Xiao Yan Peng

Risk factors for diabetic retinopathy in a rural Chinese population with type 2 diabetes: the Handan Eye Study.

Purpose:  To describe risk factors associated with diabetic retinopathy (DR) in a population‐based sample of rural Chinese with type 2 diabetes.

Tuberculous uveitis in China.

To assess tuberculous uveitis in Chinese patients.

FEATURES OF OPTICAL COHERENCE TOMOGRAPHY FOR THE DIAGNOSIS OF VOGT-KOYANAGI-HARADA DISEASE.

Background/Purpose: To examine the diagnostic value of optical coherence tomography (OCT) for the detection of acute Vogt–Koyanagi–Harada (VKH) disease. Methods: Clinical charts and OCT images were retrospectively reviewed for patients consecutively diagnosed with acute VKH, subacute VKH, multifocal central serous chorioretinopathy (CSCR), and posterior scleritis. All patients underwent OCT, fundus photography, and fluorescein angiography (FA) before treatment. The characteristics of OCT and FA were analyzed and recorded. Results: The study included 80 eyes with acute VKH, 32 eyes with subacute VKH, 33 eyes with CSCR, and 13 eyes with posterior scleritis. The most common OCT features of VKH disease were hyperreflective dots (70/80; 88%), subretinal membranous structures (64/80; 80%), retinal detachment higher than 450 &mgr;m (63/80; 79%), and retinal pigment epithelium (RPE) folds (44/80; 55%). For the detection of VKH disease, sensitivity and specificity were for subretinal membranous structures 80% and 95.6%, respectively, for high retinal detachment 78.8% and 76.1%, respectively, for subretinal hyperreflective dots, 87.5 and 60.9%, respectively, and for RPE folds 55% and 80.4% respectively. Subretinal membranous structures showed the highest positive predictive value (97.3%) and negative predictive value (65.7%) of all OCT assessed features. Conclusion: OCT-related morphological signs have a relatively high predictive value for the diagnosis of acute VKH.

Peripapillary intrachoroidal cavitations. The Beijing eye study.

Purpose To assess prevalence, size and location of peripapillary intrachoroidal cavitations (PICCs) and their associations in a population-based sample. . Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range:50-93 years). A detailed ophthalmic examination included enhanced depth imaging of the choroid by spectral-domain optical coherence tomography and fundus photography. PICCs were defined as triangular thickening of the choroid with the base at the optic disc border and a distance between Bruch´s membrane and sclera of ≥200μm. Parapapillary large choroidal vessels were excluded. Results Out of 94 subjects with high myopia (refractive error <-6.0 diopters or axial length >26.5mm in right eyes), OCT images were available for 89 (94.7%) participants. A PICC was detected in 15 out of these 89 highly myopic subjects (prevalence:16.9±4.0%) and in none of hyperopic, emmetropic or medium myopic subgroups each consisting of 100 randomly selected subjects. Mean PICC width was 4.2±2.3 hours (30°) of disc circumference and mean length was 1363±384μm. PICCs were located most frequently (40%) at the inferior disc border. On fundus photos, a typical yellow-orange lesion was found in 8 (53%) eyes with PICCs. In binary regression analysis, presence of PICCs was significantly associated with optic disc tilting (P=0.04) and presence of posterior staphylomata (P=0.046). Conclusions Prevalence of PICCs in the adult Chinese population was 16.9±4.0% in the highly myopic group, with no PICCs detected in non-highly myopic eyes. PICCs were located most frequently at the inferior optic disc border. Only half of the PICCs detected on OCT images showed a yellow-orange lesion on fundus photos. Presence of PICC was significantly associated only with an increased optic disc tilting and presence of posterior staphylomata, while it was not associated with axial length, refractive error or other ocular or systemic parameters.

MACULAR BRUCH MEMBRANE DEFECTS IN HIGHLY MYOPIC EYES: The Beijing Eye Study.

Purpose: To examine prevalence and associations of macular Bruch membrane defects (MBMDs) in a population-based setting. Design: Population-based cross-sectional study. Methods: The Beijing Eye Study 2011 included 3,468 subjects who underwent a detailed ophthalmic examination including spectral domain optical coherence tomography with enhanced depth imaging of the macula. Macular Bruch membrane defects were defined as an interruption of Bruch membrane on the optical coherence tomography images in the macular region. Results: Macular Bruch membrane defects could be detected only in highly myopic eyes (defined as refractive error of ⩽−6 diopters or axial length of ≥26.5 mm) with a prevalence of 17/164 (10.4%, 95% confidence interval [CI], 5.7%–18.1%). Best-corrected visual acuity <0.05 was found in 5 (29%) of 17 eyes with MBMDs, and in 7 (41%) eyes, visual acuity was <0.3 and ≥0.05. In the MBMD region, retinal pigment epithelium and choriocapillaris were completely lost, and the deep and middle layers of the retina and the choroid were almost completely absent. In the MBMD region, mean retinal thickness was 153 ± 57 &mgr;m (mean ± SD) and choroidal thickness was 12.7 ± 28.1 &mgr;m. On the fundus photographs, MBMDs appeared as whitish areas with round borders. In multivariate regression analysis, presence of MBMD was significantly associated only with longer axial length (Odds ratio: 3.87; 95% CI, 1.64–9.14). Conclusion: Macular Bruch membrane defects with a prevalence of approximately 10% in highly myopic eyes are associated with a complete loss of retinal pigment epithelium and choriocapillaris, an almost complete loss of photoreceptors and choroid, and marked reduction in visual acuity. Macular Bruch membrane defects may be added to the panoply of features of myopic maculopathy.

CONGENITAL CONTRACTILE PERIPAPILLARY STAPHYLOMA WITH RHEGMATOGENOUS RETINAL DETACHMENT.

Purpose: To describe the occurrence of a congenital contractile peripapillary staphyloma in association with a rhegmatogenous retinal detachment. Methods: The clinical course of a 17-year-old patient with a contractile peripapillary staphyloma and undergoing pars plana vitrectomy for repair of an associated retinal detachment was studied. Results: The left eye showed a peripapillary staphyloma which during the ophthalmoscopical examination revealed contractile movements after the presentation of a light stimulus to either eye. The contraction of the peripapillary staphyloma was not correlated with a Valsalva maneuver, neck venous compression, forced lid closure, or respiratory movements. Because of a retinal detachment involving the inferior, nasal, and temporal retina, best-corrected visual acuity was 20/100. During pars plana vitrectomy under systemic anesthesia, the contractions of the peripapillary staphyloma subsided in the early phase of surgery, and reoccurred at approximately 80 minutes after the start of general anesthesia, when the posterior pole was touched with an aspiration syringe. Conclusion: The etiology of the movements of the congenital peripapillary staphyloma in our patient may include a misbalance between intraocular pressure and orbital cerebrospinal fluid pressure or contractions of extraocular muscles. The observations may give information about the physiology and pathophysiology of the optic nerve head.

Central retinal artery pressure and carotid artery stenosis

The central retinal artery (CRA), which can be non-invasively examined with ophthalmoscopy, may be regarded as an extracranial part of the cerebrovascular system. Assessment of CRA pressure may be of help in assessing the impediment of the intracranial blood circulation in patients with a carotid artery stenosis (CAS). The aim of this study was to explore the potential associations between diastolic central retinal artery pressure (diastCRAP) and CAS. The prospective longitudinal clinical observational study included patients with CAS and a control group without CAS. diastCRAP was assessed using ophthalmodynamometry. The study group consisted of 95 patients with CAS (50 of whom had >75%CAS and underwent surgery; the surgical study group) and a control group of 64 individuals without CAS. In all study participants, a lower diastCRAP was significantly associated with a higher degree of CAS (P<0.001). Multivariate analysis indicated that a higher CAS degree was significantly (correlation coefficient: r=0.75) associated with a higher brachial diastolic blood pressure (P<0.001) and lower diastCRAP (P<0.001). Within the surgical study group at the baseline of the study, diastCRAP was significantly lower at the surgical side than at the contralateral side (P=0.02). The diastCRAP on the surgical side increased significantly (P<0.001) after surgery. In the surgical study group at baseline, diastCRAP on the surgical side was not significantly associated with brachial diastolic blood pressure (P=0.22), whereas after surgery, diastCRAP was significantly associated with brachial diastolic blood pressure (P=0.001). DiastCRAP was found to be significantly and linearly correlated with the degree of CAS in intra-individual inter-eye, inter-individual and intra-individual follow-up comparisons. The strong and linear association between diastCRAP and the degree of CAS suggest that diastCRAP should be explored further for use as an indicator of cerebrovascular status.

Cytomegalovirus retinitis in patients with AIDS before and after introduction of HAART in China.

Purpose: To determine the prevalence of cytomegalovirus retinitis (CMVR) and other fundus lesions in subjects with acquired immunodeficiency syndrome (AIDS) before and after the introduction of highly active antiretroviral therapy (HAART) in China. Methods: The retrospective study included subjects with AIDS who consecutively attended a third referral center in Beijing before and after HAART was introduced. Comprehensive systemic and ophthalmic examinations, including CD4+ T-cell count, ophthalmoscopy, and fundus photography, were carried out. Results: A total of 173 HIV-infected, HAART-naive individuals and 267 people undergoing HAART were included in the study. The HAART-naive group as compared with the HAART group was significantly older (39.5 ± 11.5 years versus 36.7 ± 11.2 years; p = 0.02) and included significantly more men (p = 0.045). Prevalence of CMVR, microvascular retinopathy, and optic neuropathy in the HAART group (9.0 ± 1.8%, 7.9 ± 1.7%, and 4.9 ± 1.3%, respectively) were significantly (all p≤0.001) lower than in the HAART-naive group (20.2 ± 3.1%, 31.2 ± 3.5%, and 13.9 ± 2.6%, respectively). Microvascular retinopathy was significantly associated with HAART-naive status (p<0.001; odds ratio [OR] 0.20; 95% confidence interval [CI] 0.12, 0.36) and higher age (p = 0.002; OR 1.04; 95% CI 1.10, 1.06). Cytomegalovirus retinitis was significantly associated with CD4+ cell count <50 cells/μL (p = 0.001; OR 5.50; 95% CI 1.95, 15.5), HAART-naive status (p = 0.02; OR 0.23; 95% CI 0.07, 0.79), and lower best-corrected visual acuity (p<0.001; OR 5.44; 95% CI 2.11, 14.0). Conclusions: As in Western countries, prevalence of CMVR and microvascular retinopathy in Chinese subjects with AIDS were significantly associated with a low CD4+ cell count and a HAART-naive status as the 2 major risk factors.

Vogt–koyanagi–harada Disease And Fungal Meningitis

PURPOSE To describe a patient who initially presented with features of Vogt-Koyanagi-Harada disease and who eventually demonstrated symptoms of mycotic meningitis. METHODS An 18-year-old immunocompetent boy showed a disseminated uveitis with patchy thickening of the posterior choroid. A clinical neurologic examination and a microbiological assessment revealed neck stiffness as well as pleocytosis, increased protein content, a decreased concentration of glucose and chloride, and cryptococcal fungi in the cerebrospinal fluid. It led to the diagnosis of cryptococcal meningitis. RESULTS Antifungal therapy was initiated and given for 2 months. After bilateral retrobulbar injections of 2.5 mg of dexamethasone and 20 mg of triamcinolone acetonide, choroidal edema regressed and visual acuity increased from 0.4 to 1.0 at 3 weeks after start of therapy. Microbiological examination of cerebrospinal fluid samples taken 30 days later was unremarkable. Ophthalmoscopy showed some fine pigment clumping and depigmentation in the macula. CONCLUSION According to the International Nomenclature Committee for Vogt-Koyanagi-Harada diagnosis, the patient was diagnosed with incomplete Vogt-Koyanagi-Harada because he had not suffered any ocular trauma, had not undergone ocular surgery, and presented with bilateral multifocal choroiditis accompanied by signs of meningitis without skin abnormalities. Because skin changes can occur months to years after the initial symptoms, the patient may eventually fulfill the criteria for complete Vogt-Koyanagi-Harada disease.

Cytomegalovirus retinitis in pre‐HAART AIDS patients in China

Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China Department of Ophthalmology, Beijing Di Tan Hospital, Capital Medical University, Beijing, China Department of Ophthalmology, Medical Faculty Mannheim of the RuprechtKarls-University, Heidelberg, Germany Infection Center, Beijing Di Tan Hospital, Capital Medical University, Beijing, China