Reproducibility of fundus autofluorescence measurements obtained using a confocal scanning laser ophthalmoscope

AIM: To evaluate the reproducibility of the background fundus autofluorescence measurements obtained using a confocal scanning laser ophthalmoscope. METHODS: 10 normal volunteers and 10 patients with retinal disease were included in the study. One eye per subject was chosen randomly. Five images of the same eye of each individual were obtained, after pupillary dilatation, by two investigators using a confocal scanning laser ophthalmoscope. Background fundus autofluorescence was measured at 7 degrees temporal to the fovea in normal volunteers and between 7 and 15 degrees temporal to the fovea in patients. Within session reproducibility of the measurements obtained by each investigator and interobserver reproducibility were evaluated. RESULTS: For investigator 1 the median values of fundus autofluorescence obtained were 31.9 units for normal volunteers and 27.3 units for patients. The median largest differences in readings in normal volunteers was 5.7 units (range 1.4-13.5 units) and in patients 4.2 units (1.5-15.1 units). For investigator 2 the median values of fundus autofluorescence obtained were 28.9 units for normal volunteers and 27.4 units for patients. The median largest difference in readings in normal volunteers was 3.6 units (2.7-11.7 units), and in patients 4.1 units (1.5-9.3 units). The median interobserver difference in readings in normal volunteers was 3.3 units and for patients 6.6 units. The median greatest interobserver difference in measurements obtained for normal volunteers was 8.8 units (8.4-23.0 units) and for patients 11.1 units (7.1-40.8 units). CONCLUSION: Within session reproducibility of the measurements of background fundus autofluorescence was satisfactory. Although interobserver reproducibility was moderate, the variability of the measurements of fundus autofluorescence between observers appears to be small when compared with variation in fundus autofluorescence with age and disease.     

共焦激光扫描检眼镜在脉络膜黑色素瘤血管造影中的应用

目的将共焦激光扫描检眼镜(cSLO)应用于脉络膜黑色素瘤中,比较同步情况下的荧光素眼底血管造影(FFA)和吲哚青绿(ICGA)造影的肿瘤内部瘤体血管尤其是微血管的显示率,并对所显示的微血管图像特点加以描述。设计回顾性病例系列。研究对象14例(14眼)脉络膜黑色素瘤患者。方法对14例未经治疗的脉络膜黑色素瘤患者采用cSLO进行同步ICGA和FFA检查,每例患者均行不同深度的共焦系列扫描并对两种造影图像进行对比分析。主要指标脉络膜黑色素瘤内微血管显示率及其特征。结果14例患者中,12例(86％)ICGA肿瘤内部不同深度的共焦系列扫描中可以显示有微血管,而FFA检查仅4例(28％)可见瘤体微血管并且仅仅在早期。1例在FFA及ICGA均可见到粗大瘤体血管。只有1例在FFA及ICGA均未见到肿瘤内血管存在。两种检查方法在发现肿瘤内微血管方面差异有统计学意义(P=0．004)。结论应用共焦激光扫描检眼镜结合ICGA显示肿瘤内部微血管特征性改变较FFA更有优势。     

Novel approach towards colour imaging using a scanning laser ophthalmoscope

AIMS—Conventional fundus imaging using a fundus camera produces colour fundus pictures. The scanning laser ophthalmoscope (SLO) has the advantages of lower levels of light exposure, improved contrast, and direct digital imaging but until now has produced monochromatic images as a laser of single wavelength is used. True representation of the fundus is possible by combining images taken using blue, green, and red lasers.
METHODS—A custom built SLO was used to capture blue, green, and red fundus images from suitable volunteers and patients with fundus disease. Images were corrected for eye movement and combined to form a colour image. Colour fundus photographs were taken using a fundus camera for comparison with the SLO image.
RESULTS—The background fundus and retinal vasculature had similar appearances with the two imaging modalities. Internal limiting membrane reflections were prominent with the SLO. Identification of new vessels in the diabetic fundus was easier with the SLO than the colour fundus photographs.
CONCLUSION—A colour SLO offers all the advantages of the present monochromatic imaging system with the added advantage of true colour representation of the fundus.

Keywords: scanning laser ophthalmoscope; fundus imaging; digital colour fundus images     

激光扫描眼底镜同时荧光血管造影和吲哚青绿血管造影

眼底荧光血管造影 (ＦＦＡ)和吲哚青绿血管造影 (ＩＣＧＡ)是检查和记录视网膜、脉络膜血管状态的重要诊断技术。现代的眼底荧光血管造影在 6 0年代就应用于临床 ,人们已经有很清楚的认识 ;而吲哚青绿血管造影是 90年代中期才开始应用 ,虽然目前ＦＦＡ、ＩＣＧＡ的检查在各地已     

Optos 200Tx广角眼底血管造影及其临床应用

广角眼底血管造影是近年来的影像检查新技术,可用于病变范围过大、传统眼底血管造影难以覆盖的患眼,可直观地显示周边部视网膜、脉络膜的血管结构.广角眼底血管造影分为接触式和非接触式两种.近期投入使用的欧堡全景200Tx激光扫描眼底成像系统(Optos 200Tx)是非接触式广角眼底血管造影的代表.它一次即可观察到200°眼底,无需散大瞳孔,且不接触患眼,操作简单、高效而安全,可用于累及周边部眼底的血管性疾病的诊断、鉴别诊断、治疗及随访方案的制定,如糖尿病视网膜病变、视网膜静脉阻塞、视网膜血管炎、葡萄膜炎、眼底肿瘤等.     

Recommended protocol and technique for doing oral fundus fluorescein angiography for adults and children

Fundus fluorescein angiography (FFA) is usually performed intravenously through injection of sodium fluorescein dye. This procedure is difficult to perform in children and patients who are afraid of intravenous needles. Oral FFA can serve as a useful alternative to intravenous FFA in many cases and gives reliable results. We describe the recommended protocol and technique for doing oral FFA in adults and children.     

虹膜荧光血管造影联合眼底荧光血管造影在全视网膜激光光凝术后糖尿病视网膜病变患者中的应用研究

目的　探讨虹膜荧光血管造影（ｉｒｉｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＩＦＡ）联合眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查在全视网膜激光光凝术后（ｐａｎｒｅｔｉｎａｌｐｈｏ-ｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）增生型糖尿病视网膜病变患者中的临床应用。方法　对ＰＲＰ术后的６５例１２３眼增生型糖尿病视网膜病变患者均行视力、眼压、裂隙灯、ＩＦＡ联合ＦＦＡ检查。采用非参数检验法对比分析裂隙灯和ＩＦＡ检测虹膜新生血管灵敏性的差异。结果　ＦＦＡ显示１２３眼中,２１眼视网膜无灌注区,３９眼视网膜新生血管,１２眼玻璃体积血和３２眼黄斑水肿。ＩＦＡ显示１２３眼中,９７眼无糖尿病虹膜病变,１３眼非增生型虹膜病变,１１眼增生型虹膜病变,２眼新生血管性青光眼。所有非增生型虹膜病变眼不能被裂隙灯发现,能被ＩＦＡ检测。ＩＦＡ检查发现虹膜新生血管眼（１１眼）比裂隙灯检查（５眼）更灵敏（Ｐ＝０．０３）。结论　ＩＦＡ联合ＦＦＡ检查能及早发现ＰＲＰ术后的增生型糖尿病视网膜病变合并糖尿病虹膜病变患者,为及时治疗提供帮助。     

特发性黄斑裂孔眼底自发荧光成像研究

目的比较分析特发性黄斑裂孔（IMH）患者眼底自发荧光（FAF）图像及荧光素眼底血管造影（FFA）图像的特征。方法对33例（36眼）IMH患者应用共焦激光扫描检眼镜进行检查,分析FAF图像与FFA图像。另外选取16例正常人作为对照。利用MIG2000图像测量系统对黄斑中心凹进行自发荧光强度测定。结果33例（36眼）IMH患者中,全层黄斑裂孔26眼（72．2％）,板层黄斑裂孔10眼（27．7％）。黄斑自发荧光的特征：正常眼底中心凹FAF呈局部低荧光;黄斑裂孔表现为高荧光,与FFA的图像相似。6例板层裂孑LFAF、FFA均未见异常,其余4例板层孔中心凹处FFA表现为轻度增强的透见荧光,相应部位FAF见轻度增强的自发荧光。全层黄斑裂孔在裂孔处有明显增强的FAF,FFA的“窗样缺损”,在位置、面积、形状上与FAF一致。结论FAF检测为黄斑裂孔的诊断提供了一个新的、快速、非创性检查手段。     

Assessment of optic nerve head topographic parameters with a confocal scanning laser ophthalmoscope

AIM: To assess the disc area, age, sex, laterality (side of the eyes) and refractive error dependent differences in optic nerve head topographic parameters in a normal population. METHODS: Optic nerve head topographic analysis of both eyes of 551 healthy Turkish subjects aged 11-75 years (1102 eyes) was performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II). The effects of disc size, sex, laterality (side of the eyes), age and refractive error on optic nerve head topographic parameters were assessed. Subjects were divided into three different age groups (<30 years, 30-60 years, >60 years) and three different disc area groups (<2.00 mm(2), 2.00-2.25 mm(2), >2.25 mm(2)). Disc area, topography standard deviation and a total of 12 topographic parameters were calculated by HRT II for each subject. Statistical analysis was performed using Student's t-test, multiple regression analysis, Tukey-HSD test, anova and Pearson's correlation coefficient. RESULTS: A total of 543 subjects (298 women and 245 men) were included in the study. The mean disc area of the subjects was 2.12 +/- 0.47 mm(2) (range 1.16-4.98 mm(2)). The mean refractive error of the subjects was -0.58 +/- 1.71 D (range -4.75 D to +4.25 D). The mean cup shape measure was -0.21 +/- 0.07 (95% confidence interval -0.07 to -0.35). The disc area was significantly correlated with all of the topographic parameters but two; namely, the cup shape measure and the height variation contour. Significant age-related differences were detected in four parameters (mean retinal nerve fibre layer [RNFL] thickness, disc area, cup-to-disc area ratio, cup area) and significant sex-related differences were detected three parameters (mean RNFL thickness, height variation contour, RNFL cross-sectional area). However, there were no significant differences in any of the parameters for laterality and refractive error. The parameter cup shape measure did not correlate with any of the five variables investigated. CONCLUSION: Cup shape measure was the only optic nerve head topographic parameter that was independent of age, sex, disc area, laterality and the refractive error. It seems to be a promising parameter in evaluation and comparison of the optic discs of normal subjects, with different disc area, age, sex, refraction error and laterality, as being independent of the main variation factors of the disc topography.     

儿童眼底荧光血管造影分析

目的：分析儿童眼底荧光血管造影的规律及特点。方法：回顾分析我院199例儿童眼底血管造影资料,分析患儿注射荧光素钠后不良反应、臂．视网膜充盈时间及造影结果。结果：199例患者中,41例（20．6％）因屈光不正或弱视造影未见异常荧光,其余158例造影异常病例中以外伤性视网膜病变35例、视网膜变性25例、黄斑营养不良24例及先天眼底异常23例等疾病为多,分别占总病例的17．6％、12．5％、12．1％及11．6％：结论：儿童眼底血管造影检查是一项安全的检查,且对了解儿童眼病发病特点及儿童眼病的诊断及鉴别诊断有积极作用。     

广角激光扫描检眼镜应用于高度近视屈光手术术前周边眼底检查

目的:评价通过免散瞳广角激光扫描检眼镜（OPTOS200）在高度近视患者屈光手术前眼底周边病变筛查中的作用。方法:由两位有经验医师对-6.00D以上准备行屈光手术的72例118眼患者分别行免散瞳广角激光扫描检眼镜检查及散瞳后三面镜检查,观察周边眼底病变的情况（有无变性区、干性视网膜裂孔、视网膜脱离等）。分别对两种检查的检查时间、病变眼数及总病变数等进行统计,再进行对比分析。结果:免散瞳广角激光扫描检眼镜检查,平均时间每眼416±1.22min。散瞳三面镜检查平均检查时间21.64±532min,有显著性差异(P＜0.01)。广角激光扫描检眼镜检查发现存在视网膜周边病变的有60眼(51%),漏诊4眼(以三面镜检查发现),其中有视网膜干性裂孔的6眼,总病变数87处,1例裂孔边缘有轻度的浅脱离。散瞳三面镜检查发现存在视网膜周边变性的有65眼(55%),漏诊1眼(以广角激光扫描检眼镜发现),总病变数128处,视网膜干性裂孔的8眼,其中3例裂孔边缘有轻度的浅脱离。广角激光扫描检眼镜发现病变眼数与三面镜检查无明显差异性(P＞0.05),但平均每眼病变总数有明显差异(P＜0.05)。广角激光扫描检眼镜未发现的视网膜变性区多位于下方,主要是由于部分小睑裂的患者上方眼睑遮挡所致。结论:广角激光扫描检眼镜（OPTOS200）用于高度近视患者屈光手术前眼底周边病变的筛查有效性方面与三面镜等同,是一种便捷、无创的眼底检查方法。但在细节及检查的全面性方面不如三面镜,当筛查有发现病变时,需要进一步的三面镜检查。     

Videofunduscopy and videoangiography using the scanning laser ophthalmoscope in Vogt-Koyanagi-Harada syndrome

AIM—To observe pathophysiological changes in patients with Vogt-Koyanagi-Harada (VKH) syndrome using the scanning laser ophthalmoscope (SLO) to perform videofunduscopy, and indocyanine green (ICG) and fluorescein videoangiography.
METHODS—18 patients diagnosed with VKH syndrome were studied. 15 patients were examined in both acute and convalescent phases, and three patients were examined in the convalescent phase only. Retrospective review of charts was performed to obtain data on visual acuities, clinical findings, and results of cerebrospinal fluid cytology and histocompatibility leucocyte antigen D locus testing.
RESULTS—Videofunduscopy revealed abnormalities in the central macula at the level of the retinal pigment epithelium or choroid in 40% of patients in the acute phase and 83% of patients in the convalescent phase. ICG videoangiography showed irregular hypofluorescence (80%), slow or patchy filling (67%), indistinct or fewer choroidal vessels (73%), filling defects (73%), and focal leakage (33%) in patients in the acute phase. These changes improved with systemic corticosteroid treatment, although at least one ICG videoangiographic abnormality persisted into the convalescent phase in 83% of patients in the absence of clinical inflammation. In contrast, fluorescein videoangiography revealed fewer and decreased severity of abnormalities, with greater resolution in the convalescent phase when compared with ICG videoangiography.
CONCLUSIONS—SLO videofunduscopy and videoangiography revealed numerous abnormalities in patients with VKH syndrome, many of which persisted well after clinical recovery, suggesting the development of permanent morphological changes in the fundus. ICG videoangiography was more sensitive than fluorescein videoangiography in delineating abnormalities in layers deep to the sensory retina.

Keywords: fluorescein; fundus angiography; indocyanine green; Vogt-Koyanagi-Harada syndrome     

Vogt-小柳-原田综合征的眼底荧光血管造影分析

目的：探讨Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada syndrome,VKHS)的眼底荧光血管造影(fundus fluorescein angiography,FFA)的表现及其临床意义。

方法：对VKHS患者16例30眼进行眼部详细检查,并行眼底彩色照相和FFA等检查。

结果：Vogt-小柳-原田综合征葡萄膜炎期的眼底表现为3种类型,脉络膜炎性渗出及渗出性视网膜脱离是视力损害的主要原因,而视盘水肿充血对视力损害较轻,且恢复较好。

结论：FFA的特征性表现对该病早期具有重要诊断意义。     

进口与国产荧光素钠在眼底血管造影中不良反应的对比研究

目的观察进口与国产荧光素钠注射液在眼底荧光血管造影中出现的不良反应,并比较两者是否存在差异性。方法将2008年至2010年在我院眼科门诊行眼底荧光血管造影术检查的患者按检查过程中所注射的进口和国产荧光素钠不同分成A、B两组:A组1156例,B组915例。A组在检查过程中注射美国爱尔康公司生产的100g.L-1荧光素钠,B组注射广州明兴制药股份有限公司生产的200g.L-1荧光素钠。在检查过程中观察患者有无不良反应,对出现不良反应者对症处理并记录症状、体征等病情。结果本研究2071例造影患者中共有186例出现不良反应,发生率为8.98%。轻度不良反应174例,占不良反应的94.05%;中度不良反应11例,占5.91%;重度不良反应1例,占0.54%。A组造影患者中共有82例出现不良反应,发生率为7.09%;B组造影患者中共有104例出现不良反应,发生率为11.37%。A组患者不良反应比B组少,差异有统计学意义(P<0.05)。A组患者轻度不良反应比B组少,差异有统计学意义(P<0.05);两组中度不良反应比较,差异无统计学意义(P>0.05);两组重度不良反应比较,差异无统计学意义(P>0.05)。结论荧光素钠注射液是一种相对安全的造影剂,不良反应发生率低,发生的不良反应多数轻微。进口荧光素钠产生的不良反应比国产荧光素钠少。     

Changes in fixation in the presence of prism monitored with a confocal scanning laser ophthalmoscope

Background: The main optical effect of an ophthalmic prism is to deviate uniformly the entire field of view seen through the prism, resulting in an equal eye movement, if fixation on the same object is to be maintained. Conversely, it has been suggested that, in the case of low vision due to central scotoma, the eye changes its eccentric viewing behaviour when a prism is introduced, that is, the eye remains stationary with a change of retinal image location. Method: A new method is described in which retinal image position was recorded with a confocal scanning laser ophthalmoscope in four experimental conditions. Results: Results showed that the normally‐sighted eye rotates rapidly to compensate for the introduction of a prism. Conclusion: Future studies are required involving subjects with central scotoma but it is likely that many subjects with low vision will also refixate behind a prism and that the prescribing and wearing of bilateral prism in cases of central vision loss will have limited effectiveness in the demonstration or training of eccentric viewing.     

视网膜中央动脉阻塞的荧光血管造影特征

目的 探讨视网膜中央动脉阻塞（ｃｅｎｔｒａｌ ｒｅｔｉｎａｌ ａｒｔｅｒｒｙ ｏｃｃｌｕｓｉｏｎ,ＣＲＡＯ）,患者眼荧光血管造影（ｆｕｎｄｕｓ ｆｌｕｏｒｅｓｃｅｉｎ ａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）的特征。方法 观察２６例２６眼ＣＲＡＯ患者荧光片的眼底血管充盈情况。结果 ＣＲＡＯ患者ＦＦＡ示：（１）动脉前期明显延长;（２）视网膜动脉完成充盈循环时间延长;（３）视网灾光素充盈前峰;（４）静脉回流迟     

眼底荧光素血管造影在小鼠氧诱导视网膜病变中的应用评价

目的：：在小鼠氧诱导视网膜病变模型( oxygen-induced retinopathy,OIR )中评价眼底荧光素血管造影( fundus fluorescein angiography,FFA)的应用价值。方法：将前期实验证实视网膜病变严重程度有明显差异的两组( B组>A组)各12只新生幼鼠于出生后第7 d置于75％浓度氧环境中,第12 d时返回正常空气环境中饲养。第17 d时将A组和B组的幼鼠均随机分配,分别进行FFA检查或高分子量FITC-Dextran灌注结合视网膜铺片检查,即每种检查方法纳入两组幼鼠各6只,利用图像分析软件对视网膜无灌注区进行定量分析和比较。结果：FFA结合图像分析软件能对视网膜无灌注区进行定量分析,与FITC-Dextran灌注结合视网膜铺片的测量结果有良好的可比性,两种方法得到的结果无统计学差异(P>0.05)。结论：FFA结合图像定量分析在小鼠OIR模型的血管病变评价中具有一定的实用价值。     

Comparison of fundus fluorescein angiography and fundus photography grading criteria for early diabetic retinopathy

AIM:To compare the assessment outcomes of the characteristics of mild to moderate non-proliferative diabetic retinopathy(NPDR) established by fundus photography and fundus fluorescein angiography(FFA).METHODS:The fundus photos and FFA results of 260 patients with diabetes mellitus were reviewed.Diabetic retinopathy(DR) severity was graded based on the international classification standard.The microaneurysms,hemorrhages,and intraretinal microvascular abnormalities(IRMA) in FFA images of patients with mild to moderate NPDR were observed.The differences between the fundus photos and the FFA results were summarized,analyzed,and compared.RESULTS:The counting of intraretinal hemorrhages identified by FFA revealed that only 9 eyes(1.9%) had more than 20 intraretinal hemorrhages in all four quadrants;15 eyes(3.1%) had more than 20 intraretinal hemorrhages in three quadrants;26 eyes(5.4%) had over 20 intraretinal hemorrhages in two quadrants;and 37 eyes(7.7%) had more than 20 intraretinal hemorrhages in only one quadrant.Furthermore,the number of IRMAs appeared ≥4 in 17 eyes,3 in 35 eyes,2 in 69 eyes,and 1 in 93 eyes.CONCLUSION:FFA has higher detection accuracy of retinal angiopathy than fundus photography.FFA grading results are helpful for timely detection and proper treatment of lesions easily missed by fundus photography.     

Fundus autofluorescence in patients with macular holes imaged with a laser scanning ophthalmoscope

AIM—To demonstrate the usefulness of a recently developed technique of imaging fundus autofluorescence and to compare it with the results of fluorescein angiography in the diagnosis and staging of macular holes.
METHODS—The intensity and distribution of fundus autofluorescence was studied in 51 patients with idiopathic macular holes and pseudoholes using a confocal laser scanning ophthalmoscope (cLSO) and the images were compared with those obtained by fundus fluorescein angiography.
RESULTS—Autofluorescence imaging demonstrated bright fluorescence of macular holes with appearance similar to that obtained by fluorescein angiography. In contrast macular pseuodoholes showed no such autofluorescence. The attached operculum in stage 2 macular holes and the preretinal operculum in stage 3 macular holes showed focal decreased autofluorescence. The associated retinal elevation and the cuff of subretinal fluid were less fluorescent compared with the background autofluorescence of the normal fellow eyes. Following successful surgical treatment the autofluorescence of the macular holes was no longer visible.
CONCLUSION—Autofluorescence imaging with the cLSO makes the assessment of macular holes possible with an accuracy comparable with that of fluorescein angiography. Being non-invasive and rapid, autofluorescence imaging may become a useful alternative to fluorescein angiography in the assessment and the differential diagnosis of full thickness macular holes.

Keywords: fundus autofluorescence; macular hole; lipofuscin; retinal pigment epithelium; laser scanning ophthalmoscope