Chronic central serous chorioretinopathy (CSC) usually demonstrates frequent recurrence, diffuse leakage and persistent subretinal fluid, which cannot be absorbed, thus lead to photoreceptor damage and poor visual acuity. As glucocorticoids have been implicated in the pathogenesis of chronic CSC, various anti-glucocorticoids oral drugs were used in the clinic to promote retinal fluid absorption and reduce the central retinal thickness of the macula and improve the vision outcomes. In addition, the 5α-reductase-specific inhibitor finasteride, the P450-3A4 inducer rifampicin, circadian rhythmic regulator melatonin, and systemic anti-inflammatory drug methotrexate have also been put into clinical trials for chronic CSC, and achieved certain effects. However, most of the clinical studies on these oral drugs were case reports, but not multi-center randomized clinical trials. The long-term effects of these oral drugs need to be observed and studied further.
ObjectiveTo observe the changes of macular vascular density of hypertensive patients without obvious hypertensive retinopathy (HRP).MethodsTwenty-three patients (hypertension group) diagnosed as grade 2 or grade 3 essential hypertension in Cardiology Department of Renmin Hospital of Wuhan University from January to April 2019 were enrolled in the study. Among them, there were 13 males and 10 females. The mean age was 61.6 ± 5.6 years, and the mean BCVA was 0.74 ± 0.16. The course of hypertension was more than 7 years; Keith Wagener (K-W) grade was 0 or 1. Fifteen age-matched people without hypertension were selected as the control group, among which included 8 males and 7 females. Their average age was 59.7 ± 4.4 years and the average BCVA was 0.79 ± 0.17, the K-W grades were 0. There was no significant difference (P=0.265, 1.000, 0.563) between the two groups in age (t=1.739), sex ratio (χ2=0.036) or BCVA (t=0.585). All subjects were examined by BCVA, fundus photography and OCTA. OCTA scanned the macular area in the range of 3 mm × 3 mm. The software automatically divided the image into two concentric circles with the macular fovea as the center, which are the inner ring with a diameter of 1 mm (foveal area) and the outer ring with a diameter of 1-3 mm. The blood flow density of the whole, temporal, upper, nasal and lower capillary layers within 3 mm of the macular area, and foveal avascular zone (FAZ) area, central foveal retinal thickness (CFT) were measured.ResultsSignificant differences were observed in the vascular densities of total, temporal, nasal and inferior area of maculas (t=2.188, 2.472, 5.105, 2.734; P=0.037, 0.020, 0.000, 0.010) between the two groups, while no significant differences were evidenced in foveal vascular densities and superior vascular densities (t=0.575, 0.140; P=0.570, 0.889). There was no significant difference in FAZ area or CFT between the two groups (t=0.367, 0.753; P=0.714, 0.457). Macular arches were intact in all hypertension patients.ConclusionsThe vascular densities of total, temporal, nasal and inferior area of maculas in the hypertension patients without HRP decreased. The area of FAZ did not expand, and the structures of macular arch ring were normal.
Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT), and explore its correlation with diabetic retinopathy (DR) stages and systemic factors. Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study. There were 75 males (138 eyes) and 60 females (104 eyes), the ages were from 29 to 83 years, with an average age of (58.8±11.1) years. The general information such as height, weight, smoking history and blood glucose [such as glycosylated hemoglobin (HbA1c)], blood pressure, blood lipid, 24 hours urine protein and other examinations were collected. The diagnosis of DR and DME were made, and the staging of DR and typing of DME were performed based on fundus color imaging and OCT. DR were divided into mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). DME were categorized into 4 types including sponge-like retinal swelling (SME), cystoid macular edema (CME), serous retinal detachment (SRD) and posterior hyaloid traction (PHT). The correlation between DME types and DR staging were analyzed byχ2 test and Fisher exact test. Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors. Results In 242 DR eyes the proportions of mild, moderate, severe NPDR and PDR were 30.99%, 32.64%, 23.14% and 13.23%, respectively. There were 199 eyes (82.23%) with DME. There were statistically significant differences in the proportion of DME in different stages of DR (χ2=21.077,P＜0.01). In the 199 eyes with DME, There were 165 eyes (68.18%) of SME, 22 eyes (9.09%) of CME, 7 eyes (2.89%) of SRD and 5 eyes (2.07%) of PHT. The distribution of DME patterns in different stages of DR was statistically significant (χ2=156.273,P＜0.01). Logistic regression analysis showed that the duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME [odds ratio (OR)=1.090, 1.510, 4.123;P＜0.05], and were also independent for SME (OR=1.092, 1.445, 3.942;P＜0.05); HbA1c was an independent risk factor for SRD (OR=2.337,P＜0.05). Conclusions There are differences in the distribution of different DME types in each stage of DR. The duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME and SME, and macroalbuminuria and HbA1c for CME and SRD.