光学相干断层扫描血管成像（OCTA）对早期原发性开角型青光眼的诊断能力

目的　探讨光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）诊断早期原发性开角型青光眼（primary open angle glaucoma，POAG）的能力。方法　选取200例200眼作为研究对象，其中包括正常组73例73眼、视野前POAG组46例46眼、早期POAG组81例81眼。观察OCTA所得视神经纤维层内放射状盘周毛细血管（radial peripapillary capillaries，RPC）的分布情况，采用分形维数的方法对不同受试者的RPC层各血管参数进行分析，并对结果进行比较。结果　正常组、视野前POAG组、早期POAG组间OCTA各血管参数:大血管占比［（39.29±6.40）%、（34.94±7.56）%、（29.00±6.56）%］、毛细血管占比［（39.24±7.47）%、（31.29±4.57）%、（25.53±4.18）%］、毛细血管间隙占比［（15.58±5.40）%、（26.25±8.04）%、（33.42±8.46）%］和无血管区占比［（5.89±3.47）%、（7.53±3.97）%、（12.16±5.35）%］差异均有统计学意义（均为P＜0.01）。视野前POAG组与正常组相比，毛细血管占比的曲线下面积（area under the curve，AUC）为0.885。早期POAG组与正常组相比，大血管占比的AUC为0.897，毛细血管占比的AUC为0.944。结论　OCTA作为一种方便无创的可测量视盘血流的血管造影技术或可为POAG的早期诊断提供新的思路。     

[In Press] Optical coherence tomography with or without enhanced depth imaging for peripapillary retinal nerve fiber layer and choroidal thickness

AIM: To assess peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness obtained with enhanced depth imaging (EDI) mode compared with those obtained without EDI mode using Heidelberg Spectralis optical coherence tomography (OCT). METHODS: Fifty eyes of 25 normal healthy subjects and 32 eyes of 20 patients with different eye diseases were included in the study. All subjects underwent 3.4 mm diameter peripapillary circular OCT scan centered on the optic disc using both the conventional and the EDI OCT protocols. The visualization of RNFL and choroidoscleral junction was assessed using an ordinal scoring scale. The paired t-test, intraclass correlation coefficient (ICC), 95% limits of agreement (LoA), and Bland and Altman plots were used to test the agreement of measurements. RESULTS: The visibility score of RNFL obtained with and without EDI was of no significant difference(P=0.532), the visualization of choroidoscleral junction was better using EDI protocol than conventional protocol (P＜0.001). Peripapillary RNFL thickness obtained with EDI was slightly thicker than that obtained without EDI (103.25±9.42 μm vs 101.87±8.78 μm, P=0.010). The ICC of the two protocols was excellent with the value of 0.867 to 0.924, the 95% LoA of global RNFL thickness was between -10.0 to 7.4 μm. Peripapillary choroidal thickness obtained with EDI was slightly thinner than that obtained without EDI (147.23±51.04 μm vs 150.90±51.84 μm, P＜0.001). The ICC was also excellent with the value of 0.960 to 0.987, the 95% LoA of global choroidal thickness was between -12.5 to 19.8 μm. CONCLUSION: Peripapillary circular OCT scan with or without EDI mode shows comparable results in the measurement of peripapillary RNFL and choroidal thickness.     

mGCC对原发性青光眼的诊断价值及其与pRNFL和视野的相关性

目的：分析黄斑区节细胞复合体(macular ganglion cell complex，mGCC)对原发性青光眼的诊断价值，探讨mGCC与视乳头周围视网膜神经纤维层(peripapillary retinal nerve fiber layer，pRNFL)及视野的相关性，以期为原发性青光眼的诊治提供科学参考依据。

方法：选取2015-01/2016-12在我院接受诊治的原发性青光眼患者67例80眼为观察组，另纳入同期我院健康体检者40例80眼为对照组。采用光学断层扫描仪(OCT)测量并比较两组受检者mGCC、pRNFL厚度，分析mGCC对原发性青光眼的诊断价值，探讨mGCC与pRNFL及视野平均缺损(MD)的相关性。

结果：观察组患者上方、下方及平均mGCC厚度显著低于对照组，差异均有统计学意义(P<0.05)。观察组患者上方、下方及平均pRNFL厚度均显著低于对照组，差异有统计学意义(P<0.05)。观察组患者MD 显著高于对照组，差异有统计学意义(P<0.05)。Pearson相关性分析显示，观察组患者mGCC与pRNFL呈显著正相关关系(r=0.58，P<0.01)，与MD呈显著负相关关系(r=-0.69，P<0.01)。ROC曲线分析显示，以86.39μm为截点值，mGCC诊断原发性青光眼的敏感性为82.5%，特异性为76.25%。

结论：mGCC对原发性青光眼具有一定的诊断价值，且与pRNFL呈正相关关系，与MD呈负相关关系。     

Optical Coherence Angiographic Demonstration of Retinal Changes From Chronic Optic Neuropathies

Glaucoma causes a decrease in peripapillary perfused capillary density on optical coherence tomography (OCT) angiography. However, other chronic optic neuropathies have not been explored with OCT angiography to see if these changes were specific to glaucoma. The authors evaluated OCT angiography in 10 patients who suffered various kinds of chronic optic neuropathies, including optic neuritis and ischaemic optic neuropathy, and found that all optic neuropathies showed a decrease in peripapillary vessel density on OCT angiography, regardless of the aetiology of the optic neuropathy. The peripapillary vessel loss on OCT angiography correlated well with the areas of retinal nerve fibre layer thinning seen on OCT.     

频域光学相干断层扫描检测原发性开角型青光眼视盘及黄斑参数的影响因素分析

目的 利用频域光学相干断层扫描（SD-OCT）检测健康对照和早中期原发性开角型青光眼（POAG）患者的视盘及黄斑参数,分析其相关影响因素。方法 选择2015年9月至2018年8月在我科就诊的早中期POAG患者40例（40眼）,其中20~39岁者20例、60~79岁者20例;纳入同期在我科就诊的40名（40眼）健康对照,其中20~39岁者20名、60~79岁者20名。受试者均接受全面的眼科检查,并利用SD-OCT测量所有受试者视盘周围视网膜神经纤维层（pRNFL）厚度、黄斑区平均神经节细胞层联合内丛状层（GCL-IPL）厚度、黄斑区最薄GCL-IPL厚度和黄斑区平均整体厚度。结果 健康对照组和早中期POAG组黄斑区平均GCL-IPL厚度及最薄GCL-IPL厚度均随年龄增长而变薄,差异均有统计学意义（P<0.05,P<0.01）;两组黄斑区平均整体厚度随着年龄的增长均无明显变化。在健康对照组,年龄因素对pRNFL厚度影响不大,20~39岁者与60~79岁者pRNFL厚度差异无统计学意义（P>0.05）。在早中期POAG组,20~39岁者和60~79岁者pRNFL平均厚度、上方厚度、下方厚度和颞侧厚度与健康对照组同年龄者相比均变薄,且60~79岁者上述pRNFL厚度与20~39岁者相比更薄,差异均有统计学意义（P<0.01）;早中期POAG组pRNFL鼻侧厚度在20~39岁者与60~79岁者之间差异无统计学意义（P>0.05）,与健康对照组同年龄者相比差异亦无统计学意义（P>0.05）。结论 SD-OCT测量的pRNFL厚度与POAG有关,可作为早期诊断POAG的检测指标。     

Clinical Profile,Treatment, and Visual Outcome of Serpiginous Choroiditis

The purpose of this study was to report the clinical profile and management of patients with serpiginous choroiditis in a tertiary care referral center in India. In a retrospective cohort study, 107 eyes of 70 patients with serpiginous choroiditis seen between January 1995 and December 2002 were analyzed. Systemic steroids and immunosuppressives were the mainstay of therapy. Antituberculous and antiviral drugs were used in selected cases. There was male preponderance (7:3). Age at presentation ranged from 11 years to 52 years (mean 30.3 ± 9 years); 52.9% had bilateral involvement. Vision improved or maintained in 86% eyes and deteriorated in 15 eyes (14%). The main cause of decrease of vision was macular involvement. Improvement in vision and resolution of lesions in patients with serpiginous choroiditis can occur with combination therapy of systemic steroids and immunosuppressive agents. Serial examination at regular intervals is needed to monitor the disease progression, recurrences, and involvement of the other eye.     

Abnormal Peripapillary Nerve Fibre Layer Thickness Demonstrated by Optical Coherence Tomography in Cases of Optic Atrophy: Is There a Correlation With Aetiology?

Optical coherence tomography of the peripapillary nerve fibre layer has been used in optic atrophy for identification of axonal loss and for differential diagnosis. In the present study, we aim to evaluate whether the pattern of peripapillary nerve fibre layer thinning, based on the optical coherence tomography normative database, correlates with aetiology in cases of optic atrophy. This retrospective study is approved by the Tan Tock Seng Hospital Ethics Review Board. Consecutive patients with optic atrophy seen in the Neuro-Ophthalmology Clinic between May 2005 and August 2006 were included. The normal eyes of the patients served as controls. All patients underwent imaging using Stratus optical coherence tomography of the peripapillary nerve fibre layer, optic disc photographs and Humphrey perimetry. The aetiology of each case of optic atrophy were made by means other than the optical coherence tomography. Significant nerve fibre layer thinning was defined as a reading in the red quadrant on the Stratus optical coherence tomography printout, which indicates the 1% percentile of the Stratus optical coherence tomography normative database. Twenty-nine patients (39 eyes) with optic atrophy were included in the study. The cases included non-arteritic anterior ischaemic optic neuropathy (14 eyes), compressive optic neuropathy (10 eyes), toxic optic neuropathy, traumatic optic neuropathy, previous optic neuritis, inflammatory optic neuropathy, and central retinal artery occlusion. Cases with isolated superior quadrant thinning were three times more likely to be non-arteritic anterior ischaemic optic neuropathy (odds ratio 4.07; 95% confidence interval: 0.8–20.75), although this was not statistically significant (p?=?0.079). Patients with isolated superior peripapillary nerve fibre layer thinning on the Stratus optical coherence tomography are more likely to be non-arteritic anterior ischaemic optic neuropathy patients. The other aetiologies did not show any specific pattern of thinning.