Laser photocoagulation control of diabetic macular oedema without fluorescein angiography.

This study included 40 eyes in 22 diabetic patients with focal macular oedema. Laser photocoagulation was directed at decompensated or leaking microvascular lesions clinically detected without using pretreatment fluorescein angiograms. Post-treatment fluorescein angiograms performed after adequate clinical control of disease showed complete resolution of the macular oedema in 25 eyes (62.5%), whereas persistent leakage from microvascular lesions closer than 500 microns from the centre of the foveola was noted in 15 eyes (37.5%). These were clinically detected during the pretreatment examination and were found not to impair or threaten the patient's vision. Our data confirm the clinical impression that fluorescein angiography is not necessary for effective treatment and should be used only if necessary.     

Correlation between intraretinal changes in diabetic macular oedema seen in fluorescein angiography and optical coherence tomography

Purpose: To study the relationship between intraretinal optical coherence tomography (OCT) and fluorescein angiography (FA) findings in eyes with diabetic macular oedema (DMO). Methods: We carried out a retrospective observational case series. Thirty eyes with previously untreated DMO underwent FA and OCT. The same ETDRS template was overlaid on the FA images in order to compare OCT and FA. Transfoveal linear high‐resolution OCT scans (at the 0‐ and 90‐degree meridians) and FA pictures were compared according to the ETDRS rings. Results: Six distinct patterns of intraretinal changes in OCT correlated with changes in FA: (a) focal angiographic leakage did not correspond to any obvious intraretinal abnormality in OCT in four eyes; (b) localized thickening of the outer nuclear layer in OCT corresponded to focal leaking microaneurysm (focal oedema) in FA in 11 eyes; (c) diffuse thickening of the outer nuclear layer in OCT corresponded to diffuse angiographic leakage in 21 eyes; (d) cystoid expansion of the outer nuclear layer was found in seven eyes with a petaloid angiographic pattern of leakage; (e) cystoid expansion of the inner nuclear layer was found in relation to honeycomb angiographic oedema in five eyes, and (f) serous detachment of the fovea in OCT did not correspond to any distinct finding in FA in four eyes. Conclusions: Intraretinal abnormalities found in OCT correlate systemically with changes in FA. Very early DMO morphological changes may be seen better with FA than with OCT. Serous detachment of the fovea is seen in OCT, but not in FA. The combination of OCT and FA is useful in facilitating understanding of the pathophysiological changes that occur in DMO.     

Pathogenesis of diabetic macular oedema

Hyperglycaemia causes breakdown of the blood retina barrier leading to formation of macular oedema and consecutive visual loss. Three major mechanisms are involved in barrier breakdown: increased paracellular permeability of vascular endothelium due to disruption of cell junctions, loss of endothelial cell layer integrity due to cell destruction, and increased transcellular transport through the endothelium. This review focuses on the molecular basis of these mechanisms and discusses the role of cytokines and cellular interactions in blood retina barrier breakdown.     

Correlation study between optical coherence tomography and fluorescein angiography in post-membrane peeling recalcitrant macular oedema

Correlation between optical coherence tomography and fluorescein angiography in a post-membrane peeling patient indicated a surgically disturbed retinal vessel as the cause of recalcitrant macular oedema.     

The importance of fluorescein angiography in planning laser treatment of diabetic macular edema

OBJECTIVE: To test the hypothesis that pretreatment fluorescein angiography (FA) is not necessary for effective laser treatment of patients with clinically significant diabetic macular edema (CSME). DESIGN: Prospective, randomized, controlled treatment simulation. PARTICIPANTS: Six fellowship trained retina specialists. INTERVENTION: The authors compared the ability of four retina specialists (observers) to plan laser treatment with and without the use of FA. One hundred consecutive cases of CSME were selected, each case consisting of a stereo pair of color photographs and a corresponding fluorescein angiogram. These cases were first read by two retina specialists who reached consensus on a treatment plan for each case (standard map). Each of the 4 observers reviewed 50 of these cases on 2 occasions and plotted 2 sets of treatment maps, 1 set created with and 1 without the aid of FA. Each observer's 100 treatment maps were graded for accuracy by comparing them to the corresponding standard maps. The role of FA in improving the accuracy of treatment maps was evaluated using logistic regression analysis to control for different observers, different cases, and different posterior pole characteristics. MAIN OUTCOME MEASURES: Accuracy was defined as the proportion of standard treatment correctly treated by the observer. RESULTS: For the observers as a group, the use of FA improved treatment planning accuracy from 49% to 54.5% (P = 0.02); however, there was significant interobserver variation in performance (P < 0.001). Treatment planning accuracy without and with FA was as follows: observer 1, 40.8% and 40.2%; observer 2, 49.8% and 72%; observer 3, 56.1% and 59.5%; and observer 4, 49.2% and 46.4%. CONCLUSION: The use of FA improves the accuracy of treatment planning for CSME. The authors' study supports the use of FA in laser treatment of patients with CSME.     

The management of diabetic macular oedema

Diabetic macular oedema (DMO) is a significant cause of visual loss in the working population. Focal/grid photocoagulation remains an effective treatment for DMO and the benchmark to which clinicians compare other newer treatment modalities. There are, however, patients who do not respond adequately or who are refractory to laser photocoagulation. This has led to the development of newer treatments such as the intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors as well as intravitreal corticosteroid releasing delivery systems. Cataract formation and raised intraocular pressure remain the major disadvantages of corticosteroid use. There is mounting evidence that intravitreal VEGF inhibitors with or without combined laser photocoagulation will become the gold standard treatment for DMO.     

Serous macular detachment in diabetic cystoid macular oedema

PURPOSE: To define serous macular detachment in patients with diabetic cystoid macular oedema (CME). METHODS: This study involved 78 eyes of 58 patients with diabetic CME. The patients underwent complete ophthalmic examination, fluorescein angiography and optical coherence tomography (OCT). Eyes with epiretinal membrane or vitreo-macular traction were not included in the study. Optical coherence tomography-3 was used in all patients and fundi were scanned on the horizontal, vertical and four oblique planes through the centre of the fovea. RESULTS: In all cases the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. With OCT, 24 of 78 eyes (31%) had serous macular detachment as shown by retinal elevation over a non-reflective cavity with minimal shadowing of the underlying tissues. Fluorescein angiography did not show serous macular detachment in any patient. CONCLUSIONS: Our data showed that the incidence of serous macular detachment in diabetic CME was much higher than previously reported. Optical coherence tomography-3 allows an in vivo cross-sectional observation of very subtle serous macular detachment that is difficult to diagnose at the slit-lamp or by fluorescein angiography in patients with diabetic CME.     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.     

糖尿病性黄斑水肿激光治疗临床分析

目的 了解氪激光治疗糖尿病性黄斑水肿(DMO)的疗效.设计回顾性病例分析.研究对象58例(110眼)DMO患者.方法 根据眼底镜观察、FFA和OCT检查了解DMO环形黄斑格栅光凝或局限光凝治疗前后的改变.平均随访18.9个月(4-64个月).主要指标视力和黄斑水肿情况.结果 110眼DMO经过激光治疗后,视力提高17眼(15.5%),视力稳定不变69眼(62.7%)和视力下降24 眼(21.8%).治疗满意者92眼(83.6%),其中黄斑水肿完全消退59眼(53.6%)和绝大部分消退33眼(30.O%);治疗不满意者(即黄斑水肿改善不明显者)18眼(16.4%).结论 氪激光治疗DMO是一种安全、有效的一线治疗技术,但其疗效受多种因素影响.(眼科,2008,17:242-245)     

高度近视性黄斑出血的荧光素眼底血管 造影和靛青绿血管造影分析

目的探讨高度近视性黄斑出血及眼底变化特征。方法对３５例（３７只眼）眼底有黄斑出血的高度近视患者进行眼底彩色照像和荧光素眼底血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查,其中８只眼行靛青绿血管造影（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｎａｎｇｉｏｇｒａｐｈｙ,ＩＣＧＡ）。结果高度近视黄斑出血的表现：（１）视网膜下新生血管（ｓｕｂｒｅｔｉｎａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＳＲＮＶ）形成导致的黄斑出血（２３只眼）,ＩＣＧＡ显示的ＳＲＮＶ较ＦＦＡ清晰;（２）无ＳＲＮＶ的黄斑出血（１４只眼）,在出血下或边缘有漆样裂纹显露者９只眼;对其中６只眼进行了随访,发现其黄斑出血是由于出血下或其边缘有脉络膜毛细血管和Ｂｒｕｃｈ膜的破裂致新的漆样裂纹形成的缘故。结论高度近视黄斑出血的原因除常见的ＳＲＮＶ形成外,还有尚不伴ＳＲＮＶ的黄斑出血。ＦＦＡ结合ＩＣＧＡ能更早期、准确地确定引起高度近视黄斑出血的这两种表现。     

外伤性黄斑孔的眼底荧光血管造影

本文41例外伤性黄斑孔的眼底荧光血管造影观察:多数发病为青年男性,平均年龄为26.3岁,均为钝挫伤所致,视力低于0.1者为73.1%.6例板层孔造影为不显荧光;9例不全孔为点状或颗粒状透见荧光;26例全层孔呈均匀一致的圆型透见荧光.造影显示了黄斑孔的层次、范围、以及孔周围粘连贴附的程度,对其诊断、治疗有重要价值.     

Stereoscopic fluorescein angiography in diabetic maculopathy

PURPOSE: To explore the possible differences in the depth location of microaneurysms in focal as well as diffuse diabetic macular edema. METHODS: The density of superficial and deep retinal microaneurysms was assessed using a stereoscopic fluorescein angiographic method. RESULTS: The density of deep retinal microaneurysms was nearly identical in the group with diffuse macular edema (89.9 +/- 28.5 microaneurysms/test grid) and the group with focal macular edema (90 +/- 65.4 microaneurysms/test grid). The density of superficial retinal microaneurysms was significantly lower in the group with diffuse macular edema (22.8 +/- 12.5) than in the group with focal macular edema (47.9 +/- 30.6). The density fraction of superficial retinal microaneurysms was lower in the group with diffuse macular edema (0.19 +/- 0.07) than in the group with focal macular edema (0.36 +/- 0.14). In the group with focal macular edema, areas without edema had a significantly lower density of superficial (6.1 +/- 2.8) and deep (15.6 +/- 7.8) retinal microaneurysms than did areas with edema (superficial: 47.9 +/- 30.6; deep: 90.0 +/- 65.4). In the group with focal macular edema, the density fraction of superficial retinal microaneurysms was nearly identical in areas with (0.36 +/- 0.14) and areas without (0.30 +/- 0.10) edema. CONCLUSION: The development of focal macular edema might be linked to the density of microaneurysms. Diffuse macular edema might be a result of some unknown effect on the deeper retina and/or the choroid.