近红外自发荧光联合荧光血管造影在黄斑脉络膜裂伤合并视神经钝挫伤中的应用

目的　探讨近红外自发荧光（ｎｅａｒ-ｉｎｆｒａｒｅｄａｕｔｏｆｌｕｏｒｅｓｃｅｎｃｅ,ＮＩＡ）及眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查在黄斑脉络膜裂伤合并视神经钝挫伤中的临床意义。方法　对确诊为黄斑脉络膜裂伤合并视神经钝挫伤的１６例（１６眼）患者进行ＮＩＡ和ＦＦＡ检查,观察其眼底变化特点。结果　１２眼黄斑脉络膜裂伤合并视网膜下出血,ＦＦＡ示部分脉络膜裂伤被视网膜下出血所遮蔽而不能显影;４眼为单纯黄斑脉络膜裂伤,ＦＦＡ晚期示脉络膜裂伤呈完整的条索状强荧光。１６眼的ＮＩＡ均可穿透斑片状视网膜下出血显示脉络膜裂伤形成的弧形或线形弱荧光。１６眼ＮＩＡ所测脉络膜裂伤长度为（１．４７±０４８）ｍｍ,较ＦＦＡ所测脉络膜裂伤长度（０．４９±０．２５）ｍｍ长,差异有统计学意义（ｔ＝１３．１５,Ｐ＝０．００）。结论　ＮＩＡ可发现黄斑区视网膜下出血遮蔽的脉络膜裂伤,ＦＦＡ可显示视神经钝挫伤,两者结合有助于及早确诊黄斑脉络膜裂伤合并视神经钝挫伤,为及时治疗提供帮助。     

息肉样脉络膜血管病变的光相干断层扫描

目的 :观察息肉样脉络膜血管病变 (polypoidalchoroidalvasculopathy ,PCV )的光相干断层扫描 (opticalcoherencetomography ,OCT)图像特征。方法 :对比分析常规眼底检查、荧光素眼底血管造影 (fundusfluoresceinangiography ,FFA )及吲哚青绿血管造影 (indocyaninegreenangiography ,ICGA)检查确诊的PCV患者 9例 9眼 (PCV组 )、渗出型老年性黄斑变性 (exudativeage -relatedmaclarde generation ,AMD)引起的浆液性视网膜色素上皮脱离 (retinalpigmentepithelialdetachments ,RPED) 11例 11眼、中心性渗出性脉络膜视网膜病变 (centralexudativechoroidoretinopathy ,CEC)引起RPED 2例 2眼 (浆液性RPED组 )的OCT检查图像资料 ,观察PCV患眼视网膜下结节样病灶特征、RPED隆起高度和基底宽度的相关性。结果 :PCV眼OCT图像表现为RPE和脉络膜毛细血管高反射层呈穹隆状隆起 ,表面不规则 ,边缘陡峭。其下或视网膜色素上皮 (retinalpigmentepithelial ,RPE)光带水平可见结节样改变。 3眼有RPED ,5眼RPED合并神经上皮脱离。RPE隆起高度和基底宽度比率 :PCV组 (0 14 5 1± 0 0 40 0 )较浆液性RPED组 (0 0 876± 0 0 3 2 5 )高 (t =-3 3 2 4,P =0 0 0 4) ,高度和基底宽度呈线形关系 ,且PCV组直线较浆液性PED组     

荧光素眼底血管造影对视网膜脉络膜裂伤的观察

目的 观察分析视嘲膜脉络膜裂伤的荧光素眼底血管造影表现.方法 对140例(140眼)眼挫伤行荧光素眼底血管造影榆查.结果 视网膜脉络膜裂伤35眼,荧光素眼底造影图象分析有4种情况:视网膜色素上皮损伤、色素上皮损伤合并脉络膜裂伤、极层脉络膜裂伤及全层脉络膜裂伤.其中色素上皮合并脉络膜裂伤多见.结论 荧光素眼底血管造影对判断视网膜脉络膜裂伤的层次和程度有重要价值.     

年龄相关性黄斑变性产生的脉络膜新生血管自发荧光成像

目的：描述年龄相关性黄斑变性（AMD）患者中脉络膜新生血管（CNV）的自发荧光（AF）特征。 方法：对连续的患者不同发展阶段的65只CNV眼的自发荧光图像作了分析。其中25幅图像为新近发生的CNV（第1组）。8幅为诊断CNV后1到6个月（第2组）。37幅为晚期CNV（第3组）。对第1组和第2组的自发荧光图像与荧光素眼底血管造影（FFA）图像进行了比较。 结果：第1组的20例中有16例显示FFA强荧光区与正常AF区相对应。13例的邻近区域显示为AF增强。20例中有18例异常AF的主要范围大于异常FFA荧光的主要范围。第2组和第3组显示AF减弱区对应于FFA原先渗漏区（在第2组）或者萎缩区。 结论：第1组中保存的AF提示视网膜色素上皮细胞（RIPE）仍有活性。这暗示了视力的预后。第2组和第3组AF降低提示RIPE和光感受器的丢失。自发荧光成像可以增进我们对年龄相关性黄斑变性中CNV的了解。     

光学相干断层扫描血管成像在脉络膜裂伤中的诊断价值

目的:研究光学相干断层扫描血管成像(OCTA)在脉络膜裂伤中的诊断价值,并总结其OCTA影像特征。方法:回顾分析我院确诊为脉络膜裂伤患者的临床资料,共25例25眼,所有患者均接受眼底照相、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、频域OCT和OCTA检查。结果:所有患者眼底检查可见病灶多位于黄斑区或视盘颞侧,呈弧形黄白色条纹,周围可伴有视网膜脉络膜水肿和视网膜下出血。FFA早期可见裂伤呈弧形透见荧光,晚期荧光着染;当继发脉络膜新生血管(CNV)时,活动性CNV呈高荧光渗漏。频域OCT可见RPE层和脉络膜毛细血管层反射断裂,临近处的组织反射增强,视网膜下可见小团状高反射隆起。OCTA可见脉络膜裂伤的肉芽组织在外层视网膜和脉络膜毛细血管层血流图中表现为具有"条纹形态"的弧形高反射;在断层B扫描(B-scan)中表现为"团状"的向内隆起或向外凹陷,内部具有血流信号。当继发CNV时,在外层视网膜和脉络膜毛细血管层的血流图中可见明确的血管形态,多呈团状,从形态上与脉络膜裂伤的肉芽组织不相同。结论:脉络膜裂伤的修复性肉芽组织与继发性CNV病灶在OCTA中虽然同样呈"团状隆起"并具有血流信号,但两者的形态和组织成分均有明显差异。通过OCTA分层显示以及对病灶细节形态上的观察,可以提高脉络膜裂伤继发CNV的诊断率。     

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。     

中心性浆液性脉络膜视网膜病变荧光造影特点

目的探讨45岁以上和45岁以下中心性浆液性脉络膜视网膜病变（CSC）患者眼底荧光血管造影的特点。方法回顾分析147例173眼45岁以上CSC的FFA特点并与同期45岁以下CSC的FFA特点相比较。结果45岁以上38例，双眼发病5例，多灶渗漏31眼，局灶渗漏12眼，形态改变以不典型渗漏及墨渍弥散型多见。45岁以下109例，双眼发病21例，多灶渗漏32眼，局灶渗漏98眼，以局灶渗漏为主。两者相比差异有统计学意义。结论45岁以上CSC患者的FFA表现以多灶渗漏及播散性色素上皮损害多见，但需与年龄相关性黄斑变性相鉴别，45岁以下以局灶性渗漏为主。     

中心性浆液性脉络膜视网膜病变眼底红外线和自发荧光的影像特征

目的:观察中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的眼底红外线(infrared ray,IR)和自发荧光(autofluorescence,AF)的影像特征。方法:采用Spectralis HRA海德堡共焦激光扫描系统的IR模式和AF模式,对76例80眼CSC患者进行IR眼底照相、AF眼底照相、荧光素眼底血管造影(FFA)检查。结果:患者80眼中,CSC病灶的IR影像:黄斑水肿区色暗,浆液性感光视网膜脱离边界清楚,可见白色斑点状病灶,尤其是对应于荧光造影时的渗漏部位。CSC病灶AF表现为黄斑区盘状的弱AF者18例18眼,占22.50%;黄斑区弱AF中包含较多点状强AF者13例13眼,占16.25%;黄斑区弱AF中包含弥漫性强AF者11例11眼,占13.75%;黄斑盘状脱离区边缘强AF环者3例3眼,占3.75%;弱AF和斑点状强AF相连的复合病灶者19例21眼,占26.25%;后极部局灶性密集强AF和低AF者3例3眼,占3.75%;黄斑区弱AF中散在点片状低或强AF者9例11眼,占13.75%。FFA荧光素渗漏点或异常荧光与异常AF相对应者45例47眼,占58.75%;不一致者31例33眼,占41.25%。眼底红外像IR与FFA荧光素渗漏点相一致者65例68眼,占85.00%;不一致者11例12眼,占15.00%。结论:IR,AF检测为CSC的诊断提供了一个新的、快速、非创性检查手段,结合FFA检查,可以对CSC影像观察起到相互补充的作用。     

中心性浆液性视网膜脉络膜病变眼底荧光造影特点

目的探讨45-55岁中年人中心性浆液性视网膜脉络膜病变(central serous chorioretinopathy,CSC)眼底荧光血管造影(fundus fluorescence angiography,FFA)的形态学改变。方法回顾分析68例79眼中年人CSC的FFA特点,并与同期45岁以下CSC的FFA特点相比较。结果中年人双眼发病11例,单眼发病57例,多灶渗漏44眼,局灶渗漏35眼。形态改变以墨渍弥散型和不典型渗漏多见,与45岁以下患者相比有显著差异(P<0.01)。结论45岁以上CSC患者的FFA表现以多灶渗漏及播散性色素上皮损害多见,但需与老年黄斑变性相鉴别。     

相干光断层扫描与荧光素眼底血管造影在中心性浆液性脉络膜视网膜病变诊断中的对比观察

目的观察对比相干光断层扫描（OCT）和荧光素眼底血管造影（FFA）在中心性浆液性脉络膜视网膜病变（CSC）诊断中的特点。设计回顾性病例系列。研究对象临床诊断为CSC的58例（62眼）患者。方法对临床诊断为CSC且均行FFA及OCT检查的58例（62眼）患者的临床资料进行对比观察,分析其影像特征。随访中每月行OCT检查,每3个月行FFA检查,对比两种影像学检查观察疾病演变过程的特点。主要指标FFA及OCT影像学表现。结果58例（62眼）患者OCT检查中,60眼（96．8％）有神经上皮脱离,其中55眼（88．7％）FFA表现为荧光渗漏,且均在OCT神经上皮脱离范围内,另5眼未见异常荧光;5眼（8．1％）伴色素上皮脱离,而FFA未见特殊表现;2眼（3．2％）OCT仅见色素上皮脱离,其中1眼FFA见黄斑鼻侧透见荧光,另1眼无异常荧光。治疗后3个月,OCT检查62眼中16眼（24．2％）见神经上皮脱离,16眼中FFA仅5眼（8．1％）有荧光渗漏;2眼伴色素上皮脱离,而FFA未有特殊表现。对FFA检查及随诊中发现渗漏点在中心凹500μm外者（57眼）行激光光凝治疗。结论OCT和FFA在对CSC的诊断上各具优势,OCT可观察到视网膜病变的形态改变,FFA可定位血管渗漏,利于激光治疗。两者结合是CSC最有效的影像诊断技术。     

Fundus autofluorescence in central serous chorioretinopathy:association with spectral-domain optical coherence tomography and fluorescein angiography

AIM: To evaluate the correlation among changes in fundus autofluorescence (AF) measured using infrared fundus AF (IR-AF) and short-wave length fundus AF (SW-AF) with changes in spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in central serous chorioretinopathy (CSC).METHODS:Two hundred and twenty consecutive patients with CSC were included. In addition to AF, patients were assessed by means of SD-OCT and FA. Abnormalities in images of IR-AF, SW-AF, FA were analyzed and correlated with the corresponding outer retinal alterations in SD-OCT findings.RESULTS:Eyes with abnormalities on either IR-AF or SW-AF were found in 256 eyes (58.18%), among them 256 eyes (100%) showed abnormal IR-AF, but SW-AF abnormalities were present only in 213 eyes (83.20%). The hypo-IR-AF corresponded to accumulation of sub-retinal liquid, collapse of retinal pigment epithelium (RPE) or detachment of RPE with or without RPE leakage point in the corresponding area. The hyper-IR-AF corresponded to the area with loss of the ellipsoid portion of the inner segments and sub-sensory retinal deposits or focal melanogenesis under sensory retina. The hypo-SW-AF corresponded to accumulation of sub-retinal liquid or atrophy of RPE. The hyper-SW-AF associated with sub-sensory retinal deposits, detachment of RPE and focal melanogenesis.CONCLUSION:IR-AF was more sensitive than SW-AF and FA for identifying pathological abnormalities in CSC. The characteristics of IR-AF in CSC were attributable to the modification of melanin in the RPE. IR-AF should be used as a common diagnostic tool for identifying pathological lesion in CSC.KEYWORDS:central serous chorioretinopathy; fluorescein angiography; fundus autofluorescence; optical coherence tomography     

Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy

AIM:To discuss and compare the fundus autofluorescence (FAF) and optical coherence tomography (OCT) in acute or chronic central serous chorioretinopathy (CSCR).METHODS: Medical records of 100 cases of CSCR were reviewed. Acute and chronic cases were evaluated according to the duration of decreased visual acuity, serous retinal detachment (RD) and focal leakage on fluorescein angiography (FA). Chi-square test was used for statistical analysis.RESULTS:Forty cases had acute and 60 cases had chronic CSCR. FAF showed focal hypo-autofluorescence in 34 (85%) and iso-autofluorescence in 6 (15%) of acute cases and hypo-autofluorescence in 51 (85%), hyper-autofluorescence in 6 (10%) and iso-autofluorescence in 3 (5%) of chronic cases. OCT showed serous RD with distinct borders correlated with FAF findings (hypo-autofluorescence) in all acute CSCR cases. In chronic CSCR group, OCT showed serous RD with indistinct borders correlated with FAF findings. The differences between the OCT and FAF findings of the two groups were significant (P=0.000).CONCLUSION: OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium, outer segments of photoreceptors and the components of serous RD.     

Infrared autofluorescence, short-wave autofluorescence and spectral-domain optical coherence tomography of optic disk melanocytomas

AIM: To investigate the findings of infrared fundus autofluorescence (IR-AF) and spectral-domain optical coherence tomography (SD-OCT) in eyes with optic disc melanocytoma (ODM). METHODS: IR-AF findings and those of other ophthalmologic imaging examinations, including short-wave autofluorescence (SW-AF), fluorescein angiography (FA), fundus color photography, and SD-OCT of 8 eyes of 8 consecutive cases with ODM were assessed. RESULTS: The ODMs in all cases (100%) presented similar IR-AF, SW-AF, and FA findings. On IR-AF images, ODMs showed outstanding hyper-AF with well-defined outline. On SW-AF images, the area of ODMs presented as hypo-AF. FA images revealed the leaking retinal telangiectasia on the surface of the ODMs. On SD-OCT images in 8 cases (100%), the ODMs were sloped with highly reflective surface, which were disorganized retina and optic nerve layers. In 7 cases (87.5%), peripapillary choroids were involved. The melanocytomas of 8 cases (100%) presented as optically empty spaces. Vitreous seeds were found in one case (12.5%). CONCLUSION: IR-AF imaging may provide a new modality to evaluate the pathologic features of ODMs, and together with SW-AF imaging, offers a new tool to study biological characteristics associated with ODMs. SD-OCT is a valuable tool in delimitating the tumor extension and providing morphological information about the adjacent retinal tissue.     

脉络膜破裂的临床与荧光素眼底血管造影表现

目的 分析外伤性脉络膜破裂的临床特点与荧光素眼底血管造影(FFA)表现,以及FFA在脉络膜破裂诊断中的应用.方法 对122例(123眼)外伤性脉络膜破裂的临床资料进行了回顾性分析,全部病例均行FFA及常规眼科检查.结果 123眼中86眼(69.92％)为脉络膜破裂与出血并存.造影前眼底检查未发现裂口者15眼,占12.20％.结论 FFA在诊断脉络膜破裂方面具有独特的优越性,能最大限度地发现脉络膜破裂病灶,尤其是检眼镜下未能发现的微小、隐匿的破裂与出血;在造影的晚期大都能清晰地显示出脉络膜破裂的部位、大小与形态.能客观地确定损伤的程度范围,有助于确诊及估计预后.     

频域OCT定性定量分析葡萄膜炎性黄斑水肿

目的 观察葡萄膜炎患者黄斑水肿的光学相干断层扫描(OCT)图像特征及与临床的关联,探讨频域OCT在葡萄膜炎性黄斑水肿定性和定量分析中的应用价值.方法 连续临床病例横断面研究.对河南省眼科研究所在2009年4月至2011年3月就诊的葡萄膜炎并黄斑水肿169只眼进行频域OCT检查,分析黄斑水肿的类型及各参数与视力的相关性,并与FFA结果对比分析.结果 (1)黄斑水肿分型:囊样水肿占43.19％,弥漫性水肿占34.91％,单纯神经上皮脱离占10.06％,11.83％同时出现3种改变;囊样水肿发生率最高.(2)光感受器内外节连接体断裂者54只眼(31.95％),玻璃体后脱离者33只眼(19.53％);存在明显玻璃体视网膜牵拉者15只眼(8.88％),黄斑前膜者33只眼(19.53％).(3)囊样水肿组平均黄斑厚度高于弥漫性水肿组,两组视网膜厚度均与视力呈负相关;连接体断裂组视力较完整组低;存在黄斑前膜组视力较低.(4) OCT与FFA对黄斑水肿的检出一致率为86.39％.结论 葡萄膜炎所导致的黄斑水肿其形态可表现为多种不同的类型,OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关.     

相干光断层扫描在人工角膜术后眼底观察中的临床应用

目的探讨利用相干光断层扫描（OCT）观察人工角膜术后患者眼底黄斑的有效性。方法人工角膜术后患者7例（7只眼）,年龄30～76岁,平均39岁,矫正视力：5米光感至1.0,全部病例（7只眼）均行直接检眼镜、眼底彩色照相及OCT检查,分析比较这三种检查是否可清楚地观察到眼底黄斑部位。结果眼底彩色照相检查无法显示人工角膜眼的黄斑图像;直接检眼镜检查仅能观察到部分病例模糊的视盘图像,而黄斑不能窥清;OCT检查可获得清晰的人工角膜眼的黄斑图像。结论与眼底彩色照相、直接检眼镜检查相比,OCT可有效地直观显示人工角膜眼患者的黄斑情况,能够准确随诊,为观察人工角膜术后患者眼底变化提供了新的检查方法。     

光學相斡斷層掃描對年齡相關性黄斑燮性及脉絡膜新生血管膜的診斷意義

目的應用光學相斡斷層掃描(0CT)觀察年齡相關性黄斑變性的不同特徵.方法 116例临床上荧光造影診斷为老年性黄斑变性的病人,160只眼,其中男性67例(88只眼),女性49例(72只眼).干性者36例(56只眼),其中女性19例(32只眼),男性17例(24只眼),平均年齡为68.5±9.82岁,平均视力为0.58±0.29.湿性者80例(104只限),其中女性30例(40只眼),男性50例(64只眼),平均年齡为71.8±8.69岁,平均视力为0.253±0.293.所有病例在散瞳下用4mm长扫描线行放射狀扫描.結果中心凹處視網膜厚度斡性病燮組爲168.01±38.24μm,顯性病燮組爲220.2±114μm;色素上皮厚度斡性病變組爲128.18±47.24μm.顯性病變組爲287±157.2μm.結論OCT可以帮助观察年齡相关性黄斑变性的发展及新生血管膜的特征及位置,对于指导临床治疗有重大意义.     

Chloroquine retinopathy: lipofuscin- and melanin-related fundus autofluorescence,optical coherence tomography and multifocal electroretinography

Purpose To evaluate melanin-related near-infrared fundus autofluorescence (NIA, excitation 787 nm, emission > 800 nm), lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm, emission >500 nm), optical coherence tomography (OCT), and multifocal electroretinography (mfERG) in patients with chloroquine (CQ) retinopathy. Methods Two patients with progressed CQ retinopathy underwent clinical examination, ISCEV mfERG evaluation, and FAF and NIA imaging using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2) with either a 30° or wide-angle field-of-view. OCT3 imaging was performed in one of these patients. Results In the foveola, FAF and NIA were relatively normal. Parafoveal loss of retinal pigment epithelium (RPE) was indicated by absent FAF and NIA. An area of reduced FAF and NIA surrounded the parafoveal region of RPE loss. In the adjacent area, FAF was increased and increased NIA marked the peripheral border of increased FAF. Wide-field imaging revealed increased FAF in association with retinal vessels. Retinal thickness was markedly reduced in the OCT predominantly in the parafoveal region. Visual field loss and mfERG amplitude reduction corresponded to areas with increased or reduced FAF and NIA. Conclusion Patterns of FAF and NIA indicate different stages of pathophysiologic processes involving lipofuscin and melanin in the RPE. Combined retinal imaging and functional testing provides further insights in the pathogenesis and development of retinal degenerative disease. An association of CQ retinopathy with retinal vessels architecture is hypothesized.