Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a peripheral retinal disease characterized by subretinal hemorrhage and/or subretinal pigment epithelial hemorrhage or exudation. It is often misdiagnosed as age-related macular degeneration, polypoidal chorioretinopathy or choroidal melanoma. With the development of multimodal imaging, PEHCR has different features under different examinations, such as B-scan ultrasound, fluorescein fundus angiography, optical coherence tomography and so on, which contributes to differention from other diseases. Clinical treatments for the disease include intravitreal injection of retinal photocoagulation therapy, anti-vascular endothelial growth factor, pars plana vitrectomyand so on, but there is still no universal consensus. In order to gain a deeper understanding of the clinical features, treatment options and prognosis of PEHCR, minimize missed diagnoses and misdiagnoses, and improve treatment efficiency, further research is required.
ObjectiveTo observe the multimodal imaging characteristics of tamoxifen retinopathy. MethodsA retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed. ResultsThe yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia. ConclusionDeposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.
ObjectiveTo observe the multi-modal fundus imaging features of subretinal drusenoid deposit (SDD) in age-related macular degeneration (AMD), and observe image features. MethodsA prospective clinical study. From December 2019 to December 2023, 65 patients (104 eyes) with a diagnosis of AMD-SDD by spectral domain optical coherence tomography (SD-OCT) examination in Shandong Eye Hospital were included. All eyes were examined by best corrected visual acuity (BCVA), traditional color fundus photography (CFP), ultra-wide-angle scanning laser fundus imaging (UWF), multicolor scanning laser fundus imaging (MC) and SD-OCT. The standard MC images were obtained by using Spectralis HRA+OCT for MC examination. The multi-mode image characteristics of SDD were analyzed retrospectively. Area under curve (AUC) was used to evaluate the sensitivity and specificity of CFP, MC and UWF in detecting SDD. ResultsAmong 65 patients with SDD, 29 cases of males (52 eyes) and 36 cases of females (52 eyes) was included. There were 26 patients with unilateral SDD and 39 patients with bilateral SDD. The average age was (71.74±10.97) years. The early, middle and late stages of AMD were 31 (29.8%, 31/104), 24 (23.1%, 24/104), 49 (47.1%, 49/104) eyes, respectively. The SDD detected by CFP, MC and UWF was 76 (73.1%, 76/104), 94 (90.4%, 94/104), 96 (92.3%, 96/104) eyes. CFP showed that the edge of SDD in the macular area was blurred. UWF showed that the dot and the ribbon SDD were light yellow pale discrete deposits and light yellow interlaced network deposits respectively. MC showed the dot SDD had a strong yellow-green circular reflection, while the edge of the ribbon SDD was surrounded by a weak reflection, and the boundary was clear. SD-OCT showed that SDD had strong reflection signal, which was located between the retinal pigment epithelium layer and the photoreceptor cell layer. The dot SDD could break through the ellipsoid zone and caused slight uplift or interruption of the external membrane, showing a cone-like strong reflection signal. While the ribbon SDD showed a continuous "hill-like" protrusion, which hardly broke through ellipsoid zone. The sensitivity and specificity of CFP, MC and UWF for SDD were 73.1%, 90.4%, 92.3% and 61.1%, 94.4% and 83.3%, respectively. ConclusionsMC and UWF show high sensitivity and specificity in diagnosing AMD-SDD, which is superior to CFP. SD-OCT can effectively reveal the location and morphoLogical characteristics of SDD under retina.
ObjectiveTo observe the multimodal imaging characteristics of choroidal metastasis.MethodsA retrospective clinical observation study. From January 2016 to November 2018, 28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People’s Hospital of Yunnan Province were included in the study. There were 12 males and 16 females, with the mean age of 50.8±6.9 years. There were 18 unilateral patients and 10 bilateral patients. The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes). All patients underwent ultra-wide-angle fundus photography, infrared fundus imaging, fundus autofluorescence, FFA, frequency-domain OCT, and B-ultrasound examinations.ResultsIn the ultra-wide-angle fundus photography, metastatic tumors were located in the posterior or middle part of the retina, of which 26 were isolated lesions and 12 were multifocal. A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes). There were 12 eyes with exudative retinal detachment. Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change, and the infrared photograph of the exudative retinal detachment area was relatively low. Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor, 13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor; 3 eyes of old lesions showed " leopard-like” autofluorescence. Among the 38 eyes in the fluorescein angiography, 32 eyes of the early lesions showed low fluorescence, and the venous phase showed a needle-like high fluorescence point, and the post-leakage fluorescence gradually increased. Two eyes with old lesions showed a " leopard-like” change. In 38 eyes, OCT showed wavy ridges of the choroid and pigment epithelium, and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer. B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo. There were 23 eyes with flat shape, 12 eyes with flat hemisphere, and 3 eyes with irregular shape.ConclusionsColor photography of the fundus showed the size, location, pigmentation and peripheral retinopathy of the metastatic lesions. Infrared photography showed different reflex signals in the tumor, exudation, and atrophy. The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion. In the fluorescein angiography, the fresh tumor showed fluorescence leakage, while the atrophic tumor showed transmitted fluorescenc. OCT reflected the height of the lesion and the change of pigment epithelium.
The update of the cognition of fundus diseases is inseparable from the rapid development of fundus multimodal imaging. Especially in recent years, the application of wide and ultra-wide fundus photography, ultra-wide fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography angiography contribute to observe the peripheral retinopathy more directly. The application of adaptive optics and fluorescence lifetime imaging ophthalmoscopy contribute to have a further understanding of fundus diseases at the cellular and metabolic level. Multimodal imageing reflect the pathological characteristics of the diseases from different angles and levels. At the same time, the digitization and intelligence of fundus images are also developing rapidly. However, there are some problems that the ophthalmologists needs to consider further, such as the correctly understanding the use of multimodal imaging, the application of artificial intelligence, and how to sum up from the images.
Macular choroidal macrovessel (MCM) is a recently reported rare choroidal vascular abnormality, characterized by a distinctly thickened choroidal vessel extending from the macular area to the temporal periphery area in fundus examinations. MCM may be an abnormal dilatation of the posterior ciliary artery. The diagnosis of MCM relies on multimodal imaging examinations, with indocyanine green angiography and optical coherence tomography being particularly critical, while optical coherence tomography angiography serves as an essential supplementary and non-invasive alternative. Due to its rarity, ophthalmologists generally have limited awareness of MCM. In clinical practice, it is essential to be familiar with the clinical manifestations and imaging characteristics of MCM, to improve diagnostic levels, enhance differentiation capabilities, and minimize the occurrence of misdiagnosis.
ObjectiveTo observe and analyze the multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia (SO). Methods A retrospective study. From October 2012 to December 2021, 28 patients (36 eyes) diagnosed SO in the Department of Ophthalmology, Beijing Tongren Hospital were inclued in the study. There were 19 males (25 eyes) and 9 females (11 eyes), with the mean age of 51.61±12.02 years. There were 8 exciting eyes and 28 sympathizing eyes. The time to onset after trauma or surgery was 46.10±107.98 months. All patients underwent examinations including vision test, color fundus photograph, optical coherence tomography (OCT), fundus fluorescence angiography (FFA), indocyanine green angiography (ICGA). Angio-OCT (OCTA) was performed on 3 eyes and fundus autofluorescence (AF) was performed on 8 eyes. The early and late phase were defined respectively as ≤2 months and ＞2 months. Their multimodal imaging characteristics were summarized. ResultsIn 8 exciting eyes, subretinal fibrosis with mutifocal retinal atrophy and pigmentation was noted in 5 eyes (62.50%, 5/8), the other 3 eyes showed sunset glow fundus (37.50%, 3/8). In 28 sympathizing eyes, in the early phase, the fundus photograph showed shallow retinal detachment with optic disc edema in 9 eyes (32.14%, 9/28); in the late phase, peripapillary yellowish-white subretinal lesions in 11 eyes (39.29%, 11/28). In the late course of the disease, there were yellow-white lesions around the optic disc (peridisc) and peripheral subretinal area in 11 eyes (39.29%, 11/28). Dalen-Fuchs nodules were found in 10 eyes (35.71%, 10/28). On OCT, multiple serous retinal detachment and irregular choroidal folds were noted in the early phase; hill-like subretinal hyperreflective elevation was noted in peripapillary area and subfovea with presence of cystic spaces in the intraretina in the late phase. FFA examination showed "pinpoint-like" strong fluorescence in the early stage, and "multi-lake-like" fluorescein accumulation and leakage in the late stage; "map-like" weak fluorescence around the disc in the early stage of the disease, dot-like strong fluorescence lesions in each quadrant of the peripheral retina, and fluorescence in the late stage of the disease course. enhanced. ICGA examination showed that the FFA strong fluorescence lesions in the middle and late stages were weak fluorescence. FAF examination, point-like strong and weak autofluorescence lesions with unclear boundaries. Nine sympathizing eyes with subretinal yellow-white lesions has vision without light-0.1 (significantly decreased vison), while 8 eyes with sunset glow fundus was 0.5-1.0 (mildly decreased vison). ConclusionsSO could not only show the semblable features of acute phases of Vogt-Koyanagi-Harada syndrome, but also the yellowish-white lesions in the peripapillary area, macula and periphery. Most of the eyes with peripapillary lesions has a significantly decreased vison, while the eyes with sunset glow fundus has a mildly decreased vison.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.