OCT对7～18岁近视黄斑参数研究

目的 探讨近视青少年黄斑厚度和黄斑容积的变异程度与等效球镜、眼轴长度、性别、年龄、及眼别的关系.方法 横断面调查研究.应用Stratus相干光断层扫描(OCT)仪的黄斑快速扫描程序用直径为6mm的相邻30°的6条扫描线,测量154例(154只眼)7～18岁近视青少年的黄斑中心小凹、中心区和旁中心凹内、外环(直径分别为1、3、6mm)的颞、上、鼻、下各个区域的厚度和容积,并用A超测定眼轴长度.各影响因素与黄斑各区域的厚度和容积分别进行双变量直线回归分析.结果 黄斑旁中心凹上方和鼻侧较下方和颞侧厚.黄斑中心凹最薄处厚度、黄斑中心区厚度和容积与等效球镜、眼轴长度、性别、年龄、及眼别均无关(P>0.05);黄斑区总容积与等效球镜度数呈正相关(r=0.273,P=0.001),与眼轴长度呈负相关(r=0.285,P=0.001);内环和外环各方位厚度及容积与等效球镜均呈正相关(P<0.05):眼轴长度与内环下方和外环各方位厚度和容积呈负相关(P<0.05);年龄与内环鼻、颞侧、外环鼻侧厚度和容积呈正相关(P<0.05);性别与外环下方厚度和容积呈负相关(P<0.05);眼别与黄斑各区域厚度和容积均无关(P>0.05).结论 随着近视程度和眼轴长度的增加,青少年黄斑部变薄的区域在旁中心凹区而不是中心区.在评价青少年黄斑厚度和黄斑容积时,需考虑其近视程度、眼轴长度、年龄及性别的影响.

Abstract：

Objective To evaluate the associations between macular thickness and volume, assessed by optic coherence tomography (OCT), with spherical equivalent (SE), axial length (AL), gender, age, eye in myopic juvenile.Methods Cross-sectional observational study.One hundred and fifty-four juvenile (age range, 7-18 years) underwent ophthalmic examination.Fast macular scans were performed by Stratus OCT with six 6-mm lines (oriented 30° apart) in a radial spokelike pattern on one randomly selected eye of each subject.Average macular thickness and macular volume was provided for each of the nine regions with outer radii for the central, inner, and outer macular regions being 1, 3 and 6mm, respectively.AL was respectively measured by A-ultrasound.The effects of several factors (SE, AL, gender, age, and eye) on macular thickness and volume were investigated in univariate analyses.Results The retina was thicker at the superior and nasal parafovea compared to the inferior or temporal parafovea.The mean minimum retinal thickness (at the foveola), the central macular thickness and volume had no significant relationship between SE, AL, gender, age and eye (P >0.05).The total macular volume showed direct linear correlation with SE (r=0.273, P =0.001), and inverse linear correlation with AL (r=-0.285, P =0.001).There was significant direct linear correlation between SE and the thickness and volume of inner and outer macula (P<0.05).AL showed inverse linear correlation with the thickness and volume of inferior inner macula and outer macula (P <0.05).Age showed direct linear correlation between the thickness and volume of nasal inner macula, temporal inner macula, nasal outer macula (P <0.05).There was significant inverse linear correlation between the thickness and volume of inferior outer macula and gender (P<0.05).Macula thickness and volume was not significantly related to the laterality.Conclusions As the AL and the myopic degree of eye increase, the macula thickness and volume decrease at the parafovea, instead of the fovela.When we asses the macular sthickness and volume in myopic juvenile.we should consider the inflnence of the refraction.axial length eye.     

Macular integrity assessment to determine the association between macular microstructure and functional parameters in diabetic macular edema

AIM: To respectively evaluate macular morphological features and functional parameters by using spectral-domain optical coherence tomography (SD-OCT) and macular integrity assessment (MAIA) in patients with diabetic macular edema (DME). METHODS: This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity (BCVA) measurement, MAIA microperimetry, and SD-OCT. DME morphology, including central retinal thickness (CRT) and central retinal volume (CRV); integrity of the external limiting membrane (ELM) and photoreceptor inner segment/outer segment (IS/OS) junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold (AT)-retinal sensitivity, macular integrity index (MI), fixation points within a circle of radius 1° (P1) and 2° (P2), and bivariate contour ellipse area considering 63% and 95% of the fixation points (A63 and A95, respectively). RESULTS: MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA (logMAR), total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA (logMAR), AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION: Functional (BCVA and visual field) and morphological parameters (retinal thickness) were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.     

视网膜静脉阻塞黄斑水肿的光相干断层扫描观察

目的 观察视网膜静脉阻塞(RVO)黄斑水肿的光相干断层扫描(OCT)图像特征以及与临床的关联,探讨新型频域OCT在RVO患者黄斑水肿形态和定量分析中的临床价值.方法 回顾分析临床确诊的RVO患者91例92只眼的OCT检查资料.其中,视网膜中央静脉阻塞(CRVO)35例35只眼;视网膜分支静脉阻塞(BRVO)56例57只眼.所有患者接受最佳矫正视力(BCVA)、直接或间接检眼镜、裂隙灯显微镜加前置镜检查.其中60例60只眼还接受了荧光素眼底血管造影(FFA)检查.5线扫描(5 Line Raster)模式下通过中心凹的水平+垂直两条扫描线的分析,对黄斑水肿类型和累及层次以及视网膜外层的细微结构进行观察,用软件自带cliaper功能模块手工测量黄斑中心凹厚度(FT)、浆液性视网膜脱离高度、中心凹囊腔的高度和宽度、中心凹囊腔下光感受器层厚度.在立方体(Cube)扫描模式下,采用软件自带的功能模块对黄斑中心厚度(CFT)、黄斑中心凹体积(V)、平均厚度(AT)进行测量.回顾分析时,重点分析黄斑水肿类型、OCT图像特征以及不同黄斑水肿类型与视力的相互关系.结果 RVO患者黄斑水肿表现为弥漫性水肿、囊样水肿、浆液性视网膜脱离、混合性水肿等多种形态.其中,弥漫性水肿表现为视网膜组织增厚,结构疏松,反射轻度降低;囊样水肿表现为视网膜神经上皮层内有单个或多个低反射囊泡,其间又可见组织柱分隔;浆液性视网膜脱离表现为视网膜神经上皮与色素上皮分离,其间有低反射液性空腔;混合性水肿表现为以上几种水肿形式的混合.92只眼中,弥漫性水肿12例12只眼,占13.0%;囊样水肿21例21只眼,占22.8%;浆液性视网膜脱离37例37只眼,占40.2%;混合性水肿58例59只眼,占64.1%.水肿位于外网状层/外核层91例92只眼.占100.0%;位于内核层67例68只眼,占74.2%;位于神经节细胞层23只眼,占25.0%.光感受器内外节连接(r=3.778 6,P=0.000)、外界膜完整性(r=4.462 2,P=0.000)和FT(r=-0.451 3,P=0.000)与其BCVA有相关性;而CFT(r=0.269 7,P=0.121)、V(r=0.052 8,P=0.054)和AT(r=0.060 8,P=0.075)与视力无相关性.结论 RVO所导致的黄斑水肿其形态和层次可表现为多种不同的类型,频域OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关;定量分析在RVO黄斑水肿患者中的价值有待进一步确定.

Abstract：

Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion (RVO), and to explore the application value of Fourier-domain (FD)OCT in RVO macular edema. Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients (60 eyes)also underwent fundus fluorescein angiography. There were 35 patients (35 eyes) with central retinal vein occlusion (CRVO) and 56 patients (57 eyes) with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema, characteristics of OCT images and the relationship between the different type of the edema and vision. Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (sponge-like thickening of the retina with reduced reflectivity) 12 patients ( 12 eyes, 13.0% ), cystoid edema (multi-cyst-like space in the neuro-retina separated by tissue column) 21 patients (21 eyes, 22.8%) and serous retinal detachment (separation of neuro-retina and retinal pigment epithelium by space with low reflectivity) 37 patients (37 eyes, 40. 2%) and mixed edema(mix of the above several edema form) 58 patients (59 eyes, 64.1 %). The edema can happen at different layers of the neuro-retina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients (92 eyes, 100. 0%), inner nuclear layer (INL) in 68 patients (68 eyes, 74.2%) and ganglion cell layer (GCL) in 23 patients (23 eyes, 25.0%).Statistic analysis revealed that BCVA was related to the integrity of IS/OS (r=3. 778 6, P=0. 000), ELM (r=4.462 2, P= 0. 000 ) and FT (r=-0.4513, P=0. 000 ), but not related to CFT (r=0.269 7, P=0.121), V(r=0.0528, P= 0. 054 ) and AT (r=0.0608, P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.     

频域OCT对高度近视性黄斑病变光感受器内外节改变的观察

目的 运用频域光学相干断层扫描(SD-OCT)来观察高度近视性黄斑病变患者的视网膜光感受器层内外节形态的改变,并评估与视功能的关系.方法 选取67例高度近视性黄斑病变患者82只眼,其中视网膜劈裂38只眼,脉络膜新生血管24只眼,板层黄斑裂孔13只眼,全层黄斑裂孔7只眼.均进行CirruTMHD-OCT扫描,获得断层成像图观察光感受器内外节层形态改变.结果 光感受器IS/OS连接线完整在高度近视性黄斑病变中,分别为视网膜劈裂6只眼(15.78%)、脉络膜新生血管5只眼(20.83%)、板层黄斑裂孔9只眼(69.23%);光感受器IS/OS连接线不完整或丢失的分别为:视网膜劈裂32只眼(84.2%)、脉络膜新生血管19只眼(79.16%)、板层黄斑裂孔4只眼(30.76%)、全层黄斑裂孔7只眼(100%).在光感受器IS/OS连接线完整中,视力在0.2以上为17只眼(85%);在光感受器IS/OS连接线不完整或丢失,为10只眼(16.12%),组间差异有统计学意义(P<0.01).结论 在CirrusTMHD-OCT下能观察高度近视性黄斑病变的视网膜微结构变化.IS/OS连接线不完整或丢失在高度近视性黄斑病变中较普遍存在,IS/OS连接线完整性与视力相关.

Abstract：

Objective To evaluate the status of the photoreceptor inner and outer segment in high myopic maculopathy with the spectral-domain optical coherence tomography (SD-OCT), and the correlation between visual function and foveal photoreceptor integrity. Methods Eighty-two eyes of 67 patients with high myopic maculopathy (Myopic foveoschisis 38 eyes, Choroidal neovascularisation 24 eyes; Lamellar macular hole 13 eyes; Macular hole 7 eyes) were included. Using CirrusTM-OCT, the status of the inner and outer segments (IS/OS) photoreceptorjunction was assessed. Results A complete IS/OS junction line was detected in Myopic foveoschisis 6 eyes (15.78%), Choroidal neovascularisation 5 eyes (20.83%), Lamellar macular hole 9 eyes (69.23%), respectively. A discontinuous or defect IS/OS junction line was detected in Myopic foveoschisis 32 eyes (84.2%), Choroidal neovascularisation 19 eyes (79.16%), Lamellar macular hole 4 eyes (30.76%),and Macular hole 7 eyes (100%), respectively. Visual acuity (VA) was 0.2 or more in 17 (85%) eyes with a complete IS/OS junction line, however in 10 (16.12%) eyes with a discontinuous or defect IS/OS junction line (P =0.019). Conclusions CirrusTM-OCT enables observation of more detailed retinal microstructures in high myopic eyes. The IS/OS junction line discontinuous or defects are common and integrity of the photoreceptor layer beneath the fovea is associated with the VA in high myopic maculopathy.     

正常人黄斑厚度及视盘旁神经纤维频域OCT分析

目的 应用频域OCT(spectral domain Optical Coherence Tomography,SD-OCT)分析正常人眼黄斑厚度、体积及视盘旁神经纤维的分布情况.方法 应用频域OCT对62名124只眼正常人(21～58岁)黄斑及视盘旁进行快速扫描,测量正常眼中心/小凹厚度(Central point thickness,CPT),黄斑部直径为3mm圆形区域内9个分区内平均厚度(Th)及体积(V);同时测量视盘旁直径为3.4mm圆形区域神经纤维分布情况.入组标准:矫正视力20/20,眼压正常,没有已知眼病.结果 124只正常眼中心小凹平均厚度为(215.11±15.475)μm,中心区为(255.56±16.709)μm),黄斑区厚度图呈开口向颞侧的马蹄形,在所有ETDRS区域中,鼻外象限厚度最大(352.87±15.886)μm;中心凹鼻侧厚度及体积大于颞侧(P<0.05);在内环区域,上下方视网膜厚度及体积无明显差异;在外环区域,上下方视网膜厚度及体积差异有统计学意义(P<0.05);视盘旁神经纤维的分布,颞下方神经纤维分布最多,鼻侧神经纤维最少差异有统计学意义.结论 应用频域OCT测量,正常人眼黄斑部中心小凹厚度为(215.11±15.475)μm,中央区为(255.56±16.709)μm,神经纤维层厚度与以往时域OCT测量结果基本一致.频域OCT成像清晰,能够精确测量黄斑视网膜厚度及视盘旁神经纤维分布情况,可为临床诊治黄斑及视神经病变提供客观、定量的指标.

Abstract：

Objective To determine normal values for macular thickness, volume and peripapillary retinal nerve fiber layer thickness(RNFL)measured by spectral domain Optical Coherence Tomography (SD-OCT)in subjects with no known retinal disease and to examine the relationship of RNFL with macular thickness. Methods Sixty-two healthy adults(124 eyes, 21-58 years old)with no known eye disease,best-corrected visual acuity 20/20, and normal intraocular pressure were enrolled. All subjects underwent a complete ophthalmologic examination to rule out any retinal diseases or glaucoma. All the OCT scans were performed by a single operator, Central point thickness(CPT)and retinal thickness(Th)in 9 Early Treatment Diabetic Retinopathy Study(ETDRS)subfields, including central subfield(CSF), were analyzed. Statistical analyses were carried out using the analysis of variance. RNFL thickness was measured around the optic nerve head using 16 automatically averaged, consecutive circular B-scans with 3.4 mm diameter. The automatically segmented RNFL thickness was divided into 7 segments. Results Overall, the mean CPT was(215.11±15.475)μ m, and mean CSF was(255.56± 16.709)μ m. The macular thickness mapping in normal persons was "horse shoe" shaped open to the temporal side. Among the ETDRS subfields, the outer nasal quadrant had the maximum thickness(352.87± 15.886)μ m. The nasal quadrant had a larger thickness and volume than temporal side(P 0.05); in the inner circle area, there was no difference between the superior and inferior retinal average thickness; on the contrary, there was a significant difference between the superior and inferior retinal average thickness and volume in outer circle area. While the distribution of peripapillary retinal nerve fiber also had marked difference. The inferior-temporally side had the most, while the nasal side had the least. Conclusions Normative values for macular thickness in otherwise healthy eyes ware measured to be(215.11 ±15.475)μ m(CPT)and(255.56± 16.709)μ m(CSF)using commercially available Spectralis SD-OCT. Normal RNFL results with SD-OCT are comparable to those reported with time-domain OCT. Due to the legible imaging characters, the SD-OCT can measure normal macular thickness and the distribution of peripapillary retinal nerve fiber accurately, which can provide objective and quantitative indexs for diagnosis and therapy of macular disease and optical neuropathy.     

硅油填充术后OCT检测黄斑中心凹厚度与视力相关分析

目的 分析硅油填充术后OCT榆测黄斑中心凹厚度与术后视力的相关性.方法 对35例(35只眼)行玻璃体切割联合硅油注入术者,分别于术后2周、1、2月行黄斑区OCT检查,观察图像特点,分析黄斑中心凹厚度与最佳矫正视力之间相关性.结果 黄斑中心凹厚度和最佳矫正视力的负对数之间为正相关,即黄斑中心凹厚度与术后最佳矫正视力呈现负相关.结论 随着黄斑中心凹厚度的减少,视力呈现上升的趋势.OCT能评估玻璃体视网膜手术后黄斑区的恢复情况,为临床治疗和预后提供了依据.

Abstract：

Objective To assess the relationships between the macular thickness measured by OCT and postoperative best-corrected visual acuity after vitrectomy with silicone oil eamponade.Methods Thirty-five consecutive cases underwent vitrectomy with silicone oil tamponade were collected.Cross-sectional images of macular with OCT at 2 weeks, 1 month, 2 months after the operation were observed and the relationships between macular foveal thickness and best-corrected visual acuity were analyzed.Results The direct correlation was showed between the macular foveal thickness and the negative logarithm of best-corrected visual acuity.The negative correlation was showed between the macular feveal thickness and postoperative best-corrected visual acuity.Conclusions Along with the increasing of macular foveal thickness, the best-corrected visual acuity is decreasing.We can assess the function of the macular post operative and find the basis of clinic therapy and prognosis.     

Three-dimensional diabetic macular edema thickness maps based on fluid segmentation and fovea detection using deep learning

AIM: To explore a more accurate quantifying diagnosis method of diabetic macular edema (DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness (CRT) and apply it in follow-up of DME patients. METHODS: Optical coherence tomography (OCT) scans of 229 eyes from 160 patients were collected. We manually annotated cystoid macular edema (CME), subretinal fluid (SRF) and fovea as ground truths. Deep convolution neural networks (DCNNs) were constructed including U-Net, sASPP, HRNetV2-W48, and HRNetV2-W48+Object-Contextual Representation (OCR) for fluid (CME+SRF) segmentation and fovea detection respectively, based on which the thickness maps of CME, SRF and retina were generated and divided by Early Treatment Diabetic Retinopathy Study (ETDRS) grid. RESULTS: In fluid segmentation, with the best DCNN constructed and loss function, the dice similarity coefficients (DSC) of segmentation reached 0.78 (CME), 0.82 (SRF), and 0.95 (retina). In fovea detection, the average deviation between the predicted fovea and the ground truth reached 145.7±117.8 μm. The generated macular edema thickness maps are able to discover center-involved DME by intuitive morphometry and fluid volume, which is ignored by the traditional definition of CRT>250 μm. Thickness maps could also help to discover fluid above or below the fovea center ignored or underestimated by a single OCT B-scan. CONCLUSION: Compared to the traditional unidimensional indicator-CRT, 3D macular edema thickness maps are able to display more intuitive morphometry and detailed statistics of DME, supporting more accurate diagnoses and follow-up of DME patients.     

OCT与FFA/ICGA在Sargardt病中的应用分析

目的利用OCT与FFA/ICGA研究Stargardt病黄斑区组织结构的变化以及对视网膜功能的影响,探讨OCT与FFA/ICGA在该病研究中的价值。方法对7例(14只眼)Stargardt病患者进行FFA/ICGA检查,利用OCT观察黄斑部结构改变,测量黄斑中心凹的厚度、黄斑容积及黄斑6mm平均容积,并对结果进行统计学分析。结果Stargardt病患眼视力低下,OCT观察Stargardt病患者黄斑区神经上皮层结构紊乱、变薄。中心凹厚度、黄斑容积及黄斑6mm平均容积与正常人有显著性差异。FFA表现为横椭圆形强透见荧光,部分合并有暗脉络膜背景荧光。ICGA则显示脉络膜毛细血管层不同程度萎缩。黄斑中心凹厚度、黄斑容积与矫正视力成正相关。结论OCT与FFA/ICGA均可观察Stargardt病患者黄斑区组织结构的变化,对测患者的视网膜功能变化、对Stargardt病的诊断与病理机制的研究具有重要意义。     

B超检查在黄斑区微小病变诊断的应用

目的 探讨B型超声检查对于白内障术前黄斑区微小病变的诊断价值,从形态结构方面协助对白内障术后视功能恢复的评价.方法 选取45例白内障术后经眼底摄片、OCT确诊的不同类型黄斑病变的患眼,将它们术前的B超不同程度的形态改变特征与OCT观察的黄斑中心平均视网膜厚度、黄斑中心视网膜体积的改变相比较.结果 B超0级组黄斑中心厚度和黄斑中心体积分别(278.29±75.66)μm和(0.26±0.13)mm3,B超1级组黄斑中心厚度和黄斑中心体积分别为(395.00±70.71)μm和(0.49±0.30)mm3,B超2级组黄斑中心厚度和黄斑中心体积分别为(336.58±69.66)μm和(0.27±0.06)mm3,B超3级组黄斑中心厚度和黄斑中心体积分别为(543.90±90.85)μm和(0.43±0.09)mm3.B超分级与黄斑中心厚度呈线性相关(F=44.849 P<0.01).B超分级与黄斑中心体积呈线性相关(F=8.260 P<0.01).结论 随着黄斑中心视网膜厚度和体积的增加,B超的阳性率也增加.B超对黄斑区局部视网膜增厚识别敏感度较高,但对视网膜后极部弥漫性视网膜增厚识别敏感度较低.提示在屈光间质混浊眼,特别是白内障术前B超检查对于黄斑区微小病变的早期诊断及术后视力预测有一定的参考价值.

Abstract：

Objective To investigate the value of B-scan in diagnosis ofmacular micropathology before cataract phacocmulsification and evaluate the visual function after cataract phacocmulsification in structure. Methods A total of 45 cases of macular micropathology diagnosed after cataract phacocmulsification were compared with finding of B-scan, fundus photographs and OCT. Results The central macular thickness and volume in classification 0 by B-scan was 278.29± 75.66um and 0.26± 0.13mm3, in classification 1 was 395.00± 70.71um and 0.49± 0.30mm3, in classification 2 was 336.58± 69.66um and 0.27± 0.06mm3, and in classification 3 was 543.90± 90.85um and 0.43± 0.09mm3. It was linear correlated between the classification and the central macular thickness (F =44.849,P <0.01), and the classification and the central macular volume (F=8.267, P <0.01). Conclusions There is positive correlation between thicknesses ofmacular to the classification by B-scan. The sensitivity of B-scan in the local thickening in macular is higher than the dispersion thickening. In patient with refractive media opacity, it is valuable to use B-scan to diagnose macular micropathology before cataract phacoemulsification and predict the visual function after cataract phacoemulsification.     

OCT对糖尿病视网膜病变光感受器细胞层的检测

目的:应用频域光学相干断层扫描(optical coherence tomography,OCT)在健康人群及各期糖尿病视网膜病变患者中测量外核层(ONL)、内节和外节层(IS/OS)、光感受器细胞层的厚度.方法:选择健康人群50例100眼作为对照组,选择2型糖尿病患者178例300眼为研究对象,分为3组:糖尿病正常视网膜组(NDR)100眼、非增生性糖尿病视网膜病变组(NPDR)100眼、增生性糖尿病视网膜病变组(PDR)100眼.用频域OCT对4组进行测量中心凹和旁中心凹(鼻侧、颞侧)ONL、IS/OS层、光感受器细胞层的厚度.结果:对照组、NPDR组、PDR组中心凹、旁中心凹颞侧ONL、光感受器细胞层厚度比较差异均有统计学意义(P<0.05);NDR组中心凹、旁中心凹颞侧各层与对照组比较差异无统计学意义(P>0.05);中心凹、旁中心凹颞侧各组IS/OS层厚度比较差异无统计学意义(P>0.05);旁中心凹鼻侧各组各层比较差异无统计学意义(P>0.05).结论:黄斑中心凹和旁中心凹颞侧ONL、光感受器细胞层在DR中均有增厚,随DR病程的进展呈动态变化;光感受器细胞层厚度的变化主要发生在ONL层,IS/OS层无变化;旁中心凹颞侧的改变显于鼻侧;频域OCT能定量定性地观察糖尿病患者黄斑区的细微变化,为糖尿病患者黄斑病变早期诊断及治疗提供可靠的检测手段.     

玻璃体黄斑牵引综合征的三维频域相干光断层扫描图像特征

目的 探讨玻璃体黄斑牵引综合征的三维频域相干光断层扫描(OCT)图像特征.方法 回顾性系列病例研究.收集18例经三维频域OCT检查确诊的玻璃体黄斑牵引综合征患者的临床资料进行回顾性分析,着重观察其三维频域OCT检测图像特征.根据频域OCT定量检测的玻璃体与黄斑区视网膜附着粘连的范围,将玻璃体黄斑牵引综合征分为局灶型和宽大型两类.运用线性回归法分析所有患者的最小分辨角对数视力(logMAR视力)与黄斑中心凹部视网膜厚度的关系.结果 玻璃体黄斑牵引综合征患者的频域OCT检测图像清晰,其病变特征明显.18例患者中,病变呈局灶型14例,宽大型4例;合并黄斑前膜8例,合并黄斑全层裂孔2例,合并黄斑板层裂孔2例.18只眼的logMAR视力为0.15～1.22,其黄斑中心凹视网膜厚度为275～899 μm,经线性回归分析,显示所有患者的logMAR视力与黄斑中心凹的视网膜厚度呈中度线性正相关(r=0.616,P=0.007).结论 三维频域OCT检测可以直观地显示眼底病变三维结构,对玻璃体黄斑牵引综合征患者的诊断和随访具有重要作用.     

玻璃体切割联合内界膜移植术治疗大直径特发性黄斑裂孔的疗效评估

背景 大直径特发性黄斑裂孔(IMH)严重损害患眼视力,手术难度较大,如何选择和优化手术方法仍是研究热点. 目的 探讨游离内界膜移植术治疗大直径IMH的有效性和安全性.方法 采用前瞻性系列病例观察研究方法,于2013年1月至2015年11月纳入在河北医科大学第二医院就诊的大直径IMH患者[平均直径为(814.31±112.95)μm]42例42眼.所有患眼均施行玻璃体切割联合游离内界膜移植+体积分数12％C3F8填充术.分别于术前及术后1、3、6、12个月对患者进行最佳矫正视力(BCVA) (LogMAR)、裂隙灯显微镜检查和双目间接检眼镜检查,并采用频域光相干断层扫描(SD-OCT)仪检查手术前后黄斑中心区视网膜变化,评估裂孔闭合率,评估和比较手术前后患眼BCVA、光感受器内段/外段(IS/OS)缺损范围、外界膜缺损范围和中心凹视网膜厚度的变化. 结果 术后12个月患者黄斑裂孔闭合率为97.6％ (41/44).术后1、3、6和12个月患者BCVA较术前均明显改善,手术前后不同时间点BCVA总体比较差异有统计学意义(F=28.032,P＜0.001);术眼术前及术后1、3、6和12个月IS/OS缺损范围分别为(1 112.00±45.44)、(859.00±84.55)、(649.00±52.47)、(486.00±46.88)和(320.00±45.13) μm,总体比较差异有统计学意义(F=38.761,P＜0.001),其中术后1、3、6和12个月术眼IS/OS缺损范围较术前均明显减小,差异均有统计学意义(均P＜0.05);术眼术前和术后1、3、6和12个月外界膜平均缺损范围分别为(1 038.00±39.63)、(748.00±64.12)、(585.00±48.88)、(438.00±42.84)和(265.00±28.97) μm,总体比较差异有统计学意义(F=36.459,P＜0.001),术后1、3、6和12个月外界膜缺损范围较术前均明显减小,差异均有统计学意义(均P＜0.05).术后1个月黄斑中心凹厚度值大于术后3、6、12个月,差异均有统计学意义(均P＜0.05).术后3个月OCT显示黄斑裂孔底部高反射信号物质消失,即移植的游离内界膜分解代谢. 结论玻璃体切割联合游离内界膜移植术治疗大直径IMH是安全、有效的,移植的游离内界膜仅作为临时性胶质细胞增生支架,不会形成永久性瘢痕.     

视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构改变与视力的相关性分析

目的　观察视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构的光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征,探讨黄斑区微结构的改变与视力的关系。方法　采用ＯＣＴ对４６例（４６眼）视网膜静脉阻塞合并黄斑水肿患者进行黄斑区微结构检查,分析黄斑水肿形态,对不同形态黄斑水肿的患者进行比较,以患眼作为黄斑水肿组,对侧眼作为对照组,分析黄斑区微结构各参数与视力的相关性。结果　ＯＣＴ扫描结果显示４６眼视网膜静脉阻塞合并黄斑水肿的患者黄斑区微结构表现为３种形态,１２眼为黄斑囊样水肿,１０眼为浆液性神经上皮层脱离,２４眼为混合型水肿即黄斑囊样水肿伴浆液性神经上皮层脱离。对照组黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积分别为（１８０．８１±１３．３５）μｍ、（２３８．７２±１６．７５）μｍ及（０．１７±０．０３）ｍｍ３,而黄斑水肿组分别为（５４１．２６±１２５．６８）μｍ、（４７３．６１±１３３．４２）μｍ及（０．３８±０．１４）ｍｍ３,两组比较差异均有统计学意义（均为Ｐ＝０．０００）。根据患者黄斑区微结构形态表现分组研究发现,浆液性神经上皮层脱离患者ＢＣＶＡ最好,为（０．５３±０．０９）ＬｏｇＭＡＲ,其次为黄斑囊样水肿患者（０．６４±０．１６）ＬｏｇＭＡＲ,而混合型患者最差（１．０２±０．２４）ＬｏｇＭＡＲ,３组之间差异有统计学意义（Ｐ＝０．００８）。浆液性神经上皮层脱离患者中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积最小,其次为黄斑囊样水肿患者,而混合型患者３个指标均最大,３组之间差异均有统计学意义（均为Ｐ＝０．０００）。对黄斑部微结构的改变与ＢＣＶＡ进行相关性分析发现:黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜容积、ＩＳ／ＯＳ断裂长度及外界膜断裂长度与ＢＣＶＡ（ＬｏｇＭＡＲ）均呈正相关（ｒ＝０．５４６,Ｐ＝０．０００;ｒ＝０．５８２,Ｐ＝０．０００;ｒ＝０．５２３,Ｐ＝０．０００;ｒ＝０．８３４,Ｐ＝０．０００;ｒ＝０．７５８,Ｐ＝０．０００）。黄斑水肿形态与ＢＣＶＡ呈正相关（ｒ＝０．６４１,Ｐ＝０．０００）,单纯的浆液性神经上皮层脱离患者ＢＣＶＡ最好,混合型的患者病变最重,ＢＣＶＡ也最差。结论　视网膜静脉阻塞所致的黄斑水肿表现形态不同,ＯＣＴ可以对黄斑部微结构改变进行定量分析,黄斑区形态改变与视力密切相关。     

糖尿病性黄斑水肿患眼微视野计参数和BCVA与黄斑区形态的相关性

目的：探究糖尿病性黄斑水肿患者黄斑完整性评估(MAIA)微视野计参数及最佳矫正视力(BCVA)和黄斑区形态结构特征的相关性。

方法：选取2018-03/2020-01在我院眼科就诊的糖尿病性黄斑水肿患者43例74眼。检查患眼MAIA微视野计参数与黄斑区外界膜及内感光层和外感光层结联(IS/OS)层完整性。分析各区域视网膜厚度及视网膜敏感度的相关性,并分析IS/OS层完整组及缺损组视网膜厚度与视网膜敏感度、BCVA的相关性。

结果：与IS/OS层缺损组比较,IS/OS层完整组患者BCVA(LogMAR)、中心视网膜厚度(CRT)、由注视点组成的63%二元轮廓椭圆面积(BCEA63)、由注视点组成的95%二元轮廓椭圆面积(BCEA95)及黄斑完整性指数(MI)水平更低,视网膜敏感度的黄斑区平均阈值(AT)、2°固视率(P2)水平更高(均P<0.01),但两组患者中心视网膜容积(CRV)、1°固视率(P1)水平无差异(均P>0.05)。与外界膜缺损组比较,外界膜完整组患者BCVA(LogMAR)、CRT、MI水平更低(均P<0.05),但两组患者CRV、AT、P1、P2、BCEA63、BCEA95水平无差异(均P>0.05)。存在硬性渗出组和不存在硬性渗出组患者各眼部参数水平均无差异(P>0.05)。纳入患者视网膜厚度及视网膜敏感度在中心凹颞侧、中央及鼻侧处呈明显负相关(P<0.05),而在中心凹上方、下方无明显相关性(P>0.05)。IS/OS层完整组患者AT与CRT、BCVA均呈负相关,而CRT与BCVA呈正相关(均P<0.05); IS/OS层缺损组患者AT与BCVA呈负相关(P<0.05)

结论：糖尿病性黄斑水肿患眼MAIA微视野计参数与黄斑区形态结构密切相关,尤其是IS/OS层及外界膜的完整性,其可能是评价患者患眼黄斑区视力和视网膜敏感度的重要指标。     

OCT在糖尿病性黄斑水肿激光治疗中的应用

目的:探讨光学相干断层扫描(optical coherence tomography,OCT)在糖尿病性黄斑水肿(diabetic macular edema,DME)激光治疗后临床观察中的应用.方法:回顾性病例研究,选取2015-01/2016-06在秦皇岛市海港医院行黄斑区格栅样光凝治疗的DME患者188例376眼,治疗1 mo后利用OCT检测黄斑区6 mm范围内视网膜厚度,采用SPSS19.0统计软件对所得数据进行分析.结果:格栅样光凝1 mo后,患者黄斑中心凹至1mm、黄斑1~3 mm、黄斑3~6 mm平均视网膜神经上皮层厚度分别为332.02±18.07、393.40±19.71、372.00±20.01μm,与治疗前(404.70±16.37、445.17±18.25、410.87±18.14μm)比较,差异具有统计学意义(P<0.05).三者厚度变化分别为72.68±14.74、51.77±9.48、38.87±17.94μm,组间及两两比较,差异具有统计学意义(P<0.05).结论:DME经格栅样光凝治疗1mo后黄斑区视网膜神经上皮层厚度降低,并且越接近黄斑中心凹处,降低作用越明显.     

频域OCT对正常人和青光眼光感受器细胞层厚度的检测

背景青光眼以视网膜内层的神经节细胞丢失为主要病理特征,但其是否累及视网膜外层尚有争议。部分研究认为青光眼将导致视网膜外层（光感受器）功能的异常,而病理学研究得出了不同的结论。目的用频域OCT测量正常人和青光眼患者光感受器细胞层的厚度,探讨青光眼对光感受器细胞层厚度的影响。方法采用病例对照研究。用频域OCT（SDOCT）对正常人38例38眼和青光眼患者48例48眼的黄斑区进行扫描,由一位检测者采用Sigma图像分析软件盲法测量黄斑中心凹和旁中心凹处（中心凹外1．5mm）视网膜光感受器层的厚度。同时采用时域OCT（Stratus OCT）测量所有检测眼的视盘周围视网膜神经纤维层（RNFL）厚度,比较正常组和青光眼组光感受器细胞核层的平均厚度,分析光感受器细胞层厚度与RNFL厚度的关系。结果正常组和青光眼组在黄斑中心凹光感受器细胞核层厚度分别是（96．7±10．7）μm、（103．7±13．3）μm,差异有统计学意义（P=0．011）;中心凹光感受器内节和外节层厚度分别是（59．3±5．5）μm、（59．5±5．5）μm,差异无统计学意义（P=0．890）。正常组和青光眼组在中心凹外3mm处光感受器细胞核层厚度分别是（70．9±14．0）μm、（68．7±10．7）μm,光感受器内节和外节层厚度分别为（45．2±6．4）μm,（43．6±5．5）μm,差异均无统计学意义（P=0．410,P=0．228）。黄斑中心凹处光感受器细胞核层厚度和RNFL厚度两者有二元线性关系（γ=-0．019X。＋2．73X＋10．34,R^2=0．211,P=0．005）。结论青光眼的黄斑中心凹光感受器细胞核层显著增厚,并随病程的变化而改变。     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

目的 观察特发性黄斑前膜的光相干断层扫描（OCT）特征以及与患者视力的相互关系。方法 回顾分析2008年5月至12月间确诊的特发性黄斑前膜患者112例116只眼的临床资料。所有患者均进行最佳矫正视力、眼底和OCT检查。视力采用LogMAR视力表检查;眼底检查采用直接检眼镜和前置镜检查;OCT检查采用Zeiss HD-OCT,扫描速度27 000 A扫描/s, 扫描区域6.0 mm×6.0 mm,扫描模式为512×128。根据OCT检查所见的黄斑前膜对视网膜不同牵引情况对黄斑前膜进行分类,测量黄斑中心厚度（CFT）、体积、平均厚度以及黄斑中心凹厚度（FT）。采用SPSS16.0软件对患者的各项OCT检查指标和临床检查结果进行统计分析。结果 116只黄斑前膜眼可分为无视网膜牵引、切线方向或切线方向合并前后方向牵引3种情况,各自分别占本组患眼的9.48%、84.48%、6.04%。97只眼合并视网膜水肿,占总眼数的83.62%;水肿分别位于外核层(ONL),外网状层(OPL),内核层(INL)。14只眼合并视网膜神经纤维层(RNFL)劈裂,占总眼数的1207%;27只眼有视细胞内外节（IS/OS）损伤,占总眼数的23.28%。CFT与视力密切相关（P<0.05）,而体积、平均厚度和FT与视力无相关性（P＞0.05）。患者年龄、性别、不同种类的视网膜牵引、是否合并板层孔、IS/OS损伤和RNFL劈裂等与视力无相关性。结论 特发性黄斑前膜的OCT特征可表现为有无视网膜牵引以及视网膜水肿和视网膜神经纤维层劈裂。在CFT、体积、平均厚度以及FT等黄斑区OCT测量指标中,CFT与患者的视力关系最为密切。     

Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before, during, and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM: To measure the difference of intraoperative central macular thickness (CMT) before, during, and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity (BCVA) outcome and postoperative CMT development. METHODS: A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed. Videos with intraoperative optical coherence tomography (OCT) were recorded. Difference of intraoperative CMT before, during, and after peeling was measured. Pre- and postoperatively obtained BCVA and spectral-domain OCT images were analyzed. RESULTS: Mean age of the patients was 70±8.13y (range 46-86y). Mean baseline BCVA was 0.49±0.27 logMAR (range 0.1-1.3). Three and six months postoperatively the mean BCVA was 0.36±0.25 (P=0.01 vs baseline) and 0.38±0.35 (P=0.08 vs baseline) logMAR respectively. Mean stretch of the macula during surgery was 29% from baseline (range 2%-159%). Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery (r=-0.06, P=0.72). However, extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis (r=-0.43, P<0.01) and 1 mm nasal and temporal from the fovea (r=-0.37, P=0.02 and r=-0.50, P<0.01 respectively) 3mo postoperatively. CONCLUSION: The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness, though there is no correlation with visual acuity development within the first 6mo postoperatively.     

频域OCT观察两种类型视网膜脱离术后黄斑中心凹结构变化

目的　利用频域光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）观察单纯视网膜脱离（ｒｈｅｇｍａｔｏｇｅｎｏｕｓｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔ,ＲＲＤ）和视网膜脱离合并脉络膜脱离（ｒｈｅｇｍａｔｏｇｅｎｏｕｓｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔａｓｓｏｃｉａｔｅｄｗｉｔｈｃｈｏｒｏｉｄａｌｄｅｔａｃｈｍｅｎｔ,ＲＲＤＣＤ）术后黄斑中心凹结构的变化,并分析中心凹结构与术后最佳矫正视力的相关性。方法　７７例（７７眼）视网膜脱离患者纳入研究,其中ＲＲＤ组４４例（４４眼）,ＲＲＤＣＤ组３３例（３３眼）,所有患者均接受玻璃体切割联合硅油填充复位视网膜,利用频域ＯＣＴ观察术后黄斑区光感受器内／外节（ｐｈｏｔｏｒｅｃｅｐｔｏｒｉｎｎｅｒａｎｄｏｕｔｅｒｓｅｇｍｅｎｔ,ＩＳ／ＯＳ）连接带及外界膜（ｅｘｔｅｒｎａｌｌｉｍｉｔｉｎｇｍｅｍｂｒａｎｅ,ＥＬＭ）的形态、视网膜中心凹厚度,分析两组间中心凹形态变化差异,并分析ＩＳ／ＯＳ连接带与ＥＬＭ形态以及视网膜中心凹厚度与术后最佳矫正视力的相关性。结果　两组间的ＩＳ／ＯＳ连接带形态差异有统计学意义（χ２＝６．８８８,Ｐ＝０．０３２）,ＲＲＤＣＤ组ＩＳ／ＯＳ连接带的形态消失率明显高于ＲＲＤ组;两组间ＥＬＭ形态差异无统计学意义（χ２＝３．５９７,Ｐ＝０．１６６）,两组的ＩＳ／ＯＳ连接带及ＥＬＭ形态的完整性均与术后最佳矫正视力有相关性（ＲＲＤ组:ｒ＝０．６４９、Ｐ＜０．０５,ｒ＝０．４６６、Ｐ＜０．０５;ＲＲＤＣＤ组ｒ＝０．４８０、Ｐ＜０．０５,ｒ＝０．４４２、Ｐ＝０．０１０）。结论　频域ＯＣＴ是一种评价视网膜脱离复位术后黄斑微结构改变的有效手段。ＲＲＤＣＤ的ＩＳ／ＯＳ连接带消失率明显高于ＲＲＤ,这也是提示术后视力较差的原因之一,ＩＳ／ＯＳ连接带及ＥＬＭ形态的完整性可能是预测视网膜脱离复位术后视力恢复的重要因素。     

特发性黄斑前膜的3D光学相干断层扫描特征

目的应用3D光学相干断层扫描（OCT）观察特发性黄斑前膜（IERM）的形态特征及其与视力的关系。方法应用3D-OCT观察IERM118例（136眼）,分析中心凹形态、中心凹厚度、感光细胞（IS/OS）情况及与视力的关系。结果在136眼中,板层裂孔者18眼,假性黄斑裂孔者19眼,囊肿者7眼,弥漫水肿者57眼,中心凹正常者35眼。弥漫水肿组的视力为0.48±0.28,明显低于中心凹正常组的视力0.75±0.27,2组比较差异有统计学意义（P〈0.05）。感光细胞完整组的中心凹厚度为（276±96）μm,不完整组为（467±172）μm,2组比较差异有统计学意义（P〈0.05）。感光细胞完整组的视力为0.64±0.28,不完整组的为0.30±0.20,2组比较差异有统计学意义（P〈0.05）。结论3D-OCT能提供更多的特发性黄斑前膜中心凹形态的信息,感光细胞完整患者的视力明显好于不完整者。