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Clinical applications of optical fundus imaging technology

Chinese Journal of Ocular Fundus Diseases.2014;30(6):535-539. doi:10.3760/cma.j.issn.1005-1015.2014.06.001

Optical imaging technology of ocular fundus,including fundus fluorescein angiography (FFA),optical coherence tomography (OCT) and fundus autofluorescence (FAF),is growing at an unprecedented speed and scale and is integrating into the routine clinical management of ocular fundus diseases,such as diagnosis,treatment,and mechanism study.While FFA allow us to observe the retinal and choroidal blood circulation,OCT and FAF are non-invasive,fast and quantifiable measurement; such techniques show even more unique advantages and are favored tools.All these retinal imaging technologies,together with a variety of retinal function assessments,bring us into the era of big data of ocular fundus diseases.All of these developments are the challenges and opportunities for the operator and user of these fundus optics imaging technologies.In order to improve its clinical applications and allocate resources rationally,we need to understand the optical properties of these retinal imaging technologies,and standardize diagnosis behavior.This is a continuous learning process needs to continue to explore.

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Optimization of treatment outcome and exploration of new indication in anti-vascular endothelial growth factor therapy

Xun XU

Chinese Journal of Ocular Fundus Diseases.2015;31(1):3-5. doi:10.3760/cma.j.issn.1005-1015.2015.01.002

Since anti vascular endothelial growth factor (VEGF) therapy has recently become the first-line treatment of wet age related macular degeneration in China,as well as retinopathy of prematurity,neovascular glaucoma and macular edema secondary to diabetic retinopathy or retinal vein occlusion in other countries,It is worth thinking about that how to perform anti-VEGF treatment properly to benefit more patients.We reviewed the fields of clinical researches to explore the best role of anti-VEGF treatment in prevention and treatment of retinal disease in future.

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The efficacy of intravitreal ranibizumab and (or)triamcinolone combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion

Shuang SONG ; Xiaobing YU ; Hong DAI

Chinese Journal of Ocular Fundus Diseases.2015;31(1):18-21. doi:10.3760/cma.j.issn.1005-1015.2015.01.006

Objective To investigate the efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to branch retinal vein occlusion (BRVO) during one year period.Methods The data of 31 eyes from 31 consecutive patients with macular edema secondary to BRVO during one year follow-up visit were retrospectively analyzed.Mean best corrected visual acuity (BCVA) logMAR was (0.74±0.36) and mean central retinal thickness (CRT) was (484.48± 164.81) μm at baseline.All patients received standardized clinical comprehensive examinations including vision,intraocular pressure and optical coherence tomography for diagnosis before treatment.All patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml) at first visit.The continue PRN treatment were based on the visual acuity changes and the optical coherence tomography findings.Eyes received combined triamcinolone acetonide 0.05 ml (40 mg/ml) and ranibizumab for macular edema recurrence after two injections of ranibizumab and received laser photocoagulation during 10-14 days after third injections of ranibizumab.Mean injection of ranibizumab was 3.52± 2.01,15 eyes with triamcinolone acetonide (0.84 ± 1.21),21 eyes with laser photocoagulation (0.97± 0.95) and 12 eyes with three treatment.Compared the visual acuities and CRTs of the first and the last visits by statistical analysis.Results Mean visual acuity improved significantly to 0.42±0.33 logMAR (t=6.611,P=0.000).Mean improvement of visual acuity was 2.90± 3.07 lines.A gain of three or more logarithmic lines was evaluated in 20/31 eyes (64.52％) at the last visit.Mean CRT was (326.19± 117.80) μm (t=4.514,P=0.000).Mean reduction of CRT was (333.58±134.17) μm.A decrease of 100 μm of CRT was evaluated in 17/31 eyes (54.84％).No severe ocular and systematic side effect was found.Conclusion The efficacy and safety of intravitreal ranibizumab and (or) triamcinolone combined with laser photocoagulation for macular edema secondary to BRVO were assured.

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Comparison of the efficacy of multi-point or single-point mode of 577 nm laser in the treatment of diabetic retinopathy

Moli ZHANG ; Bei TIAN ; Wenbin WEI

Chinese Journal of Ocular Fundus Diseases.2015;31(1):36-40. doi:10.3760/cma.j.issn.1005-1015.2015.01.010

Objective To compare the therapeutic effects of 577 nm laser panretinal photocoagulation (PRP) between one time multi-point scanning mode and multiple time single-point mode in the treatment of eyes with non-proliferative diabetic retinopathy (NPDR).Methods This is a prospective controlled study from August 2013 to February 2014.A total of 29 patients (46 eyes) with clinically diagnosed severe NPDR were randomly divided into two groups including the treatment group (12 patients,22 eyes) and the control group (17 patients,224 eyes).The treatment group received one time PRP of multi-point scanning mode,and the control group received 3-4 times of PRP with single-point mode.In order to evaluate its efficacy,the best corrected visual acuity was measured before treatment,and 1 day,1,2,6 and 12 months after treatment.The average threshold sensitivity,a/b-wave amplitude of flash ERG (F-ERG) in the 30 °-60 ° visual field,and fundus fluorescein angiography (FFA) of the change were also compared between the 2 groups.The laser energy and the number of laser spots were compared,and the laser energy density was calculated.Results The response rate was 86.4％ and 79.2％,respectively in the treatment and control group,the difference was not statistically significant (x2 =0.414,P＞0.05).Compare to the pre-treatment measurement,the average threshold sensitivity,a/b-wave amplitude of F-ERG in the 30 °-60 ° visual field were reduced at 1 day after treatment both in treatment and control group,the differences were statistically significant (P＜0.05).The average threshold sensitivity,a/b-wave amplitude of F-ERG were no difference between treatment and control group at 2m,6m and 12m after treatment (P＞0.05).The average laser power,number of laser spots and energy density were (537.50 ± 64.69) mW and (339.09 ± 132.09) mW,(1934.32 ± 426.38) points and (2061.42 ± 375.49) points,(0.35±0.12) mW o ms/μm2 and (1.95 ± 0.86) mW · ms/μm2 in the treatment group and the control group,respectively.The average laser power and energy density was statistically different between the 2 groups (P＜0.05),while the number of laser spots was no difference (P＞0.05).Conclusions 577 nm multi-point scanning laser can complete the PRP at one time,and achieve the same therapeutic outcomes with the single-point mode which need several times to complete the PRP in the eyes with severe NPDR,and have lower energy density,and thus relative minor function damage.

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Clinical analysis of 47 cases with traumatic macular hole resulted from ocular contusion

Lili YUAN ; Jindong HAN ; Xiaorong LI

Chinese Journal of Ocular Fundus Diseases.2015;31(1):45-48. doi:10.3760/cma.j.issn.1005-1015.2015.01.012

Objective To analyze the clinical characteristic,treatment and prognosis of traumatic macular holes resulted from ocular contusion.Methods The clinical data of 47 cases with traumatic macular hole was retrospectively reviewed.The general condition of the patients was summarized,optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes.The patients were divided into observation group and surgery group by the treatment they received,and the prognosis was evaluated.Results Traumatic macular hole occurs mainly in male.In the observation group,the mean diameter of macular hole was(490.0±86.9) μm.During the 12 month follow up,the holes in 7 cases (33.3％) were closed spontaneously,Vision and diameters of 14 cases (57.1％) maintained stable for a long time,the vision of 1 case (3.3 ％) declined mildly and the diameter of 1 case (3.3％) enlarged slightly.Visual acuity was improved significantly at last follow up (Z=-2.40,P＜ 0.05).The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30,5.06;P＜0.05).These data suggests that the macular function was recovered well.In the surgery group,the mean diameter of macular hole was (643.3 ± 125.0) μm and statistically larger than that of the observation group (t=-4.76,P＜0.05).At the last follow-up,visual acuity were not improved significantly (Z=-1.79,P＞0.05).The amplitudes of N1 wave in 6 cases (23.1 ％) improved merely and the difference was not statistically significant (t =1.98,P ＞ 0.05).These data suggests that the macular function was recovered slightly only in a few patients.Conclusions A part of the patients with smaller diameters of macular holes may close spontaneously,and they may get better visual acuity.Vitrectomy may help to close the macular holes in some severe cases,but the improvement of functional outcomes is not significant.

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Following the Chinese guideline of diabetic retinopathy in our practice

Xiaoxin LI

Chinese Journal of Ocular Fundus Diseases.2015;31(2):117-120. doi:10.3760/cma.j.issn.1005-1015.2015.02.002

Chinese Guideline of Diabetic Retinopathy was developed by the Chinese Ocular Fundus Society and Chinese Ophthalmological Society.It is the first prevention and intervention guideline document of diabetic retinopathy (DR) in China.Clinical pathways and strategies are clearly identified and described in this document for DR screening,referral,intervention,systematic management and patient education.The new DR stage classification combines the first Chinese DR classification since 1985 and the updated international classification of DR.This guideline is based on Chinese health care system,but also reflects the tradition and innovation,and reaches international practice standard.Learning and practice the guideline will promote the prevention and reduce the occurrence and development of DR in China.

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Comparative analysis of anxiety, depression and personality characteristics between diabetic patients with or without diabetes retinopathy

Kui ZENG ; Linkun MA ; Xia CAO

Chinese Journal of Ocular Fundus Diseases.2015;31(2):130-133. doi:10.3760/cma.j.issn.1005-1015.2015.02.005

Objective To compare the anxiety,depressive and personality characteristics between diabetes mellitus patients with or without diabetic retinopathy (DR),and look for psychological treatment and corresponding prevention measures.Methods 435 diabetic patients were enrolled in this study from April to November 2014 in our hospital,including 178 DR cases (group A) and 257 cases without retinopathy (group B).All the patients completed a questionnaire,the Self-Rating Anxiety (SAS),the SelfRating Depression Scale (SDS) and the big five personality scale (NEO-FFI),and were scored by eye doctors.According to the score,SAS can be divided into mild anxiety,moderate anxiety,and severe anxiety.SDS is divided into depression,mild depression,moderate depression and major depression.NEO-FFI was scored from emotional stability,outgoing,openness,easy-going and sense of responsibility.Multiple linear regression analysis was used to analyze the DR risk factors in those scores and education level,high blood pressure,age,alcohol consumption,occupation and other factors.Results There were 110 cases of mild anxiety,57 cases of moderate anxiety,11 cases of severe anxiety;74 cases without depression,53 cases of mild depression,31 cases of moderate depression,20 cases with major depression in group A.There were 181 cases of mild anxiety,53 cases of moderate anxiety,23 cases of severe anxiety;177 cases without depression,44 cases of mild depression,25 cases of moderate depression,11 case with major depression in group B.Group A patients had higher SAS,SDS scores than group B,the difference was statistically significant (P =0.035).Group B patients had higher NEO-FFI score in outgoing,easygoing,responsibility (P=0.022),lower NEO-FFI score in emotional stability (P=0.014) and same NEO-FFI score in openness(P =0.210)compare to Group A patients.Multiple linear regression analysis results showed that education level,high blood pressure,age,weight,drinking,occupation can affect the degree of changes in the retina (P=0.019).Conclusions Compared with those without retinopathy,DR patients were more prone to anxiety and depression.They also had low score in personality characteristics of outgoing,easygoing,responsibility.

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Clinical characteristics of 1215 cases with uveitis

Xiaoli LIU ; Guanfang SU ; Jun XIAO

Chinese Journal of Ocular Fundus Diseases.2015;31(2):150-152. doi:10.3760/cma.j.issn.1005-1015.2015.02.010

Objective To analyze the clinical character of uveitis in second hospital ot Jilin university.Methods Retrospectively analyze the clinical data of uveitis patients referred to from Second Hospital of Jilin University from September 2009 to September 2014.According to anatomical location,the manifestation of these uveitis patients were divided into anterior uveitis,panuveitis,intermediate uveitis and posterior uveitis.To discuss the possible causes of these patients according to the general information and relevant clinical laboratory examinations results.Results There were 1215 cases in this study,which included 587 male,accounting for 48.31％;and 628 female,accounting for 51.69％.The ratio of male-tofemale was 0.93∶1.The range of the age of these patients was from 4 to 91 years old.The mean age of these patients at the onset of these disease was (41.43±14.20) years.Of the 1215 cases,40 male and 43 female were younger than 20 years.The ratio of male-to-female was 0.93∶ 1;412 male and 396 female were between 21 and 50 years old.The ratio of male-to-female was 1.04∶ 1;135 male 189 female were older than 50 years.The ratio of male-to-female was 0.71∶1.There were 572 cases of anterior uveitis,accounting for 47.08％;527 cases of panuveitis,accounting for 43.37％;52 cases of intermediate uveitis,accounting for 4.28％;64 cases of posterior uveitis,accounting for 5.27％.703 cases had etiological diagnosis according to the clinical character and the auxiliary results,accounting for 57.68％.Vogt-koyanagi Haradal (VKH) syndrome,ankylosing spondylitis associated with uveitis and Behcet' s disease were the common entity,accounting for 30.44％,19.77％ and 14.22％ respectively.Conclusions The mean age of these patients in this study was older,compared to other reports.Female patients were more than male,especially in these patients older than 50 years.VKH syndrome,ankylosing spondylitis associated with uveitis and Behcet's disease were the common entities.

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The effects of bulbar subconjunctival and periocular injection of dexamethasonone on blood glucose levels of type 1 diabetic mellitus rats

Bin WANG ; Qiong ZHOU

Chinese Journal of Ocular Fundus Diseases.2015;31(2):165-168. doi:10.3760/cma.j.issn.1005-1015.2015.02.014

Objective To observe the effects of bulbar subconjunctival and periocular injection of dexamethasonone on blood glucose levels of type 1 diabetic mellitus (T1DM)rats.Methods 80 healthy adult male Sprague-Dawley rats were randomly divided into Group Ⅰ (n-=-40) and Group Ⅱ (n =40).Group Ⅰ rats received intraperitoneal (IP) injection of streptozotocin to induce T1DM model,while Group Ⅱ rats received IP injection of citrate buffer solution and was the control group.Group Ⅰ rats and Group Ⅱ rats were further divided into four subgroups:A (n=10),a (n=10),B (n=10),and b (n=10).Subgroup-A rats received bulbar subconjunctival injection of dexamethasone,subgroup-a rats received bulbar subconjunctival injection of saline,subgroup-B rats received periocular injection of dexamethasone,subgroup-b rats received periocular injection of saline.After the injection,rats were fasted but could drink water.Tail vein blood samples were collected and the blood glucose level was measured by glucose monitor.Results After modeling,the blood glucose level of Group Ⅰ and Group Ⅱ rats was(9.31±1.79) mmol/L and (5.72±0.80) mmol/L respectively,the difference was statistically significant (P＜0.05).The blood glucose level of Group Ⅰ rats reached the peak in 3h after injection.In 6-24 h after injection,the blood glucose level of Group Ⅰ A rats was obviously increased than that of the blood glucose level of Group Ⅰa rats and the difference was statistically significant (P＜0.05).In 3-24 hours after injection,the blood glucose level of Group Ⅰ B rats was obviously increased than that of the blood glucose level of Group Ⅰ b rats and the difference was statistically significant (P＜0.05).Comparing the blood glucose level during different injection time between Group Ⅰ A rats and Group Ⅰ B rats,between Group Ⅰ a rats and Group Ⅰ b rats,the difference was not statistically significant (P＞0.05).In 3-24 hours after injection,the blood glucose level of Group Ⅱ A rats was obviously increased than that of the blood glucose level of Group Ⅱ a rats and the difference was statistically significant (P ＜ 0.05);the blood glucose level of Group Ⅱ B rats was obviously increased than that of the blood glucose level of Group Ⅱb rats and the difference was statistically significant (P＜0.05).Comparing the blood glucose level during different injection time between Group Ⅱ A rats and Group Ⅱ B rats,between Group Ⅱ a rats and Group Ⅱ b rats,the difference was not statistically significant (P ＞ 0.05).Conclusion Bulbar subconjunctival injection and periocular injection of dexamethasone could both increase the blood glucose of TIDM rats,but these two injection methods had no differences on the blood glucose level.

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The effects of FTY720 on retinal photoreceptor cells and microglial following light-induced degeneration in rat retina

Bing HAN ; Su LIU

Chinese Journal of Ocular Fundus Diseases.2015;31(2):169-172. doi:10.3760/cma.j.issn.1005-1015.2015.02.015

Objective To investigate the effects of FTY720 on retinal photoreceptor cells and microglial following light-induced degeneration in rat retina.Methods 120 Sprague-Dawley rats were randomly divided into four groups including FTY720 group,solvent control group,model group and normal group.The rats of normal group were not intervened.The FTY720 group,solvent control group and model group establish retinal light injury mode.FTY720 was injected into abdominal cavity of the rats in FTY720 group 0.5 hours before light exposure.50％ dimethylsulfoxide was injected into abdominal cavity of the rats in solvent control group.The expressions of microglial cells in rat retinal were quantified using flow cytometry,the expressions of interleukin (IL)-1β were examined by enzyme-linked immuno sorbent assay at 6 hours,1 day,3 days,7 days after light exposure.The apoptosis of retinal photoreceptor cells were measured by terminal-deoxynucleoitidyl transferase mediated nick end labeling at 1 day after light exposure.The morphological change of retinal were viewed by haematoxylin and eosin staining at 7 days after light exposure.Results The expressions of microgilal and IL-1β began to rise at 1 day after light exposure,reached at peak at 3 days and decreased at 7 days.The expressions of IL-1βand microglial in FTY720 group were significantly lower than solvent control group and model group,but higher than normal group (P＜0.05).One day after exposure to light,the apoptosis cell ratio in normal group,model group,solvent control group and FTY720 group were 0,(87.66 ± 2.50) ％,(86.00 ± 2.44) ％,(49.66 ± 2.80) ％.The apoptosis cell in FTY720 group were higher than normal group,lower than solvent control group and model group (P＜0.05).Seven days after exposure to light,the retinal in normal group was structured and the cell was arranged well,the cell in solvent control group and model group was irregular arrangement and the outer nuclear layer (ONL) was thin after light exposure.The thickness of the ONL in FTY720 group was significantly higher than solvent control group and model group,below normal group.Conclusion FTY720 can prevents retinal photoreceptor cells from apoptosis and inhibits activation of microglial.

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