MYOPIC PRESENTATION OF CENTRAL SEROUS CHORIORETINOPATHY
(Retina. 2021;41(12):2472-2478. doi:10.1097/IAE.0000000000003297）
Purpose
To increase insight into the myopic presentation of central serous chorioretinopathy (CSC) by comparing a large group of myopic patients with CSC with reference groups with only one of the diagnoses.
通过比较大量患有中心性浆液性脉络膜视网膜病变（CSC）的近视患者与仅有一种诊断的对照组，增加对中心性浆液性脉络膜视网膜病变（CSC）近视表现的认识。
Methods
Myopic patients with CSC (spherical equivalent ≤−3D, n = 46), emmetropic patients with CSC (spherical equivalent −0.5 to 0.5 D, n = 83), and myopic, non-CSC patients (n = 50) were included in this multicenter cross-sectional study. Disease characteristics and imaging parameters, such as subfoveal choroidal thickness and indocyanine green angiography patterns, were compared between cases and reference groups.
患有CSC（球形等效物）的近视患者≤−3D，n=46），正视型CSC患者（球形等效物）−0.5至0.5天，n=83）和近视、非CSC患者（n=50）被纳入这项多中心横断面研究。比较病例组和对照组的疾病特征和影像学参数，如中心凹下脉络膜厚度和吲哚青绿血管造影模式。
Results
In myopic patients with CSC, median subfoveal choroidal thickness (286 µm [IQR 226–372 µm]) was significantly thicker than subfoveal choroidal thickness in myopic, non-CSC patients (200 µm [IQR 152–228 µm], P < 0.001) but thinner than emmetropic patients with CSC (452 µm [IQR 342–538 µm], P < 0.001). They also had pachyvessels in 70% of the eyes comparable with emmetropic CSC (76%, P = 0.70). Choroidal hyperpermeability was frequently present on indocyanine green angiography in both myopic and emmetropic CSC eyes. Need for treatment, treatment success, and recurrence rate were not significantly different between CSC groups.
在患有CSC的近视患者中，中心凹下脉络膜厚度（286µm[IQR 226–372µm]）明显大于患有CSC的近视非CSC患者的中心凹下脉络膜厚度（200µm[IQR 152–228µm]，P<0.001），但小于患有CSC的正视眼患者（452µm[IQR 342–538µm]，P<0.001）。他们70%的眼睛中也有厚血管，与正视式CSC相当（76%，P=0.70）。在近视眼和正视眼CSC的吲哚青绿血管造影中经常出现脉络膜通透性增高。CSC组的治疗需求、治疗成功率和复发率无显著差异。
Conclusion
Myopic CSC presents with similar imaging and clinical characteristics as emmetropic CSC, apart from their thinner choroids. Keeping in mind the structural changes of myopia, other imaging characteristics could aid the diagnostic process.
近视性CSC除了较薄的脉络膜外，还具有与正视性CSC相似的影像学和临床特征。记住近视眼的结构变化，其他影像学特征可能有助于诊断过程。
本研究通过比较大量患有CSC的近视患者与仅有一种诊断的对照组，增加对近视CSC临床和影像学特征的了解。
本研究的亮点在于调查了CSC相对罕见的近视表现，研究发现，与近视、非CSC患者相比，患有CSC的近视患者的SFCT更厚。除了近视眼和正视眼CSC的疾病特征相似外，还发现近视眼的存在并不影响治疗需要、治疗成功率或复发率。
本研究不足之处在于，正视对照组明显比近视组和对照组年轻，无法判断由于年龄导致的差异，且屈光和AL是SFCT的重要因素，但本研究正视眼未测量眼轴长度。鉴于这些限制，该研究可能高估了近视病例和正视参考文献之间的SFCT差异，低估了近视病例和近视参考文献之间的SFCT差异。
Retinal Sensitivity Correlates With the Superficial Vessel Density and Inner Layer Thickness in Diabetic Retinopathy
(Invest Ophthalmol Vis Sci. 2021;62(14):28.doi:10.1167/iovs.62.14.28）
Purpose
The purpose of this paper was to present our study on the relationship between the parafoveal sensitivity measured using microperimetry and the vessel density (VD) assessed by optical coherence tomography-angiography (OCT-A) in eyes with diabetic retinopathy (DR).
本研究旨在探讨糖尿病视网膜病变（DR）患者用显微视野计测量的中央凹旁敏感度与光学相干断层扫描血管造影（OCT-A）评估的血管密度（VD）之间的关系。
Methods
The observational case series was conducted in a tertiary ophthalmology center. Eyes with DR and without macular edema were consecutively included. All eyes underwent microperimetry and OCT-A. The correlation between the regional retinal sensitivity and the corresponding local capillary changes and structural alterations seen on OCT-A was assessed in each retinal quadrant.
观察病例系列在一家三级眼科中心进行。连续纳入DR眼和无黄斑水肿眼。所有的眼睛都接受了显微视野检查和OCT-A。在每个视网膜象限评估了区域视网膜敏感性与相应的局部毛细血管变化和OCT-A上看到的结构变化之间的相关性。
Results
Thirty-seven eyes of 21 patients were included. The mean retinal sensitivity was 28.7 ± 2 decibel (dB). The mean parafoveal VD was 43.2 ± 4.2% in the superficial capillary plexus (SCP) and 48.1 ± 3.3% in the deep capillary complex (DCC). In the multivariate linear regression model, the mean retinal sensitivity was positively correlated with the VD in the SCP in the parafoveal ring (P = 0.01) and with the inner nuclear layer (INL) thickness (P = 0.01). The qualitative analysis of each quadrant showed the presence of areas of capillary dropout with a normal sensitivity. Conversely, all areas of decreased sensitivity (<25 dB) were associated with a decreased VD in the SCP and the DCC.
纳入21例37眼。平均视网膜敏感度为28.7±2分贝（dB）。浅部毛细血管丛（SCP）和深部毛细血管复合体（DCC）的平均中心凹旁血管密度分别为43.2±4.2%和48.1±3.3%。在多元线性回归模型中，平均视网膜敏感性与中央凹旁环SCP中的VD（P=0.01）和内核层（INL）厚度（P=0.01）呈正相关。每个象限的定性分析显示存在灵敏度正常的毛细血管脱落区域。相反，所有敏感性降低（<25 dB）的区域均与SCP和DCC中VD的降低有关。
Conclusion
The parafoveal sensitivity positively correlated with the VD in the SCP in DR eyes. Areas with a low retinal sensitivity were always co-located with a loss of capillaries in the SCP and the DCC despite preserved outer retinal layers.
DR眼中央凹旁敏感度与SCP的VD呈正相关。视网膜敏感度低的区域总是与SCP和DCC中的毛细血管缺失共存，尽管保留了视网膜外层。
Diagnostic Accuracy of Monitoring Tests of Fellow Eyes in Patients with Unilateral Neovascular Age-Related Macular Degeneration: Early Detection of Neovascular Age-Related Macular Degeneration Study
(Ophthalmology. 2021;128(12):1736-1747. doi:10.1016/j.ophtha.2021.07.025）
Purpose
To evaluate the diagnostic accuracy of routinely used tests of visual function and retinal morphology compared with fundus fluorescein angiography (FFA) to detect onset of active macular neovascularization in unaffected fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD).
评价常规视觉功能和视网膜形态检查与眼底荧光血管造影（FFA）的诊断准确性，以检测单侧新生血管年龄相关性黄斑变性（nAMD）患者未受影响的对侧眼睛中活动性黄斑新生血管的发生。
Design
Prospective diagnostic accuracy cohort study conducted in 24 eye clinics in the United Kingdom over 3 years.
在英国24家眼科诊所进行了为期3年的前瞻性诊断准确性队列研究。
Participants
Older adults (>50 years) with recently diagnosed unilateral nAMD with a fellow (study) eye free of nAMD.
最近诊断为单侧nAMD的老年人（>50岁），另一位（研究）患者的眼睛没有nAMD。
Methods
Self-reported vision, Amsler, clinic-measured visual acuity (VA), fundus assessment, and spectral domain OCT. The reference standard is FFA.
自我报告视力、Amsler、临床测量视力（VA）、眼底评估和光谱域OCT。参考标准为FFA。
Main Outcome Measures
Sensitivity and specificity of the 5 index tests.
5项指标检测的敏感性和特异性。
Results
Of 552 participants monitored for up to 3 years, 145 (26.3%) developed active nAMD in the study eye, of whom 120 had an FFA at detection and constituted the primary analysis cohort. Index test positives at nAMD detection in those confirmed by FFA were self-reported vision much worse (5), distortion on Amsler (33), 10-letter decrease in acuity from baseline (36), fundus examination (64), and OCT (110). Percentage index test sensitivities were: self-reported vision 4.2 (95% confidence interval [CI], 1.6–9.8); Amsler 33.7 (95% CI, 25.1–43.5); VA 30.0 (95% CI, 22.5–38.7); fundus examination 53.8 (95% CI, 44.8–62.5); and OCT 91.7 (95% CI, 85.2–95.6). All 5 index test specificities were high at 97.0 (95% CI, 94.6–98.5), 81.4 (95% CI, 76.4–85.5), 66.3 (95% CI, 61.0–71.1), 97.6 (95% CI, 95.3–98.9), and 87.8 (95% CI, 83.8–90.9), respectively. The combination of OCT with one other index test that was a secondary outcome measure increased sensitivity marginally and decreased specificity for all combinations except fundus examination.
在552名受试者中进行了长达3年的监测，其中145名（26.3%）在研究眼中出现活动性nAMD，其中120名在检测时出现FFA，构成主要分析队列。经FFA确认的nAMD检测中的指数测试阳性者为自我报告视力更差（5），Amsler畸变（33），视力比基线下降10个字母（36），眼底检查（64）和OCT（110）。百分比指数测试敏感性为：自我报告视力4.2（95%置信区间[CI]，1.6-9.8）；Amsler 33.7（95%可信区间，25.1-43.5）；VA 30.0（95%可信区间，22.5-38.7）；眼底检查53.8（95%可信区间，44.8-62.5）；10月91.7日（95%可信区间，85.2-95.6）。所有5项指标的特异性分别高达97.0（95%可信区间94.6-98.5）、81.4（95%可信区间76.4-85.5）、66.3（95%可信区间61.0-71.1）、97.6（95%可信区间95.3-98.9）和87.8（95%可信区间83.8-90.9）。OCT与另一项作为次要结果指标的指标检测相结合，略微增加了敏感性，降低了除眼底检查以外的所有组合的特异性。
Conclusion
Tests of self-reported change in vision, unmasking of new distortion, measurements of acuity, and fundus checks to diagnose active nAMD performed poorly in contrast to OCT. Our findings support a change to guidelines in clinical practice to monitor for onset of nAMD.
与OCT相比，自我报告的视力变化、新畸变的揭穿、视力测量以及诊断活动性nAMD的眼底检查的测试表现不佳。我们的发现支持改变临床实践指南，以监测nAMD的发病情况。
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