Objective To observe multimodality imaging features of different properties in multifocal choroiditis (MFC). Methods Twenty-eight patients (51 eyes) with MFC were enrolled in this study. There were 10 males and 18 females. The patients aged from 31 to 49 years, with the mean age of (41.5±0.8) years. There were 23 bilateral patients and 5 unilateral patients. All patients underwent best corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, infrared fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) examinations. The lesions were classified as active inflammatory lesion, inactive inflammatory lesion, active choroidal neovascularization (CNV) and inactive CNV. The multimodality imaging features of different properties in MFC was observed. Results In fundus colour photography, the boundaries of active inflammatory lesions were blurry, while inactive inflammatory lesions had relatively clear boundaries. Secondary active CNV showed mild uplift and surrounding retinal edema; Secondary active CNV lesions showed mild uplift, retinal edema around the lesion; Secondary non-active CNV had no retinal exudate edema lesions, but had lesions fibrosis and varying degrees of pigmentation. Infrared fundus examination revealed that both active and inactive inflammatory lesions showed a uniform punctate or sheet-like fluorescence. The fluorescence of CNV lesions was not uniform; there was a bright ring around the strong fluorescence. FAF found that active inflammatory lesions showed weak autofluorescence (AF), surrounded by a strong fluorescence ring; inactive inflammatory lesions showed AF loss. Secondary active CNV lesions showed strong AF with a bright ring along the edge, and obscured fluorescence for co-occurred hemorrhagic edema; secondary non-active CNV lesions were strong AF, surrounded by a weak AF ring. FFA revealed that active inflammatory lesions showed weak fluorescence in the early stage, and fluorescence gradually increased in the late stage with slight leakage. Inactive inflammatory lesions showed typical transmitted fluorescence. Fluorescein leakage secondary to active CNV was significant; lesions secondary to inactive CNV showed scar staining. In OCT, the active inflammatory lesions showed moderately weak reflex signals in the protruding lesions under the retinal pigment epithelium (RPE). The inactive inflammatory lesions showed penetrable RPE defects or choroidal scar, it also showed clear RPE uplift lesions with a strong reflection signal. Secondary active CNV showed subretinal fluid retention; secondary non-active CNV showed RPE defects and choroidal scarring. Conclusions Active inflammatory lesions in MFC have blurred boundary, retinal edema and fluorescein leakage in FFA; inactive inflammatory lesions have clear boundary and typical transmitted fluorescence in FFA, and no retinal edema. Secondary active CNV showed subretinal fluid in OCT; and secondary non-active CNV showed RPE defects and choroidal scarring.
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.
ObjectiveTo observe the OCT angiography (OCTA) features of adult-onset foveomacular vitelliform dystrophy (AFVD).MethodsRetrospective clinical observational study. Twelve patients (22 eyes) diagnosed as AFVD by multi-modal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from March 2018 to May 2019 were included in this study. There were 8 males (16 eyes) and 4 females (6 eyes). The patients aged from 33 to 62 years, with the mean age of 48.7±8.9 years. Ten patients were binocular, 2 patients were monocular. The visual acuity was 0.08-0.6. In 22 eyes, the vitelloid-like substance was relatively complete in 8 eyes, the vitelloid-like substance had different degrees of rupture in 14 eyes, secondary choroidal neovascularization (CNV) was observed in 10 eyes. The Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s. A 3 mm × 3 mm scan was obtained. In the scanning process, eye-tracking technology was adopted to select images with better image quality and position for marking and saving. The image characteristics of vitelloid-like substance, fundus vascular changes and secondary CNV in OCTA were analyzed.ResultsIn 8 eyes with a relatively complete vitelloid-like substance, B-scan images showed dense vitelloid-like substance under the retinal neurocortical layer, which was located between the RPE layer and the ellipsoid zone and had a uniform density. Blood flow signals at the vitelloid-like substance can be seen in the en-face image, which was the artifact of the vitelloid-like substance reflecting the blood vessels above. In the 14 eyes with different degrees of vitellin-like material rupture, the signal of vitellin-like substance between the ellipsoid zone and the RPE layer in the B-scan image was not uniform, and some weak reflected signal lacunae could be seen. In the image of en-face, the relatively intact areas of vitelloid-like substance still showed the artifact of the blood vessels above the reflection, while there was no blood flow signal at the rupture of vitelloid-like substance. In 22 eyes, the morphology of retinal small blood vessels in the superficial and deep capillary arch ring region of retina was abnormal in 10 eyes. Some small blood vessels could be seen to have branch and shape changes, and the anastomosis failed to show a complete arch ring structure.No significant structural changes in retinal capillaries were observed in 12 eyes. Among the 10 eyes with secondary CNV, 8 eyes showed the non-active CNV which was as thick as "wild branches", and 2 eyes showed the active CNV which was composed of dense and small vascular branches.ConclusionAFVD in OCTA can be manifested as abnormal retinal vascular morphology caused by the vitelliform material pushing, vascular artifacts reflected by the vitelliform material itself, and the presence of CNV under the vitelliform material.
ObjectiveTo observe the multimodal imaging features of the eyes with acute syphilitic post-polar squamous chorioretinitis (ASPPC) at different stages of disease.MethodsA retrospective case study. From July 2016 to March 2019, 8 patients (11 eyes) of ASPPC patients diagnosed in the ophthalmological examination of Yunnan Second People's Hospital were included in the study. Among them, there were 7 males (10 eyes) and 1 female (1 eye); the average age was 48.7±8.9 years; the average course of disease was 13.24 ±11.30 months. All patients underwent fundus color photography, infrared photography (IR), FAF, FFA, OCT, OCT angiography (OCTA). According to the stage and characteristics of the disease, the affected eyes were divided into acute phase and absorption phase, with 7 and 4 eyes respectively. We observed the color fundus images of ASPPC, IR, FAF, FFA, OCT, OCTA image characteristics of different disease stages.ResultsIn the acute phase, the posterior pole subretinal yellow-white squamous lesions, neuroepithelial detachment, and yellow-white exudates were observed in fundus color photography; uneven infrared reflections can be seen in the lesion area by IR; the posterior pole was round or scaly with strong autofluorescence in FAF, the range was larger than the fundus color photography; FFA arteriovenous stage lesions showed fuzzy weak fluorescence, the fluorescence gradually increased with time, the late stage showed a round-shaped strong fluorescence, surrounded by a weak fluorescence ring, and the area with thick exudation was covered by fluorescence; the neuroepithelium of the diseased area was detached, the uniform strong reflection signal can be seen in it by OCT. In the absorption phase, fundus color photography showed the yellow-white scaly lesions under the posterior retina absorption, and the pigment was slightly depleted; IR showed the mottled infrared reflection in the lesion area was significantly reduced compared with the acute phase; FAF showed the posterior spot-like strong autofluorescence, including "leopard spot-like changes" 3 eyes; FFA showed mottled fluorescent staining in the lesion, and no fluorescein leakage or accumulation; OCT showed needle-like protrusions in the RPE layer, and the outer membrane and ellipsoid zone were unclear; OCTA showed weakened choroidal capillary blood flow signal, the signal was missing in some areas.ConclusionsIn the acute phase of ASPPC, the posterior pole subretinal shows yellow-white squamous lesions, neuroepithelial detachment, yellow-white exudate, FFA shows late fluorescein leakage in the lesion area; in the absorption period, the fundus shows yellow-white lesions have been absorbed, and FFA shows fluorescence dyed without any leakage. OCT indicates that the RPE, outer membrane and ellipsoid zone are damaged to varying degrees. OCTA indicates that the choroid of the diseased area had weakened blood flow signal.
ObjectiveTo observe the clinical and imaging characteristics of acute idiopathic macular degeneration (AIM).MethodsA retrospective clinical study. From March 2016 to January 2018, 5 eyes (5 AIM patients) in The Second People's Hospital of Yunnan Province were included in the study. Among them, there were 4 males (4 eyes) and 1 female (1 eye); all patients were monocular with the average age of 34.2 years. The course of illness from onset of symptoms to treatment was 4-22 days. All affected eyes were examined by BCVA, fundus color photography, OCT, FAF, and FFA. Among 5 eyes, 1 eye with optic disc vasculitis was given oral glucocorticoid treatment; 4 eyes were not interfered after the diagnosis. ResultsThe follow-up time was 6 months. During follow-up, BCVA, fundus color photography, and OCT examination were performed. The results were all a sudden decrease in monocular vision, accompanied by visual distortion or central dark spots. At the first visit, the BCVA was 0.1, 0.2, 0.2, 0.05, and 0.5; at the last follow-up, the BCVA of the affected eye was 0.8, 0.6, 0.5, 0.5, and 1.0, respectively. Fundus color photography showed that at the first diagnosis, all the affected eyes showed irregular round yellow-white lesions in the macular area, including 1 eye with small patches of hemorrhage and 1 eye with pseudopyous changes in the macular area. Two to three weeks after the initial diagnosis, the yellowish-white lesions and bleeding in the macular area were basically absorbed. The center of the lesion showed weak pseudopod-like fluorescence, and the surrounding area was surrounded by strong fluorescence in FAF examination. The irregular and strong fluorescence in the early macular area and accumulation of late fluorescein in FFA examination. One eye was receivied glucocorticoid therapy. The upper layer of the retinal nerve in the macular area was detached, and the inferior space showed focal strong reflective material in 3 eyes in OCT examination. At the first diagnosis, the retinal neuroepithelial layer was detached, the top of the RPE layer was irregular with strong reflective material, and the structure of the ellipsoid zone and the chimera zone was unclear; as the course of the disease prolonged, the outer retinal structure recovered.ConclusionsAIM is characterized by inflammatory exudative changes in the outer layer of the retina in the macular area; FFA is characterized by strong subretinal disc-like fluorescence or multifocal weak fluorescence in the macular area; OCT mainly manifests as neuroepithelial detachment and changes in the outer retina and RPE, The structure can be restored by itself.
Objective To observe the multimodal image features of inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC). MethodsA retrospective clinical analysis. A total of 90 eyes of 46 patients with MFC diagnosed in the Department of Ophthalmology of Yunnan University Affiliated Hospital from May 2017 to April 2021 were included in the study. Among them, there were 21 males and 25 females; the average age was 38.30±8.97 years old. Twenty-nine cases of MFC were diagnosed in the past, and they visited the doctor again due to new symptoms; 17 cases without a clear past medical history were the first visits. All eyes underwent color fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). With reference to the literature and the results of multimodal fundus imaging examinations, MFC lesions were divided into active CNV lesions, inactive CNV lesions, active inflammatory lesions, and inactive inflammatory lesions, with 31 (34.4%, 31/90), 12 (13.3%, 12/90), 26 (28.9%, 26/90), 90 (100.0%, 90/90) eyes. Nineteen eyes were treated with anti-vascular endothelial growth factor drugs. To summarize and analyze the manifestations of inflammatory lesions and CNV lesions in different imaging examinations. The Wilcoxon rank test was used to compare the detection rate of CNV lesions between FFA and OCTA. ResultsIn eyes with active inflammatory lesions and active CNV lesions, yellow-white lesions, retinal hemorrhage and exudation were seen on fundus color photography; FFA examination showed fluorescein leakage in the lesions; OCT examination showed retinal pigment epithelium (RPE) layer in the lesions was uplifted, the boundary was unclear, combined with subretinal and intraretinal fluid; OCTA examination showed that there was no blood flow signal in each layer of vascular tissue in active inflammatory lesions, and blood flow signals were seen in active CNV lesions. In the eyes of inactive inflammatory lesions and inactive CNV lesions, the fundus color photography showed that the lesions had clear boundaries without bleeding or exudation; FFA examination, the lesions were fluorescently stained, and there was no fluorescein leakage; OCT examination, inactive CNV lesions manifested as raised lesions with clear boundaries, and inactive inflammation manifested as scars formed by mild RPE hyperplasia or depressions in outer structures formed by atrophy; OCTA examination, inactive inflammatory lesions showed patchy loss of blood flow signal or penetrating blood flow signal below, blood flow signal can be seen in inactive CNV lesions. ConclusionMFC active inflammatory lesions and active CNV lesions are often accompanied by retinal hemorrhage and exudation; FFA shows fluorescein leakage; OCT shows that the boundary of raised lesions is unclear; OCTA can identify the nature of CNV or inflammatory lesions.
Objective To observe the OCT angiography imaging features of choroidal neovascularization (CNV) with different activity in age-related macular degeneration (AMD). Methods A retrospective case analysis. Forty-two eyes of 33 patients (21 males and 12 females, aged 65.3±8.61 years) who were diagnosed with AMD by multi-mode fundus imaging examination at the Ophthalmology Department of Yunnan Second People's Hospital during January 2017 and October 2018 were enrolled in this study. All patients underwent BCVA, slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, FAF, FFA and OCT examinations. The patients were divided into active CNV (27 eyes of 19 patients) and inactive CNV (15 eyes of 14 patients) by comprehensive analysis of fundus imaging characteristics and treatment process. The imaging features of OCTA in the two groups were compared. The number of eyes of each active or inactive indicator in the active CNV group and the inactive CNV group was calculated, and the composition ratio of each group of the indicators was subjected to the χ2 test. Results Among the 27 eyes of active CNV, 22 eyes (81.5%) of OCTA showed abundant small capillary branching structure, while 13 eyes (13.3%) of 15 eyes of inactive CNV showed more coarse blood vessel. Among the 27 eyes of active CNV, 26 eyes (96.3%) of OCTA showed that the marginal vascular end points of CNV lesions were "arcaded" or "ring", while 12 eyes (80.0%) of 15 eyes of inactive CNV showed the presence of isolated branches of peripheral vessels. Among the 27 eyes with active CNV lesions, there were no large feeder vessels inside the lesions, and 8 (53.3%) of the 15 inactive CNV lesions showed feeder vessels in the center of the lesion. Among the 27 eyes with active lesions, 23 eyes (85.2%) of OCTA showed a low-reflection "halo" around the CNV lesion, and no low-reflection "halo" structure was observed in the 5 eyes of the inactive CNV lesion. The statistical results showed that there were abundant small blood vessel branches (χ2=22.759, P=0.000), annular anastomosis around the lesion (χ2=31.704, P=0.000), low-reflection halo (χ2=32.327, P=0.000), and large nourishing blood vessels (χ2=26.063, P=0.000), dilated choroidal vessels (χ2=32.912, P=0.000). All the above indicators were statistically different between the two groups. Conclusion The abundant small vessel branches in OCTA, the surrounding anastomosis in a ring structure and the low reflex halo around the lesion are markers of active CNV, while the large feeding vessels and dilated choroidal vessels are indicators of inactive CNV.
As most patients of central serous retinopathy (CSC), the symptoms of acute onset will alleviate by oneself after 4-6 months. About 30%-50% of patients with CSC experience chronic or recurrent cases. Resulting in persistent neurosensory detachments and subretinal fluid, causing significant vision loss. Mineralocorticoid receptor (MR) is a kind of nuclear hormone receptors, plays a role in theregulation of water and electrolyte balance. Excessive MR signaling is associated with many diseases. Study found that MR antagonists decreased the thickness of the retina and improved in vision, there was no serious adverse reactions during the period of treatment for chronic CSC. Initial dose of MR antagonists was 25 mg per day, 1 week later, dosage was increased to 50 mg per day, and treatment for about 3 months. There is no conclusive effective treatment and the dosage are still unknown. MR antagonists may be a safe and effective way to treat chronic CSC, though evidence is scant. Prospective, multicenter, large-scale trials is required.
ObjectiveTo analyze the OCT angiography (OCTA) features of eyes affected with angioid streaks.MethodsRetrospective analysis of 26 patients (52 eyes) diagnosed as angioid streaks by multi-modal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from May 2017 to February 2019 were included in this study. There were 18 males and 8 females, with the mean age of 50.8±6.9 years. All the patients were binocular. There were 34 eyes in 20 patients with CNV. Among them, 13 eyes had a course of disease within 1 month, 16 eyes had a course of disease over 1 month, and 5 eyes were treated with anti-VEGF drugs. All patients were examined by ultra-wide-angle fundus photography, infrared fundus imaging (IR), spectral-domain OCT, FAF and FFA. At the same time, the Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s, and the width was 45 nm. A 3 mm × 3 mm scan was obtained. Each cube consisted of two 304 B scans of repeated volumes, and motion correction was performed using two orthogonally captured image volume registration. The results of fundus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.dus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.ResultsAmong 52 eyes, 40 eyes showed choroidal capillary shadows in OCTA, and no obvious abnormal OCTA images in 12 eyes. Ten eyes OCTA showed a vascular network beseide the optic disc, FFA showed fluorescent staining instead of fluorescein leakage. Among the 52 eyes, 34 eyes had secondary macular CNV, and 34 eyes had different forms of CNV. Different forms had a certain correlation with the length of medical history and treatment history. Among them, 13 eyes with short course of disease (less than 1 month) and untreated patients had smaller flower-ring morphology, 16 eyes with longer course (more than 1 month) but no treatment had larger fan-shaped segments, and 5 eyes with anti-VEGF therapy were trimmed after the dendritic shape.ConclusionsAS streaks appeared no blood flow signal area in OCTA, and repairing vascular network beside the optic disc can be observed in some AS patients. The CNV performance with different disease course and treatment experience is different.
ObjectiveTo observe the clinical evolution process and imaging characteristics of choroidal lesions in different subtypes of serpiginous choroiditis (SC), and to explore the clinical significance of subtype classification. MethodsA retrospective, uncontrolled and observational study. A total of 45 eyes of 25 SC patients diagnosed in Yunnan Eye Hospital from May 2009 to September 2021 were included in the study. According to the initial location of the lesion and fundus images, including fundus color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other examination results. SC was divided into peripapillary serpiginous choroiditis, macular serpiginous choroiditis and ampiginous choroiditis. According to the shape of the lesions at the first diagnosis, it can be divided into new lesions with only infiltrating edema, old lesions with only atrophy and recurrent lesions with coexistence of edema and atrophy. the imaging features, development and complications of different subtypes of ocular lesion were observed. ResultsAmong the 45 eyes of 25 cases, 15 cases were male and 10 cases were female, 20 cases of binocular and 5 cases of monocular, age was 42.3±5.7 years old. There were 21 eyes with active lesions, of which 5 eyes were new lesions and 16 eyes with recurrent lesions; 24 eyes were old lesions. Concurrent optic disc edema occurred in 3 eyes; mild vitreitis occurred in 5 eyes; retinal occurred vasculitis in 3 eyes; choroidal neovascularization occurred in 3 eyes. Among the 16 cases (64%, 16/25) of the peripapillary serpiginous choroiditis, 2 cases (2 eyes) were monocular, and 14 cases (28 eyes) were binocular. Active lesions were found in 16 eyes, of which patients with binocular lesions only one had active lesions. The choroidal lesions that were close to the optic disc or around the optic disc, expanded outwards centrifugally with the prolongation of the disease course, and can progress to the macula. The edge of the lesion was tortuous, with a geographic-like, amoeboid-like and finger-like, polypoid or propeller-like shape. Active lesions in FFA showed weak fluorescence in the early stage and strong fluorescence in the late stage; the old lesions showed weak fluorescence in the early stage and mottled fluorescence in the late stage, and mostly strong fluorescence on the edge. OCT showed thickening of active lesions and thinning of old lesions. Among the 4 cases (16.0%, 4/25) of macular type, 2 cases (2 monocular eyes) had active lesions; 2 cases (4 eyes) had lesion in both eyes, among them, 1 case (2 eyes) had old lesion, and the other case had alternate active lesions. The initial lesions were all located in the off-center of the macula, and most of them were disk-shaped and progressing centrifugally to the periphery. The FFA and OCT imaging findings of the lesions were similar to those of the peridisc type. Among the 5 cases (20.0%, 5/25) of ampiginous choroiditis, 1 case (1 eye) was monocular and 4 cases (8 eyes) were binocular. These lesions were multiple old lesions of varying sizes, gray-white with pigmentation, with clear borders in the posterior pole. Among them 4 eyes have new active lesions appeared near the old lesions. The old lesions showed weak fluorescence with clear borders, and the fluorescein leakage at the late edge formed a strong fluorescence ring; the active lesions showed weak fluorescent spots with blurred edges, and the fluorescence was slightly enhanced in the late stage. In old lesions, atrophy of the photoreceptor layer, RPE and choroid can be seen, and RPE hyperplasia in some areas. ConclusionsSC subtype is a classification of the location of the first lesion, but the characteristics of the repeated attack of this disease can lead to the annihilation of each subtype due to the continuous expansion of the lesion. The phenomenon that the fundus active lesions only occur in one eye that can explain the clinical manifestations of asymmetric morphology of binocular lesions. The characteristics of binocular subtype warn that the predilection site of the healthy eye should be paid attention to.