases with peripapillary staphyloma.

Conclusions

SD-OCT and SS-OCT are helpful for differential diagnosis of excavated optic disc anomalies. Morning glory syndrome, optic disc coloboma, and peripapillary staphyloma were respectively characterized by the presence of a preretinal tractional membrane, inferiorly decentered excavation, and an excavation deeper than that observed in morning glory syndrome and optic disc coloboma.     

Measurement of the posterior precortical vitreous pocket in fellow eyes with posterior vitreous detachment and macular holes

PURPOSE: To evaluate the premacular vitreous zone of liquefaction (the posterior precortical vitreous pocket [PPVP]) using contact B-scan ultrasonography and to compare the size of the observed PPVP in fellow eyes with posterior vitreous detachment (PVD) as compared with fellow eyes with macular holes. METHODS: Patients with a fellow eye having a PVD or macular hole but not having a PVD in the examined eye were evaluated with contact B-scan ultrasonography to measure the PPVP. RESULTS: The mean age +/- SD of the 19 patients was 63.9 +/- 7.8 years. There were 13 patients in the PVD group and 6 in the macular hole group. All patients in the macular hole group had a vitreous detachment in the macular region of the eye with the macular hole. There was no difference in the mean age (P = 0.44, independent samples t test) or mean refractive error (P = 0.56) of the two groups. The PPVP was seen to be round to ovoid in shape with a mean anteroposterior dimension of 8.4 mm and a mean horizontal dimension of 9.2 mm for all patients. The mean anteroposterior measurement was 7.6 mm in the PVD group versus 10.3 mm in the macular hole group, a difference that was significant (P = 0.004, independent samples t test). In a similar manner, the mean horizontal dimension was 8.2 mm in the PVD group and 11.1 mm in the macular hole group, a difference that was significant (P = 0.031). CONCLUSIONS: The PPVP was larger in fellow eyes in the macular hole group. The larger PPVP would be expected to cause a greater degree of force concentration and a more pronounced shifting of the direction of the force vector for anteroposterior tensile stress to one being more tangential to the surface of the retina in these patients.