ObjectiveTo observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy. MethodsIt was a retrospective case series study. Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014. There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years, mean axial length was (29.23±1.77) mm. The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT), including macular retinoschisis only group (MRS group, 18 eyes), foveal retinal detachment group (FD group, 13 eyes) and full-thickness macular hole group (MH group, 16 eyes). All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA), intraocular pressure, axial length, A or B- ultrasonography, fundus photography, OCT and microperimetry examinations. The average logMAR BCVA of 47 eyes was 1.43±0.52. The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45±167.61) μm. All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling. The mean follow-up period was 23.4 months. The changes of logMAR BCVA, microperimetry and macular microstructural were observed. ResultsAt the final follow-up, the logMAR BCVA of 47 eyes was 0.86±0.42, which improved compared with the preoperative vision (t=7.36,P<0.001). The mean CRT of eyes in MRS and FD group was (250.90±91.81) μm, which improved compared with the preoperative CRT (t=8.17,P<0.001). In MRS group, the retina was attached in 18 eyes. In FD group, the retina was attached in 11 eyes, MH was observed in 2 eyes. In MH group, recurrent retinal detachment was observed in 1 eye. The differences of logMAR BCVA and retinal sensitivity among MRS, FD and MH groups were significant (χ2=6.38, 11.08; P=0.030, 0.004). ConclusionThe macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.
ObjectiveTo analyze the diagnostic value of multicolor scanning laser imaging (confocal scanning laser ophthalmoscopy, cSLO) combined with swept-source optical coherence tomography (SS-OCT) for lacquer cracks (LC) and myopia stretch lines (MSL) of pathological myopia.MethodsA observational study. A total of 83 eyes of 58 patients with pathological myopia were recruited from May 2017 to January 2018 in Department of Ophthalmology of The First People’s Hospital Affiliated to Shanghai Jiao Tong University. Among 58 patients, 20 were males (30 eyes) and 38 were females (53 eyes). The mean age was 50.65±12.02 (range from 24 to 70) years old; the average BCVA was 0.37±0.32; the average diopter was −11.38±4.96 D; and the average axial length was 28.91±2.15 mm. All participants underwent FFA and ICGA examination to obtain FFA, ICGA, infrared light reflection (IR) and autofluorescence (AF) images. SS-OCT was applied for scanning macular and optic disc at 9 mm × 9 mm range. cSLO was performed with macular as the center. All images were inspected carefully by three independent observers and the consistency test was detect. LC were diagnosed as hyperreflective line in FFA and hypofluorescent linear lesions in late ICGA. MSL were defined as both hypofluorescent linear lesions in FFA and late ICGA. The accuracy of each inspection item in the diagnosis of LC was detected. The optimal technique was applied with SS-OCT to further explore the detection rate of LC.ResultsThe intra-observer reproducibility was good to excellent for all measurements (Kappa=0.938, P＜0.01). The positive detection rate of LC and MSL was highest in the standard images of cSLO (77.1%), followed by SS-OCT red free (73.1%), fundus photography (72.3%), IR (72.3%) and AF (49.4%). The cSLO was optimal in the test consistency (Kappa=0.520, P＜0.01) and accuracy (the area under the receiver operating characteristic was 0.750). SS-OCT and cSLO were jointly applied to diagnosis of LC and MSL in high myopia. The positive detection rate of LC, MSL and LC+MSL were 91.7%, 91.2% and 93.3% respectively. The characteristics of LC in SS-OCT were irregularities and discontinuous of the RPE-Bruch membrane line, discontinuous inner ellipsoid zone, thinner choroid, an increased light penetrance into deeper tissues, and RPE fracture in severe cases. MSL was mainly manifested as RPE clumps, visible large choroidal vessels protruding and pushing the overlying RPE toward the vitreous.ConclusionsThe diagnosis rate of LC in pathological myopia by cSLO is 77.1%. The standard images of cSLO combined with SS-OCT can diagnose LC, MSL and LC+MSL at rates of 91.7%, 91.2% and 93.3% respectively.
Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) were retrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes，branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT，MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1. The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r＝－0.429，P=0.069) as well as the correlation between CMT and MS (r＝－0.433，P=0.058). The difference of CMT between the unstable and stable group was significant (F=3.262, P=0.039）. The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3.173, P=0.044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location.changes, and PRL occurs.
ObjectiveTo analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. ResultsThe κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). ConclusionThe comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.