Correlation of optic disc morphometry and optic disc microvasculature assessed with optical coherence tomography angiography

ObjectiveTo compare optic disc microvasculature measurements to the disc morphometrics in normal eyes.DesignCross-sectional study.ParticipantsFifty-eight healthy subjects.MethodsEnface 4.5x4.5 mm optical coherence tomography angiography images were obtained from the optic disc of healthy individuals. The radial peripapillary capillary (RPC) and the nerve head (NH) en face images were obtained. Also, spectral domain OCT measurements of the peripapillary nerve fibre layer (NFL) thickness were recorded. Correlations of the vessel density and NFL measurements with optic disc morphometrics were analyzed.ResultsFifty-eight eyes of 58 patients were included. Mean peripapillary NFL thickness was 99.77 ± 8.47 µm. The mean disc area was 2.15 ± 0.34 mm² (range, 1.48–3.02 mm²) with an average cup/disc area ratio of 0.27 ± 0.14 (range, 0.0–0.6). On the RPC en face image, the mean vessel density of the whole image, peripapillary, and inside disc was 55.52 ± 2.90, 62.42 ± 3.30, and 45.77 ± 9.24%, respectively. On the NH en face images, the mean vessel density of the whole image, peripapillary, and inside disc was 55.69 ± 3.04, 60.15 ± 2.79, and 52.69 ± 5.31%, respectively. The NH vessel density in the inside disc area correlated with the cup/disc area ratio (R = −0.44, p < 0.001). The association of RPC vessel density in the inside disc area with the cup/disc area ratio was significant (R= −0.88, p < 0.001). The RPC vessel density in the peripapillary area correlated with the cup/disc area ratio (R = 0.37, p = 0.004). Also, the RPC vessel density in the whole image was associated with the peripapillary NFL thickness (R = 0.32, p = 0.01).ConclusionWe observed a significant negative correlation between inside disc vessel density and cup/disc area ratio, but not to the disc area in normal eyes. In addition, the whole image RPC vessel density was revealed to be weakly correlated with the average RNFL thickness.     

鞍结节脑膜瘤患者视盘及视网膜神经纤维层的形态研究

目的 分析鞍结节脑膜瘤患者的视盘参数特征及视盘周围视网膜神经纤维层（pRNFL）厚度的变化。设计 回顾性病例系列。 研究对象 2010年7月至2011年12月北京天坛医院鞍结节脑膜瘤患者40例（80眼）、正常对照40例（80眼）和青光眼患者40例（80眼）。方法 采用眼底照相和相干光断层扫描（OCT）测量视盘及不同象限pRNFL厚度,比较鞍结节脑膜瘤患者与正常对照组和青光眼组的视盘参数及pRNFL厚度,分析视盘参数改变与肿瘤大小的相关性。主要指标 视盘形态、视盘面积、杯盘面积比、水平杯盘比、垂直杯盘比、盘沿面积、视杯面积,视杯体积和不同象限pRNFL厚度。结果 鞍结节脑膜瘤组的杯盘面积比、水平杯盘比、垂直杯盘比、视杯面积和视杯体积与正常对照组相比均明显增大,而盘沿面积明显减小（P均=0.000）;且杯盘面积比、水平杯盘比、盘沿面积和盘沿体积与青光眼组相比均较大,而垂直杯盘比、视杯面积和视杯体积较青光眼组明显减小（P均=0.000）。肿瘤组视盘周围不同象限pRNFL厚度分别为上方颞侧（124.022±26.100）μm,上方鼻侧（105.856±23.410）μm,鼻侧上方（75.784±19.260）μm,鼻侧下方（65.983±15.708）μm,下方鼻侧（105.915±25.526）μm,下方颞侧（133.591±24.429）μm,颞侧下方（76.592±19.679）μm,颞侧上方（77.352±26.100）μm,与正常对照组相比差异均具有统计学意义（P均<0.05）;与青光眼组相比上方鼻侧象限不具有统计学意义（P=1.114）,其余象限均具有统计学意义（P均<0.05）。鞍结节脑膜瘤盘沿体积与肿瘤大小相关（r=0.492,P=0.011）。结论 鞍结节脑膜瘤视盘形态表现为颞侧变窄、颜色变淡,pRNFL厚度与正常人群比较下方鼻侧变薄最明显,与青光眼组相比除上方鼻侧外其他各象限均变薄,下方颞侧最明显。     

Optical coherence tomography angiography features of optic nerve head drusen and nonarteritic anterior ischemic optic neuropathy

ObjectiveTo evaluate the optic disc microvasculature in optic nerve head drusen (ONHD) vasculature in comparison to acute nonarteritic anterior ischemic optic neuropathy (NAION) and normal eyes using optical coherence tomography angiography (OCT-A).MethodsTen eyes with ONHD, 10 eyes with acute NAION, and 10 healthy eyes were included in this prospective, comparative, observational case series. OCT-A imaging was performed on the optic discs. Qualitative grading was performed for dilation and tortuosity of the peripapillary vessels by 3 graders. Quantitative comparison was performed for peripapillary and inside disc vessel densities in nerve head (NH) and retinal peripapillary capillary (RPC) slabs.ResultsThe intergrader agreement for dilation and tortuosity of the peripapillary vessels was poor (0.313 and 0.182 for vascular dilation in nerve head and radial peripapillary capillary enface images, respectively, and 0.478 and 0.490 for vascular tortuosity in nerve head and radial peripapillary capillary enface images, respectively). In NH en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05). In RPC en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05) except for nasal peripapillary sector (0.08).Conclusion: Despite poor intergrader agreement in qualitative analysis, quantitative OCT-A evaluation may differentiate optic disc edema due to NAION from pseudodisc edema due to ONHD.     

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.     

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.     

青光眼白内障联合手术前后视盘血流的变化观察 △

目的 评价青光眼白内障联合手术前后视盘血流的变化。方法 对拟做青光眼白内障联合手术、晶状体为中度混浊的青光眼患者,分别于术前、术后1 d、术后1周、术后1个月和术后3个月检查光学相干断层扫描血管成像(OCTA),采用视盘血流高清模式 4.5 mm程序(Angio HD Disc 4.5 mm),分析视网膜神经纤维层厚度变化、视盘和盘周的血流密度变化。手术中Phaco的灌注瓶高统一设置为60~65 cm。结果 共观察36例(37眼),术前、术后1 d、术后1周、术后1个月和术后3个月的视盘内所有血管密度分别为:(52.78±3.59)%、(44.90±3.59)%、(49.56±5.32)%、(51.18±6.68)%、(53.94±5.64)%;视盘内所有毛细血管密度分别为(43.64±2.91)%、(36.71±4.09)%、(40.72±6.73%)、(41.96±6.17)%、(46.2±5.47)%,术后1 d均较术前有明显下降,差异有统计学意义(P<0.000 1),术后1周均开始逐步回升,术后3个月时达术前水平,术后1 d和术后1周、1个月、3个月差异均有统计学意义(P<0.05);整幅图像所有血管血流密度、整幅图像所有毛细血管血流密度、盘周所有血管血流密度和盘周毛细血管血流密度术前、术后差异均无统计学意义。70岁以上组和70岁以下组、原发性闭角型青光眼(PACG)组和原发性开角型青光眼(POAG)组组间术前、术后视盘血流密度下降差异均无统计学意义。术前、术后的视网膜神经纤维层厚度差异也无统计学意义。结论 青光眼白内障联合手术对视网膜神经纤维层厚度没有影响,但对视盘内的血流密度有显著影响,第1天显著下降,术后逐步恢复,3个月时接近术前水平;但对视盘周围的血流没有影响。     

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。     

Optical coherence tomography angiography measured capillary density in the normal and glaucoma eyes

Purpose

To compare the diagnostic ability of optical coherence tomography angiography (OCT-A) derived radial peripapillary capillary (RPC) measured capillary density (CD) and inside the optic nerve head (ONH) CD measurements to differentiate between the normal and primary open angle glaucoma (POAG) eyes.

高度近视人群视盘周围血流密度与神经纤维层厚度的变化特征

目的：应用光学相干断层扫描血管造影（OCTA）分析年轻成人中高度近视人群视盘周围血流密度及 神经纤维层厚度的变化特征及其之间的相关性。方法：系列病例研究。纳入温州医科大学附属眼视 光医院2020年10—12月门诊近视患者90例（90眼）。根据等效球镜度（SE）将患者分为对照组27眼（-3.00 D ≤SE≤+0.75 D）、高度近视组34眼（-9.00 D≤SE＜-6.00 D）和超高度近视组29眼（SE≤-9.00 D）。采用 OCTA测量眼球矫正前后视盘周围平均、上颞、颞上、上鼻、鼻上、鼻下、下鼻、下颞、颞下侧浅 层毛细血管血流密度（RPC VD）以及视盘周围神经纤维层（pRNFL）厚度。3组间RPC VD及pRNFL 厚度比较采用单因素方差分析或非参数分析,RPC VD、pRNFL厚度、眼轴长度、SE的相关性采用 Spearman或Pearson相关分析。结果：在眼球矫正前,与对照组相比,高度近视组在颞上、颞下侧 pRNFL变厚,下鼻侧pRNFL变薄（H=14.75, P=0.001; H=11.20, P<0.001; F=11.30, P<0.001）,在鼻上、 鼻下侧RPC VD降低（H=6.82, P=0.033; H=10.90, P=0.004）。在平均、颞上、上鼻、鼻上、鼻下、下鼻 及颞下侧pRNFL与RPC VD呈正相关（r=0.29、0.25、0.35、0.44、0.50、0.40、0.48,均P<0.05）。在 眼球矫正后,平均pRNFL、RPC VD与眼轴长度呈正相关（r=0.40, P<0.001; r=0.63, P<0.001）,与SE 呈负相关（r=-0.29, P=0.006; r=-0.48, P<0.001）,且在平均、上颞、颞上、上鼻、鼻上、鼻下、下鼻、 下颞、颞下侧pRNFL与RPC VD呈正相关（r=0.48、0.40、0.58、0.38、0.47、0.57、0.29、0.43、0.56, 均P<0.05）。结论：高度近视患者RPC VD和pRNFL在眼球矫正前颞上、颞下增大,下鼻、鼻上及鼻 下侧减小,而在眼球矫正后平均RPC VD和pRNFL增大。     

水通道蛋白-4抗体阳性视神经脊髓炎谱系疾病患者光相干断层扫描血管成像特征及相关因素分析

目的:观察水通道蛋白-4 （AQP-4）抗体阳性视神经脊髓炎谱系疾病（NMOSD）患者光相干断层扫描血管成像（OCTA）特征,分析其相关因素。方法:病例对照研究。2015年9月至2017年8月在复旦大学附属眼耳鼻喉科医院眼科检查确诊的AQP-4抗体阳性NMOSD患者48例96只眼及同期年龄性别与之匹配的健康志愿者20名...     

Análisis de la perfusión del nervio óptico mediante el uso de angio-OCT en glaucoma

The introduction of optical coherence tomography angiography (OCT-A) has generated interest in evaluating vascular dysfunctions in the optic nerve head for the diagnosis and monitoring of glaucoma. The purpose of this study is to compare perfusion of the optic disc between normal subjects and subjects with glaucoma using OCT-A in order to detect changes in perfusion of the optic disc. Using the OCT-A AngioVue® system, an examination was performed on 40 eyes of 40 patients (20 with glaucoma and 20 healthy controls). Total radial peripapillary flow density (4.5 × 4.5 mm) was measured at different levels of segmentation. The study demonstrated that the peripapillary vascular flow of OCT-A and exploration of the optic nerve head was better in the normal eyes compared to glaucoma patients. This review provides a comprehensive summary of the most important current and potential applications of OCT-A in glaucoma.     

高度近视继发视盘周围脉络膜空腔视盘血流密度的变化

目的:观察高度近视继发视盘周围脉络膜空腔(peripapillary intrachoroidal cavitation,PICC)患眼视盘血流密度变化及其影响因素,分析PICC患病危险因素.方法:横断面研究.35例35眼高度近视伴PICC患眼,40例40眼高度近视不伴PIC患眼及35例35眼正常对照眼纳入研究范围.所有受试者均接受眼底照相及频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT).同时进行OCT血管成像检查,分别获得视盘周围视乳头(optic nerve head,ONH)层和视盘旁视网膜毛细血管(radial peripapillary capillaries,RPC)层的血流密度图.比较高度近视伴与不伴PICC患眼及健眼视盘形态改变和血流密度的差异,分析PICC与视盘周围血流密度的相关性和PICC患病的独立危险因素.结果:三组间屈光度、矫正视力、眼轴、视盘周围萎缩β区(peripapillary atrophy β-zone,β-PPA)面积、神经纤维层(retinal nerve fiber layer,RNFL)厚度及视盘倾斜、后巩膜葡萄肿、近视性黄斑病变(myopic maculopathy,MMD)患病率差异均存在统计学意义(P<0.05).三组间RPC层(54.34±5.58,57.54±7.44,64.42±3.50)与ONH层(51.24±7.43,52.75±9.96,61.25±4.15)视盘周围平均血流密度差异均有显著统计学意义(P<0.001).与高度近视不伴PICC组及健眼组相比,伴有PICC组RPC和ONH层颞下象限血流密度(56.76±6.62,63.84±6.02,67.52±4.78;56.47±5.79,60.38±4.72,64.18±4.37)均明显下降,RPC层血流密度与MMD、β-PPA面积和RNFL厚度存在显著相关性,而ONH层血流密度则与MMD、PICC的发生及RNFL厚度存在显著相关性(P<0.05).Logistic回归分析显示,视盘倾斜和后巩膜葡萄肿是PICC患病的独立危险因素(OR=8.007,95%CI:2.045~31.348;OR=7.558,95%CI:1.398~50.026).结论:高度近视伴PICC患眼视盘血流密度明显下降,颞侧下降尤为显著.视盘倾斜与后巩膜葡萄肿是PICC发生的独立危险因素.     

Prevalence of crowded optic discs in adult Chinese. The Beijing Eye Study

BACKGROUND: To determine the prevalence of crowded optic discs and their associations with ocular and general parameters. METHODS: The Beijing Eye Study included 4,439 subjects out of 5,324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. The present investigation consisted of 8,594 eyes (96.8%) of 4,324 subjects (97.4%) for whom readable fundus photographs of at least one eye were available. The main outcome parameter was the presence of crowded optic discs, defined as small discs with an unsharp and slightly prominent disc border without signs of pathology. RESULTS: Crowded optic discs were detected in 265 (3.1 +/- 0.2%) eyes of 168 subjects (84 women). The prevalence rate was 3.8% +/- 0.3% (95% confidence interval: 3.2%, 4.4%) per subject. Crowded optic discs were significantly associated with age (P < 0.05%) and disc size (P < 0.001). They were statistically not associated with gender (P = 0.08), intraocular pressure (P = 0.06), refractive error (P = 0.17), visual field defects (P = 0.53), and best corrected visual acuity (P = 0.57). CONCLUSIONS: Crowded optic discs are present in about 38 out of 1000 adult Chinese in Northern China, with small optic discs as the main associated factor. These data may be helpful for the assessment of a risk for nonarteritic anterior ischemic optic neuropathy.     

OCTA在原发性开角型青光眼中的应用

目的:采用光学相干断层扫描血管成像术(OCTA)观察正常人和原发性开角型青光眼(POAG)患者盘周毛细血管(RPC)层的视盘区血管密度情况,探讨该技术对POAG的诊断能力。方法:本研究为横断面研究,纳入明确诊断为POAG患者45例60眼,健康受试者48例60眼为正常对照组。采用OCTA技术对所有受检者视乳头区扫描,测量视乳头区RPC层血管密度和纵行C/D比值。Humphrey视野检测MD、PSD值。分析血管密度和C/D比值的相关性;采用ROC曲线和AUC评价患者血管密度各参数的诊断效能并进行成对比较。结果:血管密度随着青光眼的加重而降低,视盘内毛细血管密度和视盘内血管密度与MD值及PSD值相关性较弱,其它各血管密度参数与MD值及PSD值具有很强的相关性。全区域毛细血管密度、视乳头周围毛细血管密度、全区域血管密度、视乳头周围血管密度AUC>0.9,具有较高的诊断价值,各参数间均无差异(P>0.05);视盘内毛细血管密度、视盘内血管密度的诊断效力明显低于其它参数(均P<0.05),AUC分别为0.85、0.88。结论:与正常对照组相比,POAG组血管密度明显下降,并且随着病情进展而加重;视盘区血管密度是评估POAG患者结构损伤的良好指标,在POAG的诊断和随访中具有重要意义,而视盘内血管密度和毛细血管密度对POAG的诊断效能明显低于其它血管参数。     

Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography

PurposeTo investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT).MethodsParticipants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch''s membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters.ResultsOne hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI.ConclusionsMyopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.     

视神经炎的临床特征分析及早期视盘和黄斑的改变

目的　研究视神经炎患者的临床特征及早期视盘和黄斑的改变。方法　回顾性分析山西省眼科医院视神经炎患者67例85眼。分析患者基本情况、眼科检查结果及OCT检查结果。结果　67例85眼中，男24例，女43例；28例（41.8%）发生于冬季；49眼（57.6%）入院时最佳矫正视力小于1.7 logMAR。视神经脊髓炎抗体阳性者出院和入院时的最佳矫正视力均较髓鞘少突胶质糖蛋白抗体阳性者差。患眼较健眼视盘周围神经纤维层增厚，杯盘面积比、杯盘垂直比、杯盘水平比、杯容积减小，盘沿面积、视盘面积增大（均为P=0.000）；与健眼相比，患眼早期上方、下方和平均黄斑区神经节细胞层厚度及黄斑区神经节细胞复合体的局部丢失体积、整体丢失体积均未发生明显改变（均为P＞0.05）。视盘水肿与患眼平均视盘周围神经纤维层厚度存在正相关（r=0.728，P=0.000）。结论　视神经炎多发生于女性，早期视力损害严重，视神经脊髓炎抗体阳性者视力预后差。早期由于视盘水肿，视盘周围神经纤维层增厚，盘沿面积、视盘面积增大；杯容积、杯盘比减小，早期病变未累及黄斑区。     

Is There a Racial Difference in Physiologic Cup Size?

Although many clinicians believe that there is a racial difference in the size of the physiologic cup, this premise has not been studied. To evaluate this, we prospectively examined 100 black and 100 white volunteers. Stereoscopic optic disc photographs taken of each subject were masked to block out the fundus pigmentation, randomized, and then evaluated by an experienced clinician. The average cup/disc ratio in blacks (0.35) was significantly greater (P less than 0.0001) than that in whites (0.24) for both right and left eyes. Forty percent of the optic discs of blacks and 14% of the optic discs of whites had a cup/disc ratio greater than or equal to 0.4.     

中国正常人眼眼底断层扫描HRT-Ⅱ测量值

摘要目的应用海德堡视网膜断层扫描仪Ⅱ（HRT-Ⅱ）系统测定中国正常人眼的视盘结构参数。方法随机筛选出不同年龄的正常观察对象200例（400眼）。分为男、女2组进行HRT-Ⅱ检查,得出不同性别、不同眼别视盘参数的正常值。结果得出HRT—Ⅱ系统提供的部分重要视盘参数：盘面积、杯面积、盘缘面积、杯／盘面积比、盘沿／盘面积比、杯容积、盘缘容积、最大杯深、高度变异曲线、平均神经纤维层的厚度、神经纤维层截面积,不同性别及不同眼别问各参数比较差异均无统计学意义（P〉0．05）。结论所得测量值与以往国外所提供的数据有一定差异,较以往国内参考值亦有一定的差异,HRT-Ⅱ在国内应用时的参考值需进行矫正。     

Assessment of the retinal and choroidal microvascularization in polycystic ovary syndrome: an optical coherence tomography angiography study

Purpose

To examine the retinal, peripapillary, choroidal microvascularization and the choroid thickness (CT) of the patients with polycystic ovary syndrome (PCOS) using optical coherence tomography angiography (OCT-A) and compare the results to measurements obtained from healthy controls.

Methods

In total, 47 eyes of 47 patients recently diagnosed with PCOS and 47 eyes of 47 age-matched healthy women were included in this study. An RT XR Avanti instrument with AngioVue software was used for the OCT-A imaging using 6?×?6 mm macular and 4.5?×?4.5 mm optic nerve head scans. Quantitative vessel density results of superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC); flow area and flow density of choriocapillaris; and foveal avascular zone (FAZ) area were analyzed. CT was evaluated by using the measurements obtained from the subfoveolar area.

Results

No significant differences were detected between the groups for any of vessel density results for the SCP, DCP, and RPC as well as the FAZ area. The difference in the choriocapillaris flow area and flow density between the groups was not statistically significant. The choroid was significantly thicker in women with PCOS than in the healthy group (p?=?0.002).

Conclusion

Retinal and choroidal microvascularization was comparable between the women who were evaluated early after diagnosed with PCOS and age-matched healthy controls. Choroid was found thicker in patients with PCOS than in healthy women. OCT-A, as a new and noninvasive imaging method, may help in understanding the effect of PCOS on the posterior segment of the eye.

     

Glaucomatous optic neuropathy evaluation project: a standardized internet system for assessing skills in optic disc examination

Background: Development of a standardized internet‐based system to self‐assess skills in optic disc examination for glaucoma risk assessment. Design: Prospective internet‐based observational study. Participants: Total of 197 participants (glaucoma subspecialists, general ophthalmologists and trainees) from 22 countries. Methods: Forty‐two optic disc images demonstrating a range of features were selected from 2500 monoscopic disc photographs of normal and glaucomatous eyes. Images were presented to clinicians via website ( http://www.gone‐project.com ). Participants were asked to assess nine topographic features and make a subjective assessment of glaucoma likelihood. Main Outcome Measures: Inter‐observer agreement using kappa (κ) or weighted kappa (κ_w). Results: There was substantial level of inter‐observer agreement between glaucoma subspecialists for assessment of glaucoma likelihood (κ_w = 0.63). Inter‐observer agreement was high for haemorrhage (κ = 0.83) and substantial for disc size, disc shape, cup:disc ratio, peripapillary atrophy and cup shape (κ_w = 0.59–0.68). Subspecialists had stronger inter‐observer agreement for glaucoma likelihood and for most disc characteristics than did trainees: the greatest difference being the assessment for retinal nerve fibre layer loss. Analysis of individual disc answers from ophthalmology trainees showed that discs leading to lower agreement of glaucoma likelihood tend to produce lower agreement for the assessment of cup:disc ratio, cup shape, cup depth and retinal nerve fibre layer. Discs with features of moderate to deep cup or cup:disc ratio between 0.6 and 0.8 also lead to lower agreement in glaucoma likelihood. Conclusions: This internet‐based system is a readily accessible and standardized tool, for clinicians globally, that permits self‐assessment and benchmarking of skills in optic disc examination.