OCT在弱视患者眼底研究中的应用

弱视是一种常见的儿童眼部疾病,如未进行及时的矫正与治疗,将对儿童视力造成不可逆的损伤,导致单眼或双眼视力下降或丧失。弱视的发病原因复杂,目前具体发病机制尚不明确,主要集中于中枢学说与外周学说,既往传统观念认为弱视患者眼底无明显器质性改变。近年来光学相干断层扫描(OCT)技术迅速发展,作为一种便捷、直观的眼科检查手段,其安全无创、非接触性及快速清晰的优点,使OCT越来越多地应用于弱视患者的视网膜检查,弱视患者眼底结构存在的异常解剖学结构也逐渐被发现,为弱视的外周学说发病机制提供一定佐证和依据,对弱视的检查、治疗评估和预后也起到一定作用,本文对OCT技术对弱视患者视网膜厚度、脉络膜厚度及血管密度的研究情况进行综述。     

白内障术前行相关检查对视功能评估及视网膜疾病检出的有效性探索

目的:评价闪光视觉诱发电位(FVEP)、闪光视网膜电图(FERG)或图形视网膜电图(PERG)、眼底照相、眼部B超和光学相干断层扫描(OCT)应用于白内障术前对视功能的评估及对视网膜疾病检出的有效性观察。方法:对148例196眼白内障患者术前应用眼科电生理仪、眼底照相、眼部B超和OCT,根据FVEP和FERG(或PERG)、眼底照相、OCT、眼部B超检查结果的阳性率进行分析。结果:患者148例196眼中,B超检查显示玻璃体混浊165眼(84.2%),无法获取B超图像31眼(15.8%);成功获取眼底照相图像161眼(80.6%),无法获取图像35眼(19.4%);获得有价值VEP、ERG 58眼(29.6%),VEP、ERG未见明显异常138眼(70.4%);成功获取OCT图像167眼(85.2%),无法获取OCT图像29眼(14.8%)。结论:视觉电生理检查、眼底照相、眼部B超和光学相干断层图像结果可对白内障患者术前的视功能状况进行综合评估,多种检查方法相互配合,可进一步提高白内障手术前对视网膜疾病以及其他眼科疾病的检出率。     

急性视网膜坏死光相干断层扫描图像分析

目的 分析OCT对急性视网膜坏死的诊断价值.方法 回顾分析急性视网膜坏死的眼底照相和OCT图像特征,进行分析总结.结果 炎症急性期OCT显示黄白色视网膜病变的区域视网膜弥漫性水肿渗出呈高反射信号,其下结构反射信号屏蔽;神经上皮层下液体积存,视网膜各层组织结构紊乱.黄斑区OCT图像表现为弥漫性水肿,神经上皮层厚度增加,可见高反射渗出物.炎症消退期坏死区域视网膜与正常视网膜相比厚度明显减少,色素上皮破坏.结论 OCT能提供急性视网膜坏死患者视网膜精细的形态学特征,结合眼底彩照、眼部荧光造影检查对该病能进行较全面而精细的评估.     

弱视患者发病机制及眼部结构的研究进展

弱视是一种儿童视觉发育关键期常见的眼科疾病,其发病机制复杂。传统观念认为弱视不会出现明显眼球器质性改变,但近年随着研究的深入,研究者们发现弱视患者不仅脑部解剖存在差异,在眼部结构也与正常人不尽相同,这为探索弱视发病机制提供了新的思路。本文就弱视患者的发病机制及眼部结构改变进行了总结,从发病机制、脉络膜厚度(CT)、眼部血管面积及密度、视网膜神经纤维层(RNFL)厚度以及弱视患者遮盖治疗后的眼部结构改变等方面进行综述。     

单眼弱视患者黄斑光学相干断层成像检查

目的探索弱视黄斑部视网膜发育状况。方法使用光学相干断层成像技术(OCT)观察一组39例单眼弱视患者眼底黄斑区的组织形态,测定中心小凹及黄斑区周围3mm直径范围视网膜神经上皮层平均厚度,并进行相关分析。结果中心凹视网膜神经上皮厚度正常眼与弱视眼比较差异有非常显著性,弱视眼黄斑区上方、鼻侧、下方视网膜神经上皮层明显增厚,与颞侧比较差异有显著性。2例弱视患者弱视眼黄斑中心凹未形成,其中1例治疗效果不佳。结论OCT检查可以从组织形态上观察黄斑发育情况。     

OCT在弱视研究中的应用

弱视是较为常见的眼病,弱视的研究方法涉及临床和基础多个不同的学科。相干光学断层扫描(optical coherence tomography,OCT)是一种重要的眼科检查手段,能直观、便捷地检查视网膜结构,近年越来越多地应用于弱视眼视网膜的检查。本文就OCT在弱视眼的应用作一综述。     

相干光断层扫描成像在小儿眼底发育及相关疾病中的应用进展

相干光断层扫描成像(OCT)是一项无创的检查技术,可对视网膜结构进行实时分层扫描成像、测量脉络膜厚度等,已被广泛应用于成人视网膜视神经疾病的诊断及随访观察。普通OCT大多是台式机器,需要被检者体位、眼位的配合,且婴幼儿眼球生物学特点与成人相差较大,因而普通OCT在6岁以下的儿童应用中受到了限制。近年来随着手持式OCT的出现及应用,使得婴幼儿也可进行OCT检查,并可通过不同年龄婴幼儿的眼球生物学特点调节OCT参数从而获取清晰图像。OCT在婴幼儿眼部检查中的应用,使我们能动态的研究婴幼儿视网膜脉络膜视神经等的发育特点,并进一步认识小儿眼底相关疾病。     

眼咽远端型肌病相关眼部病变临床特征分析

目的研究国人眼咽远端型肌病(OPDM)相关眼部病变特征,分析不同基因突变类型OPDM眼部受累的差异。方法2021年2~10月经神经内科确诊OPDM患者,所有病例均行详细眼部及各项辅助检查,收集其特征性病变。多模式眼科检查包括最佳矫正视力、眼部照相及自发荧光(AF)、光学相干层析成像(OCT)、视网膜电图、多焦视网膜电图等。将病例按照基因检测结果分为OPDM2(GICP1)组、OPDM3(NOTCH2NLC)组及基因型未知组,采用SPSS统计学软件分析各种临床表现及影像学检查异常率在各组间的差异。结果确诊OPDM患者共15例,其中GICP1突变7例,NOTCH2NLC突变5例,已知OPDM相关基因均为阴性3例。平均BCVA在基因型未知组、OPDM2组和OPDM3组分别为0.4±0.3、1.0±0.0和0.6±0.3,组间差异有统计学意义。上睑下垂、眼球运动障碍、眼睑闭合不全发生率3组间差异无统计学意义。3组间眼底AF和黄斑区OCT结构异常比例差异具有统计学意义,OPDM2组无一例见眼底、AF及OCT结构异常,OPDM3组AF及OCT结构异常率为100%,眼底异常率为60%。结论OPDM不同基因型间临床表现存在不同,除广泛眼睑和眼球运动障碍外,OPDM3常伴有不同程度视网膜变性改变,而OPDM2通常并不累及视网膜。     

OCT联合眼部B超对白内障术前眼底检查价值评估

目的：探讨光学相干断层扫描(OCT)联合眼部B超对白内障患者术前眼底检查的临床价值。

方法：通过常规检眼镜、眼部B超及OCT对176例278眼白内障患者术前进行眼底病检查,计算三种检查方法对眼底病的阳性检出率,并利用McNemar检验对数据进行配对分析,比较不同检查方法对眼底病诊断的价值。

结果：常规检眼镜检出眼底病32眼(眼底病阳性率为11.5%),眼部B超检出眼底病18眼(6.5%),其中晶状体严重混浊患者有6眼(2.2%),OCT检出眼底病51眼(18.3%),OCT联合眼部B超眼底病阳性病例为57眼(20.5%)。OCT检出眼底病阳性率与B超、常规检眼镜及OCT联合眼部B超检出的眼底病阳性率在α=0.05水平均具有显著性差异。

结论：三种检查方法比较OCT的价值较大,对黄斑区病变检查灵敏度高,但在患者晶状体严重混浊时,OCT无法获取眼底黄斑区视网膜结构,而眼部B超很好弥补OCT眼底检查的“盲区”,两者联合使用,对眼底病的准确诊断以及术后视力恢复预测价值最大。     

单眼远视性弱视儿童黄斑区结构的光学相干扫描分析

目的：采用视网膜光学相干断层扫描( optical coherence tomography,OCT)对单眼弱视患儿的弱视眼和非弱视眼以及正常儿童测量黄斑部视网膜结构。
　　方法：选择单眼远视性弱视儿童56例及正常儿童右眼75例作为研究对象,用 OCT 检测黄斑区视网膜厚度及视网膜容积,并对结果进行统计学分析。
　　结果：弱视眼组黄斑中心区视网膜厚度最薄,内环视网膜厚度最厚,而外环视网膜厚度较内环略薄。内环的各个象限中,鼻侧视网膜最厚,为335.58依17.42μm;上方较鼻侧略薄,为326.42依15.36μm,再次为下方视网膜,颞侧视网膜最薄。外环各象限视网膜厚度变化与内环一致。非弱视眼组及正常对照眼组视网膜各区域变化与弱视眼组相同。弱视眼组黄斑中心区1mm 及内环的鼻侧和上方视网膜均比非弱视眼组、正常对照眼组对应象限的视网膜厚,差异具有统计学意义(P<0.05),弱视眼组外环的鼻侧和上方视网膜比非弱视眼组、正常对照眼组对应象限的视网膜厚,但差异无统计学意义(P>0.05),其它象限视网膜厚度均无统计学差异(P>0.05)。弱视眼组、非弱视眼组及正常对照眼组黄斑区视网膜容积最小,内环的鼻侧视网膜容积最大,其次为上方视网膜容积,再次为下方视网膜容积,颞侧视网膜容积最小。外环各象限视网膜容积变化与内环一致。弱视眼组黄斑中心区1mm 及内环的鼻侧和上方视网膜容积均比非弱视眼组及正常对照眼组对应各象限视网膜容积大,差异有统计学意义(P<0.05),其它各象限视网膜容积相比无统计学差异(P>0.05)。
　　结论：OCT 检测可以准确测量黄斑区视网膜结构,弱视眼的黄斑区结构与非弱视眼及正常眼存在差异,可能与弱视的外周发病机制有关。     

Imaging Amblyopia: Insights from Optical Coherence Tomography (OCT)

ABSTRACT

Amblyopia refers to visual impairment resulting from perturbations in visual experience during visual development, typically secondary to strabismus, uncorrected refractive error, and/or deprivation. Amblyopia has traditionally been considered a cortical disease, but the depth of our understanding of this complex neurodevelopmental condition is limited by our ability to appreciate structural pathophysiology in the visual pathway. Recent advances in Optical Coherence Tomography (OCT) have facilitated numerous studies of the structural changes in the retina and optic nerve, thereby expanding our appreciation for the pathogenesis of this condition. In this review, we summarize findings from studies evaluating retinal, retinal nerve fiber layer, and choroidal thickness changes in patients with amblyopia. Focusing on the largest and most recent studies, we discuss common limitations and confounding variables in these studies. We summarize recent advances in ocular imaging technology and reconcile the findings of early histological reports with those of structural OCT in amblyopia.     

Optical coherence tomography imaging in uveitis

Optical coherence tomography (OCT) is a non-contact noninvasive technique that allows in vivo imaging of the retina, choroid, optic nerve head, retinal nerve fiber layer, and the anterior structures of the eye. It was introduced into clinical practice two decades ago. Advances in OCT technology have been achieved by searching ultra-high-resolution OCT, adaptive optics OCT, eye-tracking OCT, and changes in signal detection technique from time-domain (TD) to spectral-domain (SD) detection. Today, SD OCT has become a part of routine uveitis practice. Apart from its diagnostic value in uveitis, OCT has enabled objective assessment of treatment response and provided predictive value for visual recovery and prognosis of uveitic entities. It is the standard diagnostic technique in the detection, monitoring of treatment, and determination of prognosis in uveitic macular edema as well as other inflammatory macular pathologies, including epiretinal membrane formation, vitreomacular traction, foveal atrophy, and lamellar/full-thickness macular holes. OCT has also shed light on the pathophysiology of several posterior uveitic entities. SD OCT has enabled visualization of four lines in the sensory retina which represent the external limiting membrane, the photoreceptor inner and outer segment junction, the photoreceptor outer segment and the retina pigment epithelium junction, and the retina pigment epithelium?choriocapillaris complex. Thus, we have gained substantial information about the pathologic and structural changes in uveitic conditions with primary or secondary outer retinal involvement. SD OCT has also provided invaluable information on the inner retinal and the vitreoretinal interface changes in uveitic conditions. With the introduction of enhanced depth imaging, visualization of the choroid and choriocapillaries has become possible. Therefore, OCT has become an indispensible ancillary test in the diagnosis and management of inflammatory diseases involving the retina and/or the choroid. As OCT technology continues to develop further it will provide new insights into the retinal and choroidal structure and the pathogenesis of posterior uveitic entities.     

近视性屈光参差性弱视患者视网膜黄斑中心凹及神经纤维层厚度的研究

背景弱视是一种从视网膜到视中枢的视觉传导系统及中枢全领域形态学及功能异常引起的临床表现,目前弱视眼的视网膜是否受累仍是争论的焦点。目的采用光学相干断层扫描（OCT）测量单眼近视性屈光参差性弱视患者的视网膜黄斑中心凹厚度及视网膜神经纤维层（RNFL）厚度,探讨单眼近视性屈光参差性弱视患者视网膜是否存在组织病理学改变。方法取近视性屈光参差性弱视患者22例44眼为弱视组;近视性屈光参差性弱视患者经治疗后视力达到正常者10例20眼为弱视治愈组;初诊为近视性屈光参差非弱视患者11例22眼为非弱视组。所有患者采用Model3000型OCT测量双眼视网膜黄斑中心凹厚度及视盘周围RNFL厚度,包括上方、下方、鼻侧、颞侧和平均厚度。采用配对t检验对各组受试者双眼间视网膜厚度的差异进行比较,用多元线性回归方法分析黄斑中心凹视网膜厚度及RNFL厚度与弱视眼眼轴长度、屈光度和年龄的关系。结果弱视组患者中弱视眼黄斑中心凹厚度明显比对侧眼增厚,差异有统计学意义（P=0．001）;弱视治愈组原弱视眼与对侧眼之间视网膜厚度的差异无统计学意义（P=0．778）,非弱视组高度数近视眼与低度数近视眼之间视网膜厚度的差异无统计学意义（P=0．943）;弱视组弱视眼颞侧RNFL厚度明显比对侧眼增厚,差异有统计学意义（P〈0．001）,弱视治愈组原弱视眼颞侧RNFL厚度比对侧眼厚,差异有统计学意义（P=0．003）,非弱视组高度数眼颞侧RNFL厚度比低度数眼厚,差异有统计学意义（P=0．046）,各组双眼视网膜上方、下方、颞侧及平均RNFL厚度的差异均无统计学意义（P〉0．05）。年龄与视盘下方RNFL厚度间呈负相关关系（r=-0．559,P=0．016）,其余各参数之间均无明显相关（P〉0．05）。结论近视性屈光参差性弱视患者的黄斑中心凹视网膜较正常眼增厚,而RNFL厚度与一般近视眼无明显差别;弱视的改善伴随着黄斑中心凹厚度的减小。     

远视性单眼弱视患者黄斑区视网膜厚度的研究

目的通过检测远视性单眼弱视者弱视眼黄斑区视网膜厚度（MRT）,研究弱视眼视网膜神经上皮层厚度的特征。方法远视性单眼弱视患者42例,正常组单眼远视但无弱视者20例。采用光学相干断层扫描仪（OCT）测量弱视眼和正常眼的MRT。结果弱视眼黄斑中心凹厚度比正常眼厚（P=0．005）,对于黄斑部位的分区测量,黄斑中心区厚度弱视眼比正常眼厚（P=0．010）,而黄斑周围外环及内环各象限弱视眼和正常眼相比差异均无统计学意义（P〉0．05）。不同程度弱视患者问黄斑中心凹及黄斑各分区的视网膜厚度差异均无统计学意义（P〉0．05）。结论远视性单眼弱视眼黄斑中心区视网膜厚度增厚,不同程度弱视眼间的视网膜厚度差异无统计学意义。     

Optical coherence tomography in a patient with tobacco-alcohol amblyopia

AIM: To report optical coherence tomography (OCT) finding in a patient with tobacco-alcohol amblyopia.METHODS: A 45-year-old man presented with a gradual decrease in vision over 4 years. He had smoked a half to one pack of cigarettes per day and had consumed 350 cc of gin per day for 30 years. A detailed ophthalmologic examination was performed.RESULTS: His corrected visual acuities were 20/800 OD and 20/200 OS. A Goldmann visual field examination showed ceco-central scotomas in both eyes. OCT using a peripapillary Fast RNFL (retinal nerve fiber layer) programme showed a small decrease in the RNFL thickness of the superotemporal quadrant in the normative diagram of the right eye in spite of a markedly increased RNFL thickness in both eyes.CONCLUSION: During the phase of visual loss in a patient with tobacco-alcohol amblyopia, visual loss may precede optic disc changes as detected by OCT.     

Correlation of the measurements of optical coherence tomography and diffuse tension imaging of optic pathways in amblyopia

The aim of this study was to investigate whether a correlation exists between optical coherence tomography (OCT) of retina and diffusion tensor imaging (DTI) of the optic pathway measurements. All subjects underwent OCT measurements of optic nerve head, retinal nerve fiber layer, and macula. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of optic pathways were analyzed using DTI. Prechiasmatic FA values were significantly decreased in unilateral amblyopic group in both affected and sound fellow eyes (p = 0.019 and 0.013), but not in bilateral amblyopic group (p = 0.221) when compared with the control group. ADC values were significantly greater in sound eye in unilateral amblyopic group in prechiasmatic and postchiasmatic regions (p = 0.001 and 0.049). ADC values were also significantly greater in bilateral amblyopic group in postchiasmatic region (p = 0.037). There were no significant differences between the affected eye and sound eye side DTI measurements. There was no significant correlation between prechiasmatic DTI and OCT measurements in affected and sound eyes of unilateral amblyopia group. DTI results demonstrated that there is a functional underdevelopment of the anterior and posterior visual pathways in both affected and sound eye of unilateral amblyopic patients. Significantly reduced FA values in prechiasmatic region where OCT values of retina were normal can be explained by possible micro-structural changes.     

多巴胺在眼科相关领域中的研究进展

多巴胺是中枢神经递质之一,在人体内与相应的膜受体结合后可激活或抑制环磷酸腺苷（cAMP）的活性,从而调控细胞的钙信号;同时多巴胺也是视网膜中一种主要的神经递质与调质,在整个视觉通路中参与视觉系统的信号传递与调控过程,如视网膜、外侧膝状体、视皮层等.近年来研究发现,多巴胺量的变化影响弱视、近视眼的形成,此外,它还通过与受体结合参与眼压的调控,这些研究对眼科临床上弱视的治疗、近视的预防和眼压的控制等方面提供了新的思路.就视网膜中多巴胺在调控形觉剥夺、光学离焦诱导的近视眼形成、眼压的调节、眼轴的发育及弱视的形成与治疗等方面的研究进展进行综述.