高度近视眼OCT检查评估和预后预测

目的对高度近视眼黄斑部进行光学相干断层扫描(Optical Coherence Tomography,OCT)检查评估。方法观察分析60例114眼OCT图象特征,测量黄斑区视网膜神经纤维层厚度,比较其与眼轴长度和矫正视力的关系。结果黄斑区视网膜神经纤维层厚度131μm～169μm,平均145μm±14μm。眼轴≤25mm时,Ⅲ组的眼数多于Ⅰ组(P<0.01);眼轴25～27mm,Ⅱ组眼数多于Ⅰ组(P<0.01);眼轴≥27mm时,Ⅰ组的眼数多于Ⅱ组(P<0.01)。视网膜神经纤维层厚度≤140μm,眼轴≥27mm的眼数多于≤25mm组(P<0.01);厚度141μm～150μm,眼轴25～27mm的眼数明显多于其它两眼轴组(均P<0.01);厚度>150μm,眼轴≤25mm的眼数多于≥27mm组(P<0.01)。厚度≤140μm,则矫正视力≤0.3的眼数多于0.4～0.5组(P<0.05);厚度141μm～150μm,0.4～0.5组的眼数多于≥0.6组(P<0.01);厚度>150μm,≥0.6组的眼数明显多于≤0.3组(P<0.01)。后巩膜葡萄肿发生率为91.23%(104眼),其中有27.88%(29眼)出现视网膜劈裂。结论OCT是高度近视眼的良好检测手段,可以观察到高度近视眼易发生的后巩膜葡萄肿和视网膜劈裂。随屈光度的增高,眼轴的增长,视网膜神经纤维层厚度逐渐变薄,矫正视力越差。     

高度近视眼黄斑劈裂的OCT影像特征

目的 观察高度近视眼黄斑劈裂的OCT形态学特征,分析其发生的相关危险因素.方法 回顾性分析268例(369只眼)屈光度≥-6.00D的高度近视眼患者继发视网膜劈裂的OCT表现以及与眼轴长度、屈光度、后巩膜葡萄肿、后极部脉络膜视网膜萎缩变性等因素的相互关系.结果 OCT显示68例(93只眼)存在视网膜劈裂;其中78只眼为外层劈裂,14只眼为混合性劈裂,1眼为内层劈裂.所有存在劈裂眼中,2只眼劈裂远离黄斑区,91只眼位于黄斑区,累及一至四个象限不等,其中53只眼为中央凹劈裂,38只眼为旁中央凹劈裂,中央凹劈裂的形态多样,并伴有视网膜前膜或玻璃体牵引、局限性视网膜脱离、黄斑板层裂孔等改变.所有高度近视眼患者中,视网膜劈裂眼与未发生视网膜劈裂眼的眼轴长度、屈光度、后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性比较,差异均有统计学意义(P均<0.01),Logistic回归结果示:超长眼轴(≥29mm)是视网膜劈裂发生的危险因素,屈光度并不是其发生的危险因素,后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性均是其发生的危险因素(P=0.002,0.073,0.027,0.003,0.011).结论 OCT能明确视网膜劈裂发生的部位,清晰地显示视网膜劈裂的形态特征,视网膜劈裂多发生在黄斑中央凹.可累及整个黄斑区,以外层劈裂多见.视网膜劈裂的发生与超长眼轴、后巩膜葡萄肿、玻璃体视网膜牵引以及后极部脉络膜视网膜萎缩变性等因素有关.

Abstract：

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

高度近视眼黄斑劈裂的OCT影像特征

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

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。     

光学相干断层扫描在眼底疾病中的应用与进展

作为一种无创性的眼科临床诊断技术,光学相干断层扫描(optical coherence tomography,OCT)在视网膜疾病诊断中发挥着重要的作用。随着OCT从时域时代进入到频域时代,高速扫描和高分辨率的OCT为视网膜的分层识别带来了巨大的进展,而随着深度成像OCT的发展,很多以往不能成像的眼组织深层结构也得以观察。在未来的发展中,OCT的分辨率和穿透力将进一步提升,而功能性OCT,如多普勒OCT的出现,也将使OCT在现代眼科诊断中发挥更加重要的作用。     

光学相干断层成像技术在帕金森病中的发现及探索

帕金森病(Parkinson’s disease,PD)是老年人常见的神经系统退行性疾病,眼部及视觉功能障碍是PD常见的非运动症状之一,进一步影响其生活质量。已有研究表明PD患者视网膜内存在多巴胺浓度的减少以及α突触核蛋白的沉积。目前,PD仍缺乏有效的早期诊断及病情评估工具,光学相干断层扫描及光学相干断层扫描血管成像技术可以显示视网膜各层微细结构及微血管的异常,应用该技术研究者发现PD患者视乳头旁视网膜神经纤维层及黄斑区视网膜的厚度均存在不同程度的变薄,视网膜浅层及深层毛细血管丛的毛细血管密度和复杂性下降。进一步研究者应用该技术在PD临床应用中进行了探索,并发现其可用于检测早期PD中发生的病理变化,反映疾病的病程及严重程度,并且在鉴别诊断中起到一定的作用。总而言之,视网膜相关检测可能成为评估PD患者脑病理严重程度的指标,并且帮助疾病诊断和监测疾病的进展,不过这仍需要大样本、多中心的重复研究以提供更多理论依据。     

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.     

扫频源光学相干断层扫描血管成像在眼科临床中的应用进展

扫频源光学相干断层扫描血管成像(SS-OCTA)检查是近几年提出的一种新型血管成像技术,具有非侵入性、快速、高分辨率、自动化血管分层成像等优势,在眼科相关疾病的早期诊断、疗效评估及监测疾病进展等方面具有很高的价值。基于OCTA的基础,SS-OCTA采用快速调谐的激光器和1 050 nm的波长,穿透力更强,对视网膜和脉络膜微血管系统进行无创深度分辨成像,加深了对多种眼部疾病(眼底病变、青光眼、神经退行性疾病等)特征的认识。此外,SS-OCTA也可用于研究眼前节结构,如角膜新生血管的深度和密度、虹膜新生血管治疗前后的变化等。该技术为眼科临床实践提供了一种新的手段。本文就SS-OCTA技术在眼科临床的应用进展进行综述。     

OCTA在青少年眼底检查及其与眼轴关系研究中的应用

目的：研究光学相干断层扫描血管成像(OCTA)检查在青少年受检者中的检查情况及其与眼轴之间的关系。

方法：前瞻性非随机临床研究。收集青少年受检者33例66眼的临床资料进行分析。所有受检者行裸眼视力、屈光度、矫正视力检查后,行眼轴测量及OCTA检查。采用SPSS19.0软件分析OCTA各检测结果及其与眼轴之间的关系。

结果：受检者眼轴长度平均为24.46±1.50mm,黄斑区平均血管密度为(47.88±2.56)%,黄斑区平均神经纤维层厚度为278.61±15.08μm,视盘周围平均血管密度为(57.79±2.99)%; 视盘周围平均毛细血管密度为(53.08±3.49)%; 其中眼轴长度与黄斑区神经纤维层厚度呈负相关(P=0.006),眼轴与其他检测结果均不相关。

结论：青少年眼底OCTA的检测指标中,黄斑区神经纤维层厚度与眼轴之间呈负相关,血管密度方面的检测指标与眼轴均无相关性。     

多模式影像检查在Coats病诊断及随访中的应用

Coats病以视网膜毛细血管扩张为明显特征。荧光素眼底血管造影是诊断Coats病视网膜血管扩张及渗漏的金标准。眼底照相及眼部B超也常用于Coats病的诊断及病情评估中, 但因检查结果缺乏特异性, 对Coats病诊断及随访帮助有限。OCT可直观呈现视网膜各层结构变化并明确病变层次, 为Coats的临床诊断提供更丰富的信息。相干光断层扫描血管成像(optical coherence tomography angiography, OCTA)及超广角荧光素血管造影术(ultra-widefield fluorescein angiography, UWFA)可对Coats病的血管病变进行准确评估。多影像检查如超广角眼底照相(ultra-widefield fundus photograph, UWF)及炫彩照相等, 对传统眼底照相技术进行了补充。UWF和UWFA结合OCT及OCTA检查能为Coats病的诊断及随访提供更全面的信息。(国际眼科纵览, 2023,47:156-162)     

红外自发荧光与相干光断层扫描在后极部脉络膜裂伤应用

目的 探讨近红外自发荧光(NIA)联合相干光断层扫描(OCT)检查在视网膜后极部脉络膜裂伤中的应用价值.方法 对2009年2月至2014年4月在河南省立眼科医院确诊为视网膜后极部脉络膜裂伤11例患者进行眼底荧光血管造影(FFA)、NIA和OCT检查,并统计FFA和NIA测量脉络膜裂伤程度结果.结果 8例视网膜后极部脉络膜裂伤未合并视网膜下出血患者FFA与NIA均能从平面显示脉络膜裂伤长度,两组数据比较差异无统计学意义(t =1.06,P=0.31＞0.05).OCT从切面显示脉络膜裂伤及与黄斑中心凹距离.3例视网膜后极部脉络膜裂伤合并视网膜下出血患者NIA和OCT能立体评估和随访视网膜下出血位置及隆起高度的变化.NIA联合OCT检查所需时间约为FFA的35.56％,所需费用为FFA的38.64％.结论 NIA和OCT为无创性检查,两者联合能更简单和经济评估后极部脉络膜裂伤及合并视网膜下出血的患者.     

高度近视眼黄斑区神经上皮层厚度的OCT检测研究

目的探讨高度近视眼黄斑区视网膜神经上皮层厚度的变化。方法选取200／年5月至2007年12月在我院就诊并行光学相干断层扫描（OCT）检查的高度近视眼患者64例（64只眼）和正常对照者铝例（48只眼）,分为高度近视组和正常对照组,测量其黄斑中心凹、中心凹上下方及颞侧、鼻侧各750μm处的视网膜神经上皮层厚度,比较两组有无显著性差异。结果高度近视组的黄斑区视网膜神经上皮层厚度均低于正常对照组,二者差异有显著意义（P〈0．01）。结论高度近视眼黄斑区视网膜神经上皮层厚度明显低于正常眼,OCT能够精确量化测定该厚度变化。     

高度近视眼黄斑视网膜厚度及中心视野的研究

目的 探讨高度近视眼黄斑结构的变化及其与中心视野改变的关系.方法 将高度近视组79例（104只眼）按等效球镜度数（spherical equivalent,SE）分为试验组1（6.00 D≤SE＜9.00 D）40例（53只眼）、试验组2（9.00 D≤SE＜12.00 D）26例（35只眼）及试验组3（12.00 D≤SE≤15.25 D）13例（16只眼）;中、低度近视对照组18例（26只眼）.采用光学相干断层成像测量黄斑中心6 mm直径范围视网膜平均厚度及容积,比较各组间的差异;采用Octopus101电脑自动视野计检测中心视野,分析高度近视中心视网膜平均厚度与中心视野平均缺失敏感度（mean defect,MD）的关系.结果 高度近视各组黄斑区视网膜平均厚度及容积,试验组1为（272.60±12.35）μm,（9.73±0.51）mm3;试验组2为（273.34±12.99）μm,（9.64±0.46）mm3;试验组3为（271.38±12.71）μm,（9.62±0.64）mm3,均明显低于对照组的（282.08±10.62）μm,（9.99±0.53）mm3（P＜0.001）.高度近视组中心视野MD与黄斑区视网膜平均厚度呈低度相关（r=-0.36,P＜0.001）.结论 高度近视者黄斑区视网膜整体厚度及容积均较低;高度近视视野缺损与视网膜萎缩存在相关性.（中国眼耳鼻喉科杂志,2010,10：285-287）     

高度近视性黄斑出血的荧光素眼底血管 造影和靛青绿血管造影分析

目的探讨高度近视性黄斑出血及眼底变化特征。方法对３５例（３７只眼）眼底有黄斑出血的高度近视患者进行眼底彩色照像和荧光素眼底血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查,其中８只眼行靛青绿血管造影（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｎａｎｇｉｏｇｒａｐｈｙ,ＩＣＧＡ）。结果高度近视黄斑出血的表现：（１）视网膜下新生血管（ｓｕｂｒｅｔｉｎａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＳＲＮＶ）形成导致的黄斑出血（２３只眼）,ＩＣＧＡ显示的ＳＲＮＶ较ＦＦＡ清晰;（２）无ＳＲＮＶ的黄斑出血（１４只眼）,在出血下或边缘有漆样裂纹显露者９只眼;对其中６只眼进行了随访,发现其黄斑出血是由于出血下或其边缘有脉络膜毛细血管和Ｂｒｕｃｈ膜的破裂致新的漆样裂纹形成的缘故。结论高度近视黄斑出血的原因除常见的ＳＲＮＶ形成外,还有尚不伴ＳＲＮＶ的黄斑出血。ＦＦＡ结合ＩＣＧＡ能更早期、准确地确定引起高度近视黄斑出血的这两种表现。     

高度近视后巩膜葡萄肿黄斑劈裂光学相干扫描图像特征

目的探讨高度近视后巩膜葡萄肿视网膜劈裂的影象学特征,及其发生机制。方法高度近视后巩膜葡萄肿(PosteriorStaphyloma,PS)患者29例(40眼),行A超测眼轴、B超检查、裂隙灯、散瞳间接检眼镜、眼底照像、最佳矫正视力及光学相干断层(opticalcoherencetomography,OCT)检查,用OCT测量黄斑区视网膜神经上皮层的厚度。结果OCT显示40眼中有10眼(25%)有视网膜劈裂。其OCT图像特征主要为一个广泛的低反射空间将视网膜神经上皮层分为内外两层,中等度柱状反射桥接两层,色素上皮层前不规则细的中等度反射附着。无视网膜劈裂PS眼黄斑中心凹、距离中心凹150μm、500μm、1000μm处视网膜神经上皮层的厚度分别为129.33±17.69μm,143.68±16.17μm,178.92±20.53μm,210.45±23.89μm,均与眼轴长呈负相关。结论OCT能清晰观察PS眼的视网膜劈裂,PS眼视网膜劈裂较常见,它与眼轴关系密切。     

光学相干断层扫描评价高度近视黄斑裂孔伴视网膜脱离的玻璃体手术疗效

目的 光学相干断层扫描(Optical Coherence Tomography，OCT)评价高度近视黄斑裂孔伴视网膜脱离行玻璃体手术的疗效。方法 回顾性分析17例(17眼)高度近视黄斑裂孔伴视网膜脱离行玻璃体切除术的住院病史资料，术后平均随访10月，所有病例均行以下检查：OCT、裂隙灯生物显微镜、三面镜、90D前置镜、验光。结果 术后OCT表现有3种：黄斑裂孔闭合2眼(11．8％)，黄斑裂孔未闭合但视网膜复位12眼(70．6％)，黄斑裂孔未闭合伴视网膜浅脱离3眼(17．6％)。预后情况与黄斑区色素上皮和脉络膜的健康状况以及黄斑裂孔的大小有关。结论 高度近视黄斑裂孔伴视网膜脱离行玻璃体手术的裂孔闭合率低。OCT是术后随访的有效手段。     

An early “reopening” case of idiopathic macular hole; supportive usefulness of fundus autofluorescence

Background  Anatomical closure of macular holes (MH) is now largely confirmed by optical coherence tomography (OCT). Fundus autofluorescence (FAF) is also helpful in diagnosis and anatomical estimation of MH. We report a case of early reopening of anatomically closed MH, 2 days after release from face-down positioning where FAF abnormalities proceeded OCT findings. Methods  A case report. A 67-year-old woman underwent vitrectomy with brilliant blue G-assisted ILM peeling for the treatment of full-thickness stage 4 MH (diameter 578 μm). FAF and OCT were used to evaluate the patient. Results  On post operative day 3, OCT showed anatomical closure of MH, but FAF persistently demonstrated hyperfluorescence in the fovea. On post operative day 5, 2 days after termination of positioning, OCT showed reopening of the MH. Intra-vitreous injection of 50 % sulfur hexafluoride (SF₆) gas was performed followed by face-down positioning again. Fourteen days after surgery, we confirmed the findings of both the anatomical closure in OCT and hypofluorescence on FAF. Two months later, MH remained closed. Conclusions  FAF might be a useful measure as a supportive method to guide release from posture restriction.     

后巩膜加固术治疗高度近视黄斑劈裂

5).未察及严重并发症的发生.结论 对于高度近视黄斑劈裂伴或不伴视网膜脱离的治疗,改进的后巩膜加固术具有较好的可行性和安全性.     

高度近视眼LASIK术后早期黄斑部视网膜厚度变化的研究

目的探讨准分子激光角膜原位磨镶术（excimer laser in situ keratomileusis,LASIK）对高度近视眼黄斑区视网膜神经纤维层厚度的影响及其影响因素。方法随机选择接受LASIK手术矫正视力≥1.0高度近视眼患者18例36眼。采用Zeiss-Humphrey光学相干断层成像仪（Optical Coherence Tomography,OCT）第三代测量近视眼LASIK术前,术后1天、1周眼底以黄斑中心凹为中心3mm半径内的视网膜平均厚度,以地形图分9个区域显示。结果18例36眼高度近视患者LASIK术后1天、1周测量黄斑区视网膜厚度包括黄斑中心凹最小值、黄斑中心凹平均值、内圈平均值、外圈平均值和黄斑区6mm直径范围的视网膜体积与术前值相比均无显著差异（p〉0.05）,术后2次测量值间也无显著差异。结论LASIK对高度近视眼患者术后早期的黄斑区视网膜厚度无明显影响。     

Choroidal changes in human myopia: insights from optical coherence tomography imaging

The choroid is a vascular tissue which plays a range of critical roles in the normal physiology of the eye, such as supplying the outer retina with oxygen and nutrients and the regulation of intraocular pressure. There is also substantial evidence, particularly from animal studies, that the choroid plays an important role in the regulation of eye growth and the development of common refractive errors like myopia. In recent years, advances in optical coherence tomography technology have improved our ability to image and measure the choroid in the human eye. Research using this technology over the past decade has dramatically improved our knowledge of the normal choroid, and its potential role in the regulation of eye growth and refractive error development. This review aims to provide an overview of recent work examining the normal human choroid, its changes with myopia and the possible role of the choroid in the mechanism regulating eye growth. Studies have demonstrated that choroidal thinning accompanies the development and progression of myopia, and have established a close link between eye growth and choroidal thickness changes. Dramatic thinning of the choroid is seen with high myopia, and associations are also observed between choroidal thinning and reduced vision, and the development of retinal pathology associated with high myopia. In the short‐term, environmental factors known to be associated with myopia development and more rapid eye growth typically lead to a thinning of the choroid, whereas factors linked to a slowing of eye growth are typically associated with short‐term choroidal thickening. Collectively, these findings suggest that the choroid is an important biomarker of eye growth in the human eye, and additional research to better understand the human choroid is likely to further our knowledge of the signals and pathways regulating eye growth, myopia development and progression.