眼挫伤后脉络膜病变FFA及ICGA的对比观察

目的 应用荧光素和吲哚青绿眼底血管造影，了解眼挫伤后脉络膜血管的病变。方法 应用德国Heidelberg共焦激光扫描眼底血管造影技术对眼挫伤患者16例（17眼）进行荧光素和吲哚青绿血管造影检查，观察脉络膜血管的异常变化。结果 17眼中，眼底荧光素血管造影显示视网膜血管充盈时间和血管形态大致正常，显示高网膜渗漏5眼。眼底吲哚青绿血管造影显示局限性脉络膜充盈延迟16眼、血管扩张5眼、荧光遮蔽2眼及吲哚青绿渗漏8眼。结论 由于脉络膜血管主要供应视膜外层，因此外伤性视网膜脉络膜病变对视功能影响很大，吲哚青绿血管造影提供了对各种程度脉络膜血管损害的分析依据。     

正常人吲哚青绿眼底血管造影的动力学观察

目的 探讨正常人脉络膜血液动力学表现特征。 方法 对50例正常人行常规吲哚青绿眼底血管造影术。 结果 眼底荧光最早出现时间平均为(14.25±3.59)秒,位于眼底后极部脉络膜动脉开始充盈的表现。脉络膜静脉开始充盈时间平均为(15.03±3.44)秒，显示脉络膜动静脉交叉重叠荧光充盈像。紧接(16.75±3.78秒时，眼底后极部出现具有一定形态的最强荧光区，为脉络膜动静脉及毛细血管像荧光表现。脉络膜静脉荧光减弱时间平均11′58″15±2′39″86,显示脉络膜静脉后期像。于造影22′13″22±3′30″55为荧光消退像，表现为朦胧荧光。 结论 正常人群吲哚青绿眼底血管造影血流动力学的各测定值及荧光表现特征,可为临床诊断脉络膜疾病提供参照依据。(中华眼底病杂志,1998,14:68-71)      

三种降眼压药物对眼部血流的影响

目的 观察３种常用的降眼压药物连续滴用１周后对眼部血流的影响。方法 选择原发性开角型青光眼或高眼压症患者３２例,分为３组,分别滴用０．５％左旋丁萘酮心安、０．５％噻吗心安及０．１％地匹福林１周,均为每日２次。将患者滴药前、后１周在激光扫描眼底镜下拍摄的荧光素、吲哚青绿视网膜和脉络膜务管造影录像带作为分析资料,利用计算机视频图像处理技术和相应测量软件,以单盲测量３组患者的眼部血流动力学目标。在正式测     

芪明颗粒对糖尿病患者脉络膜循环的影响

目的:探讨芪明颗粒对糖尿病患者眼部特别是视网膜及脉络膜血液循环的影响.方法:根据眼底造影结果将所有患者分为两组:无糖尿病视网膜病变组(no diabetic retinopathy,NDR)和非增殖型糖尿病视网膜病变组(nonproliferative diabetic retinopathy,NPDR),运用眼底血管造影检查评价糖尿病患者视网膜及脉络膜的血液循环状态及造影特征,重点观察服药前和服用芪明颗粒后的视网膜及脉络膜动脉的充盈时间,利用精确数据评价芪明颗粒对糖尿病患者眼部血液循环的影响.结果:在服用芪明颗粒3mo后NDR和NPDR两组糖尿病患者视网膜及脉络膜动脉充盈时间均加快,充盈倒置及脉络膜晚期斑点状强荧光的发生率明显下降.结论:芪明颗粒可以使视网膜及脉络膜的血流加快,改善糖尿病患者眼部血液循环状态,延缓糖尿病视网膜病变的发生和发展.     

老年黄斑变性共焦扫描激光多普勒视网膜血流分析

目的　以德国海德堡共焦扫描激光多普勒视网膜血流分析仪 (Heidelberg retinal flowmeter,HRF)探讨老年黄斑变性 (age- related m acular degeneration,AMD)的视盘及黄斑部视网膜血流动力学的变化及与吲哚青绿血管造影 (indo cyanine graen angiography,ICGA )中脉络膜毛细血管充盈时间 (choriocapillaris filling phase,CFP)的关系 ,评价施图伦 (Augentropfen Stulla Mono)滴眼剂对视盘及黄斑部视网膜血流动力学的影响。方法　对 42例(5 6只眼 ) AMD患者 ,38例 (38只眼 )正常对照组 ,其中渗出型 2 4例 (2 9只眼 ) ,萎缩型 18例 (2 7只眼 ) ,采用眼底彩色照像、眼底荧光素血管造影 (fundus fluorescein angiography,FFA)、ICGA及 HRF检查。结果　渗出型 AMD患眼视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均较对照组减低 ,血流量及流速差异均有显著性 (P <0 .0 5 ) ,红细胞移动速率及黄斑部视网膜的血流量差异均有非常显著性 (P <0 .0 1) ,萎缩型 AMD患眼视盘的血流量、流速及红细胞移动速率均较对照组减低 ,差异均有显著性 (P <0 .0 5 ) ;渗出型较萎缩型 AMD黄斑部视网膜的血流量非常显著减少 (P =0 .0 0 3) ;施图伦滴眼剂治疗后视盘血流量有一定程度的增加 (P =0 .0 5 2 ) ,视盘血流速、红细胞     

胰激肽原酶治疗早期糖尿病性视网膜病变的初步研究

目的：探讨早期糖尿病性视网膜病变（diabetic retinopathy,DR)对视盘及黄斑部视网膜血流的影响及与吲哚青绿血管造影（indocyanine green angiography,ICGA)中黄斑部脉络膜血管充盈时间（choriocapillaris filling phase,CFP)、黄斑中心凹无血管区（foveal avascular zone,FAZ)的关系，评价胰激肽原酶肠溶片（pancreatic kiniogenase tablets，商品名：怡开）对视盘及黄斑部视网膜血流动力学的影响。方法：对30例（60只眼）早期DR及49例（98只眼）正常对照组进行ICGA与荧光素血管同步造影及共焦扫描激光多普勒视网膜血流分析仪(heilberg retina flowmeter,HRF)检查。结果：早期DR组的视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均低于正常对照组，二者差异有非常显著性意义（P＜0．01）；经怡开治疗后视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均较治疗前有显著或非显著性意义（P＜0．01或P＜0．05）；CFP与黄斑视网膜的血流量、流速及红细胞移动速率呈负显著相关（P＜0．05）。结论：早期DR视盘及黄斑部视网膜毛细血管血流已发生改变，怡开可能改善DR患者的微循环障碍，HRF可评价其治疗效果。     

PRP对DR患者视网膜血液循环时间及血流动力学的影响

目的：分析全视网膜激光光凝(PRP)手术对糖尿病视网膜病变(DR)患者视网膜动静脉循环时间及血流动力学的影响,为临床治疗提供参考。

方法：选取2013-05/2018-02期间在本院接受PRP治疗的DR患者80例80眼。分别于治疗前和治疗后3mo使用眼底荧光造影系统记录视网膜静脉分支主干发生层流时间和全部充盈时间(V1和V2)、视网膜动脉分支主干显影时间和全部充盈时间(A1和A2),并计算视网膜动静脉经过时间(V2-A1)、视网膜动脉经过时间(A2-A1)、视网膜静脉经过时间(V2-V1)及视网膜毛细血管经过时间(V1-A2); 使用全自动生化分析仪检测红细胞聚集指数、血细胞压积、血浆粘度、全血粘度高切及全血粘度低切; 使用彩色多普勒超声诊断仪记录眼动脉阻力指数(RI)、收缩期最大血流速度(PSV)和舒张末期血流速度(EDV)。

结果：治疗后3mo,本组患者V1-A2时间较治疗前显著延长,红细胞聚集指数、血细胞压积、血浆粘度、全血粘度高切及全血粘度低切较治疗前显著降低,RI较治疗前显著降低,EDV、PSV较治疗前显著升高,差异均有统计学意义(P<0.05)。

结论：PRP手术对DR患者视网膜动静脉循环时间及血流动力学均会产生一定的影响,对视网膜毛细血管经过时间的影响较明显。     

视网膜静脉阻塞眼底荧光素和吲哚菁绿同步血管造影的对比研究

目的 明确吲哚菁绿眼底血管造影（ICGA）在检查视网膜静脉阻塞（RVO）中的临床应用价值。方法 使用海德堡共焦激光扫描检眼镜（HRA），对82例RVO患者进行同步的眼底荧光血管造影（FFA）和ICGA检查。结果 （1）182例RVO在ICGA的全过程中均可清晰地看到视网膜血管充盈情况，14例因出血较多FFA中看不清血管充盈情况。（2）64例ICGA可见阻塞区视网膜毛细血管呈瘤状扩张，其中有12例因出血较多FFA中看不清。（3）分枝静脉阻塞病例，ICGA比FFA更清楚地观察到动静脉交叉压迫情况，有6例在阻塞点静脉内可见到栓子存在。（4）FFA有2例，ICGA有8例可见到脉络膜血管扩张，2例可见脉络膜充盈缺损。结论 将ICGA与FFA结合用于RVO检查比单纯FFA能为临床提供更多的信息。     

非增生期糖尿病视网膜病变患者眼轴长度对眼底血管充盈状态的影响

目的 观察眼轴长度对非增生期糖尿病视网膜病变（diabetic retinopathy, DR）患者眼底血管充盈状态的影响。设计 前瞻性病例系列。研究对象 甘肃省第二人民医院眼科及内分泌科住院的无视网膜病变的糖尿病及非增生期DR患者254例（254眼）。方法 所有患者均行荧光素眼底血管造影观察记录臂-视网膜循环时间、荧光动脉期、动静脉期及静脉期时间,记录视网膜荧光动脉期-静脉期（视网膜A-V）荧光充盈期平均时间。采用眼科A超测量眼轴长度,根据眼轴长度分为三组：正常组（22~24 mm）,长眼轴组（>24 mm且<26 mm）,超长眼轴组（≥26 mm）。对比观察不同眼轴长度组眼底血管充盈状态异同。主要指标 臂-视网膜循环时间、视网膜A-V荧光充盈期平均时间及眼轴长度。结果 眼轴正常组、长眼轴组和超长眼轴组臂-视网膜循环时间平均分别为（10.94±0.46）s、（10.42±0.51）s和（10.36±0.64）s（F=1.289,P=0.252）;视网膜A-V荧光充盈期平均分别为（13.56±2.04）s、（9.15±1.36）s和（6.36±1.15）s（F=103.364,P=0.000）;超长眼轴组与眼轴正常组比较眼底血管充盈时间变快（F=108.863,P=0.000）,超长眼轴组与长眼轴组比较眼底血管充盈时间变快（F=175.516,P=0.000）。结论 随着非增生期DR患者的眼轴长度增加眼底血管充盈时间缩短,血流充盈变快,从一个侧面反映了眼轴长度对非增生性DR患者视网膜血流动力学的影响。     

糖尿病脉络膜病变的研究进展

糖尿病脉络膜病变近年来日益受到国内外学者的重视,并从组织病理学、血流动力学等方面对其进行了研究.组织病理学发现糖尿病视网膜病变患者脉络膜血管均有变性,脉络膜毛细血管管腔狭窄、闭锁或瘢痕,并可见脉络膜新生血管及纤维组织增生;血流动力学则从博动性眼血流测定、彩色多普勒超声、激光多普勒血流仪及吲哚青绿血管造影等方面描述脉络膜循环障碍.本文就各项研究结果作一综述.     

Subtraction ICG angiography in Harada''s disease

BACKGROUND/AIM: The significance of indocyanine green (ICG) angiography (ICGA) in Harada's disease still awaits clarification in many respects. This study investigates the details of choroidal lesions observed in Harada's disease by the subtraction method. METHODS: Eight patients with Harada's disease were followed with ICGA. ICG angiograms were obtained with a Topcon high resolution digital fundus camera and processed with a Topcon IMAGEnet computer system. Image subtraction was conducted for analysing serial angiograms taken at about 2 second intervals during the dye transit phase and those taken in the early and middle phases of angiography. RESULTS: Standard ICG images of acute stage disease showed delayed choroidal filling in the early phase. Mid phase angiograms showed areas with bright fluorescence of variable intensity, indicating intrachoroidal ICG leakage. With image subtraction of angiograms with an interval of seconds the choroidal vessels could be imaged sequentially, with the choroidal arteries visualised first, followed by the definition of the choriocapillaris and then the choroidal veins. The choroidal veins with delayed filling were visualised as positive images in serial subtraction angiograms. Subtraction with an interval of minutes showed uneven background fluorescence and bright fluorescence corresponding to the areas of intrachoroidal ICG leakage. After the disease subsided with steroid therapy, angiography revealed an improvement in delayed choroidal filling. Image subtraction by the second allowed a clear visualisation of improved choroidal venous filling, while subtraction by the minute showed homogeneous background fluorescence, eliminating brighter areas. CONCLUSION: Subtraction ICGA demonstrated that delayed filling of the choroidal veins of varying severity occurs in association with hyperpermeability of the choroidal vessels in the course of Harada's disease.     

Digital indocyanine-green angiography in chorioretinal disorders.

The authors performed digital indocyanine-green angiography in 37 patients with chorioretinal disorders. Eighteen patients had choroidal neovascularization, 7 patients had atrophic age-related maculopathy, and 12 patients had uncommon choroidal and retinal disorders. A Topcon indocyanine-green camera was integrated with a digital (1024-line resolution) angiography system. Compared with conventional video or photographic indocyanine-green angiography, this technique offers enhanced image resolution, the possibility of direct qualitative comparison with fluorescein angiography, image archiving, hard-copy generation, and tracing capabilities to plan laser treatment strategies and monitor the adequacy of laser therapy after surgery.     

An image processing approach to characterizing choroidal blood flow

Indocyanine green (ICG) dye angiography has made possible routine visualization of choroidal blood flow in the human eye; however, to date, its clinical utility has been limited. An overlying layer of densely pigmented tissue and the complex, multilayered vascular structure of the choroid combine to produce angiographic images of low contrast which are difficult to interpret. Conventional image processing can enhance individual images of the blood vessels, but this approach contributes no information about the dynamics of blood flow. Using relatively inexpensive, commercially available personal computer hardware, angiographic image processing algorithms were developed which appear to characterize uniquely a subject choroid in terms of various blood flow parameters. We believe this to be the first successfully demonstrated approach to routinely characterizing the human choroidal circulation in a way that conserves spatial distribution of blood flow dynamics across the entire observed choroidal area. The computer system allows acquisition of digital images from photographic film negatives; alternatively, real-time direct digitization of images from a high-resolution video camera is possible. Once acquired, the digitized data are manipulated according to various algorithms that employ time-sequence analysis to generate two-dimensional curves or three-dimensional surfaces which characterize the choroidal circulation. The unique correspondence of each three-dimensional surface to the subject choroidal circulation from which it was derived is demonstrated. Grouping the characteristic three-dimensional surfaces according to various topographic features in common may provide a basis for discriminating between normal and abnormal choroidal circulations.     

Simultaneous digital ICG and fluorescein videoangiography with the personal computer

BACKGROUND: Since the invention of the simultaneous ICG and fluorescein (SIF) videoangiography in 1995 none of the available SLOs were significantly improved. Digital video recording with a PC can simplify and improve the quality of the angiography. METHOD: SIF angiography images of a two-wavelength scanning laser ophthalmoscope were digitized with a personal computer and written to disk with at rate of 25 images/s as a non-compressed digital video file. The digitized image sequence could be replayed with any standard video player and converted to different image and video file formats with a file conversion utility, developed specifically for the needs of SIF angiography. RESULTS: Recording of digital SIF videoangiograms with a personal computer is not more complicated than the conventional video method. Since most of the parameters of the recording software are customizable, processing methods can be tailored to individual needs. Off-line processing and/or storage of the images in a digital database are possible immediately after recording. To facilitate localization of the pathological landmarks on the fundus the two channels of the SIF angiograms can be observed as combined red-green images. CONCLUSIONS: Compared to conventional videoangiography, digital SIF videoangiography has only advantages: the image quality is better, it is less complicated and not more expensive than the conventional one. Digital recording should replace the conventional one.     

中心性浆液性脉络膜视网膜病变的视网膜与脉络膜循环研究

目的 :探讨中心性浆液性脉络膜视网膜病变 (中浆 )患者视网膜与脉络膜循环的改变 ,旨在提供病因依据 ,以指导临床治疗。方法 :随机选取我院门诊已确诊为中浆的患者 16例 ( 2 1只眼 ) ,经双眼散瞳后分别行眼底荧光血管造影 (fundusfluoresceinan giography ,FFA)和吲哚青绿血管造影 (indocyaninegreenangiography ,ICGA) ,对比分析其改变。结果 :1 FFA检查 :所有患者均显示明显的晚期渗漏 ;4只眼 ( 19% )合并视网膜色素上皮脱离 (pigmentepithelialdetachment ,PEDS)。 2 ICGA检查 :( 1) 2例脉络膜动脉充盈缺损 ,余 14例早期呈动脉充盈迟缓。 ( 2 )与FFA中渗漏对应的脉络膜高渗透性 ,范围大于FFA中所见。统计学分析具有明显差异 (P <0 0 0 1)。 ( 3 )FFA未发现异常的区域 ,ICGA可见局灶或多灶性脉络膜的高渗透区。 ( 4 )与FFA中对应的PEDS及多个隐匿性的PEDS ;PEDS在ICGA中具有典型特征。结论 :脉络膜循环障碍及渗透性增强是中浆最基本的病理改变。比较FFA与ICGA检查结果 ,我们认为中浆病人脉络膜循环障碍比视网膜循环障碍更为严重。     

A new approach for studying the retinal and choroidal circulation

One advantage of advanced computer technology is the high throughput with which the retinal and the choroidal circulation can be evaluated from new aspects. To study the choroidal circulation, we first reevaluated indocyanine green video angiography to improve the visualization of indocyanine green (ICG) images, then applied computer technology to analyze images obtained by an ICG video camera system. We also developed a new instrument to measure oxygen saturation levels in the fundus using spectral retinal imaging technology. I. Choroidal circulation. 1. Reevaluation of ICG video camera system: For this purpose, the bio-chemical nature of ICG was studied. 1) Spectral absorption of ICG: The peak absorption of ICG in distilled water was 780 nm as measured with a spectrophotometer. Its maximum absorption shifted from 780 nm to 805 nm after gradually mixing ICG with human serum protein. Conjugation time of ICG as well as fluorescein sodium with human serum protein was then measured by a stopped flowmeter. It was found that fluorescein sodium conjugated with human serum protein within a few milliseconds, while ICG required more than 600 seconds before equilibrium of the binding was reached. From these observations, we developed a new ICG video system with dual light sources; one, a 780 nm diode laser for the early dye filling phase, and the other, a 805 nm diode laser for the later phase of ICG angiography. 2) Binding properties of ICG in human blood: Blood samples were obtained from three healthy volunteers after intravenous administration of ICG. The resulting plasma samples were fractionated by agarose gel immunoelectrophoresis and polyacrylamide gel DISC electrophoresis. The electrophoretic pattern obtained by each method was observed with an ICG fundus video system. We also studied the affinity of ICG for lipids that are common molecular components of lipoproteins such as high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Four kinds of ICG solutions mixed with phospholipid, free cholesterol, esterified cholesterol, and triacrylglycerol were observed with the ICG fundus video system. Both electrophoretic studies showed that ICG bound intensely to HDL and moderately to LDL, and only the solution with phospholipid fluoresced brightly when observed with the ICG fundus video system. 2. Residual fundus ICG fluorescence: Residual fundus fluorescence observed in the late phase of ICG angiography may be delineated differently in normal subjects and in patients with age-related macular degeneration (ARMD). We performed ICG angiography on 8 normal subjects aged below 36 years (8 eyes), 9 normal subjects aged above 62 years (9 eyes), and 21 patients with ARMD aged 50 to 88 years (37 eyes). The intensity and pattern of fluorescence from angiograms obtained in the ultra-late phase, 24 hours after dye injection, was recorded and analyzed. In the ultra-late phase, 95% of ARMD eyes with choroidal neovascularization (CNV) showed geographic hypofluorescent lesions. These hypofluorescent lesions occurred in 73% of ARMD eyes without CN, while age-matched normal subjects had no hypofluorescent lesions. The mean intensity of fluorescence in the normal elder subject group was significantly higher than that seen in the normal younger subject group. These findings may reflect aging change and bio-distribution of lipid on the Bruch-RPE complex. 3. The early dye filling pattern of the choroid: We performed ICG angiography on 10 healthy young volunteers aged 22 to 26 years (23.4+/-1.3; mean+/-standard deviation) using an improved ICG video camera system. ICG (50 mg) dissolved in 2 ml in distilled water was injected through the antecubital vein. Although the choroidal dye filling varied among subjects, it always began in the macular area. In the 10 subjects, initial dye filling had two patterns: reticular (n=8) and flush (n=2). The choroidal circulation filled completely before the retinal circulation did. Bright fluorescence in the macula and fast blood flow may be correlated with ample blood volume and abundant blood vessels in the macular area. 4. The spreading pattern of ICG fluorescence in the choroid: The ICG images obtained for observing the early dye filling pattern of the choroid were further processed with a computer-assisted image analyzer. Subtracted images were made using the early ICG frames with a time interval of 0.12 second. Ninety frames of time-sequential images for 3 seconds starting from the initial dye appearance in the choroid were prepared to construct an animated image. In the initial phase of eye filling, patchy fluorescence appeared in the fovea. The fluorescence then spread centrifugally in all directions in a wave-like pulsatile manner towards the peripheral fundus with increasing brightness. Thus an animated video of subtracted images allowed us to evaluate flow dynamics at the level of the choriocapillaris. Using this new approach, pathogenic involvement of choroidal circulation in varied chorioretinal diseases such as central serous chorioretinopathy can be studied with precision. II. Retinal circulation. We developed a new device to study the oxygen saturation (OS) levels in a wider fundus area. We call this device a spectral retinal image (SRI) system. We are pursuing the possibility of this instrument being in clinics to evaluate chorioretinal diseases. 1. Introduction of the device: The instrument consists of a Sagnac interferometer that has been mounted on top of a fundus camera, and a software module which consists of an acquisition module and an analysis module. The image acquisition process takes 6 seconds during which the fundus is illuminated by the white incandescent light of the fundus camera at the regular power settings. OS values in each pixel of the fundus image with a 35-degree view can then be estimated from the respective spectrum that is obtained by Fourier-transforming the interferometer signals. Each OS value is represented by a specific color, and each pixel of the fundus image is painted accordingly. 2. Clinical applications. 1) Control study: OS levels of both retinal arteries and veins within a 1 disc diameter (DD) area around the disc were measured from 20 SRIs obtained from 10 healthy volunteers, and were 96.65+/-3.30% and 56.05+/-4.69%, respectively. Then 30 healthy volunteers were recruited for further study in which the OS values were calculated in five retinal regions: (1) juxta-papillary area within 1.75 DD, (2) fovea within 1.0 DD, (3) papillomacular region within 1.0 DD, (4) superior area of the posterior fundus within 1.0 DD, and (5) inferior posterior area of the posterior fundus within 1.0 DD. The OS level of the juxta-papillary area was the highest, while that of the fovea was the lowest and the other three posterior retinal regions were in the middle. Thus OS levels differed at various areas in the retina with statistical significance. In spite of abundant choroidal circulation in the fovea, the overlying retina may have a relative by low oxygen level. As the retinal pigment epithelium may be efficient enough to block the effect of the choroid optically, our results may indicate that the OS levels represent the OS of the retina. 2) Measurement of OS levels in eyes with retinal circulatory disturbances: Eleven eyes of 10 patients with central retinal vein occlusion (CRVO), which showed various degrees of severity, and 4 fellow unaffected eyes of selected patients were examined by both fluorescein angiography (FAG) and the new SRI system. The fluroescein angiograms were correlated with OS maps that were calculated from the SRI. OS grading demonstrated by OS maps correlated well with severity of CRVO, as estimated by FAG. Thus our SRI system is noninvasive with reproducible results, and may prove to be a useful clinical tool to evaluate the degree of retinal ischemia. 3) Measurement of OS levels in eyes with glaucoma: Forty-seven eyes with open angle glaucoma (OAG) of 47 patients and 21 eyes of 21 age-matched normal subjects were recuited for the study. Twelve eyes with low-tension glaucoma (LTG) were included in the OAG eyes and the rest of the OAG eyes had primary OAG. All patients and normal subjects were examined by SRI. Visual field tests for OAG eyes were done with a Humphrey Field Analyzer using the 30-2 program, Swedish interactive threshold argorithm (SITA). OS levels in the retina at 5 different points: superior, inferior, superio- and inferio-temporal, and nasal region within a juxta-papillary area of 200 microm in diameter were calculated from the SRI. OS levels of retinal arteries were also measured and there were no significant differences between OAG and the control group. OAG eyes showed reduced OS levels in the inferio-temporal retina with statistical significance. This observation was more prominent in LTG eyes. The reduced OS levels observed in OAG eyes correlated well with mean deviation (MD) and the sum of total deviation of the 17 points in corresponding areas in the visual field analysis.     

Improved leukocyte tracking in mouse retinal and choroidal circulation

The purpose of this study is to develop a new method with which to visualize leukocyte dynamics in murine choroidal and retinal circulation. Both pigmented (B10.RIII) and non-pigmented (BALB/c) mice were used in this study. One hundred microl of 0.05% sodium fluorescein was injected via the mice tail vein to outline the vessel, followed by 150 microl (10(7) cells) C-AM labelled leukocytes. Fundus images were obtained with a confocal scanning laser ophthalmoscope. The dynamic image sequences were recorded simultaneously on videotape (S-VHS) and digitally at 25 frames per sec. The digital images were later analysed with a custom-made personal computer-based image analysis system. Both the choroidal and retinal circulation can be visualized in non-pigmented mice in the first few seconds of fluorescein angiography. However, the view of the choroidal and the retinal capillary circulation is soon blurred due to the rapid fluorescein leakage in the choroid. In contrast, in pigmented mice, retinal circulation is clear against the dark background of the choroid, while choroidal circulation is masked behind the pigment epithelial layer and cannot be seen at all. C-AM labelled leukocytes were clearly seen in the retinal circulation of all experimental mice and in the choroidal circulation of non-pigmented mice for as long as 30 min. The number of labelled circulating cells decreased as time clasped. Cells moved rapidly in the retinal arteries, slowing down or even stopping for a few seconds in the capillary system, and then moved slightly faster again through the postcapillary venules and veins. In non-pigmented mice, significant number of cells were seen to have arrested in the choroidal circulation. There was no difference between B10.RIII mice and BALB/c mice in vessel diameters, leukocyte velocities and shear stresses. This method allows the visualization of leukocytes and provides data on their behavior as they move through the choroidal and retinal circulation of non-pigmented mice, and in the retinal circulation of pigmented mice. It provides a valuable new tool for the investigation of real time leukocyte dynamics in murine retinal and choroidal microcirculations both under physiological conditions and during the development of ocular disease.     

Features of abnormal choroidal circulation in central serous chorioretinopathy

AIMS: To evaluate abnormalities in the choroidal circulation in cases of central serous chorioretinopathy (CSC). METHODS: A complete clinical ophthalmological examination was performed using simultaneous fluorescein and indocyanine green (ICG) angiography with a confocal scanning laser ophthalmoscopy and the digital images analysed in 36 consecutive patients with acute CSC. To quantify the choroidal circulation, the foveal choroidal blood flow was measured in 11 patients using laser Doppler flowmetry. RESULTS: Fluorescein angiography showed focal leakage from the retinal pigment epithelium in all patients. ICG angiography revealed delays in arterial filling in 27 eyes (75%), and fluorescein angiography showed small hypofluorescent points around the leakage in 27 eyes (75%). Abnormal choroidal hyperfluorescence was observed in 30 eyes (83%). The choroidal blood flow in eyes with CSC was 45% lower than in fellow eyes (p<0.01). CONCLUSION: Decreased choroidal blood flow in CSC was demonstrated for the first time. The decreased choroidal blood flow might be correlated with the small, localised hypofluorescent areas, which may indicate non-perfused areas of the choriocapillaris that are frequently seen during ICG angiography.     

Regional differences in optic disc and retinal circulation

PURPOSE: To determine regional differences in the circulation of the optic disc, the peripapillary choroid and the retinal vessels using the techniques of computerized image analysis and fluorescein angiography. METHODS: Ten young normal subjects were studied. Fluorescein angiography was performed with a scanning laser ophthalmoscope. The rate of filling of fluorescein or slope was measured in the four quadrants of the optic disc, the peripapillary choroid and the major retinal arteries and veins. A total of 125 points was measured from each image of the fluorescein angiograms for a total of 20 to 30 images. Retinal vessel width was measured using computerized image analysis. RESULTS: Comparison of the rates of filling of fluorescein or slopes showed significant differences from zero among the four quadrants of the optic disc (p= 0.01 to <0.02), of the peripapillary choroid (p=0.01 to <0.05) and among the major retinal arteries (p=0.01 to <0.02) and retinal veins (p=0.02 to <0.05). No significant differences were noted between the quadrants for retinal arterial width with the retinal veins only showing a significant difference between the inferior nasal and inferior temporal vein (p=0.02 to <0.05). CONCLUSION: Evaluation of the circulation of the optic disc, retina, and peripapillary choroid should take into account regional differences among these structures.     

Clinical use and research applications of Heidelberg retinal angiography and spectral-domain optical coherence tomography – a review

Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the 'Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases.