Microcystic macular edema (MME) represents a pathological change that can be observed in the inner layer of the retina in patients diagnosed with glaucoma. This phenomenon is particularly prevalent in individuals with moderate to advanced glaucoma. The majority of research in this field has focused on primary open-angle glaucoma. The occurrence of MME in glaucoma has been demonstrated to be associated with younger age, advanced stage and disease progression. MME occurs in the parafoveal region, most frequently located in the inferior perimacular region, which corresponded with the most vulnerable area of ganglion cells in glaucoma. The presence of MME may affect the automatic layering of optical coherence tomography images, suggesting that clinicians should be mindful of the occurrence of MME to avoid misdiagnosis of the disease. It is hypothesised that the occurrence of MME in glaucoma may be related to macular vitreous traction, mechanical stress of the stent, and Müller cell dysfunction. A comprehensive investigation of the precise pathophysiological mechanism of MME in glaucoma will facilitate the development of a novel perspective and a scientific foundation for the diagnosis, disease monitoring and evaluation of treatment efficacy in glaucoma.
Objective To characterize the clinical features of punctate inner choroidopathy (PIC) in Chinese patients.Methods The clinical data of 75 PIC patients (112 eyes) attending this center from June 1999 to October 2009 were reviewed retrospectively. All patients received routine examination and fluorescein fundus angiography (FFA). Twentyeight patients also received indocyanine green angiography (ICGA). VISUPAC 3.3 software was used to determine the size of lesions in early image of FFA at the artery stage. Results Of the 75 PIC patients (112 eyes), 54 patients (72%) were female, 37 patients (49%) were bilateral cases. Sixty patients (80%) were myopic, including eight patients (7%) with mild myopia, 22 patients (20%) with moderate myopia, and 57 patients (51%) with high myopia. The mean age at presentation was 32 years (range: 17-61). Multifocal PIC lesions (1-56 lesions) were mostly restricted to posterior pole of affected eyes (95%). Eightyfour eyes (75%) had 10 PIC lesions. The active lesions were yellowwhite and butterlike, 20-500mu;m in diameter. FFA showed that most acute lesions were early hyperfluorescence, and stained or slightly leaked on late period. The atrophic lesions were pouchedout, 502000 mu;m in diameter, with irregular pigmentation. Choroidal neovascularization developed in 70 eyes (63%). Papilledema (three eyes, 3%), staining of optic disc on latephase fluorescein angiography (three eyes, 3%), and segmental retinal phlebitis (two eyes, 2%) were rare.Conclusions PIC primarily affects young women with moderate or high myopia. It is featured by multifocal small yellow creamy lesions and/or atrophic punchedout lesions principally in the posterior pole. Choroidal neovascularization is the most common complication.
Objective To observe the characteristics of fundus fluorescein angiography (FFA) in different types of pathologic myopic maculopathy and evaluate the influence factor.Methods The clinical data of 251 patients (451 eyes) with pathologic myopic maculopathy were retrospectively analyzed. The patients were divided into 6 groups according to FFA characteristics: (1) lacquer cracks (LC); (2) choroidal neovascularization (CNV); (3) macular hemorrhage with LCs; (4) Fuchs spots; (5) macular atrophy; (6) macular hole. Their relationship with age, gender, refraction and (BCVA) were analyzed.Results Older age was significantly associated with CNV and macular atrophy (OR=1.034,CI=1.019-1.049,P＜0.001;OR=1.054,CI=1.031-1.076,P＜0.001; respectively);younger age was associated with hemorrhage with LC (OR=0.906,CI=0.876-0.937,P＜0.001). Higher myopic refractive error was associated with macular atrophy (OR=0.762,CI=0.705-0.824,P＜0.001), whereas lower myopic refractive error was associated with CNV and macular hole(OR=1.233,CI=1.136-1.338,P＜0.001;OR=1.554,CI=1.185-2.038,P＜0.001; respectively). A worse visual acuity was associated with CNV (OR=1.835,CI=1.180 -2.854,P=0.007), while better visual acuity was associated with LC (OR=0.506,CI=0.328 - 0.782,P=0.002). There was no gender difference in distribution of high myopic maculopathy types. Conclusions Pathologic myopic maculopathy can be divided into six types. With increasing age, the incidence rates of CNV and macular atrophy increases, hemorrhage with LC but decreases. With the rise of myopic refractive, the incidence rates of CNV and macular hole decreases, macular atrophy but increases.
Objective To observe the characteristics of indocyanine green angiography (ICGA) in inactive polypoidal lesions of polypoidal choroidal vasculopathy (PCV). Methods The clinical data of 36 PCV patients (37 eyes) with inactive polypoidal lesions were retrospectively analyzed. The follow-up of 11 eyes were ranged from nine to 29 months, with a mean of (12.3plusmn;5.5) months. All the patients were examined for visual acuity, intraocular pressure, slit lamp microscope, fundus photography, fundus fluorescein angiography (FFA) and ICGA. According to the ICGA characteristics, PCV lesions were divided into active polypoidal lesions (pocket like hyperfluorescence at early stage and fluorescence leakage or stained with fluorescein at late stage) and inactive polypoidal lesions (pocket like hyperfluorescence and it was gradually faded). According to clinical and ICGA characteristics, inactive polypoidal lesions were divided into asymptomatic group, atrophic and/or cicatricial group and combined (with active polypoidal lesions) group. The visual acuity, fundus, lesions change and image characteristics of three groups were evaluated and analyzed. Results Among the 37 eyes, the time from indocyanine green (ICG) injection to inactive polypoidal lesions begin showing was ranged from 8.2 to 27.0 minutes, with a mean of (15.5plusmn;4.8) minutes. There were five eyes (13.5%), eight eyes (21.6%) and 24 eyes (64.9%) in asymptomatic group, atrophic and/or cicatricial group and combined group, respectively. The results of fundus examination showed that there was no hemorrhage, exudates, retinal pigment epithelium detachment (PED) and/or neural retina detachment in asymptomatic group; atrophy lesions and/or scar lesions were observed in atrophic and/or cicatricial group and there was also no hemorrhage, exudate, PED and/or neural retina detachment; there was no atrophy lesion and/or scar lesion, but there were 10 eyes with subretinal hemorrhage, 15 eyes with retinal exudate, 10 eyes with PED and four eyes with neural retina detachment in combine group. The results of ICGA showed that there were inactive polypoidal lesions in asymptomatic group; inactive polypoidal lesions located at the border of atrophy lesions and/or scar lesions in atrophic and/or cicatricial group; active polypoidal lesions and inactive polypoidal lesions coexisted in combine group. In 11 eyes which completed the follow-up, inactive polypoidal lesions regressed in three eyes (27.3%), partial regressed in two eyes (18.2%), unchanged in six eyes (54.5%). Conclusions The inactive polypoidal lesions of PCV mainly appear in the middle or late stage of ICGA and are manifested in asymptomatic, atrophic and/or cicatricial and combined eyes. The combined type which coexisted with active polypoidal lesions is the main form.