OCT和OCTA生物学标志物在糖尿病性黄斑水肿预后和监测中的应用

糖尿病性黄斑水肿(DME)是糖尿病视网膜病变(DR)的并发症,也是DR患者视力下降和失明的主要原因。光学相干断层扫描(OCT)和光学相干断层扫描血管造影(OCTA)作为无创、非侵入性评估视网膜各层微结构和微血管病理改变的主要检查手段,是检测和评估DME的常用方法。随着OCT和OCTA技术的不断发展,各种参数被赋予生物标志物的作用,例如中央凹厚度(CST)、黄斑部平均厚度(CAT)和黄斑部容积(CV)、视网膜内层结构紊乱(DRIL)、高反射灶(HRF)和中央凹下神经视网膜脱落(SND)等,广泛运用于临床。OCT可以直观显示黄斑区视网膜及脉络膜的层次变化和细微结构,而OCTA更常运用于微血管改变。本文就OCT及OCTA相关生物学标志物在DME中预后和监测的作用进行阐述,同时检测结果中可见的生物学标志物可以为DME的监测和治疗策略提供新思路,并为DR和DME的发病机制提供新的见解。     

正视儿童脉络膜厚度的分布特征及相关影响因素

目的：应用扫频源光学相干断层扫描血流成像技术（SS-OCTA）观察正视儿童黄斑区脉络膜厚度（CHT）的分布特征,并探讨其相关影响因素。方法：横断面研究。连续性纳入2021年5—9月在郑州大学第一附属医院眼科就诊的6~12岁正视儿童63例。以黄斑中心凹为中心,使用SS-OCTA测量黄斑区的CHT和脉络膜血管指数（CVI）,根据ETDRS分区将图像划分为3个环区：黄斑中心凹区（直径0~1 mm）、内环区（直径1~3 mm）和外环区（直径3~6 mm）。均纳入右眼数据分析。采用单因素方差分析比较3个环区和内、外环区的上方、颞侧、下方和鼻侧4个区域的CHT,并采用单因素线性回归和多元线性回归分析3个环区的CHT与性别、年龄、屈光度、父母屈光度、眼轴长度、瞳孔直径和CVI等参数的相关性。结果：黄斑中心凹区、内环区和外环区的CHT分别为（320±58）（315±55）（299±47）μm（F=2.77,P=0.065）,外环区的CHT比黄斑中心凹区的CHT薄（t=2.20,P=0.025）,其余两两环区CHT相比,差异均无统计学意义（均P>0.05）。黄斑中心凹区和内、外环区的上方、颞 侧、下方及鼻侧共9个区域的CHT相比,总体差异有统计学意义（F不同区域=19.20,P<0.001）,在内环区和外环区的上方、颞侧、下方和鼻侧4个区域的CHT相比,差异均有统计学意义（F内环区=8.15,P<0.001;F外环区=43.11,P<0.001）,均是鼻侧最薄。经单因素线性回归分析,黄斑中心凹区、内环区的CHT均与瞳孔直径相关（β=14.31,P=0.035;β=13.88,P=0.039）;黄斑中心凹区、内环区和外环区的CHT均与对应环区的CVI相关（β=264.60、335.87、463.22,均P<0.001）。去除混杂因素后,经多因素线性回归分析发现黄斑中心凹区、内环区和外环区的CHT均与对应环区的CVI呈正相关（β=233.96、306.93、429.25,均P<0.001）,其中黄斑中心凹区、内环区的CHT与瞳孔直径呈正相关（β=18.32、17.56,P=0.023、0.027）;内环区和外环区的CHT与性别有相关性（β=24.92、23.50,P=0.043、0.038）;外环区的CHT与年龄呈正相关（β=10.71,P=0.025）;与其余参数间无相关性。结论：6~12岁正视儿童黄斑外环区的CHT比黄斑中心凹区的薄,且内、外环区的鼻侧最薄。男性、年龄越大、瞳孔直径越大和CVI越大的儿童,黄斑各环区的CHT越厚。     

基于扫频光源光学相干断层成像观察病理性近视眼脉络膜厚度和血管变化

目的：:利用扫频光源光学相干断层扫描研究病理性近视眼脉络膜厚度（CT）和血管的变化。方法：:系列病例研究。共纳入2019年9月至2020年6月在温州医科大学附属眼视光医院就诊的40名受试者,根据诊断分为高度近视组和病理性近视组2组,其中高度近视组20例,病理性近视组20例,用VG200 OCT对受试者右眼以黄斑中心凹为...     

Macular Microvasculature and Associated Retinal Layer Thickness in Pediatric Amblyopia: Magnification-Corrected Analyses

PurposeThe purpose of this study was to characterize macular microvasculature and structural retinal layers using magnification-corrected optical coherence tomography angiography (OCTA) images in children with amblyopia.MethodsThis prospective cross-sectional study included 22 children with unilateral amblyopia (4–11 years of age) receiving spectral-domain OCTA. Vessel densities in foveal and parafoveal regions of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured in amblyopic and fellow eyes using a customized image analysis program correcting the scale of retinal image with axial length. Iowa Reference Algorithms (Iowa Institute for Biomedical Imaging) were used to measure mean thickness values of 10 intra-retinal layers rescaled for image size correction.ResultsFoveal and parafoveal vessel densities in amblyopic eyes were lower than that of the fellow eyes in the SCP (fovea: P = 0.006 and parafovea: P = 0.003) and the DCP (P = 0.024 and P = 0.025, respectively). Amblyopic eyes had significantly smaller foveal avascular zone (FAZ) area than fellow eyes (P < 0.001). There were significant differences in retinal layer thickness between paired eyes, particularly in the inner retina in both foveal and parafoveal regions; retinal nerve fiber layer (RNFL) (P = 0.024 and P = 0.095, respectively), ganglion cell layer (P < 0.001 and P = 0.008), inner plexiform layer (IPL; P = 0.12 and P = 0.037), inner nuclear layer (P = 0.005 and P = 0.005), and outer plexiform layer (OPL; P = 0.02 and P = 0.057), except in the foveal IPL, the parafoveal RNFL, and OPL.ConclusionsUnilateral amblyopic eyes demonstrate reduced macular vessel density and thicker inner retinal layers compared with fellow eyes even after correcting for image magnification. Changes in macular microvasculature and structural layers may offer valuable insights in the development of amblyopia.     

Exploring the Relationship Between Multilayered Choroidal Neovascularization and Choriocapillaris Flow Deficits in AMD

PurposeWe used optical coherence tomography angiography to test the hypothesis that more complex, multilayered choroidal neovascular (CNV) membranes in AMD are associated with worse flow deficits (FD) in the choriocapillaris.MethodsRetrospective, cross-sectional study including 29 eyes of 29 subjects with neovascular AMD. En face choriocapillaris images were compensated for signal attenuation using the structural OCT slab and signal normalization based on a cohort of healthy subjects. We binarized the choriocapillaris using both local Phansalkar and global MinError(I) methods and quantified FD count, FD density, and mean FD size in the entire area outside the CNV, in the 200-µm annulus surrounding the CNV, and in the area outside the annulus. We used projection-resolved optical coherence tomography angiography to quantify CNV complexity, including highest CNV flow height, number of flow layers, and flow layer thickness. We explored the relationship between CNV complexity and choriocapillaris FD using Spearman correlations.ResultsThe highest CNV flow signal significantly correlated with lower FD count (P < 0.01), higher FD density (P < 0.05), and higher mean FD size (P < 0.05) in the area outside the annulus and the entire area outside the CNV using both Phansalkar and MinError(I). Within the annulus, CNV complexity was not consistently correlated with choriocapillaris defects.ConclusionsCNV vascular complexity is correlated with choriocapillaris FD outside the CNV area, providing evidence for the importance of choriocapillaris dysfunction in neovascular AMD, as well as the potential role of choroidal ischemia in the pathogenesis of complex CNV membranes.     

Macular Choroidal Thickness and the Risk of Referable Diabetic Retinopathy in Type 2 Diabetes: A 2-Year Longitudinal Study

PurposeThe purpose of this study was to evaluate the associations between choroidal thickness (CT) and the 2-year incidence of referable diabetic retinopathy (RDR).MethodsThis was a prospective cohort study. Patients with type 2 diabetes in Guangzhou, China, aged 30 to 80 years underwent comprehensive examinations, including standard 7-field fundus photography. Macular CT was measured using a commercial swept-source optical coherence tomography (SS-OCT) device (DRI OCT Triton; Topcon, Tokyo, Japan). The relative risk (RR) with 95% confidence intervals (CIs) was used to quantify the association between CT and new-onset RDR. The prognostic value of CT was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsA total of 1345 patients with diabetes were included in the study, and 120 (8.92%) of them had newly developed RDR at the 2-year follow-up. After adjusting for other factors, the increased RDR risk was associated with greater HbA1c (RR = 1.35, 95% CI = 1.17–1.55, P < 0.001), higher systolic blood pressure (SBP; RR = 1.02, 95% CI = 1.01–1.03, P = 0.005), lower triglyceride (TG) level (RR = 0.81, 95% CI = 0.69–0.96, P = 0.015), presence of diabetic retinopathy (DR; RR = 8.16, 95% CI = 4.47–14.89, P < 0.001), and thinner average CT (RR = 0.903, 95% CI = 0.871–0.935, P < 0.001). The addition of average CT improved NRI (0.464 ± 0.096, P < 0.001) and IDI (0.0321 ± 0.0068, P < 0.001) for risk of RDR, and it also improved the AUC from 0.708 (95% CI = 0.659–0.757) to 0.761 (95% CI = 0.719–0.804).ConclusionsCT thinning measured by SS-OCT is an early imaging biomarker for the development of RDR, suggesting that alterations in CT play an essential role in DR occurrence.     

OCT和OCTA在特发性黄斑前膜术后视力预测中的研究进展

特发性黄斑前膜(IERM)是指一类没有任何已知其他眼病的黄斑前膜,多发于50岁以上的中老年人。随着IERM的进展,会引起黄斑区视网膜结构和功能的改变,引起视力下降、视物变形等症状。目前关于IERM的发病机制尚不明确,手术是主要的治疗方式,但对于手术时机尚未标准化,术后的视力恢复结局也存在差异。光学相干断层扫描(OCT)和OCT血管成像(OCTA)作为一种无创、快速的检测手段,可观察黄斑区视网膜微结构和血流变化,已经在临床中广泛应用。利用OCT和OCTA各参数去预测术后视力已经成为IERM的研究热点。本文就OCT与OCTA各参数和IERM术后视力预测的相关研究现状进行综述,以期为临床工作者确定手术时机,权衡手术收益和风险时提供依据。     

Thinning of Choroidal Thickness in Patients with Rheumatoid Arthritis Unrelated to Disease Activity

Purpose: To investigate subfoveal and perifoveal choroidal thickness (CT) in patients with rheumatoid arthritis (RA).

Methods: A study group of 117 patients with RA and a control group of 46 age-matched healthy individuals were enrolled in the study. Subfoveal and perifoveal CTs were measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Perifoveal CT was measured 1,500?µm nasally and 1,500?µm temporally apart from the foveal center. Relationship between the disease activity score 28 (DAS-28) and subfoveal CT was also evaluated.

Results: The mean subfoveal CT values in the study and control groups were 226.90?±?43.61?μm and 299.74?±?48.06?μm, respectively, which made for a statistically significant difference (p?Conclusions: CT was significantly thinner in patients with RA when compared with healthy controls.     

应用OCT及OCTA观察孔源性视网膜脱离巩膜扣带术后的眼底变化

目的：应用OCT及OCTA观察孔源性视网膜脱离(RRD)行巩膜扣带术(SB)术后的黄斑形态结构、黄斑及视盘血管密度及视网膜神经纤维层厚度变化。

方法：横断面病例对照研究。将2014-07/2021-03在赣州市人民医院眼科诊断为RRD的患者25例25眼纳入本研究。对比术后末次随访患眼和健眼黄斑浅层血管(SVC)的血管密度(VD)、黄斑深层血管(DVC)的VD、视盘SVC-VD、视网膜神经纤维层(RNFL)、黄斑中心凹厚度(CMT)、中心凹下脉络膜厚度(SFCT)、黄斑外层结构之间的差异,并分析影响末次随访患眼BCVA(LogMAR)的相关性指标。

结果：术后末次随访患眼与健眼黄斑SVC-VD、黄斑DVC-VD、视盘SVC-VD、RNFL、CMT、SFCT无差异(均P>0.05); 末次随访患眼与健眼OCT下黄斑外层结构对比显示外界膜(ELM)、肌样体区(MZ)、椭圆体带区(EZ)、光感受器外节(OS)的光带完整性无差异(均P>0.05),嵌合体区(IZ)光带完整性则有差异(P=0.014); 末次随访患眼与健眼BCVA有差异(P=0.002)。术后末次随访患眼BCVA与有无波及黄斑、视盘SVC-VD、黄斑外层结构ELM、MZ、EZ、OS、IZ光带完整性有显著相关性,其中与有无波及黄斑呈现正相关(r_s=0.401,P=0.047); 与视盘SVC-VD、黄斑外层结构ELM、MZ、EZ、OS、IZ光带完整性呈负相关(均P<0.05)。

结论：OCT及OCTA用于观察RRD行SB术后眼底改变可获得与视力预后相关的长期随访信息,其术后视力预后取决于视网膜外层结构的恢复情况而定,IZ结构的完整性对于视力恢复更为重要; 视盘SVC-VD与视力预后有相关性,视盘SVC-VD的改变与术后眼压是否相关还需要术后连续数据进一步观察验证。     

Choroidal thickness in pregnant women: a cross-sectional study

AIM: To investigate choroidal thickness in pregnant women and compare the measurements with those of normal nonpregnant women. METHODS: Using enhanced depth imaging optical coherence tomography (EDI-OCT), choroidal thickness was measured at the fovea and at 1 mm and 3 mm superior, inferior, temporal, and nasal to the fovea in both healthy pregnant women and nonpregnant women. Pearson correlation analysis was performed to evaluate the relationships between subfoveal choroidal thickness (SFCT) and the demographic and ocular parameters. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed-effects model when Meta-analyses were conducted. RESULTS: Comparison of choroidal thickness between the groups showed that it was significantly greater in healthy pregnant women’s eyes than in normal nonpregnant women’s eyes at all locations except at 3 mm superior and 3 mm temporal from the fovea (P<0.05). The mean SFCT was 344.13±50.94 μm in healthy pregnant women’s eyes and 315.03±60.57 μm in normal nonpregnant women’s eyes, with a statistically significant difference (P=0.008). Pearson correlation analysis showed that age and axial length were significantly related to SFCT in healthy pregnant women, normal nonpregnant women, and all subjects. The results of our cross-sectional study were consistent with the results of the further Meta-analysis, with a pooled weighted mean difference (WMD) of 33.66 μm (95% CI: 26.16 to 41.15) for SFCT. CONCLUSION: Our results, along with the comprehensive Meta-analysis, suggest that choroidal thickness in healthy pregnant women is greater than that in normal nonpregnant women.     

应用EDI-OCT 检测NAION患者脉络膜厚度的研究

目的：评价利用光学相干断层扫描增强深部成像(enhanced depth imaging optical coherence tomography,EDI-OCT)测量非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy, NAION)脉络膜厚度的临床意义。

方法：选取2014-12/2016-10门诊就诊的NAION患者(对侧眼未受累)共30例30眼,选取与病例组性别、年龄、屈光度相匹配的正常对照组60例60眼,应用EDI-OCT分别测量患病眼、对侧眼及对照组右眼的脉络膜厚度。

结果：患病组与对照组相比,年龄、性别、屈光度无统计学差异(P>0.05)。经统计学检验,患病眼、对侧眼中心凹附近及视盘盘周各部位脉络膜厚度均小于对照组,差异有统计学意义(P<0.01),而患病眼与对侧眼脉络膜厚度比较差异无统计学意义(P>0.05)。

结论：NAION患者患病眼、对侧眼脉络膜厚度较正常对照组明显减低,提示睫状后短动脉小血管的阻塞可能影响脉络膜的血供,进而影响脉络膜厚度。     

OCTA与ICGA检查在CNV和PCV中的影像对比分析

目的:对比观察脉络膜新生血管(CNV)与息肉状脉络膜血管病变(PCV)在吲哚菁绿血管造影(ICGA)与光学相干断层扫描血管成像(OCTA)中的特征性表现,探讨二者的区别和优缺点。方法:回顾分析2018-09/2020-04在河北省眼科医院确诊的CNV患者26例34眼和PCV患者19例19眼的影像学资料,CNV患者中湿性年龄相关性黄斑变性(w-ARMD)20例28眼,慢性中心性浆液性脉络膜视网膜病变(CCSC)继发CNV 6例6眼。所有患者均行OCTA、荧光素眼底血管造影(FFA)+ICGA检查,分析其特征性改变。结果:w-ARMD患者28眼OCTA检查示,除2眼因出血较多未见明显异常外,余26眼均可显示CNV形态,呈现效果形态更加锐利、立体,且能够分辨出CNV所在的解剖层面,其中11眼OCTA检查不仅能够很好地显示出CNV的形态、大小、范围,而且对于CNV中的滋养血管、新生血管及吻合支也都能较好地分辨。CCSC继发CNV患者6眼OCTA发现了FFA+ICGA未发现的CNV形态。PCV患者19眼OCTA检查异常脉络膜分支血管网(BVN)显示优于ICGA,但OCTA图像上末端囊袋样扩张(p...     

Development of Secondary Choroidal Neovascularization in Focal Choroidal Excavation of Punctate Inner Choroidopathy

ABSTRACT

Purpose: To elaborate a case of focal choroidal excavation (FCE) in punctate inner choroidopathy (PIC) complicated by secondary choroidal neovascularization (CNV) based on multimodal imaging findings.

Methods: In this retrospective case report, multimodal imaging including near-infrared reflectance, blue peak autofluorescence, spectral domain-optical coherence tomography (OCT), fluorescein and indocyanine green angiography (Heidelberg Engineering GmbH, Germany), and swept source-OCT angiography (SS-OCTA; Topcon Corporation, Japan) was performed.

Patients: A 27-year-old moderate myopic woman presented with inactive CNV of unknown origin in her left eye, which had been previously treated with intravitreal anti-vascular endothelial growth factor.

Results: Multimodal imaging revealed PIC as the causative disease and systemic corticosteroids were administered. Similar complaints 13 months later showed new CNV formation at the already documented FCE. No sign of PIC could be detected at follow-up.

Conclusion: This well-documented case highlighted FCE as the preferential location for CNV development in PIC with multimodal imaging emphasizing a chorioretinal entity.

Summary: This case report demonstrated the clinical course of focal choroidal excavation in a patient initially diagnosed with punctate inner choroidopathy complicated by choroidal neovascularization and its treatment response, well documented by multimodal imaging including optical coherence tomography angiography.     

OCT及OCTA观察垂体腺瘤患者黄斑区视网膜结构和微循环的改变

目的：应用光学相干断层扫描(OCT)及光学相干断层扫描血管成像(OCTA)观察垂体腺瘤(PA)患者黄斑区视网膜结构和微循环的改变。

方法：横断面研究。纳入2021-09/2023-03在广东医科大学附属医院神经外科治疗的PA患者40例作为PA组，另选取年龄、性别相匹配的健康志愿者42例作为正常对照组，均进行视野、OCT和OCTA检查，并分析PA患者眼部参数的相关性。

结果：PA组患者黄斑区视网膜各层血管密度(VD)均低于正常对照组，且黄斑区浅层血管复合体(SVC)-VD与神经节细胞复合体(mGCC)厚度(除内环鼻侧、外环下方)均呈正相关(P<0.05)，黄斑区各象限mGCC厚度、视盘周围各象限视网膜神经纤维层(CP-RNFL)厚度与视野平均缺损(MD)值均呈负相关(P<0.05)，中心凹无血管区(FAZ)面积与MD值呈正相关(P<0.05)。

结论：OCT与OCTA检查相结合可以全面了解PA患者视网膜结构和微循环功能的微观变化，对评估PA患者术前视功能具有重要价值。     

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.     

肥厚型脉络膜谱系疾病影像特征研究进展

肥厚型脉络膜谱系疾病(PSD)是近年来被定义的一组具有相似脉络膜解剖学特点及相同病理过程的一组疾病,包括中心性浆液性脉络膜视网膜病变(CSC)、息肉样脉络膜血管病变(PCV)等。其主要特征是脉络膜各血管层厚度改变和血管通透性增强。随着以光学相干断层扫描血流成像(OCTA)为代表的现代眼科影像技术不断发展,使这类疾病脉络膜各血管层的变化得以更直观地呈现,从而对该谱系疾病发病机制研究有了新的认识。本文对健康人及PSD的共同临床特点进行归纳,对各种PSD的最新影像学发现进行综述。从遗传背景及解剖学结构等不同角度,讨论各型PSD是同一疾病不同阶段的表型还是类似特征的不同疾病。以期为该类疾病的发病机制、早期临床诊断及防治提供参考。