共焦激光断层扫描评价黄斑裂孔手术解剖疗效

目的 探讨共焦激光断层扫描（scanning laser tomography，SLT）在评价黄斑裂孔手术疗效中的作用。 方法 采用德国海德堡公司的视网膜断层扫描仪（Heidelberg retina tomograph，HRT），检测14例黄斑裂孔患者15只患眼黄斑部视网膜地形图参数，并对其中11只眼行玻璃体视网膜手术前后视网膜地形图差异进行分析。HRT扫描野设置为15°×15°，扫描深度范围为1.5～2.0 mm。每只受检眼探测3次，取3次图像的均值分析。 结果 HRT定量检测显示15只眼黄斑裂孔的平均面积为(0.499±0.34) mm2，裂孔最大深度为(0.284±0.11) mm。11只黄斑裂孔眼玻璃体视网膜手术后裂孔周围视网膜高度较手术前明显降低，手术后裂孔最大深度为(0.063±0.04) mm。 结论 SLT能探测黄斑裂孔的三维结构，并作定量的地形图参数分析，可作为一种客观评价黄斑裂孔手术解剖疗效的有效手段。 (中华眼底病杂志, 2002, 18: 125-127)     

Optical coherence tomography and confocal scanning laser tomography for assessment of macular edema

PURPOSE: To compare optical coherence tomography (OCT) and confocal scanning laser tomography (cSLT) for quantitative retinal thickness mapping of the macula and their ability to detect macular edema. DESIGN: Prospective, comparative, clinical observational study. METHODS: The study population of 138 eyes (97 patients) was divided into a study group consisting of 45 (32.6%) eyes with macular edema and a control group consisting of 93 (67.4%) eyes without macular edema. All patients underwent OCT and cSLT of the macula. Retinal thickness measurements obtained by OCT were compared with signal width and edema index, determined by cSLT. RESULTS: The OCT measurements and cSLT edema index were significantly (P <.001) correlated with each other. Correlation coefficients decreased (P <.001) with increasing diameter of the measurement circle. In the macular edema group, correlation coefficients were significantly (P <.001) higher than in the control group. To separate the study and control groups, receiver operator characteristic curves covered a larger area for OCT measurements than for cSLT measurements. Retinal thickness measurements and edema index correlate with visual acuity (correlation coefficient r = -.653 for OCT, r = -.608 for cSLT; P <.001). CONCLUSIONS: Macular edema can be quantitatively mapped by OCT and cSLT. The retinal thickness and edema index measurements correlate with visual acuity. The fast and standard examination modes of OCT give similar measurements. Both OCT and cSLT can differentiate between eyes with and without macular edema, with OCT showing a higher predictive value.     

Predicting visual outcome after macular hole surgery using scanning laser ophthalmoscope microperimetry

AIMS—To determine if postoperative visual outcome after successful macular hole surgery can be predicted with preoperative scanning laser ophthalmoscope (SLO) microperimetry.
METHODS—A prospective non-comparative study of 16 eyes in 15 patients examined before the surgery.
RESULTS—Visual outcome following macular hole surgery correlated with the "maximum parahole sensitivity", the highest intensity of stimulus to which the patient did not respond to any of the stimuli around the hole. Preoperative visual acuity, duration of the symptoms, size of the macular hole, and the "minimum parahole sensitivity", the lowest intensity to which the patient responded to all the stimuli around the hole, did not correlate significantly with postoperative visual acuity.
CONCLUSION—Preoperative assessment of patients using SLO microperimetry is a good predictor of visual outcome after macular hole surgery.

     

Infrared scanning laser tomography of macular cysts

OBJECTIVE: To perform three-dimensional, noninvasive, quantitative analysis of cystoid macular edema and macular cysts using infrared scanning laser tomography and to correlate findings with visual acuity (VA) as a basis for interventional studies. DESIGN: Cross-sectional, nonrandomized study. PARTICIPANTS: Seventeen patients (29-86 years of age) with macular cysts associated with a broad spectrum of diseases. INTERVENTION: Confocal infrared imaging with scanning laser tomography with the TopSS (790 nm) (Laser Diagnostic Technologies, San Diego, CA) with digitized images was used to perform three-dimensional, quantitative analysis of cysts in the central 5 degrees of the macula. MAIN OUTCOME MEASURES: Measurements of macular cyst number, area, volume, depth, slope, height of the surrounding macular elevation, and correlation with VA. RESULTS: Scanning laser tomography detected macular cysts in all patients. The number per patient ranged from 1 through 15. Cysts were accompanied by surrounding macular elevation in 16 patients (mean macular height, 216 microm). The area covered by cysts in the central 5 degrees was 0.087 to 0.969 mm2, and volume was 0.007 to 0.549 mm3. Visual acuity was significantly poorer in patients with greater cyst area (P = 0.0007), cyst volume (P = 0.0009), macular thickening (P = 0.0002), and cyst depth (P = 0.0013). Cyst number, average slope, and maximum slope, however, did not correlate significantly with VA. Grouping of macular cysts according to macular height and average cyst depth revealed that cysts in a more thickened retina were significantly deeper, had steeper slopes, and corresponded to worse VA. Macular height and average cyst depth were highly associated with each other, suggesting that in eyes with surrounding macular edema, cysts were deeper and may reflect more widespread tissue destruction. Individual confocal tomographic images provided additional information. Neither ophthalmoscopy nor fluorescein angiography delineated features such as retinal folds that suggested vitreous traction or changes in deeper layers that suggested occult choroidal new vessels. CONCLUSIONS: Infrared scanning laser tomography is a rapid and noninvasive imaging method that provides quantitative analysis of macular cysts in addition to qualitative information not seen clinically. Because poor VA is related to severe involvement of the central retina, scanning laser tomography could provide an objective outcome measure for interventional studies.     

Evaluation of successful macular hole surgery by optical coherence tomography and multifocal electroretinography

PURPOSE: To evaluate successful macular hole surgery using optical coherence tomography (OCT) and multifocal electroretinography (MFERG). DESIGN: Interventional case series. METHODS: In a prospective study, 20 eyes of 20 patients with successful surgery for stage II, III, or IV idiopathic macular hole were evaluated by best-corrected visual acuity (BCVA), ocular examination, OCT, and MFERG preoperatively and 1, 3, 6, and 12 months postoperatively. For statistical analysis, the paired t test and nonparametric methods were used, as well as the Spearman analysis. RESULTS: Postoperatively, all 20 eyes of 20 patients had anatomic closure of the macular hole confirmed by OCT. The center of the fovea, measured by OCT from the retinal pigment epithelium to the inner retinal surface, had a mean +/- SD thickness of 116.5 +/- 30.9 microm (range, 68-175 microm) 1 year postoperatively. Best-corrected visual acuity significantly improved (preoperative mean +/- standard deviation [SD] value, 0.131 +/- 0.081 and 1 year postoperative mean +/- SD value, 0.407 +/- 0.193). Multifocal electroretinography values area 1 (0-2.8 degrees) and area 2 (2.8-9 degrees from the center of the fovea) significantly improved (preoperative mean +/- SD values 3.10 +/- 1.334 nV/deg(2) and 3.573 +/- 1.545 nV/deg(2), respectively, and 1 year postoperative +/- SD mean values, 5.53 +/- 1.208 nV/deg(2) and 4.748 +/- 1.404 nV/deg(2), respectively). The thickness of the fovea, measured by OCT, significantly correlated with the BCVA 1 year postoperatively. One year postoperative MFERG values areas 1 and 2 were not correlated with 12-month BCVA and OCT findings. CONCLUSIONS: Twelve months postoperatively BCVA and MFERG values significantly improved in this series of eyes with successful macular hole surgery. Optical coherence tomography findings were correlated to BCVA, but MFERG values were not correlated to BCVA and OCT findings, 1 year postoperatively.     

Natural history of foveolar lucencies observed by optical coherence tomography after macular hole surgery

PURPOSE: To describe the incidence, course, and anatomic and functional outcomes of foveolar lucencies observed by optical coherence tomography after macular hole surgery. METHODS: Retrospective chart review of all idiopathic macular hole surgeries performed between February 2002 and August 2003. Available data involving eyes with foveolar lucencies after macular hole surgery were collected regarding best-corrected visual acuity, lens status, slit-lamp biomicroscopy, and optical coherence tomography before and at follow-up visits ranging from 1 week to 27 months after macular hole surgery. RESULTS: Thirty-five eyes of 35 patients were identified. Foveolar lucencies were detected by optical coherence tomography in 9 of the 35 eyes (26%). Operative procedures included creation of a posterior vitreous detachment in 8 eyes and indocyanine green-assisted internal limiting membrane peeling in 5 eyes. Intraocular tamponade consisted of 30% sulfur hexafluoride gas in 6 eyes and 20% perfluoropropane gas in 3 eyes with at least 1 week of face-down positioning. Postoperative visual acuity showed gradual improvement coinciding with decreasing size and eventual disappearance (3 to 11 months) of the foveolar lucency. CONCLUSION: Foveolar lucencies observed by optical coherence tomography are a common finding after macular hole surgery (26%). They occur with and without indocyanine green-assisted internal limiting membrane peeling. Earlier disappearance of the foveolar lucency does not correlate with the type of gas used for tamponade. They gradually decrease and eventually resolve with time without additional surgical intervention and with further improvement of visual acuity.     

共焦激光视网膜断层扫描在老年性黄斑变性检查中的应用

目的 观察共焦激光视网膜断层扫描在老年性黄斑变性(agedrelated macular degeneration, AMD)检查中的应用价值。 方法 应用德国海德堡共焦激光视网膜断层扫描仪(Heidelberg retinatomograph,HRT)对59例AMD患者的75只眼进行测量。其中渗出型AMD患者20例25只眼、萎缩型AMD患者16例25只眼、AMD玻璃疣患者23例25只眼。对比分析其扫描图像的Z轴面信号宽度、容积、最大深度的异同。 结果 渗出型AMD患眼黄斑部的Z轴面信号的宽度显著增宽，最大深度及容积大小与玻璃疣患眼比较，差异有显著性的意义(t值分别是2.787、4.487及3.054, P值分别是0.008、0.000及0.004);萎缩型AMD患眼黄斑部的Z轴面信号的宽度、最大深度及容积大小与玻璃疣患眼比较，差异有显著性的意义(t值分别是2.172、2.394及2.635, P值分别是0.041、0.020及0.015);渗出型AMD患眼黄斑部的容积显著大于萎缩型AMD患眼黄斑部容积(t=4.106, P=0)。 结论 渗出型AMD患眼黄斑部视网膜病变严重,HRT能够评价AMD患眼黄斑部视网膜病变的程度并监测其进展。 (中华眼底病杂志, 2002, 18: 262-265)     

Objective retinal nerve fiber laser assessment by scanning laser polarimetry in patients with chiasmal compression

PURPOSE: To assess the evaluation ability of retinal nerve fiber layer (RNFL) in patients with visual tracts' compression and to assess the correlation between visual field loss and changes in RNFL. MATERIAL AND METHODS: Polarimetric RNFL analysis (scanning laser polarimeter- NFA/GDx, software version 1.0.16, LDT(inc)) and kinetic perimetry were done in 41 eyes with different types of optic chiasma compression and in 40 healthy eyes, age matched controls. RESULTS: In eyes with optic chiasma compression most of the GDx parameters were statistically different from the control group (P<0.05). In eyes with normal visual fields and with optic chiasma compression most of GDx parameters were statistically different from the other analyzed groups. CONCLUSIONS: GDx may be a helpful tool in diagnosis of optic chiasma diseases. GDx is a useful visual prognostic indicator in the preoperative assessment of optic chiasma compression. Objective RNFL assessment is especially important in patients with serious visual field loss and poor visual acuity.     

Visual function assessment and metamorphopsia after macular hole surgery.

The purpose of this study was to develop a new resolution acuity measure for patients after macular hole surgery. Fifty eyes of 44 patients who had undergone successful treatment were tested. Visual acuity was measured with the Snellen, Early Treatment of Diabetic Retinopathy Study and Landolt-C charts. A Line Resolution Test was performed as part of their follow-up exam where a vertical line was presented. Participants were categorized by their perception of the line as solid, bent or broken. The line could be distorted into a sine-wave pattern in order to determine the participants' detection threshold for the distortion. Chart acuities did not differ among the three groups, as categorized by their line perception. Only the distortion measure was sensitive enough to differentiate the solid- from the broken-line group. The distortion measure assesses resolution power of the macula in smaller increments than acuity charts. This hyperacuity approach is more appropriate in the assessment of functional outcome after microsurgery.     

Complications of macular hole surgery

Macular hole is a serious vision-threatening disease for which, until the early 1990s, no effective treatment was available. However, with advanced techniques in microsurgical vitrectomy surgery, effective and successful closure of macular holes now can be obtained. Many complications can occur after any ocular surgery. Some of the specific complications associated with macular hole surgery are RPE alterations, retinal detachments, CME, subretinal neovascular membrane, endophthalmitis, hypopyon, late re-opening of macular holes, increased intraocular pressure, visual field defects, and cataract formation. Because macular hole surgery is a relatively recent operation devised in the last 8 years, data on complications still are being compiled and studied to understand and minimize the rates of complications after such surgery. We hope that, in the future, the rate of complications after macular hole surgery will be no higher than that for any other ophthalmic procedure.