Multimodal imaging characteristics of acute macular neuroretinopathy after COVID-19 infection北大核心

目的探讨新型冠状病毒感染后出现的急性黄斑神经视网膜病变(AMN)的多模影像学特征。方法回顾性分析南昌大学第一附属医院感染新型冠状病毒后诊断为AMN的患者6例12眼,结合患者病史、临床表现、眼底照相、SD-OCT、OCTA、En-face结构图、眼底自发荧光(FAF)、红外成像(IR)、荧光素眼底血管造影(FFA)、多焦视网膜电图(mfERG)、视野等检查结果,综合分析AMN的多模影像学特征。结果6例患者中女4例,男2例;年龄16~30岁;发病时间3~15 d;2例4眼属于急性期AMN,4例8眼属于进展期AMN。4眼(33.3%)眼底黄斑区可见楔形棕红色病灶;12眼(100.0%)IR可见一个或多个楔形弱反射病灶;SD-OCT示8眼(66.7%)进展期AMN黄斑区视网膜局灶性椭圆体带、嵌合带断裂及缺失,4眼(33.3%)急性期AMN黄斑区视网膜外核层及外丛状层可见高反射病灶;8眼(66.7%)进展期AMN椭圆体带和嵌合带En-face结构图可见片状低反射病灶,4眼(33.3%)急性期AMN深层视网膜En-face结构图可见片状高反射病灶;4眼(33.3%)mfERG示黄斑中心凹一阶反应振幅密度稍降低;6眼(50.0%)视野检查可见一个或多个中心、旁中心暗点。FFA、FAF、OCTA检查均未见明显异常改变。结论新型冠状病毒感染后AMN患者多为青年人,急性发病,眼底改变不明显,多模影像学可实现对AMN的早期诊断。     

Choroidal imaging biomarkers

The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.     

Artifacts in optical coherence tomography

Optical coherence tomography (OCT) is now an integral part of management for numerous retinal diseases for diagnosis, treatment planning and follow up. OCT interpretation must involve the understanding of the associated artifacts. These artifacts can mislead physicians to wrong diagnosis or inappropriate management. This review article discusses the various types of artifacts in OCT scans obtained from various devices in various retinal diseases. This article would help to improve the understanding about the various artifacts and their clinical importance.     

重视光相干断层扫描血流成像的临床应用及其图像的判读

光相干断层扫描血流成像(OCTA)是在OCT的基础上发展而来的眼病诊断新技术,也是目前眼科影像学检查中发展最快速的检查方法之一.目前,对眼底血管性疾病的主要检查方法包括荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA),具有对血管异常动态显现的特点,能对异常血管形态和病变特征提供有用的诊断信息,但其为有创的检查方法,且无法对病变进行分层分析.与FFA和ICGA相比,OCTA除了具备无创、快速、高分辨率的特点外,还具有无创性对血流显影的能力,其不受血管渗漏和视网膜出血的影响,能够提供三维测量的病变图像,并能实现病变的定量检测和分层检测,目前已用于多种眼科疾病的诊断和病情监测.OCTA技术的临床应用丰富了眼科影像学对疾病的诊疗信息及发病机制的探索结果.OCTA的检测过程和正确判读是基于对其原理和眼部待测组织解剖知识的理解和掌握,因此理解其原理及临床应用是临床眼科医师的必修课程.     

OCT血流成像技术的现在与未来

光相干断层成像血流成像（OCT angiography,OCTA）是近年来发展起来的一项新的眼科影像检查技术,它通过特殊的运算法则对连续扫描的OCT进行计算,获取血流信号,可快速、无创地重建视网膜、脉络膜血管的三维结构。虽然这种血流成像技术目前尚无法检测眼底血管的充盈时间,也无法评价血-视网膜屏障的功能,但是它已经显示出与传统血管造影基本一致的眼底血管结构,甚至可以更好地揭示视网膜深层毛细血管的形态,发现早期脉络膜新生血管,从而提供更多的病理信息,因此该技术正广泛应用于糖尿病性视网膜病变、黄斑旁毛细血管扩张症、年龄相关性黄斑变性、中心性浆液性脉络膜视网膜病变、视网膜静脉阻塞等多种眼底血管性疾病的检查。尽管这项新技术目前还存在各种局限性,如移动性伪影、浅层血管在视网膜色素上皮层的投影等问题,但是未来随着设备和软件的不断更新,现有技术必将进一步完善,影像会更加清晰而完美,而我们对疾病的认识也会更加深入和彻底。     

En-Face Optical Coherence Tomography of Acute Syphilitic Posterior Placoid Chorioretinopathy

Purpose: To report a unique case series of acute syphilitic posterior placoid chorioretinopathy (ASPPC) correlating en-face optical coherence tomography (OCT) with standard imaging modalities.

Methods: In this retrospective case series, multimodal imaging was performed in three ASPPC patients at the time of disease presentation.

Results: Clinical and laboratory findings were consistent with the diagnosis of ASPPC. In all the study patients, multiple hyperreflective dot-like lesions distributed in the macular area and observed with en-face OCT at the level of retinal pigment epithelium (RPE) corresponded to the nodular RPE elevations on cross-sectional OCT and to the hyperauto?uorescent spots on fundus autofluorescence. In addition, the cross-sectional OCT scans showed disorganization of the outer retinal bands and punctate choroidal hyperre?ectivity.

Conclusion: By combining en-face OCT with multimodal imaging analysis, we propose that a primary inflammation at the level of the choroid may be the pathogenic mechanism for the occurrence of outer retinal band abnormalities.     

Multimodal Imaging in Retinal Vasculitis

Retinal vasculitis presents with inflammation involving the retinal vasculature as an isolated disease or in combination with other ocular or systemic conditions. This entity may be associated with a wide variety of clinical manifestations such as vascular sheathing, cotton-wool spots, retinal ischemia, and neovascularization. Often, retinal vasculitis and its complications lead to diagnostic challenges in identifying the exact etiology of the inflammation. Ancillary investigations such as fundus photography, fluorescein angiography, and more recently, adaptive optics imaging and optical coherence tomography angiography, may provide valuable information that help in establishing the exact diagnosis and initiation of appropriate therapy. In the index review, multimodal imaging features of retinal vasculitis are described. In addition, detection of vascular inflammation using novel noncontact imaging techniques has been highlighted.     

视网膜大动脉瘤的多模式影像学特征及并发症观察

目的　观察视网膜大动脉瘤的多模式影像学特征及并发症。方法　回顾性分析2014年1月至2018年11月在我院确诊为视网膜大动脉瘤的临床病例资料。所有患者均行常规的眼部检查和眼底影像学检查,包括眼底彩照、频域光学相干断层扫描（spectral-domain optical coherence tomography,SD-OCT）、荧光素眼底血管造影（fundus fluorescein angiography,FFA）和（或）吲哚菁绿血管造影（indocyanine green angiography,ICGA）检查。分析其眼底影像学特征,观察并发症情况。结果　39例患者纳入本研究,均为单眼发病。男7例（17.95%）,女32例（82.05%）,年龄53~86(71.33±9.06)岁。有高血压病史者30例（76.92%）。除1例为双瘤体外,其余均为单瘤体。所有患者均完成了眼底彩色照相和SD-OCT检查,38例完成FFA检查,8例完成ICGA检查。各项检查发现大动脉瘤体的情况:眼底彩色照相32例（82.05%）,SD-OCT检查31例（79.49%）,FFA检查32例（84.21%）,ICGA检查8例（100.00%）。39例患者中,9例并发了不同程度的玻璃体积血,1例并发视网膜分支动脉阻塞,1例并发视网膜分支动脉阻塞和分支静脉阻塞。结论　眼底彩色照相、SD-OCT检查联合FFA检查可对大部分视网膜大动脉瘤进行明确诊断,ICGA检查可作为一项重要的补充检查手段。视网膜大动脉瘤可合并视网膜分支动脉或分支静脉阻塞,应引起临床重视。     

视盘黑色素细胞瘤多模态影像学特征的临床研究

目的探讨视盘黑色素细胞瘤(MCOD)的多模态影像学特征。方法收集2010年8月至2022年3月就诊于首都医科大学附属北京同仁医院眼科中心确诊为MCOD患者21例(21只眼)的临床资料进行研究。其中,男性4例(4只眼),女性17例(17只眼),年龄28~82岁,平均年龄(53.1±14.6)岁。分别进行了彩色眼底照相、眼底自发荧光(FAF)、近红外反射成像(NIR-I)、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、频域光学相干断层扫描(SD-OCT)及光相干断层扫描血流成像(OCTA)检查,观察肿瘤的颜色、大小、位置、边界、是否继发视盘改变、与邻近视网膜或脉络膜的关系、肿瘤FAF特征、NIR-I特征、肿瘤荧光特征、视盘荧光特征、肿瘤的SD-OCT分型及OCTA血流特征。均采用频数和百分比进行描述。结果彩色眼底照相检查中,MCOD呈墨黑色、颜色均匀且边界清晰者17例(17只眼),占80%(17/21)。瘤体位于视盘颞侧者10例(10只眼),占47.6%(10/21)。出现视盘继发改变者14例(14只眼),占66.6%(14/21)。蓝光FAF检测MCOD均表现为完全的低自发荧光,占100%(21/21)。NIR-I检测MCOD均表现为边界清晰的高反射病灶且瘤体表面均呈平行纤维样或绒毛样外观,占100%(21/21)。FFA和ICGA检查MCOD均为低荧光,FFA早期可发现瘤体表面的细小血管者16例(16只眼),占76.2%(16/21)。接受SD-OCT检查MCOD患者10例(10只眼),呈典型表现者7例(7只眼),占70%(7/10);瘤体的不同部位分别呈典型和非典型表现者2例(2只眼),占20%(2/10),呈非典型表现者1例(1只眼),占10%(1/10)。接受OCTA检查者4例(4只眼),均可检测到表面瘤体浅层和深层血管网,占100%(4/4)。结论多模态影像检查可以为MCOD的诊断提供重要的信息。MCOD在NIR-I和FAF检测中的特征性表现具有诊断和鉴别诊断价值。     

Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)

The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited.In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.     

Multimodal Imaging in Ocular Tuberculosis

Intraocular tuberculosis presents a diagnostic challenge because of its protean clinical manifestations. Thus, it becomes imperative to distinguish chorioretinal inflammation due to tuberculosis from other infectious as well as non-infectious posterior uveitis since the clinical manifestations of these entities may be quite similar. With advancing technology, a number of novel imaging modalities are available today that enable in vivo near-histologic assessment of the chorioretinal tissue, greatly aiding the clinician in establishing a diagnosis and monitoring the therapeutic response of tubercular lesions. Techniques such as ultra-wide field fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography and most recently, optical coherence tomography angiography, provide valuable information that helps in advancing our knowledge regarding the pathogenesis and natural history of the disease. The index review describes how these techniques supplement each other, and highlights the relevance of multimodal imaging in the management of intraocular tuberculosis.     

Evaluación multimodal de un «micromelanocitoma» del disco óptico: un reporte de caso

An optic disk melanocytoma is a benign pigmented neoplasm of the optic disk measuring 2.00 mm of diameter in average. Smaller optic disk melanocytomas are rare and have not been studied with multiple imaging studies. A case of a “micro” optic disk melanocytoma measuring 0.71 mm in diameter was studied by multiple imaging modalities, including fundus autofluorescence, ultrasound, visual fields, optical coherence tomography (OCT) and OCT angiography. While clinical appreciation and fundus autofluorescence reveal changes compatible with previously reported cases, OCT, OCT angiography and ultrasound reveal specific changes that could be useful for follow up.     

视盘周围卵状团块样强反射结构研究进展

视盘周围卵状团块样强反射结构(PHOMS)是2018年基于光相干断层扫描增强深部成像(EDI-OCT)提出的新定义。其位于视盘之外、Bruch膜开口(BMO)处上方、卵形、是与视网膜神经纤维层的反射相似的团块状均质结构。既往认为该结构是埋藏型视盘玻璃疣，目前主流观点倾向于PHOMS是视盘周围神经纤维轴突的膨出，提示视神经纤维轴浆流受阻。本文通过PHOMS这一概念提出的原因，辨析了其与视盘玻璃疣(ODD)之间关系，探讨了可能的组织病理机制，总结PHOMS在眼底多模影像上与其他影像特征之间的区别，分析PHOMS在不同疾病中的临床表现及可能的病理生理机制，这对更好地理解神经眼科相关疾病，如近视视神经病变、视神经炎有着重要的意义。此外，本文还提出PHOMS未来可能的研究方向，以获得对PHOMS及其相关疾病的新认识。     

Imaging in retinal vascular disease: A review

Retinal vascular diseases represent a broad field of ocular pathologies. Retinal imaging is an important tool for diagnosis, prognosis and follow up of retinal vascular diseases. It includes a wide variety of imaging techniques ranging from colour fundus photography and optical coherence tomography to dynamic diagnostic options such as fluorescein angiography, and optical coherence tomography angiography. The newest developments in respective imaging techniques include widefield imaging to assess the retinal periphery, which is of especial interest in retinal vascular diseases. Automatic image analysis and artificial intelligence may support the image analysis and may prove valuable for prognostic purposes. This review provides a broad overview of the imaging techniques that have been used in the past, today and maybe in the future to stage and monitor retinal vascular disease with focus on the main disease entities including diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion.     

Recent advances in optical coherence tomography for anterior segment imaging in small animals and their clinical implications

Anterior segment optical coherence tomography (AS-OCT) is a rapidly evolving area of OCT imaging, providing high-resolution and non-invasive volumetric imaging of the anterior segment. This review focuses on recent advances in AS-OCT imaging in small animals, which we categorize into ultrahigh-resolution, spectroscopic, magnetomotive, polarization-sensitive, and angiographic AS-OCTs. We summarize their technical foundations, review their applications to small animal imaging, and briefly discuss their current and future clinical applications.     

OCT检测青光眼视网膜神经纤维层局部缺损的临床研究

背景传统眼底照相的方法诊断视网膜神经纤维层（RNFL）局部缺损依赖于检查者的主观经验,而光学相干断层扫描（OCT）可以客观判断RNFL的局部缺损,新的频域OCT对RNFI,缺损的显示更直观。目的评价频域OCT、时域OCT对青光眼RNFL局部缺损的诊断价值及其与眼底彩色照相的一致性。方法由2位青光跟专家通过眼底彩色照相一致确认存在RNFL局部缺损的青光眼患者55例55眼和正常对照41名41眼纳入研究,分析眼底彩色照相、频域CirrusHD-OCT、时域Stratus OCT分别检测的RNFL局部缺损的位置和宽度,进行三者检测结果的一致性和相关性研究,评价OCT对RNFL局部缺损的诊断价值。结果确认青光眼患者55眼中共有RNFL局部缺损75处,分别位于颞上和颞下象限。CirrusHD-OCT和Stratus OCT检测RNFL损害的灵敏度分别是88．O％和69．3％,特异度分别是927％和97．6％。CirrusHD-OCT和Stratus OCT检测RNFL缺损的位置均与眼底彩色照相结果的检测值呈高度正相关（r=0．993、r=0．992,P〈0．01）;二者检测的RNFL缺损宽度与眼底彩色照相结果的检测值呈正相关（r=0．420、r=0．432,P=0．019、P=0．002）,CirrusHD-OCT和Stratus OCT检测RNFL缺损宽度与眼底彩色照相的检测值比较差异均无统计学意义（CirrusHD-OCT：P=0．114;Stratus OCT：P：0．074）。CirrusHD-OCT和Stratus-OCT检测RNFL缺损宽度值差异有统计学意义（P：0．002）。结论频域OCT和时域OCT均具有较好的诊断RNFL局部缺损的价值,与眼底彩色照相检测值有较好的一致性。     

光相干断层扫描血管成像在眼底疾病诊断研究中的应用

光相干断层扫描血管成像(OCTA)通过对同一体素多次扫描信号间的差异进行处理,得到视网膜与脉络膜血流信息.OCTA因其无创、三维显示、分辨率高等优点,可用于眼底疾病的检查.OCTA能发现眼底疾病的血流改变,可以清晰显示正常眼底与年龄相关性黄斑变性、糖尿病视网膜病变、视网膜血管阻塞等疾病的视网膜与脉络膜毛细血管血流.本文就OCTA的基本原理及其在正常眼、年龄相关性黄斑变性与脉络膜新生血管、糖尿病视网膜病变、特发性黄斑中心凹旁毛细血管扩张症2型、视网膜血管阻塞、中心性浆液性脉络膜视网膜病变、息肉样脉络膜血管病变等眼底疾病诊断中的应用进行综述.     

Acetazolamide for Cystoid Macular Oedema in Bietti Crystalline Retinal Dystrophy

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.     

Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries

Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.