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Chi, Y.T., Yang, C.H., Cheng, C.K.

期刊名称:JAMA Ophthalmology



摘要:重要性:探讨息肉状物的定量三维解剖结构对于更好地了解息肉状脉络膜血管病变(PCV)的发病机制具有重要意义。目的:旨在使用光学相干断层扫描血管造影(OCTA)和多图像系统定量评价息肉样结构分支血管网络(BVNs)的三维特征,以及PCV起源。设计,设置和研究对象:从2015521日至2017430日,对连续47名台湾患者(47只眼)进行前瞻性观察研究。使用Optovue-RTVue-XR-Avanti OCTA系统对所有研究对象进行扫描。对OCTA中确定PCV的患者进行了检查,以确定OCTA显示的脉络膜,息肉结构和BVN的原始血管的特征和结构。主要预后和指标:定量分析息肉3-D结构。结果:47例患者中,平均年龄68.98.0)岁,男性28例(59.6%)。在26只眼(55.3%,26只眼)中,17只眼的息肉状结构(36.2%,22个息肉样结构),26只眼的BVNs55.3%,26BVNs)和26只眼可见脉络膜来源的stalks结构(55.3%, 26 stalks) 图像清晰。所有的息肉样结构均在视网膜色素上皮(RPE)参考平面上方平均(SD)高度45.336.1)μm处发现,但BVNRPE参考平面下方平均(SD28.614.2)μm处,脉络膜stalks RPE参考平面下方80.424.4)μm处。息肉样结构的平均厚度(SD)为38.415.5)μmBVNs的平均厚度为60.225.0)μm。所有息肉样结构均位于RPE脱离区圆顶内的Bruch膜上方,脉络膜stalks全部位于脉络膜层。 BVN可以在Bruch膜上方(18μm以上),内,或下(28μm以上),并且接近扁平化RPE分离双层。结论和意义:这些结果证明了PCV 3D结构可能有助于更好地了解PCV的解剖,病理生理和发病机制。

Importance:Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV).Objective:To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems.Design, Setting, and Participants:A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and structures of the original spouting vessels (stalks) from the choroid, polypoidal structures, and BVNs on OCTA.Main Outcomes and Measures:Quantitative analysis of 3-D structures of the polypoidal complex.Results:Among the 47 patients, the mean (SD) patient age was 68.9 (8.0) years, and 28 (59.6%) men were included. Clear images of polypoidal structures could be detected in 17 eyes (36.2%, 22 polypoidal structures), BVNs in 26 eyes (55.3%, 26 tufts of BVNs), and stalks of origin from the choroid in 26 eyes (55.3%, 26 stalks) on the en face plane on OCTA. All polypoidal structures were found at a mean (SD) height of 45.3 (36.1) μm above the retinal pigment epithelium (RPE) reference plane that was preset by the machine, while the BVNs were found at a mean (SD) depth of 28.6 (14.2) μm below the RPE reference plane and the choroidal stalks at 80.4 (24.4) μm below RPE reference plane. The mean (SD) thickness of polypoidal structures was 38.4 (15.5) μm and of BVNs, 60.2 (25.0) μm. The polypoidal structures were all above the Bruch membrane within the dome of the RPE detachment, the choroidal stalks were all in the choroid layer. The BVNs could be either above (up to 18 μm), within, or below (up to 28 μm) the Bruch membrane and were in proximity to the double layers of flattened RPE detachment.Conclusions and Relevance:These results demonstrate a 3-D architecture of PCV that may be helpful for a better understanding of the anatomy, pathophysiology, and pathogenesis of PCV.


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