Objective::To observe the image characteristics of the macular area in patients with grade Ⅲ hypertensive retinopathy (HRP) using optical coherence tomography (OCT) and angiography (OCTA).Methods::This was a case series study. Seventy-nine patients (129 eyes) with grade Ⅲ (KWB) HRP were examined and analyzed by fundus photography, OCT and OCTA from May 2018 to May 2020 in the First Affiliated Hospital of Wenzhou Medical University. Morphological characteristics of macular OCT and OCTA were analyzed. The abnormality rate of OCT and OCTA was analyzed by χ2 text. Results::Twenty-nine patients had grade Ⅲ HRP changes in one eye (all the contralateral eyes had grade Ⅱ HRP changes), and 50 patients had grade Ⅲ HRP changes in both eyes among the 79 patients with grade Ⅲ HRP. Abnormal lesions were found in 48 eyes (37%) by OCT and in 93 eyes (72%) by OCTA among the 129 eyes with grade Ⅲ HRP. The sensitivity of abnormal lesions was higher with OCTA than with OCT ( χ2=28.04, P<0.001). The abnormal image features of OCT in the macula were as follows: The reflection from the outer plexiform layer of the retina was uneven, local thinning and elevation (35 eyes, 27%), scattered strong reflective light spots between the neuroepithelial layers (30 eyes, 23%), local strong reflection masses within the neuroepithelial layer (18 eyes, 14%), thinning of the inner layer of the neuroepithelial layer (18 eyes, 14%), local serous uplift in the neuroepithelial layer (11 eyes, 9%), diffuse edema and thickening in the neuroepithelial layer (6 eyes, 5%). The main abnormal image features of the macula in OCTA were local destruction and enlargement of the arch ring (66 eyes, 51%), sparsely scattered capillary foci (43 eyes, 33%), scattered microangioma (27 eyes, 21%), and focal capillary nonperfusion (9 eyes, 7%) at the levels of the superficial and deep vascular networks. Scattered strips of strong reflexive foci (12 eyes, 9%) were at the level of the deep vascular networks. The lesions at the levels of the deep vascular networks were more serious than those at the level of the superficial vascular network. Conclusions::Timely OCT combined with OCTA can evaluate the macular structure and blood flow imaging characteristics early in HRP patients, and OCTA is more intuitive and sensitive to retinal microvascular abnormalities. These findings can help to better understand the pathophysiological mechanisms of HRP and guide effective follow-up and treatment strategies.

Hypertension is a serious global health problem. Hypertensive retinopathy is generally considered to be a predictor of vascular disease elsewhere in the human body. In the past few decades, a variety of grading systems have been proposed for hypertensive retinopathy. However, these grading systems have some limitations. This study utilized optical coherence tomography angiography (OCTA) to investigate the morphological changes and macular retinal microvasculature in depth among 100 patients with hypertensive retinopathy and 66 healthy participants. Five main pathological changes were discovered in hypertensive retinopathy, as follows: focal capillary sparsity, scattered microangioma, focal macular arch ring defects, focal capillary disorder, and focal capillary nonperfusion at the levels of the superficial and deep vascular networks. In addition, we have found that the number of various pathological changes shows an increasing trend as hypertensive retinopathy progresses and may be related to renal damage. Finally, deep vessel density tended to decrease with progressive stages of hypertensive retinopathy and could be the best indicator to predict the risk of hypertensive retinopathy. Our study, therefore, proposes 3 stages of hypertensive retinopathy without macular edema according to the pathophysiology found by OCTA: stage 1 (only focal capillary sparsity), taking the place of KWB grade I; stage 2 (focal capillary sparsity and scattered microangioma), taking the place of KWB grade II; and stage 3 (focal capillary sparsity, scattered microangioma, focal capillary disorder, and nonperfusion), taking the place of KWB grade III. Hence, OCTA may be a potentially useful tool for evaluating the pathophysiology and staging of hypertensive retinopathy. Further longitudinal prospective studies are needed to confirm our findings.

目的:观察早期系统性红斑狼疮(SLE)患者出现的眼部病变特征,特别是视网膜血管病变程度与疾病活动的相关性.方法:30例无视网膜血管病变的早期SLE患者作为对照组,32例确诊为视网膜血管病变(视网膜组)的早期SLE患者为研究对象.所有SLE患者经眼科医生检查视力、裂隙灯检查、视野、光学相干断层扫描(OCT)检查、眼底照相、荧光素眼底血管造影(FFA),并根据BenEzra评分系统进行评分,同时评估各系统受累情况及临床表现、实验室检查、影像学检查等.结果:早期SLE患者现网膜血管病变可表现为程度不同的棉绒斑,血管迂曲扩张,视网膜前或视网膜下小片出血,最后可导致视网膜血管增生性改变;视网膜组与对照组比较,前者雷诺现象的发生率及抗ds-DNA抗体阳性率更高(P＜0.05),且视网膜组患者的SLE疾病活动指数(SLEDAI)与对照组比较差异有统计学意义(Z=-2.695,P=0.007);视网膜组的BenEzra评分和SLEDAI评分呈正相关(r=0.836,P＜0.001).结论:早期SLE患者即可发生视网膜血管病变,尤其是存在雷诺现象者;BenEzra评分对SLE患者疾病活动的早期判断和血管炎病变有一定的预测价值.

Objective To determine the condition of conjunctival and corneal calcificationin in maintenance haemodialysis patients,and explore the relationship between conjunctival and corneal calcificationin (CCC) and abdominal aortic calcification (AAC).Methods CCC was evaluated by slit -lamp eye photographs,and was graded and scored according to Porter' s classification system in the literature.Abdomen lateral X-ray examination were used as a criteria to determine the abdominal aortic calcification.The abdominal aortic calcification (AAC) score was calculated.Spearman correlation coefficient was used to analyze the relationship between CCC and AAC.Logistic regression analysis was used to determine the risk factor of CCC in MHD patients.Results Ninety-eight MHD patients were recruited.Their average age and dialysis vintage were (61.89±12.54) years and 51.67 (3.00～ 192.00)months,ninety-seven patients had conjunctival and corneal calcificationin,and seventy-two patients had abdominal aortic calcification,The median CCC was 8 (0,17),the median AAC was 6 (0,20),and the CCC was positively correlated with AAC (r=0.376,P ＜ 0.001).Compared with the patients of CCC score≤5,the patients of CCC score ＞ 10 had a higher level of phosphate,calcium-phosphate product,iPTH,hs-CRP,and longer dialysis vintage,as well as a higher score of AAC (all P ＜ 0.05).Multivariate logistic regression analysis showed that the higher score of AAC and the longer dialysis vintage were independent risk factors for severe corneal calcificationin calcification.Conclusions Conjunctival and corneal calcificationin is common in MHD patients,and CCC is positively associated with AAC,the risk of CCC rises as a result of a severer AAC and a longer dialysis vintage.

国外学者认为结膜和角膜钙化是尿毒症患者常见的一种转移性钙化.严重的球结膜和角膜钙化预示着患者会在1年内死亡[1].血液透析相关红眼症状是结膜和角膜钙化的重要表现[2],对于早期发现和早期干预有重要意义.现将2012年1月至2013年6月本科血液透析相关红眼症状10例报告如下.

Objective:To study the foveal retinoschisis and(or) retinal detachment in high myopic eyes with posterior staphyloma using optical coherence tomography(OCT).Methods: In 575 high myopic eyes of 301 consecutive patients with posterior staphyloma confirmed by B Ultrasound,we performed complete ophthalmic examinations and studied cross-sectional images of the macula with OCT.Results: In sixty-seven(53 patients)of 575 high myopic eyes with posterior staphyloma,OCT revealed foveal retinoschisis and(or) retinal detachment.All sixty-seven eyes with foveal retinal detachment had severe fundus changes.Only 5 patients complained of recent,progressive visual impairment.Conclusion: In high myopic eyes with posterior staphyloma,foveal retinoschisis and(or) retinal detachment tend to be easily diagnosed by OCT.Periodic examination using OCT is recommended for high myopic eyes with severe myopic degenerative changes and posterior staphyloma.