相干光断层扫描技术在角膜屈光手术中的应用

相干光断层扫描（optical coherence tomography, OCT）是一项非接触性、非侵入性、高分辨率的生物组织结构显像技术,可提供形态学图像和量化分析。其在角膜屈光手术方面的应用除了角膜厚度的测量、角膜瓣的评估、负压对视网膜影响的评估等方面之外,在圆锥角膜的筛查、角膜病变的观察与手术设计、术前黄斑区病变的筛查和术后视力预测等方面也发挥重要的作用。重视OCT在角膜屈光手术中的综合应用,有利于提高角膜屈光手术的效果。     

相干光断层扫描术在青光眼前节检查中的应用

青光眼的眼前节形态学检查对于其诊断和鉴别诊断非常重要。相干光断层扫描术(OCT)是一种新的光学诊断技术,可对生物组织细微结构进行实时、非接触、非侵入性、高分辨率横断面活体成像,起初主要应用于眼后节的检查中,其对视盘和视网膜神经纤维层厚度的检查对青光眼的早期诊断很有帮助。近年来,学者们对其在眼前节的应用进行了大量研究,推进了这项检查技术的发展并取得了许多重要成果。本文主要综述了OCT眼前节成像演变历史、OCT在青光眼前节检查中的应用、OCT与其它青光眼前节检查技术的比较。     

相干光断层扫描在糖尿病合并白内障术前临床应用

目的：探讨相干光断层扫描（ OCT）在糖尿病合并白内障患者施行超声乳化术前的临床应用价值。方法选取2011年4月至2013年4月确诊为糖尿病,在我院行白内障超声乳化吸除联合人工晶状体植入术的患者216例（259只眼）,术前均行裂隙灯下前置镜及OCT扫描检查眼底,并比较检查结果。结果术前裂隙灯下前置镜检查发现黄斑部病变55只眼,包括黄斑水肿15只眼,黄斑前膜8只眼,黄斑渗出16只眼,黄斑出血15只眼,黄斑裂孔1只眼;术前OCT检查发现黄斑部病变144只眼,包括黄斑水肿55只眼,黄斑前膜41只眼,黄斑渗出21只眼,黄斑出血23只眼,黄斑裂孔4只眼。两者比较,OCT眼底病变的检出率显著高于裂隙灯下前置镜检查（ P ＜0．05）。结论糖尿病合并白内障患者术前行OCT检查有助于提高眼底病变的检出率,对手术预后的评估有重要的指导意义,有较高的临床应用价值。     

相干光断层扫描对白内障患者术前眼底评估的意义

目的探讨相干光断层扫描（OCT）对白内障患者行术前眼底评估的优势。方法通过OCT对患者黄斑进行扫描,观察年龄相关性白内障患者术前黄斑区视网膜的显微结构。结果 127例（185只眼）白内障患者中,49例（52只眼,28.1%）患者由于晶状体混浊严重,用OCT仪无法进行扫描,107例（133只眼,71.9%）可通过OCT对黄斑区的细微结构进行大概评估。其中,80例（103只眼）OCT检查未见明显异常;术前OCT检查发现异常的有27例（30只眼）：硬性渗出1例（1只眼）,黄斑水肿8例（10只眼）,视网膜前膜2例（2只眼）,玻璃膜疣4例（5只眼）,色素上皮脱离4例（4只眼）,视网膜劈裂3例（3只眼）,视网膜出血3例（3只眼）,陈旧性脉络膜破裂1例（1只眼）,玻璃体黄斑牵拉1例（1只眼）。结论术前通过OCT检查,可了解黄斑区视网膜的细微结构,及早发现眼底病变,可对大多数白内障患者的眼底进行有效评估。     

屈光参差性弱视眼视网膜厚度的相干光断层扫描检测

目的 了解屈光参差性弱视患儿黄斑中心凹平均厚度与视网膜神经纤维层平均厚度及其与视力的关系.方法 对本院门诊确诊为远视性屈光参差性弱视的17例患儿,应用相干光断层扫描仪(OCT)检测双眼黄斑中心凹平均厚度与视网膜神经纤维层平均厚度.弱视眼为病例组,优势眼为对照组,用SPSS13.0统计软件分析两组黄斑中心凹平均厚度和视网膜神经纤维层平均厚度的差异.结果 弱视眼黄斑中心凹平均厚度平均(153.82±15.10)μm,优势眼黄斑中心凹平均厚度平均(140.65±19.50)μm.弱视眼视网膜神经纤维层平均厚度(114.40±19.94)μm,优势眼视网膜神经纤维层平均厚度(111.16±11.98)μm.优势眼组与弱视眼组黄斑中心凹平均厚度的差异有统计学意义(t=3.02,P=0.008),平均差异(13.18±18.01)μm.优势眼组与弱视眼组视网膜神经纤维层平均厚度差异无统计学意义(t=0.64,P=0.54).结论 屈光参差性患儿弱视眼视力与黄斑中心凹平均厚度有一定关系,随视力提高厚度有否改变及其厚度与中心凹的X通道的关系等有待进一步探索.OCT技术为非侵人性,可靠、安全,可作为儿童弱视的一种辅助检测方法,能否用于客观评估弱视预后及检测弱视治疗效果有待进一步研究.     

相干光断层扫描在眼内肿瘤诊断中的临床应用

目的 研究相干光断层扫描（OCT）在多种眼内肿瘤诊断中的临床价值.设计回顾性系列病例.研究对象 49例（52眼）未行治疗的多种眼内肿瘤的OCT图像.方法 收集2006～2009年在北京同仁医院进行OCT检查（Zeiss StratusOCT Model 3000）的49例（52眼）未行治疗的眼内肿瘤的临床资料,对各种肿瘤的OCT图像进行分析.肿瘤诊断根据患者的典型症状、病史、跟底镜下表现并综合眼底血管造影、眼彩色多普勒超声检查、眼眶CT和MRI结果.其中14例脉络膜黑色素瘤及3例睫状体肿瘤在局部切除后病理检查确诊 2例脉络膜转移癌有明确原发恶性肿瘤.主要指标OCT图像表现.结果 42眼脉络膜肿瘤（脉络膜黑色素瘤27眼、脉络膜转移癌2眼、脉络膜血管瘤5眼、脉络膜骨瘤8眼）的OCT表现为瘤体处视网膜及色素上皮层（RPE）光带隆起,伴不同程度的反射强度改变及层次紊乱,光带后瘤体为暗区 瘤体局部（27眼）和黄斑部（27眼）可见视网膜神经上皮层脱离.视网膜内（下）高反射点仅见于脉络膜黑色素瘤,脉络膜骨瘤的RPE光带反射显著增强且极不规则.7眼视网膜肿瘤（视网膜星形细胞错构瘤2眼、视网膜血管瘤5眼）的OCT表现为视网膜光带隆起,反射强度不均匀,RPE光带不能显示 3眼可见黄斑区视网膜神经上皮层水肿、脱离.其中视网膜星形细胞错构瘤隆起的视网膜光带可见特殊的虫蚀样外观.3眼睫状体肿瘤（黑色素瘤1眼、无色素上皮腺瘤2眼）OCT未能扫描到瘤体,2眼黄斑部OCT正常,1眼黄斑部视网膜水肿伴神经上皮层浅脱离.结论 OCT可显示肿瘤继发性的瘤体局部和邻近的视网膜及黄斑部改变,在一定程度上提示肿瘤的性质帮助诊断.     

白内障术前频域相干光断层扫描对黄斑疾病诊断价值的探讨

目的探讨白内障术前频域相干光断层扫描（SD-OCT）对黄斑疾病的诊断价值。方法随机选取2012年1～10月在本院准备行白内障超声乳化联合人工晶状体植入手术患者共418例（418眼）,分别采用双目间接检眼镜及海德堡公司生产的Spectralis OCT对所有患者进行术前黄斑区视网膜检查,判断黄斑疾病。术后1～2d再行检眼镜及OCT检查随访,阳性病例及疑似病例于术后1周进行荧光素眼底血管造影（FFA）或吲哚青绿血管造影（ICGA）检查。对比检眼镜与OCT2种检查方法在白内障术前对黄斑疾病的检出率。结果术后最终确诊为黄斑疾病42例。白内障术前,289例成功获取OCT图像,占总数69．14％,其中36例显示有不同类型的黄斑疾病,检出率为85．71％;206例通过双目间接检眼镜可查见眼底,其中14例显示有黄斑病变,检出率为33．33％。2种方法在白内障术前对黄斑疾病检出率差异有统计学意义（P〈0．01）。结论与传统的双目间接检眼镜相比,SD-OCT可以大大提高白内障术前黄斑疾病的检出率,有利于对白内障术后预后效果的判断。SD．OCT在白内障术前对黄斑疾病的诊断具有较高的临床价值,可广泛应用于白内障术前检杏。     

前节相干光断层扫描在球结膜及相关疾病中的应用

相干光断层扫描(optical coherence tomography,OCT)自问世以来,以其无创、非接触、高分辨率的优势,迅速在眼科领域推广应用,检查部位从眼后节黄斑、视神经,发展到眼前节结构的观察及相关疾病的诊治,为临床诊疗与科研提供更为可靠、准确的临床资料.近年来,前节OCT技术被应用于球结膜的参数测定(如球结膜厚度测量)、小梁切除术后滤过泡评估,以及结膜松弛症、翼状胬肉、睑裂斑、结膜肿瘤、球结膜淋巴管扩张等球结膜组织结构观察与结膜疾病的诊疗过程中,拓展了前节OCT的应用领域.     

相干光断层扫描在眼前节的应用

相干光断层扫描(OCT)是基于眼组织结构的不同光学散射性,采用干涉测量法进行二维显像和定量分析的新技术。与目前临床应用的其它检测手段相比,OCT具有非接触性、高分辨率等特点。除了进行视网膜和视神经的显像与检测,OCT可应用于角膜、前房角、晶状体等眼前节结构的生物测量和疾病研究,并可进行术中动态观察和实时显像。OCT日渐成为眼前节的主要检测工具。     

角膜屈光手术后患者的白内障手术治疗

角膜屈光手术后年龄相关性白内障以及并发性白内障患者白内障手术治疗时与正常白内障患者有许多不同,术前屈光状态的检查使用IOLMaster能采集更准确的数据,术中无晶状体状态下使用波前像差仪计算精确的人工晶状体度数,同时选择合适的非球面和多焦点等高端人工晶状体来提高视觉质量,以及采用新型的光调节人工晶状体在白内障术后可以无创地调节术后屈光状态,获得最精准的屈光度数,最终使角膜屈光手术后白内障患者在白内障术后达到满意的视觉效果.     

Optical coherence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis

PURPOSE: To examine the use of optical coherence tomography (OCT) in evaluating anatomical changes after laser in situ keratomileusis (LASIK) and complications related to the interface and corneal flap. SETTING: Istanbul University Eye Research Center and Department of Ophthalmology, Cerrahpasa Medical School, Istanbul, Turkey. METHODS: Eleven eyes of 11 patients who had myopic LASIK were included in the study. Mean age of the 7 men and 4 women was 29.4 years +/- 6.9 (SD). Cases analyzed included uneventful LASIK (4 eyes), epithelial ingrowth (5 eyes), and flap striae (2 eyes). Corneas were examined by OCT (Humphrey Systems). RESULTS: Optical coherence tomography resolved corneal flap and residual stromal layers in all cases. The mean thickness of the corneal flap and residual stroma was 138.2 +/- 16.5 microm and 321.7 +/- 32.1 microm, respectively. Interface between the corneal flap and residual stroma was shown by OCT. Optical coherence tomography revealed that the eye with flap striae had flap displacement undetected by biomicroscopy. Epithelial ingrowth was shown as a highly reflective area. CONCLUSION: Optical coherence tomography appears to be a promising method for evaluating anatomical changes in the cornea after LASIK.     

光学相干断层扫描在屈光不正中的应用

从1990年代起光学相干断层扫描(OCT)技术的应用使更多的眼病得到了及早的诊断、治疗,它使视网膜、脉络膜不仅可视化,而且可量化,具有无创、无痛、高分辨率等优点.近年来,随着屈光不正的发病率增高,呈现出低龄化,它发病早、发生快、进展快,引起越来越多的学者的重视,并将OCT运用在屈光不正研究中,也得出大量的结果,可以早期发现视网膜、脉络膜厚度的微小变化,及时采取相应的措施,为日后更深入地研究屈光不正的光学机制奠定基础.本文将从光学相干断层扫描在屈光不正中的应用做一综述.     

Optical coherence tomography evaluation of posterior capsule opacification related to intraocular lens design

PURPOSE: To evaluate posterior capsule opacification (PCO) and the impact of different intraocular lens (IOL) models on PCO characteristics using optical coherence tomography (OCT). METHODS: Eighty-three eyes with PCO (fibrosis or pearl type) and 32 pseudophakic eyes without PCO were included. Horizontal 3.0 mm long OCT scans of the posterior capsule were obtained. Measurements and means of the peak posterior capsule intensity (PCI) and posterior capsule thickness (PCT) (distance between 2 spikes at posterior capsule) at 3 scan points were recorded. The PCI and PCT were compared with best corrected visual acuity (BCVA) and IOL data. RESULTS: The PCT was high for IOLs with a rounded edge (P = .001) and with poly(methyl methacrylate) (PMMA) IOLs (P<.001). If the IOL optic was concave-convex, the PCT was higher than if the optic was biconvex (P = .001). The PCT of hydrophilic acrylic IOLs was higher than of hydrophobic acrylic IOLs (P = .04). Multivariate analysis of PCT showed that PMMA was the only factor statistically associated with PCT (P = .02). The worse logMAR BCVA correlated significantly with a higher PCT value (P<.001) but not with PCI (P = .42). An IOL size of 12.5 mm was related to fibrosis-type PCO (odds ratio, 3.14; P = .04). CONCLUSIONS: The PCT was most affected by IOL characteristics. Poly(methyl methacrylate) IOLs and IOLs with rounded edges were associated with higher PCT. Hydrophilic acrylic IOLs were associated with greater PCT than hydrophobic IOLs. Posterior capsule thickness was a factor in decreased BCVA.     

Optical coherence tomography for the noninvasive evaluation of the cornea

PURPOSE: To determine the optical coherence tomographic (OCT) characteristics of normal corneas and to characterize the OCT images of abnormal corneal lesions. METHODS: Eleven eyes from 10 patients were examined at the Cornea Service of the Nagoya University Hospital: 4 had corneal pathologies, 4 underwent keratoplasty, and 2 were normal controls; 1 enucleated eye was also examined. OCT (OCT 2000 Zeiss-Humphrey) was used to study the normal cornea and various corneal abnormalities. We compared the OCT images to the observations made by slit-lamp biomicroscopy. RESULTS: Fluid spaces were detected as black images. A highly reflective reflex was observed at the interface of different tissues, and intensive backscattering (reflex) was seen when the incident ray hit the laminated layers vertically. Corneal opacities were not clearly imaged when they were diffuse and mild, or when they were arranged axially in a small area, as was the scar of the graft-host junction. It was possible to obtain images from the region of the cornea that was not clearly visible by slit-lamp examination because of a corneal opacity. CONCLUSION: OCT is a noncontact and noninvasive technique that can be performed safely on diseased corneas. OCT can provide objective documentation of corneal disorders that cannot be obtained by slit-lamp examination. The use of OCT in conjunction with other conventional instruments should provide a more complete image of the cornea.     

频域OCT定性定量分析葡萄膜炎性黄斑水肿

目的 观察葡萄膜炎患者黄斑水肿的光学相干断层扫描(OCT)图像特征及与临床的关联,探讨频域OCT在葡萄膜炎性黄斑水肿定性和定量分析中的应用价值.方法 连续临床病例横断面研究.对河南省眼科研究所在2009年4月至2011年3月就诊的葡萄膜炎并黄斑水肿169只眼进行频域OCT检查,分析黄斑水肿的类型及各参数与视力的相关性,并与FFA结果对比分析.结果 (1)黄斑水肿分型:囊样水肿占43.19％,弥漫性水肿占34.91％,单纯神经上皮脱离占10.06％,11.83％同时出现3种改变;囊样水肿发生率最高.(2)光感受器内外节连接体断裂者54只眼(31.95％),玻璃体后脱离者33只眼(19.53％);存在明显玻璃体视网膜牵拉者15只眼(8.88％),黄斑前膜者33只眼(19.53％).(3)囊样水肿组平均黄斑厚度高于弥漫性水肿组,两组视网膜厚度均与视力呈负相关;连接体断裂组视力较完整组低;存在黄斑前膜组视力较低.(4) OCT与FFA对黄斑水肿的检出一致率为86.39％.结论 葡萄膜炎所导致的黄斑水肿其形态可表现为多种不同的类型,OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关.     

Optical coherence tomography

Optical coherence tomography is a novel, noninvasive, noncontact and repetitive imaging technique which produces high depth resolution cross-sectional tomographs of ocular tissue. It's value is given by the possibility of achieving pseudo-histological images of the target tissue. It is optically based, analogue to ultrasound B-scan examination and similar to laser reflectometry. Optical coherence tomography involves shining low-level infrared light on a tissue specimen, an interferometer and a computerized imaging system. The most attractive applications of optical coherence tomography are the diseases of the retina such as: central serous retinopathy, macular hole, chronic macular edema, age-related macular degenerescence.     

Optical coherence tomography in the evaluation of retinal changes associated with suspicious choroidal melanocytic tumors

PURPOSE: Subretinal fluid (SRF) is a strong risk factor for growth of choroidal melanocytic tumors. However, subtle SRF can be difficult to assess clinically and to distinguish from chronic retinal changes overlying a dormant lesion. This study investigates optical coherence tomography (OCT) in evaluating SRF in suspicious choroidal melanocytic tumors. DESIGN: Interventional case series. METHODS: Review of 33 patients with untreated choroidal melanocytic tumors who underwent OCT for suspicion of subtle SRF. Fluorescein angiography was performed in 26 of the patients. The main outcome was tumor growth. RESULTS: No retinal separation was found in 12 tumors, of which 1 (8%) grew on follow-up and 3 (25%) were treated. Chronic retinal changes (localized retinal separation with retinal atrophy or intraretinal cysts) were found in nine tumors: one (11%) grew on follow-up and none were treated. Active SRF (localized retinal separation with normal retinal appearance) was found in 12 tumors: 6 (50%) grew on follow-up, and 7 (58%) were treated. The active OCT pattern was associated with fluorescein angiography hotspots (P =.041), documented tumor growth (P =.033), and tumor treatment (P =.014), and inversely associated with drusen (P =.024), atrophic retinal pigment epithelium changes surrounding the tumor (P =.048), and intraretinal cysts by OCT (P =.002). CONCLUSIONS: Optical coherence tomography is useful in distinguishing active subretinal fluid from chronic retinal changes overlying a choroidal melanocytic tumor. Optical coherence tomography findings may have predictive value in identifying tumors that are likely to grow and require treatment.     

Optical coherence tomography measurements with the LENTIS Mplus multifocal intraocular lens

Background

To investigate optical coherence tomography (OCT) measurements following implantation of the LENTIS Mplus multifocal IOL, compared with a control group.

Methods

OCT scans were performed on 50 eyes with the Topcon 3D OCT-1000 in two groups of patients. The first group consisted of patients following implantation of the LENTIS Mplus, and a second group of age-matched control eyes following implantation of a monofocal aspheric IOL. Macular thickness and macular volume values were compared between groups and assessment for any onscreen visible artifacts.

Results

OCT scans were successfully performed in all 50 eyes with no visible artifacts in either group during scan acquisitions. There were no statistically significant differences (p?>?0.05) in any measured or calculated macular thickness or volume values between the two groups.

Conclusions

OCT measurements with the Topcon 3D OCT-1000 is possible and free from visible artifacts in eyes which have had the LENTIS Mplus multifocal IOL implanted. Macular thickness and volume values were similar to those of an age-matched control group of monofocal aspheric IOLs.