Optical coherence tomography (OCT) can depict mild papilledema and slight changes in the internal segment and external segment; measure thickness of the retinal nerve fiber layer, retinal thickness and macular volume; detect missing axons and damage to the macular ganglion cell complex. Thus, OCT has important application values and widespread prospects in diagnosis and differential diagnosis of glaucoma and nonglaucoma optic neuropathy, optic nerve diseases and macular diseases, outer and inner retinopathy as well as evaluation of curative effects, followup observation, prognosis and mechanisms in neuroophthalmological diseases. Neuro-ophthalmologists should pay more attention to the exploration and application of OCT in the field of neuro-ophthalmology.
Objective To investigate the relationship of choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment (RRD) in eyes without high myopia. Methods Fifty-three eyes of 53 patients with RRD and without highly myopic eyes after anatomically successful surgical repair were enrolled in this study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. Spectral domain-optical coherence tomography (OCT) was used to assess the postoperative foveal structure, central foveal thicknesses (CFT) and choroidal thickness. The correlation between the postoperative BCVA and abnormality of the fovea, CFT and choroidal thickness was evaluated. According to the postoperative thickness of the choroid, the patients were divided into le;150.00 mu;m group and ＞150.00 mu;m group; the improvement of postoperative BCVA in the two groups was analyzed. The state of inside and outside section (IS/OS) and the external limiting membrane (ELM) was divided into reconstructed and un-reconstructed categories. The postoperative BCVA, CFT and choroidal thickness of two types were comparatively analyzed. Results At the last time of follow up, the mean BCVA was 0.52plusmn;0.47. The results of spectral domain OCT showed that the mean CFT was (207.45plusmn;63.63) and mean choroidal thickness was (175.46plusmn;62.68) mu;m. The postoperative BCVA correlated positively with IS/OS junction and choroidal thickness (r=4.92, 4.63; P＜0.05), but was insignificantly associated with ELM junction, whether subretinal fluids were present or not, whether epiretinal membrane was affected or not, whether there was macular edema or not and CFT (r=0.24, 1.20, 0.30, 0.03, 0.14; P＞0.05). Two weeks to three months after surgery, the improvement of BCVA in ＞150.00 mu;m group was significantly higher than that in le;150.00 mu;m group (t=-2.318, P＜0.05). Compared the reconstructed with un-reconstructed IS/OS eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.253, 2.396; P＜0.05). The difference of mean CFT was not statistically significant (t=1.454，P＞0.05). Compared the reconstructed with un-reconstructed ELM eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.940, 3.563;P＜0.05). The difference of mean CFT was not statistically significant (t=1.117, P＞0.05). Conclusion The choroidal thickness has a significant correlation with visual acuity after successful repair of RRD in eyes without high myopia.
Objective To investigate the risk factors associated with visual acuity after minimally invasive vitrectomy of idiopathic macular hole (IMH). Methods Forty-six IMH patients (50 eyes) who underwent minimally invasive vitrectomy were enrolled in this prospective clinical study. The patients included eight males (nine eyes) and 38 females (41 eyes), with a mean age of (60.7plusmn;9.6) years. All the patients were examined for Snellen corrected visual acuity (CVA), optometry, slit lamp microscope and preset lens, as well as spectral domain optical coherence tomography (SD-OCT). The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The mean logMAR CVA was 0.95plusmn;0.29 (CVA ranged from 0.02 - 0.6). The mean duration was (11.1plusmn;7.8) months. The mean breaking length of inner segment/outer segment (IS/OS) junction was (1566.9plusmn;830.5) mu;m. The mean maximum diameter of the bottom of macular hole was (914.0plusmn;484.8) mu;m. There were 10, 19, 21 eyes with stage two, three and four IMH, respectively. The therapeutic effects were evaluated at three months after surgery. The relationship between visual acuity after surgery and age, duration, visual acuity before surgery, stage of IMH, breaking length of IS/OS before and after surgery, the maximum diameter of the bottom of macular hole, thickness of photoreceptors after surgery were analyzed. The safety of minimally invasive vitrectomy for IMH was observed. Results Three months after surgery, the closure rate of macular hole was 100.0%. The mean logMAR CVA was 0.45plusmn;0.25. The mean thickness of photoreceptors and breaking length of IS/OS were (183.8plusmn;62.6), (477.5plusmn;341.9) mu;m respectively. The mean breaking length of IS/OS after surgery was significantly shorter than before surgery (t=12.679, P＜0.001). The difference of logMAR CVA before and after surgery was statistically significant (Z=6.571, P＜0.001). The logMAR CVA before surgery (r=0.569), duration (r=0.465), breaking length of IS/OS before (r=0.574) and after surgery (r=0.564) had a positive correlation with logMAR CVA after surgery (P＜0.001). The logMAR CVA after surgery was independent of age, the maximum diameter of the bottom of macular hole and thickness of photoreceptors after surgery (r=0.546, 0.361, -0.441; P＞0.05). The logMAR CVA after surgery in eyes with stage four IMH was significant decreased than that in eyes with stage two and three IMH (Z=0.455, 2.556; P＜0.05). Except 17 eyes with complicated cataract and eight eyes with macular epiretinal membrane, there were no other surgery-related serious complications. The cataract eyes had improved visual acuity after phacoemulsification. Conclusion The visual acuity before surgery, duration and breaking length of IS/OS are main influence factors of visual acuity after surgery.
Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.
Objective To observe retinal thickness changes of diabetes patients after shortterm insulin intensive treatment. Methods Thirty-two eyes of 32 diabetes patients with non-proliferative diabetic retinopathy who underwent short-term insulin intensive treatment were enrolled in this study. There were 12 males and 20 females. The patients aged from 35 to 72 years with a mean age of (56plusmn;9) years. The macular edema index (MED) and morphosis parameter of the optic disc including cup area (CA), rim area (RA), cup volume (CV), rim volume (RV), mean retinal nerve fiber layer thickness (mRNFLT), height variation contour (HVC), the ratio of cup/rim area (C/DAR) in all the patients were measured by Heidelberg retinal tomography Ⅱ (HRTⅡ) before treatment and at the 1st, 3rd and 6th month after treatment. The repeated measurement and leastsignificant difference (LSD) pairwise comparison statistical methods were used to analyze the data. Results At the 1st, 3rd and 6th month after treatment, the 1string and the 2nd-ring MED both decreased after treatment, which were significantly different compared with before treatment (1st-ring: t=2.169, 2.261, 2.306; P＜0.05. 2nd-ring: t=2.293, 2.147, 2.038; P＜0.05).There was no significant difference on the 3rd-ring MED between before and after treatment (t=1.719, 1.145, 1.280; P＞0.05). There was no significant difference in CA, RA, CV, RV, mRNFLT and C/DAR between before and after treatment. There was significant difference in HVC between before treatment and at the 1st month after treatment (t=-2.242, P=0.037), but no significant differences at the 3rd and 6th month after treatment (t=-1.485, -0.527; P＞0.05). Conclusions The MED of diabetes patients decreases within six months after short-term insulin intensive treatment, but there is no obvious change in morphosis parameters of the optic disc.
Objective To analyze the correlation and difference of axial length (AL) measurements by comparing magnetic resonance imaging (MRI) of different pulse sequence with IOL Master of normal eyes. Methods The 67 emmetropic volunteers were selected by the slit lamp microscope, direct ophthalmoscope and refractive examination in this study. The patients included 30 males and 37 females. The patientsprime; ages ranged from eight to 21 years, with a mean age of 14.9 years. Fast spin echo (FSE) T1WI, FSE T2WI, fluid attenuated inversion recovery (FLAIR) T2WI, FSPGR T1WI were performed. The axial (AX) and oblique sagittal (OS) sections were taken and the AL from MRI section with different sequences were measured. The AL taken by IOL-Master was used as standard. The difference and correlation between measurements of two methods were analyzed. Results The AL of AX FSE T1WI, AX FSE T2WI, AX FLAIR T2WI, AX FSPGR T1WI, OS FSE T1WI, OS FSE T2WI, OS FLAIRT2WI and OS FSPGR T1WI were (24.14plusmn;0.81), (24.26plusmn;0.81), (23.87plusmn;0.79), (24.11plusmn;0.82), (24.08plusmn;0.86), (24.22plusmn;0.81), (23.84plusmn;0.79) and (24.03plusmn;0.81) mm, respectively. The AL of IOLMaster was (23.91plusmn;0.80) mm. The differences of AL between IOL-Master and various MRI sequences were statistically significant (t=－13.54,－23.20, 4.08, －15.55, －8.00, －23.22, 5.25, －10.62;P＜0.01). There were excellent correlations between IOL-Master and various MRI sequences (r=0.97, 0.96, 0.98, 0.97, 0.96, 0.80, 0.98, 0.97;P＜0.01). Conclusion There are differences and significant correlations between MRI sequences and IOL-Master.