2015年 · 第51卷第11期

fundus imaging techniques are commonly used in clinical examination of macular diseases such as age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and high myopic macular degeneration, including color fundus photography (FP), fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). In order to further unify the image acquisition and storage operation of color FP, FFA and ICGA in the clinical diagnosis and treatment of macular diseases, and improve the standardization of clinical diagnosis and treatment and research of macular diseases, a standard operating procedure for the acquisition and storage of clinical fundus photography and angiography images of macular diseases is specially formulated (the OCT image acquisition specification of macular diseases will be detailed in the OCT Image Acquisition Specification).

The patient was a 68-year-old female. He was admitted to the Department of Nephrology of Peking University First Hospital with foam urine for 5 months and edema of both lower limbs aggravated for 1 month for 1 week. Previous depression for 4 years, oral flupentixol and melitracen tablets; Hyperlipidemia for 2 years, intermittent oral treatment with Xuezhikang and aspirin. A history of hypertension was found for 4 months, blood pressure was controlled at 140/70 mmHg (1 mmHg =0.133 kPa), and oral benazepril was used for antihypertensive therapy. On admission, urine routine showed 4+ urine protein, 24-h urine protein quantitative examination was 17.66 g/L (normal value 0.00~0.15 g/L), biochemical examination albumin was 21 g/L (normal value 35~50 g/L), and abdominal B-ultrasound showed ascites. Combined with the patient's systemic symptoms and laboratory results: 24-h urine protein quantification>3.5 g/d, plasma albumin less than 30 g/L, edema and ascites of both lower limbs, hyperlipidemia, and nephrotic syndrome was diagnosed. One day after admission, the patient suffered from sudden visual loss in both eyes, accompanied by edema of the upper eyelids of both eyes and difficulty in opening eyes. Please consult an ophthalmologist. Check the visual acuity of 0.1 for the right eye and 0.15 for the left eye; Non-contact IOP was 24 mmHg in the right eye and 26 mmHg in the left eye; Upper lid edema and pale skin in both eyes; Edema of the conjunctiva in both eyes, not congested (Figure 1), clear cornea in both eyes, deep anterior chamber, aqueous humor flash (-), plankton (-), transparent lens; Fundus examination shows: the color of the optic papilla edge is normal, the blood vessels run normally, the foveal reflex disappears, retinal edema can be seen in the macular area, and the posterior pole omental edema is irregular and round with clear boundaries (Figure 2）。 Further OCT was performed (Figure 3) and fundus fluorescence angiography (Figure 4), OCT results showed that the retinal neuroepithelial layer in the macular area of both eyes was detached, multiple cystoid edema cavities were seen in the outer nuclear layer, and the hyperreflective band composed of the internal and external ganglion junction band of photoreceptor cells and the outer membrane showed irregular wave-like changes; In the early stage of fluorescein angiography, large irregular near-circular hypofluorescence areas in the posterior poles of both eyes were seen, surrounded by multifocal hyperfluorescence areas; In the late stage of angiography, the low fluorescence area was gradually filled with dye and showed high fluorescence, with clear boundaries. The macular area of both eyes showed typical petal-shaped high fluorescence, and the high fluorescence focus around the optic head gradually leaked and expanded. Therefore, the ophthalmological diagnosis was exudative retinal detachment in both eyes and cystoid macular edema in both eyes.

The patient was a 72-year-old female. Two years ago, a small incision cataract extraction combined with IOL implantation in the left eye was performed due to simple senile cataract in the left eye. One month after the operation, the eye was accidentally bruised, and the vision was blurred and the sensation of foreign body appeared. Recently, due to the continuous aggravation of symptoms, he went to the local hospital for a follow-up visit and was transferred to Hebei Eye Hospital because he could not deal with it. Twenty years of previous history of hypertension. Admission: Visual acuity: right eye 0.4, correction 1.75 DS to 0.6, left eye 0.15, correction 1.003.25 DC x 20° to 0.4; Intraocular pressure: 16 mmHg (1 mmHg =0.133 kPa) in the right eye and 8 mmHg in the left eye. The lens of the right eye was slightly opaque, and there were no abnormalities in the remaining anterior and posterior segments. The conjunctiva of the left eye was slightly congested, and a cystic vesicle with a diameter of about 7 mm was seen outside the upper limbus, with a protuberance of about 3 mm, a thin and translucent wall, pigment membrane tissue was visible inside it, and conjunctival scar wrapped at the margin (Figure 1）。 The cornea is clear, the depth of the anterior chamber axis is normal, the upper iris is embedded in the scleral tunnel incision, no upper pupil margin is seen, the position of the intraocular lens is normal, the vitreous body is slightly flocculate and opaque, the border of the fundus optic papilla is clear, the color is normal, and the C/D is about 0.3. The flow of omental blood vessels is roughly normal, the foveal light reflection disappears, and there is no obvious edema in the macular area. UBM displays (Figure 2): The scleral tunnel incision above the left eye was dehisced, and the pigment membrane tissue prolapsed and imprisoned in the scleral tunnel incision, and partially prolapsed into the upper cystic vesicle. Admission diagnosis: scleral fistula after cataract surgery in left eye with pigment membrane incarceration, intraocular lens eye in left eye, age-related cataract in right eye, hypertension. Surgical treatment was performed 3 days after admission. During the operation, the bulbar conjunctiva was cut from the outer edge of the cystic vesicle, the peripheral adhesive tissue was peeled off, and the cystic vesicle and the prolapsed pigment membrane tissue were removed (Figure 3), the pigment membrane in the tunnel was also incorporated into the anterior chamber, and the tunnel incision was intermittently sutured with two needles to decompress. A 1/2 thick scleral flap with the limbus as the base was made above the tunnel incision, about 8 mm ×3 mm in size. The inverted scleral flap completely covered the original tunnel incision, and 10-0 nylon thread was continuously sutured to a watertight state (Figure 4）。 Radial incision was made from both sides of the conjunctival incision, and the subconjunctival tissue was separated to reduce tension, and the conjunctiva was sealed and sutured (Figure 5）。 The conjunctival sac was applied with tobramycin and dexamethasone eye ointment and pressurized. On the second postoperative day, the conjunctival incision of the left eye was well aligned, the repair site was flat, there was no leakage, the visual acuity was 0.05, and the intraocular pressure was 22 mmHg. On the 5th day, the visual acuity of left eye was 0.2 after discharge, and the correction was 1.001.25 DC ×40° to 0.4, intraocular pressure 14 mmHg, superior conjunctival incision well aligned, suture in place, clear cornea, normal anterior chamber depth, fundus examination as before surgery. UBM showed that the scleral tunnel incision was well closed and there was no pigmented membrane tissue imprisonment.

The patient was a 26-year-old female. Due to the sudden decrease of visual acuity in his right eye for 1 week, he went to the Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine on August 25, 2014. The patient suddenly developed blurred vision in his right eye after forced defecation 1 week ago, without symptoms such as red eye and eye pain. Deny past history of hypertension, diabetes, etc., and deny history of ocular trauma, surgery and family diseases. General examination: The general condition was good, blood pressure: 128/86 mmHg (1 mmHg =0.133 kPa), routine hematuria examination, liver and kidney function examination and coagulation function examination were no abnormalities. Eye examination: visual acuity was 0.15 for the right eye (uncorrectable) and 0.8 for the left eye; A dark brown round hemorrhagic lesion with a diameter of about 2 PD was visible at the right fundus about 1 PD from the nasal side of the optic papilla and about 0.5 PD below, and an anterior retinal scaphoid hemorrhage connected to it was visible below it (Figure 1A), no obvious abnormalities were observed. FFA examination: the arteriovenous filling time of the right eye was normal, and the anterior retinal occlusion fluorescence with a diameter of about 7 PD was visible on the nasal side of the optic head in the arteriovenous phase (high possibility of bleeding) (Figure 1B), large preretinal occlusion fluorescence (hemorrhage) is visible under the temporal retina and under the nose, and the macular structure is clear (Figure 1C), no obvious abnormalities in the arteriovenous vessels and no obvious fluorescein leakage in the late stage. OCT examination: No obvious abnormalities were found in the macular area of the right eye (Figure 1in D); Hyperreflectivity of a finger-like bulge under the inner limiting membrane of the retina at the lesion, covering its lower retinal structure, sheet-like hyperreflectivity below, and hypo-reflectivity with uniform density above, without abnormality in its pararetinal structure (Figure 1In E, F). Clinical diagnosis: Valsalva retinopathy in the right eye.

The patient was a 25-year-old female. The right eye was blurred for 2 days, and he went to the Department of Ophthalmology of Cangzhou Central Hospital. Eye examination: visual acuity is 1 foot index in the right eye and 1.0 in the left eye; There were no abnormalities in the anterior segment and vitreous body of the right eye, gray-black depression on the temporal side of the fundus papilla, and retinal bulge in the macular area (A in Quintessence Picture 1). No obvious abnormalities were observed in the left eye. Ophthalmic B-ultrasound, FFA and OCT examinations are shown inQuintessence Picture 1In B, C, D. Clinical diagnosis: right eye visual papilla fovea; Retinoschisis and detachment of the right eye.

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This issue focuses on the progress of fundus diseases. Professor Xu Xun is the responsible editorial committee responsible for the planning, composition and review of the key contents of this issue.