眼内病变的彩色多普勒超声诊断

为探讨用彩色多普勒超声对眼内病变的辅助诊断价值,用彩色血流显像（ＣｏｌｏｒＤｏｐｐｌｅｒＦｌｏｗＩｍａｇｉｎｇＣＤＦＩ）对４５例眼内病变进行探查,以脉冲多普勒（ＰｕｌｓｅｄＷａｖｅＤｏｐｐｌｅｒＰＷＤ）探查肿瘤内的频谱,并分析其血流动力学特征。结果：４５眼内病变中,１５例脉络膜黑色素瘤均显示肿瘤内的彩色血流,血流多分布于肿瘤的基底部,血供丰富;３例脉络膜血管瘤ＣＤＦＩ类似于脉络膜黑色素瘤;２例脉络膜转移癌ＣＤＦＩ显示更加丰富的彩色血流。ＰＷＤ频谱分析均显示动脉血流频谱。１５例视网膜母细胞瘤中,１４例显示肿瘤内血流来源于视网膜中央动脉,频谱显示较高阻力的动脉频谱;１例永存性原始玻璃体增殖症（ＰＨＰＶ）玻璃体腔内可见条状由视盘向晶体后延伸的动脉血流;２例Ｃｏａｔｓ＇病脱离的网膜表面可见血流,而网膜下的中低回声区内无血流显示;１例老年性黄斑变性,１例玻璃体囊尾蚴;５例玻璃体积血均无血流显示。结论：彩色多普勒超声对眼内病变的诊断和鉴别诊断有重要的意义。     

彩色多普勒诊断仪在眼内病变中的应用

目的探讨彩色多普勒超声诊断仪（ｃｏｌｏｒＤｏｐｐｌｅｒｕｌｔｒａｓｏｎｏｇｒａｐｈｙ，ＣＤＵ）对眼内病变的辅助诊断价值。方法用高频率（７．５ｍＨｚ）的ＣＤＵ对８２例眼内病变进行检查，在二维特征的基础上分析其血管血流特征。结果ＣＤＵ显示２１例视网膜脱离至少部分脱离的视网膜血管血流；而２２例玻璃体积血和机化膜病例中，２１例玻璃体腔内无血流显示，仅在１例糖尿病增殖型视网膜病变中可见细小的血管血流。在１８例脉络膜黑色素瘤中的１７例和４例脉络膜转移癌中的３例可见肿瘤内呈枝状分布的血管血流，频谱显示为较高阻力的供血血流波形；５例脉络膜血管瘤显示肿瘤内充满或呈弥散星点状的混杂血流，频谱显示为含动脉血流和静脉血流的波形；而在类似的肿瘤病变中，５例脉络膜积血和２例视网膜下出血未见病变区内血流。在３例（４只眼）永存性原始玻璃体增殖症中，玻璃体腔内可见呈条索状由视乳头向晶体后延伸的动脉血管血流。结论ＣＤＵ对眼内病变（视网膜脱离与玻璃体积血或机化膜、恶性脉络膜黑色素瘤或转移癌与良性脉络膜血管瘤、永存性原始玻璃体增殖症等）的诊断与鉴别具有重要意义。     

视网膜色素变性的彩色超声多普勒应用

通过彩色超声多普勒成像定量检测视网膜色素变性患者的血流动力学改变,用彩色超声多普勒诊断仪对１７例视网膜色素变性患者进行检测,测定双侧眼动脉、视网膜中央动脉、睫状后动脉的血流参数,对所测得数值用ｔ检验做统计学处理分析。结果：视网膜色素变性患者的血流改变与眼别无关,右、左眼对比无显著性差异（Ｐ＞０．０５）,双侧眼动脉血流正常（Ｐ＞０．０５）,双侧视网膜中央动脉及睫状后动脉血流速度较正常人显著减慢（Ｐ＜０．００１）。结论：彩色超声多普勒检查为视网膜色素变性患者的血流改变提供了量化指标     

彩色多普勒血流显像对低压性青光眼的血流动力学研究

目的观察低压性青光眼血流动力学变化。方法应用彩色多普勒检测１５例正常人和１９例低压性青光眼（ｌｏｗ－ｔｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）的眼动脉、睫状后短动脉及视网膜中央动脉的血流参数。测定收缩期血流峰值速度（ｐｅａｋｓｙｓｔｏｌｉｃｆｌｏｗｖｅｌｏｃｉｔｙ，Ｖｍａｘ）、舒张末期血流速度（ｅｎｄｄｉａｓｔｏｌｉｃｆｌｏｗｖｅｌｏｃｉｔｙ，Ｖｍｉｎ）、平均血流速度（ｍｅａｎｅｎｖｅｌｏｐｅｄｖｅｌｏｃｉｔｙ，Ｖｍｅａｎ）、搏动指数（ｐｕｌｓｅｉｎｄｅｘ，ＰＩ）、阻力指数（ｒｅｓｉｓｔａｎｃｅｉｎｄｅｘ，ＲＩ）及收缩期血流峰值速度和舒张末期血流速度比值（Ｖｍａｘ／Ｖｍｉｎ，Ｓ／Ｄ）。结果（１）ＬＴＧ组睫状后短动脉血流速度低于正常人组（两组双眼Ｖｍａｘ、Ｖｍｉｎ及右眼Ｖｍｅａｎ比较，Ｐ＜０．０５），左眼ＲＩ及Ｓ／Ｄ低于正常人组（Ｐ＜０．０５）；（２）ＬＴＧ组左眼视网膜中央动脉血流的Ｖｍａｘ及Ｖｍｅａｎ低于正常人组（Ｐ＜０．０１）；（３）ＬＴＧ组与正常人组眼动脉血流的Ｖｍａｘ等６项参数比较，差异无显著性（Ｐ＞０．０５）。结论ＬＴＧ组的睫状后短动脉血流速度低于正常人组，支持ＬＴＧ视乳头损害的血管学说。     

眼外伤所致眼内病理膜的彩色多普勒超声诊断特点

目的探讨眼外伤所致眼内病理膜的彩色多普勒超声诊断特点。方法回顾性病例研究。选择2013年1-12月因眼外伤行眼部彩色多普勒超声检查的患者1 156例（1 162眼）,对其彩色多普勒超声诊断特点进行总结和分析,部分病例经手术确定诊断,判断彩色多普勒超声诊断的准确性。结果1 156例（1 162眼）的超声诊断包括玻璃体积血（1 071 眼）、眼内炎（78眼）、玻璃体后脱离（624眼）、视网膜脱离（521眼）、脉络膜脱离（221眼）、脉络膜上腔积血（117眼）等。眼外伤所致的玻璃体内膜状病变的彩色多普勒超声诊断特点为单一疾病表现典型,但多数患者存在2种或2种以上病变。应用彩色多普勒超声检查,在参考二维超声检查结果的同时,根据视网膜、脉络膜的血供特点,可以在错综复杂的眼内条带状回声中分辨出脱离的视网膜和脉络膜,为手术和治疗提供可靠的依据。本组部分病例经手术治疗。总体超声诊断与临床和手术诊断的符合率为99.1%。结论应用彩色多普勒超声检查眼外伤所致玻璃体内膜状病变是一种经济、简便、无创、可重复性好的诊断方法,根据视网膜和脉络膜的血流特征分析方法,可以提高超声诊断的准确性。     

青光眼眼部彩色多普勒血流动力学研究

为研究青光眼眼部血流动力学变化,应用彩色多普勒能量图（ＣＤＰＩ）及彩色多勒血流图（ＣＤＦＩ）对２８只青光眼和３０只正常眼分别检测眼动脉、视网膜中央动脉和睫状动脉。结果显示：青光眼患者眼动脉及视网膜中央动脉收缩期血流峰值速度（Ｖｓ）有所降低,舒张末期血流速度（Ｖｄ）明显降低,阻力指数（ＲＩ）显著升高,与正常组存在明显差异（Ｐ＜０．０５）,睫状动脉两组无明显差异。结论：彩色多普勒能量图及彩色多普勒血流图对青光眼血流病理改变均有较高的敏感性,对早期诊断及病情变化预测具有重要价值。结果还提示ＣＤＰＩ较ＣＤＦＩ敏感度高、准确性好。     

正常人及缺血性视神经病变眼血管血流检测

本文应用彩色多普勒血流显像技术，对３０例正常人及２０例缺血性视神经病变（ＩｓｃｈｅｍｉｃＯｐｔｉｃＮｅｕｒｏｐａｔｈｙ，ＩＯＮＰ）患者视网膜中央动脉、眼动脉及睫状后动脉血流进行检测。结果，ＩＯＮＰ患者眼动脉收缩期血流速度峰值较正常人减低，阻力指数增大。视网膜中央动脉阻力指数及搏动指数也较正常人增大，Ｐ＜０．０１。为ＩＯＮＰ诊断提供血流动力学依据。提示该方法能够为临床研究视网膜与视神经病理生理血液微循环提供有效信息。     

超声造影剂时间-强度曲线在眼内肿瘤诊断及鉴别诊断的应用

目的 观察超声造影剂在眼内肿瘤内的时间强度曲线特征.方法 临床诊断的眼内肿瘤236例238只眼纳入研究.所有患者均行常规眼科检查及二维超声、彩色多普勒超声、超声造影检查.其中,脉络膜黑色素瘤166例166只眼;脉络膜转移癌16例18只眼;脉络膜血管瘤52例52只眼;视网膜血管瘤2例2只眼.记录超声造影的全过程,以Dicom格式输出图像,应用德国Tomteck公司的Sonoliver软件对输出的图像进行处理,绘制肿瘤内造影剂的时间-强度曲线.结果 所有患眼肿瘤病灶完全被造影剂填充,部分患眼可见自周边向中心的向心性填充.脉络膜黑色素瘤和脉络膜转移癌的时间强度曲线特征基本一致;脉络膜血管瘤和视网膜血管瘤的时间-强度曲线基本相同.所有肿瘤在充盈期的表现均为快速充盈型;但在肿瘤的消退期,前者表现为病变内的造影剂消退早于对照组织,后者表现为病灶内造影剂消退与对照组织同步或略晚于对照组织.脉络膜黑色素瘤166只眼中,完全符合上述变化特点者138只眼,占83.1％;基本符合上述变化特点者28只眼,占16.9％.脉络膜转移癌、脉络膜血管瘤和视网膜血管瘤均完全符合上述变化特点,占100.0％.结论 常见眼内恶性肿瘤的时间-强度曲线的特点为快进快出型;常见血管性良性肿瘤的时间-强度曲线的特点为快进慢出型.     

噻吗心安对视乳头血液循环的影响及临床意义

本文应用双功能彩色多普勒测定了２２只正常人眼局部应用０．５％噻吗心安眼药水后睫状后短动脉和视网膜中央动脉血流动力学的变化。研究结果表明噻吗心安治疗眼睫状后短动脉血流量显著大于对照眼，并且血流量与灌注压呈明显线性关系（Ｐ〈０．０５）；而视网膜中央动脉血流量无明显的变化（Ｐ〉０．０５）。本文探讨了局部应用噻吗心安对视神经乳头血液循环的影响及临床意义。     

外伤性视神经萎缩眼的研究动脉血流速度

本文利用经颅超声多普勒扫描仪（ＴＣＤ）对视神经萎缩（外伤性）的患、健眼眼动脉血流速度进行检测，且探讨其与睫状后动脉之间的关系以期探讨此病的发病机制，为临床合理治疗提供资料。结果表明：外伤性视神经萎缩患眼与配对的正常眼之间眼动脉血流速度无明显差异（Ｐ＞０．０５），中心固视组眼动脉血流速度增高占６０％，血流速度降低的占４０％。偏心固视组血流速度增高及降低的均占４４．４％，无变化的占１１．１％，患眼眼动脉血流速度与后睫状动脉灌注压之间无显著的直线相关关系（ｒ＝０．０４６６８，Ｐ＞０．０５）。     

彩色多普勒超声检查对眼内膜状物的鉴别诊断意义

目的：探讨彩色多普勒超声检查（color Doppler imaging,CDI）对眼内膜状物的鉴别诊断价值。方法：用CDI对42例（42只眼）眼内膜状物进行探查，结合其二维血流信号进行分析。结果：CDI显示20例视网膜脱离中19例有由视盘流出的血流信号；在3例脉络膜脱离中，则出现不与视盆相连的血流信号；在全部9例玻璃体机化膜及10例玻璃体后脱离病例均未探及血流。结论：CDI对视网膜脱离、脉络膜脱离、玻璃体机化膜及玻璃体后脱离的鉴别诊断有重要意义。     

Optic nerve and peripapillary choroidal microvasculature of the rat eye

PURPOSE: To investigate the three-dimensional microvascular anatomy of the optic nerve and peripapillary choroid in the rat eye. METHODS: Gross vascular anatomy of the posterior eye segment of Wistar rats was studied in serial microsections with a light microscope. The optic nerve and peripapillary choroidal vessels were sequentially microdissected, using methylmethacrylate corrosion microvascular castings, and were examined with a scanning electron microscope to determine the three-dimensional relationships of the vessels. RESULTS: The posterior ciliary artery traveled along the inferior side of the optic nerve sheath, directly entered the optic nerve head, and divided into three branches: the central retinal artery and medial and lateral long posterior ciliary arteries, which provided several short branches to the choroid. The optic nerve head vasculature was consistently nourished by a recurrent arteriole from the central retinal artery and an arteriole from the choroidal artery at the peripapillary choroid. The central retinal vein flowed into a venous anastomosis along the optic disc border of the peripapillary choroid. Capillaries within the optic nerve drained into the central retinal vein, the marginal venous anastomosis of the peripapillary choroid, and the pial veins, all of which flowed into the posterior ciliary veins along the optic nerve sheath. CONCLUSIONS: The findings illustrate vascular anatomic differences in optic nerve and peripapillary choroidal microcirculation between rat and human. In rats, the peripapillary choroid plays a significant role in both blood supply and venous drainage of the optic nerve head. The central retinal artery also contributes to the optic nerve head circulation.     

Relationship between blood flow velocities in retrobulbar vessels and laser Doppler flowmetry at the optic disk in glaucoma patients

The relationship between blood flow velocities in retrobulbar vessels and blood flow at the optic nerve in glaucoma patients was assessed in a prospective study. The Heidelberg retina flowmeter (HRF) was used to assess optic nerve head blood flow in 13 open-angle glaucoma patients. In the same patients, color Doppler imaging (CDI) measurements were obtained from the ophthalmic artery, the central retinal artery and the posterior ciliary arteries. Using data for one randomly selected eye per subject, correlations between HRF recordings and CDI measurements were evaluated by means of Spearman's rank correlation factor. All three HRF parameters correlated with CDI measurements obtained from retrobulbar vessels. The most marked correlations were those of the HRF parameter 'volume' with the end-diastolic velocity in the ophthalmic artery and the medial posterior ciliary artery (R = 0.79, p = 0.0012 and R = 0.81, p = 0.0007, respectively), and the peak systolic velocity in the lateral posterior ciliary artery (R = 0.82, p = 0.0006). The present study suggests that glaucoma patients with altered blood flow in retrobulbar vessels are likely to show an alteration in optic nerve blood flow as measured with the HRF.     

Color Doppler Imaging of Retinal Diseases

Color Doppler imaging (CDI) is a widely used method for evaluating ocular circulation that has been used in a number of studies on retinal diseases. CDI assesses blood velocity parameters by using ultrasound waves. In ophthalmology, these assessments are mainly performed on the retrobulbar blood vessels: the ophthalmic, the central retinal, and the short posterior ciliary arteries. In this review, we discuss CDI use for the assessment of retinal diseases classified into the following: vascular diseases, degenerations, dystrophies, and detachment. The retinal vascular diseases that have been investigated by CDI include diabetic retinopathy, retinal vein occlusions, retinal artery occlusions, ocular ischemic conditions, and retinopathy of prematurity. Degenerations and dystrophies included in this review are age-related macular degeneration, myopia, and retinitis pigmentosa. CDI has been used for the differential diagnosis of retinal detachment, as well as the evaluation of retrobulbar circulation in this condition. CDI is valuable for research and is a potentially useful diagnostic tool in the clinical setting.     

A review of ocular blood flow measurement techniques

Several major eye diseases may be characterized by deficits in ocular blood flow. Maintaining adequate nutrient delivery to the choroid, retina, and optic nerve head may prevent cellular damage and loss, complementing efforts to provide neuroprotection. The ability to quantify deficits in ocular blood flow has increased in recent years with the introduction of several new techniques. 1) Scanning laser ophthalmoscopic fluorescein angiography allows the measurement of bulk retinal flow and macular capillary transit rates. 2) Scanning laser ophthalmoscopic indocyanine green angiography measures choroidal perfusion in selected areas near the optic nerve head and macula. 3) Confocal scanning laser Doppler flowmetry permits quantitation of retinal capillary perfusion. 4)Color Doppler ultrasound imaging measures flow velocities in the ophthalmic, central retinal, and short posterior ciliary arteries. While these techniques represent a major advance, significant issues regarding blood flow and ocular disease remain. First, the hemodynamic characteristics of the disease state need further definition. Second, the blood flow effects of current and future treatments must be established. Third, improvements in ocular blood flow techniques are required, both to increase anatomic precision and to allow non-invasive measurements during times of potential ischemic risk such as sleep. These developments could enhance prevention, diagnosis, and treatment of several major eye diseases.     

Choroidal and ciliary body blood flow analysis: application of laser Doppler flowmetry in experimental animals

Laser Doppler flowmetry (LDF) measures the flux of red blood cells in a vascular network embedded in tissue. In the present report, choroidal and ciliary body blood flow was measured continuously using an LDF technique in pentobarbital anesthetized cats. Blood flow measurements were made from the choroid beneath the lateral and superior rectus muscles and from the surface above the ciliary body 2-3 mm posterior to the limbus. In some experiments, the sympathetic nerve to the eye was stimulated; in others, intraocular pressure (IOP) was monitored manometrically with a controlled saline infusion delivered into the anterior chamber to gradually elevate IOP. Norepinephrine (NE) and methacholine (MC) also were tested for their effects on choroidal blood flow when given intravenously and intra-arterially. Transient bilateral carotid artery occlusions produced a significant drop in blood flow, but flow did not decrease to zero probably due to collateral contribution of the vertebral circulation. Sympathetic nerve stimulation produced a frequency-dependent decrease in both choroidal and ciliary body blood flow with the latter exhibiting a lower threshold and a greater magnitude of effect. Gradual elevation of IOP produced a proportional decrease in choroidal blood flow. The level of intraocular pressure required to decrease blood flow was dependent on the existing ocular perfusion pressure. Both intravenous and intra-arterially administered NE produced dose-dependent decreases of choroidal blood flow despite graded increases of systemic arterial blood pressure. In contrast, MC produced dose-dependent increases of choroidal blood flow in conjunction with graded decreases of systemic blood pressure. The results of the present report demonstrate the validity of the LDF technique for performing continuous reading of blood flow changes in the choroid and ciliary body of experimental animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser Doppler flowmetry and optic nerve head blood flow

PURPOSE: Ischemic disorders of the optic nerve head constitute an important cause of visual loss. The optic nerve head is supplied by two main sources of blood flow: the superficial layers by the central retinal artery and the deeper layers by the posterior ciliary arteries. This study was conducted in rhesus monkey eyes to obtain a better understanding of which part of the optic nerve head circulation is measured by laser Doppler flowmetry. METHODS: By means of a fundus camera-based laser Doppler flowmetry technique to measure blood flow in the optic nerve head tissue, laser Doppler flowmetry measurements were taken at baseline and then after experimental occlusion of central retinal artery (12 eyes), posterior ciliary arteries (nine eyes), and combined occlusion of central retinal artery and posterior ciliary arteries (nine eyes). Optic nerve head, choroidal, and retinal circulations were investigated by fluorescein fundus angiography after the various arterial occlusions. RESULTS: Average laser Doppler flowmetry flow during central retinal artery occlusion alone was significantly decreased (P<.001) by 39%+/-21% (mean +/- 95% confidence interval) compared with normal baseline. Combined occlusion of central retinal artery and posterior ciliary arteries reduced laser Doppler flowmetry flow even more markedly by 57%+/-27% (P<.0005), but the difference between this flow reduction and that with central retinal artery occlusion alone was not significant (P>.20). After posterior ciliary artery occlusion alone, however, measurements showed a nonsignificant increase in laser Doppler flowmetry flow of 17%+/-37%. CONCLUSIONS: The findings of this study suggest that the standard laser Doppler flowmetry technique is predominantly sensitive to blood flow changes in the superficial layers of the optic nerve head and less sensitive to those in the prelaminar and deeper regions, and their relative proportions are not known. In this laser Doppler flowmetry technique, the weaker Doppler signal from the deep layers cannot be separated from the dominant signal from the superficial layers to exclusively study the circulation in the deep layers; the latter circulation is of interest in optic nerve head ischemic disorders, including glaucoma. Emerging new optical modalities of the laser Doppler flowmetry technique may help in selectively measuring blood flow in the deeper layers.     

High Frequency Color Doppler Image of Choroidal Detachment

Purpose:To study the Color Doppler Image (CDI) characteristics of choroidal detachment and the applied value of CDI.Methods:Seventy-two cases (74 eyes) of choroidal detachment were studied retrospectively.Results:The typical ultragraph of chroridal detachment displayed one or several smooth hemispherical or lobuler circular thick bands, with convex side toward vitreous cavity.Most of the choroidal detachments were located before the equator, a few of them were beyond the equator.CDI displayed blood flow singnal in the band.Pulse Doppler showed the frequency spectrum features of retinal detachment band were similar to those of central retinal vessels, whereas the frequency spectum features of choroidal detachment bend resembled those of ciliary artery in some cases of retinal detachment (RD) accompanied by choroidal detachment.Conclusion:CDI could make a correct and precise diagnosis of choroidal detachment.Eye Science 2000;16:61-64.     

High Frequency Color Doppler Image of Choroidal Detachment

Purpose: To study the Color Doppler Image (GDI) characteristics of choroidaldetachment and the applied value of GDI.Methods: Seventy-two cases (74 eyes) of choroidal detachment were studiedretrospectively.Results: The typical ultragraph of chroridal detachment displayed one or severalsmooth hemispherical or lobuler circular thick bands, with convex side toward vitreouscavity. Most of the choroidal detachments were located before the equator, a few of themwere beyond the equator. GDI displayed blood flow singnal in the band. Pulse Dopplershowed the frequency spectrum features of retinal detachment band were similar to thoseof central retinal vessels, whereas the frequency spectum features of choroidaldetachment bend resembled those of ciliary artery in some cases of retinal detachment(RD) accompanied by choroidal detachment.Conclusion: GDI could make a correct and precise diagnosis of choroidal detachment.Eye Science 2000; 16: 61 - 64.