AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).ME...AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.展开更多
AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a ...AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a retrospective study.A total of 20 patients(32 eyes)were included.The medical records and multimodal imaging,including wide-field fundus photography,wide-field fundus autofluorescence(FAF),and swept-source optical coherence tomography(SS-OCT)were analyzed.RESULTS:The study included 20 patients with a mean age of 38.2±10.9y,and females accounted for 60%.Lesions could involve peripapillary areas,macular region,and peripheral retina.The mean best-corrected visual acuity(BCVA)at presentation was 0.38±0.60 logMAR,with no significant difference in visual acuity between acute cases(within 6mo of onset)and chronic cases(beyond 6mo of onset;P=0.390).There was no statistically significant difference in visual acuity between eyes of acute case(within 6mo of onset)and the chronic case(beyond 6mo of onset).In some chronic case,FAF examination revealed the presence of a hyperautofluorescent(hyperAF)ring around the macular area(6/18),a phenomenon not observed in the acute case(P=0.024).A higher proportion of chronic cases showed predominantly hypoautofluorescent(hypoAF)lesions compared to the acute case(13/18 vs 2/14,P=0.0016).SS-OCT examination showed that both acute and chronic cases exhibited hyperreflective dots above the retinal pigment epithelium(RPE),and ellipsoid zone(EZ)and RPE damage.In the chronic case,eyes with hyperreflective dots above the RPE were more likely to exhibit EZ and RPE damage in the macular region compared to those without these dots.CONCLUSION:Multimodal imaging plays a crucial role in the follow-up of patients with AZOOR.In chronic cases of AZOOR,the presence of hyperreflective dots above the RPE indicates a higher likelihood of outer retinal involvement in the macular region.This study provides critical insights into the complex presentation and progression of AZOOR.展开更多
With the advancement of retinal imaging,hyperreflective foci(HRF)on optical coherence tomography(OCT)images have gained significant attention as potential biological biomarkers for retinal neuroinflammation.However,th...With the advancement of retinal imaging,hyperreflective foci(HRF)on optical coherence tomography(OCT)images have gained significant attention as potential biological biomarkers for retinal neuroinflammation.However,these biomarkers,represented by HRF,present pose challenges in terms of localization,quantification,and require substantial time and resources.In recent years,the progress and utilization of artificial intelligence(AI)have provided powerful tools for the analysis of biological markers.AI technology enables use machine learning(ML),deep learning(DL)and other technologies to precise characterization of changes in biological biomarkers during disease progression and facilitates quantitative assessments.Based on ophthalmic images,AI has significant implications for early screening,diagnostic grading,treatment efficacy evaluation,treatment recommendations,and prognosis development in common ophthalmic diseases.Moreover,it will help reduce the reliance of the healthcare system on human labor,which has the potential to simplify and expedite clinical trials,enhance the reliability and professionalism of disease management,and improve the prediction of adverse events.This article offers a comprehensive review of the application of AI in combination with HRF on OCT images in ophthalmic diseases including age-related macular degeneration(AMD),diabetic macular edema(DME),retinal vein occlusion(RVO)and other retinal diseases and presents prospects for their utilization.展开更多
AIM:To analyze the relationship between optical coherence tomography(OCT)and OCT angiography(OCTA)imaging in patients with diabetic macular edema(DME)who are treated with a combination of aflibercept and triamcinolone...AIM:To analyze the relationship between optical coherence tomography(OCT)and OCT angiography(OCTA)imaging in patients with diabetic macular edema(DME)who are treated with a combination of aflibercept and triamcinolone acetonide(TA).METHODS:A total of 76 eyes newly diagnosed DME were included in this study.They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA.Injections once a month for a total of three injections.Central macular thickness(CMT),number of hyperreflective foci(HRF),height of subretinal fluid(SRF),and area of foveal avascular zone(FAZ)were evaluated using OCT and OCTA at baseline and after each monthly treatment.RESULTS:Both groups showed improvement in best corrected visual acuity(BCVA)and reduction in macular edema after treatment,and the difference in BCVA between the two groups was statistically significant after each treatment(P<0.05).The difference in CMT between the two groups was statistically significant after the first two injections(P<0.01),but not after the third injection(P=0.875).The number of HRF(1mo:7.41±8.25 vs 10.86±7.22,P=0.027;2mo:5.33±6.13 vs 9.12±8.61,P=0.034;3mo:3.58±3.00 vs 6.37±5.97,P=0.007)and height of SRF(1mo:82.39±39.12 vs 105.77±42.26μm,P=0.011;2mo:36.84±10.02 vs 83.59±37.78μm,P<0.01;3mo:11.57±3.29 vs 45.43±12.60μm,P<0.01)in combined group were statistically significant less than aflibercept group after each injection,while the area of FAZ showed no significant change before and after treatment in both groups.CONCLUSION:The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF.However,both aflibercept and combination therapy show no significant change in the area of FAZ.展开更多
AIM:To describe the characteristics of peripapillary hyperreflective ovoid mass-like structure(PHOMS)in myopic children and to investigate factors associated with PHOMS.METHODS:This retrospective observational study i...AIM:To describe the characteristics of peripapillary hyperreflective ovoid mass-like structure(PHOMS)in myopic children and to investigate factors associated with PHOMS.METHODS:This retrospective observational study included 101 eyes of 101 children(age≤17y)with myopia.All included patients underwent comprehensive clinical examination.Optic nerve canal parameters,including disc diameter,optic nerve head(ONH)tilt angle,and border tissue angle were measured using serial enhanced-depth imaging spectral-domain optical coherence tomography(EDI-OCT).Based on the optic disc drusen consortium’s definition of PHOMS,eyes were classified as PHOMS group and non-PHOMS group.PHOMS was categorized according to height.RESULTS:Sixty-seven(66.3%)eyes were found with PHOMS.Small PHOMS could only be detected by optical coherence tomography(OCT).Medium PHOMS could be seen with blurred optic disc borders corresponding to OCT.The most frequent location of PHOMS was at the nasosuperior(91%,61 of 67 eyes)to ONH disc.The axial length and spherical equivalent were more myopic in the PHOMS group than in the non-PHOMS group(both P<0.001).ONH tilt angle was also significantly greater in PHOMS group than in non-PHOMS group[8.90(7.16-10.54)vs 3.93(3.09-5.25),P<0.001].Border tissue angle was significantly smaller in PHOMS group than in non-PHOMS group[29.70(20.90-43.81)vs 45.62(35.18-60.45),P<0.001].In the multivariable analysis,spherical equivalent(OR=3.246,95%CI=1.209-8.718,P=0.019)and ONH tilt angle(OR=3.275,95%CI=1.422-7.542,P=0.005)were significantly correlated with PHOMS.There was no disc diameter associated with PHOMS.In the linear regression analysis,border tissue angle was negatively associated with PHOMS height(β=-2.227,P<0.001).CONCLUSION:PHOMS is associated with optic disc tilt and optic disc nasal shift in myopia.Disc diameter is not a risk factor for PHOMS.The changes in ONH caused by axial elongation facilitated an understanding of the mechanism of PHOMS.展开更多
Diabetic retinopathy, characterized as a microangiopathy and neurodegenerative disease, is the leading cause of visual impairment in diabetic patients. Many clinical features observed in diabetic retinopathy, such as ...Diabetic retinopathy, characterized as a microangiopathy and neurodegenerative disease, is the leading cause of visual impairment in diabetic patients. Many clinical features observed in diabetic retinopathy, such as capillary occlusion, acellular capillaries and retinal non-perfusion, aggregate retinal ischemia and represent relatively late events in diabetic retinopathy. In fact, retinal microvascular injury is an early event in diabetic retinopathy involving multiple biochemical alterations, and is manifested by changes to the retinal neurovascular unit and its cellular components. Currently, intravitreal anti-vascular endothelial growth factor therapy is the firstline treatment for diabetic macular edema, and benefits the patient by decreasing the edema and improving visual acuity. However, a significant proportion of patients respond poorly to anti-vascular endothelial growth factor treatments, indicating that factors other than vascular endothelial growth factor are involved in the pathogenesis of diabetic macular edema. Accumulating evidence confirms that low-grade inflammation plays a critical role in the pathogenesis and development of diabetic retinopathy as multiple inflammatory factors, such as interleukin-1β, monocyte chemotactic protein-1 and tumor necrosis factor-α, are increased in the vitreous and retina of diabetic retinopathy patients. These inflammatory factors, together with growth factors such as vascular endothelial growth factor, contribute to blood-retinal barrier breakdown, vascular damage and neuroinflammation, as well as pathological angiogenesis in diabetic retinopathy, complicated by diabetic macular edema and proliferative diabetic retinopathy. In addition, retinal cell types including microglia, Müller glia, astrocytes, retinal pigment epithelial cells, and others are activated, to secrete inflammatory mediators, aggravating cell apoptosis and subsequent vascular leakage. New therapies, targeting these inflammatory molecules or related signaling pathways, have the potential to inhibit retinal inflammation and prevent diabetic retinopathy progression. Here, we review the relevant literature to date, summarize the inflammatory mechanisms underlying the pathogenesis of diabetic retinopathy, and propose inflammation-based treatments for diabetic retinopathy and diabetic macular edema.展开更多
AIM：To evaluate the potential role of hyperreflective foci（HF） as a prognostic indicator of visual outcome in patients with macular edema（ME） due to retinal vein occlusion（RVO）.METHODS：We retrospectively revie...AIM：To evaluate the potential role of hyperreflective foci（HF） as a prognostic indicator of visual outcome in patients with macular edema（ME） due to retinal vein occlusion（RVO）.METHODS：We retrospectively reviewed 50 eyes of 50 patients with ME due to ischemic central retinal vein occlusion（CRVO）,non-ischemic CRVO and branch retinal vein occlusion（BRVO） who were treated with anti-vascular endothelial growth factor（anti-VEGF） at Beijing Tongren Eye Center from January 2013 to July 2016.All patients underwent best-corrected visual acuity（BCVA）,spectral domain optical coherence tomography（SD-OCT） at baseline and follow-up.Such factors were evaluated and compared among three groups as baseline and final BCVA,central retinal thickness（CRT）,external limiting membrane（ELM） status and the numbers of HF in different position.Multiple linear regression analysis was employed to analyze the relationship between baseline HF and final BCVA.Changes of HF before and after treatment were evaluated too.RESULTS：Among three groups,HF could be located in each retinal layers,as well as in vitreous cavity.The mean HF in outer retinal layer（ORL） at baseline was 5.29±8.48 in ischemic CRVO with intact ELM,1.93±2.76 in non-ischemic CRVO,and 1.75±2.05 in BRVO.With disrupted ELM,the mean HF in ORL increased.There was statistically difference of HF in ORL between intact and disrupted ELM.The numbers of HF in ORL were associated with poor visual outcome among three groups.However,HF in inner retinal layer（IRL） and vitreous cavity were not associated with poor visual outcome.Meanwhile,the baseline HF in ORL and vitreous cavity reduced significantly in nonischemic CRVO and BRVO after anti-VEGF treatment.CONCLUSION：The numbers of HF in ORL are prognostic factors associated with the final BCVA in patients with ME due to RVO after anti-VEGF treatment.展开更多
AIM: To investigate the anti-inflammatory effect of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF) in patients with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Twen...AIM: To investigate the anti-inflammatory effect of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF) in patients with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Twenty-eight eyes from twenty-eight treatment-na?ve patients(14 males and 14 females) with RVO-ME were included in this retrospective study.The retinal vein occlusion(RVO) was comprised of both central retinal vein occlusion(CRVO,n=14) and branch retinal vein occlusion(BRVO,n=14).Intravitreal injection of anti-VEGF reagents were administered monthly for three consecutive months,in which 18 patients were injected with ranibizumab and 10 patients were injected with conbercept.All eyes were imaged with optical coherence tomography angiography(OCTA) at baseline and 1wk after monthly intravitreal anti-VEGF injection.The visual acuity(VA),central macular thickness(CMT),the number of hyperreflective foci(HRF) recognized as an inflammatory sign in OCT images,and non-perfusion area(NPA),were compared before and after anti-VEGF treatments.RESULTS: The mean interval between baseline and follow-up was 29.4±0.79(range,27-48)d.Compared with the baseline,the VA improved(log MAR 1.5±0.1 vs 0.8±0.1,P<0.05) and CMT decreased(460±34.0 μm vs 268.8±12.0 μm,P<0.05),significantly,after antiVEGF treatment.The number of HRF was decreased significantly(76.5±4.8 vs 47.8±4.3,P<0.05) after antiVEGF treatment.CONCLUSION: Anti-VEGF therapy is effective in treating RVO-ME.The mechanisms for the decreased HRF and the reduction of NPA by anti-VEGF therapy merits further exploration.展开更多
Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely ...Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.展开更多
AIM: To evaluate the effects of intravitreal conbercept(IVC) as adjunctive treatments before panretinal photocoagulation(PRP) to decrease hyperreflective dots(HRDs) in Chinese proliferative diabetic retinopathy(PDR) p...AIM: To evaluate the effects of intravitreal conbercept(IVC) as adjunctive treatments before panretinal photocoagulation(PRP) to decrease hyperreflective dots(HRDs) in Chinese proliferative diabetic retinopathy(PDR) patients. METHODS: Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC(0.5 mg/0.05 m L) 1 wk before PRP(Plus group) or PRP only(PRP group). Six months later, we measured the best corrected visual acuity(BCVA), central macula thickness(CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. RESULTS: The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. CONCLUSION: IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.展开更多
Dear Editor,We’re interested in the article by Mo and colleagues about＂Evaluation of hyperreflective foci as a prognostic factor of visual outcome in retinal vein occlusion＂.They performed a multiple linear regress...Dear Editor,We’re interested in the article by Mo and colleagues about＂Evaluation of hyperreflective foci as a prognostic factor of visual outcome in retinal vein occlusion＂.They performed a multiple linear regression analysis with backward elimination to analyse the association of best corrected visual acuity（BCVA）with the numbers of hyperreflective foci（HF）in different layers.展开更多
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-037A)Tianjin Key Laboratory of Retinal Functions and Diseases Independent and Open Project(No.2023tjswmm004)Tianjin Medical University Eye Hospital High-level Innovative Talent Programme(No.YDYYRCXM-B2023-02).
文摘AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.
文摘AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a retrospective study.A total of 20 patients(32 eyes)were included.The medical records and multimodal imaging,including wide-field fundus photography,wide-field fundus autofluorescence(FAF),and swept-source optical coherence tomography(SS-OCT)were analyzed.RESULTS:The study included 20 patients with a mean age of 38.2±10.9y,and females accounted for 60%.Lesions could involve peripapillary areas,macular region,and peripheral retina.The mean best-corrected visual acuity(BCVA)at presentation was 0.38±0.60 logMAR,with no significant difference in visual acuity between acute cases(within 6mo of onset)and chronic cases(beyond 6mo of onset;P=0.390).There was no statistically significant difference in visual acuity between eyes of acute case(within 6mo of onset)and the chronic case(beyond 6mo of onset).In some chronic case,FAF examination revealed the presence of a hyperautofluorescent(hyperAF)ring around the macular area(6/18),a phenomenon not observed in the acute case(P=0.024).A higher proportion of chronic cases showed predominantly hypoautofluorescent(hypoAF)lesions compared to the acute case(13/18 vs 2/14,P=0.0016).SS-OCT examination showed that both acute and chronic cases exhibited hyperreflective dots above the retinal pigment epithelium(RPE),and ellipsoid zone(EZ)and RPE damage.In the chronic case,eyes with hyperreflective dots above the RPE were more likely to exhibit EZ and RPE damage in the macular region compared to those without these dots.CONCLUSION:Multimodal imaging plays a crucial role in the follow-up of patients with AZOOR.In chronic cases of AZOOR,the presence of hyperreflective dots above the RPE indicates a higher likelihood of outer retinal involvement in the macular region.This study provides critical insights into the complex presentation and progression of AZOOR.
基金Supported by Zhejiang Provincial Natural Science Foundation of China(No.LGF22H120013)the Ningbo Natural Science Foundation(No.2023J209,No.2021J023)+2 种基金Ningbo Medical Science and Technology Project(No.2021Y57)Ningbo Yinzhou District Agricultural Community Development Science and Technology Project(No.2022AS022)Ningbo Eye Hospital Scientific Technology Plan Project and Talent Introduction Start Subject(No.2022RC001).
文摘With the advancement of retinal imaging,hyperreflective foci(HRF)on optical coherence tomography(OCT)images have gained significant attention as potential biological biomarkers for retinal neuroinflammation.However,these biomarkers,represented by HRF,present pose challenges in terms of localization,quantification,and require substantial time and resources.In recent years,the progress and utilization of artificial intelligence(AI)have provided powerful tools for the analysis of biological markers.AI technology enables use machine learning(ML),deep learning(DL)and other technologies to precise characterization of changes in biological biomarkers during disease progression and facilitates quantitative assessments.Based on ophthalmic images,AI has significant implications for early screening,diagnostic grading,treatment efficacy evaluation,treatment recommendations,and prognosis development in common ophthalmic diseases.Moreover,it will help reduce the reliance of the healthcare system on human labor,which has the potential to simplify and expedite clinical trials,enhance the reliability and professionalism of disease management,and improve the prediction of adverse events.This article offers a comprehensive review of the application of AI in combination with HRF on OCT images in ophthalmic diseases including age-related macular degeneration(AMD),diabetic macular edema(DME),retinal vein occlusion(RVO)and other retinal diseases and presents prospects for their utilization.
基金Supported by the Natural Science Foundation of Guangdong Province,China(No.2022A1515010742)Hunan Provincial Natural Science Foundation of China(No.2023JJ70039)Scientific Research Program of Xiangjiang Philanthropy Foundation.
文摘AIM:To analyze the relationship between optical coherence tomography(OCT)and OCT angiography(OCTA)imaging in patients with diabetic macular edema(DME)who are treated with a combination of aflibercept and triamcinolone acetonide(TA).METHODS:A total of 76 eyes newly diagnosed DME were included in this study.They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA.Injections once a month for a total of three injections.Central macular thickness(CMT),number of hyperreflective foci(HRF),height of subretinal fluid(SRF),and area of foveal avascular zone(FAZ)were evaluated using OCT and OCTA at baseline and after each monthly treatment.RESULTS:Both groups showed improvement in best corrected visual acuity(BCVA)and reduction in macular edema after treatment,and the difference in BCVA between the two groups was statistically significant after each treatment(P<0.05).The difference in CMT between the two groups was statistically significant after the first two injections(P<0.01),but not after the third injection(P=0.875).The number of HRF(1mo:7.41±8.25 vs 10.86±7.22,P=0.027;2mo:5.33±6.13 vs 9.12±8.61,P=0.034;3mo:3.58±3.00 vs 6.37±5.97,P=0.007)and height of SRF(1mo:82.39±39.12 vs 105.77±42.26μm,P=0.011;2mo:36.84±10.02 vs 83.59±37.78μm,P<0.01;3mo:11.57±3.29 vs 45.43±12.60μm,P<0.01)in combined group were statistically significant less than aflibercept group after each injection,while the area of FAZ showed no significant change before and after treatment in both groups.CONCLUSION:The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF.However,both aflibercept and combination therapy show no significant change in the area of FAZ.
基金Supported by Wuhan Central Hospital Discipline Fund(No.2021XK017).
文摘AIM:To describe the characteristics of peripapillary hyperreflective ovoid mass-like structure(PHOMS)in myopic children and to investigate factors associated with PHOMS.METHODS:This retrospective observational study included 101 eyes of 101 children(age≤17y)with myopia.All included patients underwent comprehensive clinical examination.Optic nerve canal parameters,including disc diameter,optic nerve head(ONH)tilt angle,and border tissue angle were measured using serial enhanced-depth imaging spectral-domain optical coherence tomography(EDI-OCT).Based on the optic disc drusen consortium’s definition of PHOMS,eyes were classified as PHOMS group and non-PHOMS group.PHOMS was categorized according to height.RESULTS:Sixty-seven(66.3%)eyes were found with PHOMS.Small PHOMS could only be detected by optical coherence tomography(OCT).Medium PHOMS could be seen with blurred optic disc borders corresponding to OCT.The most frequent location of PHOMS was at the nasosuperior(91%,61 of 67 eyes)to ONH disc.The axial length and spherical equivalent were more myopic in the PHOMS group than in the non-PHOMS group(both P<0.001).ONH tilt angle was also significantly greater in PHOMS group than in non-PHOMS group[8.90(7.16-10.54)vs 3.93(3.09-5.25),P<0.001].Border tissue angle was significantly smaller in PHOMS group than in non-PHOMS group[29.70(20.90-43.81)vs 45.62(35.18-60.45),P<0.001].In the multivariable analysis,spherical equivalent(OR=3.246,95%CI=1.209-8.718,P=0.019)and ONH tilt angle(OR=3.275,95%CI=1.422-7.542,P=0.005)were significantly correlated with PHOMS.There was no disc diameter associated with PHOMS.In the linear regression analysis,border tissue angle was negatively associated with PHOMS height(β=-2.227,P<0.001).CONCLUSION:PHOMS is associated with optic disc tilt and optic disc nasal shift in myopia.Disc diameter is not a risk factor for PHOMS.The changes in ONH caused by axial elongation facilitated an understanding of the mechanism of PHOMS.
基金supported by the National Natural Science Foundation of China,No. 82171062 (to JFZ)。
文摘Diabetic retinopathy, characterized as a microangiopathy and neurodegenerative disease, is the leading cause of visual impairment in diabetic patients. Many clinical features observed in diabetic retinopathy, such as capillary occlusion, acellular capillaries and retinal non-perfusion, aggregate retinal ischemia and represent relatively late events in diabetic retinopathy. In fact, retinal microvascular injury is an early event in diabetic retinopathy involving multiple biochemical alterations, and is manifested by changes to the retinal neurovascular unit and its cellular components. Currently, intravitreal anti-vascular endothelial growth factor therapy is the firstline treatment for diabetic macular edema, and benefits the patient by decreasing the edema and improving visual acuity. However, a significant proportion of patients respond poorly to anti-vascular endothelial growth factor treatments, indicating that factors other than vascular endothelial growth factor are involved in the pathogenesis of diabetic macular edema. Accumulating evidence confirms that low-grade inflammation plays a critical role in the pathogenesis and development of diabetic retinopathy as multiple inflammatory factors, such as interleukin-1β, monocyte chemotactic protein-1 and tumor necrosis factor-α, are increased in the vitreous and retina of diabetic retinopathy patients. These inflammatory factors, together with growth factors such as vascular endothelial growth factor, contribute to blood-retinal barrier breakdown, vascular damage and neuroinflammation, as well as pathological angiogenesis in diabetic retinopathy, complicated by diabetic macular edema and proliferative diabetic retinopathy. In addition, retinal cell types including microglia, Müller glia, astrocytes, retinal pigment epithelial cells, and others are activated, to secrete inflammatory mediators, aggravating cell apoptosis and subsequent vascular leakage. New therapies, targeting these inflammatory molecules or related signaling pathways, have the potential to inhibit retinal inflammation and prevent diabetic retinopathy progression. Here, we review the relevant literature to date, summarize the inflammatory mechanisms underlying the pathogenesis of diabetic retinopathy, and propose inflammation-based treatments for diabetic retinopathy and diabetic macular edema.
文摘AIM：To evaluate the potential role of hyperreflective foci（HF） as a prognostic indicator of visual outcome in patients with macular edema（ME） due to retinal vein occlusion（RVO）.METHODS：We retrospectively reviewed 50 eyes of 50 patients with ME due to ischemic central retinal vein occlusion（CRVO）,non-ischemic CRVO and branch retinal vein occlusion（BRVO） who were treated with anti-vascular endothelial growth factor（anti-VEGF） at Beijing Tongren Eye Center from January 2013 to July 2016.All patients underwent best-corrected visual acuity（BCVA）,spectral domain optical coherence tomography（SD-OCT） at baseline and follow-up.Such factors were evaluated and compared among three groups as baseline and final BCVA,central retinal thickness（CRT）,external limiting membrane（ELM） status and the numbers of HF in different position.Multiple linear regression analysis was employed to analyze the relationship between baseline HF and final BCVA.Changes of HF before and after treatment were evaluated too.RESULTS：Among three groups,HF could be located in each retinal layers,as well as in vitreous cavity.The mean HF in outer retinal layer（ORL） at baseline was 5.29±8.48 in ischemic CRVO with intact ELM,1.93±2.76 in non-ischemic CRVO,and 1.75±2.05 in BRVO.With disrupted ELM,the mean HF in ORL increased.There was statistically difference of HF in ORL between intact and disrupted ELM.The numbers of HF in ORL were associated with poor visual outcome among three groups.However,HF in inner retinal layer（IRL） and vitreous cavity were not associated with poor visual outcome.Meanwhile,the baseline HF in ORL and vitreous cavity reduced significantly in nonischemic CRVO and BRVO after anti-VEGF treatment.CONCLUSION：The numbers of HF in ORL are prognostic factors associated with the final BCVA in patients with ME due to RVO after anti-VEGF treatment.
基金Supported by the National Natural Science Foundation of China (No.81970811No.81970810+1 种基金No.82171062)Domestic Science and Technology Cooperation Project of Shanghai Municipal Science and Technology Commission (No.21015800700)。
文摘AIM: To investigate the anti-inflammatory effect of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF) in patients with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Twenty-eight eyes from twenty-eight treatment-na?ve patients(14 males and 14 females) with RVO-ME were included in this retrospective study.The retinal vein occlusion(RVO) was comprised of both central retinal vein occlusion(CRVO,n=14) and branch retinal vein occlusion(BRVO,n=14).Intravitreal injection of anti-VEGF reagents were administered monthly for three consecutive months,in which 18 patients were injected with ranibizumab and 10 patients were injected with conbercept.All eyes were imaged with optical coherence tomography angiography(OCTA) at baseline and 1wk after monthly intravitreal anti-VEGF injection.The visual acuity(VA),central macular thickness(CMT),the number of hyperreflective foci(HRF) recognized as an inflammatory sign in OCT images,and non-perfusion area(NPA),were compared before and after anti-VEGF treatments.RESULTS: The mean interval between baseline and follow-up was 29.4±0.79(range,27-48)d.Compared with the baseline,the VA improved(log MAR 1.5±0.1 vs 0.8±0.1,P<0.05) and CMT decreased(460±34.0 μm vs 268.8±12.0 μm,P<0.05),significantly,after antiVEGF treatment.The number of HRF was decreased significantly(76.5±4.8 vs 47.8±4.3,P<0.05) after antiVEGF treatment.CONCLUSION: Anti-VEGF therapy is effective in treating RVO-ME.The mechanisms for the decreased HRF and the reduction of NPA by anti-VEGF therapy merits further exploration.
文摘Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.
文摘AIM: To evaluate the effects of intravitreal conbercept(IVC) as adjunctive treatments before panretinal photocoagulation(PRP) to decrease hyperreflective dots(HRDs) in Chinese proliferative diabetic retinopathy(PDR) patients. METHODS: Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC(0.5 mg/0.05 m L) 1 wk before PRP(Plus group) or PRP only(PRP group). Six months later, we measured the best corrected visual acuity(BCVA), central macula thickness(CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. RESULTS: The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. CONCLUSION: IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.
文摘Dear Editor,We’re interested in the article by Mo and colleagues about＂Evaluation of hyperreflective foci as a prognostic factor of visual outcome in retinal vein occlusion＂.They performed a multiple linear regression analysis with backward elimination to analyse the association of best corrected visual acuity（BCVA）with the numbers of hyperreflective foci（HF）in different layers.
