OCTA与FFA在小鼠脉络膜新生血管模型中应用的比较研究

目的　以脉络膜铺片为金标准,探讨小鼠脉络膜新生血管（CNV）模型中荧光素眼底血管造影（FFA）与光学相干断层扫描血管成像（OCTA）描述小鼠CNV形态准确性的差异。方法　应用激光诱导制作小鼠CNV模型,在激光造模后第7、14天分别利用FFA、OCTA进行小鼠眼底扫描,并与小鼠脉络膜铺片结果进行对比,寻找与脉络膜铺片一致性最高的检查技术。结果　CNV模型小鼠眼底经测量的FFA、眼底激光成像、OCTA与脉络膜铺片中激光斑的面积,通过ICC一致性分析发现:以脉络膜铺片作为金标准,与它一致性最显著的为FFA,眼底激光成像次之,缺乏一致性的为OCTA。以此得出结论:对于小鼠CNV模型眼底CNV的形态,FFA检查与脉络膜铺片的一致性较好;OCTA与脉络膜铺片的一致性弱于FFA。结论　OCTA、FFA以及多重眼底照相都可以描述小鼠CNV的形态,但FFA仍是描述CNV形态较为准确的工具。     

Changes on optical coherence tomography angiography and fluorescein angiography in eyes with neovascular age-related macular degeneration

AIM: To evaluate the changes on optical coherence tomography angiography (OCTA) and fluorescein angiography (FA) and their correlation in neovascular age-related macular degeneration (nAMD) before and after intravitreal aflibercept injections (IAIs). METHODS: In 43 treatment-naïve patients with nAMD, choroidal neovascularization (CNV) in OCTA were morphologically and quantitatively analyzed before and after IAIs to determine whether they are correlated with leakage on FA or not. By combining CNV in OCTA and leakage in FA, lesions were characterized as three types: L+C+ (with both CNV and leakage), L-C+ (with CNV but without leakage), or L+C- lesion (with leakage outside CNV). RESULTS: Before IAI, while 27 eyes had L+C+ lesion only, 16 eyes had both L+C+ and L-C+ lesions simultaneously. Tiny capillaries and anastomosis in CNV were more developed in L+C+ lesion, at 86.0% and 58.1%, respectively, relative to 9.3% and 9.3% in L-C+ lesions (P<0.001). After IAIs in 33 eyes, tiny capillaries and anastomosis were decreased in the lesions with cessation of leakage on FA (P<0.001 and P=0.001, respectively). In quantitative analysis, neovascularization length and numbers of junctions and endpoints were also significantly decreased. CONCLUSION: Leakage on FA is associated with CNV morphology in OCTA and remained so after IAIs. Therefore, by carefully assessing the morphological and quantitative changes of CNV in OCTA before and after treatment, activity of nAMD is expected even though CNV on OCTA is not completely matched with fluorescein leakage.     

Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by optical coherence tomography angiography

AIM: To investigate foveal avascular zone (FAZ) and parafoveal vessel densities (PRVD) by means of optical coherence tomography angiography (OCTA) in diabetic patients with or without diabetic retinopathy (DR) and to assess the reproducibility of FAZ and PRVD measurements. METHODS: Sixty diabetic patients (60 eyes) with different stage of DR (graded according to the International Clinical Severity Scale for DR) and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners. FAZ area in all patients was also assessed using fluorescein angiography (FA). RESULTS: In subject with proliferative DR and with moderate-severe non proliferative DR, FAZ area was significantly increased compared to healthy controls (P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA). OCTA showed significantly less inter-observer variability compared to FA. Concordance correlation coefficient (CCC) for FAZ area measurements was 0.829 (95%CI: 0.736-0.891) P<0.001 with FA and 1.000 (95%CI: 0.999-1.000) P<0.001 with OCTA. CCC was 0.834 (95%CI: 0.746-0.893) P<0.001 and 0.890 (95%CI: 0.828-0.930) P<0.001 for parafoveal superficial and deep vessel density measurements, respectively. CONCLUSION: OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity. FAZ area and PRVD measurements using OCTA are highly reproducible.     

[In Press] Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by OCT angiography

AIM: To investigate foveal avascular zone (FAZ) and parafoveal vessel densities (PRVD) by means of optical coherence tomography angiography (OCTA) in diabetic patients with or without diabetic retinopathy (DR) and to assess the reproducibility of FAZ and PRVD measurements. METHODS: Eighty diabetic patients (80 eyes) with different stage of DR (graded according to the International Clinical Severity Scale for DR) and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners. FAZ area in all patients was also assessed using fluorescein angiography (FA). RESULTS: In subject with proliferative DR and with moderate-severe non proliferative DR, FAZ area was significantly increased compared to healthy controls (P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA). OCTA showed significantly less inter-observer variability compared to FA. Concordance correlation coefficient (CCC) for FAZ area measurements was 0.829 (95%CI:0.736-0.891) P<0.001 with FA and 1.000 (95%CI:0.999-1.000) P<0.001 with OCTA. CCC was 0.834 (95%CI: 0.746-0.893) P<0.001 and 0.890 (95%CI: 0.828-0.930) P<0.001 for parafoveal superficial and deep vessel density measurements, respectively. CONCLUSION: OCTA shows progressive increase of FAZ area and reduction of parafoveal vessel density in both superficial and deep plexus at increasing diabetic retinopathy severity. FAZ area and parafoveal vessel density measurements using OCTA are highly reproducible.     

Fluorescein angiography compared to three-dimensional measurements by the retinal thickness analyzer in classic choroidal neovascularization

PURPOSE: To compare and correlate imaging of classic subfoveal choroidal neovascularization (CNV) with noninvasive 3-dimensional imaging by the retinal thickness analyzer (RTA) to conventional fluorescein angiography (FA). METHODS: A total of 29 eyes of 29 consecutive patients with predominantly classic CNV eligible for photodynamic therapy underwent FA and RTA imaging. The FA dimensions of the CNV were measured independently by two graders. With the RTA, masked to FA the size of the CNV itself as imaged in 3-dimensional reconstruction, the size of significantly thickened retina overlying the CNV and the maximum retinal thickness were measured. RESULTS: The mean diameter of the CNV determined from 3-dimensional RTA reconstructions showed an excellent correlation with measurements from FA (r = 0.91, p < 0.001). The area of retinal thickening was by a mean of 0.7 mm in diameter larger and correlated moderately well with the size of the CNV on FA (r = 0.65, p < 0.001). In contrast, there was no correlation between the absolute retinal thickness and the CNV size on FA. Conclusions: Noninvasive quantitative mapping of predominantly classic CNV by RTA is feasible and also allows 3-dimensional measurement of the lesion itself. The results correlate well with FA assessment but visualize different properties of the disease.     

基于OCTA的中心性浆液性脉络膜视网膜病变患者脉络膜新生血管检测

目的观察光学相干断层扫描血管成像(OCTA)在中心性浆液性脉络膜视网膜病变(CSC)患者脉络膜新生血管(CNV)检测中的应用价值。方法回顾性病例观察研究。选取2018年3月至2019年3月在云南省第二人民医院诊断为慢性中心性浆液性脉络膜视网膜病变伴脉络膜新生血管患者30例(34眼)纳入研究,总结分析其OCTA与眼底彩色照相、眼底自发荧光、荧光素眼底血管造影(FFA)和OCT等传统影像学对比运用的临床体会。结果12眼FFA存在荧光素渗漏,但形态模糊,不能确定是否伴有CNV,行OCTA则可以清晰显示新生血管影像。8眼FFA未检出CNV,但OCTA清晰显示出新生血管形态。3眼眼底彩色照相及OCT检查高度怀疑CNV的存在,但因荧光素钠皮试阳性,均无法实施FFA,而OCTA则显示出病变区域血流信号,明确了CNV的存在。6眼FFA无明显荧光素渗漏,OCT示无神经上皮层脱离、无色素上皮层脱离,但OCTA提示CNV的存在。5眼通过随访过程中的病情跟踪观察,发现给予患者单一抗VEGF或PDT治疗之后视网膜下积液无明显吸收,而联合治疗后积液明显吸收。结论OCTA在CNV的检查敏感性方面优于传统的检测手段。OCTA可以作为一项安全有效的眼底影像学检查手段对慢性CSC患者的CNV进行观察,从而指导该类患者的诊断、治疗及预后分析。     

Triton光学相干断层扫描血管成像图像中正常人的中心凹无血管区的自动测量方法

背景:目前已有研究报道了一种MATLAB的定制算法,用于Triton光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)图像的中心凹无血管区(fovea avascular zone,FAZ)的自动测量.由于这种算法非开源,且难以获取,因而大大限制了其在...     

OCTA与ICGA检查在CNV和PCV中的影像对比分析

目的：对比观察脉络膜新生血管(CNV)与息肉状脉络膜血管病变(PCV)在吲哚菁绿血管造影(ICGA)与光学相干断层扫描血管成像(OCTA)中的特征性表现,探讨二者的区别和优缺点。

方法：回顾分析2018-09/2020-04在河北省眼科医院确诊的CNV患者26例34眼和PCV患者19例19眼的影像学资料,CNV患者中湿性年龄相关性黄斑变性(w-ARMD)20例28眼,慢性中心性浆液性脉络膜视网膜病变(CCSC)继发CNV 6例6眼。所有患者均行OCTA、荧光素眼底血管造影(FFA)+ICGA检查,分析其特征性改变。

结果：w-ARMD患者28眼OCTA检查示,除2眼因出血较多未见明显异常外,余26眼均可显示CNV形态,呈现效果形态更加锐利、立体,且能够分辨出CNV所在的解剖层面,其中11眼OCTA检查不仅能够很好地显示出CNV的形态、大小、范围,而且对于CNV中的滋养血管、新生血管及吻合支也都能较好地分辨。CCSC继发CNV患者6眼OCTA发现了FFA+ICGA未发现的CNV形态。PCV患者19眼OCTA检查异常脉络膜分支血管网(BVN)显示优于ICGA,但OCTA图像上末端囊袋样扩张(polyps)的显示及数量不如ICGA明显,部分不能显示。

结论：OCTA检测CNV阳性率较ICGA高,检测CNV和PCV病变范围较ICGA更清晰、立体,但在PCV中不能全部显示末端囊袋样扩张,且不能观察CNV或PCV渗漏情况及病变动态发展过程,较 FFA+ICGA尤为不足。OCTA作为无创检查可以随访观察CNV或PCV治疗前后病变发展情况。     

视网膜血管样条纹光相干断层扫描血管成像特征分析

目的观察分析视网膜血管样条纹(AS)的OCT血管成像(OCTA)影像特征。方法回顾性病例观察研究。2017年5月至2019年2月在云南省第二人民医院眼科经全身病史结合多模式影像检查手段确诊为AS的26例患者52只眼纳入研究。其中,男性18例,女性8例;平均年龄(50.8±6.9)岁。均为双眼发病。伴脉络膜新生血管(CNV)者20例34只眼;其中,病程1个月内13只眼,病程1个月以上16只眼,接受过抗VEGF药物治疗5只眼。所有患者行超广角眼底照相、红外眼底成像(IR)、OCT、FAF及FFA等检查。同时采用海德堡OCTA仪行OCTA检查,中心波长840 nm,采集速度85000次/s,宽度45 nm。获得3 mm×3 mm的扫描,每个立方体由2个重复体积的304 B扫描组成,使用两个正交捕获的成像体积的配准来执行运动校正。对比分析眼底彩色照相、IR、FAF、FFA、OCT及OCTA等多模式影像检查结果,总结AS及其继发CNV在OCTA中的影像特征。结果52只眼中,条纹区在OCTA上表现为脉络膜毛细血管阴影40只眼,可见Bruch膜与脉络膜毛细血管层面的脉络膜毛细血管较为稀疏,原本均匀的网状结构发生分离,显示线条样的无血流信号区;条纹区未见明显异常OCTA影像12只眼。OCTA可见视盘条纹附近区出现血管网10只眼,其血管密度丰富。继发CNV的34只眼,其CNV表现为不同形态。病程小于1个月且未经治疗的13只眼,CNV呈较小的"花环"状形态;病程长于1个月但未接受治疗的16只眼,CNV呈血管较为粗大的"扇形"形态。经过抗VEGF药物治疗的5只眼,CNV呈修剪后的"树枝"状形态。结论AS条纹本身在OCTA中表现为无血流信号区,部分AS患者可见视盘旁修复性血管网存在。不同病程及治疗经历的患者CNV表现有所差异。     

Multimodal Evaluation of Patients with Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Serpiginous Choroiditis

Purpose: To evaluate retinal and choroidal changes in patients with non-granulomatous choroiditis using the multimodality imaging (MMI).

Methods: Eight eyes of four patients were analyzed. Three patients (six eyes) were diagnosed with serpiginous choroiditis (SC) and one patient (two eyes) with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). The patients were imaged on the same day using the RTVue Avanti XR instrument OCT/OCTA (Optovue Inc, Fremont, CA), Heidelberg Retina Angiograph 2 FAF and FA (Heidelberg Engineering, Germany), and TRC50DXi Topcon FP (Topcon Medical Systems, Oakland, NJ).

Results: OCT angiography (OCTA) showed hypoperfusion in all the cases, reperfusion in choriocapillaris in two eyes after treatment and identified a choroidal neovascularization (CNV), which was not detected on the fluorescein angiography (FA).

Conclusions: OCTA may be an effective noninvasive image modality to follow up these patients and may provide further information to help us to understand the pathophysiology and complications of these diseases.     

病理性近视黄斑出血的OCTA影像特征

目的：观察病理性近视黄斑出血的光学相干断层扫描血管成像(OCTA)影像特征。

方法：收集南京医科大学眼科医院2016-06/2020-12确诊为病理性近视黄斑出血患者100例108眼的临床资料进行回顾性分析。所有患眼均行验光、眼轴、彩色眼底照相、频域光学相干断层扫描(SD-OCT)、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)及OCTA检查。根据检查结果分为漆样裂纹性黄斑出血和脉络膜新生血管(CNV)性黄斑出血,所有患者OCTA检查随访3mo以上。

结果：漆样裂纹性黄斑出血40例42眼,OCTA检查可见出血处脉络膜毛细血管反射被遮挡; 出血吸收后,脉络膜毛细血管层血流图暴露出完整的漆样裂纹形态,呈线状或星状,联合B-scan图像可见色素上皮层(RPE)反射不连续、脉络膜变薄及后方声影。在所有漆样裂纹性黄斑出血吸收后,OCTA随访模式发现原出血下方仅2眼(4.8%)未见漆样裂纹,漆样裂纹呈线状有28眼(66.7%),呈星状有12眼(28.6%)。随访过程中还发现有8例8眼(19.0%)再次复发漆样裂纹性黄斑出血,4例4眼(9.5%)患者继发CNV性黄斑出血。CNV性黄斑出血60例66眼,OCTA检查可见出血处脉络膜毛细血管反射被遮挡,外层视网膜及脉络膜毛细血管层血流图可见出血周围CNV形态,联合B-scan图像可见CNV突破RPE层,内部血流信号丰富; 行玻璃体内注射抗血管内皮生长因子(VEGF)治疗后,CNV病灶面积减小。在所有CNV性黄斑出血灶周围,OCTA发现48眼(72.7%)周围可见漆样裂纹,其中漆样裂纹呈线状有28眼(42.4%),漆样裂纹呈星状有20眼(30.3%)。

结论：OCTA在病理性近视黄斑出血的诊断中有重要意义,快捷无创是其最大优势,脉络膜毛细血管层血流图可清晰观察到出血灶、漆样裂纹及CNV的形态及位置,随访模式能够帮助直观了解病情变化,在一定程度上可以替代眼底血管造影直接判断分型,及时帮助临床选择正确治疗方式。     

Correlation of structural retinal nerve fibre layer parameters and functional measures using Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography at different levels of glaucoma severity

Background: To compare the structure/function relationship in glaucoma cases at different levels of severity, and with different disc sizes, between the Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography. Design: Retrospective study of glaucoma patients attending a Sydney‐based private practice. Participants: 169 eyes of 169 patients with a clinical diagnosis of glaucoma. Methods: Patients were divided on visual field criteria into early (mean deviation > –4 dB), moderate (–4 dB < mean deviation < –10 dB) and severe (mean deviation < –10 dB) disease. Bivariate correlation (Spearman's rho) between mean threshold scores for each area and the corresponding mean retinal nerve fibre layer thickness sectoral measurement were calculated. Main Outcome Measures: Correlation, as measured by Spearman's rho, between retinal nerve fibre layer measurements and mean threshold scores. Comparison of correlation strengths between the two scanning modalities with analysis of the effect of disease severity and disc size. Results: Both imaging techniques showed only moderate correlations at best. Spectral domain optical coherence tomography (global retinal nerve fibre layer Spearman's rho = 0.670, P < 0.01) had higher correlation coefficients compared with Heidelberg Retinal Tomography rim area (Spearman's rho = 0.449, P < 0.01) and retinal nerve fibre layer (Spearman's rho = 0.421, P < 0.01). Disc size did not have a significant influence on the structure/function relationship. Conclusions: Spectral domain optical coherence tomography retinal nerve fibre layer measurements demonstrated closer correlations to visual field threshold reductions using a structure/function model in varying stages of glaucoma.     

OCTA在脉络膜新生血管治疗效果评估中的作用

目的：采用光学相干断层扫描血管成像（OCTA）技术观察抗血管内皮生长因子（VEGF）治疗后脉络膜新生血管（CNV）的形态变化，并探讨OCTA在诊断该类疾病以及在判断预后方面的优势。方法：回顾性系列病例研究。收集2017年7月至2018年4月在青岛眼科医院就诊的CNV患者17例（17眼）。所有患者常规进行最佳矫正视力（BCVA）、频域相干光断层扫描（SD-OCT）以及OCTA等检查，对患眼行玻璃体腔注射抗VEGF药物（雷珠单抗或康博西普）0.05 ml，治疗后每个月随访1次，采用OCTA观察CNV在治疗前后的变化情况。采用配对t检验比较治疗前后BCVA和SD-OCT显示的黄斑中心凹视网膜厚度（CMT）的变化。结果：所有患者治疗前BCVA（LogMAR）为0.69±0.35，治疗后改善到0.49±0.38，差异有统计学意义（t=3.541，P=0.003）。CMT由治疗前的（363±66）μm下降到了治疗后的（302±66）μm，差异有统计学意义（t=4.227，P=0.001）。OCTA显示，抗VEGF治疗后所有患者CNV密度呈不同程度降低；部分患者CNV基本消失，神经上皮层脱离与水肿减轻甚至消失；部分患者虽仍存在粗大的异常血管，但神经上皮层脱离与水肿已完全消失。1例患者虽神经上皮层水肿消失，但仍存在边缘血管吻合，随访3个月复发。结论：OCTA能够清晰显示抗VEGF治疗后CNV的形态变化，可作为临床上CNV的诊断以及治疗效果评估的可靠工具。     

Photodynamic therapy of experimental choroidal neovascularization in the mouse

PURPOSE: To evaluate the qualitative and quantitative effects of verteporfin photodynamic therapy (PDT) on laser-induced choroidal neovascularization (CNV) in the mouse. METHODS: PDT was applied to the normal mouse fundus using light doses of 32, 64, and 83 s, and histological analysis of the treated areas was performed. CNV was induced using krypton laser photocoagulation of the fundus, and the CNV lesions were subsequently treated with PDT using light doses of 32, 64, and 83 s. Enucleated eyes were analyzed with light and transmission electron microscopies, and measurements of CNV size were done on histologic sections and on isolectin B4-stained choroidal flat mounts. RESULTS: PDT induced a light dose-dependent damage to the surrounding neural retina in normal eyes. At a light dose of 32 s, minimal damage was detected in the neural retina, whereas higher light doses caused distortion and disruption of the outer and inner nuclear layers and of the retinal pigment epithelium. When PDT was applied over laser-induced CNV lesions, the relative height of the lesions was significantly reduced (p < 0.05) using all light doses. Transmission electron microscopy 1 day after PDT treatment revealed occlusion of many of the CNV vessels. One week after PDT treatment, the CNV lesions contained patent vessels irrespective of light dose applied. Accordingly, PDT treatment inhibited (p < 0.05) but did not halt CNV lesion growth. CONCLUSIONS: PDT treatment of laser-induced CNV may create an acute occlusion of neovessels and an inhibition of CNV lesion growth without apparent injury to the surrounding neural retina. However, PDT-treated areas will remain vascularized with continued growth of the CNV lesion, which in turn may explain the often limited effect of PDT in patients with neovascular age-related macular degeneration. Elevating the PDT light dose will not increase the treatment effect substantially but may lead to increased collateral injury.     

In-vivo investigation of laser-induced choroidal neovascularization in rat using spectral-domain optical coherence tomography (SD-OCT)

Purpose

This study investigated the in-vivo formation process of laser-induced choroidal neovascularization (CNV) in rat using high-resolution spectral-domain optical coherence tomography (SD-OCT), and compared the results to histological methods.

Methods

Brown Norway rats (n = 60, 6–8 weeks of age) received 532-nm diode laser photocoagulation. SD-OCT and fluorescein angiography (FA) were performed in vivo 2, 5, 7, 14, and 21 days post-laser application. Haematoxylin and eosin (H&E) staining and immunohistochemistry for CD31, phosphorylated vascular endothelial factor receptor 2 (pVEGFR2) were conducted at each time point to observe the CNV in vitro. Choroidal flatmount preparations were observed using a confocal laser scanning microscope (CLSM) and a scanning electron microscope (SEM).

Results

SD-OCT monitored the longitudinal morphological changes of laser-induced CNV. CNV reached its maximal size on day 7, and began a gradual reduction on day 14. FA revealed similar dynamic changes in leakage. CNV thickness, as assessed by SD-OCT, was consistent with H&E-stained sections at each time point. CLSM and SEM revealed the details of the fibrovascular membrane. CD31 and pVEGFR2 expression supported the results of SD-OCT and histology.

Conclusions

SD-OCT was a convenient and reliable tool for the imaging of the CNV formation process and quantification of the lesion size in vivo.     

OCT血管成像术在病理性近视黄斑新生血管病变诊疗中的应用价值

背景 病理性近视合并黄斑区新生血管严重影响视功能,以往的检查方法为荧光素眼底血管造影(FFA)和频域OCT(SD-OCT),前者为有创检查,后者不能显示眼底各层面的血管形态.OCT血管成像术(OCTA)是一种新的无创检查方法,可显示眼底多个层面的新生血管形态,其临床价值有待评估. 目的 评估OCTA在病理性近视黄斑新生血管病变诊疗中的应用价值.方法 采用前瞻性系列病例观察方法,纳入2015年1-10月在武汉大学人民医院眼科中心经FFA确诊的病理性近视黄斑新生血管病变患者40例42眼,患眼屈光度为(-10.5±3.74)D.所有患者均行常规眼科检查及影像学检查,包括眼底照相、FFA、SD-OCT及OCTA,OCTA的扫描区域分别为黄斑区3 mm×3 mm、6 mm×6 mm范围.经患者的知情同意,35例患者接受雷珠单抗注射液玻璃体腔注射,分别于注射后1d、1周及每个月复查OCT及OCTA,注射后1个月复查FFA,共随访1～6个月,评估OCTA在监测病情变化中的临床应用价值.结果 40例42眼FFA均显示造影晚期黄斑区脉络膜新生血管(CNV)渗漏,OCT均可见突破视网膜色素上皮层的异常脉络膜血管网的高反射信号,OCTA显示所有患眼均呈现脉络膜毛细血管层清晰的团状异常血管信号,其中31例31眼可在视网膜外层观察到异常的团状血管形态,清晰度均优于FFA.接受雷珠单抗注射液玻璃体腔注射的35例35眼注射后1周OCTA显示视网膜外层及脉络膜毛细血管层CNV面积缩小,于注射后1个月时病情稳定.7例7眼复发再次接受雷珠单抗注射液玻璃体腔注射后CNV高信号影面积较前缩小. 结论 OCTA能够在视网膜外层和脉络膜血管层面清晰显示病理性近视黄斑新生血管病变的CNV形态.OCTA在雷珠单抗注射液玻璃体腔注射后1周即可观察到CNV的明显变化,在CNV的病情监测方面有重要的临床价值.     

不同类型脉络膜新生血管光学相干断层扫描血管成像（OCTA）的图像特征

目的　观察不同类型脉络膜新生血管（choroidal neovascularization，CNV）光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）的图像特征，探讨OCTA在CNV诊治中的作用。方法　回顾性分析经荧光素眼底血管造影联合吲哚菁绿血管造影确诊的未经治疗的黄斑部Ⅰ型及Ⅱ型CNV患者的OCTA图像，观察不同类型CNV的OCTA图像特点，采用Image J图像分析软件测量不同类型CNV在OCTA图像上的异常血管面积。结果　31例31眼患者符合纳入标准，其中男19例、女12例；Ⅰ型CNV 17眼，血管构型较疏松，形状不规则，异常血管长、直，面积较大，为（1.565±1.400）mm²；Ⅱ型CNV 14眼，血管分支浓密，多呈圆形或类圆形，异常血管相对粗短，呈绒球状构型，面积较小，为（0.418±0.374）mm²。Ⅰ型CNV和Ⅱ型CNV异常血管面积比较，差异有统计学意义（P=0.008）。结论　不同类型的CNV有不同的OCTA图像特征，这些特征与荧光素眼底血管造影和（或）吲哚菁绿血管造影所显示的特征一致。OCTA可作为CNV诊断、分型的重要工具。     

脉络膜新生血管动物模型的建立与评估

目的:评价氪激光诱导棕色挪威(brown norway,BN)大鼠脉络膜新生血管(choroidal neovascularization,CNV)模型的可行性。方法:BN大鼠32只一眼行氪激光(659nm)眼底光凝,另一眼作空白对照。激光功率、光凝斑直径和曝光时间分别为360mW、50μm及0.05s。分别在光凝后7,14,21,28d随机选取7只大鼠行眼底照像、荧光素眼底血管造影(FFA)检查。随机选取1只大鼠行脉络膜血管铺片检查。眼球标本行组织病理切片光镜、免疫组织化学染色观察。结果:光凝后7d,CNV开始形成,21d达到高峰,14~28dCNV无明显变化。7~21d,FFA显示造影晚期荧光素渗漏及光镜下CNV厚度逐渐增加,28d时可能因瘢痕开始形成,故FFA渗漏和CNV厚度开始减少。结论:氪激光诱导BN大鼠的CNV模型是一种较为理想的模型,FFA及CNV厚度分析是CNV定量研究的有效手段。     

DART-OCTA对视网膜分支静脉阻塞黄斑区毛细血管灌注的观察研究

目的：通过高清断层光学相干断层扫描血管造影术(DART-OCTA)观察累及黄斑区的视网膜分支静脉阻塞(BRVO)的影像学特点,分析其对黄斑区毛细血管灌注成像的诊断价值。

方法：纳入2020-06/12在温州医科大学附属眼视光医院确诊的BRVO患者51例51眼,分别行荧光素血管造影术(FA)、光学相干断层扫描血管造影术(OCTA)和DART-OCTA检查观察BRVO黄斑区影像学特点,根据视网膜毛细血管灌注情况将纳入患者分为毛细血管灌注成像组和非成像组,比较三种检查方法BRVO黄斑区毛细血管灌注成像检出结果,并对DART-OCTA图像中病变累及区与非累及区毛细血管血流密度进行定量分析。

结果：本研究纳入患者51眼中,FA、OCTA、DART-OCTA检查可对毛细血管灌注成像者分别为10、14、34眼,三种检测方法BRVO黄斑区毛细血管灌注成像检出结果比较,DART-OCTA较FA和OCTA对缺血区毛细血管灌注成像的敏感性更高。DART-OCTA检查中,毛细血管灌注成像组和非成像组患者病变累及区视网膜毛细血管血流密度均低于非累及区(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm,均P<0.0001)。

结论：DART-OCTA可以提供更清晰的断层视网膜毛细血管灌注成像,采用其观察累及黄斑区的BRVO时黄斑区毛细血管灌注成像受黄斑出血的影响最小,对伴有明显视网膜出血的BRVO是重要的补充检查手段。     

Reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy patients by two different OCTA sweep modes

AIM: To assess the reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy (NPDR) patients measured by different examiners and two different sweep modes of optical coherence tomography angiography (OCTA). METHODS: Ninety-eight (98 eyes) patients with NPDR were included in this study. All participates were performed three times using Cirrus OCTA with Angiography 3×3 mm2 and 6×6 mm2 sweep mode by two examiners. The macular foveal avascular zone (FAZ) and vessel density (VD) in the superficial retinal layer (SRL) were measured. The reproducibility of the measurements was evaluated with intraclass correlation coefficients (ICC) and coefficient of variation (CoV). RESULTS: The intra-mode ICCs of Angiography 3×3 mm2 and 6×6 mm2 sweep mode were 0.957 to 0.959 and 0.964 to 0.977, respectively; and the inter-mode ICCs were 0.962 to 0.970. The intra-examiner ICCs of macular perfusion parameters were >0.950; and the inter-examiner ICCs were 0.928 to 0.969. All CoVs were <1.0%. CONCLUSION: Cirrus OCTA can measure macular perfusion parameters in NPDR patients with excellent reproducibility. The measurements of FAZ and VD in the SRL determined by Angiography 3×3 mm2 and 6×6 mm2 sweep mode are highly consistent and both sweep modes are suitable for macular perfusion parameters measurement.