OCT联合FFA对埋藏性视盘玻璃膜疣诊断价值

目的探讨光相干断层扫描（OCT）联合眼底荧光血管造影（FFA）对埋藏性视盘玻璃膜疣的临床诊断价值。方法回顾性研究2009年1月至2015年6月就诊于黄骅市人民医院眼科,诊为埋藏性视盘玻璃膜疣125例（246只眼）,并分析其OCT、FFA的相应特征。结果埋藏性视盘玻璃膜疣OCT表现为视盘神经纤维层下、神经上皮层间发现类圆形似有囊膜包裹的团状高反射信号,相应处视杯变浅,FFA则为高荧光结节。结论无创的OCT检查并联合FFA检查,可以明确是否存在埋藏性视盘玻璃膜疣,从而提高该病的诊断率,降低其漏诊和误诊率。     

埋藏性视盘玻璃膜疣的临床分析

目的 探讨埋藏性视盘玻璃膜疣的临床表现、眼底荧光血管造影(fundus fluores-cein angiography,FFA)和B超特征.方法 回顾性分析2003年3月至2006年7月确诊为埋藏性视盘玻璃膜疣的32例(32眼)患者的临床资料,对其眼底表现、FFA及B超检查结果进行分析讨论,结果眼底表现:3例未见异常,26例可见视盘周围视网膜前或视网膜下出血.3例出现玻璃体腔出血.FFA:26例视盘周围可见视网膜下出血遮蔽荧光;12例早期视盘可见局限性强荧光,晚期边界呈结节状强荧光,余20例未见特异性结节状着色.32例患者B超检查均可见视盘处的不规则扁平隆起病灶,呈类圆形强回声.结论 对于伴有近视合并视盘周围出血的青年患者,采用FFA结合B超检查可提高埋藏性视盘玻璃膜疣的检出率     

频域相干光断层扫描联合超声检查诊断埋藏性视盘玻璃疣

目的 探讨频域相干光断层扫描(SD-OCT)联合超声检查对埋藏性视盘玻璃疣的诊断价值.方法 通过SD-OCT对视盘进行横向扫描,采用超声检查观察视盘前有无强回声光团.结果 通过SD-OCT联合超声检查诊断埋藏性视盘玻璃疣15例(27只眼),平均年龄25.6岁,其中12例为双眼发病(80.0％).27只眼中,所有病灶均位于鼻侧视盘,其中23只眼为近视状态(85.2％),平均屈光度-3.6 DS.埋藏性视盘玻璃疣的SD-OCT特征为:视网膜外核层下方可见一个或多个圆形或类圆形的高反射信号的疣体,疣体上方的视网膜神经纤维高度隆起呈强反射光带;在连续扫描的数个层面上,均可以看到疣体.该病的眼球超声检查表现为:视盘前一个结节状的强回声光团,当增益降低至眼球正常结构消失时,强回声光团仍清晰可见.结论 SD-OCT联合超声检查可诊断埋藏性视盘玻璃疣,是值得推荐的方法.     

年龄相关性黄斑变性玻璃膜疣的F-10共焦激光扫描检眼镜retro-mode成像检查

目的:探讨F-10共焦激光扫描检眼镜(cSLO)retro-mode成像在年龄相关性黄斑变性(AMD)玻璃膜疣检查中的应用价值.方法:回顾性病例研究.选取 2015-10/2016-12于我院眼科门诊确诊的AMD患者67例67眼和对侧67眼的临床资料纳入研究.所有患者均行眼底彩色照相、光学相干断层扫描(optical coherence tomography,OCT)和F-10cSLOretro-mode成像检查.对比观察单侧AMD患者患眼玻璃膜疣的眼底彩色照相、OCT及retro-mode成像图像特征,并计算分析retro-mode成像与眼底彩色照相及OCT对单侧AMD患者对侧眼玻璃膜疣的检出率.结果:F-10cSLOretro-mode成像能够清晰显示单侧AMD患者患眼一些在眼底彩色照相和OCT检查中并未出现的玻璃膜疣病灶.在67例单侧AMD患者对侧眼,retro-mode成像发现玻璃膜疣56眼(84%),眼底彩色照相发现玻璃膜疣36眼(54%),OCT发现玻璃膜疣48眼(72%),差异有统计学意义(χ2=14.31,P<0.05).两两分别比较,retro-mode成像对玻璃膜疣的检出率显著高于眼底彩色照相,差异有统计学意义(χ2=13.87,P′<0.0125);而retro-mode成像与OCT比较对玻璃膜疣的检出率差异无统计学意义(χ2=2.75,P′>0.0125).结论:F-10cSLOretro-mode成像作为一种非侵入性的检查方法,能够有效地检测AMD玻璃膜疣.     

相干光断层成像检查对视盘小凹的临床意义

目的探讨相干光断层成像(OCT)检查对视盘小凹的临床意义。方法对6例(6只眼)视盘小凹患者进行回顾性研究,全部病例均采用OCT进行扫描,详细分析患者视盘、乳头黄斑束区及黄斑区的结构改变。结果 OCT显示全部6例患者视盘表现为颞侧筛板组织缺失,呈无组织反射的暗区,5例视盘小凹与视网膜劈裂腔之间有光学空腔相连,伴有黄斑区神经上皮浆液性脱离,2例有脉络膜缺损。结论由于OCT是横截面成像,能在活体上观察视盘小凹患者的视盘、乳头黄斑束区、黄斑区视网膜各层次的改变;因而OCT在视盘小凹的发病机制、诊断、随访中有重要临床意义。     

双眼视盘埋藏玻璃膜疣误诊为视神经炎1例

视盘玻璃膜疣(optic disc drusen,ODD)是发生在视盘上崩解的神经纤维轴突线粒体内非细胞钙化沉积.神经纤维的轴浆流改变和轴突变性是主要形成原因.1858年,Müller首次对ODD作了组织学描述[1],1868年,Liebrich[2]报道了第1例临床病例.本文报道我科收治的双眼视盘埋藏玻璃膜疣1例,并结合相关文献对ODD作一介绍.     

视盘埋藏性玻璃膜疣误诊分析

视盘埋藏性玻璃膜疣是一种原因不明，双眼或单眼受累的先天性视神经发育异常。该病发病隐匿，患者自觉症状表现轻微，往往易被误诊或漏诊。现将我院2例(3眼)确诊病例报告如下。     

50岁以上患者黄斑区视网膜浆液性色素上皮脱离的相干光断层扫描特征分析

目的 探讨50岁以上患者黄斑区视网膜浆液性色素上皮脱离(FED)的相干光断层扫描(OCT)图像特征.方法 回顾分析2003年6月至2007年8月50岁以上患者出现黄斑区浆液性PED的37例(50只眼)临床资料,患者均进行经黄斑区OCT检测,观察其图像特征,并结合眼底彩色照相、荧光素眼底血管造影(FFA),部分病例行吲哚菁绿血管造影(ICGA)检查结果 进行分析.结果 根据本文所选病例的OCT特征,将50岁以上患者出现黄斑区浆液性PED脱离分为3种:单纯性PED者14只眼(28%),玻璃膜疣样PED者26只眼(52%),合并神经上皮层脱离的PED者10只眼(20%).单纯性PED见于部分萎缩型年龄相关性黄斑变性(AMD)9只眼(18%)、特发性浆液性PED者5只眼(10%);玻璃膜疣样PED见于部分黄斑玻璃膜疣样病变26只眼(52%);合并神经上皮层脱离的FED见于部分复发性/迁延性中心性浆液性脉络膜视网膜病变(CSC)6只眼(12%)、视网膜下血管病变病例4只眼(8%).结论 50岁以上患者发生黄斑区浆液性PED可能是早期和基础性的老年性改变,其进一步的变化将导致脉络膜和视网膜的损害.OCT能够发现无明显临床症状的浆液性PED,清晰地显示PED形态,准确地测量PED范围,简化随访过程,有利于年龄相关性黄斑病变的早期诊断和治疗.     

非动脉炎性前部缺血性视神经病变患者眼底影像检查特征及其与视力、病程转归的关系

目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者的荧光素眼底血管造影(FFA)与光相干断层扫描(OCT)检查等影像特征.探讨其与视力、病程转归的关系.方法 回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料.所有患者均接受视力、眼底、视野等常规眼科检查.初诊时同时进行FFA和OCT检查.FFA及视野检查按常规方法进行;OCT检查分别选择线性和环形扫描方式,进行黄斑和视盘的扫描.其中35例NAION患者分别于发病后0.5、1、2、3、6个月时进行OCT复查.回顾分析时,以36例患者的对侧健眼作为对照组,对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系.结果 FFA检查结果显示,所有患眼均表现为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏,24只患眼在黄斑区出现强荧光渗漏.OCT检查结果显示,所有患眼视盘隆起,生理凹陷变窄或消失;视盘与黄斑(盘斑)之间神经上皮层组织增厚或神经上皮层隆起,下方有液性暗区.对照眼中,14只跟有正常视盘生理凹陷,22只眼无生理凹陷或较小的生理凹陷.NAION组0.5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度,视盘周围视网膜神经纤维层厚度均高于对照组,差异均有统计学意义(F＝6.51,26.12,75.49;P<0.05).2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时变薄.3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时明显变薄,低于对照组,差异有统计学意义(F＝75.49,37.92;P<0.05).视野检查结果显示,下方视野缺损21例,占45.7%.OCT检查结果显示,随病程进展,视盘上方神经纤维层厚度下降的程度更明显,与视野的表现相一致.视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系(r=-0.394,-0.424,-0.412,-0.464;P<0.05).结论 NAION患者FFA特征为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏;OCT特征为随病程发展,视网膜神经上皮层增厚,神经纤维层变薄.视盘形态及视网膜神经纤维层变化的OCT检查与视野检查结果一致;患者视力与神经上皮层厚度的OCT检查结果呈负相关关系.     

显性玻璃膜疣合并高度远视一家系

目的 观察显性玻璃膜疣合并高度远视一家系的临床表现.方法 回顾分析来自同一家系的3例显性玻璃膜疣合并高度远视患者的临床资料.采用复方托品酰胺充分散大瞳孔后,在验光中心采用电脑验光和检影的方法确定患者的屈光状态.采用Zeiss公司FF450 plus眼底照相机行眼底彩色照相及荧光素眼底血管造影(FFA)检查.同时行视网膜电图(ERG)检查,观察患者的ERG表现特征.结果 散瞳验光结果显示,3例患者均存在不同程度的远视性屈光不正.除先证者母亲左眼矫正视力可达正常视力外,其余患眼均存在屈光不正性弱视.眼底彩色照相检查显示,3例患者均有不同程度的玻璃膜疣存在.先证者弟弟病变程度最轻；先证者母亲病变最为明显,除黄斑区外,周边部也存在大量散在的玻璃膜疣.FFA检查显示,相应于彩色眼底像中的玻璃膜疣处,均表现为透见荧光.ERG检查显示,先证者弟弟明视ERG振幅下降,暗视ERG正常.先证者及其母亲明视、暗视ERG均正常.结论显性玻璃膜疣合并高度远视患者可伴有屈光不正性弱视.相应于玻璃膜疣处,FFA表现为透见荧光.ERG表现除明视振幅可发生下降外,其余表现均正常.     

糖尿病性视神经病变的OCT图像特点分析

目的：回顾分析糖尿病性视神经病变( diabetic optic neuropathy, DON )的相干光断层成像( optical coherence tomography,OCT)的特点。
　　方法：回顾性系列病例研究。选择2013-12/2015-10西安交通大学医学院第二附属医院眼科门诊和内分泌科会诊期间诊断为2型糖尿病且伴有眼底病变的患者175例350眼的临床资料,记录患者的全身检查情况和疾病史,阅读所有患者的彩色眼底照相、荧光素眼底血管造影( fluorescein fundus angiography,FFA)、OCT的影像结果,并进行分析统计。
　　结果：通过FFA 检查视乳头具有异常荧光表现,确定有DON的有49例90眼,占25.7%。 OCT结果显示DON 90眼中15眼(16.7%)表现为视神经形态大致正常;20眼(22.2%)表现为视杯凹陷变小或消失,筛板前组织肿胀,同时伴有盘周神经纤维层水肿;26眼(28.9%)表现为视杯深陷,杯盘比变大;18眼(20.0%)表现为视盘内或视盘表面组织增生;11眼(12.3%)玻璃体视乳头牵拉,视盘边缘抬高。在FFA中有相同荧光表现的DON患眼,在OCT检查可表现出不同的组织形态。
　　结论：FFA从视神经的血循环状态变化定义DON,而OCT可以发现FFA所不能显示的视神经组织形态的变化,从而更清晰视神经病变的位置和原因,为治疗提供依据。OCT无创、快捷、费用低、可重复性强等优点有利于DON患者的复查及治疗效果追踪。     

Glaucoma masqueraders: Diagnosis by spectral domain optical coherence tomography

BackgroundAdvances in optic nerve and retinal imaging have dramatically changed the care of glaucoma patients, complementing the importance of the clinical exam of the optic nerve and automated perimetry in making the diagnosis of glaucoma. Computerized imaging, however, does not replace the clinical exam, as there can be overlap in the appearance of non-glaucomatous optic neuropathies with glaucoma.MethodsThe spectral domain optic coherence tomography (SD-OCT) images of five patients with non-glaucomatous optic nerve pathology are presented.CasesThe first patient had bilateral temporal thinning on OCT imaging and subsequent positive syphilis testing. The second patient had a glaucomatous-appearing inferior arcuate scotoma and associated superior thinning on OCT; these findings were due to buried optic nerve head drusen, clearly appreciated on OCT of the optic nerve head. Bilateral diffuse macular thinning, with preservation of the superior and inferior fiber bundles, was seen in the third patient, who had multiple sclerosis, with no clinical history of optic neuritis. Dense and marked thinning of a macular half, respecting the horizontal meridian, is seen in two patients, one patient with non-arteritic anterior ischemic optic neuropathy and lastly, in a patient with hemi-retinal vein occlusion.ConclusionSD-OCT of the optic nerve and retina complements the essential clinical examination of patients with glaucomatous and non-glaucomatous optic neuropathies.     

眼底炫彩成像联合光相干断层扫描对视网膜动脉阻塞快速诊断及分类

目的:探讨眼底炫彩成像(MCI)联合光相干断层扫描成像(OCT)在视网膜动脉阻塞(RAO)的快速诊断及分类中的应用。方法:对本院2018-02/2020-07诊断为RAO的患者19例19眼进行回顾性研究。所有患者在经过眼科检查后确诊为RAO,均为单眼发病,其中视网膜中央动脉阻塞(CRAO)13眼,视网膜分支动脉阻塞(BRAO)5眼,睫状视网膜动脉残留的CRAO 1眼。所有患者行最佳矫正视力、裂隙灯、OCT、MCI、FFA及视野检查及分析。结果:经裂隙灯检查,12眼(63%)出现瞳孔对光反射迟钝或消失,16眼(84%)可发现全部或部分后极部视网膜苍白水肿,10眼(53%)可发现视网膜动脉变细。行FFA检查的患者为10例(53%),其余9例未行检查,其中6例患有严重的系统性疾病,2例拒绝检查、1例有药物过敏史。所有患者经MCI及OCT检查可发现特征性眼底表现,OCT特征性改变为弥漫性内层视网膜反射增强与MCI图像绿色缺血区域形成严密的一对一关系。结论:联合MCI及OCT检查可快速确诊RAO,而且结合两者的图像特征可更精确辨认出视网膜缺血区域,有助于疾病分类及预后判断。     

FFA和OCT在Vogt-小柳原田病和多发中心性浆液性脉络膜视网膜病变鉴别诊断中的影像学特点

目的:探讨荧光素钠眼底血管造影(fundus fluorescein angiography,FFA)与频域光学相干断层扫描(optical coherence tomography,OCT)检查在Vogt-小柳原田病(Vogt-Koyanagi-Harada disease,VKH)和多发中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)鉴别诊断中的影像学特点.方法:回顾性分析2009/2016来我院接受诊治的VKH患者17例32眼和多发CSC患者30例35眼,通过FFA和OCT检查对比分析两种疾病的影像学特征.结果: VKH患者早期多呈密集针尖样高荧光,晚期多湖状荧光积存17眼(53%),视盘相对高荧光24眼(75%).多发CSC患者早期多处点状高荧光,随时间延长渗漏,晚期有2眼(6%)视盘相对高荧光.VKH患者14例28眼于我院行OCT检查,多发CSC患者22例25眼于我院行OCT检查,其中RPE皱褶仅见于VKH患者,而内界膜波浪样改变和膜样结构较多见于VKH患者,对鉴别多发CSC敏感度(54%、68%)较高.结论:VKH和多发CSC在FFA、OCT检查方面有一定相似性,但FFA和OCT检查可显示不同的影像学特点,对VKH、多发CSC的诊断各具优势,两者结合最有利于VKH和多发CSC的鉴别诊断.     

Visual field defects and retinal nerve fiber layer defects in eyes with buried optic nerve drusen

PURPOSE: To evaluate the visual field with the use of automated perimetry and to evaluate the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT) in patients with buried optic nerve drusen (OND). DESIGN: Observational case control study. METHODS: Eyes with buried OND were defined as eyes with ultrasound-proved drusen that were not visible with indirect slit-lamp biomicroscopy. All eyes underwent automated perimetry. Some eyes underwent OCT to evaluate the RNFL. RESULTS: Fifty-eight eyes of 41 patients with buried OND were evaluated. Three eyes (5%) had inferior arcuate scotomas. The other 55 eyes did not have visual field defects. Twenty-one of the eyes without visual field defects underwent RNFL analysis with OCT. All 21 eyes had normal average RNFL thickness. Some eyes had focal RNFL defects, but it is not clear whether these defects were clinically significant. CONCLUSION: Visual field defects are uncommon in eyes with buried OND. Eyes with buried OND may have focal RNFL defects but have normal average RNFL thickness. In patients with buried OND and a visual field defect, consideration should be given to searching for other causes of the defect, especially if the defect is substantial.     

A case of optic nerve drusen associated with Grönblad-Strandberg syndrome

PURPOSE: We report a rare case of optic nerve drusen associated with Gr?nblad-Strandberg syndrome. CASE: The patient was a 29-year-old woman who had pseudoxanthoma elasticum on her neck. OBSERVATIONS: On eye examination, there were no abnormal findings in the anterior segment or ocular media. Ophthalmoscopic examination revealed milky white granular lesions on the optic nerve disc, and angioid streaks around the disc in both eyes. Orbital computerized tomography(CT), B-scan echography and photography with a fluorescein angiography filter identified the granular lesions as optic nerve drusen. With a scanning laser ophthalmoscope(SLO), poorly-visible drusen buried below the nerve head could be detected. The optic nerve drusen could be seen more clearly by infrared laser than by helium-neon laser. CONCLUSIONS: SLO using infrared laser is useful for evaluation of superficial and buried drusen.     

OCT: New perspectives in neuro-ophthalmology

Optical coherence tomography (OCT) has become essential to evaluate axonal/neuronal integrity, to assess disease progression in the afferent visual pathway and to predict visual recovery after surgery in compressive optic neuropathies. Besides that OCT testing is considered a powerful biomarker of neurodegeneration and a promising outcome measure for neuroprotective trials in multiple sclerosis (MS).Currently, spectral-domain OCT (SD-OCT) technology allows quantification of retinal individual layers. The Ganglion Cell layer (GCL) investigation has become one of the most useful tools from a neuro-ophthalmic perspective. It has a high correlation with perimetry, is predictive of future progression and is a highly sensitive, specific of several neuro-ophthalmic pathologies. Moreover the superior correlation with clinical measures compared to peripapillary retinal nerve fiber layer (pRNFL) suggests that GCL analysis might be a better approach to examine MS neurodegeneration.In disorders with optic disk edema, such as ischemic optic neuropathy, papillitis and papilledema, reduction in RNFL thickness caused by axonal atrophy is difficult to distinguish from a swelling resolution. In this setting, and in buried optic nerve head drusen (ONHD), GCL analysis may provide more accurate information than RNFL analysis and it might be an early structural indicator of irreversible neuronal loss.Enhanced depth imaging OCT (EDI-OCT) provides in vivo detail of ONHD, allowing to evaluate and quantify the drusen dimensions.OCT is improving our knowledge in hereditary optic neuropathies. Furthermore, there is growing evidence about the role of OCT as an adjunctive biomarker of disorders such as Alzheimer and Parkinson’s disease.     

Anterior ischemic optic neuropathy in association with optic nervehead drusen

Optic nerve head drusen (ONHD) are incidental ophthalmologic finding in the optic nerve. Patients with ONHD are often asymptomatic, but sometimes present with transient visual obscuration''s (TVO), the reported incidence of which is 8.6%. Optic nerve head drusen are of two types: Superficial; visible and deep. The deep-buried drusen mimic papilledema. Because of the varied presentation deep-buried drusen pose a diagnostic challenge to the ophthalmologists. In young patients, they are mistaken for papilledema as it is clinically difficult to detect a buried drusen in the optic nerve head, but are seen on the surface with aging as the retinal nerve fiber layer thins out. They are observed as pale yellow lesions more often located towards the poles. Clinical examination aided with diagnostic tests like computed tomography (CT) orbits and ultrasound B scan can help establish the diagnosis. Herein, we report a rare case of optic nerve head drusen in a young lady, who presented with loss of vision and clinical evaluation and investigations suggested ONHD with anterior ischemic optic neuropathy.     

视力骤降待查患者行OCT检查的临床意义

目的：探讨在因屈光介质因素而首诊为视力骤降待查的患者中,应用OCT检查来判断视网膜动脉阻塞这类眼科急症的可行性和临床意义。
　　方法：回顾分析我院78例因视力骤降待查接受OCT检查并最终通过FFA检查确诊的病例。以FFA检查作为判断标准,以OCT检查作为待评价的检查手段,并用软件统计OCT的灵敏度、特异度和总符合率。同时统计分析两种检查方法从门诊医生开出检查单到报告给出的用时差异。结果：OCT检查的灵敏度、特异度和总符合率均相当高,分别为100%,94.1%和98.4%。而在从门诊医师开出检查单到报告给出的用时上,OCT检查的时间明显短于FFA,其差异有统计学意义(P=0.000)。
　　结论：临床上对于因屈光介质因素而首诊为视力骤降待查的患者,应首先使用OCT检查来判断是否为视网膜动脉阻塞类疾病,以便更快地收治患者,为抢救视力赢得时间。     

Computed tomographic diagnosis of buried drusen of the optic nerve head

We present three patients with optic nerve drusen. On the basis of headaches, transient obscurations of vision, or visual field loss the patients underwent orbital computed tomographic (CT) scanning. This procedure confirmed the presence of buried drusen in the four optic discs that had yielded poor ophthalmoscopic and angiographic evidence of drusen; drusen had been observed in the other two discs. The indications for CT scanning in the presence of visible or buried drusen of the optic nerve head are discussed.