Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

Purpose

To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes.

Methods

The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was <3.0 mg/dL and serum creatinine was >1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher''s exact test.

Results

The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%).

Conclusions

Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.     

Role of OCT in the Diagnosis and Management of Macular Edema from Uveitis

Uveitis is a potentially visually threatening disease accounting for 10% of vision loss in the developed world. The most common cause of vision loss in patients with uveitis has been shown to be macular edema (ME). The early detection and management of ME is critical to preserve vision in these patients. Optical coherence tomography (OCT) is a valuable tool in the management of many ocular diseases. The use of OCT has revolutionized the diagnosis and management of macular edema from a wide variety of ophthalmological diseases, including uveitis. In this review, we evaluate the role of OCT in the diagnosis and management of uveitic macular edema.     

渗出型老年性黄斑变性患者继发黄斑囊样水肿分析

目的 探讨渗出型老年性黄斑变性（AMD）患者继发黄斑囊样水肿（CME）的原因 。 方法 回顾性分析临床确诊的渗出型AMD患者140例171只眼的光相干断层扫描（OCT）检查结果，对其脉络膜新生血管(CNV)进行分类，并分析其与CME发生的关系。 结果 171只AMD患 眼中，89只眼存在CME，占52.0%；82只眼无CME，占48.0%。有CME的患眼中，76只眼存在活动性CNV病变，占85.4%；13只眼已有盘状瘢痕形成，占14.6%。无CME的患眼中， 69只眼存在活动性CNV病变，占84.1%；13只眼有盘状瘢痕形成，占15.9%。有CME且同时存在活动性CNV病变的76只患眼中，结合型CNV 61只眼，占80.3%；Gass 2型CNV 14只眼，占18.4%； Gass 1型CNV 1只眼，占1.3%。视网膜下CNV（结合型+Gass 2型）占98.7%。无CME但有活动性CNV的69只患眼中，57 只眼CNV是位于视网膜色素上皮（RPE）下的Gass 1型，占82.6%；12只眼为视网膜下CNV，占 17.4%。有无CME两组之间视网膜下CNV的发生率比较，其差异有显著性的意义（χ2=99.5838，P=0.0000）。 结论 CME发生与CNV侵入视网膜感觉层下生长密切相关，视网膜下CNV很可能是渗出型AMD继发CME的直接原因。 （中华眼底病杂志，2004，20：299-302）     

Assessment for Macular Thickness after Uncomplicated Phacoemulsification Using Optical Coherence Tomography

PurposeMacular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study.MethodsMacular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT.ResultsA total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range.ConclusionsThe intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.     

光学相干断层成像术观察超声乳化白内障吸除术后黄斑变化

目的　探讨超声乳化白内障吸除术后黄斑形态的变化及其可能的影响因素。方法　对行超声乳化白内障吸除术 ,且术前无合并症、术中无并发症发生的单纯老年性白内障患者 80例 (80只眼 )于术前和术后 1周分别行光学相干断层成像术 (opticalcoherencetomography ,OCT)检查 ;按术中使用的超声能量高低分成 2个组。观察黄斑中心凹视网膜厚度的变化及其与术中超声能量、术后前房炎性反应和视力的关系。结果　 80只眼黄斑中心凹视网膜平均厚度术前为 (14 2 9± 16 7) μm ,术后为 (15 7 9± 36 7) μm ,两者比较差异无显著意义 (P >0 0 5 )。术后 3只眼出现黄斑水肿 ,11只眼出现房水中度闪光 ,黄斑中心凹视网膜平均厚度术前为 (139 9± 11 3) μm ,术后为 (197 6± 36 9) μm ,两者比较差异有显著意义 (t =2 75 1,P <0 0 5 )。低能量组术后黄斑中心凹视网膜平均厚度为 (15 6 2± 18 3) μm ,高能量组为 (172 6± 32 9) μm ,两者比较差异有显著意义 (t=2 4 11,P <0 0 5 )。术后最佳矫正视力与黄斑中心凹视网膜厚度呈负相关性 (r=- 0 82 ,P <0 0 5 )。结论　超声乳化白内障吸除术可导致术眼黄斑中心凹视网膜厚度增加及黄斑水肿 ;术中高超声能量可明显影响术后黄斑中心凹视网膜的形态 ;术后黄斑中心     

视网膜静脉阻塞的黄斑区视网膜厚度与多焦视网膜电图分析

目的观察视网膜静脉阻塞的黄斑区厚度与多焦视网膜电图(multifocal electroretinogram,mf-ERG)变化的关系。方法随机选择视网膜静脉阻塞患者36例(37只眼),分别行多焦视网膜电图及光学相干断层扫描(optical coherence tomography,OCT)检查,多焦视网膜电图选取中央4环内(约13°),分为黄斑中心凹及其上方、下方、颞侧和鼻侧共5部分,与OCT视网膜厚度分析相对应。结果黄斑各部位视网膜厚度与mf-ERG各波反应密度负相关,与潜伏期呈正相关,且与潜伏期相关程度较高。其中中心凹及其鼻侧、下方与各波的相关性较好。结论mf-ERG与OCT相结合能更好显示视网膜静脉阻塞眼受损状况,其黄斑区形态与功能改变不完全一致,与部位有关,中心凹及其鼻侧、下方厚度改变对mf-ERG各波影响相对较明显。N1波潜伏期是较好的观察指标。     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

Best卵黄样黄斑营养不良一家系的基因突变型及临床表型

目的探究Best卵黄样黄斑营养不良(Best vitelliform macular dystrophy,BVMD)一家系的基因突变表型及临床特点方法回顾性分析BVMD一家系所有患者详细病史资料及检查结果,眼部检查包括视力、色觉、裂隙灯、散瞳眼底检查、光学相干断层扫描等,根据眼底表现对BVMD病变进行分期,了解BVMD中儿童及成人发病特点的相关差异。对家系中有关直系亲属取外周静脉血行基因分析,通过靶向捕获高通量测序,对BVMD致病基因进行分析,寻找可能致病突变。结果 8名家庭成员中5例为BVMD患者,其中1例2眼为Ⅱ期,3例5眼为Ⅲ期,1例1眼为Ⅳ期,1例2眼为V期。基因检查结果为常染色体显性遗传,BEST1 (OMIM607854)基因c.238T>C;p.Phe80Leu杂合突变。结论此家系呈现常染色体显性遗传,基因检测对于BVMD的诊断及遗传学咨询具有重要作用。在同一分期中儿童患者眼底表现较重,需更密切的随访监测。OCT可作为此类疾病随访的监测指标。     

The correlation between optical coherence tomographic features and severity of retinopathy,macular thickness and visual acuity in diabetic macular edema

Purpose To investigate the correlation between the features of optical coherence tomography (OCT) and the severity of concurrent retinopathy, central macular thickness (CMT), and best-corrected visual acuity in clinically significant diabetic macular edema.Methods In a prospective study, OCT was performed in 55 eyes of 55 patients with clinically significant diabetic macular edema, in 58 eyes of 30 patients with diabetes without retinopathy, and in 40 eyes of 21 healthy control subjects. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; type 3, serous retinal detachment; and type 4, vitreofoveal traction.Results The CMT in eyes with diabetic macular edema was significantly higher than in eyes of healthy controls or in eyes of diabetic patients without retinopathy (P < 0.001). Visual acuity correlated with CMT in diabetic macular edema (r = 0.558, P < 0.001). The prevalence of OCT type 1 was significantly higher in eyes with mild-to-moderate non-proliferative retinopathy (NPDR) than in eyes with severe NPDR to proliferative retinopathy (PDR) (P = 0.0069). The prevalence of OCT types 3 and 4 was significantly higher in eyes with severe NPDR to PDR than in eyes with mild-to-moderate NPDR (P = 0.0056). OCT type 1 showed the least CMT (P < 0.001) and the best visual acuity (P = 0.002).Conclusions There was a significant correlation between OCT patterns of clinically significant diabetic macular edema and severity of retinopathy, CMT, and visual acuity.     

Predictive Findings of Visual Outcome in Spectral Domain Optical Coherence Tomography after Ranibizumab Treatment in Age-related Macular Degeneration

Purpose

To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD).

Methods

We reviewed the medical records of patients with treatment-naïve NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values.

Results

Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment.

Conclusions

Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.     

Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

Purpose

To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME).

Methods

A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery.

Results

Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery.

Conclusions

Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.     

Comparison of Each Retinal Layer Thicknesses between Eyes with Central Retinal Vein Occlusion and Normal Contralateral Eyes

PurposeTo evaluate the difference in each retinal layer thickness in central retinal vein occlusion (CRVO) with resolved macular edema after intravitreal antivascular endothelial growth factor injection and normal contralateral eyes..MethodsPatients with ischemic and nonischemic CRVO whose macular edema resolved after intravitreal antivascular endothelial growth factor injections and did not recur for at least 6 months, and a normal contralateral eye were enrolled. Each retinal layer thickness between CRVO and normal contralateral eyes was compared according to Early Treatment Diabetic Retinopathy Study subfields using spectral domain optical coherence tomography.ResultsThe thicknesses of outer nuclear layer, photoreceptor layer, and retinal pigment epithelium in central ring, ganglion cell layer, inner plexiform layer, outer nuclear layer, and photoreceptor layer in the inner ring, and ganglion cell layer in the outer ring of CRVO eyes were significantly thinner than those of normal contralateral eyes (all p < 0.05). Whereas, inner nuclear layer and outer plexiform layer thicknesses in central ring of CRVO eyes were 23.86 ± 8.8 and 25.76 ± 7.6 μm, respectively, which was significantly thicker than those of normal contralateral eyes (19.52 ± 7.7 and 22.76 ± 6.5 μm; p = 0.019 and p = 0.043, respectively). Additionally, the mean best-corrected visual acuity of CRVO eyes were significantly correlated with photoreceptor layer thickness in central ring (p = 0.005).ConclusionsIn CRVO eyes with resolved macular edema, the outer retinal layers were thinner as well as inner retinal layers, whereas inner plexiform layer and outer nuclear layer were thicker than normal fellow eyes. Additionally, photoreceptor layer thickness in foveal area had a significant impact on visual acuity in CRVO.     

结晶样视网膜变性患者五种血清离子的异常变化

目的　分析结晶样视网膜变性（Ｂｉｅｔｔｉｃｒｙｓｔａｌｌｉｎｅｄｙｓｔｒｏｐｈｙ,ＢＣＤ）患者血清中镁、钙、钾、钠及氯离子浓度的变化情况。方法　采用回顾性序列病例研究方法,选取临床诊断为ＢＣＤ患者５０例纳入ＢＣＤ组,另选取９９位正常人作为正常对照组,按盲法由专业技术人员完成血清离子浓度检测,并分别行ＢＣＤ组和正常对照组比较。结果　ＢＣＤ组患者血清中,钙离子和钾离子浓度分别为（２．３２３±０．０９２）ｍｍｏｌ·Ｌ－１和（４．１２３±０．３５５）ｍｍｏｌ·Ｌ－１,与正常对照组相比均显著升高（ｔ＝－４．２６６,Ｐ＝０．０００;ｔ＝－４．０８１,Ｐ＝０．０００）;镁离子浓度为（０．８４５±０．０５２）ｍｍｏｌ·Ｌ－１,与正常对照组血清中镁离子浓度（０．８７４±０．０７６）ｍｍｏｌ·Ｌ－１相比显著下降（ｔ＝２．７６７,Ｐ＝０,００６）;钠和氯两种离子血清浓度与正常对照组相比差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＢＣＤ患者血清中钙离子和钾离子浓度升高,镁离子浓度降低,其可能与ＢＣＤ的发病有关。     

频域OCT定性定量分析葡萄膜炎性黄斑水肿

目的 观察葡萄膜炎患者黄斑水肿的光学相干断层扫描(OCT)图像特征及与临床的关联,探讨频域OCT在葡萄膜炎性黄斑水肿定性和定量分析中的应用价值.方法 连续临床病例横断面研究.对河南省眼科研究所在2009年4月至2011年3月就诊的葡萄膜炎并黄斑水肿169只眼进行频域OCT检查,分析黄斑水肿的类型及各参数与视力的相关性,并与FFA结果对比分析.结果 (1)黄斑水肿分型:囊样水肿占43.19％,弥漫性水肿占34.91％,单纯神经上皮脱离占10.06％,11.83％同时出现3种改变;囊样水肿发生率最高.(2)光感受器内外节连接体断裂者54只眼(31.95％),玻璃体后脱离者33只眼(19.53％);存在明显玻璃体视网膜牵拉者15只眼(8.88％),黄斑前膜者33只眼(19.53％).(3)囊样水肿组平均黄斑厚度高于弥漫性水肿组,两组视网膜厚度均与视力呈负相关;连接体断裂组视力较完整组低;存在黄斑前膜组视力较低.(4) OCT与FFA对黄斑水肿的检出一致率为86.39％.结论 葡萄膜炎所导致的黄斑水肿其形态可表现为多种不同的类型,OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关.     

Detailed functional and structural phenotype of Bietti crystalline dystrophy associated with mutations in CYP4V2 complicated by choroidal neovascularization

Purpose: To describe in detail the phenotype of a patient with Bietti crystalline dystrophy (BCD) complicated by choroidal neovascularization (CNV) and the response to intravitreal Bevacizumab (Avastin^®; Genentech/Roche).

Methods: A 34-year-old woman with BCD and mutations in CYP4V2 (c.802-8_806del13/p.H331P:c992A>C) underwent a complete ophthalmic examination, full-field flash electroretinography (ERG), kinetic and two-color dark-adapted perimetry, and dark-adaptometry. Imaging was performed with spectral domain optical coherence tomography (SD-OCT), near infrared (NIR) and short wavelength (SW) fundus autofluorescence (FAF), and fluorescein angiography (FA).

Results: Best-corrected visual acuity (BCVA) was 20/20 and 20/60 for the right and left eye, respectively. There were corneal paralimbal crystal-like deposits. Kinetic fields were normal in the peripheral extent. Retinal crystals were most obvious on NIR-reflectance and corresponded with hyperreflectivities within the RPE on SD-OCT. There was parafoveal/perifoveal hypofluorescence on SW-FAF and NIR-FAF. Rod > cone sensitivity loss surrounded fixation and extended to ~10° of eccentricity corresponding to regions of photoreceptor outer segment-retinal pigmented epithelium (RPE) interdigitation abnormalities. The outer nuclear layer was normal in thickness. Recovery of sensitivity following a ~76% rhodopsin bleach was normal. ERGs were normal. A subretinal hemorrhage in the left eye co-localized with elevation of the RPE on SD-OCT and leakage on FA, suggestive of CNV. Three monthly intravitreal injections of Bevacizumab led to restoration of BCVA to baseline (20/25).

Conclusion: crystals in BCD were predominantly located within the RPE. Photoreceptor outer segment and apical RPE abnormalities underlie the relatively extensive retinal dysfunction observed in relatively early-stage BCD. Intravitreal Bevacizumab was effective in treating CNV in this setting.     

High-resolution Spectral Domain Optical Coherence Tomography Findings in Multifocal Vitelliform Macular Dystrophy

We describe the abnormalities seen in the mid periphery and posterior pole of two patients with multifocal vitelliform macular distrophy as evaluated by high-definition spectral domain optical coherence tomography (HD-OCT). In patient 1, HD-OCT scans revealed, in the central area, a thicker and more reflective layer compared with the normal macula, located between the retinal pigment epitelium and the interface of the inner segment /outer segment, corresponding to the Verhoeff‘s membrane. Moreover, HD-OCT macular scans, as well as C-scans, revealed a slight hyper-reflective lesion just above an area of reduced reflectivity between the photoreceptor layer (interface of the inner segment and outer segment) and the Verhoeff‘s membrane. In patient 2, on HD-OCT macular scans, the layer corresponding to the interface of inner segment and outer segment of the photoreceptor, and the Verhoeff's membrane, appeared disrupted, whereas the retinal pigment epithelium layer appeared preserved. On the other hand, in both patient 1 and 2, the clinically evident vitelliform lesions outside the macular area appeared on HD-OCT scans either as small focal hyper-reflective lesions at the level of the retinal pigment epithelium/photoreceptor complex, either as a more pronounced diffuse thickening of the retinal pigment epithelium/photoreceptor complex, facing the deposition of lipofuscin reported on the histopathologic examination. These new findings would help in a further understanding of multifocal vitelliform macular distrophy.     

Structure-function Relationships in Uveitic Cystoid Macular Edema: Using En Face Optical Coherence Tomography to Predict Vision

Purpose: To explore whether preserved retinal tissue on baseline en face optical coherence tomography (OCT) correlates with post-treatment visual acuity in patients with uveitis-associated cystoid macular edema (CME).

Methods: A retrospective cohort study was conducted on 25 eyes (23 patients) with uveitis and CME, with resolution of CME at post-treatment follow-up. Baseline en face OCT images were analyzed to determine the proportion of pixels representing preserved retinal tissue. Macular thickness and volume data were also analyzed.

Results: The proportion of preserved retinal tissue on baseline OCT strongly correlated with baseline visual acuity (r?=?0.61, p?=?0.0014), and correlated even better with vision after CME resolution (r?=?0.73, p?r?=?0.38, p?=?0.058 and r?=?0.39, p?=?0.055).

Conclusions: Preserved retinal tissue at baseline strongly correlates with post-treatment visual acuity in patients with uveitis-associated CME, and is a better predictor of future vision than macular thickness or volume.