部分眼底病红外线及自发荧光影像特点初步观察

目的观察部分眼底病眼底红外线（infrared ray,IR）和自发荧光（autofluorescence,AF）的影像特征。方法采用HRA-2共焦激光扫描系统的IR模式和FA模式检测73例（85眼）眼底病患者,其中年龄相关性黄斑变性25例（34眼）,中心性浆液性脉络膜视网膜病变16例（16眼）,黄斑裂孔5例（5眼）,视网膜静脉阻塞17例（17眼）,前部缺血性视神经病变（anterior ischemic optic neuropathy,AION）10例（13眼）。结果年龄相关性黄斑变性的IR影像见散在不规则白色病灶,AF影像呈低信号,边缘见环形高信号。中心性浆液性脉络膜视网膜病变的IR影像为异常范围大于AF影像所见。全层黄斑裂孔的IR影像见白色斑点,AF影像呈圆形高信号。IR影像在显示视网膜静脉阻塞黄斑水肿边缘方面优于AF。AION的AF呈低信号。结论IR影像不同于以往的其他检查方法,可以揭示较深层次的视网膜病变。眼底出血时AF表现为遮蔽,视网膜下积液导致荧光信号降低,脂褐质积累荧光信号增强。IR和AF影像是评价视网膜尤其是视网膜色素上皮的有效方法。     

眼底自发荧光影像及其临床应用进展

眼底自发荧光（FAF）影像是近二十年来开展的一项技术。它能够反映视网膜色素上皮（RPE）细胞的功能,也可以作为临床上RPE细胞代谢活力的一个指标。动态观察眼底自发荧光,可以监测病情的进展,判断疾病预后,结合进一步的基础实验研究,正确了解视网膜脉络膜病变的发病机制。本文就眼底自发荧光的原理,分布和检测方法及在临床应用的新进展作一综述。     

眼底自发荧光技术的临床应用进展

眼底自发荧光技术是近十年来发展起来的新技术.利用共焦扫描激光眼底镜(cSLO)获得的眼底自发荧光图像能够显示视网膜色素上皮内脂褐素的含量与分布,依此评价视网膜色素上皮细胞的代谢状况.脂褐素的沉积是许多视网膜疾病发生发展的共同途径,提示眼底自发荧光的特性在了解疾病的发病机制、病程进展、治疗及预后方面均有重要的指导意义.     

原色眼底荧光血管造影术及眼底自发荧光研究

目的我们研究了记录眼底荧光血管造影原始色彩的方法,并利用原色眼底荧光血管造影的方法(Primary-color fundus fluorescence angiography,PCFFA)研究眼底自发荧光(autofluorescence,AF)现象。方法我们使用TOPCON-50IA眼底荧光造影机,SONY彩色摄像机和"先德"计算机图象处理系统,记录原始色彩的眼底荧光血管造影图像,并对有自发荧光现象的几种疾病进行观察研究。结果发现原色眼底荧光血管造影像呈黄绿色调,眼底黄白色渗出不显示强荧光,新鲜的红色出血呈遮蔽荧光。各种疾病所致的眼底自发荧光均为红色。结论原色眼底荧光血管造影色彩更真实、丰富;眼底红色自发荧光的形成可能与血卟啉类物质有关。     

特发性黄斑裂孔眼底自发荧光成像研究

目的比较分析特发性黄斑裂孔（IMH）患者眼底自发荧光（FAF）图像及荧光素眼底血管造影（FFA）图像的特征。方法对33例（36眼）IMH患者应用共焦激光扫描检眼镜进行检查,分析FAF图像与FFA图像。另外选取16例正常人作为对照。利用MIG2000图像测量系统对黄斑中心凹进行自发荧光强度测定。结果33例（36眼）IMH患者中,全层黄斑裂孔26眼（72．2％）,板层黄斑裂孔10眼（27．7％）。黄斑自发荧光的特征：正常眼底中心凹FAF呈局部低荧光;黄斑裂孔表现为高荧光,与FFA的图像相似。6例板层裂孑LFAF、FFA均未见异常,其余4例板层孔中心凹处FFA表现为轻度增强的透见荧光,相应部位FAF见轻度增强的自发荧光。全层黄斑裂孔在裂孔处有明显增强的FAF,FFA的“窗样缺损”,在位置、面积、形状上与FAF一致。结论FAF检测为黄斑裂孔的诊断提供了一个新的、快速、非创性检查手段。     

中心性浆液性脉络膜视网膜病变眼底自发荧光影像的特点

目的：研究急性和慢性特发性中心性浆液性脉络膜视网膜病变眼底自发荧光影像模式及眼底荧光血管造影相关性发现。

方法：观察性研究案例。回顾性分析中心性浆液性脉络膜视网膜病变患者临床数据,眼底荧光血管造影及眼底自发荧光影像,并对其调查结果进行比较。

结果：该研究共纳入17例25眼。确诊为急性中心性浆液性脉络膜视网膜病变5眼,慢性疾病或复发性慢性疾病20眼。急性病例眼底自发荧光影像显示低荧光点与荧光血管造影检测出的荧光渗漏点位置相同。慢性特发性中心性浆液性脉络膜视网膜病变眼底荧光血管造影为视网膜色素上皮弥漫性萎缩区域,可透视荧光。眼底自发荧光影像的低荧光区域的形态和位置与眼底荧光血管造影的高荧光区域相对应,然而眼底荧光血管造影的低荧光区域与眼底自发荧光影像的高荧光区域相对应。在急性病例中,低自发荧光点不能准确指出视网膜色素上皮的渗漏点。

结论：中心性浆液性脉络膜视网膜病变眼底自发荧光影像模式能够描述疾病不同阶段的特征,具有无风险和可再生性,可替代荧光素血管造影术治疗中心性浆液性脉络膜视网膜病变。     

急性Vogt-小柳-原田病眼底自发荧光观察

目的:对急性期Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada,VKH)患者的眼底自发荧光(fundusauto fluorescence,FAF)特征进行观察。方法:对9例18眼急性期VKH患者进行眼底荧光血管造影、眼底自发荧光成像检查,并对结果进行比较。结果:急性期VKH眼底检查见多囊状浆液性视网膜脱离。FFA检查早期可见色素上皮水平多发性点状荧光素渗漏,晚期形成多囊状的荧光素积存。FAF检查见浆液性视网膜脱离区呈低自发荧光;低自发荧光区内,尚可见环形或半环形高自发荧光,与FFA渗漏点位置对应。VKH恢复期水肿消退后视网膜复位,黄斑区可见色素紊乱。FAF检查见自发荧光分布基本恢复至正常状态,但黄斑区出现一些点状高自发荧光颗粒散在分布。结论:FAF技术为临床医生研究VKH提供了一种活体观察视网膜色素上皮(RPE)细胞代谢和功能改变的手段。但有关FAF在VKH的应用价值尚需进一步研究。     

视网膜色素上皮挫伤的眼底自发荧光改变

目的 观察视网膜色素上皮挫伤时的眼底自发荧光(AF)形态改变,探讨AF检查对眼外伤造成的视网膜色素上皮挫伤的诊断意义.方法 对31例(36只眼)视网膜色素上皮挫伤的的患者,进行眼底自发荧光检查.采用海德堡激光眼底扫描系统获取自发荧光图像.与同病例的眼底检查及FFA做对比分析,得出其自发荧光特征.结果 所有病例在视网膜色素上皮挫伤区域的自发荧光普遍弥漫性增强,有色素上皮增生处大多表现为更强的自发荧光点,色素脱失处大多表现为低荧光,在总体增强区域表现为地图状的自发荧光.结论 眼球钝挫伤早期导致的视网膜色素上皮的损害会引起相应的自发荧光的改变,主要以自发荧光增强为主,反映该区域色素上皮高代谢状态或增殖活动为主,弱的AF较少,表明挫伤后短期局部的色素上皮萎缩.这些改变与一些以萎缩性病变为主的眼底病的AF有明显区别,因而AF应用于视网膜色素上皮挫伤的诊断有明显的意义.     

眼底自发荧光技术在部分视网膜疾病中的应用进展

眼底自发荧光(fundus autofluorescence,FAF)技术是近几年发展起来的一项新技术,它能够显示视网膜色素上皮内脂褐素的含量与分布,主要反映视网膜色素上皮细胞的功能及代谢情况.观察视网膜疾病不同时期FAF的分布情况及其强度变化,有助于早期诊断、观察疗效及评价疾病预后.本文对FAF的基本原理及其在部分视网膜疾病中的临床应用进展作一综述.     

七种眼底形态的红外线扫描和自发荧光图像的分析

目的解析7种眼底形态的红外线（IR）扫描和自发荧光图像（AF）。方法使用Heidelberg公司HRA-Spectralis眼底检查系统,对537例患者（1023只眼）进行眼底IR和AF检查。结果从中选出8例（8只眼）具有典型特征的眼底图像。结论IR分辨率较一般眼底照相高,可用于眼底浅层疾病的检查诊断;AF在诊断视网膜色素上皮（RPE）病变上有无可比拟的优势,它反映的是RPE代谢的变化,且视网膜色素变性（RP）患者的AF图像有极其明显的特征,是检查诊断RP病的金指标。     

Correlation of ultra-widefield fundus autofluorescence patterns with the underlying genotype in retinal dystrophies and retinitis pigmentosa

Purpose: Ultra-widefield fundus autofluorescence (UW-FAF) allows the characterization of the peripheral retinal features of vitreoretinal diseases. The purpose of this study was to examine possible genotypic/phenotypic correlations of UW-FAF patterns in patients with a variety of retinal dystrophies and retinitis pigmentosa (RP).

Methods: An IRB-approved retrospective consecutive case series study was performed of genetically characterized retinal dystrophy or RP patients who underwent UW-FAF imaging. UW-FAF was performed with the Optos 200Tx system. Clinical variables, genotypic analysis, and phenotypic characteristics were reviewed.

Results: Seventeen patients were identified who had identified mutations in retinal dystrophy or RP genes and who also had undergone UW-FAF. Three patients had X-linked RP with RPGR mutations. Six patients had autosomal dominant RP (four with RHO mutations and one with a PRPF31 mutation, and one with RDS/PRPH2 mutation). Four patients had autosomal recessive RP (four with USH2A mutations). Three patients had Leber Congenital Amaurosis (LCA) with mutations including CRB1, CEP290, and RPGRIP1. Macular hyperautofluorescence was noted in all patients. A ring of hyperautofluorescence was clear in patients with RHO and USH2A mutations, and patients with USH2A mutations demonstrated a second ring of hyperautofluorescence. In the periphery, patients with RHO or RPGR mutations exhibited hyperautofluorescence with patchy areas of hypoautofluorescence. Patients with USH2A mutations had a distinctive pattern of diffuse and homogeneous peripheral hypoautofluorescence.

Conclusion: UW-FAF may provide important information to facilitate diagnosis and further research is needed to better characterize this technology as an imaging biomarker for genotype association in retinal dystrophies and RP.     

Fundus autofluorescence in serpiginous choroiditis

Background  Fundus autofluorescence is already used to evaluate inflammatory disorders affecting the chorioretinal interface. We investigated the autofluorescence characteristics of two cases of serpiginous choroiditis (SC) during recurrent acute episodes, and followed them until their resolution. We compared the autofluorescence findings with those obtained with other imaging techniques. Methods  Autofluorescence photographs of the eyes were taken in a 26-year-old female and a 68-year-old male with SC at the first appearance of active lesions and during a strict follow-up period. Patients had complete ophthalmological evaluations including optical coherence tomography (OCT) and fluorescein and indocyanine green (ICG) angiography. Autofluorescence findings were compared with features from other imaging techniques. Patients were treated with systemic or intravitreal steroids. Results  Hyperautofluorescence was detected 2 to 5 days after the appearance of the lesions, providing a clear delineation of the area of definitive retinal pigment epithelium (RPE) damage. This area was less extensive than the perfusion defect of the choriocapillaris indicated by ICG angiography. OCT showed very early increased reflectance of the photoreceptor layer in the area of hyperautofluorescence. A progressive decrease in autofluorescence was seen during the scarring phase of the disease. OCT changes in the photoreceptor layer were still present in the atrophic hypoautofluorescent lesions. Conclusion  Fundus autofluorescence seems to be a very sensitive imaging technique for detecting damage of the RPE in acute episodes of SC. A sequence of autofluorescence changes reflects the passage from activation to resolution of new lesions. Similarities, but also differences can be found by comparing our SC findings with those obtained with autofluorescence and OCT in posterior multifocal placoid pigment epitheliopathy. Supported by the Fondazione per la Macula Onlus, Genova, Italy. The authors have no proprietary interest in any aspect of this report. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical anf experimental Ophthalmology to review their data upon request.     

Intrinsic tissue fluorescence in an organotypic perfusion culture of the porcine ocular fundus exposed to blue light and free radicals

BACKGROUND: A wide variety of pathological pathways may result in age-related macular degeneration. Because of its complexity, there is no comprehensive model of the disease yet. One key feature is the accumulation of the autofluorescent pigment lipofuscin in the retinal pigment epithelium (RPE). Thus, we developed an organotypic perfusion culture model of the porcine ocular fundus, generating lipofuscin under exposure to blue light and hydrogen peroxide. METHODS: Porcine fundi (choroid, Bruch's membrane, RPE, and retina) were explanted in toto, transferred into a perfusion culture chamber, perfused with cell culture medium and kept at 37 degrees C. Free radical stress was induced by supplementation of H(2)O(2), and/or the specimens were exposed to blue light, or kept untreated as controls. After a culture period of 7 days, the specimens were subject to microscopic inspection, histology, fluorescence microscopy, and measurement of fluorescence spectra as well as fluorescence decay times. RESULTS: Histology showed atrophic ganglion cells and rod outer segments. All other tissue structures were morphologically intact. Compared to the controls, RPE and retina exposed to light showed increased fluorescence, which was shifted towards shorter wavelengths. The fluorescence spectra and decays resembled that of lipofuscin granules isolated from human donor eyes. HPLC analysis revealed the abundance of the lipofuscin component N-retinylidene-N-retinylethanolamine (A2E), its precursor products, as well as two new, green-emitting fluorophores. CONCLUSIONS: Porcine ocular fundi were successfully preserved in an organotypic perfusion culture for 7 days, and exhibited remarkable autofluorescence after light and free radical exposure, making the model suitable for investigations of lipofuscinogenesis.     

Correlation between optical coherence tomography and autofluorescence in acute posterior multifocal placoid pigment epitheliopathy

Purpose To report a case of bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) evaluated by optical coherence tomography (OCT), fundus autofluorescence (AF) and microperimetry, both in the acute phase and after resolution of symptoms.Methods Complete ophthalmological evaluation, including fluorescein angiography, OCT, AF, and microperimetry upon presentation and 1 month later, after lesions have subsided. An attempt to correlate the findings on presentation and changes after resolution is performed using the results of these new investigational techniques.Results APMPPE showed hyperreflectance in OCT at the level of the outer retinal layers, without increase in retinal thickness. AF revealed early decreased fluorescence due to a masking effect, and later reveals increased fluorescence after resolution of OCT findings. Function is disturbed at the lesion sites, as shown by microperimetry, and later returns to near normal values on microperimetry.Conclusion APMPPE shows outer retinal layers changes on OCT, which resolve totally after subsidence of the acute phase. AF shows areas of increased fluorescence after resolution, with near normal return of function on microperimetry.     

复方樟柳碱注射液治疗眼底病疗效观察

目的探讨复方樟柳碱注射液治疗眼底病疗效。方法采用治疗前后自身对照法，通过显效、有效、无效三个标准判断疗效。结果治疗缺血性视神经病变有效率达84．6％，治疗视网膜动脉阻塞有效率达88．2％，治疗视网膜静脉阻塞有效率达80．0％，治疗视网膜血管炎有效率达81．8％，治疗外伤性眼底出血有效率达84．6％。结论复方樟柳碱注射液对眼底病有显著疗效。     

应用人工智能识别超广角眼底照相多病种的初步研究

目的:构建一个小样本超广角眼底照相（UWFI）多疾病分类人工智能模型,初步探究人工智能对UWFI多病种分类任务的能力。方法:回顾性研究。2016年至2021年于武汉大学人民医院眼科就诊并行UWFI检查的1 123例患者的1 608张图像用于UWFI多疾病分类人工智能模型构建。其中,糖尿病视网膜病变（DR）、视网膜静脉阻...     

高度近视眼的视野改变和眼底病变的相关性研究

目的 探讨高度近视眼患者的中心视野改变特点及其与眼底病变的关系,评价高度近视眼的发展状态和预后。方法 利用微机化视野分析仪和激光扫描眼底镜检查高度近视２５４眼,以中低度近视组作对比。结果 高度近视中心视野ＭＳ、ＭＤ及ＣＬＶ在各组间有显著性差异（Ｐ〈０．０１）,各组间眼底损害程度构成比有非常显著性差异（Ｐ〈０．００５）。结论 近视屈光度与中心视野ＭＤ及ＣＬＶ之间的关系分析有助于早期判断高度近视的病变     

眼底自发荧光在急性后极部多发性鳞状色素上皮病变不同阶段的特征分析

目的　探讨眼底自发荧光在急性后极部多发性鳞状色素上皮病变（ａｃｕｔｅｐｏｓｔｅｒｉ-ｏｒｍｕｌｔｉｆｏｃａｌｐｌａｃｏｉｄｐｉｇｍｅｎｔｅｐｉｔｈｅｌｉｏｐａｔｈｙ,ＡＰＭＰＰＥ）中的影像学特征。方法　对２１眼急性期和１８眼恢复期ＡＰＭＰＰＥ患者行眼底自发荧光检查,对比眼底彩色照像及眼底荧光血管造影结果,观察不同病变阶段的影像学特征,分析该病的发展转归。结果　急性期眼底自发荧光可见与眼底彩色照像及眼底荧光血管造影一致的高自发荧光区,高荧光边缘可见一低荧光区域。部分眼底彩色照象及眼底荧光血管造影已显示的病灶,在自发荧光成像上尚未显现。恢复期患者眼底自发荧光可见与眼底彩色照像及眼底荧光血管造影相一致的完全低荧光区,如尚存部分未完全死亡的视网膜色素上皮细胞,则在部分区域可见强荧光。结论　ＡＰＭＰＰＥ患者可根据自发荧光的强弱判断病变阶段、病变进程情况,评估视网膜色素上皮细胞的功能。     

雌激素在眼底疾病中的作用：一项值得关注的研究课题

雌激素除了作为性激素在生殖系统具有重要作用外，还影响骨骼、 心血管及神经系统的结构和功能；并且对老年性黄斑变性和视网膜神经变性等各种年龄相关 性眼底疾病的发生发展具有重要影响。雌激素在眼底疾病中的作用是一项值得关注的研究课 题，随着雌激素对眼底疾病的影响以及其 分子水平作用机制的了解逐渐深入，将为具有争议性的激素替代治疗提供新的认识依据。