Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography

AIM: To evaluate optic nerve head (ONH) vessel density (VD) changes after cataract surgery using optical coherence tomography angiography (OCTA). METHODS: This was a prospective observational study. Thirty-four eyes with mild/moderate cataracts were included. ONH scans were obtained before and 3mo after cataract surgery using OCTA. Radial peripapillary capillary (RPC) density, all VD, large VD and retinal nerve fiber layer thickness (RNFLT) in total disc, inside disc, and different peripapillary sectors were assessed and analyzed. Image quality score (QS), fundus photography grading and best-corrected visual acuity (BCVA) were also collected, and correlation analyses were performed between VD change and these parameters. RESULTS: Compared with baseline, both RPC and all VD increased in inside disc area 3mo postoperatively (from 47.5%±5.3% to 50.2%±3.7%, and from 57.87%±4.30% to 60.47%±3.10%, all P<0.001), but no differences were observed in peripapillary area. However, large VD increased from 5.63%±0.77% to 6.47%±0.72% in peripapillary ONH region (P<0.001). RPC decreased in inferior and superior peripapillary ONH parts (P=0.019, <0.001 respectively). There were obvious negative correlations between RPC change and large VD change in inside disc, superior-hemi, and inferior-hemi (r=-0.419, -0.370, and -0.439, P=0.017, 0.044, and 0.015, respectively). No correlations were found between VD change and other parameters including QS change, fundus photography grading, postoperative BCVA, and postoperative peripapillary RNFLT. CONCLUSION: RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract. No obvious VD changes are found in peripapillary area postoperatively.     

Application of optical coherence tomography angiography in assessment of posterior scleral reinforcement for pathologic myopia

AIM: To investigate the effect of posterior scleral reinforcement (PSR) on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography (OCTA). METHODS: The study included 30 pathologic myopia eyes with posterior staphyloma which underwent PSR (PSR group) for 6 to 18mo ago, and 30 age and myopia matched eyes without PSR surgery as control group. Macular, choriocapillaris and radial peripapillary capillary (RPC) flow density were measured by OCTA, and the measurements were compared between groups. RESULTS: OCTA found no significant differences in macular flow density between PSR and control groups. For the superficial flow, whole enface flow density (WED), fovea density (FD), and parafoveal density (PD) were 46.55%±5.19% vs 47.29%±4.12% (P=0.542), 31.45%±6.35% vs 31.17%±4.48% (P=0.841), and 48.82%±5.66% vs 49.21%±4.15% (P=0.756) in PSR and control groups, respectively. For the deep flow, WED, FD, and PD were 52.07%±5.78% vs 53.95%±4.62% (P=0.168), 29.62%±6.55% vs 29.50%±6.38% (P=0.940), and 56.93%±6.17% vs 58.15%±5.13% (P=0.407) in PSR and control groups, respectively. The choriocapillary flow density was 61.18±3.25% in PSR group vs 60.88%±2.56% in control group (P=0.692). Also, OCTA found no significant differences in RPCs flow density between PSR and control groups. The optic disc WED, inside disc flow density and peripapillary flow density were 48.47%±4.77% vs 48.11%±4.57% (P=0.813), 45.47%±11.44% vs 46.68%±9.02% (P=0.709), 54.32%±5.29% vs 52.47%±6.62% (P=0.349) in PSR and control groups, respectively. CONCLUSION: OCTA provides a non-invasive and quantitative approach for monitoring macular and papillary blood flow in pathologic myopia. PSR can not improve but may maintain the circulation of pathologic myopia eyes with posterior staphyloma.     

Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes

AIM: To introduce a modified technique of internal limiting membrane (ILM) centripetal dragging and peeling to treat idiopathic macular hole (IMH) and to observe the ILM-retina adhesive forces. METHODS: Twenty-six consecutive patients with stage 3 to 4 IMH and followed up at least six months were enrolled. All patients underwent complete par plana vitrectomy, ILM dragging and peeling, fluid and gas exchange, 15% C3F8 tamponade and 2-week prone position. The best corrected visual acuity, macular hole evaluation by optical coherence tomography, and complications were evaluated. RESULTS: The mean diameter of IMH was 524.2±147.9 μm (range: 201-683 μm), with 21 cases (80.7%) greater than 400 μm. ILM dragging and peeling were successfully performed in all cases. Most of the ILM-retina adhesive forces are severe (43.3%, 11/26), followed by mild (38.46%, 10/26), and moderate (19.23%, 5/26). The mean follow-up duration was 21.2±6.1mo. The IMH was closed in 25 (96.2%) eyes. Visual acuity (logMAR) improved significantly from 1.2±0.6 preoperatively to 0.7±0.5 postoperatively (P<0.001). CONCLUSION: Preexisting ILM-retina adhesive force is found in IMH patients. With assistance of this force, this modified technique may help to release the IMH edges and improve the closure rate of large IMH.     

Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography

AIM: To evaluate the predictive value of superficial retinal capillary plexus (SRCP) and radial peripapillary capillary (RPC) for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer (pRNFL) and ganglion cell complex (GCC). METHODS: This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery. Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness pre- and post-operatively and with healthy controls. Logistic regression models were used to assess the relationship between preoperative GCC, pRNFL, SRCP, and RPC parameters and visual field recovery after surgery. RESULTS: The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls. Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values. The best predictive GCC and pRNFL models were based on the superior GCC [area under the curve (AUC)=0.866] and the tempo-inferior pRNFL (AUC=0.824), and the best predictive SRCP and RPC models were based on the nasal SRCP (AUC=0.718) and tempo-inferior RPC (AUC=0.825). There was no statistical difference in the predictive value of the superior GCC, tempo-inferior pRNFL, and tempo-inferior RPC (all P>0.05). CONCLUSION: Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion. This reduction persists despite the recovery of the visual field after decompression surgery. GCC, pRNFL, and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.     

Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy: a systematic review

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing’s syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.     

[In Press] Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes.. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (p < 0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t = 3.65, p < 0.01, R2 = 0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t = 4.32, p < 0.01, R2 = 0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (P<0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t=3.65, P<0.01, R2=0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t=4.32, P<0.01, R2=0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

Optic disc progression and rates of visual field change in treated glaucoma

Purpose: To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. Methods: Glaucoma patients with repeatable VF loss, ≥8 SITA‐Standard 24‐2 VF tests and good quality optic disc stereophotographs evaluated over a 10‐year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta‐zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. Results: Three‐hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, ?7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty‐two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (?0.66 ± 0.7 versus ?0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). Conclusions: Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.     

非动脉炎性前部缺血性视神经病变患眼视盘周围及黄斑区视网膜血流参数变化特征

目的：观察非动脉炎性前部缺血性视神经病变（NAION）患眼视盘周围及黄斑区视网膜血流相关参数的变化特征。方法：回顾性病例对照研究。选择2017年10月至2018年6月在南京医科大学附属无锡第二医院确诊的萎缩型NAION患者（发病时间>3个月）18例（18眼）。另选取眼部检查正常的门诊健康体检者20例（20眼）作为正常对照组。使用AngioVue OCT血管成像系统对所有受检者进行视盘及其血流成像、黄斑区血流成像及黄斑视神经节细胞复合体（GCC）扫描,测量视盘周围神经纤维（pRNFL）厚度、GCC厚度和整个平面视网膜血流密度（wiVD）,包括视盘周围放射状毛细血管（RPC）、视乳头旁的RPC血流密度（ppVD）、浅层毛细血管丛（SCP）、深层毛细血管丛（DCP）及黄斑中心凹旁血流密度（pfVD）。组间数据比较采用卡方检验及独立样本t检验,Logistic回归及线性回归分析各血流参数对NAION发病、GCC等的影响,Pearson相关分析上下部分ppVD与pRNFL的相关性。结果：与正常对照组比较,NAION组pRNFL厚度、RPC wiVD、ppVD明显较低（t=-6.567、-6.958、-6.668,P<0.001）,SCP wiVD、DCP wiVD及GCC厚度亦明显较低（t=-6.226、-2.760、-6.340,P<0.001）。Logistic回归分析显示NAION发病与ppVD相关（b=0.502,OR=1.653,P=0.045）。线性回归分析显示NAION患者的LogMAR BCVA与SCP wiVD相关（b=-0.726,P=0.003）,pRNFL厚度与ppVD相关（b=0.883,P=0.001）。上半部分的pRNFL厚度与上半部分ppVD呈正相关（r=0.946,P<0.001）,下半部分的pRNFL厚度与下半部分ppVD呈正相关（r=0.680,P=0.031）。结论：病程>3个月的NAION患眼视盘周围及黄斑区大血管附近血流显著减少。NAION患眼ppVD越稀疏,NAION发病可能性越大,pRNFL相对越薄;SCP wiVD越稀疏,NAION患眼的视力相对越差。     

Analysis of retinal vasculature changes in indirect traumatic optic neuropathy using optic coherence tomography angiography

AIM: To assess the retinal vasculature alterations in indirect traumatic optic neuropathy (ITON) patients following craniofacial trauma by optic coherence tomography angiography (OCTA). METHODS: Patients diagnosed of monocular ITON were recruited from August 2016 to May 2020. OCTA was performed using the AngioVue OCT-A system for two cube scans centered at the optic nerve head and fovea. OCTA data included thicknesses of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), as well as proportion of capillary perfusion and data were analyzed for correlation with post-injury timepoints: within 7, 8-30, 31-90, and 91-365d. RESULTS: A total of 73 ITON patients were studied. Significant thinning of RNFL and GCC layers and attenuation of microvascular perfusion were observed in ITON eyes as compared to contralateral unaffected eyes (for most of the analyzed sectors and quadrants, P<0.05). Without respect to surgical intervention and vision recovery, the decrease in retinal layer thicknesses and microvascular perfusion was time-dependent, and most significant within three months (P<0.001). CONCLUSION: ITON presents with time-dependent thinning of retinal layers and attenuation of microvasculature, indicating possible degeneration of retinal ganglion cells due to reduced retinal blood supply.     

非动脉炎性前部缺血性视神经病变患者OCTA视盘量化参数及其与病程、视力预后的关系

目的 应用相干光断层扫描血管成像（OCTA）研究不同病程的非动脉炎性前部缺血性视神经病（NA-AION）的影像特征及视盘量化参数,并探讨其与病程、视力预后之间的关系。设计 回顾性病例系列。研究对象 2019年1-6月就诊于南京医科大学附属眼科医院的NA-AION患者24例（24眼）。方法 回顾分析临床确诊为NA-AION患者（24例24眼）的临床资料。所有患者均进行最佳矫正视力（BCVA）（LogMAR）、OCTA检查并于1、3个月时复诊。比较不同病程患眼BCVA（LogMAR）、平均视盘视网膜神经纤维层（RNFL）厚度、放射状视盘周围毛细血管（RPC）血流密度的变化,并将OCTA量化参数与BCVA（LogMAR）、病程进行相关因素分析。主要指标 BCVA（LogMAR）、RNFL厚度、RPC血流密度。结果 首诊时患眼RNFL厚度（315.76±21.45 μm）较对照组（108.67±3.02 μm）显著增厚,RPC血流密度（45.49%±1.60%）较对照组（50.64%±0.74%）显著降低（P均<0.05）。与病程≤7天的患眼比较,＞7天的患眼缺血区与非缺血区间的RPC血流密度差异更为显著（P<0.05）。1个月及3个月时BCVA均较基线时提高（P<0.05）,1个月与3个月的BCVA无显著差异（P=0.329）。与基线值相比,1个月及3个月的RNFL厚度、RPC血流密度逐渐递减,差异具有统计学意义（P<0.05）。BCVA与RNFL厚度、RPC血流密度呈显著正相关关系（r=0.527,0.550;P＜0.05）。结论 OCTA可以观察NA-AION视盘RNFL厚度及RPC血流密度变化,视力预后与视盘RNFL及血流密度显著相关。（眼科,2021, 30： 425-429）     

OCTA在DR患者黄斑血流密度观察中的应用

目的:应用光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)观察糖尿病视网膜病变(diabetic retinopathy,DR)患者黄斑血流密度的改变和临床意义.方法:收集28例47眼DR患者纳入研究组(DR组),依据DR国际临床分期标准将DR患眼分为两组,其中非增殖组(NPDR组)19例30眼和增殖组(PDR组)11例17眼.取年龄相匹配的27例46眼健康眼作为对照组.所有入选受试者均应用OCTA对黄斑区视网膜行3mm×3mm范围模式扫描,获得4个层面黄斑血流密度图,同时测量3个层面黄斑血流密度,包括表层视网膜层、深层视网膜层和脉络膜毛细血管层.结果:DR组表层视网膜、深层视网膜及脉络膜层毛细血管层黄斑血流密度分别为0.4963±0.0840、0.4798±0.0801、0.5290±0.0528;其中NPDR组分别为0.5064±0.0843、0.4983±0.0766、0.5345±0.0529,而PDR组分别为0.4786±0.0830、0.4473±0.0778、0.5192±0.0526;正常对照组分别为0.5919±0.0704、0.6301±0.0527、0.5691±0.0169.对照组分别和NPDR组、PDR组、DR组表层视网膜、深层视网膜、脉络膜毛细血管层的黄斑血流密度比较,差异有显著统计学差异(P<0.001).NPDR组和PDR组之间黄斑血流密度在深层视网膜比较,差异有统计学意义(P=0.029),但在表层视网膜、脉络膜毛细血管层比较,差异无统计学意义(P=0.236、0.268).结论:DR患者黄斑血流密度在表层视网膜、深层视网膜和脉络膜毛细血管层均较正常对照组下降,提示黄斑区视网膜及脉络膜均存在缺血现象.OCTA可以量化黄斑血流变化的情况,为早期监测糖尿病的进展、发现DR提供有效手段.     

视野半侧缺损的原发性开角型青光眼视网膜微循环改变的研究

目的研究视野半侧缺损的原发性开角型青光眼(POAG)视盘旁和黄斑区血管密度的改变及其与视网膜神经纤维层(RNFL)厚度及视野指标的关系。方法横断面研究。收集2015年10月至2018年10月于复旦大学附属眼耳鼻喉科医院眼科应用Humphery视野计30-2程序检测为视野半侧缺损的POAG患者(POAG组)28例(28只眼),同期纳入性别、年龄匹配的健康志愿者(健康对照组)31名(31只眼)。所有受试者均接受了全面的眼科检查,包括RNFL、视网膜神经节细胞复合体(GCC)厚度及视野检查等,并收集了一般信息。采用相干光层析血管成像术检测视盘旁放射状盘周毛细血管(RPC)和黄斑区视网膜浅层毛细血管丛(SCP)的血管密度。健康对照组与POAG组、健康对照组与POAG组视野正常半侧检测结果比较采用独立样本秩和检验,POAG组内视野缺损半侧与视野正常半侧检测结果比较采用配对秩和检验。结果POAG组男性16例,女性12例,年龄(47±12)岁;POAG组与健康对照组性别分布、年龄、眼压、中央角膜厚度、眼轴长度和眼内灌注压差异均无统计学意义(均P>0.05)。POAG组上、下半侧视野缺损者分别有19、9例。POAG组视盘旁RPC和黄斑区SCP血管密度分别为45.86%(34.92%~52.78%)、39.31%(32.55%~46.79%),均低于健康对照组[56.90%(51.69%~60.84%)、47.48%(37.95%~52.25%)],差异均有统计学意义(Z=-6.56,-5.86;均P<0.01)。POAG组RNFL和GCC厚度分别为84.4(62.1~97.1)、76.4(60.3~92.5)μm,均小于健康对照组[110.6(95.7~131.6)、98.1(84.0~109.2)μm;Z=-6.57,-6.36;均P<0.01]。POAG组中视野缺损半侧对应的视盘旁RPC和黄斑区SCP血管密度分别为44.12%(34.73%~53.20%)和36.81%(29.73%~47.82%),明显低于视野正常半侧对应的血管密度[51.85%(38.64%~61.02%)、41.78%(33.93%~49.22%);Z=-4.62,-4.12;均P<0.01]。POAG组视野正常半侧对应的视盘旁RPC和黄斑区SCP血管密度均低于健康对照组(Z=-5.08,-4.95;均P<0.01);视野正常半侧对应的RNFL和GCC厚度分别为93.0(61.9~116.5)μm和86.3(67.2~98.2)μm,均小于健康对照组(Z=-5.15,-5.35;均P<0.01);但二者间视野指标差异无统计学意义(均P>0.05)。结论视野半侧缺损的POAG患者视盘旁RPC及黄斑区SCP血管密度降低并伴有RNFL及GCC变薄,其中视野正常半侧对应区域的视盘旁RPC及黄斑区SCP血管密度也降低并伴有RNFL及GCC变薄,提示POAG视网膜血管和结构的改变发生在视功能改变前。(中华眼科杂志,2021,57:201-206)     

Automated evaluation of parapapillary choroidal microvasculature in crowded optic discs: a controlled, optical coherence tomography angiography study

AIM: To compare superficial and deep vascular properties of optic discs between crowded discs and controls using optical coherence tomography angiography (OCT-A). METHODS: Thirty patients with crowded discs, and 47 control subjects were enrolled in the study. One eye of each individual was included and OCT-A scans of optic discs were obtained in a 4.5×4.5 mm2 rectangular area. Radial peripapillary capillary (RPC) density, peripapillary retinal nerve fiber layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical c/d ratio were obtained automatically using device software. Automated parapapillary choroidal microvasculature (PPCMv) density was calculated using MATLAB software. When the vertical c/d ratio of the optic disc was absent or small cup, it was considered as a crowded disc. RESULTS: The mean signal strength index of OCT-A images was similar between the crowded discs and control eyes (P=0.740). There was no difference in pRNFL between the two groups (P=0.102). There were no differences in RPC density in whole image (P=0.826) and peripapillary region (P=0.923), but inside disc RPC density was higher in crowded optic discs (P=0.003). The PPCMv density in the inner-hemisuperior region was also lower in crowded discs (P=0.026). The pRNFL thickness was positively correlated with peripapillary RPC density (r=0.498, P<0.001). The inside disc RPC density was negatively correlated with c/d area ratio (r=-0.341, P=0.002). CONCLUSION: The higher inside disc RPC density and lower inner-hemisuperior PPCMv density are found in eyes with crowded optic discs.     

眼轴对原发性开角型青光眼视盘和黄斑血管密度的影响

目的：运用光学相干断层扫描血管成像（OCTA）进行视网膜视盘区和黄斑区血管成像,探讨眼轴对 原发性开角型青光眼（POAG）视盘和黄斑血管密度的影响。方法：病例对照研究。连续收集2019年 6 ─11 月于中山眼科中心确诊的POAG病例,依据眼轴长度分为中等眼轴青光眼组（眼轴范围为 22.51～25.50 mm）和长眼轴青光眼组（眼轴>25.50 mm）,并匹配年龄和病情严重程度,所有患者单 眼入组。最后共42例纳入中等眼轴青光眼组,37例纳入长眼轴青光眼组。所有受检者完成视野、光 学相干断层扫描成像（OCT）、OCTA检查。通过OCTA测量视盘周围放射状毛细血管密度（RPC VD） 和黄斑浅层血管密度。采用独立样本t检验、Pearson相关等分析数据。结果：长眼轴青光眼组神 经节细胞复合体（GCC）厚度小于中等眼轴青光眼组[（74.5±9.6）μm vs. （80.5±13.6）μm;t=2.244, P=0.028],但2组视网膜神经纤维层（RNFL）厚度差异无统计学意义。长眼轴青光眼组黄斑全图、 黄斑旁区、黄斑周围区血管密度均小于中等眼轴青光眼组,但仅黄斑周围区颞侧血管密度的差 异有统计学意义（t=2.235,P=0.028）。2组的平均和各象限RPC VD差异均无统计学意义。眼轴与 GCC、黄斑浅层血管密度参数呈负相关（眼轴与GCC：r=-0.333,P=0.003;眼轴与黄斑浅层血管密 度：r=-0.303～-0.282,均P<0.05）,与RPC VD无显著相关性（P=0.383）。结论：在病情相近的情 况下,POAG眼轴的延长主要损害黄斑血管,尤其是周边部颞侧血管,对视盘周围微血管无显著 影响。     

Distribution characteristics of retinal nerve fiber layer thickness in macular area and its relationship with vessel density in highly myopic eyes

AIM: To investigate the distribution characteristics of retinal nerve fiber layer thickness and vessel density in macular area of eyes with high myopia, using optical coherence tomography angiography (OCTA). METHODS: Forty eyes in 20 patients diagnosed with high myopia, age 29.90±7.92 years old, with a spherical equivalent of -8.95±2.01 D, were recruited. The retinal nerve fiber layer (RNFL) thickness and the vessel density of the superficial retinal capillary plexus, deep retinal capillary plexus, and choroidal capillary were measured by OCTA. Macular regions within a 6-mm diameter circle were divided into 9 subfields: the central subfield, and the pericentral and peripheral regions of superior, inferior, nasal, and temporal quadrants. The retinal nerve fiber layer thicknesses of different subfields were compared, and their relationships with spherical equivalent, axial length, and vessel density were analyzed. RESULTS: In the pericentral region, the retinal nerve fiber layer thickness of the superior quadrant was the lowest, whereas thickness was highest in the inferior quadrant (all P<0.05). In the peripheral region, the retinal nerve fiber layer thickness of the temporal quadrant was the lowest (all P<0.05). A negative correlation was found between the retinal nerve fiber layer thickness and spherical equivalent (r=-0.356, P=0.024) in the peripheral superior subfield. The vessel density of superficial retinal capillary plexus was positively correlated with retinal nerve fiber layer thickness in the nasal and inferior quadrants of the pericentral region and in the superior, nasal, and inferior quadrants of the peripheral region (r=0.314, 0.408, 0.467, 0.655, and 0.737 respectively; and all P<0.05), whereas the vessel density of choroidal capillary was negatively correlated with retinal nerve fiber layer thickness in the peripheral superior subfield (r= -0.356, P=0.024). CONCLUSION: The RNFL of macular areas is not uniformly distributed in high myopia (HM). As the spherical equivalent (SE) increases, the RNFL thickness decreases in certain areas, which correlates with the vessel density(VD) of superficial retinal capillary plexus (SCP) and choroidal capillary (CC) layers.     

光学相干断层扫描血管成像在脉络膜裂伤中的诊断价值

目的:研究光学相干断层扫描血管成像(OCTA)在脉络膜裂伤中的诊断价值,并总结其OCTA影像特征。方法:回顾分析我院确诊为脉络膜裂伤患者的临床资料,共25例25眼,所有患者均接受眼底照相、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、频域OCT和OCTA检查。结果:所有患者眼底检查可见病灶多位于黄斑区或视盘颞侧,呈弧形黄白色条纹,周围可伴有视网膜脉络膜水肿和视网膜下出血。FFA早期可见裂伤呈弧形透见荧光,晚期荧光着染;当继发脉络膜新生血管(CNV)时,活动性CNV呈高荧光渗漏。频域OCT可见RPE层和脉络膜毛细血管层反射断裂,临近处的组织反射增强,视网膜下可见小团状高反射隆起。OCTA可见脉络膜裂伤的肉芽组织在外层视网膜和脉络膜毛细血管层血流图中表现为具有"条纹形态"的弧形高反射;在断层B扫描(B-scan)中表现为"团状"的向内隆起或向外凹陷,内部具有血流信号。当继发CNV时,在外层视网膜和脉络膜毛细血管层的血流图中可见明确的血管形态,多呈团状,从形态上与脉络膜裂伤的肉芽组织不相同。结论:脉络膜裂伤的修复性肉芽组织与继发性CNV病灶在OCTA中虽然同样呈"团状隆起"并具有血流信号,但两者的形态和组织成分均有明显差异。通过OCTA分层显示以及对病灶细节形态上的观察,可以提高脉络膜裂伤继发CNV的诊断率。     

Visual quality after implantation of trifocal intraocular lenses in highly myopic eyes with different axial lengths

AIM:To analyze postoperative clinical results after implantation of trifocal intraocular lenses(IOLs)in highly myopic eyes with different axial lengths(ALs).METHODS:This retrospective study describes 61 eyes of 44 patients that were implanted with trifocal diffractive IOLs(AT LISA tri 839 MP).Twenty-one eyes(15 patients)were included in the AL<26 mm group,19 eyes(13 patients)in the AL≥26 mm and<28 mm group,and 21 eyes(16 patients)in the AL≥28 mm group.Postoperative outcomes,including corrected and uncorrected distance visual acuity(UDVA),intermediate and near visual acuity at 167 cd/m2 luminance,depth of focus at 85 cd/m2 luminance,and objective optical quality parameters assessed using the Optical Quality Analysis System(OQAS),were compared among the groups at 3 mo.RESULTS:There were no significant differences in the mean UDVA,uncorrected intermediate visual acuity,uncorrected near visual acuity,corrected distance visual acuity,distance-corrected intermediate visual acuity,and distance-corrected near visual acuity(DCNVA)among the three groups(P>0.05).Better near and intermediate visual acuity(from-1.5 D to-3.0 D)were noted on the defocus curve of the AL<26 mm group(P<0.01 vs AL≥28 mm group).Significantly higher objective scatter index(OSI)values and lower modulation transfer function(MTF)cut-off values,Strehl ratio(SR),and OQAS values(OVs)were observed in the AL≥28 mm group(P<0.01 vs AL<26 mm group).All OQAS parameters had statistically significant correlations with DCNVA and visual acuity at the vergence of-2.5 D(P<0.05 to P<0.01).CONCLUSION:Implantation of trifocal IOLs provides good short-term visual and refractive outcomes in highly myopic eyes with different ALs.However,the near vision decreases in the extremely myopic eyes at lower luminance,which is associated with the lower objective optical quality in these eyes.     

Notch-1调控视网膜前体细胞向视网膜神经节细胞分化

目的研究Notch-1对视网膜前体细胞(RPC)向视网膜神经节细胞(RGC)分化的调控作用。方法分离培养胚胎14 d龄Sprague-Dawley大鼠的RPC，实验组和对照组分别用含有Notch-1反义寡核苷酸链和无关序列寡核苷酸链的培养液进行诱导分化14 d，倒置相差显微镜每天观察细胞的生长和分化情况，Thy1.1标记RGC并进行计数。结果实验组和对照组的RPC都能分化为多种视网膜细胞类型，包括Thy1.1阳性的RGC，但两组RPC向RGC分化的百分比不同。实验组和对照组RGC的百分比分别为(16.57±4.31)%和(31.19±6.90)%，两组比较差异有统计学意义（t=9.84,P＜0.001）。结论Notch-1对RPC的分化具有负向调控作用，阻断Notch-1能促进RPC向RGC分化。(中华眼底病杂志, 2007, 23: 101-103)     

深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病

目的：探究深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病的临床治疗效果及安全性。

方法：分析我科既往住院患者病历,纳入2019-01/2020-05在我科住院的符合纳入标准的甲状腺相关性眼病患者17例。所有患者均在全身麻醉下行深外侧壁联合内侧壁眼眶减压术,比较患者术前术后的视力、暴露性角膜炎恢复情况、突眼度、眼压以及并发症情况。

结果：所纳入研究的对象中,有甲状腺相关眼病视神经病变(DON)8例9眼,术前的最佳矫正视力0.78±0.15,术后1mo 0.36±0.12,与术前视力相比有差异(P<0.01),术后6mo 0.38±0.12,与术后1mo无差异(P=0.594)。术前眼球突出度23.75±2.55mm,术后1mo为14.85±1.53mm,与术前突眼度相比有差异(P<0.01),术后6mo为14.60±1.64mm,与术后1mo基本保持稳定(P=0.658)。术前眼压25.56±3.23mmHg,术后1mo为18.42±2.35mmHg,与术前相比有差异(P<0.01),术后6mo眼压降至15.82±2.57mmHg,与术后1mo眼压相比有差异(P<0.01)。术前有暴露性角膜炎6例6眼,术后1mo有4眼好转,2眼治愈,术后6mo 6眼全部治愈。术后患者复视情况均有不同程度减轻,并有部分患者复视症状在此后6mo持续好转,未出现其他严重并发症。

结论：深外侧壁联合内侧壁眼眶减压术可以有效地改善眼突,对DON及暴露性角膜炎等严重并发症也有良好的疗效,并发症少,是治疗严重甲状腺相关性眼病的有效手术方案。