Objective To investigate the serum levels of vitamin B12 and folic acid (FA) of exudative agerelated macular degeneration (AMD).Methods A total of 84 patients with exudative AMD（AMD group）and 78 patients with non-exudative AMD （control group） diagnosed at Xijing Hospital between June 2008 and September 2009 were assessed in this study. Serum vitamin B12 and FA levels were measured by chemiluminescence immunoassay. The statistical information of epidemiology and risk factors exposure histories were collected and compared.Results AMD group had significantly lower serum vitamin B12 levels ［（247.51plusmn;93.92）ng/ml］ compared with the control group ［（312.52plusmn;143.08） ng/ml］，the difference was statistical significance (t=5.013, P＜0.001). Serum FA levels in AMD group ［（5.64plusmn;3.72）ng/ml］ were slightly lower than the control group ［（10.14plusmn;4.48） ng/ml］, the difference was not statistical significance (t=0.780, P=0.437).Conclusion People with lower serum vitamin B12have higher risk of exudative AMD. Low levels of serum vitamin B12 may relate with the occurrence of exudative AMD.
Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
ObjectiveTo investigate the characteristics of fundus image in patients with combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). Methods Eight eyes of 8 cases with CHRRPE were included in this study.There were 5 males and 3 females, ranging from 6 to 21 years old (mean 14.13 years).In all cases, unilateral eye was affected. The best-corrected visual acuity (BCVA) was 0.02 to 0.2. The intraocular pressure in all eyes was normal. The ocular anterior segment in all cases was alright. For all cases, fundus photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral-domain optical coherence tomography (SD-OCT) were taken. The characteristics of fundus image were analyzed. ResultsAll the CHRRPE lesions located at posterior pole, presenting as yellow-white elevations, surrounded by hyperpigmentation. Retinal vascular tortuosity and proliferation of epiretinal membrane were found in all CHRRPE lesions. In 8 affected eyes, lesions were involved in macula and optic disc in 3 eyes (37.5%), lesions were located in macula in 5 eyes (62.5%). AF images showed lesion bulges and the surrounding hyperpigmentation corresponding to the local hypo-AF in 7 eyes (87.5%), dense epiretinal membrane corresponding to the local hyper-AF in 1 eye (12.5%). FFA showed local hypofluorescence of choroidal background corresponding to lesions and the surrounding hyperpigmentation, tortuous retinal vascular due to traction of shrinkage membranes. Retinal capillary leakage and the fluorescence brightness gradually increased in all lesions.No retinal hemorrhage, exudation, area of capillary non-perfusion, retinal and choroidal neovascularization could be found in 8 CHRRPE eyes. SD-OCT showed disorganized and elevated lesion with uneven reflectivity in inner retina, mild attenuation of the retinal pigment epithelium (RPE) and photoreceptor inner segment/outer segment junction in all CHRRPE eyes. Of the 8 CHRRPE eyes, cavernous hypo-reflective shadowing due to the shielded optical signal acquisition below dense epiretinal membranes in 2 eyes (25.0%), membrane-like hyper-reflective signals connecting with RPE in 1 eyes (12.5%). ConclusionsDecreased AF appear in the location of CHRRPE lesion and the surrounding hyperpigmentation. Hypofluorescence of choroidal background can be found in the early phase of FFA, the fluorescence brightness of CHRRPE lesion gradually increases in FFA process. The retinal elevation, attenuated signal reflection of the RPE and photoreceptor inner segment/outer segment junction in CHRRPE lesion can be verified by OCT.
ObjectiveTo observe the imaging features of short-wave length fundus autofluorescence (SW-AF), near-infrared fundus autofluorescence (NIR-AF)and spectral-domain optical coherence tomograph (SD-OCT) in acute central serous chorioretinopathy (CSC). MethodsThis is a retrospective observational consecutive case series study. Eighty-two eyes with acute CSC from 76 patients were enrolled in this study.There were 50 males (56 eyes) and 26 females (26 eyes), average age was (41.32±7.37) years old, average course of the disease was (0.47±1.73) months. The routine clinical examinations included best corrected visual acuity, slit lamp microscope, indirect ophthalmoscope, fundus fluorescein angiography (FFA), SW-AF, NIR-AF and SD-OCT. The imaging features of NIR-AF, SW-AF, SD-OCT and FFA in same eye with acute CSC were analyzed comparatively. ResultsSD-OCT showed retinal pigment epithelium (RPE) detachment corresponding to RPE leakage point on FFA images in all CSC eyes. RPE leakage points in all eyes corresponding to local hypo-NIR-AF, whereas corresponding to normal SW-AF. NIR-AF demonstrated the area of decreased AF corresponding to serous retinal detachment in all eyes, of which, the area of hypo-SW-AF was consistent with that of sensory retinal detachment in 75 eyes. Except for RPE leaking fluorescein in 82 eyes, FFA showed window defects corresponding to clusters of hypo-NIR-AF in 45 eyes, of which, 27 eyes showed hypo-SW-AF appearing concurrently with the locations of window defects of FFA. In 18 eyes, the extent and amount of hypo-SW-AF were less than that of hypo-NIR-AF. ConclusionsThere was local RPE detachment in all eyes with acute CSC. The locations of sensory retinal detachment, local RPE detachment and RPE depigmentation showed hypo-NIR-AF. The locations of sensory retinal detachment and RPE depigmentation showed hypo-SW-AF in most of acute CSC eyes.