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...     

Clinical use and research applications of Heidelberg retinal angiography and spectral-domain optical coherence tomography – a review

Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the 'Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases.     

病理性近视脉络膜新生血管形态学分析及单次光动力治疗临床效果观察

目的分析病理性近视脉络膜新生血管(choroidal neovascularization,CNV)图像特征,并观察单次光动力治疗(photo-dynamic therapy,PDT)治疗CNV的临床效果。方法确诊病理性近视CNV患者12例13眼,进行单次PDT治疗,随访1～24个月,平均7.7个月,观察PDT前后症状、视力以及CNV的光学相干断层扫描(optical coherence tomography,OCT)、荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿脉络膜血管造影(indocyanine green angiography,ICGA)、眼底照像的变化,探讨CNV的形态学特征及PDT治疗效果。结果 60.0%眼视物变形症状减轻或消失。末次随访时84.6%眼保持PDT前裸眼视力或不同程度提高。OCT将CNV分为类圆形、纺锤形、不规则形及色素上皮下型;结果示8眼类圆形CNV经过PDT治疗后6眼(占总数的46.2%)CNV瘢痕形成、2眼(占总数的15.4%)无改善,其他型CNV5眼(占总数的38.5%,包括纺锤形、不规则形及色素上皮下型)经过PDT后CNV消退。眼底血管造影示92.3%眼荧光素渗漏减弱或消退,7.7%眼荧光素渗漏未见减弱。眼底照像可见69.2%眼有Fuch斑;30.8%眼有灰色、扁平、较小病灶,相应处CNV形成;30.8%可见黄斑新鲜出血。结论 OCT对病理性近视CNV形态分型、观察具有重要意义;单次PDT具有抑制或消退CNV的作用和稳定视力的临床效果。     

光学相干断层扫描血管造影(OCTA)在眼科临床的应用

随着现代医学检测技术的发展,对眼科领域诊断要求的不断提高,许多新的测量方法开始在研究及临床中应用,并且不断推陈出新,使得眼科领域检测手段越来越精准、舒适.而光学相干断层扫描血管造影(optical coherence tomography angiography,OCTA)是一种快速的、非侵入性的新型血流成像技术,具有分辨率高、扫描速度快、可量化血流等优点,不仅能够精确地定性分析眼部血管形态,更重要的是能够无创性定量测量眼部血管及血流灌注,同时还能对病变深度进行评估.目前,OCTA在眼部具有广泛的临床应用前景.本文将对OCTA在眼科临床的应用进展进行简要综述.     

Choroidal Folds in Acute Vogt-Koyanagi-Harada Disease

Purpose: To shed light on the clinical significance of choroidal folds (CFs) in acute Vogt-Koyanagi-Harada disease (VKH). Methods: Twenty-three acute uveitic VKH patients diagnosed between October 2001 and January 2008 were reviewed retrospectively. Results: Twelve (52%) patients had CFs; for patients with CFs, more had poor initial visual acuity (≤ 0.1 in either eye, p <.05), and more received immunomodulatory therapy (IMT) than those without CFs (p <.05). Patients without CFs had better best-corrected visual acuity (BCV) at final visit (p <.01). Conclusions: CFs are probably a sign of severe choroidal inflammation and associated with corticosteroid resistance and/or dependence, which indicates IMT.     

高度近视眼弧形斑形态与眼底病变关系的研究

目的研究高度近视眼近视弧形态与近视性眼底病变发生的关系,为临床上早期发现近视性眼底病变提供形态学上的参考。方法回顾性分析高度近视眼25例46眼患者黄斑光学相干断层扫描图像(optical coherence tomography,OCT)、吲哚青绿血管造影(indocyanine green angiography,ICGA)、视力等资料,将单纯漆纹样裂纹改变眼设为A组(5例10眼);出现近视性眼底病变眼为B组(17例30眼;包括A组);无近视性眼底病变眼为C组(8例16眼);分析3组近视弧类型、近视弧面积、白色脉络膜萎缩弧面积、白色脉络膜萎缩弧与近视弧面积比、黄斑部视网膜厚度、黄斑部视网膜体积等形态学变化。结果 A组、B组、C组矫正远视力分别为0.45±0.29、0.34±0.25、0.82±0.22,A、B组与C组比较,差异均有统计学意义(均为P<0.05)。A、B2组近视弧形态各方面比较差异均无统计学意义。B、C组比较:近视弧面积比较差异有统计学意义(P=0.030),95%可信区间分别是5.85～8.45mm2、2.67～6.79mm2;白色脉络膜萎缩弧面积比较差异有统计学意义(P=0.010),95%可信区间分别是2.03～4.04mm2、0.08～2.07mm2;白色脉络膜萎缩弧与近视弧面积比比较差异也有显著统计学意义(P=0.000),95%可信区间分别为0.28～0.47、0.00～0.25。75%(24/32)环形弧眼、82.7%白色脉络膜萎缩弧眼出现近视性眼底病变。A、B、C3组黄斑区视网膜厚度、黄斑部视网膜体积差异均无统计学意义(均为P>0.05)。结论近视性眼底病变明显影响视力;近视弧面积超过5.85mm2,白色脉络膜萎缩弧面积达到2.00mm2且与近视弧面积比超过0.28以上,白色脉络膜萎缩弧、环形弧的出现,均应警惕近视性眼底病变的发生。     

OCT血管成像在眼科的应用

光学相干断层扫描血管成像(OCTA)是近年来新兴的血管成像技术,除具备传统OCT的优点外,还能够分层观察视网膜脉络膜血管形态及血流改变情况,使用伪彩可区分正常与异常的血管结构,并且能够对血流信号进行探测和量化分析。此外,与传统的荧光素眼底血管造影(FFA)和吲哚菁绿造影(ICGA)技术不同,OCTA无需静脉注射造影剂就能提供比传统眼底血管造影技术更多、更准确的血流信息。但是,任何技术的临床应用都有其局限性。本文将对OCTA的基本原理及其在眼科的应用、局限性进行综述。     

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.     

视网膜色素上皮炎的OCT图像与FAA图像对比性研究

目的 通过光学相干断层扫描（optical coherence tomography，OCT）和眼底荧光血管造影（fundus fluorescein angiography，FFA）观察视网膜色素上皮炎（retinal pigment epithelitis）患者视网膜影像学特征。方法 对临床诊断为视网膜色素上皮炎的82例145眼进行光学相干断层扫描检查，观察其病变区形态并测量病灶的高度和宽度，同时与眼底荧光血管造影对照。结果 视网膜色素上皮炎（retinal pigment epithelitis）的OCT图像，共有6种表现：（1）色素上皮断裂并视网膜下新生血管膜；（2）色素上皮脱离合并神经上皮脱离；（3）“沙漏”样神经上皮脱离；（4）隐匿性色素上皮脱离；（5）色素上皮脱失；（6）色素上皮增殖。结论 OCT同时辅助FFA可准确地诊断视网膜色素上皮炎。     

多模式成像在匍行性脉络膜炎中的应用进展

匍行性脉络膜炎(SC)是一种罕见的慢性特发性炎性疾病,主要侵犯视网膜色素上皮(RPE)和脉络膜毛细血管,以视盘周围青灰色或灰黄色的地图状病变为特征。病因不清,脉络膜毛细血管炎可能是其主要病理类型。根据眼底表现可分为视盘周围型、黄斑型、变异型SC。由于SC的临床表现丰富多样,且与急性后部多灶性鳞状色素上皮病变(APMPPE)、结核、视网膜弓形虫病和脉络膜缺血等表现类似,所以对不具有典型眼底改变的SC诊断仍然存在一定困难。随着科技的进步,像荧光素眼底血管造影、吲哚菁绿血管造影、眼底自身荧光及光相干断层扫描等多模式影像检查联合应用有助于SC的早期诊断、评估病变范围、活动性以及可能的并发症,且对于避免不必要的药物使用至关重要。     

局灶性脉络膜凹陷的临床特征分析

目的　观察局灶性脉络膜凹陷（ｆｏｃａｌｃｈｏｒｏｉｄａｌｅｘｃａｖａｔｉｏｎ,ＦＣＥ）的临床特征。方法　回顾性分析１６例（１７眼）临床确诊的ＦＣＥ患者的临床资料。所有患者行最佳矫正视力（ｂｅｓｔ-ｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、裂隙灯显微镜、间接眼底镜检查及光学相干断层扫描检查,部分患者行眼底彩色照相检查、眼底荧光血管造影、吲哚青绿血管造影（ｉｎｄｏｃｙａ-ｎｉｎｅｇｒｅｅｎａｎｇｉｏｇｒａｐｈｙ,ＩＣＧＡ）检查。结果　１６例患者中男１１例（６８．８％）,女５例（３１．２％）;年龄２５～７５（４３．５６±１２．５３）岁;双眼１例,单眼１５例。１７眼中,正视６眼（３５．３％）,近视１１眼（６４．７％）。患眼初诊ＢＣＶＡ０．２～１．０（０．６９±０．２２）。眼底检查ＦＣＥ处表现为大致正常、不同程度脱色素或黄白色病灶。光学相干断层扫描检查示１６眼为单一ＦＣＥ,１眼有２处ＦＣＥ;９眼（５２．９％）为偏中心凹型ＦＣＥ,８眼（４７．１％）为中心凹下型ＦＣＥ。ＦＣＥ病灶处眼底荧光血管造影呈透见荧光或者大致正常,ＩＣＧＡ呈程度不同的低荧光。结论　ＦＣＥ多单眼发病,也可双眼发病;与屈光状态无显著相关性;视力可正常或不同程度下降;ＦＣＥ处眼底表现为不同程度脱色素或黄白色改变,也可大致正常。     

光动力疗法治疗渗出性年龄相关性黄斑变性

目的观察光动力疗法(photodynamic therapy,PDT)治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾分析经荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)以及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的21例(31眼)渗出性AMD患者PDT治疗前及治疗后的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出性AMD的治疗效果。结果治疗后13眼视力明显改善(视力提高≥2行),占41.9%;14眼视力稳定不变(视力波动在1行以内),占45.2%;4眼视力下降2行,占12.9%。大部分患眼于PDT治疗后眼底出血和渗出减轻;ICGA检查显示:PDT治疗后1周,16眼CNV的渗漏明显减少或完全停止,8眼渗漏完全停止。OCT检查显示:CNV周围视网膜脉络膜水肿以及神经上皮脱离好转。5例6眼患者在PDT治疗过程中及治疗后发生视网膜神经上皮脱离范围变大,1例1眼发生黄斑部再次大面积出血,所有病例均未发生任何全身不良反应。结论单次和重复PDT治疗可以部分或完全封闭渗出性AMD的CNV,PDT治疗对病灶周围的正常视网膜和脉络膜组织短期内有轻度影响,对视力无损害。     

Imaging in Neovascular Age-Related Macular Degeneration

Imaging plays an essential role in the diagnosis and treatment of age-related macular degeneration (AMD). This review describes the imaging modalities most commonly employed by ophthalmologists caring for patients with neovascular AMD. Imaging modalities discussed include fluorescein angiography, optical coherence tomography, indocyanine green angiography, and fundus autofluorescence.     

Changes of Indocyanine Green and Fluorescein Angiography in Multiple Evanescent White-dot Syndrome： A Case Report

Purpose:To study the clinicopathological change on "Multiple Evanescent White-dot Syndrome (MEWDS)" through fundus angiogrphy analyses.Methods:Examing the case with fluorescein angiography (FFA) and indocyanine green angiography(ICGA), visual field and following up for 15 months.Results:There exist multiple white dots in the fundus photo and angiography. The changes on ICGA maintain longer than fundus photo and FFA. Papille may be edematous and macula could present with special hypofluorescent flecks.Conclusions:MEWDS has specific angiographic features. Its pathological changes involve deep retinal pigment epithelium(RPE) as well as choroidal capillaries. The prognosis of the visual acuity for MEWDS is very good. Eye Science 2003;19:171-173.     

眼科影像学检查对Vogt-小柳-原田病疗效的评价

目的 探讨眼B超、光学相干断层扫描（OCT）、眼底荧光血管造影（FFA）、吲哚青绿眼底血管造影（ICGA）对Vogt-小柳-原田病（Vogt-Koyanagi-Harada Disease,VKH）疗效评价的意义.方法 对1998年1月～2006年6月在本院确诊、治疗和随访的80例VKH患者的资料进行回顾性分析,所有患者均予以糖皮质激素治疗,在治疗前和治疗后不同的时间点进行眼B超、OCT、FFA、ICGA检查,对检测结果进行对比分析.结果 所有患者经过系统治疗后,炎症均得到了控制,患眼视力明显提高.治疗后,B超示玻璃体混浊和脉络膜增厚减轻至正常,OCT示视网膜神经上皮或色素上皮脱离逐渐平复,FFA示视网膜渗漏逐渐减轻至消失.治疗前ICGA示弱荧光黑斑、脉络膜灌注不良、脉络膜血管扩张、血管壁染色和渗漏、片状强荧光,治疗后上述病变逐渐恢复正常.结论 眼B超、OCT、FFA、ICGA对VKH疗效评价具有重要意义,为疾病的病情追踪、疗效评价和指导用药提供了客观依据,从而有利于对VKH的规范化治疗.     

Vogt-小柳-原田综合征葡萄膜炎期荧光素钠及吲哚菁绿同步眼底血管造影特征分析

目的探讨Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada disease,VKH)葡萄膜炎期荧光素钠及吲哚菁绿同步眼底血管造影的影像学特征及其临床意义,为诊断及病程监测提供依据。方法回顾性分析11例22眼VKH葡萄膜炎期患者应用海德堡HRA2共焦激光扫描眼底血管造影系统进行的荧光素钠眼底血管造影(fundus fluorescein angiography,FFA)和吲哚菁绿血管造影(indocyanine green angiography,ICGA)同步检查资料,比较2种检查的影像学特征。结果 11例22眼中,FFA检查8眼(36.36%)后极部多处脉络膜充盈迟缓;9眼(40.91%)视盘渗漏水肿;22眼(100.00%)后极部视网膜色素上皮密集针尖状高荧光渗漏,18眼(81.82%)后极部神经上皮脱离部位FFA晚期形成多囊样或多湖状荧光积存;13眼(59.09%)静脉期散在、均匀脉络膜炎性病灶,呈斑点状低荧光。ICGA检查15眼(68.18%)脉络膜充盈迟缓;14眼(63.64%)脉络膜血管扩张;16眼(72.73%)播散状分布、斑点状脉络膜炎性低荧光病灶;18眼(81.82%)后极部神经上皮脱离区大多呈现持续低荧光,晚期部分囊样病灶呈中强荧光;9眼(40.91%)视盘水肿晚期显示视盘及盘周低荧光。FFA和ICGA同步检查结果:FFA检查100.00%患眼静脉期视盘周及后极部密集点状高荧光渗漏,而在ICGA上无此征象;FFA检查视盘表面毛细血管扩张比ICGA显示更明显;ICGA检查脉络膜充盈迟缓15眼(68.18%)及斑点状炎性病灶16眼(72.73%),均高于FFA检查结果的8眼(36.36%)和13眼(59.09%),而且ICGA早期脉络膜血管扩张显示更清晰;后极部神经上皮脱离病灶在FFA静脉期表现为低荧光,晚期形成荧光积存,而病变区域ICGA检查相应部位多为持续低荧光。结论 VKH葡萄膜炎期FFA清晰显示视网膜色素上皮损伤特征以及炎症累及视盘、视网膜的程度和范围;ICGA能够清晰显示脉络膜循环改变及脉络膜炎症的活动性和范围。FFA和ICGA同步检查对VKH诊断及发病机制有重要的指导意义。     

吲哚青绿眼底血管造影诊断视网膜大动脉瘤

目的：评价吲哚青绿眼底血管造影（Ｉｎｄｏｃｙａｎｉｃｅ Ｇｒｅｅｎ Ａｎｇｉｏｇｒａｐｈｙ,ＩＣＧＡ）在诊断视网膜大动脉瘤（Ｒｅｔｉｎａｌ Ｍａｃｒｏａｎｅｕｒｙｓｍ）中的作用。方法：使用德国ＨＥＩＤＥＬＢＥＲＧ ＥＮＧＩＮＥＥＲＩＮＧ生产的海德堡眼底血管造影仪（ＨＲＡ）,对两例临床分别诊断为老年性黄斑变性和眼底出血的患者,进行同步的眼底荧光血管造影（Ｆｕｎｄｕｓ Ｆｌｕｏｒｅｓｃｅｉｎ Ａｎｇｉ     

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.     

光动力疗法联合抗血管内皮生长因子治疗息肉状脉络膜血管病变的效果:基于光学相干断层扫描血管成像（OCTA）的观察

目的　利用光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）及频域光学相干断层扫描（optical cohorence tomography，OCT）评估息肉状脉络膜血管病变（polypoid choroidal vasculopathy，PCV）光动力疗法（photodynamic therapy，PDT）联合抗血管内皮生长因子（vascular endothelial growth factor，VEGF）治疗后疗效。方法　回顾性分析PCV患者46例48眼的临床资料，患眼均行荧光素眼底血管造影（fundus fluorescein angiography，FFA）、吲哚菁绿血管造影（indocyanine green angiography，ICGA）、OCT及OCTA检查，所有患者按照常规剂量先行PDT治疗，3~5 d内再联合抗VEGF治疗，随访3~24个月。分析并比较PCV治疗前后视力、中央视网膜厚度（central retinal thickness，CRT）的变化，以及治疗前后OCTA上息肉病灶、异常分支血管网（branching vascular network，BVN）的变化。结果　治疗后3个月、6个月、12个月、24个月患眼视力均提高，CRT均下降。治疗前最佳矫正视力为（0.50±0.40）logMAR，治疗后24个月为（0.44±0.37）logMAR，差异有统计学意义（t=4.452，P＜0.05）。治疗前CRT为（601.89±183.88）μm，治疗后24个月CRT厚度为（457.54±207.80）μm，差异有统计学意义（t=5.968，P＜0.05）。治疗前48眼中OCTA上息肉病灶检出率70.8%，ICGA上息肉病灶检出率100.0%；34眼联合OCTA检查治疗后3个月、6个月、12个月、24个月息肉病灶完全消退率分别为79.4%、78.8%、75.8%和83.3%。治疗前14眼在OCTA检查中未发现息肉病灶，在联合治疗后复查OCT，治疗后3个月、6个月、12个月、24个月指状突起消退率分别为71.4%、76.9%、75.0%、87.5%。患者联合治疗OCTA上BVN的面积治疗前为（0.916±0.215）mm²，治疗后3个月、6个月、12个月及24个月分别为（0.823±0.286）mm²、（0.909±0.312）mm²、（1.121±0.389）mm²和（1.672±0.230）mm²。结论　典型的PCV病变在PDT联合抗VEGF治疗后能安全有效地显著改善和稳定患者的视力、降低CRT、促进息肉病灶消退。无创、快速和可重复的OCTA联合OCT可作为联合治疗后评价PCV病情有用的随诊技术。     

Review for Diagnostics of the Year: Multimodal Imaging in Behçet Uveitis

Behçet disease is a chronic relapsing multisystem inflammatory disorder. Ocular involvement is characterized by a bilateral recurrent non-granulomatous panuveitis and retinal vasculitis. Posterior segment findings vary during the course of the disease, in parallel with the relapsing and remitting intraocular inflammation. Structural alterations occur with increased disease duration. Fluorescein angiography is the gold standard in revealing the extent and severity as well as the leaky and/or occlusive nature of retinal vasculitis. Multimodal imaging using color fundus photography, fluorescein angiography, and optical coherence tomography is essential in visualizing diagnostic features, detecting structural changes, and monitoring disease activity and response to treatment in patients with Behçet uveitis.