Optical coherence tomography (OCT) has developed rapidly since its first realisation in medicine and is currently an emerging technology in the diagnosis of skin disease. OCT is an interferometric technique that detects reflected and backscattered light from tissue and is often described as the optical analogue to ultrasound. The inherent safety of the technology allows for in vivo use of OCT in patients. The main strength of OCT is the depth resolution. In dermatology, most OCT research has turned on non-melanoma skin cancer (NMSC) and non-invasive monitoring of morphological changes in a number of skin diseases based on pattern recognition, and studies have found good agreement between OCT images and histopathological architecture. OCT has shown high accuracy in distinguishing lesions from normal skin, which is of great importance in identifying tumour borders or residual neoplastic tissue after therapy. The OCT images provide an advantageous combination of resolution and penetration depth, but specific studies of diagnostic sensitivity and specificity in dermatology are sparse. In order to improve OCT image quality and expand the potential of OCT, technical developments are necessary. It is suggested that the technology will be of particular interest to the routine follow-up of patients undergoing non-invasive therapy of malignant or premalignant keratinocyte tumours. It is speculated that the continued technological development can propel the method to a greater level of dermatological use.

https://link.springer.com/content/pdf/bfm%3A978-3-319-06419-2%2F1.pdf

Optical Coherence Tomography

Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis.

background Pegaptanib, an anti–vascular endothelial growth factor therapy, was evaluated in the treatment of neovascular age-related macular degeneration. methods We conducted two concurrent, prospective, randomized, double-blind, multicenter, dose-ranging, controlled clinical trials using broad entry criteria. Intravitreous injection into one eye per patient of pegaptanib (at a dose of 0.3 mg, 1.0 mg, or 3.0 mg) or sham injections were administered every 6 weeks over a period of 48 weeks. The primary end point was the proportion of patients who had lost fewer than 15 letters of visual acuity at 54 weeks. results In the combined analysis of the primary end point (for a total of 1186 patients), efficacy was demonstrated, without a dose–response relationship, for all three doses of pegaptanib (P<0.001 for the comparison of 0.3 mg with sham injection; P<0.001 for the comparison of 1.0 mg with sham injection; and P=0.03 for the comparison of 3.0 mg with sham injection). In the group given pegaptanib at 0.3 mg, 70 percent of patients lost fewer than 15 letters of visual acuity, as compared with 55 percent among the controls (P<0.001). The risk of severe loss of visual acuity (loss of 30 letters or more) was reduced from 22 percent in the sham-injection group to 10 percent in the group receiving 0.3 mg of pegaptanib (P<0.001). More patients receiving pegaptanib (0.3 mg), as compared with sham injection, maintained their visual acuity or gained acuity (33 percent vs. 23 percent; P=0.003). As early as six weeks after beginning therapy with the study drug, and at all subsequent points, the mean visual acuity among patients receiving 0.3 mg of pegaptanib was better than in those receiving sham injections (P<0.002). Among the adverse events that occurred, endophthalmitis (in 1.3 percent of patients), traumatic injury to the lens (in 0.7 percent), and retinal detachment (in 0.6 percent) were the most serious and required vigilance. These events were associated with a severe loss of visual acuity in 0.1 percent of patients. conclusions Pegaptanib appears to be an effective therapy for neovascular age-related macular degeneration. Its long-term safety is not known.

/pdf/pegaptanib-for-neovascular-age-related-macular-degeneration-1v9fdtlpva.pdf

Pegaptanib for Neovascular Age-Related Macular Degeneration

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Objective: To demonstrate optical coherence tomography for high-resolution, noninvasive imaging of the human retina. Optical coherence tomography is a new imaging technique analogous to ultrasound B scan that can provide cross-sectional images of the retina with micrometer-scale resolution. Design: Survey optical coherence tomographic examination of the retina, including the macula and optic nerve head in normal human subjects. Settings Research laboratory. Participants: Convenience sample of normal human subjects. Main Outcome Measures: Correlation of optical coherence retinal tomographs with known normal retinal anatomy. Results: Optical coherence tomographs can discriminate the cross-sectional morphologic features of the fovea and optic disc, the layered structure of the retina, and normal anatomic variations in retinal and retinal nerve fiber layer thicknesses with 10- μm depth resolution. Conclusion: Optical coherence tomography is a potentially useful technique for high depth resolution, cross-sectional examination of the fundus.

Optical Coherence Tomography of the Human Retina

PURPOSE To evaluate the choroidal vascular patterns of patients with pachychoroid-related diseases in eyes images with wide-field indocyanine green angiography. METHODS Retrospective study of wide-field indocyanine green angiographic images of patients with pachychoroid, peripapillary pachychoroid syndrome, central serous chorioretinopathy, and pachychoroid-associated neovascularization that were evaluated for anastomoses between vortex vein systems, which are ordinarily separated by a watershed zone. RESULTS There were 21 subjects with a mean age of 57.4 years and 15 were male. Among the 42 eyes evaluated, central serous chorioretinopathy was found in 24 eyes (57.1%), peripapillary pachychoroid syndrome in 5 (11.9%), pachychoroid associated neovascularization in 7 (16.7%), and pachychoroid in 6 (14.3%). Every eye showed anastomosis between the superonasal, superotemporal, and inferotemporal vortex vein systems. The inferonasal vortex vein system was less likely to demonstrate anastomosis except for peripapillary pachychoroid syndrome, which showed anastomosis in all eyes. The anastomotic connections were prominent in the central macula in the central serous chorioretinopathy and pachychoroid-associated neovascularization cases, and around the nerve in the peripapillary pachychoroid syndrome cases. Although the large choroidal veins were particularly prominent in the neovascular cases, the number was fewer in the macular region than in other pachychoroid-related diseases in this series. Compared with a control group of nine eyes, the inferotemporal-superotemporal-superonasal anastomotic connections were more common in the case group (P < 0.001) and inferonasal quadrant (P = 0.023 right eye; P = 0.01, left eye). CONCLUSION Intervortex venous anastomosis is common in pachychoroid, central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid-associated neovascularization. This finding has important implications concerning pathogenesis and classification of disease.

INTERVORTEX VENOUS ANASTOMOSIS IN Pachychoroid-RELATED DISORDERS.

Volume-Rendering Optical Coherence Tomography Angiography of Macular Telangiectasia Type 2.

Methodology.- Lipofuscin of the Retinal Pigment Epithelium.- Origin of Fundus Autofluorescence.- Fundus Autofluorescence Imaging with the Confocal Scanning Laser Ophthalmoscope.- How To Obtain the Optimal Fundus Autofluorescence Image with the Confocal Scanning Laser Ophthalmoscope.- Autofluorescence Imaging with the Fundus Camera.- Macular Pigment Measurement-Theoretical Background.- Macular Pigment Measurement -Clinical Applications.- Evaluation of Fundus Autofluorescence Images.- Clinical Application.- Macular and Retinal Dystrophies.- Discrete Lines of Increased Fundus Autofluorescence in Various Forms of Retinal Dystrophies.- Age-Related Macular Degeneration I-Early Manifestation.- Age-Related Macular Degeneration II-Geographic Atrophy.- Age-Related Macular Degeneration III-Pigment Epithelium Detachment.- Age-Related Macular Degeneration IV-Choroidal Neovascularization (CNV).- Idiopathic Macular Telangiectasia.- Chorioretinal Inflammatory Disorders.- Autofluorescence from the Outer Retina and Subretinal Space.- Miscellaneous.- Perspectives in Imaging Technologies.- Perspectives in Imaging Technologies.

Atlas of fundus autofluorescence imaging

Purpose: To examine predictive factors for visual acuity in highly myopic eyes. Methods: Consecutive patients with high myopia (≥6 diopters [D]) with no other pathology such as lacquer cracks in the fovea, choroidal neovascularization, or myopic macular schisis, were evaluated. The study was performed in 2 retina centers, one in the United States and the other in Japan. Enhanced depth imaging optical coherence tomography was obtained, and the central foveal, outer retinal hyporeflective layer and inner segment to retinal pigment epithelium aggregate, and the subfoveal choroidal thicknesses were measured. Correlations were calculated among the measured variables and visual acuity. Generalized estimating equation models were used to identify predictors of visual acuity. Results: The New York cohort was composed of 35 eyes of 25 patients who had a mean age of 57 years (standard deviation, ±18.1 years) and a mean refractive error of −10.9 D (±3.6 D). The Japanese cohort was composed of 110 eyes of 61 patients who had a mean age of 46.8 years (±14.7 years) and a mean refractive error of −9.2 D (±3.1 D) and a mean axial length of 27 mm (±1.4 mm). The mean subfoveal choroidal thickness was 113.3 &mgr;m (±53.9 &mgr;m) in the New York group and 172.9 &mgr;m (±72.8 &mgr;m) in the Japanese group. In each group, the subfoveal choroidal thickness showed a significant inverse correlation with age and myopic refractive spherical equivalent. The subfoveal choroidal thickness was inversely correlated with logarithm of the minimum angle of resolution visual acuity (P = 0.041, New York group; P = 0.001, Japan group). The only significant predictor in the pooled data for logarithm of the minimum angle of resolution visual acuity was subfoveal choroidal thickness (P ⩽ 0.001). Clinic location was not a significant predictor. Conclusion: Choroidal thickness in high myopia is inversely correlated with increasing age and myopic refractive error and is an important predictor of visual acuity. Given that myopia is increasing worldwide, these findings may have epidemiologic significance.

Choroidal Thickness and Visual Acuity in Highly Myopic Eyes

Choroidal neovascularization (CNV) is the most common cause of legal blindness in older adults in the United States. The most common cause for CNV in this age group is age-related macular degeneration, a condition manifesting with drusen (particularly soft drusen) and pigmentary alterations in the macular region. CNV can occur in younger people (< 50 years), who usually do not have conspicuous drusen or pigmentary abnormalities. In this age group CNV may occur as a secondary manifestation of many inherited and acquired conditions such as angioid streaks, high myopia, trauma, choroidal tumors, familial macular dystrophies, and inflammatory retinochoroidopathies. Occasionally, CNV in young people has no apparent antecedent cause, and these cases are termed "idiopathic CNV." This review examines the common reasons for CNV in young adults, with reference to some of the older literature as well as to recently published papers.

Richard F. Spaide

Papers

INTERVORTEX VENOUS ANASTOMOSIS IN Pachychoroid-RELATED DISORDERS.

Volume-Rendering Optical Coherence Tomography Angiography of Macular Telangiectasia Type 2.

Atlas of fundus autofluorescence imaging

Choroidal Thickness and Visual Acuity in Highly Myopic Eyes

Choroidal neovascularization in younger patients.