重视光相干断层扫描血流成像的临床应用及其图像的判读

光相干断层扫描血流成像(OCTA)是在OCT的基础上发展而来的眼病诊断新技术,也是目前眼科影像学检查中发展最快速的检查方法之一.目前,对眼底血管性疾病的主要检查方法包括荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA),具有对血管异常动态显现的特点,能对异常血管形态和病变特征提供有用的诊断信息,但其为有创的检查方法,且无法对病变进行分层分析.与FFA和ICGA相比,OCTA除了具备无创、快速、高分辨率的特点外,还具有无创性对血流显影的能力,其不受血管渗漏和视网膜出血的影响,能够提供三维测量的病变图像,并能实现病变的定量检测和分层检测,目前已用于多种眼科疾病的诊断和病情监测.OCTA技术的临床应用丰富了眼科影像学对疾病的诊疗信息及发病机制的探索结果.OCTA的检测过程和正确判读是基于对其原理和眼部待测组织解剖知识的理解和掌握,因此理解其原理及临床应用是临床眼科医师的必修课程.     

眼眶神经源性肿瘤影像学特征及临床意义

目的 探讨超声、CT及MRI对眼眶神经源性肿瘤的诊断价值.方法 收集长征医院眼科2004年1月至2007年11月经手术治疗,具有完整病理资料的眼眶神经源性肿瘤76例,回顾分析超声、CT、MRI检查的影像学表现.结果 各种眼眶肿瘤的影像学表现均有一定的特征性.超声检杳有利于揭示病变内的组织结构.CT利于显示病变的空间位置以及相邻结构的继发改变.MRI即可以显示病变的空间位置、病变蔓延情况.也可以通过显示信号强度提示病变的内部结构.结论 联合应用眼部超声、CT、MRI是发现和诊断眼眶肿瘤的重要检查手段,对大多数肿瘤可以做出明确定性、定位诊断.     

甲状腺功能障碍性视神经病变的影像学研究进展

甲状腺功能障碍性视神经病变（ DON）是甲状腺相关眼病（ TAO）引起视神经功能损害的严重并发症,主要由眶内肿胀的眼外肌压迫眶尖视神经所致。早期诊治对疾病的疗效和预后至关重要。眼眶影像学检查在DON的诊断和评估上发挥着重要的作用,可以显示眼眶组织解剖结构,评估疾病分期及疗效,还能帮助识别倾向于发展为DON的患者。本文回顾了DON的病因、临床特征和影像学,着重对DON的影像学研究进行综述,包括CT、MRI和多普勒超声研究。     

值得进一步深入研究的眼底病热点:息肉样脉络膜血管病变与老年性黄斑变性的异同

息肉样脉络膜血管病变(PCV)是以视网膜下出血、视网膜色素上皮脱离和神经上皮脱离为特征的渗出性黄斑病变,占我国新生血管性老年性黄斑变性(AMD)患者的33.5％.吲哚青绿血管造影检查发现脉络膜来源的单个或多个结节样强荧光为当前PCV诊断的金标准.组织病理学检查显示脉络膜毛细血管透明样变,与动脉硬化表现相似;基因研究目前尚未发现PCV与AMD的区别;环境因素显示高血压与PCV的相关性超过与AMD的相关.PCV与AMD是不同的基因型还是相同的基因产生不同的表型,以及两种疾病发病机制的异同均有待进一步的研究.     

先天性视网膜劈裂症的影像学观察

目的 观察总结先天性视网膜劈裂症的影像学图像特征.方法 回顾性分析2008年4月至2012年3月我院确诊的先天性视网膜劈裂症患者28例(52眼)的临床资料,所有患者均进行OCT、眼科A/B超、视网膜电图(electroretinogram,ERG)和光学生物测量仪(IOL Master)检查,记录分析检查结果.结果 OCT显示,28例(52眼)患者中5眼病变局限于黄斑部(≤4mm),26眼病变位于后极部(≤7 mm),16眼病变波及赤道部甚至更前部球壁(OCT无法探及的范围),5眼黄斑部为正常表现.A/B超图像显示,患者患眼黄斑区或后极部球壁欠光滑,且双眼均无后巩膜葡萄肿.ERG显示,b波振幅下降或消失,a波则基本正常或轻度降低.IOL Master检查显示,患眼眼轴长度为(22.50±2.14)mm,较正常眼(23.20±2.45) mm偏小;患眼角膜曲率为42.61 ～44.06(43.45±1.26)D,较正常眼41.72 ～42.99(42.08±1.04)D偏大.结论 OCT对鉴别视网膜劈裂症有重要意义,眼科A/B超和IOL Master检查可以帮助降低误诊几率.     

糖尿病性角膜病变的研究进展

糖尿病性角膜病变是糖尿病眼病主要表现之一,是一种潜在的致盲性眼病.糖尿病对角膜各层组织结构、代谢及功能均有重要影响.糖尿病性角膜病变的发病机制尚未完全明确.本文就糖尿病性角膜各层组织结构改变以及角膜神经改变的研究现状作一综述.     

糖尿病性视网膜病变药物治疗进展-PKCβ抑制剂

β型蛋白激酶C(PKCβ)的活化在糖尿病性视网膜病变的发生和发展过程中起着关键作用。PKCβ抑制剂LY333531对视网膜正常代谢影响很小,它能有效阻止与糖尿病性视网膜病变有关的病理变化,包括视网膜渗漏及新生血管形成。Ⅰ期临床试验显示人体能耐受LY333531的治疗剂量。药代动力学预试验结果显示该药对缓解早期糖尿病性视网膜病变所致血管功能异常有明显效果。PKCβ抑制剂可延缓甚至可能逆转糖尿病性视网膜病变的过程,为早期药物治疗糖尿病性视网膜病变带来了新希望。     

432例眼眶肿瘤影像诊断分析

目的：探讨眼眶肿瘤的影像诊断特征。方法：总结经手术组织学证实的眼眶肿瘤４３２例的Ｂ超、ＣＴ、ＭＲＩ表现。结果：各种眼眶肿瘤的影像学表现均有一定的特征性,Ｂ超有利于揭示病变内的组织结构以及显示病变与软组织关系。ＣＴ利于显示病变的空间位置以及相邻结构的继发改变。ＭＲＩ即可以显示病变的空间位置、病变蔓延情况,也可以通过显示信号强度提示病变的内部结构。结论：影像检查技术在眼眶肿瘤的诊断中有重要价值。     

Adie瞳孔患者的神经影像学和神经电生理检查

目的 探讨Adie瞳孔的神经发病机制.方法 回顾分析具有光-近反射分离及虹膜括约肌的节段性麻痹的Adie瞳孔特征的42例患者的神经影像学和神经电生理检查资料.其中,单侧瞳孔扩大者37例,双侧瞳孔扩大者5例.患者中,23例行头颅核磁共振成像(MRI)检查,其中1例同时行头颅CT检查.另有14、5、9、18、11、5例患者分别进行神经传导速度、四肢肌电图、双下肢肌电图、视觉诱发电位(VEP)、体感诱发电位、脑电图检查.结果 23例行MRI和CT检查的患者中,13例出现中枢神经系统中线结构解剖变异或微小病变.14例同时行肌电图和神经传导速度检查的患者中,6例表现为感觉神经传导速度减慢和多发性感觉运动性周围神经损害;18例行视觉诱发电位检查的患者中,5例P100潜伏期延长;11例行体感诱发电位检查的患者中,2例显示周围神经损害;5例检查脑电网的患者中,1例显示异常.结论 周围神经损害可能是Adie瞳孔的重要发病机制,中枢神经系统损害也参与其发病.     

先天性上睑下垂发病机制的研究进展

先天性上睑下垂是一种较为常见的眼睑运动功能障碍性病变,主要表现为双眼或单眼上睑提起困难,睑裂狭小,不仅影响外观,而且影响患者视力和视野.对于该病的确切致病因素迄今尚不明确.本文对近年来有关先天性上睑下垂在遗传相关性、提上睑肌组织学及影像学等方面的研究进展作一综述.     

眼底炫彩成像在眼底疾病诊断中的临床应用研究现状与进展

眼底炫彩成像(MCI)是通过共焦激光扫描眼底镜以三束不同波长的激光同时扫描后极部眼底,由于不同波长激光的组织穿透力不同,可获得不同层面眼底结构的反射信号,得到的信息量比传统眼底照相更丰富。目前国内外临床应用MCI与OCT、FAF或FFA等联合模式成像,为视网膜及脉络膜不同层面疾病的诊断、鉴别诊断、病情监测等方面提供了重要信息及参考价值,然而MCI在眼底疾病诊断中仍存在误区,仔细解读视网膜细节在MCI、CFP和其他成像方式显示上的差别,更有利于眼底疾病的正确诊断。     

正确认识OCT血管成像技术的临床应用价值

OCT血管成像(OCTA)是一项无创、快捷的血流检测技术,目前主要用于视网膜脉络膜的血流成像.与传统的荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)技术不同,OCTA无需静脉注射造影剂就能够对血流信号进行探测和量化分析,并且能够分层观察和判断视网膜脉络膜的血流改变情况,因此OCTA比传统的眼底血管造影技术提供的血流信息更多、更准确.OCTA作为一项具有革命性突破的新技术,在眼科血管性疾病的诊断及血流改变有关眼病的发病机制探讨方面具有划时代的意义.但是,任何新技术的临床应用都有其限制性和局限性,如OCTA观察的眼底范围并不如FFA和ICGA大,且检查和读图过程中也受到一些因素的影响.充分了解OCTA的成像原理和成像特点有助于眼科医师更好地了解视网膜脉络膜疾病、青光眼和神经眼科疾病的血流改变,并加深对这些疾病发病机制的认识,同时利用该技术对相关眼病进行有效监测和随访.     

拓展眼底自身荧光临床研究的广度和深度,提升其应用研究水平

眼底自身荧光(FAF)主要来源于视网膜色素上皮(RPE)细胞内堆积的代谢产物脂褐质,是活体条件下评价RPE活性与形态学改变的重要检测下具.作为一种无损伤、可重复、简便快捷的检测手段,FAF结合其他眼底形态与功能检测方法,可从RPE结构和功能变化的角度为部分常见眼底疾病提供辅助诊断依据.在逐步认识各种眼底疾病FAF表现特...     

正确认识理解光学影像检查的原理特点,提高光学影像检查技术的应用水平

眼科医学影像检查包括放射影像、声学影像和光学影像检查等三大类.由于眼的生理特点,光学影像检查在眼底疾病诊断中具有特殊意义.眼底光学影像检查经历了检眼镜、荧光素眼底血管造影两个历史阶段,至今已经发展成红外眼底照相、眼底自发荧光、荧光素与吲哚青绿血管造影、光相干断层扫描等多种检查技术综合的新兴学科,在眼底疾病诊断和治疗评价中发挥着无法替代的作用.正确理解各种光学影像检查的原理和特点,才能充分认识各项检查的意义,提高光学影像检查技术的应用水平,从而对眼底疾病发生、发展及转归等本质规律有更加深入的认识.

Abstract：

Ophthalmic imaging including radiographic imaging, acoustic imaging and optical imaging,as a branch of medical imaging has developed rapidly. Optical imaging is very suitable for fundus examination because of the physiological characteristics of the eye. Ophthalmoscope and fundus fluorescein angiography are two historical stages of fundus optical imaging, which become an independent new discipline now, including infrared fundus photography, fundus autofluorescence, fundus fluorescein and indocyanine green angiography and optical coherence tomography. Comprehensive optical imaging plays an irreplaceable role in the diagnosis and treatment evaluation of ocular fundus diseases. Appropriate understanding the principles and significance of various optical imaging methods is very important for their clinical applications.     

关注黄斑区肥厚型脉络膜疾病谱的概念及研究

肥厚型脉络膜疾病谱是近年来随着眼科诊疗技术的进步而提出的新概念.眼底影像学诊断技术的巨大进步,特别是扫频源OCT在扫描速度、深度、扫描模式以及扫描软件方面的突破,克服了以往眼底成像技术的局限性,使得深达脉络膜,甚至巩膜的结构得以清晰成像,为视网膜脉络膜疾病的诊断、分型及发病机制研究提供了有用信息和依据.近年来正是基于OCT对脉络膜越来越精细的成像特点提出了肥厚型脉络膜疾病谱的概念,国外学者将与慢性持续性脉络膜增厚相关的具有临床表型及发病机制相似的黄斑疾病进行归类并加以病名,为该类疾病的临床诊疗及临床研究提供了新的方向.眼科医师应该关注这些新的进展和相关的研究工作.本文就其概念、发病机制、临床表型做一简要评述.     

Advances in imaging the blood and aqueous vessels of the ocular limbus

The vessels of the limbus play a pivotal role in the drainage of the major portion of aqueous humour from the anterior chamber. Aberrations in the limbal architecture can lead to raised intraocular pressure, which in turn can lead to blinding conditions such as glaucoma. Imaging these vessels in the normal eye, in development, and in conditions where there is anterior segment dysgenesis remains a challenge. Here we review the progress in limbal vessel imaging in the past 50 years and provide key information on their strengths and limitations. Included is an analysis of serial histological sectioning, ultrathin sections, microvascular perfusion with plastics and corrosion casting, X-ray microcomputed tomography, in vivo imaging including analysis of transgenic mice expressing GFP-vascular endothelium fusion proteins, in vivo microscopy imaging using fluorescent-labelled antibodies, slit-lamp microscopy and gonioscopy, fluorescein angiography, optical coherence tomography, and various labelling procedures for the vascular endothelium and the various forms of microscopy used to view these.     

Degeneration of cortical function in the Royal College of Surgeons rat

The purpose of the current study was to determine the progress of cortical functional degeneration in the Royal College of Surgeons (RCS) rat. Cortical responses were measured with optical imaging of intrinsic signals using gratings of various spatial frequencies. Subsequently, electrophysiological recordings were also taken across cortical layers in response to a pulse of broad-spectrum light. We found significant degeneration in the cortical processing of visual information as early as 4 weeks of age. These results show that degeneration in the cortical response of the RCS rat starts before development has been properly completed.     

Quantitative approaches in multimodal fundus imaging: State of the art and future perspectives

When it first appeared, multimodal fundus imaging revolutionized the diagnostic workup and provided extremely useful new insights into the pathogenesis of fundus diseases. The recent addition of quantitative approaches has further expanded the amount of information that can be obtained. In spite of the growing interest in advanced quantitative metrics, the scientific community has not reached a stable consensus on repeatable, standardized quantitative techniques to process and analyze the images. Furthermore, imaging artifacts may considerably affect the processing and interpretation of quantitative data, potentially affecting their reliability. The aim of this survey is to provide a comprehensive summary of the main multimodal imaging techniques, covering their limitations as well as their strengths. We also offer a thorough analysis of current quantitative imaging metrics, looking into their technical features, limitations, and interpretation. In addition, we describe the main imaging artifacts and their potential impact on imaging quality and reliability. The prospect of increasing reliance on artificial intelligence-based analyses suggests there is a need to develop more sophisticated quantitative metrics and to improve imaging technologies, incorporating clear, standardized, post-processing procedures. These measures are becoming urgent if these analyses are to cross the threshold from a research context to real-life clinical practice.     

Qualitative perfusion imaging of the human optic nerve

PURPOSE: Standard methods for the evaluation of human optic nerve perfusion provide limited information. In this pilot study, the authors investigated the feasibility of qualitative perfusion imaging, a recently developed neuroradiologic technique, as a method of assessing human intraorbital optic nerve blood flow. METHODS: Qualitative perfusion imaging (based on magnetic resonance fast spin-echo sequences) was used to study the optic nerves of 7 healthy volunteers and 5 patients with known optic nerve disease. Data regarding both study subject background and alteration in optic nerve signal intensity were statistically analyzed. RESULTS: Control group subjects were significantly younger than study group subjects. No significant differences in optic nerve signal patterns were found within the control group. Comparison of patients with optic neuropathy against the normal composite revealed substantial differences in enhancement characteristics. CONCLUSIONS: Qualitative perfusion imaging of the human optic nerve is feasible and may serve as the basis for more advanced neuroradiologic studies of optic nerve blood flow abnormalities.     

开展小儿视网膜疾病影像检查，提高小儿视网膜疾病诊断治疗水平

随着眼底影像检查设备技术的进步以及应用水平的提高，视频检眼镜、眼底照相、荧光素眼底血管造影、光相干断层扫描以及眼部超声等眼底病影像检查手段逐步应用于小儿视网膜疾病的检查、诊断、治疗过程中。这些实时、精确、可重复的检查手段所提供的小儿眼底检查信息，不仅有助于更好地理解和观察小儿视网膜发育，揭示小儿特有的视网膜疾病的发病机制和病程进展，监测治疗效果和预后，而且使众多既往不能早期发现和诊断的小儿视网膜疾病的早期诊断成为可能。通过多学科专业合作，使这些小儿视网膜疾病影像检查过程更简便、安全，检查结果更加全面、客观，则将进一步扩大影像检查在小儿视网膜疾病诊断治疗过程中的应用，提高小儿视网膜疾病的诊断治疗水平。