Optical coherence tomography study of adult vitelliform macular detachment in a patient with basal laminar drusen

To report the morphological data of adult vitelliform macular detachment in a patient with basal laminar drusen using optical coherence tomography (OCT-3) as an observational case report. A 70-year-old man presented with adult vitelliform macular detachment and basal laminar drusen underwent fundus biomicroscopy, fundus fluorescein angiography and OCT-3. Fundus examination showed bilateral yellow subretinal macula deposits with associated basal laminar drusen. Examination with OCT revealed areas of hyper-reflectivity compatible in size with the subretinal deposits below and elevating the photoreceptor layer. This was accompanied by underlying disruption of the OCT signal from retinal pigment epithelium (RPE) in the more affected left eye. In adult vitelliform macular detachment and basal laminar drusen, OCT may demonstrate that the yellow material is located predominantly below RPE in early disease and between the photoreceptor layer and the retinal pigment epithelium in later disease.     

Fundus autofluorescence in central serous chorioretinopathy:association with spectral-domain optical coherence tomography and fluorescein angiography

AIM: To evaluate the correlation among changes in fundus autofluorescence (AF) measured using infrared fundus AF (IR-AF) and short-wave length fundus AF (SW-AF) with changes in spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in central serous chorioretinopathy (CSC).METHODS:Two hundred and twenty consecutive patients with CSC were included. In addition to AF, patients were assessed by means of SD-OCT and FA. Abnormalities in images of IR-AF, SW-AF, FA were analyzed and correlated with the corresponding outer retinal alterations in SD-OCT findings.RESULTS:Eyes with abnormalities on either IR-AF or SW-AF were found in 256 eyes (58.18%), among them 256 eyes (100%) showed abnormal IR-AF, but SW-AF abnormalities were present only in 213 eyes (83.20%). The hypo-IR-AF corresponded to accumulation of sub-retinal liquid, collapse of retinal pigment epithelium (RPE) or detachment of RPE with or without RPE leakage point in the corresponding area. The hyper-IR-AF corresponded to the area with loss of the ellipsoid portion of the inner segments and sub-sensory retinal deposits or focal melanogenesis under sensory retina. The hypo-SW-AF corresponded to accumulation of sub-retinal liquid or atrophy of RPE. The hyper-SW-AF associated with sub-sensory retinal deposits, detachment of RPE and focal melanogenesis.CONCLUSION:IR-AF was more sensitive than SW-AF and FA for identifying pathological abnormalities in CSC. The characteristics of IR-AF in CSC were attributable to the modification of melanin in the RPE. IR-AF should be used as a common diagnostic tool for identifying pathological lesion in CSC.KEYWORDS:central serous chorioretinopathy; fluorescein angiography; fundus autofluorescence; optical coherence tomography     

中心性浆液性脉络膜视网膜病变神经上皮脱离区的频域光相干断层扫描观察

目的 观察中心性浆液性脉络膜视网膜病变(CSC)神经上皮脱离区在频域光相干断层扫描(FD-OCT)的图像特征。方法 对采用国际标准视力表、裂隙灯显微镜、直接或间接检眼镜、荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查确诊的黄斑部有神经上皮浆液性脱离的CSC患者88例92只眼进行FD-OCT检查。采用二极管反射的红外光对眼底黄斑中心部进行线性水平扫描,扫描深度2 mm, 扫描面积6 mm×6 mm,轴向分别率5 μm,横向分辨率18 μm,扫描模式512×128。对比分析患者的FFA、ICGA检查资料,重点观察神经上皮脱离区域的FD-OCT图像特征。结果 所有患眼均有神经上皮的隆起与视网膜色素上皮(RPE)光带分离及脱离区内RPE光带的异常改变。其中,色素上皮脱离(PED)83只眼,占90.22%;RPE有结节状突起改变68只眼,占73.91%;PED灶有RPE局部缺损5只眼,占5.43%。神经上皮脱离腔内有细小尘状反光点36只眼,占39.14%。其中簇状分布17只眼（17.61%）,柱状8只眼（8.69%）,环形6只眼（6.52%）,团块状5只眼（5.43%）。神经上皮脱离区内有较多颗粒状强反光物质59只眼,占64.14%。结论 CSC的FD-OCT特征为RPE的光带分离及脱离区的RPE光带异常。FD-OCT能准确地发现CSC神经上皮脱离区内视网膜组织的各种细微形态学改变。     

日食性视网膜病变中的微小黄斑损伤

【摘要】 目的 观察日食性视网膜病变微小黄斑损伤的表现及预后。设计 回顾性病例系列。研究对象 2009年日食发生后就诊于北京同仁医院的黄斑损伤患者6例（11眼）。方法 回顾患者的临床表现及相干光断层扫描（OCT）、眼底自发荧光、多焦视网膜电图（mfERG）、微视野等检查结果,对其视力损害恢复情况以及黄斑病变辅助检查结果进行分析。随访2~18个月。主要指标 视力、OCT、眼底自发荧光检查结果。结果 6例（11眼）OCT检查均发现黄斑中心凹视网膜感光细胞内节和外节层（IS/OS层）断裂。其中7眼眼底自发荧光可见黄斑细小暗点,彩色眼底像表现为相应的细小黄点。微视野、mfERG和荧光素眼底血管造影检查未见异常。就诊时视力0.6~0.8,1周~1个月时视力均1.0以上。结论 OCT和眼底自发荧光检查能及时发现日食性视网膜病变中的微小黄斑损伤,此病视力恢复较好。（眼科,2012,21：244-247）     

Macular associations of tilted disc syndrome

Purpose:The aim of this study was to describe macular changes associated with tilted disc syndrome (TDS) using multimodality imaging.Methods:This is a retrospective observational study of the consecutive TDS cases which were studied for macular changes using color fundus photographs and optical coherence tomography (OCT). Fundus autofluorescence, fundus fluorescein angiography, and OCT angiography were performed wherever required.Results:Twenty consecutive TDS cases (36 eyes) were included. OCT showed inferior depression of all layers in specific scans and macular pathologies seen included lamellar macular hole, full-thickness macular hole, retinal pigment epithelial detachment, acute and resolved subretinal fluid, central serous chorioretinopathy, and choroidal neovascular membrane. Macular involvement was seen in 13 eyes (36.11%) while in the remaining 23 eyes, outer retinal changes were seen on OCT in 9 eyes and normal retinal layers in 14 eyes (38.89%).Conclusion:Various macular pathologies associated with TDS are described using multimodality imaging. These provide understanding of changes which can occur with TDS. It also highlights the need for recognition, differentiation from similar confusing entities, and the necessity to follow-up of these cases carefully to detect the macular changes earlier.     

多模式影像技术在Stargardt病不同病变阶段的临床运用

目的： 观察多模式影像技术在Stargardt病不同病变阶段的影像特征。 方法： 回顾性系列病例研究。 对云南大学附属医院2016 年5 月至2019 年8 月确诊的28 例（ 56 眼） Stargardt患者进行眼底彩色照相、 自发荧光、 眼底荧光血管造影、 光学相干断层扫描（ OCT）、 炫彩眼底成像、 血流成像OCT（ OCTA） 等多模式检查, 总结各类影像检查在疾病不同阶段的特征。 结果： 眼底彩色照相可显示, 随病变进 展黄斑区的萎缩病变逐渐扩大, 伴后极部眼底色泽改变。炫彩成像通过多波长的组合, 可用更好的 对比度和层次感显示出萎缩的细胞和范围。眼底自发荧光通过自发荧光的高低变化提示视网膜色 素上皮（ RPE） 的受损情况, 同时能清楚直观地显示黄斑区萎缩病灶的大小。眼底荧光血管造影在 Stargardt病中的观察可直接反映视网膜色素上皮层、 脉络膜血管的损伤程度。 随着Stargardt病的发展, 黄斑区RPE层萎缩范围扩大, 视网膜及脉络膜毛细血管继发进行性萎缩。 OCT提供了断层眼底的影 像信息, 随病变进展, 中心凹周围神经上皮层变薄, 光感受器不同程度萎缩、 消失, RPE层不同程 度萎缩, 反光减弱, 脉络膜层毛细血管萎缩, 从层次深度和范围的广度都体现了病变的发展。 OCTA 中本研究观察到随着病变的进展, 各层次血管密度呈减少趋势。扫描视网膜深层血管时, 透见了 下方的脉络膜血管, 随着萎缩加重, 透见的脉络膜血管的范围扩大。 结论： 不同的眼科影像技术在 Stargardt病的不同阶段表现有各自特点和优势, 为临床医师提供了更多角度的追踪随访、 病情评估 的手段。     

病理性近视的相干光断层扫描

目的研究病理性近视的相干光断层扫描(OCT)的图像特征。方法对100例(195只眼)高度近视患者行OCT检查。患者年龄16～76岁。屈光度数-6．00～-36．00D。结果OCT检查正常者7只眼(3．6％),视网膜色素上皮及脉络膜毛细血管光带不均匀和薄变者161只眼(82．6％),黄斑全层裂孔21只眼(10．8％),其中合并视网膜脱离10只眼(5．1％),黄斑限局性视网膜浅脱离24只眼(12．3％),其中合并视网膜劈裂7只眼(3．6％),黄斑脉络膜新生血管膜19只眼(9．7％),Fuchs斑9只眼(4．6％),厚的黄斑出血3只眼,黄斑前膜18只眼(9．2％),常合并有视网膜水肿。黄斑视网膜神经上皮薄变5只眼(2．6％),漆裂纹3只眼(1．5％)。结论与裂隙灯全视网膜显微镜检查比较,OCT在观察视网膜色素上皮和脉络膜毛细血管改变,确诊黄斑裂孔,发现小的神经上皮脱离和劈裂,诊断黄斑前膜,神经上皮薄变等方面均有优越性。但对薄的黄斑出血及小色素点不能分辨,对厚出血与色素难以分辨,因而也有其局限性。     

Optical coherence tomography of choroidal nevus in 120 patients

OBJECTIVE: To describe the optical coherence tomography (OCT) findings of choroidal nevi. METHODS: Retrospective, single-center case series of 120 eyes of 120 consecutive patients with choroidal nevi who were evaluated by OCT. Diagnostic imaging was performed with a Zeiss StratusOCT Model 3000 (Carl Zeiss Ophthalmic Systems, Dublin, CA) using scan acquisition protocols of 6 radial lines and retinal thickness analysis overlying the nevus. RESULTS: The mean patient age was 59 years (median, 60 years; range, 14-87 years). The choroidal nevus was a mean of 5.2 mm in basal dimension and 1.7 mm in thickness and was located a mean of 2.7 mm from the optic disk and 2.5 mm from the foveola. Related retinal findings by ophthalmoscopic evaluation included overlying retina edema (3%), subretinal fluid (16%), retinal thinning (0%), drusen (58%), and retinal pigment epithelium (RPE) detachment (2%). In comparison, related retinal findings at the site of the nevus by OCT included overlying retina edema (15%), subretinal fluid (26%), retinal thinning (22%), drusen (41%), and RPE detachment (12%). Furthermore, OCT permitted classification of the overlying retinal edema as focal cystoid (3%), diffuse cystoid (8%), coalescent cystoid (3%), and noncystoid edema (1%). By OCT, the overlying retina was normal thickness (32%), thinned (22%), or thickened (45%), and photoreceptor loss or attenuation was noted in 51% of cases. Specific OCT findings of the choroidal nevus were limited to its anterior surface with minimal penetration into the mass. These findings included increased thickness of the RPE/choriocapillaris layer (68%) and optical qualities within the anterior portion of the nevus of hyporeflectivity (62%), isoreflectivity (29%), and hyperreflectivity (9%). Hyporeflectivity was observed in 68% of pigmented nevi and 18% of nonpigmented nevi. When comparing OCT with clinical examination, OCT was more sensitive in the detection of related retinal edema, subretinal fluid, retinal thinning, photoreceptor attenuation, and RPE detachment. CONCLUSIONS: OCT is a useful diagnostic modality for imaging the retina overlying a choroidal nevus. Numerous overlying changes such as subretinal fluid, retinal edema, retinal thinning, and photoreceptor attenuation are visible by OCT.     

OCT和FFA联合检测对中心性浆液性脉络膜视网膜病变发病机制的研究

背景以往中心性浆液性脉络膜视网膜病变（CSC）的确诊主要依靠荧光素眼底血管造影（FFA）,而光学断层相干扫描（OCT）与FFA的联合应用为CSC的动态观察及评价其发病机制提供了新的途径。目的通过将CSC患者的FFA图像导人OCT中,研究2种检查方法定位病变部位的一致性,探讨CSC的发病机制。方法44例单眼诊断为CSC的患者纳入本研究,包括男36例,女8例;年龄（39．34±5．3）岁,视力0．64±0．27。所有患者均进行了FFA和OCT检查。在Topcon3DOCT1000中导人FFA图像,直接对照OCT病灶与FFA渗漏点,观察二者病变部位的一致性,并用OCT方法测量中心凹神经上皮厚度及其脱离高度。结果OCT显示视网膜色素上皮（RPE）的改变包括RPE脱离34例（77．3％）,RPE小隆起和粗糙10例（22．7％）;在RPE脱离的34眼中OCT与FFA定位一致者占31例31眼（91．2％）,2种结果不一致者为3例3眼（8．8％）。OCT检测CSC患眼中心凹神经上皮层的厚度为（138．5±19．40）μm,与正常眼的（137．35±5．01）μm比较,差异无统计学意义（t=0．39,P〉0．05）;神经上皮层脱离的高度为（263．34±126．7）μm。结论CSC的病理机制为RPE脱离继发黄斑区神经上皮脱离,FFA渗漏点基本与OCT所测RPE脱离的部位相对应。无RPE脱离者可能与RPE通透性改变有关,OCT能精确测量中心凹神经上皮厚度及脱离的高度。     

Fundus autofluorescence in patients with blunt ocular trauma

Acta Ophthalmol. 2011: 89: e89–e94

Abstract.

Purpose: To report fundus autofluorescence and optical coherence tomography (OCT) findings in patients with blunt ocular trauma. Methods: Six eyes of six consecutive patients with blunt ocular trauma were evaluated in an observational case series using colour fundus photography, the Heidelberg Retina Angiograph 2 (HRA2) system for fundus autofluorescence (FAF) and OCT (Stratus OCT). Results: Three patients presented with secondary retinal pigment epitheliopathy that was identified as a reduced FAF plaque with interposed increased FAF granular smaller lesions. These findings were not as evident in fundus examination and colour photography in two patients. Visual field in one patient showed a decreased area of sensitivity that correlated to the reduced/increased autofluorescent lesion. The other three patients had subretinal haemorrhage and choroidal rupture, which appeared with a reduced FAF with an increased FAF rim after resolution. OCT demonstrated a choriocapillaris/ retinal pigment epithelium (RPE) complex disruption and its resolution over time in all patients with choroidal rupture. Conclusion: Damaged RPE area was more evident and better delineated by FAF imaging compared with fundus examination and fundus photography alone. Autofluorescence imaging might be a useful exam to show the length and severity of post‐traumatic retinal lesions and it may add relevant information in the global evaluation of blunt ocular trauma complications. Moreover, OCT added valuable information to the diagnosis and progression of choroidal rupture. Further studies to determine the predictive value of FAF in ocular blunt trauma are warranted.     

Electrooculogram (EOG) findings in a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) detected following trauma

Purpose

The purpose of this study was to monitor a case of acute exudative polymorphous vitelliform maculopathy detected following trauma.

Methods

Clinical examination included fundus photographs, optical coherence tomography (OCT) and fluorescein angiography. Pattern and full-field electroretinograms (PERG; ERG) and serial electrooculograms (EOG) were performed, incorporating the international standards.

Results

A 45-year-old Caucasian woman developed blurring of vision in both eyes 5 days after a serious road traffic accident. On examination, bilateral serous macular detachments and multiple small yellow subretinal lesions were observed in both eyes associated with areas of serous retinal detachment superior and inferior to the yellow lesions in the left eye. OCT showed retinal elevation with a band of high reflectance on the outer retina but no intra-retinal fluid or elevation of the retinal pigment epithelium (RPE). There was bilateral EOG reduction in keeping with generalised RPE dysfunction and pattern ERG evidence of left macular involvement. After 9 months, the patient reported spontaneous improvement in vision with gravitational settling and coalescence of the subretinal yellow deposits. At 37 months, there was improvement in the EOG and visual acuity.

Conclusions

A rare case of AEPVM is described that was detected following trauma and which gradually improved over 37 months. The EOG showed evidence of generalised RPE dysfunction that resolved and may be useful in the monitoring of AEPVM.     

Multimodal imaging of dry age‐related macular degeneration

Purpose: The purpose of this study was to understand clinical significance of near‐infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near‐infrared autofluorescence (NIA) in dry age‐related macular degeneration (AMD), by correlation with fluorescein angiography (FA) and cross‐sectional spectral domain optical coherence tomography (SD OCT). Methods: We evaluated 110 eyes (62 patients, mean age: 64 ± 8 years) diagnosed with dry AMD between January 2010 and December 2010, which underwent NIR (λ = 830 nm), FAF and FA (excitation λ = 488 nm; emission λ > 500 nm), NIA (excitation λ = 787 nm; emission λ > 800 nm), and simultaneous SD OCT scanning using a combined confocal scanning laser ophthalmoscope/SD OCT device (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany). Results: Drusen showed variable increased/decreased NIR, FAF, NIA and FA, which corresponded to variable increased/decreased thickness of the retinal pigment epithelium (RPE) and possible presence of subretinal deposits on SD OCT. Geographic atrophy (GA) was present in 43/110 eyes (39.0%) and showed increased NIR and fluorescence (FA), absent FAF and NIA, and loss of RPE on SD OCT. The hyperautofluorescence of the GA margin was never larger in FAF than that in NIA, while in 16.2% of cases, it was larger in NIA than that in FAF and corresponded to mild choroidal hyperreflectivity on SD OCT. Conclusions: Simultaneous recording of SD OCT scans provided ultrastructural data for the evaluation of NIR, FAF, NIA and FA in dry AMD. Near‐infrared autofluorescence might detect earlier than FAF areas of RPE cell loss at the GA margin.     

Alterations of retinal pigment epithelium in central serous chorioretinopathy

BACKGROUND: To examine with en face optical coherence tomography (OCT) the alterations of retinal pigment epithelium (RPE) in central serous chorioretinopathy (CSC) and their role in the pathophysiology of CSC. METHODS: We examined retrospectively 30 consecutive eyes of 30 patients with various phases of CSC. All patients underwent fluorescein angiography, indocyanine green angiography, and en face and longitudinal OCT examinations. RESULTS: Of 25 eyes with acute CSC, en face OCT showed RPE abnormalities in 22 eyes (88%) with pigment epithelial detachment (PED) in nine eyes (36%) and a small bulge of RPE in the posterior pole in 15 eyes (60%). Of four eyes with chronic CSC, OCT showed PED in one eye (25%) and a small bulge of RPE in other three eyes (75%). Of 29 eyes with acute or chronic CSC, fluorescein angiography showed characteristic pinpoint leakage in 20 eyes (69%). Of these 20 eyes, a leaking point was located within PEDs in five eyes (25%) and was consistent with the bulge of RPE in nine eyes (45%). With indocyanine green angiography, 28 (97%) eyes showed choroidal vascular hyperpermeability. Ten of the 11 eyes with PED (91%) showed PED within the areas of choroidal vascular hyperpermeability. Sixteen of the 18 eyes with a bulge of RPE (89%) showed the bulge within areas of choroidal vascular hyperpermeability. The one eye in the quiescent CSC exhibited multiple small PEDs within the areas of choroidal vascular hyperpermeability by en face OCT. CONCLUSIONS: En face OCT enables us to detect alterations of RPE in eyes with CSC. Most alterations of RPE were associated with choroidal abnormalities.     

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。     

全身应用皮质类固醇激素致中心性浆液性脉络膜视网膜病变的临床特征

目的 探讨全身应用皮质类固醇激素致中心性浆液性脉络膜视网膜病变（CSC）的临床特征,指导临床诊断及治疗。方法 回顾性病例研究。分析经眼底检查、荧光素眼底血管造影（FFA）及光学相干断层扫描（OCT）确诊并结合全身疾病诊断为全身应用皮质类固醇激素致CSC 12例患者的临床资料。结果 12例患者均为双眼发病。眼底检查见视网膜后极部均有神经上皮脱离,伴有色素上皮脱离者6眼,伴有视网膜色素上皮多发性萎缩2眼,伴有黄色纤维素样渗出14眼,伴有大泡性视网膜脱离4眼。FFA后极部见单个渗漏点4眼,多个渗漏点20眼;伴有色素上皮萎缩条带2眼,伴有视网膜下大量积液4眼。OCT检查提示24眼存在单发或多发的神经上皮脱离伴/不伴有色素上皮脱离,其中6例患者有神经上皮脱离伴下方高反射信号。12例患者中,肾脏移植术后2例,多发性硬化3例,系统性红斑狼疮2例,肾病综合征2例,脱髓鞘疾病1例,另外2例患者因发热或者其他原因在当地输注过大剂量激素。结论 全身应用皮质类固醇激素致CSC对患者视力的损害极大,其典型的眼底特征可帮助诊断,对此类患者应定期进行眼底检查,便于早期发现,避免出现不可逆的视力损害。     

脉络膜骨瘤的多模式影像分析

目的：探讨脉络膜骨瘤患眼的眼底多模式影像特征。

方法：回顾性病例观察研究。选取2015-10/2019-08在西安市第三医院眼科检查确诊且资料完整的脉络膜骨瘤患者9例15眼纳入研究。所有患者均接受眼底彩色照相、短波长眼底自发荧光(SW-AF)、红外眼底自发荧光(IR-AF)、眼底荧光素血管造影(FFA)、吲哚菁绿血管造影(ICGA)、光学相干断层扫描成像(OCT)以及眼眶X线电子计算机断层扫描(CT)检查。

结果：眼底彩色像显示15眼中,病变累及黄斑及视盘5眼(33%),仅累及黄斑8眼(53%),位于视盘旁2眼(13%); 所有患眼的脉络膜骨瘤均呈橙红色或黄白色,表面有色素沉着。SW-AF检查显示15眼(100%)的脉络膜骨瘤及其周围均有斑驳状低荧光及高荧光,而IR-AF检查则显示所有脉络膜骨瘤所在部位有点、片状高荧光及低荧光。FFA显示15眼(100%)的脉络膜骨瘤在造影过程中亮度逐渐增强,其中6眼(40%)有剧烈渗漏荧光的视网膜下新生血管(SRNV)呈现。ICGA显示9眼(60%)存在SRNV,造影早期所有脉络膜骨瘤对应部位呈低荧光,造影过程中瘤体亮度逐渐增强。OCT显示10眼(67%)的脉络膜骨瘤呈强、弱不均匀反射,5眼(33%)的脉络膜骨瘤呈弱反射,所有患眼均有视网膜神经上皮下暗反射腔。15眼(100%)的脉络膜骨瘤在CT图像上均呈高密度骨性肿块。

结论：脉络膜骨瘤呈橙红色或黄白色,其在CT图像上为骨性表现,这是诊断脉络膜骨瘤的重要依据。脉络膜骨瘤所在区域有视网膜色素上皮受损所致斑驳状强、弱不均的SW-AF及IR-AF。FFA及ICGA可明确病变区域异常循环状况。OCT可显示瘤体切面反射强弱不一,并有助于观察视网膜下积液及新生血管状况。     

特发性眼底血管样条纹的临床特征

目的分析特发性眼底血管样条纹的临床特征。方法分析13例（26眼）特发性眼底血管样条纹患者的临床表现、荧光素眼底血管造影（FFA）及黄斑区光学相干断层扫描（OCT）表现。结果11眼视力≤0.3,占42.31%。26眼眼底后极部均可见类似血管样的放射状条纹,5眼为斑驳状外观,占19.23%;17眼条纹通过黄斑,占65.38%;1眼（3.8%）合并眼外伤致多发性脉络膜破裂出血。FFA显示26眼血管样条纹均表现为透见荧光,11眼黄斑区可见脉络膜新生血管（CNV）影,其亮度逐渐增强,后期有明显的荧光素渗漏。黄斑区OCT检查发现11眼有CNV表现。Ⅰ型CNV（生长于RPE光带下）：表现为在隆起的视网膜色素上皮（RPE）和脉络膜毛细血管层光带下有不均匀的中或高反射带;混合型CNV：表现为CNV侵入RPE光带及视网膜神经上皮层下空间,RPE光带中断,呈现边界不清的高反射组织。结论眼底、FFA及OCT典型表现的综合分析有助于特发性眼底血管样条纹的诊断、分期及治疗指导。     

部分眼底病眼底自发荧光影像特点初步观察

目的观察部分眼底病眼底自发荧光（AF）的影像特征。方法采用HRA-2共焦激光扫描系统的FA模式检测45例（54只眼）眼底病患者。其中年龄相关性黄斑变性（AMD）17例（23只眼）,中心性浆液性脉络膜视网膜病变（CSC）16例（17只眼）,黄斑裂孔5例（5只眼）,前部缺血性视神经病变（AI0N）5例（5只眼）,视网膜色素上皮挫伤5例（5只眼）,视网膜色素变性2例（4只眼）。结果 AMD的AF影像呈低信号,边缘常见环形高信号。CSC的AF影像所见大多在渗漏的附近呈高荧光。全层黄斑裂孔的AF影像呈圆形高信号。所有病例在视网膜色素上皮挫伤区域的自发荧光普遍弥漫性增强,色素脱失处大多表现为低荧光,在总体增强区域表现为地图状的自发荧光。视网膜色素变性表现黄斑区环形高荧光。结论眼底出血时AF表现为遮蔽。视网膜下积液导致荧光信号降低,褐质积累,荧光信号增强。色素上皮萎缩荧光消失。AF影像是评价视网膜色素上皮的有效方法。     

Visual recovery after scleral buckling for macula-off retinal detachments: an optical coherence tomography study

PURPOSE: To assess the postoperative macular reattachment through OCT3 in eyes treated with episcleral surgery due to macula-off rhegmatogenous retinal detachment, as well as to verify if there is a statistically relevant relation between the persistence of a subfoveal detachment and poor postoperative functional recovery. METHODS: Twelve eyes of 12 patients who underwent episcleral surgery due to macula-off rhegmatogenous retinal detachment were enrolled and examined in a prospective study. Exclusion criteria were the following: traumatic retinal detachments, detachment relapses, macular holes, amblyopia, and grade B proliferative vitreoretinopathy or higher. The time period from the onset of subjective symptoms of retinal detachment to retinal surgery ranged from 3 to 7 days. All patients were evaluated in the preoperative and the postoperative period (after 1, 3, and 6 months) through measurement of visual acuity by ETDRS charts, fundus photographs, and macular tomography with OCT3. The postoperative tomography outcomes and the visual acuity were statistically examined using the Mann-Whitney U-test. RESULTS: One month after surgery, despite the macular reattachment assessable ophthalmoscopically and through fundus photographs, the OCT examination showed macular subretinal fluid persistence in 66.6% of cases. After 3 and 6 months, the persistence of such foveal detachment was respectively observed in 41.6% and in 33.3% of cases. Moreover, the macular subretinal fluid persistence in the postoperative period showed a statistically significant relation with poor functional recovery. CONCLUSIONS: Delayed or incomplete visual recovery after episcleral surgery for macula-off retinal detachment may be related to macular subretinal fluid persistence, assessable with tomography and not visible ophthalmoscopically.     

引起黄斑下脉络膜新生血管的几种常见疾病的 光相干断层扫描图像特征分析

目的观察引起黄斑下脉络膜新生血管(CNV)的几种常见疾病的光相干断层扫描（OCT）图像特征并对其分类，为CNV的鉴别诊断和治疗提供依据。方法回顾分析经常规眼底检查以及荧光素眼底血管造影（FFA）检查确诊的老年性黄斑变性(AMD)、病理性近视、中心性渗出性脉络膜视网膜炎(CEC)和特发性脉络膜新生血管(ICNV)患者165例187只眼的OCT检查资料，结合FFA检查结果对OCT图像进行分类并总结分析各类图像特征。结果可确定边界的CNV 60只眼，表现为边界清楚的视网膜色素上皮(RPE)层和脉络膜毛细血管层的梭形增厚；不易确定边界的CNV 101只眼，表现为弥散的脉络膜反向散射增强；浆液性RPE脱离19只眼，表现为RPE下的光学暗区；出血性RPE脱离11只眼，表现为RPE下的高反向散射区域，迅速衰减；纤维血管性RPE脱离10只眼，表现为RPE和脉络膜之间的轻至中度无反向散射区；神经上皮脱离45只眼，表现为神经上皮层与RPE分离，其间为光学暗区。结论引起黄斑下CNV的几种常见疾病的OCT图像可以分为6类，分析OCT的图像特征有助于CNV的鉴别诊断与治疗。(中华眼底病杂志,2005,21:69-73) 