OCT及OCTA在阿尔茨海默病诊断中的研究进展

阿尔茨海默病是一种进行性且不可逆转的神经系统疾病,由于视网膜和中枢神经系统有相似的胚胎起源和生理特征,眼科检查可提供简单无创的诊断方法。光学相干断层扫描技术(OCT)能够精确地测量视网膜各个组织层面的厚度,以评估视网膜的退行性改变,光学相干断层扫描血管成像(OCTA)可以提供高分辨率三维成像,从而更直观地检测视网膜血管的变化,间接地反映脑神经元和血管的病理特征。就OCT测量视网膜厚度及OCTA测量视网膜血流变化在阿尔茨海默病诊断中的研究进展进行综述。     

中医辨证论治前后CSC患者OCTA变化及其与视力的相关性研究

目的 探讨中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC)患者中医辨证论治前后光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)变化及其与视力的相关性。方法 选取单眼CSC患者75例(75眼)进行中医辨证分型入组,其中湿浊上泛证组25例(25眼)、肝经郁热证组25例(25眼)、肝肾不足证组25例(25眼)。对入组的患者对证予以中药方剂水煎服,3个月(3个疗程)后统计疗效。应用OCTA测量入组患者患眼(75眼)治疗前与治疗1个月、2个月、3个月后的黄斑区脉络膜和视网膜血流密度指标及形态结构指标,分别对3组CSC患眼治疗前后的OCTA指标进行比较,并分析各指标治疗前后的变化。采用标准对数视力表检查3组CSC患眼治疗前与治疗1个月、2个月、3个月后的最佳矫正视力(best-corrected visual acuity, BCVA),再换算成logMAR视力表数值观察治疗前后的视力变化,并分析OCTA指标变化与logMAR BCVA的相关性。结果 与治疗前比较,治疗...     

高度近视患者黄斑区视网膜劈裂分型与脉络膜特征分析

目的 探讨不同类型高度近视视网膜劈裂患者脉络膜特征及临床意义。方法 采用横断面研究。2019年1月至2022年3月于首都医科大学附属北京友谊医院眼科就诊的患者中,选取根据黄斑病变萎缩-牵拉-新生血管(atrophic, tractional, neovascular components, ATN)分型符合T0～T3级高度近视患者74例74只眼纳入研究。其中,男性20例20只眼、女性54例54只眼;平均年龄(64.3±11.2)岁;眼轴长度(axial length, AL)(29.2±2.78)mm。患者均行加强深度成像模式光学相干断层扫描。依据ATN分型将患者按照病变程度分为T0～T3级,分别为20、23、18、13只眼。获取黄斑中心凹多个部位脉络膜厚度数据,采用MATLAB软件计算该区域的脉络膜容积(macular choroidal volume, MCV)。参数间行相关性分析。组间差异比较采用单因素分析和多因素分析。结果 T0～T3组患者MCV分别为(4.6±2.3)mm³、(3.1±1.2)mm³、(2.9±1.3)mm^...     

光学相干断层扫描联合眼底彩色照相在中心性浆液性脉络膜视网膜病变诊断中的应用

目的探讨光学相干断层扫描（OCT）和眼底彩色照相对中心性浆液性脉络膜视网膜病变（CSC）定位的临床意义。方法对经荧光素眼底血管造影（FFA）确诊的CSC43例（49眼59个渗漏点）行OCT联合眼底彩色照相检查,并测量渗漏点距黄斑中心凹的距离。结果59个渗漏点在OCT上和/或眼底彩色照相上有阳性体征者54个（91.5%）。FFA测量的54个渗漏点到黄斑中心凹的平均距离为(2.15±1.06)mm,OCT测量的平均距离为（2.09±1.04）mm,二者差异无统计学意义（P＞0.05）。 结论OCT联合同步眼底彩色照相可以用于CSC的定位诊断。     

颈内动脉闭塞患者黄斑区视网膜脉络膜厚度变化分析

目的 探讨颈内动脉闭塞(internal carotid artery occlusion, ICAO)患者黄斑区视网膜厚度及黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness, SFCT)的变化。方法 回顾性分析50例(100眼)确诊为ICAO的患者,入选患者为一侧ICAO,对侧颈内动脉无狭窄或狭窄率<50%。使用频域光学相干断层扫描仪以黄斑中心凹为中心进行扫描,测量黄斑中心视网膜厚度(central macular thickness, CMT)、距离黄斑中心凹1 mm区域内、外层视网膜平均厚度及SFCT。结果 ICAO同侧眼与对侧眼比较,CMT分别为(244.56±18.25)μm、(248.02±23.12)μm,两者差异无统计学意义(t=-1.673,P=0.101);距离黄斑中心凹1 mm区域内层视网膜厚度[(63.76±10.16)μm vs(64.92±10.89)μm]和外层视网膜厚度[(180.80±17.31)μm vs(184.22±22.01)μm]差异均无统计学意义(t=-1.569,P=0.123;t=-1.839,P...     

中心性浆液性脉络膜视网膜病变的视力预后与视网膜光感受器的关系

目的 探讨慢性中心性浆液性脉络膜视网膜病变(CSC)光动力疗法治疗后的视力恢复情况与黄斑区视网膜光感受器完整性之间的关系。方法 对经临床诊断为CSC的30例患者(30眼)给予半剂量微替泊芬,联合光动力疗法(PDT),在治疗后第12个月,检查患者的最佳矫正视力,同时进行光学相干断层成像术检查,观察黄斑区视网膜光感受器层(IS/OS)的状态,并与患者的最佳矫正视力进行相关分析。结果 PDT治疗后12个月,26眼(86.7%)视力保持稳定或明显提高。20眼(66.7%)在黄斑区可见完整的IS/OS,呈连续线状;6眼(20.0%)的IS/OS线呈断续状; 2眼(6.7%)未发现IS/OS线。具有连续或断续线状IS/OS的患者视力均好于IS/OS阙如患者的视力,差异有统计学意义(P＜0.05),患者的最后视力与IS/OS的完整性明显相关(P＜0.05)。结论 慢性CSC光动力疗法治疗后的视力恢复与黄斑区视网膜光感受器的完整性密切相关。     

高度近视豹纹状眼底视网膜脉络膜血流改变及相关性分析

目的 观察并定量分析高度近视不同级别豹纹状眼底患者黄斑及视盘区域视网膜、脉络膜血流参数变化。方法 采用横断面临床研究,收集2018年6月～12月在医院就诊的高度近视患者42例(76眼),所有患者均行彩色眼底照相和光学相干断层扫描血管成像(OCTA)检查。应用ETDRS分区,根据脉络膜大血管暴露程度,将受检眼分为0级组、1级组、2级组和3级组。采用OCTA测量黄斑不同区域视网膜浅层毛细血管丛、视网膜深层毛细血管丛(DCP)以及视盘区视乳头层、放射状视盘周围毛细血管层(RPC)血管密度,测量中心凹下脉络膜厚度(SFCT)、脉络膜总面积(TCA)、脉络膜管腔面积(LA)、脉络膜基质面积(SA),并计算脉络膜血管指数(CVI)。统计学采用Kruskal-Wallis H检验、单因素方差分析、Dunnett’s检验及多重线性回归,视网膜、脉络膜血流参数与豹纹状眼底分级的关系采用偏相关分析。结果 各组间黄斑中心凹DCP血管密度、视盘区RPC层血管密度、SFCT、TCA、LA、SA、CVI比较差异有统计学意义(P均<0.05)。豹纹状眼底分级与黄斑中心凹DCP血管密度、CVI呈正相关(r=0....     

眼缺血综合征患者脉络膜厚度的分析

目的 应用频域光学相干断层扫描仪(SD-OCT)测量眼缺血综合征(OIS)患者黄斑中心凹下脉络膜厚度(SFCT),观察OIS患者SFCT的特征,探索早期评估OIS的指标.方法 为回顾性病例对照研究,共纳入2017年1月至2020年1月在北京市垂杨柳医院就诊患者48例(48眼),以是否确诊OIS将患者分为OIS组24例(...     

超声乳化术对老年性白内障黄斑区视网膜结构影响的临床研究

目的 应用光学相干断层扫描血管成像(OCTA)观察老年性白内障患者超声乳化术后黄斑区血流密度、视网膜厚度和中心凹无血管区(FAZ)面积的变化。探究术中参数对黄斑区结构变化的影响以及探索影响术后视力的因素。方法 这是一项前瞻性观察研究。老年性白内障患者超声乳化术前及术后1 d、1周、1个月、3个月应用OCTA进行黄斑区3 mm×3 mm自动化扫描,以获得黄斑区血流密度、视网膜厚度及FAZ面积。记录术中累计释放能量(CDE)和有效超声乳化时间(EPT),分析其与黄斑区视网膜结构变化的相关性。应用二分类Logistic回归分析探究影响术后视力的因素。结果 41例(41眼)纳入最终分析。与术前相比,术后1 d、1周、1个月、3个月黄斑区血管线性密度、灌注密度均增加(P<0.05),FAZ面积均降低(P<0.001);术后1个月、3个月黄斑区视网膜厚度均较术前增加(P<0.05)。术中CDE、EPT与黄斑区视网膜结构变化无相关性(P>0.05),术后最佳矫正视力(BCVA)与黄斑区血流密度、视网膜厚度、FAZ面积、CDE和EPT均无相关性(P>0.05)。结论 老年...     

OCT在原发性急性闭角型青光眼中的应用

目的应用光学相干断层扫描仪（OCT）测量原发性急性闭角型青光眼（APACG）视网膜神经纤维层（RNFL）厚度,观察其变化规律。方法应用OCT测量首次急性发作（＜6?h）的APACG患者(26例)RNFL厚度的改变,测量时间为入院经治疗角膜透明后当天和经治疗眼压下降至正常范围后1周、1个月、3个月、6个月（共5次）。同时测量正常成人（年龄匹配,30例）的RNFL厚度作为对比。结果入院经治疗角膜透明当天和眼压正常后1周平均RNFL厚度分别为（122.14±21.37）、（110.25±17.43）μm,较正常对照组增厚（P<0.01,P<0.05）;眼压正常后1个月平均RNFL厚度为（103.34±15.19）μm,较正常稍增厚（P>0.05）;眼压正常后3个月和正常后6个月平均RNFL厚度分别为（102.56±14.11）、（101.22±15.54）μm,较正常对照组稍下降（P>0.05）。结论眼压急性升高在早期造成RNFL水肿,RNFL厚度增厚,经过治疗眼压降至正常范围后,RNFL厚度逐渐下降。眼压正常后3个月和6个月RNFL厚度趋于稳定。     

Imaging of the pediatric airway using optical coherence tomography

OBJECTIVES: Optical coherence tomography (OCT) is an imaging modality that uses a broadband light source to produce high-resolution cross-sectional images in living tissue (8-20 microm). A prospective study of normal, benign, and pathologic tissues in the pediatric airway was conducted to assess the utility of OCT technology in characterizing the microanatomy of the pediatric upper aerodigestive tract in vivo. STUDY DESIGN: Prospective clinical trial. MATERIALS AND METHODS: Fifteen patients from 1 to 17 years of age underwent surgical endoscopy and OCT for various airway disorders. OCT imaging was performed at a frame rate of 1 Hz using a 1.3-microm broadband light source to produce images 1.6 x 6 mm in vertical and horizontal dimensions. The epithelium, lamina propria, and unique tissue microstructures were visualized and then measured using digital micrometry. Direct comparison of OCT images with endoscopic photography was performed. RESULTS: Systematic imaging of the oral cavity, oropharynx, hypopharynx, and larynx was performed in all 15 patients. Normal microstructures identified included papillae, ducts, glands, and vessels, whereas pathologic conditions included distinct zones of mature scar, granulation tissue, edema, ulceration, and papillomatosis. Endoscopic photographs were well correlated with OCT images. CONCLUSIONS: OCT is capable of obtaining high-resolution microanatomy images of pediatric airway in vivo tissue. OCT clearly identifies the epithelium and lamina propria while providing detailed structural information on normal and diseased tissues. OCT is a promising emerging imaging modality for use in current pediatric patient populations.     

光学相干断层扫描技术在非动脉炎性前部缺血性视神经病变中的诊断现状

非动脉炎性前部缺血性视神经病变(NA-AION)是一种中老年人常见急性致盲性眼病,临床表现为晨起或短暂休息后突发性的视力下降或视野缺损,视野缺损通常与生理盲点相连。目前,眼底和视野检查、荧光素眼底血管造影、视觉诱发电位是NA-AION常用的辅助检查手段。近年来,光学相干断层扫描技术(OCT)因具有无创、安全性高、分辨率高、扫描速度快、可三维重建和分层分析的特点已广泛用于NA-AION的诊疗中。本研究主要对OCT在NA-AION中的诊断现状及临床意义进行综述。     

Technique of optical coherence tomography of the larynx during microlaryngoscopy

Optical coherence tomography (OCT) is a new, noninvasive imaging technology for the evaluation of superficial lesions. Because of a penetrating depth of a few millimeters and an ultrahigh tissue resolution, it qualifies for use in the larynx and might in the near future play an important role in the pre-, intra-, and postoperative investigation of early laryngeal cancer and its precursor lesions. Especially directed to otolaryngologists, this paper describes the technique of in vivo OCT imaging of the larynx in detail during microlaryngoscopy and supplies a number of personal hints.     

Optical coherence tomography of the cochlea in the porcine model

Objectives/Hypothesis: To demonstrate the feasibility of optical coherence tomography in microstructural imaging of the porcine cochlea. Study Design: Ex vivo, porcine model. Methods: Optical coherence tomographic images of the porcine cochlea were obtained by thinning the bone from the basal turn of the cochlea leaving the endosteum intact. The images were compared with the corresponding histological sections. Results: In the areas of thinned bone, images were obtained of the stria vascularis, Reissner's membrane, basilar membrane, tectorial membrane, scala media, scala tympani, and scala vestibuli. The bone was too thick for adequate light penetration in the areas where it was not thinned. Good histological correlation was obtained. Conclusions: Cochlear and vestibular microanatomic structures of the pig cochlea were clearly identified with histological confirmation, suggesting the potential application of this noninvasive imaging modality for in vivo imaging of the human cochlea.     

3‐D optical coherence tomography of the laryngeal mucosa*

Laryngeal carcinoma is one of the commonest primary head and neck malignancy and the need for early identification is very important for successful treatment. Outpatient fibreoptic examination of the larynx is unreliable in differentiating benign, pre‐malignant and malignant lesions, and therefore surgeons have to rely on biopsies for a definitive diagnosis. This is an invasive procedure requiring general anaesthesia and may have a detrimental effect on the patient's voice. Conventional imaging modalities (ultrasound, computed tomography and magnetic resonance imaging) have a limited resolution and hence cannot give sufficient information on the extent or nature of laryngeal lesions. The aim of our study is to investigate the feasibility of optical coherence tomography (OCT) in imaging the normal larynx, to lay the foundations for an investigation of its ability to differentiate between benign and malignant disease. Ten tissue specimens from normal larynges were imaged with an 850 nm OCT system that was capable of providing both B‐scan (longitudinal or cross‐section) images as well as C‐scan (en‐face or images at constant depth). The en‐face OCT mode allowed us to reconstruct 3‐D OCT images of the tissue examined. Imaged specimens were processed with standard histopathological techniques and sectioned in the plane of the B‐scan OCT images. Haematoxylin–eosin stained specimens were compared with the OCT images thus collected. Preliminary results showed good correlation between OCT images and histology sections in normal tissue.     

Optical coherence tomography of laryngeal cancer

OBJECTIVES: Optical coherence tomography (OCT) is a high-resolution optical imaging technique that produces cross-sectional images of living tissues using light in a manner similar to ultrasound. This prospective study evaluated the ability of OCT to identify the characteristics of laryngeal cancer and measure changes in the basement membrane, tissue microstructure, and the transition zone at the edge of tumors. MATERIALS AND METHODS: One hundred thirty-three patients underwent OCT examination during surgical endoscopy of the head and neck. Twenty-two patients with laryngeal cancer or a history of laryngeal cancer were imaged with a fiberoptic OCT system. Tumor and adjacent transition zones were imaged along with uninvolved subsites. OCT images were correlated with histopathology. RESULTS: Twenty-six OCT examinations were performed in 22 patients. Basement membrane disruption was seen in 18 subjects, all of whom had histology showing classic features of cancer. A transition zone to uninvolved epithelium at the tumor periphery was also often observed. In six studies, benign or premalignant processes were histologically confirmed. In three thin, superficial lesions, an intact basement membrane was observed. The basement membrane could not be identified in three other bulky exophytic, premalignant lesions, primarily because of increased superficial signal backscattering observed in pathologic tissues. CONCLUSIONS: OCT clearly identifies basement membrane violation from laryngeal cancer and can identify transition zones at the cancer margin. In bulky exophytic lesions, OCT signal may not penetrate deeply enough to show the basement membrane, but for many suspicious lesions that require exclusion of cancer, OCT shows potential for assisting in diagnostic assessment.     

OCT测量RNFLT、mGCCT在视神经萎缩诊断和视功能评价中的应用

目的 利用频域光学相干断层扫描（OCT)观察视网膜神经纤维层厚度（RNFLT）、黄斑神经节细胞复合体厚度（mGCCT）在视神经萎缩诊断和视功能评价中的作用。方法 选择视神经萎缩患者50例,其中健眼26眼、患眼68眼纳入研究,行最佳矫正视力（BCVA）检查,BCVA≥0.05者行视野检查。利用频域OCT测量mGCCT及RNFLT,分析OCT主要参数对视神经萎缩诊断的价值及其与BCVA、视野等视功能指标的相关性,以及区分正常眼与视神经萎缩眼的能力和对BCVA的影响程度。结果 单因素分析显示,平均mGCCT、整体丢失体积(GLV) 、局部丢失体积(FLV）、平均RNFLT对各评价指标均有统计学意义(P<0.05)。多因素分析显示,平均mGCCT、GLV对视神经萎缩的诊断,平均mGCCT、GLV对BCVA,平均mGCCT对视野平均偏差（MD）、视野模式标准偏差（PSD）,FLV对视野MD,GLV对视野PSD有统计学意义(P<0.01),而平均RNFLT对视神经萎缩的诊断、BCVA、视野分析等均无统计学意义(P>0.05)。受试者工作特征曲线下面积（AUC）分析显示,平均mGCCT,上、下方平均mGCCT,平均RNFLT,颞侧、上方平均RNFLT对视神经萎缩诊断准确性较高（0.9相似文献