Objective To observe the clinical features of acute zonal occult outer retinopathy (AZOOR).Methods Eighteen patients (18 eyes) with AZOOR were enrolled in this study. All the patients were examined for corrected visual acuity, fundus examination, visual field and electroretinography (ERG). For part of these patients, fluorescein angiography (FFA), optic coherence tomography (OCT), visual evoked potential (VEP) and multifocal ERG (mf-ERG) were performed. Clinical features were observed. Comparative analysis was performed on the electrophysiological results between affected eyes and fellow eyes. The consistency of OCT, visual field and mf-ERG results was investigated.Results The patients included three males and 15 females. All patients were unilateral involved. 16 eyes (88.9%) were myopia, two eyes (11.1%) were emmetropia. 11 eyes (61.1%) have normal fundus; single yellow-white punctuate lesion or old RPE lesion near macular were found in three eyes (16.7%); depigmented zones in temporal retina were found in four eyes (22.2%). All central visual field results were abnormal, but peripheral visual field results were normal. OCT findings included irregularity, absence or breaks of the photoreceptor inner segment/outer segment (IS/OS) junction. Amplitudes of full-field ERG were reduced in the affected eyes (t=3.516，2.689，3.103，3.517，2.999，3.309；P＜0.05), and implicit times were delayed in most responses except for rod response (t=1.023,P=0.306). Amplitudes of P100 wave of visual evoked potential were reduced statistically (t=2.04,P=0.041), but the differences of implicit times between the affected eyes and the fellow eyes were not statistically significant (t=1.687,P=0.092). Amplitude reduction of multifocal ERG existed in all affected eyes. Coincidence was found between results of OCT and mf-ERG. But abnormal zones found by central visual field did not always coincide with those by mf-ERG. Conclusions The majority of patients who develop AZOOR are young women with myopia. Most patients have normal fundus. Central visual field and electrophysiological examinations are always abnormal. Irregularity, absence or breaks of the photoreceptor IS/OS junction can be proved by OCT.
Objective To observe the characteristics of fundus fluorescein angiography（FFA）and optical coherence tomography（OCT）in nonarteritic anterior ischemic optic neuropathy (NAION),and investigate its relation with visual acuity and course of disease.Methods The clinical data of 47 patients (47 eyes) with NAION were retrospectively analyzed. All the patiens had undergone visual acuity，fundus and visual field examination，meanwhile FFA and OCT were carried out at first visit. FFA and visual field were carried out by routine. OCT was carried out by line and circle shape scanning in macula and optic disc. Thirtyfive NAION patients were checked with OCT at half, one, two, three and six month after onset in respectively. Take the healthy fellow eyes of 36 NAION patiens as control group.The FFA,visual field,OCT characteristics and relation with visual acuity and course disease were comparatively analyzed.ResultsFFA showed that all the eyes appear as delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage，besides hyperfluorescence presented to macular area in 24 eyes. OCT showed that optic papilla swelling and physiological depression narrow or nearly disappearance, neuroepithelial layer thickening or neuroepithelial layer eminence and subretinal fluidity area opaca between optic disc and macula. There were 14 eyes with normal physiological depression and 22 eyes with small physiological depression or non physiological depression in control group. Half month after onset，the neuroepithelial layer thickness of macula fovea, the maximum thickness of neuroepithelial layer between optic disc and macula，and the average retinal nerve fiber layer（RNFL）thickness in NAION group were higher than those in the control group，the difference were statistically significant (F=6.51，26.12，75.49；P＜0.05).Two months after onset，the maximum thickness of neuroepithelial layer between optic disc and macula, the average RNFL thickness, and the RNFL thickness of temporal optic disc in NAION group were significant thinner, but the elevated height of the optic disc in NAION group were near those of the control group. Three months after onset，the average RNFL thickness and the RNFL thickness of temporal optic disc in NAION group decreased continually, they were lower than those of the control group, the difference were statistically significan（F=75.49，37.92；P＜0.05）.Visual field showed that inferior defect were found in 21 eyes (45%). With progress, the superior RNFL thickness obviously decreased, coincidence with appearance of visual field. It indicate that the superior optic atrophy serious. Visual acuity had significant negative correlation with the neuroepithelial layer thickness of macula fovea, the neuroepithelial layer maximum thickness between optic disc and macula, the average RNFL thickness, the RNFL thickness of temporal optic disc(r=-0.394,-0.424,-0.412,-0.464；P＜0.05).Conclusions FFA showes that hyperfluorescence leakage appearanced in part macula. OCT showes that RNFL becomes thinner as the disease duration increases. The results of OCT and visual field examinaion in the configuration of optic disc and changes of RNFL are accordant.
Objective To observe the relationship between shallow optic cup，small disc and occurrence in patients with nonarteritic anterior ischemic optic neuropathy (NAION).Methods Ninetysix patients（96 diseased eyes）who accorded with the diagnosis criteria for NAION，with duration ge; three months and optic disc edema in paracmasis were selected. The fellow eyes of 96 NAION patients and 80 normal eyes were selected in our study. The horizontal and vertical disc and cup diameters，optic cup depth, and peripapillary retinal nerve fiber layer (RNFL) thickness were measured by quot;crossquot; and quot;ringquot; scan of optical coherence tomography (OCT，Humphrey 2000，German Carl Zeiss Company) inspection system. The cup depth were classified four grades by cup shape according to OCT images：GradeⅠ，bottom of optic cup above the anterior plane of peripapillary neuroepithelial layer（PNL）；GradeⅡ，bottom of optic cup above the plane of PNL；Grade Ⅲ，bottom of optic cup between the plane of PNL and choroidal pigment epithelium；Grade Ⅳ，bottom of optic cup under the plane of choroidal pigment epithelium connection. The grades of optic cup and value in three groups were statistically analyzed. The follow up ranged from six months to three years.Results The disc diameter in horizontal scanning of diseased eyes，fellow eyes and normal eyes were (1.29plusmn;0.19), (1.32plusmn;0.17), (1.40plusmn;0.15) mm，and diameters in vertical scanning were (1.52plusmn;0.14), (1.49plusmn;0.17), (1.60plusmn;0.22) mm, respectively. Compared the diseased eyes and fellow eyes with normal eyes，the difference were statistically significant in horizontal scanning (t=4.291,3.315; P＜0.05) and in vertical scanning (t=2.812, 3.654; P＜0.05). Compared the diseased eyes with fellow eyes，the difference of average diameter were not statistically significant in horizontal and vertical scanning (t=1.153,1.335; P＞0.05). Of the diseased eyes，GradeⅠoptic cup in 36 eyes（37.50），Grade Ⅱ-Ⅲoptic cup in 52 eyes（54.17%），Grade Ⅳoptic cup in eight eyes（8.33%），and GradeⅠ-Ⅲ optic cup in 88 eyes（91.67%）were found. Of the fellow eyes，GradeⅠoptic cup in 18 eyes（18.75%），Grade Ⅱ-Ⅲoptic cup in 69 eyes（71.88%），Grade Ⅳoptic cup in nine eyes（9.34%），and GradeⅠ-Ⅲ optic cup in 87 eyes（9066%）were found. Compared the average RNFL thickness of diseased eyes with the fellow eyes and normal eyes，the differences were statistically significant in temporal, upper, nasal, lower quadrant(t=12.862，10.147，15.046，8.180，12.859，9.562，12.174，8.632；P＜0.001). Compared the average RNFL thickness of the fellow eyes and normal eyes，the differences were not statistically significant in all quadrants（t=1.040，1.576，1.062，1.192；P＞0.05）. During the followup，eight eyes with recurrence which optic cup were GradeⅠand Ⅱin diseased eyes；44 eyes（45.8%）occurred NAION. Correlation analysis showed that there was negative correlation between incidence of fellow eye and optic cup depth(t=-0.757, P=0.000). Conclusion Optic cup and disk in NAION patients are smaller than that in the normal，the anatomical characteristics of shallow cup and small disc was one of the NAION pathogenesis.
Objective To observe the changes of retinal nerve fiber layer (RNFL) thickness and its correlation with visual field mean defects（MD）in Parkinsonprime;s disease (PD).Methods Fifteen eyes of 15 PD patients in early stage and 18 eyes of 18 normal controls undertook RNFL examination by Stratus OCT3. Circular scans (diameter is 3.46 mm) were taken around the optic nerve head including eight quadrants (superior, inferior, temporal, nasal, temporalsuperior, temporalinferior, nasalsuperior and nasalinferior). The RNFL thickness in different quadrants in the two groups was analyzed. The visual field of PD patients was measured by central 302 program of Humphery750 visual field analyzer, and the MD was recorded. The correlation between RNFL thickness and MD was analyzed by linear correlation and regression analysis.Results RNFL thicknesses of superior, inferior, temporal, nasal, temporalsuperior, temporalinferior, nasalsuperior, nasalinferior and average RNFL thickness in the control group were (132.7plusmn;17.4), (141.5plusmn;15.3) ,（83.2plusmn;17.5）, (83.7plusmn;22.3) ,（120.8plusmn;21.2）, (117.9plusmn;24.5) ,（109.6plusmn;20.6）,（110.2plusmn;27.7）, and（109.9plusmn;8.5）mu;m respectively, while in the PD group they were (128.1plusmn;25.3) , (128.6plusmn;13.2) , (68.7plusmn;13.5) , (76.5plusmn;17.8) ,（102.6plusmn;23.7）, (103.3plusmn;14.1) ,（101.2plusmn;20.9）,（96.6plusmn;15.0）,（102.3plusmn;11.9） mu;m. Compared with each other, the differences of RNFL thickness of inferior, temporal, temporalsuperior, temporalinferior and average RNFL thickness were statistically significant（t=2.595，2.700，2.330，2.153，2.131；P=0.014，0.011，0.026，0.040，0.041）. There was a close negative relationship between average RNFL thickness and MD in PD patients (r=-0.933，P＜0.0001). Conclusions RNFL thickness was significantly thinner in PD patients than that in the normal controls. There was a negative relationship between RNFL thickness and MD in PD patients.
Objectives To observe the clinical characteristics of Leber congenital amaurosis (LCA) and analyze the features to differentiate LCA from other similar disorders.Methods Prospective study of 15 LCA patients which include 10 males and 5 females, aged from 2 to 31 years with the mean age 13.6 years. Medical history, family history, perinatal conditions, as well as complete ocular evaluations were well documented. Among the subjects, 12 patients underwent optometry check, 10 patients underwent ERG and 8 patients had OCT testing. Results All of the patients had nystagmus and sluggish pupillary reflex. The visual acuity distributed from light perception to 0.1. Fivepatients (33.3%) were presented with photophobia, while 7 patients (46.7%) had nyctalopia. Among 12 cases underwent refraction examination, 6 patients (50%) had spherical equivalent of ge;+5D；1 patient（8.3%）had spherical equivalent of ge;+5D; 2 patients (16.7%) had bilateral mild to moderate hyperopia；1 patient (8.3%) had one emmertropic eye and one mild myopic eye; 2 patients (16.7%) had moderate to high myopia. Eight patients (53.3%) had enophthalmus,4 patients (26.7%) had oculodigital sign. All of the 10 patients underwent ERG showed extinguished waveform. Under OCT assesement, 7 patients had decreased fovea thickness; 1 patient had increased fovea thickness, complicated by epiretinal membrane; mild abnormality of microstructure of the retina with diminished and disrupted IS/OS hyperreflectivity were found in 2 cases；while more pronounced disarrangement of the retinal layers were found in 6 cases，inner layers were better reserved in all patients.Conclusions Severe visual impairment or blindness, nystagmus, pupillary reflex, extinguished ERG and hyperopia are main clinical characteristics of LCA.
Objective Toinvestigate the influence of photocoagulation on macular function and morphous in patients with diabetic retinopathy (DR).Methods Forty eyes of thirty patients with severe nonproliferative diabetic retinopathy (NPDR) were examined by multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) before and 2,7, and 14 days after photocoagulation. The results were statistically analyzed by using analysis of variance and t test; the changes of macular function and macular fovea thickness were detected and observed.Results P1 response densities of ring 1,3,and 5 were 131.79plusmn;50.92，37.50plusmn;17.27，24.07plusmn;11.49，respectively,2 days after photocoagulation; and were 212.96plusmn;53.75，46.70plusmn;15.89，and 30.91plusmn;10.78, respectively, before photocoagulation. The densities before and after photocoagulation differed much（t=7.910, 2.174, 2.205; Plt;0.05）. N1 response density of ring 4 was（60.39plusmn;20.69） and the prephotocoagulation corresponding response density was （107.11plusmn;44.63）; the difference was significant（t=5.375，Plt;0.01）. The latency of P1 of ring 4 was（41.83plusmn;3.41），which had significant statistically difference（t=-2.770，Plt;0.05) with that before photocoagulation（39.52plusmn;2.64); there was no significant changes in the latency of N1 (Pgt;0.05). The most significant changes of P1 and N1 response densities occurred in the central macular 5deg; area. Seven days after photocoagulation, the response density of P1 and N1 in the central macular 5deg; area seemed to be recoverd to some extend and increased to （179.70plusmn;47.10）and (81.11plusmn;34.18) respectively until 14 days after photocoagulation, which was still much lower than that before the photocoagulation（t=3.840, 2.746; P＜0.05）; the response densities of other areas had no significant differences (P＞0.05). Seven days after photocoagulation,the latency of P1 in ring 4 was delayed to（41.78plusmn;3.57）, which had significant difference（t=-3.144，P＜0.01）with that before the photocoagulation（39.52plusmn;2.64) ; but there was no significant difference between 14 days after photocoagulation and prephotocoagulation (t=-1.809，P＞0.05). The latency of N1 in ring 1 was（20.67plusmn;3.85）at seven days after photocoagulation, It had no significant difference (t=-1.171,P＞0.05) with that before the phtocoaguation（18.78plusmn;3.29）. Before and 2 days after photocoagulation, the macular fovea thickness were（224.42plusmn;122.88）and（274.85plusmn;108.20）respectively, and the difference was statistically significant（t=-2.420，P＜0.05）. Forteen days after photocoagulation，the macular fovea thickness was（236.29plusmn;70.45），It had no significant difference with that before the photocoagulation（t=-0.578，P＞0.05）. Before and seven days after photocoagulation, P1 response density had obvious negative correlation with corresponding macular fovea thickness（r=-0.755，Plt;0.01; r=-0.594，Plt;0.05）. Conclusions After photocoagulation in patients with DR，the macular function decreased in a certain degree，and the relationship of macular retinal function and macular morphology changes was close; combination of mfERG and OCT can evaluate macular function and macular morphology structure comprehensively and objectively.
ObjectiveTo evaluate Micron Ⅳ retinal imaging system in three mouse models of retinal diseases. MethodsMouse models of oxygen induced retinopathy (OIR) model (OIR group), N-methyl-N nitrosourea (MNU) model (MNU group) and N-methyl-D-aspartate (NMDA) model (NMDA group) were induced in 24 healthy male C57BL/6J mice. Fundus photograph, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) and electroretinogram (ERG) were used to evaluate these mice. All the imaging examinations were performed by Micron Ⅳ retinal imaging system. ResultsOIR mice showed tortuous and dilated retinal vessels in fundus photograph, neovascularization plexus and vascular leakage in FFA, and epiretinal fibrovascular tissue and tortuous expansion vascular vessels in OCT. MNU mice showed wax yellow optic disk without retinal pigmentary changes, slight thinning of retinal blood vessels in FFA, and normal structure and thickness in OCT. The a-wave amplitudes of the maximum mixed response decreased significantly, and were (15.38±4.36) μV and (13.78±5.52) μV at 2 or 3 days of modeling, respectively. NMDA mice showed a pale retina with vasospasm. ERG revealed that there was no obvious change in latency of a- and b-wave, but significantly decreased amplitude of b-wave at 12 hours and 24 hours after modeling with (72.28±7.18) μV and (65.35±9.18) μV, respectively. ConclusionMicron Ⅳ retinal imaging system is a real-time, non-invasive tool to study the retinal structure and function in animal models of retinal diseases.
With the renovations of modern retinal imaging modality, such as video ophthalmoscopy, fundus photography, fundus fluorescein angiograph and spectral domain optical coherence tomography, it is possible to get high resolution and reproducible in vivo imaging of retina from neonates to improve the diagnosis and treatment of pediatric retinal disease. Now we have a better tool to investigate the early development of human retina, the pathogenesis and progression of pediatric retinal diseases, and to monitor the treatment efficacy and prognosis of these diseases. To expand these technologies in the diagnosis and treatment of pediatric retinal disease, we need simple, safe, comprehensive and objective applications which can only be achieved through multi-disciplinary cooperation.
Fundus photograph, angiography, optical coherence tomography, ultrasonography and other image technology and visual electrophysiology can provide a wealth of information for the diagnosis and treatment of pediatric retinal diseases. However, it put forward higher requirements on pediatric retinal imaging equipment and techniques which will be quite different from adult, because of pediatric retinal disease has its own characteristics, such as disease spectrum, pathogenesis, and pathophysiology. The principles and methods of image results interpretation on adult were not quite ready for children. It is necessary to further study the fundus imaging techniques suitable for children, gradually establish standardized examination procedures and clinical interpretation system, to promote the diagnosis of retinopathy in children.
Objective To observe the macular morphology and circumpapillary retinal nerve fiber layer thickness (RNFL) in Parkinson's disease (PD) evaluated by spectral-domain optical coherence tomography (SD-OCT). Methods A total of 37 patients (74 eyes) with PD were in the PD group, 32 age- and sex-matched healthy subjects (64 eyes) in the control group. All subjects underwent SD-OCT examination with 5 line scanning, macular cube 512×128 scanning and optic disc volume 200×200 scanning. The retinal thickness, central foveal thickness (CFT), macular volume and thickness of circumpapillary, superior, inferior, nasal, and temporal of RNFL between two groups were comparatively analyzed. The relationship between SD-OCT parameters and age, disease duration, scores of Hoehn-Yahr and unified PD rating scale (UPDRS) Ⅲ in PD patients was analyzed by Pearson correlation analysis. Results Both of the retinal thickness and macular volume in PD group were significantly reduced than those in control group (t= −2.546, −3.410;P=0.012, 0.001). There was no difference of CFT (t= −0.463,P=0.644) and the thickness of circumpapillary (t= −1.645,P=0.102), superior (t= −0.775,P=0.439), inferior (t=−1.844,P=0.067), nasal (t= −0.344,P=0.732) and temporal (t= −0.541,P=0.590) of RNFL between two groups. The retinal thickness, macular volume, CFT and the thickness of circumpapillary, superior, inferior, nasal, temporal of RNFL had no relationship with age, disease duration and scores of Hoehn-Yahr and UPDRS Ⅲ in PD patients (P＞0.05). Conclusions In PD patients, the retinal thickness and macular volume are decreased, however, the circumpapillary RNFL have no obvious alterations.