光学相干断层扫描在原发性开角型青光眼诊断中的应用

目的：探讨光学相干断层扫描（ optical coherence tomography ,OCT）在原发性开角型青光眼（ primary open-angle glaucoma,POAG）诊断中的应用。方法应用OCT对20例POAG患者（ POAG组,40只眼）及20例正常人（对照组,40只眼）行视神经纤维层（ RNFL）及视盘扫描,观察各组RNFL厚度及视盘参数。结果 POAG组患者各象限RNFL厚度均较对照组明显变薄,视盘面积比、水平杯盘比及垂直杯盘比均较对照组明显增大,差异有统计学意义（ P＜0.01）。结论 OCT能够反映POAG患者RNFL厚度及视盘的改变,且能检测出POAG患者RNFL局限性损害,可以作为POAG的诊断方法。     

光学相干断层成像术在原发性慢性闭角型青光眼诊断中的应用

目的 探讨光学相干断层成像术（opticalcoherence tomography，0CT）检测视网膜神经纤维层（retinal nenre fiber laver，RNFL）厚度与原发性慢性闭角型青光眼（primary chronic angole-dosure glaucoma，Chronic PACG）病程进展的关系，评价OCT在早期诊断青光眼中的意义。方法正常人20例（40眼）及分成早期、进展期、晚期的Chronic PACG 20例（38眼），采用OCT进行视盘周围RNFL厚度检测，比较正常组及Chronic PACG组的各象限及平均RNFL厚度。结果 Chronic PACG组较正常组RNFL平均厚度明显变薄（P〈0．001）；早期Chronic PACG表现为局限性RNFL缺损，以下方最为显著（P〈0．001），晚期Chronic PACG表现为弥漫性RNFL缺损；早期、进展期、晚期Chronic PACG患者RNFL厚度差异有显著性（P〈0．001）。结论 随着Chronic PACG病情的发展，RNFL厚度逐渐减少，OCT能够反映青光眼RNFL厚度的改变，并能为临床早期诊断青光眼提供更多的信息。     

图形视网膜电图联合视网膜神经纤维厚度测定在青光眼诊断中的临床应用价值

目的探讨图形视网膜电图联合视网膜神经纤维厚度测定对于青光眼的诊断的临床意义。方法选自2007年5月至2009年09月在我院经治的青光眼患者40例进行PERG,PVEP和OCT及视野检查,并对检查结果进行分析处理,分析各种方法对于青光眼的早期诊断所具有的特异性和敏感性。结果 PERG、PVEP在青光眼组与对照组的比较中差异具有统计学意义（P〈0.05）。青光眼组PERG与PVEP振幅异常率比较差异具有统计学意义（P〈0.05）。青光眼组PERG与OCT异常率指数比较差异具有统计学意义（P〈0.05）;在早期青光眼的异常率的比较显示PERG较PVEP,OCT和视野明显（P〈0.05）。结论图形视网膜电图联合视网膜神经纤维厚度测定对于青光眼的诊断具有很大的临床意义,在很大程度上提高了青光眼早期诊断的准确率,值得在临床广泛使用和推广。     

经频域相干光断层扫描检测视乳头形态、RNFL厚度诊断青光眼的价值分析

目的研究经频域相干光断层扫描检测视乳头形态、视网膜神经纤维层(RNFL)厚度诊断青光眼的价值。方法选择2017年1月至2019年3月来郑州市第二人民医院诊治的182例青光眼患者作为研究对象,根据视野平均缺损程度分为早期(73例)与中晚期组(109例),另选取同期进行体检的正常人100人作为对照组,均采用经频域相干光断层扫描检测视乳头形态、RNFL厚度,并对检测结果进行比较分析。结果对照组研究对象视盘面积(DA)为(2. 49±0. 32) mm2,早期组为(2. 43±0. 34) mm2,中晚期组为(2. 39±0. 38) mm2,三组比较差异未见统计学意义(P 0. 05),但早期组、中晚期组患者与对照组其余视乳头形态参数比较差异有统计学意义(P 0. 05);早期、中晚期青光眼患者RNFL厚度均值的ROC曲线下面积(AUROC)和敏感度最高;早期患者杯盘比(C/D)的AUROC和敏感度最大,中晚期患者垂直C/D的AUROC和敏感度最大。结论经频域相干光断层扫描可客观准确的检测视乳头形态以及RNFL厚度的改变,同时视乳头形态以及RNFL厚度参数可作为早期青光眼的诊断指标。     

光学相干断层扫描技术在Leber家族遗传视神经病变不同病程中的应用

目的探讨Leber家族遗传视神经病变(LHON)中视盘周围视网膜神经纤维层(RNFL)厚度与病程发展之间的关系。方法选择确诊LHON并行频域光学相干断层扫描(FD-OCT)检查视盘周围RNFL厚度的患者58例(共116只眼),分析不同病程阶段的RNFL平均厚度变化、各象限厚度变化及RNFL厚度与患者视力的相关性。结果 LHON患者各象限RNFL厚度:上方>下方>鼻侧>颞侧。随着病情进展,RNFL厚度呈先增厚,之后逐渐变薄趋势。病程前3个月RNFL增厚,其中上方和下方象限较显著。病程4～6个月RNFL薄变明显,上方和下方象限RNFL厚度均下降约70μm,而鼻侧和颞侧象限下降约20μm。6个月之后,各象限RNFL厚度薄变幅度减缓并逐渐趋于稳定。不同病程组之间LHON患者检查时平均视力差异有显著性(P=0.000);但病程与患者视力无明显相关性(P=0.052),患者的视力在病程4～6个月期间降至最低,随后又逐渐提高。不同病程患者视力与其RNFL厚度无明显相关性(P=0.384)。结论 LHON患者各象限中,颞侧RNFL厚度最薄。病程的前3个月RNFL增厚,4～6个月各象限RNFL薄变明显,提示病程6个月之内是修复受损视网膜神经节细胞的最佳时间窗。     

光学相干断层扫描检测黄斑区厚度及其在青光眼诊断中的应用研究

目的 探讨光学相干断层扫描（optical coherence tomography,OCT）测量黄斑厚度对青光眼的诊断价值。方法采用OCT2000型对正常人42例（60）和原发性开角型青光眼患者43例（66眼）的黄斑区厚度进行测量,观察两组人群黄斑厚度地形图的图像特征;并将正常人和青光眼患者黄斑厚度值进行比较;用受试者特征曲线下面积（areaunder the receive operator characteristic curve,AROC）的分析方法找出青光眼早期诊断的最佳指标。结果正常人黄斑厚度地形图呈“马蹄形”,青光眼患者“马蹄形”特征不典型或“马蹄形”特征消失;青光眼患者黄斑各分区视网膜厚度均比正常人减少,差异有统计学意义（P〈0．05）;早期青光眼患者的黄斑外环各分区厚度也较正常人减少,差异也有统计学意义（P〈0．05）;正常人和青光眼患者之间比较,黄斑下方外环区的AROC值最大（早期青光眼患者为0．719;青光眼患者为0．881）,表明该指标对青光眼的诊断价值最大。结论OCT测量黄斑厚度是青光眼诊断和早期诊断的新型敏感的有效手段。     

原发性青光眼诊断中频域OCT测量视盘周围神经纤维层和黄斑区GCC厚度的应用价值

选取40例(55眼)为正常组,35例(40眼)进展期青光眼组患者,35例(43眼)早期青光眼组患者,通过频域OCT对所有研究对象视盘周围神经纤维层和黄斑区GCC厚度进行测量,对各参数诊断能力进行分析。结果青光眼组患者视盘周围神经纤维层(RNFL)和黄斑区GCC厚度值根据疾病严重程度而下降,且参数间存在明显差异性,P<0.05,早期青光眼组、正常组与进展期青光眼组下方、平均RNFL和黄斑区GCC厚度值存在相关性。进展期青光眼组和正常组对比、和早期青光眼组对比,各象限RNFL、黄斑区GCC厚度均具有明显差异性(P<0.05),具有统计学意义。黄斑区GCC厚度与视盘周围神经纤维厚度是早期对原发性青光眼诊断的敏感指标,而频域OCT对黄斑区GCC厚度与视盘周围神经纤维厚度的测量对早期诊断原发性青光眼极为有利。     

激光眼底扫描仪在开角型青光眼诊断中的应用

目的评价激光眼底扫描仪对原发性开角型青光眼 (POAG )的诊断价值。方法利用海德堡共焦激光眼底扫描仪(HRT Ⅱ )检测高度近视合并可疑青光眼者、POAG患者和正常人的盘沿面积、盘沿体积和神经纤维层 (RNFL)厚度 ,对比 3者之间的关系。结果POAG患者、高度近视并可疑青光眼和正常人各象限盘沿面积、盘沿体积和RNFL厚度存在显著差异 (P <0 0 5 )。结论激光眼底扫描仪 (HRT Ⅱ )可应用于原发性开角型青光眼的诊断。     

光学相干断层扫描在妊娠高血压综合征诊断评估中的应用

妊娠晚期因血压增高而产生的一系列眼底症状与血压有关,称为妊娠高血压综合征（简称妊高征）[1]。临床特点是高血压、水肿与蛋白尿。眼底改变与高血压紧密相关。表现为视网膜动脉痉挛性收缩。多见于视盘附近的小动脉支,并可进展为普遍性狭窄,当达到严重程度时,可引起高血压性视网膜病变或视盘视网膜病变。     

泪河的光学相干断层扫描分析在干眼症诊断中的应用

目的观察光学相干断层扫描(OCT)对泪河面积测量的应用,探讨其在干眼症诊断中的作用。方法对水液缺乏性干眼症和正常人各40人(40只眼)作为实验组和对照组,分别进行泪液分泌实验I、泪膜破裂时间、主观症状评分和OCT测量泪河面积。结果泪液分泌实验I:干眼症组7.26±2.85 mm,对照组20.03±5.39 mm;泪膜破裂时间:干眼症组3.57±2.46 s,对照组:10.64±5.37 s;症状评分:干眼症组1.92±1.12分,对照组0.71±0.93分;泪河面积平均值:干眼症组0.0110±0.0051 mm2,对照组0.0294±0.0186 mm2。两组4项指标差异均有统计学意义(P<0.01),泪河面积值与Schirmer试验结果呈正相关(r=0.94,P<0.001)。结论 OCT作为一种安全、快捷、非侵入性的检查方式,通过测量泪河面积的大小,对干眼症的诊断准确性高,可行性好。     

AGE challenge: Angle Closure Glaucoma Evaluation in Anterior Segment Optical Coherence Tomography

Angle closure glaucoma (ACG) is a more aggressive disease than open-angle glaucoma, where the abnormal anatomical structures of the anterior chamber angle (ACA) may cause an elevated intraocular pressure and gradually lead to glaucomatous optic neuropathy and eventually to visual impairment and blindness. Anterior Segment Optical Coherence Tomography (AS-OCT) imaging provides a fast and contactless way to discriminate angle closure from open angle. Although many medical image analysis algorithms have been developed for glaucoma diagnosis, only a few studies have focused on AS-OCT imaging. In particular, there is no public AS-OCT dataset available for evaluating the existing methods in a uniform way, which limits progress in the development of automated techniques for angle closure detection and assessment. To address this, we organized the Angle closure Glaucoma Evaluation challenge (AGE), held in conjunction with MICCAI 2019. The AGE challenge consisted of two tasks: scleral spur localization and angle closure classification. For this challenge, we released a large dataset of 4800 annotated AS-OCT images from 199 patients, and also proposed an evaluation framework to benchmark and compare different models. During the AGE challenge, over 200 teams registered online, and more than 1100 results were submitted for online evaluation. Finally, eight teams participated in the onsite challenge. In this paper, we summarize these eight onsite challenge methods and analyze their corresponding results for the two tasks. We further discuss limitations and future directions. In the AGE challenge, the top-performing approach had an average Euclidean Distance of 10 pixels (10 µm) in scleral spur localization, while in the task of angle closure classification, all the algorithms achieved satisfactory performances, with two best obtaining an accuracy rate of 100%. These artificial intelligence techniques have the potential to promote new developments in AS-OCT image analysis and image-based angle closure glaucoma assessment in particular.     

Optical Coherence Tomography in Assessing Plaque Characteristics

Optical coherence tomography (OCT), a new imaging modality, has shown a superior ability in detecting and distinguishing different types of plaques (fibrous, fibrocalcific, and lipid-rich plaques), in visualizing of vascular microstructures such as intraluminal thrombi, vascular dissection, and structure of restenotic tissues, and finally in identifying vulnerable plaques, otherwise missed by intravascular ultrasound. However, limitations in the use of OCT such as poor penetration and its attenuation by blood or the clinical relevance of OCT should be clarified through further investigation, and careful attention should be paid to the future studies on OCT.     

光学相干断层扫描诊断黄斑部视网膜前膜的评价

目的　探讨黄斑部视网膜前膜的光学相干断层扫描 (OCT)图像特征及临床应用价值。方法　对特发性黄斑前膜 9例和继发性黄斑前膜 13例患者进行经黄斑中心凹的OCT线性扫描并测量膜厚度。结果　OCT图像能清晰显示与视网膜分离或部分分离的前膜 13例 ,并可显示与视网膜紧密粘连的前膜及其对视网膜的牵拉形态改变。结论　OCT能直接客观地显示黄斑前膜横断面特征及其与玻璃体视网膜的关系并能提供定量的分析。     

Optical Coherence Tomography: Potential Clinical Applications

Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.     

Optical Coherence Tomography and Fibrous Cap Characterization

The pathophysiology of acute coronary syndromes has long been associated with atherosclerotic plaque rupture. Inflammation, thinning, and disruption of the fibrous cap have been implicated with the final processes leading to plaque rupture, but confirmation of these mechanisms of coronary thrombosis in humans has been hampered by the lack of imaging methods with sufficient resolution to resolve fibrous cap characterization and thickness in vivo. Intravascular optical coherence tomography (OCT) provides images with micron-level axial and lateral resolution, enabling detailed visualization of micro-structural changes of the arterial wall. The present article provides an overview of the potential role of OCT in identifying and characterizing fibrous cap morphology, thickness, and inflammation in human coronary plaques.     

Recent Advances in the Field of Optical Coherence Tomography

Purpose of Review

The scope of this text is to critically review the most important recent advances in the field of optical coherence tomography, both from a clinical, scientific, and technical point of view.

Recent Findings

In recent years, important steps forward have been put in the field of optimization of PCI (with a focus on optimal sizing of stents and optimization of stent expansion after implantation) and the differentiation and its possible applications of various underlying morphologic characteristics of acute coronary syndrome lesions. Several efforts have been made to elucidate underlying mechanical causes of stent thrombosis, based on optical coherence tomography (OCT) imaging. This had led to the recognition of neoatherosclerosis as an important cause for very late stent thrombosis, fueling new research into this area and to the development of intracoronary devices which could be even more safe for patients on the very long term.

Summary

With an ever increasing use for clinical and scientific applications in coronary artery disease, OCT has come to a mature and solid tool in the armamentarium of the coronary artery disease specialist. With new areas deserving more intensified focus and several innovations ahead, it seems that OCT is there to defend its position as the standard intracoronary imaging modality for the next decennium.

     

外伤性黄斑病变光学相干断层成像的应用研究

目的探讨光学相干断层成像（OCT）在外伤性黄斑病变中应用的临床意义。方法对56例外伤性黄斑病变（56眼）行OCT检查,并进行图像分析。结果OCT检查显示全层黄斑孔23眼、板层黄斑孔3眼、黄斑前膜3眼、黄斑区出血8眼、神经上皮浆液性脱离5眼、出血性色素上皮脱离各4眼、黄斑水肿4眼、黄斑区神经上皮层变薄6眼。结论OCT在外伤性黄斑病变的鉴别诊断、病情监测及对其发病机制的分析研究等方面均有重要的应用价值。     

视网膜前膜光学相干断层扫描图像分析

目的探讨光学相干断层扫描（OCT）检查对黄斑区视网膜前膜临床诊断和术后的评估价值。方法对在我院眼底检查拟诊或诊断为黄斑区视网膜前膜的49例患者（61眼）术前及术后进行OCT检查。结果黄斑区视网膜前膜的OCT图像表现为视网膜表面厚薄不一的高反光带，部分视网膜内表面完全紧密粘连，大部分与视网膜内层分离，多数为黄斑中心凹变浅，厚度增加，部分可伴黄斑假性裂孔、板层裂孔、黄斑囊样水肿或视网膜神经上皮脱离。术后黄斑区视网膜前膜消失，部分黄斑区神经上皮损害或黄斑部不同程度水肿。结论OCT检查可直接客观显示黄斑区前膜及术后黄斑区视网膜组织结构的改变。