相干光断层扫描对视网膜脱离复位术后视力恢复的评估

【摘要】 目的 通过相干光断层扫描（OCT）观察孔源性视网膜脱离行巩膜扣带术后黄斑区的结构 ,分析其与视力变化的关系。设计 回顾性病例系列。研究对象 绵阳市中心医院孔源性视网膜脱离 已累及黄斑区,经行巩膜扣带术视网膜成功复位的41例（41眼）患者。方法 分别于术后1周,1、3 、6、12个月行最佳矫正视力、眼底检查,OCT检查。对术后6个月OCT检查视网膜下液完全吸收者, 第9个月增加一次最佳矫正视力、眼底检查,OCT检查。主要指标 最佳矫正视力,OCT表现。结果 （1）术后1周,1、3、6、12个月最佳矫正视力≥0.3者分别为3眼（7.32%）、8眼（19.51%）、22 眼（53.66%）、28眼（68.29%）、31眼（75.61%）;各时间点OCT检查黄斑区视网膜下液完全吸收 者分别为2眼（4.88%）、11眼（26.83%）、21眼（51.22%）、37眼（90.24%）、40眼（97.56%）。 （2）OCT显示首次黄斑区视网膜下液完全吸收者,较之前一次检查时间最佳矫正视力提高2行以上 者35眼（85.37%）,差异有统计学意义（P=0.008）;术后6个月内OCT示黄斑区视网膜下液完全吸 收的37眼,其后1~3个月最佳矫正视力再提高2行以上者22眼（59.46%）,而黄斑区视网膜下液完全 吸收3个月之后复查时,最佳矫正视力较黄斑区视网膜下液完全吸收3个月内提高均未超过1行,两 者比较差异有统计学意义（P=0.032）。结论 OCT检查可更好地判断黄斑区视网膜的解剖复位;视 网膜脱离术后解剖复位（黄斑区视网膜下液完全吸收）后功能恢复多在3个月内。（眼科, 2012, 21： 401-404）     

Self-reported acute decrease in visual acuity after photodynamic therapy for age-related macular degeneration

PURPOSE: To evaluate the incidence of self-reported decrease in visual acuity within 7 days of photodynamic therapy (PDT) for choroidal neovascularization secondary to age-related macular degeneration (AMD) and to describe the anatomical and clinical course of patients with documented significant visual loss. METHODS: Consecutive records of all patients with exudative AMD treated with PDT over a 16-month period at a community-based retina referral practice were reviewed for instances of self-reported visual change within 7 days of treatment. The primary outcome measure was Snellen visual acuity. Secondary outcome measures were fluorescein angiography (FA) and anatomical findings. RESULTS: Among 1,894 PDT treatments performed for 821 patients, there were 32 instances (for 30 patients) of self-reported visual change within 7 days of PDT. A decrease in > or =2 lines of Snellen visual acuity was documented for 10 patients (1.2% of patients or 0.5% of treatments), and all occurred within 3 days of PDT (median, 1 day) in all patients. Median pre-PDT vision was 20/60 (range, 20/50 to 20/200). Vision within 3 days after PDT was 20/100 or worse in all 10 cases and counting fingers or worse in 3. Subretinal hemorrhage occurred in four cases. FA of eyes without hemorrhage showed a circular area of choroidal hypoperfusion (corresponding to the PDT spot) in all five eyes with persistence of the hypofluorescence up to 4 months later. Visual improvement after the initial acute decrease was seen in 3 patients (30%; 95% confidence interval, 7-65%) by 3 months after PDT. CONCLUSIONS: Acute visual decrease after PDT for AMD is uncommon. Visual recovery may occur in some patients, but a precise estimate is difficult to determine given the small sample size.     

累及黄斑的视网膜脱离术后5a的视功能和光学相干断层扫描的分析

目的:观察累及黄斑区视网膜脱离巩膜扣带术后的黄斑光学相干断层扫描(OCT)图像及术前和术后最佳矫正视力(BCVA)之间的关系的研究。方法:回顾分析5a随访的47例47眼累及黄斑区视网膜脱离患者,并将其分成两组:黄斑脱离≤7d组和>7d组。间接眼底镜行眼底检查,并行TOPCON光学相干断层扫描。结果:患者47例术后5a较术后3mo平均术后BCVA增加1.60±0.02行。≤7d组术后5a的BCVA为0.53,>7d组为0.25,两组之间有显著差异(P=0.008)。≤7d组术后BCVA≥0.4者28例,而>7d组术后BCVA≥0.4者7例(P<0.01)。5a术后随访间接检眼镜检查表明,视网膜脱离均复位。而OCT显示视网膜下液1眼(2%),黄斑区神经上皮层组织堆积1眼(2%),这2例患者术后5a的平均视力只有0.13,明显低于其他45例,术后5a平均BCVA视力为0.54(P=0.025)。术后视网膜较厚组BCVA明显高于视网膜较薄的组,并有统计学差异(P=0.008)。结论:累及黄斑的视网膜脱离时间对术后视力的恢复有很大影响,呈负相关,同时术后视力在较长时间里仍会不同程度的提高,术后视网膜的厚度与术后视力呈正相关性。我们建议对于某些术后复位良好而视力不佳者进行OCT扫描,以便发现视力不佳的原因。本研究对临床预测评估累及黄斑的视网膜脱离复位术后,潜在视功能恢复的情况提供依据。     

Macular structure on optical coherence tomography after lamellar macular hole surgery and its correlation with visual outcome

Objective

To report macular structure on optical coherence tomography (OCT) after lamellar macular hole surgery and its relationship with visual outcome.

Design

Retrospective interventional case series; private practice setting.

Participants

Twelve patients diagnosed with a lamellar hole who had undergone vitrectomy and who had OCT scanning before and after surgery and at least 6 months follow-up were included.

Methods

Surgery consisted of 25 g vitrectomy, peeling of epiretinal and internal limiting membrane, fluid/air/gas exchange, and 2 weeks of face-down positioning.

Results

OCT showed an epiretinal membrane in all cases. After a mean follow-up of 16.7 months, VA improved by ≥2 lines in nine patients and remained stable in three. There was a complete closure of the lamellar hole in ten patients; in four a retinal pseudocyst was found during the healing process, resolving spontaneously in two and persisting in the other two after 8 and 9 months, respectively. Two patients developed a full-thickness macular hole that closed successfully after surgical repair. All patients had a VA ≥ 20/32 at the end of follow-up.

Conclusion

Epiretinal membranes appear to have a role in the pathogenesis of lamellar macular holes. Vitrectomy is a useful technique to obtain closure of the lamellar hole and visual improvement. The presence of a retinal pseudocyst is a common feature during the healing process and is compatible with a favorable visual outcome. A full-thickness macular hole is a severe and not uncommon complication of this procedure.     

Correlations between optical coherence tomography measurement of macular thickness and visual acuity after cataract extraction

PURPOSE: To investigate correlations between optical coherence tomography macular thickness measurements and visual acuity after cataract surgery. METHODS: Sixty-two patients underwent routine cataract surgery as part of a randomized clinical trial of oral Cox-2 inhibitor prophylaxis of cystoid macular oedema. Optical coherence tomography was used to quantify several parameters of macular thickness. Optical coherence tomography measurements were obtained before surgery, day one, week two and week six after surgery. These measurements were then correlated with logMAR best-corrected visual acuity. RESULTS: Optical coherence tomography macular thickness parameters increased after surgery by up to 20%. A significant correlation was identified between foveal minimum macular thickness and best-corrected visual acuity at day one and week six after surgery. Other macular parameters failed to show any significant correlation. At day one and week six, the 10 patients with greatest macular thickness had significantly lower visual acuity than the other patients. CONCLUSION: In this study routine cataract surgery caused an increase in macular thickness. Some significant positive correlations between macular thickness and best-corrected visual acuity were found, although not for all parameters or time points. There may be a threshold relationship between degree of foveal anatomic change and significant loss of visual acuity.     

Early optical coherence tomography changes after photodynamic therapy in patients with age-related macular degeneration

PURPOSE: To evaluate early changes after photodynamic therapy (PDT) in patients with age-related macular degeneration (AMD) by optical coherence tomography (OCT). DESIGN: Prospective interventional case series. METHODS: PDT was performed on 20 eyes of 20 patients who presented with subfoveal choroidal neovascularization (CNV) attributable to AMD. OCT was used to evaluate changes at 2, 12, and 24 hours and at 3, 7, 15, and 30 days after therapy. RESULTS: In the first 24 hours, OCT showed an increase in the subretinal fluid (SF) in all eyes and an increase in intraretinal fluid (IF) in 13 eyes. On the 15th day and the 30th day after therapy, reduction of SF and IF was observed in almost all eyes. CONCLUSIONS: Serial OCT evaluation of patients with subfoveal CNV attributable to AMD suggests that the initial response after PDT is an increase in SF and IF.     

Macular edema in central retinal vein occlusion: correlation between optical coherence tomography, angiography and visual acuity

To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 μm) than in non-ischemic CRVO (mean, 440 μm, p < 0.01). In eyes with foveal thickness (central retinal thickness without subretinal fluid) of 700 μm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis (p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO.     

Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy

PURPOSE: To investigate retinal morphology by means of fluorescein angiography (FA) and optical coherence tomography (OCT) in patients who had undergone photodynamic therapy (PDT) with verteporfin at their 3-month-interval examination. METHODS: Sixty patients with predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration were evaluated with FA and OCT 3 months after their last PDT. FA images were evaluated in a masked fashion for staining of and leakage from the lesion and also for cystoid loculation of fluorescein in the macula. OCT was used to evaluate foveal thickness and the presence of subretinal fluid or cystoid spaces within the retina, also in a masked fashion. RESULTS: The median age of the 60 patients was 78 years, and the median visual acuity of the eyes examined was 20/100. The median number of previous PDT sessions was 2. Fluorescein staining was seen in 57 eyes (95%), and fluorescein leakage was seen in 50 eyes (83%). Cystoid loculation of fluorescein was seen in 21 eyes (35%). By OCT, cystoid spaces in the macula were seen in 42 patients (70%), and subretinal fluid was seen in 15 patients (25%). Leakage seen shown by FA was correlated with the OCT finding of cystoid spaces but not with the OCT finding of subretinal fluid. Some patients had leakage during FA that did not have any observable induced OCT abnormality attributable to fluid accumulation. CONCLUSIONS: After PDT leakage from CNV seen during FA is associated with intraretinal fluid, often seen in loculated cystoid spaces, but not with subretinal fluid.     

OCT和OCTA在特发性黄斑前膜术后视力预测中的研究进展

特发性黄斑前膜(IERM)是指一类没有任何已知其他眼病的黄斑前膜,多发于50岁以上的中老年人。随着IERM的进展,会引起黄斑区视网膜结构和功能的改变,引起视力下降、视物变形等症状。目前关于IERM的发病机制尚不明确,手术是主要的治疗方式,但对于手术时机尚未标准化,术后的视力恢复结局也存在差异。光学相干断层扫描(OCT)和OCT血管成像(OCTA)作为一种无创、快速的检测手段,可观察黄斑区视网膜微结构和血流变化,已经在临床中广泛应用。利用OCT和OCTA各参数去预测术后视力已经成为IERM的研究热点。本文就OCT与OCTA各参数和IERM术后视力预测的相关研究现状进行综述,以期为临床工作者确定手术时机,权衡手术收益和风险时提供依据。     

Foveal microvascular anomalies on optical coherence tomography angiography and the correlation with foveal thickness and visual acuity in retinopathy of prematurity

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess foveal microvascular structure and the correlation between foveal retinal thickness and best corrected visual acuity...     

Follow-up of age-related macular degeneration patients treated by photodynamic therapy with optical coherence tomography 3

Background Photodynamic therapy (PDT) has been described to effectively reduce or delay severe vision loss in eyes with predominantly classic form of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Optical coherence tomography 3 (OCT3) is a non-invasive diagnostic procedure which provides information about retinal thickness and volume at the posterior pole, as well as about the presence of certain structures under the retina.Methods Prospective interventional study. Eleven eyes (9 patients) with AMD and CNV were treated with Verteporfin PDT. A complete ophthalmologic examination was performed. Fluorescein angiography (FA) and OCT3 scans were performed before treatment and 1, 2, 4, and 12 weeks after it.Results Two different patterns of changes were observed. One group (7 eyes) showed changes in the amount of subretinal fluid (decrease, increase, and finally stable decrease), with a reduction in the CNV and the appearance of a subretinal band of hyperreflective tissue. The second group (4 eyes) showed little or no changes in retinal thickness, fluid, or reflectivity.Conclusion Changes observed in OCT3 scans represent variations in retinal thickness, fluid, and CNV after PDT. OCT3 provides a useful tool in the follow-up and measurement of changes appeared in eyes with CNV associated to AMD after treatment with PDT.     

病理性近视黄斑部脉络膜新生血管光动力疗法治疗后光相干断层扫描观察结果分析

目的评价光相干断层扫描(OCT)检查在病理性近视(PM)所致的黄斑部脉络膜新生血管(CNV)光动力治疗(PDT)中的临床应用价值。方法对比分析25例PM患者28只患眼PDT治疗前后OCT图像中黄斑区视网膜高度及CNV复合体厚度,观察CNV与黄斑中心凹的关系。结果治疗前22只眼表现为CNV伴视网膜神经上皮水肿;2只眼为CNV合并神经上皮浆液性浅脱离;6只眼为CNV合并有视网膜层间出血。17只眼CNV位于中心凹处,11只眼位于中心凹旁。治疗后CNV强反光团逐渐缩小,神经上皮水肿或出血吸收,黄斑视网膜高度和CNV复合体厚度均显著降低(P值分别为0.02、0.03)。CNV复发表现为OCT图像中强反光团扩大,神经上皮水肿增厚,伴或不伴视网膜层间出血。结论OCT检查对于判定PM所致CNV的活动性以及决定是否进行PDT治疗和重复治疗有重要的辅助作用。     

Optical coherence tomography after photodynamic therapy for patients with pathologic myopia

PURPOSE: To evaluate early changes after photodynamic therapy (PDT) for patients with subfoveal choroidal neovascularization (CNV) due to pathologic myopia by optical coherence tomography (OCT). METHODS: PDT was performed on 10 eyes of 10 patients who presented with subfoveal CNV due to pathologic myopia. OCT was used to evaluate changes 1 day, 3 days, and 7 days after therapy. Changes in intraretinal and subretinal fluid and CNV were examined on the images obtained. The retinal elevation and the height of the neurosensory retinal detachment were calculated. From these two values, the thickness of the neurosensory retina was obtained. The thickness of the neurosensory retina was measured to ascertain the intraretinal fluid change, and the height of the neurosensory retinal detachment was measured to ascertain the subretinal fluid change. RESULTS: The mean pretherapy retinal elevation+/-SD increased from 211+/-28 microm to 230+/-39 microm 1 day after PDT and decreased to 221+/-36 microm 3 days after therapy. At 7 days after therapy, the mean retinal elevation+/-SD was 211+/-22 microm. The retinal elevation was due to a subretinal fluid accumulation, whereas the thickness of the neurosensory retina increased only to a minor extent (range, 0-22 microm) and the foveal architecture remained unchanged. The mean pretherapy height+/-SD of the neurosensory retinal detachment was 6+/-11 microm. It was 18+/-20 microm, 12+/-12 microm, and 3+/-6 microm 1 day, 3 days, and 7 days after therapy, respectively. No change in CNV was observed during follow-up. CONCLUSION: The results of our study indicate that the acute infiltration observed in patients with pathologic myopia after PDT occurs in the first day and regresses during the first week. Yet, it should be noted that, unlike in patients with age-related macular degeneration, the acute infiltration phase can be observed by OCT only to a limited extent.     

PDT治疗前后脉络膜新生血管的光学相干断层扫描观察

目的利用光学相干断层扫描(OCT)观察光动力学治疗(PDT)黄斑脉络膜新生血管(CNV)前后CNV的组织形态变化,以评价PDT的疗效。方法回顾性分析从2004年5月至2005年6月在我院接受PDT治疗的各类CNV患者34例38眼,对治疗前后CNV的OCT形态特征进行评估和分类。结果PDT治疗后的OCT形态特征可分为5型。I型:急性炎症反应,有4眼,平均出现于PDT后26h;II型:黄斑中心凹结构基本恢复正常,视网膜下积液吸收,有38眼,平均出现于PDT后2.8w;III型:视网膜下积液重新出现伴纤维化,根据积液与纤维化程度又可分为IIIa/IIIb。IIIa:视网膜下积液为主,有8眼,平均出现时间为PDT后1.7m;IIIb:视网膜下纤维化30眼,平均出现时间PDT后1.9m;IV型:黄斑囊样水肿伴视网膜下纤维化有3眼,于PDT后平均4.9m出现。V型视网膜下纤维化伴萎缩有8眼,于PDT后平均8.1m出现。结论OCT可用于动态观察PDT后CNV的形态变化,根据分型可协助制订治疗方案,IIIa型代表CNV复发,可能需再次PDT治疗,而IIIb和IV型则可随访观察。