中心性浆液性脉络膜视网膜病变光学相干断层扫描血流成像（OCTA）的图像特征

目的　观察中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy,CSC）患者的光学相干断层扫描血流成像（optical coherence tomographic angiography,OCTA）图像,分析患眼及对侧眼脉络膜的改变特征。方法　经确诊的30例单眼CSC患者及20例（20眼）正常人纳入研究,患眼30眼、对侧眼30眼及正常对照眼20眼均行常规检查及吲哚菁绿血管造影、OCTA检查。利用Optovue OCT获得OCTA图像及黄斑中心凹下脉络膜厚度（subfoveal choroidal thickness,SFCT）值,观察患眼及对侧眼的脉络膜毛细血管层图像特点及SFCT变化。结果　患眼SFCT为（423.70±72.88）μm,对侧眼SFCT为（370.70±61.97）μm,正常对照眼SFCT为（244.23±51.24）μm;患眼SFCT较对侧眼增厚（t=3.205,P＜0.05）,患眼和对侧眼SFCT均较正常对照眼增厚（t=7.161,5.667;均为P＜0.05）。30只患眼中29眼（96.7%）OCTA见脉络膜毛细血管层异常血流信号,高信号范围与吲哚菁绿血管造影高灌注区域基本对应;1眼（3.3%）未见异常血流信号。其中高血流信号外环绕低血流信号7眼,低血流信号区内外均见高血流信号5眼,斑驳状高血流信号16眼,新生血管形态1眼。30只对侧眼中12眼（40.0%）见脉络膜毛细血管层异常血流信号,呈斑驳状改变;18眼（60.0%）未见异常。20只正常眼脉络膜毛细血管均表现为正常均匀的血流信号。结论　CSC的脉络膜改变主要表现为脉络膜毛细血管层的异常血流信号及SFCT增厚,部分对侧无症状眼也会出现相应改变。OCTA作为一种检查手段,在CSC的诊断、预防和病情评价中均有明确的临床应用价值。     

Efficacy and safety of subthreshold micropulse laser in the treatment of acute central serous chorioretinopathy

AIM: To analyze the efficacy and safety of subthreshold micropulse laser (SML) in the treatment of acute central serous chorioretinopathy (CSC). METHODS: This is a retrospective case analysis study. Totally 58 eyes of 58 patients were enrolled, and they were divided into different groups. And 39 patients were treated with SML (SML group) and 19 patients were only observed (observation group). The follow-up period was 3mo after diagnosis. The best corrected visual acuity (BCVA), central retinal thickness (CRT), superficial retinal vascular density (SRVD), deep retinal vascular density (DRVD), the superficial and deep foveal avascular zone (FAZ) area, retinal light sensitivity (RLS), perfusion area of choroidal capillary layer (CCL), subfoveal choroidal thickness (SFCT) and fundus autofluorescence (FAF) were investigated. RESULTS: The BCVA, CRT, SRVD, DRVD, the superficial and deep FAZ area, RLS, SFCT of SML group were significantly improved at 3mo (all P<0.05). In the observation group, only CRT, DRVD and SFCT were improved (all P<0.05). Other research items in the observation group were not significantly different from baseline (all P>0.05). At the last follow-up, the BCVA and RLS in the SML group were better than those in the observation group, and CRT was lower, SRVD and DRVD, perfusion area of CCL were larger (all P<0.05). On FAF, no change of treatment spots was found after treatment. No structural laser damage was observed on optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and no choroidal neovascularization was observed. CONCLUSION: SML treatment of acute CSC can improve BCVA, RLS, and perfusion area of CCL, reduce CRT, increase SRVD and DRVD, and is safe.     

息肉状脉络膜血管病变的光学相干断层扫描及血管成像的观察

目的：对比观察息肉状脉络膜血管病变(PCV)频域光相干断层成像(OCT)与光相干断层扫描血管成像(OCTA)的图像特征。

方法：选取2018-03/12在我院确诊为息肉状脉络膜血管病变(PCV)的患者25例25眼纳入研究,所有患者均行频域OCT和OCTA检查,观察上述检查结果的图像特征。

结果：本研究纳入患者25眼,频域OCT检查表现为浆液性和出血性色素上皮脱离(PED)14眼,OCTA检查示相应病变部位为低信号暗区,其旁有强信号点9眼; 频域OCT检查表现为“双层征”11眼,OCTA检查显示为网状结构的脉络膜异常分支血管网(BVN); 频域OCT检查表现为息肉样病变(polyps)12眼,OCTA检查表现为强或低信号区。

结论：PCV患眼OCTA检查对BVN的表现更直观明显,息肉样病变表现为强或弱的信号,浆液性、出血性PED的OCT和OCTA图像均表现为低反射或低信号暗区,不具有特征性。二者显示的病变位置和形态具有相似性,但也有不同。     

人类白细胞抗原-B27相关性急性前葡萄膜炎病情与脉络膜厚度变化的关系

目的　探讨人类白细胞抗原（human leukocyte antigen,HLA）-B27相关性急性前葡萄膜炎（acute anterior uveitis,AAU）病情与脉络膜厚度变化的相关性。方法　HLA-B27 相关性AAU患者32例32眼及其对侧眼被纳入本研究,除对患者进行眼底荧光血管造影（fluorescein fundus angiography,FFA）等常规检查外,利用光学相干断层扫描 （optical coherence tomography,OCT） 对患者双眼黄斑中心凹下脉络膜厚度（subfoveal choroidal thickness,SFCT）及黄斑中心凹视网膜厚度（central foveal thickness,CFT）进行测量。对比AAU患者治疗前后SFCT及CFT变化。结果　FFA显示,32眼HLA-B27相关性AAU患者视盘毛细血管均有荧光素渗漏 （100.0%）,其中13眼（40.63%）视网膜毛细血管荧光素渗漏 。OCT检测结果显示,在炎症急性期,32眼HLA-B27相关性AAU患者的黄斑区脉络膜血管扩张显著。HLA-B27 相关性AAU患眼的SFCT ［（342.54±70.71）μm］较对侧眼的SFCT［（283.41±79.15）μm］显著增加 （P=0.003）,AAU患眼的CFT［（281.46±56.42）μm］与对侧眼的CFT［（268.49±51.91）μm］比较,差异无统计学意义（P=0.342）。经治疗炎症消退后,AAU患眼的SFCT减少至（284.13±99.07）μm,与治疗前相比,差异有统计学意义（P=0.009）。结论　HLA-B27 相关性AAU患眼SFCT增加,脉络膜厚度可作为评估HLA-B27相关性AAU病情严重程度的指标之一。     

Choroidal Analysis of Polypoidal Choroidal Vasculopathy by Spectral Domain Optical Coherence Tomography

 Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness (SFCT) and choroidal maximal vessel diameter (MVD) of the affected and unaffected fellow eyes in patients with polypoidal choroidal vasculopathy (PCV) and compare them to healthy controls. Methods: In this cross-sectional observational clinical study, SFCT and MVD were measured in both eyes of 53 patients with unilateral PCV. PCV eyes were subgrouped into group A and unaffected fellow eyes into group B. All patients were diagnosed with PCV by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Sixty age- and gender-matched healthy subjects were enrolled in the control group (group C). Results: No statistical difference was observed among groups in age and gender. Overall, SFCT was correlated with MVD in all subjects (P< 0.001; correlation coefficient: 0.759). P values were < 0.001 with a correlation coefficient of 0.686, 0.801, and 0.808 in groups A, B, and C, respectively. No statistical significance was noted in SFCT among groups A (266.45 ± 99.51μm), B (269.57 ± 105.10 μm), and C (243.83± 99.68 μm) (P=0.335). However, the MVD in group A was (202.55 ± 72.45 μm), significantly larger than that in group C (166.45 ± 56.18 μm, P=0.008), while the MVD in group B (194.75 ± 85.27 μm) was equally significantly greater than that in group C (166.45 ± 56.18μm) (P=0.038). Conclusion: For both PCV patients and healthy subjects, SFCT was positively correlated with MVD. No statistical significance was noted in SFCT between PCV eyes and unaffected fellow/ normal eyes. However, MVD was significantly larger in the PCV affected eyes than in unaffected fellow or normal control eyes, suggesting that MVD could be considered as a sensitive indicator to evaluate choroidal perfusion in PCV patients.     

慢性中心性浆液性脉络膜视网膜病变与息肉样脉络膜血管病变多模式影像学特征的比较

目的　比较慢性中心性浆液性脉络膜视网膜病变（chronic central serous chorioretinopathy,CCSC）与息肉样脉络膜血管病变（polypoidal choroidal vasculopathy,PCV）的多模式影像学差异。方法　回顾性分析CCSC组11例11眼患者及PCV组21例21眼患者的临床资料。所有患者均行最佳矫正视力、黄斑中心凹下脉络膜厚度测量及荧光素眼底血管造影、吲哚菁绿血管造影、光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）和频域光学相干断层扫描多模式影像学检查,并对检查结果进行统计学分析。结果　CCSC组患者最佳矫正视力为0.33±0.11,显著高于PCV组（0.21±0.13）,差异有统计学意义（P<0.05）。CCSC组患者黄斑中心凹下脉络膜厚度为（368.20±51.65）μm,PCV组为（342.28±37.18）μm,两组相比差异无统计学意义（P>0.05）。荧光素眼底血管造影检查结果显示,CCSC组和PCV组均为斑点状高荧光表现,CCSC组患眼可伴有色素上皮萎缩带或慢性神经上皮脱离通道表现。吲哚菁绿血管造影检查结果显示,CCSC组11眼病灶区出现周围脉络膜血管扩张及高通透性改变;而PCV组21眼均出现脉络膜息肉样病变,其中12眼为脉络膜分支血管网。OCTA检查结果显示,CCSC组4眼病灶部位表现为脉络膜毛细血管层高血流信号,其外环绕低血流信号,7眼表现为粗颗粒形态的斑驳状血流信号;PCV组15眼可检出息肉样病变,表现为高反射信号,呈结节状、环状或点状,12眼检出脉络膜分支血管网病变,表现为血管样结构的高血流信号。频域光学相干断层扫描检查发现,CCSC组7眼为浆液性视网膜色素上皮脱离（pigment epithelium detachment,PED）;PCV组12眼为波浪形隆起的视网膜色素上皮层与Bruch膜组成的双层征,10眼为陡峭的视网膜色素上皮指状突起（或称PED峰）,18眼为浆液性或出血性PED。CCSC组患者治疗随访时,OCTA检查发现2眼继发I型脉络膜新生血管。结论　CCSC与PCV之间存在不同的影像学表现,多模式影像检查有助于两者的鉴别。另外,OCTA能够较好地显示脉络膜新生血管结构,可用于该类疾病的治疗随访。     

Detection of macular ganglion cell complex loss and correlation with choroidal thickness in chronic and recurrent central serous chorioretinopathy

AIM: To investigate the association of ganglion cell complex thickness (GCCt), global loss volume percentage (GLV%), and focal loss volume percentage (FLV%) with structural and functional findings among patients with chronic central serous chorioretinopathy (CCSC) and recurrent central serous chorioretinopathy (RCSC) by optical coherence tomography (OCT). METHODS: Among 29 patients with monocular affected central serous chorioretinopathy (CSC), 15 had CCSC, and 14 had RCSC. The GCCt, FLV%, GLV%, and subfoveal choroidal thickness (SFCT) and sublesional choroidal thickness (SLCT) values were determined using OCT, and the association of these characteristics with neural structure parameters, choroidal morphology, features and functional alterations were estimated for the CCSC and RCSC patients. RESULTS: In CCSC, the affected eyes had significantly lower GCCt values than the fellow eyes in the macular regions (all P<0.05), with the highest GCCt observed in the inferior area. A significant association was found between the GCCt in different regions and the change in best corrected visual acuity (BCVA; r=-0.696; -0.695; -0.694, P<0.05) in CCSC patients. A statistically significant moderate negative correlation indicated that long-term CCSC was associated with greater differences in the GCCt in different regions between affected and fellow eyes (r=-0.562; r=-0.556; r=0.525, P<0.05). Additionally, observation of thickened SFCT was associated with a worse FLV% (r=0.599; r=0.546, P<0.05) in both groups. Similarly, thickened SLCT was associated with FLV% in RCSC patients (r=0.544, P<0.05). CONCLUSION: The distribution and GCCt are associated with the duration and visual outcomes of CCSC, whereas there is no correlation among RCSC patients. FLV% may be instrumental in differentiating the various outer choroidal vessels (pachyvessels) in long-term CSC. These results suggest that neural structure parameters may aid in estimating and predicting the recovery of altered morphology and function in CCSC and RCSC patients.     

基于OCTA的中心性浆液性脉络膜视网膜病变患者脉络膜新生血管检测

目的观察光学相干断层扫描血管成像(OCTA)在中心性浆液性脉络膜视网膜病变(CSC)患者脉络膜新生血管(CNV)检测中的应用价值。方法回顾性病例观察研究。选取2018年3月至2019年3月在云南省第二人民医院诊断为慢性中心性浆液性脉络膜视网膜病变伴脉络膜新生血管患者30例(34眼)纳入研究,总结分析其OCTA与眼底彩色照相、眼底自发荧光、荧光素眼底血管造影(FFA)和OCT等传统影像学对比运用的临床体会。结果12眼FFA存在荧光素渗漏,但形态模糊,不能确定是否伴有CNV,行OCTA则可以清晰显示新生血管影像。8眼FFA未检出CNV,但OCTA清晰显示出新生血管形态。3眼眼底彩色照相及OCT检查高度怀疑CNV的存在,但因荧光素钠皮试阳性,均无法实施FFA,而OCTA则显示出病变区域血流信号,明确了CNV的存在。6眼FFA无明显荧光素渗漏,OCT示无神经上皮层脱离、无色素上皮层脱离,但OCTA提示CNV的存在。5眼通过随访过程中的病情跟踪观察,发现给予患者单一抗VEGF或PDT治疗之后视网膜下积液无明显吸收,而联合治疗后积液明显吸收。结论OCTA在CNV的检查敏感性方面优于传统的检测手段。OCTA可以作为一项安全有效的眼底影像学检查手段对慢性CSC患者的CNV进行观察,从而指导该类患者的诊断、治疗及预后分析。     

颈内动脉狭窄患者的脉络膜厚度和脉管指数的改变

目的:使用扫频光相干断层扫描(SS-OCT)比较无眼部症状的颈内动脉狭窄(ICAS)患者和健康人之间黄斑区脉络膜厚度(SFCT)和脉管指数(CVI)。方法:回顾性研究。纳入2018-03/2019-06我院神经外科确诊ICAS患者40例,取其与颈内动脉狭窄同侧的40眼为ICAS组,另外纳入20例性别年龄相匹配的健康人的双眼作为对照组。所有受试者均于同一时间段用SS-OCT行黄斑扫描,测量SFCT,并将OCT图像以Image J软件二值化处理测量中心凹3mm范围脉络膜的CVI。结果:ICAS组和对照组的SFCT分别为208±66、234±77μm(P=0.27)。ICAS组和对照组的CVI值分别为64.5%±1.7%和66.1%±2.7%(P=0.04)。受试者工作曲线(ROC curve)中CVI的曲线下面积(AUC)为0.76(P=0.005),而SFCT的AUC为0.58(P=0.41)。结论:无眼部症状的ICAS患者CVI低于正常对照组,而SFCT无明显改变,提示对无眼部症状的ICAS患者检测其CVI较SFCT更有助于早期的发现脉络膜血液循环的改变。     

Evaluation of macular choroidal and microvascular network changes by activity scores and serum antibodies in thyroid eye patients and healthy subjects

AIM: To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease (TED) patients at different stages and the relationship of those changes with risk factors, serum antibodies and the severity of TED. METHODS: A total of 85 participants were enrolled. All participants underwent ophthalmology and endocrinology examinations. Subfoveal choroidal thickness (SFCT), superficial (s) and deep (d) foveal avascular zone (FAZ) area, mean (m) and central (c) superficial vascular density (SVD), deep vascular density (DVD) measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography (OCT)/OCT angiography (OCTA) DRI OCT Triton. Multiple linear regression analysis was used to explore the associations between SFCT, FAZ area, SVD, DVD and the relevant factors of TED. RESULTS: Those with active TED patients had higher c-DVD and m-DVD levels (P<0.05), however there is no statistically significant difference in SFCT between active and stable TED patients. Among the serum antibodies, it was observed that s-FAZ and d-FAZ increased, c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies (TRAB) level, whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin (hTG). There was no significant difference in SFCT, FAZ, SVD and DVD measurement at gender, between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma. CONCLUSION: The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density. It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.     

Chorioretinal response to intravitreal aflibercept injection in acute central serous chorioretinopathy

AIM: To evaluate chorioretinal responses to intravitreal aflibercept injection (IAI) in patients with acute central serous chorioretinopathy (CSC). METHODS: Seventy-one eyes from 71 patients with symptomatic CSC for less than six months were included. Thirty-five eyes received a single IAI and 36 eyes were observed without treatment. Best-corrected visual acuity (BCVA), central subfield foveal thickness (CSFT), and subfoveal choroidal thickness (SFCT) were assessed at baseline and at 1, 2, and 3mo. RESULTS: The mean SFCT in the IAI group decreased at 1mo, rebounded at 2mo and remained stable at 3mo compared to the baseline, while significant change was not noted in the observation group. The mean CSFT decreased significantly during the 3-month study period in both groups, and was significantly lower in the IAI group at 1mo (P<0.001). A rebound of CSFT between 1 and 2mo was noted in 14 eyes (40.0%) in the IAI group and in 1 eye (2.8%) in the observation group (P<0.001). The significant visual improvement was achieved from 1mo in the IAI group, and from 2mo in the observation group. The rate of complete absorption of subretinal fluid at 3mo did not differ between the two groups. (45.7% vs 41.7%, P=0.813). CONCLUSION: A single IAI for acute CSC induce a transient decrease in SFCT and CSFT, which implies that IAI may have a pharmacological effect on the underlying hyperpermeable choroid in acute CSC.     

单眼发病的原发性开角型青光眼黄斑脉络膜厚度及影响因素初探

目的:初步探讨原发性开角型青光眼（POAG）单眼发病患者黄斑中心凹下脉络膜厚度（SFCT）与其对侧眼和健康人的差异及其影响因素。方法:横断面研究。收集2018年9月至2019年9月就诊于首都医科大学附属北京同仁医院青光眼门诊确诊为POAG的单眼发病、对侧眼正常的患者（POAG组）以及健康志愿者（健康对照组）。对所有参与...     

康柏西普玻璃体内注射治疗特发性脉络膜新生血管

目的　探究康柏西普玻璃体内注射治疗特发性脉络膜新生血管（idiopathic choroidal neovascularization,ICNV）的疗效。方法　选择2016年1月至2018年1月我院眼科收治的ICNV患者146例（146眼）纳入研究,所有患者均行玻璃体内注射康柏西普治疗,测量治疗前后最佳矫正视力（BCVA）、眼压、黄斑中心凹脉络膜厚度（subfoveal choroidal thickness,SFCT）及上侧脉络膜厚度（superior choroidal thickness,SCT）、下侧脉络膜厚度（inferior choroidal thickness,ICT）、鼻侧脉络膜厚度（nasal choroidal thickness,NCT）、颞侧脉络膜厚度（temporal choroidal thickness,TCT）,观察并评价脉络膜新生血管（CNV）渗漏情况,比较患眼治疗前后BCVA、眼压及各区域脉络膜厚度,以及患眼及对侧眼脉络膜厚度差异。结果　与治疗前比较,患眼治疗后 1 d、1个月时BCVA均显著提高(均为P<0.05）。患眼治疗前后眼压比较差异均无统计学意义（均为P>0.05）。随访12个月时患眼渗漏区面积较治疗前均有下降,CNV渗漏治疗有效率为80.82%。治疗前患眼SFCT、NCT 2.2 mm、TCT 2.2 mm、TCT 3.45 mm均显著高于对侧眼（均为P<0.05）;治疗后12个月患眼各部位脉络膜厚度均较治疗前显著降低,差异均有统计学意义（均为P<0.05）。治疗过程中及治疗后均未见严重不良反应发生。结论　玻璃体内注射康柏西普可改善ICNV患者视力,减少视网膜渗漏症状,降低SFCT,效果较好。     

Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy

AIM: To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS: This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS: There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1, and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose PDT group (P<0.05). CONCLUSION: Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups are efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.     

康柏西普治疗慢性中心性浆液性脉络膜视网膜病变的疗效

目的:观察玻璃体腔注射康柏西普治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床疗效.方法:选取2015-10/2016-05我院门诊确诊的9例9眼慢性CSC患者,给予玻璃体腔注射0.5mg/0.05mL康柏西普治疗(其中6眼1mo后再次给予相同剂量的玻璃体腔注射).注射后第1、2、6mo随访观察,观察指标包括治疗前后的最佳矫正视力(best-corrected visual acuity,BCVA)、眼压、OCT、眼底血管荧光素造影(fundus fluoresceine angiography,FFA)、脉络膜吲哚菁绿血管造影(indocyanine green angiography,ICGA)、黄斑中心凹厚度(central macular thickness,CMT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT).结果:患者9例9眼中,7眼对康柏西普有明显应答,2眼患者无应答.玻璃体腔注药前9眼患者CMT平均值为373.12±72.43μm,康柏西普治疗后1、2、6mo时CMT分别为332.05±67.13、282.24±62.30、225.56±71.08μm,与治疗前相比均具有统计学差异(P<0.05).9眼患者治疗前SFCT厚度为422.11±64.82μm,无应答患者治疗前脉络膜厚度低于平均值,分别为353、65μm.9眼患者治疗后1、2、6mo的SFCT分别为391.45±75.24、365.53±63.07、355.40±66.65μm,治疗前与治疗后1mo相比差异无统计学意义(P=0.074),与治疗后2、6mo相比较有统计学差异(P<0.01).治疗前平均视力为0.53±0.32,注射后平均视力为0.65±0.20,无统计学差异(P>0.05).结论:慢性CSC玻璃体腔注射康柏西普可以有效促进视网膜下液的吸收,降低CMT.玻璃体腔注药后6mo内黄斑中心凹下脉络膜厚度较治疗前显著降低,而黄斑中心凹下脉络膜厚度可能是患者是否应答的一个指标.     

Optical Coherence Tomography-based Diagnosis of Polypoidal Choroidal Vasculopathy in Korean Patients

PurposeTo evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients.MethodsThis retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features.ResultsIn eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%.ConclusionsThe OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.     

原发性房角关闭性疾病患者脉络膜厚度的临床研究

目的:应用频域光学相干断层扫描深度增强成像技术(EDI-OCT)测量并探讨原发性房角关闭性疾病(PACD)患者黄斑区及视盘周围脉络膜厚度的特点及规律,分析脉络膜厚度在PACD发病机制中的作用。方法:前瞻性研究。收集2015-01/2019-12于我院就诊的PACD患者82例155眼,其中可疑原发性房角关闭(PACS)组24例24眼;急性原发性房角关闭(APAC)组28例35眼;慢性原发性房角关闭(CPAC)组30例38眼;原发性闭角型青光眼(PACG)组38例58眼。另收集健康志愿者87例87眼纳入正常对照组。所有研究对象均应用EDI-OCT测量黄斑区及视盘周围脉络膜厚度。结果:PACD各组黄斑区脉络膜厚度均高于正常对照组(P<0.05)。在PACD患者中,除距黄斑中心凹3mm处鼻侧,PACG组黄斑区其余各点位脉络膜厚度均低于PACS组、APAC组、CPAC组(P<0.05)。APAC组黄斑中心凹下脉络膜(357.17±61.49μm)最厚,PACS组(318.04±56.52μm)次之,PACG组最薄(263.55±67.87μm)。除CPAC组,其余各组黄斑中心凹旁1mm处脉络膜厚度均较黄斑中心凹下脉络膜厚度降低(P<0.05)。各组受检者黄斑中心凹旁3mm处脉络膜厚度均低于黄斑中心凹下和黄斑中心凹旁1mm处(P<0.05)。各组受检者视盘周围脉络膜厚度无差异(P>0.05)。结论:PACD患者及正常人黄斑中心凹下脉络膜最厚,离黄斑中心凹越远,脉络膜越薄。黄斑区脉络膜增厚是PACD患者又一特征性解剖结构,可能是诱发青光眼急性发作的重要因素。PACD患者视盘周围脉络膜厚度与正常人相比并无特征性改变。     

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。     

Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types

Purpose: We assessed the characteristic indocyanine green angiographic (ICGA) and spectral domain optical coherence tomographic (SD‐OCT) findings of two types of polypoidal choroidal vasculopathy (PCV), distinguishable by different filling patterns on ICGA. Methods: Thirty‐one eyes with PCV were classified into types 1 and 2 based on ICGA findings of either the presence or absence of both a feeder and a draining vessel. Characteristic ICGA findings were evaluated for each type of PCV. Spectral domain optical coherence tomographic images of the 31 eyes were also used to compare the two types of PCV. Results: Both a feeder and a draining vessel were observed in 13 eyes (type 1). Eighteen eyes had neither feeder nor draining vessels (type 2). In PCV type 1, a break in the highly reflective line thought to be Bruch’s membrane was detected, corresponding to the feeder vessel in‐growth site on SD‐OCT. This line was straight. In PCV type 2, the highly reflective line exhibited irregular thickness and had highly reflective substances adhering to its lower portion. It curved downward and became increasingly obscure, ultimately disappearing at a point corresponding to the site at which network vessel filling began. The mean subfoveal choroidal thicknesses in eyes with PCV type 1 and PCV type 2 were 199 ± 65 and 288 ± 98 μm, respectively. Conclusions: Our observations support the existence of two distinct types of PCV. The first type represents choroidal neovascularization, whilst the second type involves choroidal vasculature abnormalities.     

特发性黄斑前膜患者视网膜和脉络膜厚度分析:基于扫频源OCT

目的 采用扫频源OCT(SS-OCT)研究特发性黄斑前膜(IMEM)患者视网膜和脉络膜厚度特点.方法 横断面研究.纳入2019年3月至2020年12月就诊于郑州大学第一附属医院的IMEM患者60例60眼为试验组,另纳入36例60眼正常眼为对照组.使用SS-OCT测量并分析受检者黄斑中心凹下视网膜厚度(SFRT)、黄斑中...