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光学相干人工血管造影在中心性浆液性脉络膜视网膜病变中的应用

Chan SY, Wang Q, Wei WB, et al.

期刊名称:Retina

卷期:2016年第36卷第11期

庄文娟 留美博士,教授、主任医师、硕士生导师。 现任宁夏人民医院宁夏眼科研究所所长、宁夏人民医院宁夏眼科医院副院长、视光中心主任。兼任中华医学会眼科学分会第十一届青年委员会青年委员,中华医学会激光医学分会第六届青年委员会青年委员;中国医师协会眼科医师分会葡萄膜炎与免疫专业委员会第一届委员会副主任委员,中华医学会宁夏眼科分会委员。2015年获得宁夏回族自治区科技创新领军人才,享受自治区政府特殊津贴。 长期从事眼科学临床、科研和教学工作,具有扎实的理论基础,丰富的临床经验和娴熟的显微外科手术技术,擅长白内障和屈光手术

眼底荧光血管造影(FFA)和吲哚菁绿血管造影(ICGA)是临床上对于视网膜脉络膜疾病诊断的有效方法乃至是金标准检查方法,但因其有创性及可能产生的过敏反应等问题使得部分患者不能进行该项检查。血管造影OCT(OCT-angiography)是近年来用于临床的新型检查手段,作者通过采用OCT-angiography21位患者的26眼中心性浆液性视网膜脉络膜炎(CSC)的检查发现所有患者显示高信号强度图像,并且21眼同时伴有脉络膜毛细血管层的血管扩张。这些特征性的改变显示了在CSC的诊断上OCT-angiography的良好诊断价值和无创性,并且认为对于其他的黄斑疾病诊断中也会显示其独特的优势。当然我们仍还需要更多的样本观察来充分发挥其优势而更好的服务于临床诊断中。

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摘要

目的:采用光学相干断层扫描血管造影(OCT-angiography),我们检查了中心性浆液性脉络膜视网膜病变(CSC)患者的脉络膜毛细血管的血管。方法:这项前瞻性观察性临床研究包括中央视敏度无痛性下降和存在浆液性黄斑脱离(经光谱域OCT可视化确定)的CSC患者。所有的眼睛都进行OCT血管造影。测量中心凹脉络膜厚度和绒毛膜毛细血管宽度。结果:该研究包括21例平均年龄为47.0±7.9岁(范围:34-65岁)患者的26只眼。所有26只眼显示高信号强度图像,21只眼另外在OCT-血管图像中显示扩张的毛细血管。 OCT-血管造影中显示异常的区域与荧光素血管造影中的泄漏区域或吲哚青绿血管造影中高渗透性区域一致。在16例单侧CSC患者中,1例患者对侧临床未受影响眼OCT-血管造影中显示高强度类型。与单侧CSC中对侧未受影响眼相比,OCT-血管造影显示受影响眼的脉络膜毛细血管层厚度明显较薄,与受影响眼较厚的脉络膜厚度相对。常规荧光素血管造影术未能发现临床诊断为CSC18只眼中的14只眼渗漏。结论:在具有CSC临床诊断的大多数眼中,光学相干断层摄影血管造影显示所有CSC和毛细血管扩张眼为高信号强度图像类型。结果表明OCT血管造影可能成为诊断CSC和一般诊断黄斑疾病的一种非侵入性的有价值工具

PURPOSE:Using optical coherence tomographic angiography (OCT-angiography), we examined the vasculature of the choriocapillaris in patients with central serous chorioretinopathy (CSC).METHODS:The prospective observational clinical study included patients with CSC defined by painless loss of central visual acuity and presence of a serous macular detachment as visualized by spectral-domain OCT. All eyes underwent OCT-angiography. Subfoveal choroidal thickness and choriocapillaris width were measured.RESULTS:The study included 26 eyes of 21 patients with a mean age of 47.0 ± 7.9 years (range: 34-65 years). All 26 eyes showed an image pattern of high signal intensity, and 21 eyes additionally demonstrated dilated capillaries in the OCT-angio images. The areas showing abnormalities in the OCT-angiography were congruent with leaking areas in fluorescein angiography or areas with hyperpermeability in indocyanine green angiography. Among 16 patients with unilateral CSC, 1 patient showed a high intensity pattern in the OCT-angiogram in the contralateral, clinically unaffected eye. Parallel to thicker choroidal thickness measurements in affected eyes as compared with contralateral unaffected eyes in unilateral CSC, OCT-angiography revealed significantly thicker choriocapillaris measurements in the affected eyes. Conventional fluorescein angiography did not demonstrate leakage in 14 of 18 eyes with clinically diagnosed CSC.CONCLUSION:Optical coherence tomographic angiography showed an image pattern of high signal intensity in all eyes with CSC and dilated vessels in the choriocapillaris in most eyes with clinically diagnosed CSC. The results indicate that OCT-angiography may become a noninvasive valuable tool for the diagnosis of CSC in particular and for the diagnosis of macular disorders in general.


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