Evaluation of central serous chorioretinopathy with optical coherence tomography

PURPOSE: To evaluate central serous chorioretinopathy with optical coherence tomography during the acute phase and after resolution of the acute phase. METHODS: In a prospective study, 23 consecutive eyes of 23 patients (19 men, four women; mean age +/- SD, 46.0+/-8.1 years; range, 29 to 60 years) with central serous chorioretinopathy were examined with optical coherence tomography during the acute phase and after resolution of the retinal detachment. After the initial examination, the patients were reexamined for 3 to 6 months (mean, 4.7+/-1.1 months). Cross-sectional retinal images through the center of the fovea were obtained from all eyes by optical coherence tomography. The retinal thickness at the center of the fovea was measured. The difference between the retinal thickness during the acute phase and after resolution of the retinal detachment was statistically analyzed using the Wilcoxon test. We also examined a grayish-white lesion that corresponded to the leakage point in fluorescein angiography in four eyes. RESULTS: In the acute phase, neurosensory retina was thickened within the area of serous retinal detachment in all 23 eyes. The detached retina was thicker than the reattached retina after resolution of the retinal detachment in all eyes. The retinal thickness at the center of the fovea during the acute phase (range, 157 to 236 microm; mean +/- SD, 196.9+/-22.6 microm) was significantly thickened compared with that after resolution (range, 105 to 152 microm; mean +/- SD, 124.8+/-10.7 microm; P<.0001, Wilcoxon test). In the acute phase, areas of low reflectivity localized within the detached retina were observed in 18 of the 23 eyes. In the area of the grayish-white lesion, optical coherence tomography showed a moderately reflective mass bridging the detached neurosensory retina and retinal pigment epithelium in the four eyes; the outer layer of the detached retina was more highly reflective in these eyes. The retinal pigment epithelium was focally detached beneath the subretinal reflective mass in three of the four eyes. CONCLUSIONS: In all eyes studied, neurosensory retina was thickened within the area of serous retinal detachment in the acute phase of central serous chorioretinopathy. The grayish-white lesion seems to be a fibrinous exudate that accumulates in the subretinal space and infiltrates into the outer retina.     

中心性浆液性视网膜脉络膜病变的光学相干断层扫描图像改变

目的　研究中心性浆液性视网膜脉络膜病变 (CSC)的光学相干断层扫描 (OCT)图像的变化。方法　对 4 2例患者的 4 4眼进行OCT检查 ,对其进行动态观察和测量 ,分析其结果。结果　根据OCT图像 ,病变表现为视网膜神经上皮层脱离、神经上皮层和色素上皮层同时脱离、色素上皮脱离 3种不同形式。结论　OCT对CSC的诊断和判断治疗的预后有临床应用价值     

Evaluation of peripapillary detachment in pathologic myopia with en face optical coherence tomography

BACKGROUND: A newly recognized lesion in pathologic myopia is peripapillary detachment of the retinal pigment epithelium (RPE) and retina. Recently introduced en face optical coherence tomography (OCT) provides not only cross-sectional but also coronal scans of the retina, and allows lateral extent visualization and thickness measurement of lesions. METHODS: Three patients presenting bilateral peripapillary yellow-orange lobulated area in high myopia have been evaluated with fluorescein angiography (FA), indocyanine green angiography (ICGA), en face OCT (OCT/SLO; Ophthalmic Technologies Inc, Toronto, Canada), and Humphrey visual field analyzer. RESULTS: In all eyes, en face OCT has shown the presence of a peripapillary sub-RPE nonreflective area. The lateral extent of this area was clearly detectable and the measurement of its thickness was obtained. We detected a cleft in the RPE at one edge of the cavitation in two eyes, vascular tractions and vitreoretinal tractions in two eyes, a macular hole with posterior retinal detachment, and small areas of RPE detachment nonconnected with the peripapillary detachment in one eye. In the four eyes presenting a proper central fixation, glaucomatous visual field defects were evident. CONCLUSION: En face OCT has allowed to evaluate the thickness and the lateral extent of the peripapillary detachment. Therefore, its use could be important in determining the size and grading of these lesions at first visit, and to detect minimal changes of width and thickness during follow-up as an alternative to fluorescein angiography.     

Visualization of vitreomacular tractions with en face optical coherence tomography

BACKGROUND: In vitreomacular traction syndrome, an incomplete vitreous detachment with persistent vitreous traction on the macula is present. This condition may determine formation of epiretinal membranes, macular puckering, macular oedema, and traction macular detachment. Recently introduced en face optical coherence tomography (OCT) provides not only longitudinal B-scan but also coronal C-scan images of the retina. METHODS: Fifteen eyes of 11 non-diabetic patients presenting vitreomacular traction syndrome have been evaluated with en face OCT (OTI, Toronto, Ontario, Canada). RESULTS: In 12 eyes, cystoid macular oedema was detectable at fundus examination and was associated with a broad-based adherence of the posterior hyaloid to the macula. In three eyes, foveal detachment appeared to be associated with focal foveal vitreoretinal traction. In all eyes, the lateral extent of the hyaloidal tractions on the macula was clearly detectable at coronal C-scan. They appeared as sigmoid hyper-reflective bands in the hyporeflective vitreous chamber. Overlay of C-scans on red-free confocal images allowed the visualization of the edges of the adherences in relation to the structures of the posterior pole. CONCLUSIONS: The C-scan images allowed clear visualization of the total extension of the posterior vitreomacular adherences and their relationships with the vascular arcades, the optic disc, and the fovea.     

Polypoidal choroidal vasculopathy examined with en face optical coherence tomography

BACKGROUND: To study the morphologic features of polypoidal choroidal vasculopathy (PCV) with the use of en face optical coherence tomography (OCT). METHODS: We reviewed retrospectively 57 eyes of 57 patients with PCV. The macular region was examined with OCT en face planes scanned at different sequential depths, following which detailed scanning was performed of arbitrarily selected longitudinal planes. RESULTS: In 48 of the cases (84.2%), en face OCT allowed us to detect round protrusions of the retinal pigment epithelium (RPE) that corresponded to the polypoidal lesions seen on indocyanine green angiography (ICGA); the branching vascular networks seen on ICGA often induced slight elevation of the overlying RPE, which typically assumed a geographical shape. In 30 cases (52.6%), branching vascular networks were detected as elevations of the RPE. With en face OCT, serous pigment epithelial detachments, most of which were seen as round protrusions of the RPE, were often accompanied by adjacent smaller round protrusions of the RPE, consistent with polypoidal lesions. These protrusions of the RPE were often fused and typically appeared as a 'snowman'. Subsequent longitudinal examination revealed the polypoidal lesions to be sharp protrusions of the RPE with moderate inner reflectivity. Consistent with the location of the branching vascular network, a highly reflective line was seen often just beneath the slightly elevated reflective line of RPE. CONCLUSIONS: En face examination using OCT has an advantage in screening lesions of PCV and in examination of the detailed relationship of each component of these lesions.     

Imaging the retina by en face optical coherence tomography

PURPOSE: To present the possibilities of a new system that combines optical coherence tomography (OCT) and confocal ophthalmoscopy, producing en face OCT images in patients with retinal diseases. METHODS: A prototype OCT Ophthalmoscope (OTI, Toronto, Canada) was used to scan patients with retinal conditions. The system uses a super luminescent diode (lambda = 820 nm; Deltalambda = 20 nm) and currently scans at a rate of 2 frames per second. In each frame, the OCT Ophthalmoscope simultaneously produces a transversal OCT scan and a confocal image in the X/Y plane. Both images correspond pixel to pixel. RESULTS: Between January 2002 and August 2003, >800 patients with various retinal diseases were scanned with the OCT Ophthalmoscope. Illustrative cases with regularly seen macular diseases are presented, such as macular hole and central serous retinopathy. CONCLUSION: Current difficulties as well as future possibilities of this new en face OCT ophthalmoscope are discussed. By presenting normal and pathologic transversal OCT images made by a prototype OCT Ophthalmoscope, we show that it can provide information not available using conventional OCT imaging.     

慢性中心性浆液性脉络膜视网膜病变患者双眼脉络膜厚度频域光相干断层扫描检查分析

[目的]观察慢性中心性浆液性脉络膜视网膜病变(CSC)患者患眼和对侧健眼的黄斑部脉络膜厚度.[方法]连续的慢性CSC患者45例纳入研究.其中,男性36例,女性9例;单眼39例,双眼6例.平均年龄(46.18±8.20)岁;平均病程(16.34±7.23)个月.散瞳后前置镜眼底检查,荧光素眼底血管造影和吲哚青绿血管造影检查确诊,分为CSC患眼组(A组)、单眼CSC患者对侧健眼组(B组),分别为51、39只眼.选择同期年龄、性别、屈光度匹配的正常人50名50只眼作为正常对照组(C组).采用海德堡Spectralis频域光相干断层扫描(OCT)对所有受检者行加强深度扫描,测定中心凹下脉络膜厚度(SFCT)和距中心凹3 mm处鼻侧(NCT3mm)、颞侧(TCT3mm)、上方(SCT3mm)和下方脉络膜厚度(ICT3mm).[结果]A、B、C组平均SFCT值分别为(436.76±87.01)、(394.71±61.63)、(294.86±75.30)μm.A、B组平均SFCT值均较C组平均SFCT值明显增加,三组间平均SFCT值比较,差异有统计学意义(F=44.791,P＜0.00l).三组间NCT3mm (F=15.816)、TCT3mm(F=22.823)、SCT3mm(F=15.147)和ICT3mm(F=11.527)平均脉络膜厚度值比较,差异均有统计学意义(P＜0.001).单眼者患眼平均SFCT值为(416.34±79.44) μm,较对侧健眼明显增厚,差异有统计学意义(t=2.897,P=0.007).[结论]CSC患眼脉络膜厚度明显增加,对侧健眼脉络膜厚度亦较正常对照者明显增厚.     

FD OCT在中心性浆液性脉络膜视网膜病变的临床应用

目的:应用第四代傅立域光学相干断层扫描(fourier-do-main optical coherence tomography,FDOCT)对中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的FDOCT表现及视网膜光凝术后黄斑体积变化情况进行动态观察。方法:对40例40眼经眼底荧光血管造影(fluorescein fun-dus angiography,FFA)确诊为CSC的患者,先行FDOCT检查,观察其黄斑结构变化;再行532激光治疗后跟踪FDOCT检查。结果:FDOCT显示CSC有视网膜神经上皮层或合并视网膜色素上皮层(RPE)脱离、RPE层断裂三种表现。激光治疗后病员视力恢复情况与黄斑体积缩小相一致。结论:FDOCT在CSC的诊断中对FFA有补充和完善,对CSC激光治疗的预后估计有临床指导意义。     

Quantitative anomaloscopy and optical coherence tomography scanning in central serous chorioretinopathy

BACKGROUND: Dyschromatopsia is a prominent sign in a variety of central retinal diseases, such as central serous chorioretinopathy (CSC). The changes in colour vision may be due to either optical or neuronal factors in the diseased retina. The relative contribution from the two causes is unknown, but may be elucidated by obtaining knowledge of the anatomical derangement in the diseased retina in CSC. METHODS: Twenty-six normal persons had their colour vision tested using the Tomey anomaloscope. The calculation of setting range (SR) and central mean point (CMP) for Rayleigh match and Moreland match was optimized, and normal ranges for these values were defined. Subsequently 24 patients with CSC were examined by anomaloscopy and optical coherence tomography scanning, and the measures of colour vision were related to the anatomical changes observed on the scans. RESULTS: The algorithm for calculating SR and CMP which is integrated into the Tomey anomaloscope could be considerably improved to increase sensitivity and reproducibility of these measures. Fifteen patients had abnormal colour vision. Nine patients had pseudo-protanomaly, seven patients had pseudo-tritanomaly, and three patients had abnormalities in both matches. There was no relation between these colour vision abnormalities and the anatomical derangement as seen by OCT in the diseased central retina. CONCLUSION: The findings argue against the notion that the density of retinal cell nuclei, the orientation of photoreceptors, or the size of the central serous detachment are related to the colour vision abnormalities in CSC. The question of whether these abnormalities are due to optical or neuronal factors remains open.     

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

Objective To evaluate the morphological changes of retinal neuroepithelium of central serous chorioretinopathy (CSC) by Fourier-domain optical coherence tomography(FD-OCT). Methods FD-OCT scan was performed on 92 eyes of 88 patients with CSC. The CSC diagnosis was established by international visual acuity chart, slit-lamp microscope, direct/indirect ophthalmoscope, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). 6 mm horizontal line OCT scan was performed utilizing the infrared light emitted by diode, the scan depth was 2 mm with a 6 mm × 6 mmtransverse area. The vertical and horizontal resolution was 5 μm and 18/.tin respectively. The scan mode was 512× 128. Results The uplift of retinal neuroepithelium, separation or abnormal band of retinal pigment epithelial (RPE) were found in all eyes. There were 83 eyes (90. 22%) of pigment epithelial detachment (PED), 68 eyes (73.91%) of nodular protruding of RPE, 5 eyes (5. 43%) of localized RPE defects in the PED lesion, 36 eyes (39.14%) of dust-like reflects in the subretinal space and 59 eyes (64. 14%) of granular deposits in the subretinal space. Conclusion Fourier-domain OCT scans can detect detailed morphologic changes in the retina of CSC patients.     

OCT与mf-ERG在CSCR中的应用进展

中心性浆液性脉络膜视网膜病变(CSCR)为我国常见眼底疾病。近年来OCT在研究CSCR视网膜下渗出及分析视网膜结构改变等方面发挥着重要作用,同时脉络膜深层成像OCT(EDI-OCT)清晰地呈现了脉络膜形态学改变。此外,多焦视网膜电图(mf-ERG)证实了CSCR所引起的视网膜功能障碍,OCT和mf-ERG联合应用可以更好的理解CSCR结构和功能异常间的相关性。众多新技术的广泛应用,为CSCR的临床诊治、预后评估及随访提供了线索和依据。     

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

Objective To evaluate the morphological changes of retinal neuroepithelium of central serous chorioretinopathy (CSC) by Fourier-domain optical coherence tomography(FD-OCT). Methods FD-OCT scan was performed on 92 eyes of 88 patients with CSC. The CSC diagnosis was established by international visual acuity chart, slit-lamp microscope, direct/indirect ophthalmoscope, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). 6 mm horizontal line OCT scan was performed utilizing the infrared light emitted by diode, the scan depth was 2 mm with a 6 mm × 6 mmtransverse area. The vertical and horizontal resolution was 5 μm and 18/.tin respectively. The scan mode was 512× 128. Results The uplift of retinal neuroepithelium, separation or abnormal band of retinal pigment epithelial (RPE) were found in all eyes. There were 83 eyes (90. 22%) of pigment epithelial detachment (PED), 68 eyes (73.91%) of nodular protruding of RPE, 5 eyes (5. 43%) of localized RPE defects in the PED lesion, 36 eyes (39.14%) of dust-like reflects in the subretinal space and 59 eyes (64. 14%) of granular deposits in the subretinal space. Conclusion Fourier-domain OCT scans can detect detailed morphologic changes in the retina of CSC patients.     

急性中心性浆液性脉络膜视网膜病变的频域光相干断层扫描特征

目的 观察急性中心性浆液性脉络膜视网膜病变(CSC)频域光相干断层扫描(FD-OCT)的图像特征.方法 对比分析31例单眼急性CSC患者的FD-OCT以及荧光素眼底血管造影(FFA)检查资料.观察患眼FFA检查发现的渗漏点视网膜色素上皮(RPE)层、视网膜脱离区域以及对侧无症状眼RPE层的FD-OCT图像特征.结果 31只患眼中,FFA检查共发现荧光渗漏点34个.其中,RPE层面18个,占52.9%.荧光渗漏点在FD-OCT图像中表现为色素上皮脱离(PED)者17只眼,占54.8%;8只眼8个渗漏点表现为RPE层突起,分别占患眼及渗漏点的25.8%、23.5%;4只眼的6个渗漏点表现为RPE层不规则,分别占患眼及渗漏点的12.9%、17.6%;2只眼2个渗漏点表现为RPE层无明显异常,分别占患眼及渗漏点的6.5%、5.9%.其中,7只眼7个渗漏点见RPE层缺损,分别占患眼及渗漏点的22.6%、20.6%.所有患眼均可检测到后极部浆液性视网膜脱离以及光感受器内外节(IS/OS)层强反光带的断裂或消失.24只眼可见外节(0S)层厚度不均,占77.4%;10只眼可见外节层剥脱样改变,占32.3%;8只眼可见视网膜神经上皮外层以及RPE表面的颗粒样强反光点,占25.8%.0S层厚度不均的24只眼中,14只眼可见下垂征.31只无症状对侧眼中,11只眼存在RPE异常,占35.5%.其中,2只眼为PED,占无症状对侧眼的6.5%;1只跟为RPE层突起,占无症状对侧眼的3.2%;8只眼表现为RPE层不规则,占无症状对侧眼的25.8%.结论 急性CSC患眼渗漏点处RPE层的FD-OCT图像特征为PED、RPE层突起、RPE层不规则、RPE层无明显异常.视网膜脱离区域FD-OCT图像特征为浆液性视网膜脱离、IS/OS层断裂或消失、OS层厚度不均、OS层剥脱样改变、视网膜神经上皮外层以及RPE表面颗粒样强反光点.     

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

Objective To evaluate the morphological changes of retinal neuroepithelium of central serous chorioretinopathy (CSC) by Fourier-domain optical coherence tomography(FD-OCT). Methods FD-OCT scan was performed on 92 eyes of 88 patients with CSC. The CSC diagnosis was established by international visual acuity chart, slit-lamp microscope, direct/indirect ophthalmoscope, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). 6 mm horizontal line OCT scan was performed utilizing the infrared light emitted by diode, the scan depth was 2 mm with a 6 mm × 6 mmtransverse area. The vertical and horizontal resolution was 5 μm and 18/.tin respectively. The scan mode was 512× 128. Results The uplift of retinal neuroepithelium, separation or abnormal band of retinal pigment epithelial (RPE) were found in all eyes. There were 83 eyes (90. 22%) of pigment epithelial detachment (PED), 68 eyes (73.91%) of nodular protruding of RPE, 5 eyes (5. 43%) of localized RPE defects in the PED lesion, 36 eyes (39.14%) of dust-like reflects in the subretinal space and 59 eyes (64. 14%) of granular deposits in the subretinal space. Conclusion Fourier-domain OCT scans can detect detailed morphologic changes in the retina of CSC patients.     

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

Objective To evaluate the morphological changes of retinal neuroepithelium of central serous chorioretinopathy (CSC) by Fourier-domain optical coherence tomography(FD-OCT). Methods FD-OCT scan was performed on 92 eyes of 88 patients with CSC. The CSC diagnosis was established by international visual acuity chart, slit-lamp microscope, direct/indirect ophthalmoscope, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). 6 mm horizontal line OCT scan was performed utilizing the infrared light emitted by diode, the scan depth was 2 mm with a 6 mm × 6 mmtransverse area. The vertical and horizontal resolution was 5 μm and 18/.tin respectively. The scan mode was 512× 128. Results The uplift of retinal neuroepithelium, separation or abnormal band of retinal pigment epithelial (RPE) were found in all eyes. There were 83 eyes (90. 22%) of pigment epithelial detachment (PED), 68 eyes (73.91%) of nodular protruding of RPE, 5 eyes (5. 43%) of localized RPE defects in the PED lesion, 36 eyes (39.14%) of dust-like reflects in the subretinal space and 59 eyes (64. 14%) of granular deposits in the subretinal space. Conclusion Fourier-domain OCT scans can detect detailed morphologic changes in the retina of CSC patients.     

中心性浆液性脉络膜视网膜病变的光学相干断层成像分析

目的探讨中心性浆液性脉络膜视网膜病变(centralserouschorioretinopathy,CSC)光学相干断层成像(opticalcoherencetomography,OCT)的特征和临床应用.方法对临床诊断为急性期CSC患者(即出现主观症状4～8周之内)47例50只眼,经散瞳后进行OCT检查,并对病变图像进行分析和测量.结果急性期CSC患者OCT图像特征为累及黄斑中心凹的视网膜神经上皮层的拱形隆起与色素上皮层之间的浆液性弱反射暗区.病变范围618～6400μm,平均(3185.01±1495.21)μm;高度59～790μm,平均(262.28±175.20)μm.经统计学处理,表明CSC神经上皮层脱离范围、高度均与视力相关(P＜0.05).结论OCT是一种新型非侵入性的客观定量检查技术.通过OCT对所有急性期CSC眼表现的浆液性视网膜脱离病变的定量分析,表明它对CSC的诊断、鉴别诊断、定量测量和病情监测等方面具有重要的临床应用价值.     

中心性浆液性脉络膜视网膜病变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(central serous chorioretinopathy,CSC)在频域光相干断层扫描(FD-OCT)中的图像特征,以及CSC患者外核层厚度与最佳矫正视力(BCVA)的关系。方法:对确诊为CSC患者54例58眼和健康人30例60眼(对照组)行FD-OCT检查,采用Cirrus 3D-OCT模式对眼底黄斑部进行线性水平扫描。扫描深度1.9mm。扫描面积5.8mm×5.8mm,扫描模式512×496。观察CSC的FD-OCT图像特征,并测量不同时期CSC患者中央凹处外核层厚度,评估外核层厚度与BCVA的关系。结果:所有54例58眼CSC患者OCT检查典型的形态改变,以单纯性神经上皮层脱离和神经上皮层脱离伴色素上皮层脱离为主,约84.5%。CSC患者黄斑中心凹处外核层的平均厚度在急性期最厚,随着病情的缓解,逐渐变薄,但恢复期仍较正常人厚;CSC患者的中心凹处外核层的厚度与BCVA呈负相关。结论:FD-OCT能清楚地显示CSC的形态特征及病理形态学变化。CSC患者的中心凹处外核层的厚度与BCVA呈负相关。