光学相干断层扫描血管成像在DR中的临床应用

光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)是近年新兴发展的一种无创性血管成像技术,无需使用造影剂便能快速、安全获得高分辨率眼底血管成像,已被广泛应用于眼科疾病的诊治和随访,尤其是血管性病变如糖尿病性视网膜病变(DR),年龄相关性黄斑变性(AMD),视网膜中央/分支静脉阻塞(CRVO/BRVO),脉络膜新生血管(CNV)等.本文就OCTA在糖尿病性视网膜病变的临床应用进行综述.     

光学相干断层扫描血管成像在DR中的诊疗进展

光学相干断层扫描成像(OCT)是眼科影像学中发展最快的技术之一。随着OCT技术逐步改良更新,光学相干断层扫描血管成像(OCTA)随之出现,OCTA在视网膜和脉络膜血流成像中能为多种眼底血管性疾病提供诊疗价值。本文综述了OCTA的原理,以及OCTA观察糖尿病患者眼底的微动脉瘤(MAs)、视网膜缺血、视网膜新生血管(RNV)及其在DR各期组织病理改变的特征、OCTA的局限性及其发展前景。     

光学相干断层扫描血管成像技术在糖尿病视网膜病变中的应用

光学相干断层扫描血管成像技术( optical coherence tomography angiography,OCTA)是近年来光学相干断层扫描( optical coherence tomography,OCT)的新兴技术,是一种无创、快速、高分辨率的眼底血管成像技术,现已被逐渐应用于各类眼底血管疾病的诊治及随访,如糖尿病视网膜病变、脉络膜新生血管等。 OCTA拥有能分层观察不同层面的视网膜脉络膜血管结构及形态和量化一定范围内的血流指数及病灶血流面积的独特优势。但OCTA存在观察视网膜范围有限、观察视网膜血管屏障功能有限、要求高固视力高配合度等不足,如果克服这些局限,将有助于我们提升对视网膜血管疾病的认识,完善对视网膜血管疾病的诊治和观察。     

光学相干断层扫描血管成像在糖尿病微血管病变中的应用

糖尿病视网膜病变(DR)和糖尿病肾病(DN)是糖尿病患者最常见、最严重的两大微血管并发症,是引起致盲和终末期肾病的主要原因。视网膜血管是糖尿病早期常见的损害靶点,也是人体血管系统中唯一可直视的活体血管,其形态结构或功能的变化可直接或间接反映糖尿病引起的微血管病变。特别是近年来光学相干断层扫描血管成像(OCTA)这一新型、无创技术的发展,在血管成像分辨率、血管深度以及血管形态方面都有新的突破,并能提供客观的定量数据,在糖尿病微血管病变中具有一定应用价值。因此,本文旨在对OCTA及其在糖尿病微血管病变中的应用作一综述。     

光学相干断层扫描血管成像(OCTA)和荧光素血管造影(FFA)对比观察增生型糖尿病视网膜病变(PDR)

目的 运用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)和荧光素血管造影(fundusfluorescein angiography,FFA)对比观察增生型糖尿病视网膜病变(proliferating diabetic retinopathy,PDR)的临床特征,分析OCTA与FFA对PDR患眼眼底病变检出的一致性.方法 回顾性病例研究.选择PDR患者25例(36眼),每例患者均行OCTA和FFA检查,并且两项检查间隔时间不超过2h.对比观察记录PDR患眼在OCTA和FFA图像中黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤、视网膜新生血管、视网膜无灌注区5种眼底病变的影像学特征,并分析两种检查方法对上述眼底改变检出的一致性.结果 PDR患眼的OCTA特征主要为黄斑拱环结构改变区视网膜浅层毛细血管扩张迂曲、深层中心凹无血管区扩大,黄斑水肿区视网膜浅层血管迂曲扩张、视网膜深层片囊状弱信号,视网膜微血管瘤区浅层、深层毛细血管局部囊样扩张膨大或梭形改变,视网膜新生血管区浅层、深层不规则异常血管网状结构,视网膜无灌注区片状弱信号;PDR患眼的FFA图像特征主要为黄斑拱环结构改变区周围血管扩张弯曲,黄斑水肿区、视网膜微血管瘤区和视网膜新生血管区造影期强荧光,视网膜无灌注区表现和OCTA相似.OCTA检查发现PDR患眼黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤、视网膜新生血管、视网膜无灌注区分别为26眼、26眼、25眼、13眼、30眼;FFA检查发现5种眼底病变依次为20眼、28眼、28眼、12眼、30眼;OCTA与FFA检查对PDR患眼黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤检出的一致性一般(Kappa=0.416、0.705、0.646,均为P＜0.01),对视网膜新生血管、视网膜无灌注区检出的一致性较好(Kappa=0.816、0.800,均为P＜0.01).结论 OCTA与FFA能较好地观察到PDR患眼5种眼底病变,并对PDR患眼的部分眼底病变的检出具有良好的一致性.     

光学相干断层扫描血管成像在糖尿病性视网膜病变临床应用研究进展

光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)作为一项近年来兴起的新型成像技术,具有非侵入性、快速、高分辨率等特点。相比于传统的造影检查,OCTA更加快速、安全且避免了传统造影剂带来的副作用和风险。如今OCTA已经逐渐应用于眼科疾病的诊疗与随访。通过对视网膜脉络膜血管的实时成像,可以用于观察疾病如糖尿病视网膜病变、脉络膜新生血管等的进展。本文就OCTA在糖尿病视网膜病变的临床应用研究进展进行综述。     

光学相干断层扫描血管成像量化分析糖尿病患者黄斑区毛细血管参数

目的：应用光学相干断层扫描血管成像技术(OCTA)量化2型糖尿病患者黄斑区毛细血管的早期变化。方法：回顾性病例研究。分别纳入49名健康受试者、52例无视网膜病变的2型糖尿病患者(noDR)和43例轻度非增殖性糖尿病视网膜病变(mNPDR)患者，并得到在黄斑区3 mm×3 mm浅层毛细血管丛和深层毛细血管丛的OCTA图像。去除大血管后分别计算毛细血管灌注密度、血管长度密度(VLD)和平均血管直径(AVD)并进行比较。应用受试者工作特征曲线评估该参数监测2型糖尿病患者视网膜微血管早期改变的能力。结果：比较三组间VLD和AVD，差异均有统计学意义(P<0.001)。与健康受试者相比，noDR组的AVD均显著增加(P<0.05)。mNPDR组患者深层及浅层的VLD较noDR组显著下降(均P<0.01)。深层AVD鉴别noDR组与健康受试者的曲线下面积(AUC)为0.796，鉴别mNPDR组和健康受试者的AUC最高为0.920，其次为深层VLD(AUC=0.899)，显著高于其他参数。结论：在糖尿病视网膜病变的临床前阶段，2型糖尿病患者的深层及浅层AVD均显著高于健康人，VLD均显著高于mNPDR患者。与健康人相比，深度AVD较其他参数更能检出noDR患者早期视网膜毛细血管的变化。     

糖尿病视网膜病变患者黄斑病变的 光学相干断层扫描

目的观察糖尿病视网膜病变患者黄斑病变的光学相干断层扫描(optical coherence tomography,OCT)图像特征。方法对60例糖尿病黄斑病变患者以及30例正常对照者进行OCT检查。其中54例糖尿病黄斑病变患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,对两种检查方法的结果进行比较。结果OCT检查糖尿病黄 斑病变患者中心凹平均厚度为(314.54±154.13)μm。视网膜水肿者占57.1%,视网膜水肿合并黄斑囊样水肿(cystoid macular edema,CME）者占38.5%,合并神经上皮脱离者 占9.2%,合并CME及神经上皮脱离者占16.9%。OCT检查黄斑正常厚度及轻度水肿者,FFA主要呈限局性渗漏;中重度水肿者,FFA呈弥漫性渗漏。CME检出率FFA检查者为28.6%,OCT检 查者为58.9%,二者比较差异有显著性意义(t=3.39,P<0.05) 。结论糖尿病黄斑病变者的OCT图像有视网膜水肿、CME及神经上皮脱离3种形态特征。OCT在检测发现CME等方面优于FFA。(中华眼底病杂志,2001,17:184-186)     

Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by optical coherence tomography angiography

AIM: To investigate foveal avascular zone (FAZ) and parafoveal vessel densities (PRVD) by means of optical coherence tomography angiography (OCTA) in diabetic patients with or without diabetic retinopathy (DR) and to assess the reproducibility of FAZ and PRVD measurements. METHODS: Sixty diabetic patients (60 eyes) with different stage of DR (graded according to the International Clinical Severity Scale for DR) and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners. FAZ area in all patients was also assessed using fluorescein angiography (FA). RESULTS: In subject with proliferative DR and with moderate-severe non proliferative DR, FAZ area was significantly increased compared to healthy controls (P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA). OCTA showed significantly less inter-observer variability compared to FA. Concordance correlation coefficient (CCC) for FAZ area measurements was 0.829 (95%CI: 0.736-0.891) P<0.001 with FA and 1.000 (95%CI: 0.999-1.000) P<0.001 with OCTA. CCC was 0.834 (95%CI: 0.746-0.893) P<0.001 and 0.890 (95%CI: 0.828-0.930) P<0.001 for parafoveal superficial and deep vessel density measurements, respectively. CONCLUSION: OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity. FAZ area and PRVD measurements using OCTA are highly reproducible.     

Bimodal imaging of proliferative diabetic retinopathy vascular features using swept source optical coherence tomography angiography

AIM: To categorize neovessels morphology and to detect response to anti-angiogenic therapy by using structural and angiographic modes of swept source optical coherence tomography (SS-OCT). METHODS: Thirty-two eyes with neovessels at disc (NVD) and neovessels elsewhere (NVE) - as diagnosed by fluorescein angiography- were included. Cross sectional OCT images of disc and macular regions were registered to enface OCT angiography (OCTA), B-scan blood flow over lay and density maps. Three eyes received anti-angiogenic treatment. RESULTS: Pin point registration of cross-sectional OCT and OCTA images differentiated active NVD with vascular elements from fibrous or equivalent fibrovascular elements. En face images delineated NVE as vascular tufts or area of filling while cross-sectional images differentiated NVE from microvascular intraretinal abnormality (IRMA). All cases were associated with enlargement of foveal avascular zone and or areas of capillary non perfusion. Regressed NVD appeared as ghost vessel or pruned vascular loops after injection. CONCLUSION: Structural and angiographic modes of SS-OCT can detect, characterize and categorize the pattern of wide spectrum of neovessels based on blood flow data and density maps. It is potentially useful to detect ischemic changes in the vascular bed and regression of NVD after therapeutic regimens providing substitute for invasive techniques.     

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。     

糖尿病性黄斑水肿OCT和FFA形态学分类的对比分析

目的探讨糖尿病性黄斑水肿相干光断层扫描(OCT)和眼底荧光素血管造影(FFA)的形态学特征、分类及相互关系。设计前瞻性病例系列。研究对象临床有意义糖尿病性黄斑水肿(CSME)患者102例177眼。方法分别对CSME组患者进行OCT及FFA检查,观察两种分类之间的相互关系,并与中心凹中心厚度、最佳矫正视力等临床资料进行对比分析。主要指标CSME患者的OCT及FFA类型、中心凹中心厚度、最佳矫正视力。结果FFA分类的局限水肿型在OCT1型中所占的比例为70.6%,高于弥漫水肿型(27.2%)和囊样水肿型(2.2%)(P<0.05)。FFA弥漫水肿型在OCT2型中占47.9%,明显高于局限水肿型(25.0%)和囊样水肿型(27.1%)(P<0.05)。FFA分类的囊样水肿型在OCT3型(3A型 3B型)中占56.8%,明显高于局限水肿型(10.8%)和弥漫水肿型(32.4%)(P<0.05)。OCT1型及FFA局限水肿型的矫正视力最好,黄斑中心凹中心厚度值最小(P<0.05)。结论CSME患者OCT与FFA的形态学类型密切相关。结合两种检查方法,可更加全面地反映CSME患者黄斑区视网膜的变化,为揭示糖尿病性黄斑水肿的病理机制、寻求每种类型的最佳治疗方案提供参考。     

Aqueous angiopoietin-like levels correlate with optical coherence tomography angiography metrics in diabetic macular edema

AIM: To quantitatively detect aqueous levels of angiopoietin-like (ANGPTL)3, ANGPTL4, and ANGPTL6 and investigate their correlation with optical coherence tomography angiography (OCTA) findings in patients with diabetic macular edema (DME).METHODS: This cross-sectional study included 23 patients (27 eyes) with type 2 diabetes and 16 control subjects (20 eyes). All patients underwent OCTA imaging and ultra-wide field fundus photography. Diabetic patients were categorized into two groups according to the presence or absence of diabetic retinopathy (DME group, 14 patients, 16 eyes); and non-diabetic retinopathy (NDR) group, 9 patients, 11 eyes, respectively. Aqueous levels of ANGPTL3, ANGPTL4, and ANGPTL6 were assessed using suspension array technology, and foveal-centered 3×3 mm2 OCTA scans were automatically graded to determine the central, inner, and full vessel density (CVD, IVD, FVD); central, inner, and full perfusion density (CPD, IPD, FPD), foveal avascular zone (FAZ) area, FAZ perimeter, and FAZ circularity index (FAZ-CI) on superficial capillary plexuses. Additionally, central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) were measured in a model of macular cube 512×128.RESULTS: Aqueous ANGPTL3 levels were not significantly different among the three groups (P>0.05). ANGPTL4 levels were significantly higher in the DME group than the control and NDR groups (P<0.0001 and P<0.001), while ANGPTL6 levels were significantly higher in the DME group than the control group (P<0.05). In the whole cohort, the aqueous ANGPTL3 levels correlated negatively with the IVD, FVD, IPD, and FPD, and positively with the CV and CAT. The aqueous ANGPTL4 levels correlated negatively with the CVD, IVD, FVD, CPD, IPD, and FPD, and positively with the FAZ perimeter, CST, CV, and CAT. The aqueous ANGPTL6 levels correlated negatively with the IVD, FVD, IPD, FPD, FAZ-CI and positively with CST, CV, CAT.CONCLUSION: ANGPTL4 and ANGPTL6 may be associated with vascular leakage in DME and may represent good targets for DME therapy. In addition, OCTA metrics may be useful for evaluating macular ischemia in DME.