年龄相关性黄斑变性的脉络膜厚度评价

目的：通过光学相干断层扫描(optical coherence tomography, OCT; RTVue 100-2; V 5.1, Optovue, Fremont, CA, USA)测量比较非新生血管性与新生血管性年龄相关性黄斑变性(age-related macular degeneration, AMD)黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness, SFCT), 并分析脉络膜厚度(choroidal thickness, CT)对AMD新血管形成的影响。

方法：本研究为回顾性、横断面研究。以单侧眼患有新生血管性AMD且对侧眼患有非新生血管性AMD的24例患者(48眼)作为研究组,选取年龄与眼轴长度相匹配的40例健康眼作为对照组。非新生血管性AMD亚组研究对象是黄斑区有玻璃疣和/或色素变化眼,而新生血管性AMD亚组研究对象是由于脉络膜新生血管而致视网膜下或视网膜内有渗出液和/或脂性渗出眼。运用OCT垂直测量外侧高反射线(视网膜色素上皮层)到脉络膜巩膜交界面间的距离。选取7个不同点进行脉络膜厚度测量,测量区域为距黄斑中心凹颞侧和鼻侧1 500μm范围,测量间距为500μm。测量结果在亚组间进行统计学对比研究。

结果：研究组患者平均年龄为72.4±8.97(60～82)岁,对照组受试者平均年龄为71.2±8.8(58～81)岁。新生血管性AMD组中平均SFCT明显大于非新生血管性AMD组的厚度(P<0.05)。非新生血管性AMD组中,平均SFCT与平均鼻、颞侧脉络膜厚度比较,差异无统计学意义(P>0.05); 而新生血管性AMD组中,平均SFCT与平均鼻、颞侧脉络膜厚度比较,差异有统计学意义(P<0.05)。

结论：运用OCT对脉络膜厚度进行测量,有助于理解AMD的病理生理机制。然而,仍需要大型前瞻性研究来探求新生血管性AMD中SFCT增厚的原因。     

OCTA对年龄相关性黄斑变性的诊断评价及图像特征分析

光学相干断层血管造影(OCTA)是一种快速、无创的成像方法,可以提供视网膜和脉络膜的实时血流信息。与传统的血管造影相比较,OCTA可以产生更详细、更高分辨率的血管图像,而不增加造影剂相关风险。年龄相关性黄斑变性(ARMD)是全球主要的老年性致盲眼病,OCTA能很好地显示脉络膜新生血管的影像,为ARMD的早期诊断及干预提供可能。本文将对OCTA在ARMD的相关图像特征及其诊断价值进行综述。     

年龄相关性萎缩型黄斑变性OCT和电生理检查的关系

目的将年龄相关性萎缩型黄斑变性患者黄斑区的OCT形态学检查及视觉电生理视功能检查相结合,探讨该病变黄斑部形态学改变与视功能改变之间的相互关系。方法选取初次诊断为年龄相关性萎缩型黄斑变性患者35例（40眼）以及同年龄段正常对照20例（40眼）,分别设为萎缩组和正常组。对两组分别进行黄斑中心凹的OCT检查及眼电生理检查,眼电生理检查包括视网膜电图（electroretinogram,ERG）和图形视觉诱发电位（pattern visual evoked potential,P-VEP）。采用独立样本t检验分析检查结果。结果①黄斑中心凹水平及垂直神经上皮层厚度：萎缩组与正常组差异无统计学意义（P〉0.05）。②暗适应ERG：萎缩组较正常组有b波潜伏期的延长（P〈0.05）和a、b波振幅的下降（P〈0.05）;萎缩组a波潜伏期与正常组相比,差异无统计学意义（P〉0.05）。③Ops振荡电位：萎缩组幅值较正常对照组显著下降（P〈0.05）。④P-VEP：萎缩组较正常组（空间频率34′）潜伏期显著延长（P〈0.05）,振幅显著下降（P〈0.05）。结论对于萎缩型黄斑变性患眼,眼电生理的变化早于OCT变化。这说明,年龄相关性萎缩型黄斑变性患者视功能改变早于视网膜神经上皮层的厚度改变,对于早期患者可优先选择电生理检查。     

脉络膜厚度与年龄相关性黄斑变性发病关系的研究进展

年龄相关性黄斑变性(ARMD)是一种慢性的、进行性的黄斑视网膜退行性疾病,是目前中老年人的主要致盲性眼病,其发展过程和发病机制复杂。研究表明,脉络膜厚度在ARMD不同分期和分类中均有显著变化。鉴于脉络膜是一种能够快速改变血流的血管结构,脉络膜厚度的变化可能主要是由脉络膜血流的变化引起的。并且,脉络膜的异常血流灌注可进一步损害视网膜色素上皮细胞的功能,导致视网膜色素上皮层缺氧、缺血,最终诱发ARMD。目前,越来越多的人意识到脉络膜厚度的测量在ARMD的诊断和治疗中的重要性,因此本文将针对脉络膜厚度和脉络膜血流在ARMD病程和治疗后的改变以及相关发病机制进行综述,这可能为ARMD发病提供新的预测指标,并为开发新的ARMD治疗方法提供新的目标。     

脉络膜在年龄相关性黄斑变性发病机制中的研究进展

年龄相关性黄斑变性（AMD）是一种与多因素相关、能引起中心视力丧失的致盲性眼病,目前尚无逆转AMD 的方法。AMD 发病机制复杂,是眼科领域研究的热点。其中,脉络膜通过脉络膜毛细血管层向视网膜色素上皮（RPE）和视网膜提供氧气、营养物质并清除代谢产物,在AMD 的发病机制中发挥着关键作用。由于脉络膜组织解剖位置较深,人们对脉络膜在AMD 发病机制中的认识有限。因此,本文就AMD 脉络膜的组织病理、基因表达、炎症、血流改变作一综述,有利于 AMD 脉络膜特征的识别,并进一步拓展临床诊疗思路。     

OCTA在湿性年龄相关性黄斑变性诊疗中的研究进展

光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)是一种快捷的、无创的新兴成像技术,可以定性、定量分析视网膜血流灌注,在临床的应用越来越广泛。脉络膜新生血管(choroidal neovascularization,CNV)是湿性年龄相关性黄斑变性(neovascular age-related macular degeneration,nARMD)导致老年人视力丧失的主要原因,因此在nARMD中对CNV的检测十分重要。本文通过OCTA对CNV的诊断、形态、面积及血流灌注的分析,综述了其在nARMD诊疗中的研究进展。     

年龄相关性黄斑变性合并出血性视网膜-脉络膜脱离一例

患者女性，71岁，因右眼视力下降3年，于2001年6月来本院眼科诊治。患者于11年前，在外院诊断为左眼年龄相关性黄斑变性、玻璃体出血，曾于本院行左眼玻璃体切除术。术后1年又发生视网膜脱离，在当地医院行巩膜外环扎术，术后视力恢复差，并逐渐失明。     

年龄相关性黄斑变性脉络膜新生血管的抗VEGF治疗

血管内皮生长因子(VEGF)是最重要的影响新生血管形成的因子，在年龄相关性黄斑变性的脉络膜新生血管形成中有重要作用。抗VEGF药物可抑制CNV的产生，从而起治疗作用。本文就VEGF及其受体的生理及病理作用，以及近两年来出现的抗VGF治疗AMD的进展做一综述。     

玻璃体内注射康柏西普对渗出性老年性黄斑变性患者脉络膜厚度的影响

目的　观察玻璃体内注射康柏西普对渗出性老年性黄斑变性（ａｇｅ-ｒｅｌａｔｅｄｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎ,ＡＭＤ）患者脉络膜厚度（ｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＣＴ）的影响。方法　确诊为渗出性ＡＭＤ患者４２例４２眼,分为典型ＡＭＤ（ｔｙｐｉｃａｌ-ＡＭＤ,ｔＡＭＤ）组和息肉样血管病变（ｐｏｌｙｐｏｉｄａｌｃｈｏｒｏｉｄａｌｖａｓｃｕｌｏｐａｔｈｙ,ＰＣＶ）组,均行３＋ＰＲＮ方案的玻璃体内注射康柏西普治疗。采用光学相干断层扫描的增强深度成像技术测量治疗前及初次治疗后１个月、２个月、３个月、６个月治疗眼及对侧眼中心凹下脉络膜厚度（ｓｕｂｆｏｖｅａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＳＦＣＴ）及距离中心凹１ｍｍ的鼻侧和颞侧ＣＴ,对比分析康柏西普治疗前后的ＣＴ变化。结果　渗出性ＡＭＤ患眼玻璃体内注射康柏西普后１个月、２个月、３个月、６个月ＳＦＣＴ分别为（２２３．５５±３０．７１）μｍ、（２２１．５２±３３．３７）μｍ、（２１４．４３±３１．８１）μｍ、（２１４．９３±３１．４１）μｍ;治疗后６个月鼻侧ＣＴ从（２２５．４０±４３．９７）μｍ减少至（２０５．７１±４２．２０）μｍ,颞侧ＣＴ从（２３５．２１±４７．２２）μｍ降至（２０３．５２±３９．１５）μｍ;与基线相比,差异均具有统计学意义（均为Ｐ＜０．００１）。其中,ｔＡＭＤ组ＳＦＣＴ从（２３４．０６±４１．０４）μｍ减至（２０９．１９±３２．１４）μｍ,ＰＣＶ组从（２７４．６０±２７．７３）μｍ减至（２３３．３０±２１．０８）μｍ,各随访时间点所测ＳＦＣＴ与基线时相比差异均具有统计学意义（均为Ｐ＜０．０５）,而对侧正常眼６个月各时间点ＳＦＣＴ无明显改变。结论　玻璃体内注射康柏西普会引起渗出型ＡＭＤ（ｔＡＭＤ和ＰＣＶ）ＣＴ降低。     

Genetic analysis of simultaneous geographic atrophy and choroidal neovascularization

AimTo investigate clinical presentation and genotypes in patients with simultaneous geographic atrophy (GA) and choroidal neovascularization (CNV) and to compare with patients with GA or CNV only.Patients and methodsTwenty patients with combined CNV-GA and 154 CNV only and 154 GA only were chosen based on clinical exam and imaging. Six single-nucleotide polymorphisms (SNPs)-rs2274700 and rs1061170 (complement factor H), rs10490924 and rs11200638 (HTRA1/LOC387715), rs2230199 (C3), rs9332739 (C2)-were genotyped using the SNaPshot method. Chi-squared tests were used for genetic analysis.ResultsIn patients with CNV-GA, GA progressed slowly and often preceded CNV. CNV presented as subretinal haemorrhage or fluid, with a sudden drop in visual acuity (VA). Comparing combined CNV-GA to GA and CNV only, patients with both had a higher frequency of at-risk alleles at both SNPs within the HTRA1 gene-rs10490924 (52.5%), rs11200638 (52.6%). Statistical significance was not achieved. CNV-GA patients had no protective alleles at SNP rs9332739 (C2), compared with GA (27%) and CNV only (10%).ConclusionThere is a paucity of reports describing simultaneous CNV-GA. Clinical and genetic results may support the fact that GA and CNV fit on an age-related macular degeneration (AMD)-disease continuum and may clarify the disease processes in AMD.     

ARMD的光学相干断层成像分析

本文给出了一种老年性黄斑变性(age-related macular degeneration,ARMD)的早期诊断方法,在ARMD的发展过程中出现的各种病理改变如玻璃膜疣、脉络膜视网膜地图状萎缩、视网膜色素上皮萎缩、脉络膜新生血管、视网膜色素上皮/神经上皮脱离等,用光学相干断层成像技术(optical coherence tomography,OCT)对其进行图像分析。     

OCTA对湿性年龄相关性黄斑变性脉络膜新生血管诊断价值的Meta分析

目的：采用Meta分析方法评价相干光断层扫描血管成像(OCTA)对湿性年龄相关性黄斑变性(wARMD)患者脉络膜新生血管(CNV)的诊断价值。

方法：计算机检索PubMed、Embase、Web of science、Cochrane library、CNKI、Wanfang、CBM和VIP数据库建库至2020-10-27关于OCTA诊断wARMD患者CNV的相关研究。由两位研究员独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险,使用Meta-Disc 1.4及Stata 16.0软件进行Meta分析。

结果：纳入文献11篇,患者995眼。OCTA诊断wARMD患者CNV的Meta分析结果显示,合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比、sROC曲线下面积和阳性验后概率依次为0.88\〖95%CI(0.83,0.92)\〗、0.95\〖95%CI(0.85,0.99)\〗、18.45\〖95%CI(5.36,63.52)\〗、0.12\〖95%CI(0.08,0.18)\〗、152.73\〖95%CI(36.39,641.05)\〗、0.95\〖95%CI(0.92,0.96)\〗和0.96。

结论：相干光断层扫描血管成像用于诊断wARMD患者CNV具有较高价值,尤其适用于wARMD的早期诊断。     

Optical coherence tomography analysis of bilateral end-stage choroidal neovascularization where one eye is treated with photodynamic therapy

BACKGROUND: To compare retinal thickness and subretinal hyper-reflectivity using Stratus optical coherence tomography (OCT3) between the eyes of patients with bilateral end-stage exudative age-related macular degeneration (AMD), where one eye has been treated with photodynamic therapy (PDT). METHODS: Patients with PDT-treated stable choroidal neovascularization (CNV), defined as a fibrotic lesion not requiring treatment for 6 months, in one eye and an untreated end-stage CNV (disciform) scar in their fellow eye, underwent refraction protocol logMAR visual acuity (VA) in letters, slit-lamp biomicroscopy, fluorescein angiography and OCT3 scan. Subretinal scar thickness was measured as Outer High Reflectivity Band Thickness (OHRBT) and retinal thickness as neuroretinal foveal thickness (NFT) on OCT3. RESULTS: Thirty-two eyes of 16 patients were studied. Mean OHRBT was 255.62 microm in treated eyes and 350.8 microm in untreated eyes (P = 0.001). Mean NFT was 130.3 microm in the treated eye and 79.9 microm in the untreated eye (P = 0.017). Mean VA was 42 letters in treated eyes and 15 letters in untreated eyes (P < 0.005). CONCLUSION: Based on OCT3 findings, eyes with AMD treated with PDT have a thinner fibrous scar and better preserved retinal thickness when compared with untreated fellow eyes with end-stage fibrotic scarring.     

老年黄斑变性43例光学相干断层扫描分析

目的:研究老年黄斑变性的光学相干断层扫描(optical coherence tomography,OCT)特征.方法:对经眼底荧光造影(fundus fluorescein angiography,FFA)确诊的老年黄斑变性患者43例45眼,其中湿性型28例30眼、干性型15例15眼,按年龄匹配的正常人30例43眼利用OCT分别进行检测.观察黄斑部神经纤维层(nerve fiber layer of macular,MNFL)、色素上皮/脉络膜毛细血管复合层(retinal pigment epithelium/choriocapillaris,RPE/CC)及视网膜神经上皮层(retinal neurepithelium layer,RNE)的厚度变化.应用秩和检验比较其差异性.结果:MNFL厚度:湿性型老年黄斑变性组为76.5±51.7 μm、干性型老年黄斑变性组为32.5±7.6 μm、正常对照组为27.7±6.4 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RNE厚度:湿性型老年黄斑变性组为307.1±130.8 μm、正常对照组为239.9±13.4 μm、干性型老年黄斑变性组为223.4±22.6 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RPE/CC厚度:湿性型老年黄斑变性组为115.3±30.6 μm、干性型老年黄斑变性组为81.7±20.4 μm、正常对照组为76.4±11.5 μm,湿性型组与其他组比较差异有显著性(P＜0.05).结论:黄斑部神经纤维层厚度、视网膜神经上皮层厚度及色素上皮/脉络膜毛细血管复合层厚度随着老年黄斑变性病程的发展,其厚度增加.OCT可以作为湿性型老年黄斑变性发生与发展的监测工具之一.     

Tomographic fundus features in pseudoxanthoma elasticum: comparison with neovascular age-related macular degeneration in Japanese patients

PurposeTo determine the retinal and subretinal features characteristic to pseudoxanthoma elasticum (PXE) compared with age-related macular degeneration by using spectral-domain optical coherence tomography (SD-OCT) in Japanese patients.MethodsWe reviewed colour fundus photographs, fluorescein angiograms, and SD-OCT images of 52 eyes (27 Japanese patients) with angioid streaks (AS) due to PXE. Then we compared the incidence of tomographic features between 24 eyes (24 patient) with choroidal neovascularization (CNV) secondary to AS and 44 eyes (44 patients) with CNV secondary to age-related macular degeneration (AMD).ResultsSecondary CNV was found in 44 eyes (84.6%) of 52 patients with PXE during follow-up. We found characteristic round or ovoid tubular structures with highly reflective annular lines (termed 'outer retinal tubulation' (ORT)) in 31 (70.5%) of 44 eyes with CNV, but none were found in eyes without CNV. We also found characteristic undulations of Bruch's membrane in 38 (73.1%) eyes with AS. The incidence of ORT was significantly greater in eyes with CNV secondary to AS (70.8%; P=0.005) compared with eyes with CNV secondary to AMD (34.1%). The incidence of Bruch's membrane undulation was significantly greater in eyes with CNV secondary to AS (70.8%; P<0.0001) than in eyes with CNV secondary to AMD (11.4%).ConclusionSD-OCT imaging clearly revealed a greater incidence of unique lesions, including ORT and Bruch's membrane undulation, in eyes in PXE patients with CNV secondary to AS than in eyes with CNV secondary to AMD.     

Segmentation error and macular thickness measurements obtained with spectral-domain optical coherence tomography devices in neovascular age-related macular degeneration

Purpose:

To evaluate frequency and severity of segmentation errors of two spectral-domain optical coherence tomography (SD-OCT) devices and error effect on central macular thickness (CMT) measurements.

Materials and Methods:

Twenty-seven eyes of 25 patients with neovascular age-related macular degeneration, examined using the Cirrus HD-OCT and Spectralis HRA + OCT, were retrospectively reviewed. Macular cube 512 × 128 and 5-line raster scans were performed with the Cirrus and 512 × 25 volume scans with the Spectralis. Frequency and severity of segmentation errors were compared between scans.

Results:

Segmentation error frequency was 47.4% (baseline), 40.7% (1 month), 40.7% (2 months), and 48.1% (6 months) for the Cirrus, and 59.3%, 62.2%, 57.8%, and 63.7%, respectively, for the Spectralis, differing significantly between devices at all examinations (P < 0.05), except at baseline. Average error score was 1.21 ± 1.65 (baseline), 0.79 ± 1.18 (1 month), 0.74 ± 1.12 (2 months), and 0.96 ± 1.11 (6 months) for the Cirrus, and 1.73 ± 1.50, 1.54 ± 1.35, 1.38 ± 1.40, and 1.49 ± 1.30, respectively, for the Spectralis, differing significantly at 1 month and 2 months (P < 0.02). Automated and manual CMT measurements by the Spectralis were larger than those by the Cirrus.

Conclusions:

The Cirrus HD-OCT had a lower frequency and severity of segmentation error than the Spectralis HRA + OCT. SD-OCT error should be considered when evaluating retinal thickness.