Choroidal Thickness in Patients Diagnosed with Human Immunodeficiency Virus Infection: Results from Two Populations of Different Ethnicities

Purpose: To measure the choroidal thickness among subjects with human immunodeficiency virus (HIV) infection from two diverse ethnic populations and to compare it with healthy controls.

Methods: Subjects with HIV infection and healthy controls were enrolled in two referring centers in Italy and India. Clinical data were collected. All subjects underwent enhanced-depth imaging optical coherence tomography and measurement of choroidal thickness.

Results: A total of 68 eyes from 68 patients with HIV (44 Caucasian, 24 Indians) and 60 eyes from 60 healthy volunteers (36 Caucasian, 24 Indians) were included. Mean choroidal thickness was significantly higher in HIV patients compared to controls (312.91 ± 65 µm vs. 266.57 ± 47 µm; p < 0.001). Choroidal thickness was higher among subjects with HIV-related retinopathy compared to HIV without retinopathy (285 ± 30 µm vs. 352 ± 17 µm; p < 0.01).

Conclusions: Patients with HIV infection, especially with HIV microangiopathy, have thicker choroid compared to age- and gender-matched healthy control subjects. These changes may be related to HIV-associated choroidal vascular dysfunction.     

基于OCTA的中心性浆液性脉络膜视网膜病变患者脉络膜新生血管检测

目的观察光学相干断层扫描血管成像(OCTA)在中心性浆液性脉络膜视网膜病变(CSC)患者脉络膜新生血管(CNV)检测中的应用价值。方法回顾性病例观察研究。选取2018年3月至2019年3月在云南省第二人民医院诊断为慢性中心性浆液性脉络膜视网膜病变伴脉络膜新生血管患者30例(34眼)纳入研究,总结分析其OCTA与眼底彩色照相、眼底自发荧光、荧光素眼底血管造影(FFA)和OCT等传统影像学对比运用的临床体会。结果12眼FFA存在荧光素渗漏,但形态模糊,不能确定是否伴有CNV,行OCTA则可以清晰显示新生血管影像。8眼FFA未检出CNV,但OCTA清晰显示出新生血管形态。3眼眼底彩色照相及OCT检查高度怀疑CNV的存在,但因荧光素钠皮试阳性,均无法实施FFA,而OCTA则显示出病变区域血流信号,明确了CNV的存在。6眼FFA无明显荧光素渗漏,OCT示无神经上皮层脱离、无色素上皮层脱离,但OCTA提示CNV的存在。5眼通过随访过程中的病情跟踪观察,发现给予患者单一抗VEGF或PDT治疗之后视网膜下积液无明显吸收,而联合治疗后积液明显吸收。结论OCTA在CNV的检查敏感性方面优于传统的检测手段。OCTA可以作为一项安全有效的眼底影像学检查手段对慢性CSC患者的CNV进行观察,从而指导该类患者的诊断、治疗及预后分析。     

miRNA表达在肾脏病中应用的研究进展

miRNAs是一组短小非编码RNA,在转录后调节基因表达水平从而影响机体重要的生理和病理生理过程。许多miRNA具有组织或器官特异性,可能成为潜在的生物标志物。同样,miRNAs在肾脏的生理功能和肾脏疾病方面发挥重要作用。文章综述miRNA对肾脏疾病影响的最新进展,为今后肾脏病的诊断和治疗提供参考。     

康柏西普玻璃体内重复注射治疗息肉状脉络膜血管病变疗效及相关因素分析

目的　观察康柏西普玻璃体内重复注射治疗息肉状脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）随访24个月的疗效及第13~24个月需要进行重复注射的相关因素。方法　回顾性研究。将临床确诊为PCV的35例35眼患者纳入研究，所有患者均行最佳矫正视力（best corrected visual acuity，BCVA）、眼底彩色照相、荧光素眼底血管造影、吲哚菁绿血管造影和光学相干断层扫描（optical coherence tomography，OCT）检查。所有患眼均采用每月注射1次、连续注射3个月后按需治疗的方案行康柏西普玻璃体内注射治疗。随访时间均在24个月以上。治疗后 1个月、2个月、3个月、6个月、9个月、12个月、24个月重复行BCVA及OCT检查；治疗后 3个月、6个月、9个月、12个月、24个月重复行荧光素眼底血管造影及吲哚菁绿血管造影检查。对比治疗前后BCVA、黄斑中心凹视网膜厚度及浆液性视网膜脱离（serous retinal detachment，SRD）、息肉消退的变化，并分析随访第13～24个月需要进行重复注射的相关因素。结果　治疗后 1个月、2个月、3个月、6个月、9个月、12个月、24个月患眼BCVA均较治疗前有不同程度提高，差异均有统计学意义（均为P<0.05）；黄斑中心凹视网膜厚度较治疗前有不同程度下降，差异均有统计学意义（均为P＜0.001）。Logistic回归分析显示，基线视网膜色素上皮脱离是第13～24个月需要进行重复注射的独立相关因素（P=0.042）,治疗后6个月、9个月、12个月 SRD与第13～24个月需要重复注射相关（P=0.043、0.023、0.012）。结论　康柏西普玻璃体内重复注射治疗PCV随访24个月能稳定或提高视力，基线视网膜色素上皮脱离和治疗后6个月、9个月、12个月SRD是第13～24个月需要进行重复注射的相关因素。     

PDT联合雷珠单抗对PCV合并玻璃体积血患者视力和术后并发症的影响

目的：研究光动力疗法(photodynamic therapy，PDT)联合玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab，IVR)对息肉状脉络膜血管病变(polypoidal choroidal vasculopath，PCV)合并玻璃体积血(vitreous hemorrhage，VH)患者视力、黄斑中心凹厚度(central macular thickness，CMT)和术后并发症的影响。

方法：将71例71眼PCV合并VH患者根据治疗方式不同分为两组，其中观察组(n=43)在玻璃体切割术后采用PDT联合IVR进行治疗，对照组(n=28)则仅用IVR辅助治疗。随访两组患者治疗后第1、3、6mo时最佳矫正视力(best corrected visual acuity，BCVA)、CMT变化和并发症发生情况。

结果：治疗后两组患者BCVA随时间逐渐改善、CMT随时间逐渐降低，组内不同时间差异有统计学意义(P<0.05)，两组患者治疗后同一时间BCVA、CMT差异有统计学意义(P<0.05)； 治疗后观察组CNV病灶闭合情况明显优于对照组，差异有统计学意义(P<0.05)，完全闭合率高于对照组，差异有统计意义(χ²=4.508，P<0.05)； 治疗后观察组出现相关并发症6眼(14%)，对照组5眼(18%)，两组比较差异无统计学意义(P>0.05)。

结论：PDT联合IVR用于PCV合并VH患者玻璃体切除术后治疗有利于促进血管渗出物质吸收和息肉样病灶消退，从而减轻黄斑水肿，改善患者视力并减少术后并发症发生，临床疗效和安全性均值得肯定。     

Changes in Choroidal Thickness after Cataract Surgery

Objective: The aim of this study is to compare subfoveal choroidal thickness (SFCT) before and after uneventful phacoemulsification using enhanced depth imaging optical coherence tomography (EDI-OCT).Background: Cataract is a major cause of visual impairment in the elderly. Cataract surgery is the most common ophthalmic surgery and is performed simultaneously with glaucoma or vitreous surgery in many cases. However, according to the results in epidemiology studies, cataract surgery is associated with the onset of age-related macular degeneration (AMD) and cataract surgery increases visual acuity in these patients without an increased risk of progression to exudative AMD. Methods: A prospective study was conducted on 53 eyes of 53 patients who had phacoemulsification. Measurements of SFCT were performed preoperatively, 7 days (D7), 1 month (M1), and 3 months (M3) postoperative using the EDI-OCT technique. Central retinal thickness was also measured at the same time. Results: Twenty-seven male (50.9%) and 26 female (49.1%) with a mean age of 56.43 years ± 10.34 (SD) were analyzed. The mean choroidal thickness was 199.9 ± 60.74 µm. It significantly increased to 228.42 ± 59.77 µm at D7, then decreased to 210.78 ± 59.59 µm at M1, and then decreased to 200.63 ± 61 µm at M3. The mean retinal thickness was 260.79 ± 6.12 µm. It significantly increased to 294.09 ± 7.20 µm at D7 and then decreased to 274.70 ± 6.00 µm at M1 and 258.92 ± 5.89 µm at M3. Conclusion: Mean SFCT increased after cataract surgery. The changes in SFCT return to near the baseline after 3 months.     

Prevalence and Risk Factors for Polypoidal Choroidal Vasculopathy in a General Japanese Population: The Hisayama Study

Purpose: To estimate the prevalence and risk factors for polypoidal choroidal vasculopathy (PCV) in a general Japanese population. Methods: This population-based, cross-sectional study was conducted in 2007 with subjects from the Hisayama Study. Of the 3,648 residents in Hisayama, Japan, 2,663 who were ≥ 50 years old were enrolled in this study. The characteristics of PCV were determined by fundus examination or based on indocyanine green and fluorescein angiographic findings. We evaluated the contributions of the risk factors for PCV. Results: Among the 207 participants with age-related macular degeneration (AMD), 174 (6.5%) had early AMD, and 33 (1.2%) had late AMD, including 10 participants with PCV (0.4%). Male and smoking habit were significant risk factors for the development of PCV. Conclusions: The prevalence of PCV is higher among Japanese subjects than Caucasians in Western countries. Male gender and smoking habit were significant risk factors for PCV in a general Japanese population.     

Foveoschisis with focal choroidal excavation

We report a rare case with a focal choroidal excavation (FCE) associated with foveoschisis. We describe the patient's medical records and review the pertinent literature. A 51-year-old man had an FCE, which was considered to be associated with foveoschisis. Although the patient was treated with repeated intravitreal injection of perfluoropropane, foveoschisis persisted. FCE-linked foveoschisis may be noted in a low myopic patient. Gas tamponade failed to induce retinal reattachment, and aggressive surgical therapy may be needed in this condition.