Objectives To observe the clinical characteristics of patients with posterior scleritis. Methods Ten patients with 16 eyes diagnosed as posterior scleritis were enrolled in this study. Ten patients consisted of seven males and three females. Their age ranged from 18 to 75 years old, with a mean age of 42.0plusmn;14.7 years old. Except for two patients aged 18 and 75 years old, the other eight patients aged 33 to 55 years old. Routine eye examination was performed including visual acuity, slit lamp microscope, ophthalmoscope, B scan ultrasound, color fundus photography, fundus fluorescein angiography (FFA), orbit MRI and chest Xray. According to the B scan ultrasonic examination, these ten posterior scleritis cases were divided into diffused and nodular types. Among them, the diffused type had 8 cases (14 eyes), the nodular type had 2 cases (2 eyes). The visual acuities of ten patients were from light perception to 0.4. The blood laboratory tests were negative in all cases. The diffused posterior scleritis patients received systemic and (or) local glucocorticoid therapy. The nodular posterior scleritis patients could not be ruled out choroidal melanoma in the initial evaluation, and they underwent enucleation operation in other hospitals. Results In the 14 eyes of diffused posterior scleritis, conjunctival congestion and edema were observed in 8 eyes, eyelid edema in 2 eyes, normal eye surface in 4 eyes. In the two eyes of nodular posterior scleritis, there was no conjunctival congestion and edema or eyelids swelling. All 16 eyes performed FFA, 11 eyes had fundus posterior pole early dot-like hyperfluorescence followed by leakage of fluorescence in the late stage, two eyes had hyperfluorescence mixed with hypofluorescence in the nearby retina of the lesion, and the rest three eyes had no abnormality in FFA. In 14 eyes of diffused type posterior scleritis, B scan ultrasound showed diffused scleral thickening more than 2 mm in 10 eyes with a typical quot;Tquot; shape sign. The other 4 eyes did not show typical sign in ultrasound. In 2 eyes of nodular type, ultrasound showed nodular enhanced echo in choroid with medium internal reflection and abundant blood flow. Eleven eyes underwent orbit MRI scan, 9 eyes displayed diffused posterior sclera thickening, 2 eyes showed nodular lesions in choroid. All lesions showed low signal on T1WI, high signal on T2WI. After treatment, six diffused posterior scleritis patients recovered to normal scleral thickness. Two nodular posterior scleritis patients underwent enucleation showed granulomatous posterior scleritis and necrotic posterior scleritis in pathology. Overall, 16 eyes of 10 patients were misdiagnosed as chronic angleclosure glaucoma in 2 eyes, acute iridocyclitis in 1 eye, central serous chorioretinopathy in 2 eyes, retrobulbar neuritis in 2 eyes, and choroidal melanoma in 2 eyes. Conclusions Posterior scleritis occurs mostly in young patients. The diffused posterior scleritis patients usually has anterior segment signs including conjunctival congestion and edema or eyelids swelling, while the nodular posterior scleritis patients has normal anterior segment signs. B scan ultrasonic and MRI examination showed typical image features. Systemic and (or) local glucocorticoid therapy can effectively release the symptoms of these patients.
Objectives To investigate the clinical characteristics and prognosis of syphilitic uveitis. Methods Clinical charts of 32 syphilitic uveitis patients were retrospectively analyzed. The diagnosis was confirmed by clinical and laboratory tests. There were 32 patients (50 eyes), 18 males and 14 females; the ages were from 21 to 62 years ole, with a mean age of 42 years old. Eighteen patients were bilateral. All patients had complete ocular examinations including visual acuity, intraocular pressure, slit-lamp biomicroscopy, ophthalmoscopy, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA). Results Inflammatory cells in the anterior chamber and corneal endothelium were present in 42 eyes. Thirty eyes showed congestion and swelling of optic discs. Yellowwhite lesions in the posterior pole were present in 18 eyes. No change in 6 eyes. FFA showed staining or hyperfluorescence of optic disc in 32 eyes, venous leakage in 34 eyes, and cystoid macular edema in 15 eyes．ICGA showed squamous or disseminative hypofluorescence damages in 26 eyes. All patients were treated with penicillin and glucocorticoids, 36 eyes had improved vision and fundus damage had abated. Conclusions Most syphilitic uveitis was panuveitis with retinal vasculitis. The prognosis is good with early diagnosis and timely treatment of this disease．
Objective To investigate the clinical characteristics of patients with polypoidal choroidal vasculopathy (PCV) from Central China . Methods This was a retrospective study, and 403 eyes of 362 patients diagnosed as PCV by ocular fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled. The general clinical data, fundus manifestation and ocular fundus examinations were statistically analyzed. Results Three hundred and sixty-two cases included 249 males (68.8%) and 113 females (31.2%). Age ranged from 45 to 91 years old, and mean age was (64.81plusmn;9.31) years old. Bilateral lesions were observed in 41 patients (11.3%) and unilateral lesions were observed in 321 patients (88.7%)． In these 403 eyes, typical orangered lesions were observed in 162 eyes (40.2%); yellowishwhite exudate could be found in 185 eyes (45.9%); 268 eyes (66.5%) showed variable degrees of subretinal hemorrhage. Drusen was found in 23 eyes (5.7%), pigment proliferation in 20 eyes (5.0%) and fiber vascular scar in 96 eyes (23.8%). The lesions of 386 eyes (95.8%) located in macular region, 53 eyes (13.2%) in peripapillary area. Lesions presented multifoci in 67 eyes (16.6%). Three hundred and four eyes (75.4%) presented typical polypoidal lesions and 152 eyes (37.7%) with abnormal branching choroidal networks. Hemorrhagic retinal pigment epithelial detachments (PED) were found in 200 eyes (49.6%) and serous PED in 96 eyes (23.8%), both existed in 25 eyes（6.2%）. OCT showed 56 eyes (13.9%) presented cystoid dark chamber between the neurosensory retina and 109 eyes (27.0%) with double-layer sign formed by the separation of retinal pigment epithelium and Bruchprime;s membrane (27.0%). Two hundred and seventy-four eyes (68.0%) were found with conelike elevation beneath the RPE layer and 151 eyes (37.6%) with neurosensory detachment. Conclusions In Central China, the majority of PCV patients were male, unilateral. Most PCV lesions were located in the macula. Subretinal hemorrhage, polypoidal lesions and abnormal choroidal vascular networks were common in the PCV patients. Hemorrhagic PED presented a higher ratio than serous PED.
Objective To observe the clinical features of combined central retinal artery and vein occlusion. Methods The clinical data of eight patients of combined central retinal artery and vein occlusion diagnosed by fundus examination and fundus fluorescein angiography (FFA) was analyzed retrospectively, including the causes, fundus manifestations and FFA features. Results 4/8 patients had hypertension and dyslipidemia, 2/8 patients had traumatic retrobulbar hemorrhage, one patient had orbital cellulitis and one patient had systemic lupus erythematosus. All the patients had posterior pole retinal edema, hemorrhage, thin retinal artery, dilated vein, and papilledema. FFA showed delayed arterial filling, and there was no filling of retinal arterial branches until the late stage of FFA. Laminar flow delayed in large retinal veins, and there was no filling or only retrograde filling in retinal vein branches. Large areas with dot-like or patchy weak choroidal fluorescence can be observed in five patients. Conclusions Combined central retinal artery and vein occlusion is rare with complex etiology. The fundus manifestations and FFA features are atypical, but have features of central retinal artery occlusion and central retinal vein occlusion.
Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM). Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study. All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision. There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI). The patients were divided into PDR with CRVO group (group A, 41 eyes) and PDR group (group B, 200 eyes) according to the results of fundus examination. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B. The difference of number in silicone oil-filled eyes in two groups was statistically significant (chi;2=5.110,P＜0.05). There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B. There was no difference in C3F8 gas-filled eyes numbers in two groups (chi;2=0.048, P＞0.05). The follow-up ranged from one to 60 months, with the mean of (28.69plusmn;17.28) months. The corrected vision, retinal reattachment, persisting macular edema (ME), neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed. Results Of 241 eyes, there were 41 eyes (17.0%) with CRVO. Before surgery, the differences of corrected vision (Z=-0.138), intraocular pressure (t=0.966), whether there was TRD or not (chi;2=0.412), whether underwent panretinal photocoagulation or not (chi;2=1.416) were not statistically significant (P＞0.05), but the difference of whether NVI were present or not was statistically significant (chi;2=31.724,P＜0.05) between two groups. After surgery, the corrected vision improved in both two groups (Z=2.319, 4.589; P＜0.05). There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05). Postoperative complications occurred in 94 eyes, including 26 eyes in group A and 68 eyes in group B. The differences of incidence of reoperation (chi;2=0.498), retinal reattachment (chi;2=0.818), persisting ME (chi;2=2.722) between two groups after surgery were not statistically significant (P＞0.05). The incidence of repeated VH (chi;2=5.737) and NVG (chi;2=6.604) in group A were higher than those in group B (P＜0.05). Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH. Combined with CRVO patients are more likely to suffer NVI. Vitrectomy can improve the visual function in PDR with CRVO patients.
Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis. Methods This is a retrospective non-comparative interventional clinical research. A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study. Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis. The patients, seven males and two females, aged from 19 to 66 years, with an average of 43.89 years. The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days. Visual acuity, slit lamp ophthalmoscopy, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), hematological and tuberculosis related investigations were examined and analyzed. All patients had standard anti-tuberculosis treatment. Treatment outcomes were followed for six to 37 months with an average of 14.11 months. Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28. Among 11 eyes, six presented mild to moderate vitritis, five presented as retinal vein occlusion with no obvious vitirits. Fundus examination showed six cases with retinal hemorrhage, four cases with macular edema, two with macular epiretinal membrane, and two with vitreous hemorrhage. FFA revealed 11 cases with leakage of vessels, 11 with nonperfusion area, four with macular edema, three with retinal neovascularization, and two with choroidal lesions. OCT of nine eyes suggested six eyes with retinal edema, three with macular edema, three with macular epiretinal membrane. TST of seven patients were all b positive. T-SPOT.TB of four patients were all positive. Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection. Four to six weeks after the start of anti-tuberculosis treatment, vitritis, exudates, retinal and macular edema subsided. During follow up, inflammation was stable with no recurrence observed. The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51. Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis, retinal vein occlusion, and retinal hemorrhage. Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.
Objective To observe the clinical characteristics of ocular albinism type 1 (OA1) in China.Methods Sixteen patients with OA1 and eight female carriers (eight OA1 patients and four carriers were from the same family) were enrolled in this study. All subjects were examined for corrected visual acuity, slit-lamp microscopy and GPR143 gene mutation detection. Some subjects also received indirect ophthalmoscopy, photography of anterior segment and ocular fundus, retinoscopy and optical coherence tomography (OCT). Iris pigmentation was divided into type A, B and C according to the above findings. Type A: slight pigmentation; type B: uneven pigmentation; type C: large patch of hypo-pigmentation with hippus. Result The corrected visual acuity of 16 OA1 patients was from 0.1 to 0.3. All the OA1 patients have bilateral horizontal nystagmus without strabismus. All eight subjects received retinoscopy have medium to low hypermetropia and astigmatism. Type A, B and C iris pigmentation were found in eight (50.0%), seven (43.7%) and one (6.3%) patients, respectively. Two (25.0%) carriers have Type A iris pigmentation, and other six carriers (75.0%) were normal. There is no typical albinism retinopathy, however macular foveal structures were never found in these patients. Four carriers have fundus striate or uneven hypo-pigmentation. The macular foveal structure of all the carriers was normal. The macular foveal structure was not found in three subjects who underwent examination of OCT. GPR143 gene mutation was found in all the OA1 patients (100.0%) and all the carriers.Conclusions The major clinical characteristics of Chinese OA1 patients are foveal hypoplasia and GPR143 gene mutation.
Objective To observe the clinical features of systemic lupus erythematosus (SLE) with retinopathy.Methods Ninety-seven SLE patients were enrolled in this comparative clinical study. The patients were divided into retinopathy group (positive group, 32 eyes of 23 patients) and non-retinopathy group (negative group, 148 eyes of 74 patients). The age, course of disease, clinical features, laboratory results in these two groups were comparatively analyzed.Results The positive rate of retinopathy in all SLE patients was 23.7%. Seventeen patients (22 eyes, 73.9%) of positive group had retinal cotton-wool spot, retinal hemorrhage, tortuous retinal vein, retinal arterial spasm, microaneurysm and hard exudates. The other six patients (10 eyes, 26.1%) in this group showed retinal main vessel occlusion. The incidence rate of rash, cutaneous vasculitis, elevated erythrocyte sedimentation rate (ESR), decreased complement C3 and positive anti double stranded-DNA (anti-ds-DNA) antibody in the positive group were higher than those in the negative group (chi;2=9.206, 6.987, 7.824, 8.581, 6.599;P＜0.05). There was no significant difference between these two groups in age, course of disease, mucosal ulcers, arthritis, fever, headache, neutropenia, thrombocytopenia, proteinuria, elevated blood urea nitrogen, increased creatinine, positive antinuclear (ANA) and anti-Sm antibodies (t=0.321, 0.063;chi;2=0.135, 0.046, 0.176, 0.002, 0.036, 0.113, 0.053,0.032,0.012,0.000,0.004;P＞0.05). Conclusions Tortuous retinal veins, retinal cotton-wool spots and retinal main vessels occlusion are the three major fundus features of SLE patient with retinopathy. Rash, cutaneous vasculitis, increased ESR, decreased complement C3 and positive anti-ds-DNA antibody are the five major systemic clinical features of SLE patient with retinopathy.
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.