Optical coherence tomography angiography in the evaluation of vascular patterns of ocular surface squamous neoplasia during topical medical treatment

PurposeOptical coherence tomography angiography (OCTA) was utilized to examine changes in ocular surface squamous neoplasia (OSSN) vascular patterns over time in individuals treated with topical medical therapy.MethodsTen individuals with OSSN diagnosed by clinical examination and high resolution (HR)-optical coherence tomography (OCT) were recruited. All individuals received topical immuno- or chemotherapy. OCTA images were obtained and analyzed at three points: presentation, mid-treatment and tumor resolution. Tumor metrics including tumor area (TA), tumor volume (TV), tumor depth (TD), and total tumor density (TTD) were calculated. Vessel area density (VAD) was also quantified within the OSSN, the subepithelium under and adjacent to the OSSN and the subepithelium of the uninvolved, contralateral eye. Vascular network changes were also subjectively evaluated.ResultsTA, TV, TD and TTD all significantly decreased with time (p < 0.001). The mean VAD within the OSSN significantly decreased (p < 0.001) between visits (presentation: 26.52 ± 6.8%, mid-treatment: 7.19 ± 5.88%, tumor resolution: 0.11 ± 0.34%). The mean subepithelial VAD under the OSSN also decreased with time (23.22 ± 11.03%, 20.99 ± 5.99% and 19.58 ± 7.08%), and after resolution the sub-tumor VAD (19.58 ± 7.08%) was comparable to the subepithelial VAD in the contralateral eye (15.47 ± 4.37%, p > 0.05). The mean VAD in the subepithelium adjacent to the OSSN increased with treatment, then decreased significantly between mid-treatment and resolution (23.26 ± 4.54, 28.30 ± 7.43% and 21.68 ± 6.10%, p = 0.009). Qualitatively, the tumor subepithelial vascular network was complex and dense but with tumor resolution appeared less tortuous and similar to the uninvolved eye.ConclusionOCTA provided insight into the pathophysiology of tumor angiogenesis, showing decreased vascular density and normalization of vascular networks associated with tumor resolution.     

Long-term outcome of amniotic membrane transplantation combined with mitomycin C for conjunctival reconstruction after ocular surface squamous neoplasia excision

The aim of the study is to evaluate the long-term clinical results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) for reconstruction of conjunctival defects created during the excision of ocular surface squamous neoplasia (OSSN). Eight consecutive eyes of seven patients (five males and two females; mean age, 64 ± 19 years) treated by one surgeon (KH) were included in this study. AMT was performed after excision of a mass region, along with 0.04 % MMC treatment for the exposed sclera. The tumor size, histopathological retrieval, AM graft size after tumor excision, recurrence, and postoperative complications were recorded. During a mean postoperative follow-up period of 60.9 ± 14.6 months (range 36–78 months), the ocular surfaces completely re-epithelialized in all cases. The median size of the tumor was 44.4 ± 21.2 mm² (range 13–67 mm²). The histopathological diagnoses were five cases of squamous cell carcinoma in situ (SCC in situ) and three cases of dysplasia. The median size of the AM graft after tumor excision was 100.8 ± 32.7 mm² (range 49–151 mm²). A case of recurrent SCC in situ with a preoperative history of using MMC eye drops developed further corneal limbal deficiency and was treated with therapeutic soft contact lenses. A case of dysplasia with a history of large pterygial excision developed symblepharon postoperatively was treated with AMT 6 months after tumor excision. The tumors recurred in two eyes with SCC in situ and were successfully treated with continuous AMT and MMC. No severe complications, such as infections, corneal or scleral thinning, or ulceration developed in all cases. The combination of AMT and MMC is effective for safe reconstruction over the long-term after the excision of OSSN with postoperative careful observation and treatment. In recurrent tumor excision cases, AMT is a suitable technique for repeated ocular surface reconstruction.     

Early phenotypic features of aniridia-associated keratopathy and association with PAX6 coding mutations

PurposeTo investigate corneal phenotype in aniridia-associated keratopathy (AAK) including its earliest manifestations, in relation to PAX6 mutational status.Methods46 subjects (92 eyes) with congenital aniridia from a German registry were examined using slit lamp biomicroscopy, anterior segment optical coherence tomography, contact esthesiometry and in vivo confocal microscopy. Cytogenetic analysis was conducted by Sanger sequencing of PAX6 exons and/or MLPA analysis. Measured parameters included AAK grade, distance-corrected visual acuity (DCVA), central corneal thickness (CCT), corneal sensitivity, subbasal nerve density, mature dendritic cell (DC) density and corneal epithelial phenotype.Results46 subjects (age range: 1–64 years) were examined, including 23 (50%) children under the age of 18. Five subjects (11.1%) with absent PAX6 coding mutation (non-PAX6 cases) had mild AAK (Grade 0–1) into the fourth decade of life and maintained corneal epithelial phenotype, greater subbasal nerve density (16.8 mm/mm² vs. 3.58 mm/mm², P = 0.01) and better corneal sensitivity (41 ± 11 mm vs. 28 ± 12 mm, P = 0.03) relative to those with PAX6 coding mutations. In five subjects, corneal endothelial cell density ranged from 3245 to 4399 cells/mm². Independent of mutational status, an increased CCT, over tenfold increased mature DC density and reduced corneal sensitivity characterized all subjects.ConclusionsPAX6 coding mutations influence AAK phenotype and progression from the earliest stages of life. A minimal keratopathy present in 100% of congenital aniridia cases is independent of the specific mutation and consists of increased corneal thickness, reduced touch sensitivity, and increased ocular surface immune activity.     

In vivo corneal confocal microscopic analysis in patients with keratoconus

AIM:To quantify corneal ultrastructure using laser scanning in vivo confocal microscopy (IVCM) in patients with keratoconus and control subjects.METHODS: Unscarred corneas of 78 keratoconic subjects without a history of contact lens use and 36 age-matched control subjects were evaluated with slit-lamp examination (SLE), corneal topography and laser scanning IVCM. One eye was randomly chosen for analysis. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve structure were evaluated.RESULTS: IVCM qualitatively demonstrated enlarged basal epithelial cells, structural changes in sub-basal and stromal nerve fibers, abnormal stromal keratocytes and keratocyte nuclei, and pleomorphism and enlargement of endothelial cells. Compared with control subjects, significant reductions in basal epithelial cell density (5817±306 cells/mm² vs 4802±508 cells/mm², P<0.001), anterior stromal keratocyte density (800±111 cells/mm² vs 555±115 cells/mm², P<0.001), posterior stromal keratocyte density (333±34 cells/mm² vs 270±47 cells/mm², P<0.001), endothelial cell density (2875±223 cells/mm² vs 2686±265 cells/mm², P<0.001), sub-basal nerve fiber density (31.2±8.4 nerves/mm² vs 18.1±9.2 nerves/mm², P<0.001), sub-basal nerve fiber length (21.4±3.4 mm/mm² vs 16.1±5.1 mm/mm², P<0.001), and sub-basal nerve branch density (median 50.0 (first quartile 31.2 - third quartile 68.7) nerve branches/mm² vs median 25.0 (first quartile 6.2 - third quartile 45.3) nerve branches/mm², P<0.001) were observed in patients with keratoconus.CONCLUSION: Significant microstructural abnormalities were identified in all corneal layers in the eyes of subjects with keratoconus using IVCM. This non-invasive in vivo technique provides an important means to define and follow progress of microstructural changes in patients with keratoconus.     

Regional variability in corneal endothelial cell density between guttae and non-guttae areas in Fuchs endothelial corneal dystrophy

ObjectiveTo assess the regional variability of corneal endothelial cell density (ECD) between guttae and non-guttae areas in subjects with Fuchs endothelial corneal dystrophy (FECD) using non-contact specular microscopy and confocal microscopy.DesignRetrospective chart review from 2009 to 2014 at the Massachusetts Eye and Ear Infirmary.ParticipantsOne hundred fifteen eyes of 73 subjects with FECD.MethodsSubjects with FECD underwent same-day specular and confocal microscopy in the same eye. Clinical stage of disease was documented on the day of image acquisition. Regional variability of ECD associated with guttae and non-guttae areas was assessed. Manual endothelial cell counts were performed.ResultsThirty-two percent of subjects had high quality endothelial images by both specular and confocal microscopy. Of these subjects, 83% were classified clinically as early-stage FECD. There was a significant association between stage of disease and the ability to obtain high quality specular images (χ²; p = 0.0012). There was no difference in mean ECD derived from specular (1363 ± 594 cells/mm²) or confocal (1391 ± 493 cells/mm²; p = 0.75) images. There was a statistically significant decrease of 31.8 ± 21.7% in mean ECD in areas surrounding guttae (1296 ± 560 cells/mm²) compared to non-guttae areas (1926 ± 674 cells/mm²; p < 0.0001) as determined by confocal microscopy.ConclusionThese findings support confocal microscopy as an alternative to specular microscopy for evaluating the corneal endothelium of patients with FECD, especially those with advanced disease. Confocal microscopy also revealed regional differences in ECD in guttae and non-guttae areas in patients with FECD.     

Corneal endothelial cell density and morphology and central corneal thickness in Guangxi Maonan and Han adolescent students of China

AIM:To investigate the corneal endothelial cell density and morphology and central corneal thickness in the Guangxi Maonan and Han adolescent students of China.METHODS:Noncontact specular microscope (Topcon SP3000P, Tokyo, Japan) was performed in 133 adolescent students of Maonan nationality (M:F 54:79) and 105 adolescent students of Han nationality (M:F 50:55), 5 to 20y of age, who were randomly selected from 3 schools in Huanjiang Maonan Autonomous County of Guangxi Zhuang Autonomous Region of China. Parameters studied included endothelial cell density, mean cell area, coefficient of variation in cell size, percentage hexagonality and central corneal thickness.RESULTS:Endothelial cell density, mean cell area, coefficient of variation in cell size, percentage hexagonality and central corneal thickness in the study population were (2969.50±253.93) cells/mm², (339.23±29.44) μm², (29.96±4.07) %, (64.58±9.41) % and (523.71±32.82) μm in Maonan and (2998.26±262.65) cells/mm², (336.11±30.07) μm², (29.89±5.03) %, (64.91±11.64) % and (524.39±33.15) μm in Han, respectively. No significant differences were observed in endothelial cell density, mean cell area, coefficient of variation in cell size, percentage hexagonality and central corneal thickness between Maonan and Han (P=0.615, 0.659, 0.528, 0.551, 0.999). In Maonan and Han, we found age was negatively correlated with endothelial cell density and percentage hexagonality and positively correlated with mean cell area and coefficient of variation in cell size. Negative correlation was also found between central corneal thickness and age in Han, whereas no correlation was found in Maonan.CONCLUSION:There were no differences between Maonan and Han in corneal endothelial cell density and morphology and central corneal thickness. In these two nationalities, there were statistically significant decrease in endothelial cell density and percentage hexagonality with increasing age and statistically significant increase in cell area and coefficient of variation in cell size with increasing age. Central corneal thinned with increasing age in Han, whereas difference did not attain statistical significance in Maonan.     

Long-term (≥10 years) results of corneal endothelial cell loss after cataract surgery

ObjectiveTo investigate the extent of long-term corneal endothelial loss after uneventful cataract surgery and the factors associated with decreases in corneal endothelial cell density (ECD).DesignRetrospective case series.ParticipantsPatients who had undergone uncomplicated cataract surgery.MethodsThis study comprised 81 eyes of 48 patients who had undergone cataract surgery >10 years previously by a single surgeon with the same intraocular lens and visited the outpatient clinic between January 2014 and February 2017. Long-term (≥10 years) changes in visual outcome and ECD after uncomplicated cataract surgery were evaluated. To analyze factors correlated with endothelial cell loss, preoperative biometric variables, including cataract grade, anterior chamber depth, axial length, and postoperative corneal edema, were evaluated.ResultsThe mean ± SD preoperative and long-term postoperative ECD was 2793 ± 351.09 and 2148 ± 478.38 cells/mm², respectively. The mean follow-up period was 11.08 ± 1.06 years and 10-year ECD loss rate was 20.62 ± 13.63%. Preoperative nuclear firmness was most statistically correlated with 10-year ECD loss (β-coefficient 0.394 [95% CI 3.402–9.448]; p < 0.001). The degree of postoperative corneal edema was also a significant predictive factor of 10-year ECD loss after cataract surgery (β-coefficient 0.378 [95% CI 2.854–8.358]; p = 0.002).ConclusionPreoperative nuclear firmness and postoperative corneal edema were predictors of long-term (≥10 years) endothelial cell loss and severe endothelial cell loss after cataract surgery. It is important to remember that eyes with increased nuclear firmness have a significantly higher risk of long-term enhanced ECL.     

带角膜缘的自体结膜瓣移植术治疗翼状胬肉合并结膜囊肿

目的:观察带角膜缘的自体结膜瓣移植术治疗翼状胬肉合并结膜囊肿患者的疗效.方法:收集华中科技大学同济医学院附属同济医院眼科于2013-08/2015-08住院接受手术的翼状胬肉患者126例188眼,其中翼状胬肉合并区域结膜囊肿者11例11眼作为观察组,余为对照组,所有患者均行裂隙灯显微镜检查、眼前节照相、眼前节OCT检查,并采用翼状胬肉颈部宽度×遮盖角膜的长度计算翼状胬肉的大小,采取翼状胬肉切除联合带角膜缘的自体结膜瓣移植的手术方式,切除物均行病理切片HE染色观察,术后随访4~28mo.结果:观察组术后病检结果均证实为翼状胬肉合并结膜囊肿,囊壁完整,内附单层上皮细胞.观察组翼状胬肉大小平均为6.9±1.7mm2,对照组大小平均为6.3±1.8mm2,两组间比较无统计学差异(P>0.05).观察组术后角膜上皮愈合时间平均为2.1±0.9d,对照组术后角膜上皮愈合时间平均为1.9±0.8d,两组间比较无统计学差异(P>0.05).随访期内观察组术后未见翼状胬肉复发,对照组术后2例2眼复发.结论:带角膜缘的自体结膜瓣移植治疗翼状胬肉合并结膜囊肿是一种安全有效的治疗方法,结膜囊肿术后对翼状胬肉的复发率无显著影响.     

Corneal endothelial cell density and morphology in low and moderate myopic Chinese eyes

AIM: To describe and compare the corneal endothelial cell density and morphology in young, low and moderate myopic Chinese adults in Malaysian Chinese population.METHODS: Non-contact specular microscopy (Topcon SP3000P, Tokyo, Japan) was performed in low (n=78; 21.22±1.51 years) and moderate (n=78; 21.82±1.40 years) myopic subjects. The mean of three consecutive measurements of endothelial cell density (MCD), coefficient of variation (CV) in the cell size, and hexagonal appearance of the cell were obtained.RESULTS: In low myopic eyes the MCD was 3 063.0±176.2/mm², the mean CV was 33.4±4.0% and the mean hexagonal appearance of the cell was 57.9±2.7%. In moderate myopic eyes the MCD was 2961.6±159.0/mm², the mean CV was 33.9±3.6% and mean hexagonal appearance of the cell was 56.2±4.7%. There were statistically significant differences in MCD (P<0.000) and hexagonal appearance of the cell (P<0.005) between low and moderate myopic eyes.CONCLUSION:The corneal endothelial cell layer in more myopic eyes tends to have less MCD and cell hexagonality compared to lower myopic eyes. Nevertheless, there is no significant difference in CV between low and moderate myopic eyes.     

Hallazgos tempranos por microscopia confocal en cross-linking

ObjectiveTo determine the effects of in vivo cross-linking treatment of the cornea.MethodsEighteen eyes of eighteen keratoconus patients underwent cross-linking treatment using a 0.1% riboflavin solution and ultraviolet A radiation at 370 nm at 3 mW/cm² for 30 minutes. In vivo confocal microscopy was performed before, and at 1 week and 1 month after treatment.ResultsAt 1 week after treatment, keratocyte activation and collagen fiber organization showed as hyper-reflective structures and were observed from the first sub-epithelial image to a corneal stromal depth of 275.1 ± 85.9 μm. At 1 month after treatment, activated keratocytes and fiber organization were also observed from the first sub-epithelial image to a corneal stromal depth of 324.9 ± 66.0 μm. The deepest hyper-reflective structures at 1 month showed as thick, linear-shaped hyper-reflective structures.ConclusionIn vivo confocal microscopy in humans showed corneal stromal changes at 1 week and 1 month after cross-linking treatment, in some cases at depths in excess of 300 μm.     

The Effect of Surgical Wide Excision and Amniotic Membrane Transplantation with Adjuvant Topical Mitomycin C Treatment in Recurrent Conjunctival--Corneal Intraepithelial Neoplasia

Abstract

Purpose: To investigate the effect of surgical wide excision and amniotic membrane transplantation with adjuvant mitomycin C 0.04% eye drops on recurrent conjunctival–corneal intraepithelial neoplasia (CCIN). Methods: The authors applied amniotic membrane transplantation after total surgical excision of a tumor to a patient with recurrent conjunctival–corneal intraepithelial neoplasia. The tumor co-existed as a conjunctival lesion and corneal opacity. After one week, the patient received mitomycin C 0.04% eye drops four times a day for one month to prevent recurrence. Ocular complications and recurrence were evaluated under slit lamp microscopy for one year. Results: Corneal epithelium completely healed within one week after the surgery. Both conjunctival and corneal lesions were completely regressed and no recurrence has been found with follow-up to 24 months. Conclusions: Surgical wide excision and amniotic membrane transplantation with adjuvant topical MMC would be an effective treatment modality for treatment of recurrent CCIN.     

Endothelial cell density in porcine corneas after exposure to hypotonic solutions

Purpose To evaluate exposure to sucrose solution (1.8%) and hypotonic balanced salt solution (BSS) for its effects on endothelial cell density of porcine corneas.Methods Two groups of central discs from pig corneas were organ-cultured for 24 h. Twelve corneas per group were exposed to sucrose solution (1.8%) or hypotonic BSS for 4 min each. The paired corneal discs were not treated and served as controls. After further organ culture with and without dextran for 48 h, corneal endothelium was stained with alizarin red and examined by light microscopy. The endothelial cell densities were determined manually on three central images.Results The endothelial cell density differed significantly between corneas exposed to sucrose and the control corneas (3982±382 cells/mm² and 4360±331 cells/mm² respectively, and 3876±364 cells/mm² versus 4374±168 cells/mm² respectively with 6% dextran). In contrast, the endothelial cell density did not differ significantly between corneas exposed to hypotonic BSS and the control corneas (4374±296 cells/mm² and 4317±193 cells/mm² respectively, and 4348±151 cells/mm² versus 4426±175 cells/mm², respectively with 6% dextran).Conclusions Exposure to 1.8% sucrose for 4 min induces a significant endothelial cell loss of 10% on average, whereas exposure to hypotonic BSS did not significantly influence the endothelial cell density.Presented in part at the annual meeting of the Deutsche Opthalmologische Gesellschaft (DOG), Berlin, 2005.     

Visualization of microneuromas by using in vivo confocal microscopy: An objective biomarker for the diagnosis of neuropathic corneal pain?

PurposeThe diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate it from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivo confocal microscopy (IVCM).MethodsThis was a comparative, retrospective, case-control study. Patients with clinical diagnosis of NCP (n = 25), DED (n = 30), and age- and sex-matched healthy controls (n = 16), who underwent corneal imaging with IVCM (HRT3/RCM) were included. Central corneal IVCM scans were analyzed by 2 masked observers for nerve density and number, presence of microneuromas (terminal enlargements of subbasal corneal nerve) and/or nerve beading (bead-like formation along the nerves), and dendritiform cell (DC) density.ResultsThere was a decrease in total nerve density in both NCP (14.14 ± 1.03 mm/mm²) and DED patients (12.86 ± 1.04 mm/mm²), as compared to normal controls (23.90 ± 0.92 mm/mm²; p < 0.001). However, total nerve density was not statistically different between NCP and DED patients (p = 0.63). Presence of nerve beading was not significantly different between patients and normal controls (p = 0.15). Interestingly, microneuromas were observed in all patients with NCP, while they were not present in any of the patients with conventional DED (sensitivity and specificity of 100%). DC density was significantly increased in both NCP (71.89 ± 16.91 cells/mm²) and DED patients (111.5 ± 23.86 cells/mm²), as compared to normal controls (24.81 ± 4.48 cells/mm² (p < 0.05). However, there was no significant difference in DC density between DED and NCP patients (p = 0.31).ConclusionIVCM may be used as an adjunct diagnostic tool for the diagnosis of NCP in the presence of neuropathic symptoms. Microneuromas may serve as a sensitive and specific biomarker for the diagnosis of NCP.     

Konfokale In-vivo-Hornhautmikroskopie nach Keratoplastik

Background

Seven eyes with clear grafts after penetrating keratoplasty were examined with in vivo confocal corneal microscopy in 1999. Our aim was the confocal microscopic investigation of the subclinical changes in clear grafts after long-term follow-up.

Methods

The preoperative diagnoses were keratoconus (two), granular corneal dystrophy (two), pseudophakic bullous keratopathy due to ACL (two), and corneal ulcer (one). The epithelium, corneal nerves, keratocytes of the anterior and posterior stroma, and endothelium were evaluated with confocal microscopy.

Results

Mean density of basal epithelial cells was 3928±378 cells/mm² at 15 months and 3284±565 cells/mm² at 66 months postoperatively. At 15 months the keratocyte density was 750±113 cells/mm² in the anterior stroma and 601±98 cells/mm² in the posterior stroma, at 66 months 383±53 cells/mm² in the anterior stroma and 411±98 cells/mm² in the posterior stroma. Endothelial cell density decreased from 1719±576 cells/mm² (15 months) to 965±272 cells/mm² (66 months).

Conclusions

In the follow-up period a significant decrease of keratocyte and endothelial cell density was detectable with confocal microscopy. The clinical importance of our findings must be clarified with further examinations on more patients.     

Corneal endothelial status in the subtypes of primary angle closure glaucoma

Purpose: To study the corneal endothelium and pachy­metry in eyes with different subtypes of primary angle closure glaucoma (PACG), as compared to controls. Methods: A cross‐sectional study was conducted on 30 consecutive patients in each subtype of PACG, subacute, acute and chronic, and 30 age and refraction matched controls. The parameters recorded included gonioscopy, optic disc evaluation, applanation tonometry, specular microscopy and central ultrasonic pachymetry. Results: The mean endothelial cell counts in the four groups were as follows: subacute PACG 2396 ± 271 cells/mm², acute PACG 1597 ± 653 cells/mm², chronic PACG 2229 ± 655 cells/mm² and controls 2461 ± 321 cells/mm². The mean endothelial cell count in the fellow eyes of subacute PACG, acute PACG and chronic PACG patients was 2294 ± 305 cells/mm², 2388 ± 226 cells/mm² and 2108 ± 203 cells/mm², respectively (NS). The acute PACG patients had significantly lower endothelial cell counts (P < 0.001) as compared to the other three groups. Eyes in which the acute attack of angle closure persisted for less than 72 h had a mean endothelial cell count of 2016 ± 306 cells/mm², as compared to 759 ± 94.4 cells/mm² in eyes with an attack lasting for 72 h or more (P < 0.001). The endothelial count was also significantly lower in eyes with chronic PACG as compared to control eyes (P < 0.001). There was increased pleomorphism and polymegathism of the corneal endothelial cells seen in eyes with resolved acute and chronic PACG. The mean central corneal thickness was 531.4 ± 25.3 µm in eyes with subacute PACG, 567.9 ± 37.3 µm in eyes with acute PACG, 526.4 ± 31.9 µm in eyes with chronic PACG and 525 ± 12.6 µm in control eyes. The acute PACG eyes had a significantly higher corneal thickness (P < 0.001) when compared to all the other groups. Conclusion: There is a significant decrease in the corneal endothelial cell density in eyes that have had an acute attack of angle closure glaucoma and in eyes with chronic PACG. The endothelial cell population in eyes with sub­acute PACG and in the fellow eyes of all subtypes of PACG is not significantly different from the normal population.     

视网膜内微血管异常及其来源的新生血管的临床特征

目的:观察糖尿病性视网膜病变(DR)患者视网膜内微血管异常(IRMA)及由IRMA来源的视网膜新生血管的临床特征。方法:本研究为前瞻性、观察性的研究。于2016-10/2017-12期间,经荧光素血管造影(FFA)检查明确有IRMA或者视网膜新生血管的未经治疗的DR患者36例39眼纳入研究。在FFA引导下,对IRMA及视网膜新生血管进行光相干断层扫描血流成像(OCTA)检查。记录并比较IRMA及IRMA来源的新生血管的形态特征、血管来源层次、无灌注区面积、与无灌注区位置关系及病灶在FFA中的渗漏情况。无灌注区面积采用Image J软件进行测量。结果:OCTA成功扫描到IRMA病灶20个,IRMA来源的新生血管22个。20个IRMA病灶均来源并回流于视网膜静脉,血管分支较少,表现为“经修剪过的树干”样外观;IRMA均从无灌注区的边缘长出,位于视网膜静脉的无灌注区一侧,并且在无灌注区内生长;IRMA均位于视网膜内,没有突破内界膜向玻璃体腔内生长。22个IRMA来源的新生血管病灶,血管分支较多,表现为“海扇”样外观;IRMA来源的新生血管往往横跨视网膜静脉,向视网膜静脉的两侧生长、延伸;其主要部分在视网膜内,有个别分支突破内界膜沿着玻璃体后皮质生长,与视网膜紧密黏连。IRMA来源的新生血管20个(91%)位于无灌注区当中,2个(9%)位于无灌注区的边缘。IRMA来源的新生血管病灶旁的无灌注区面积为26.1±4.2mm2,大于IRMA旁的无灌注区面积12.9±4.7mm2(P<0.05)。IRMA及其来源的新生血管的来源层次无差异(P>0.05)。结论:OCTA是IRMA及增殖期糖尿病性视网膜病变(PDR)新生血管的有效检查手段。IRMA及IRMA来源的新生血管具有明显不同的临床特征,OCTA能够有效地对两者进行鉴别,从而为DR患者的诊断及随访治疗提供重要的临床依据。     

Changes in in vivo confocal microscopic findings of ocular surface squamous neoplasia during treatment with topical interferon alfa-2b

Purpose

To evaluate in vivo confocal microscopy (IVCM) findings of ocular surface squamous neoplasia (OSSN) during treatment with topical interferon alfa-2b (IFN alfa-2b).

Responses of Types 1 and 2 Neovascularization in Age-Related Macular Degeneration to Anti-Vascular Endothelial Growth Factor Treatment: Optical Coherence Tomography Angiography Analysis

Purpose: To compare the responses of types 1 (sub-pigment epithelial) and 2 (subretinal) neovascularization in neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF) treatment.

Methods: Fifty-five treatment-naïve neovascular AMD eyes (53 patients) were retrospectively included for analysis. All patients were treated with three loading injections of anti-VEGF agent, followed by further injections as required. The lesion size and vascular density of type 1 and 2 lesions before and after treatment for 12 months were analyzed using optical coherence tomography angiography (OCTA).

Results: The mean lesion size of the type 1 neovascularization group (42 eyes) showed no significant change from 2.12 ± 1.01 mm² at baseline to 2.08 ± 0.91 mm² at 12 months (P = .682). However, the mean lesion size of type 2 neovascularization significantly decreased from 1.23 ± 0.93 mm² at baseline to 0.79 ± 0.61 mm² at 12 months (P = .022). The proportion of eyes with lesion sizes that decreased by more than 40% from baseline was also significantly higher for the type 2 compared to the type 1 neovascularization group (46.2% versus 11.9%, P = .007). Vascular density showed no significant changes for both groups after treatment and showed no association with the change in lesion size. There was no significant difference between the groups in terms of visual acuity improvement.

Conclusion: OCTA analysis revealed different responses to anti-VEGF treatment depending on the location of neovascularization in neovascular AMD. Type 2 neovascularization was significantly regressed compared to type 1 neovascularization after anti-VEGF treatment. However, the changes in vascular density and visual outcome showed no significant differences between groups after 12 months of treatment.     

共焦显微镜观察青光眼患者角膜内皮细胞的变化

目的：利用共焦显微镜观察青光眼患者角膜内皮细胞密度及形态学变化,探讨角膜内皮细胞损伤原因,采取必要措施进行保护。
　　方法：选取不同类型青光眼患者97例143眼,与患者年龄相匹配的正常人20例40眼。采用共焦显微镜观察、测量角膜内皮细胞密度和细胞面积、细胞变异系数等各项指标,分析比较不同类型青光眼各组角膜内皮细胞各项测量指标的差异。
　　结果：年龄相匹配正常人组角膜内皮细胞密度2893.88±255.026个/mm2,急性闭角型青光眼组1674.11±683.95个/mm2,开角型青光眼组2687.22±391.87个/mm2,慢性闭角型青光眼组2706.97±351.27个/mm2。,在各项指标中,角膜内皮平均密度、平均面积均有统计学意义(F=62.950,8.795;P值均为0.000),其中尤以急性闭角型青光眼组与各组相比差异显著。
　　结论：急性闭角型青光眼发作眼角膜内皮细胞各项指标明显低于正常人。开角型与慢性闭角型青光眼角膜内皮细胞与正常人相比,有差别但不显著。眼压升高时限是损伤角膜内皮细胞主要因素。