OCT血管成像术在中心性渗出性脉络膜视网膜病变中的应用
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摘要
目的观察相干光断层血管成像(OCTA)在中心性渗出性脉络膜视网膜病变(CEC)中的不同时期的影像特征,评价其在诊断中的作用。方法回顾分析2017年1月至2018年6月在我院就诊的21例(21只眼)经眼底检查、荧光素眼底血管造影(FFA)及相干光断层扫描(OCT)确诊为CEC患者的治疗前、治疗后1、2、3、4个月的临床资料,包括患者视力、屈光检查、眼底彩色图像、OCT及OCTA资料。患者均采用玻璃体腔注射雷珠单克隆抗体进行治疗。结果本研究患者均随访6个月以上。OCTA图像可现实脉络膜和视网膜毛细血管层血管的病变情况,并能够检查出脉络膜新生血管,并可发现视网膜色素上皮(RPE)损伤。14例CEC患者OCTA图像显示新生血管位于RPE下; 5例像显示新生血管位于RPE上; 2例显示视网膜黄斑部RPE层上下均可见新生血管。患者治疗前BCVA为0. 38±0. 42,治疗后1个月BCVA平均提高到0. 67±0. 36,治疗后2个月0. 73±0. 46,治疗后3个月0. 76±0. 32,治疗后4个月0. 78±0. 41,术后较术前显著提高。治疗前、后中央视网膜厚度(CFT)差异有显著性,术前、术后各随访时间点CFT的平均值分别是(456±94)μm、(240±83)μm、(218±78)μm、(181±83)μm和(173±75)μm。治疗前OCTA显示:视网膜出现深层和脉络膜新生血管(CNV)的有21例,治疗3个月时14例(66. 7%)CNV完全闭合; 4例(19. 0%) CNV部分闭合; 3例(14. 3%) CNV未闭合;有6例(28. 6%)出现RPE损害。结论OCTA能准确的发现CEC患者脉络膜和视网膜毛细血管层血管的病变及新生血管,指导临床治疗。
Objective To observe the imaging features of OCTA in different stages of central exudative chorioretinopathy( CEC) and evaluate its role in diagnosis of CEC. Methods The study included 21 patients with CEC diagnosed by fundus examination,fluorescein fundus angiography( FFA) and optical coherence tomography( OCT) from January2017 to June 2018. The clinical data was retrospectively analyzed,including visual acuity,refractive examination,fundus color image coherence tomography( OCT) and OCT angiography( OCTA). All patients were treated with intravitreal injection of Lucentis. Results All patients were followed up for more than 6 months. OCTA images can show the choroidal and retinal capillary vessels,choroidal neovascularization,and retinal pigment epithelium damage. The OCTA images of 14 CEC patients showed that the neovascularization was located under RPE,5 CEC patients showed that the neovascularization was located above RPE,and 2 CEC patients showed that the neovascularization was located above and under the RPE layer.BCVA of patients was 0. 38 ± 0. 42 before treatment,BCVA increased to 0. 67 ± 0. 36 on average in 1 month,0. 73 ± 0. 46 in 2 months,0. 76 ± 0. 32 in 3 months,0. 78 ± 0. 41 in 4 months after treatment. BCVA was significantly higher after treatment. There was significant difference in central retinal thickness( CFT) between before and after treatment. The mean values of CFT were 456 ± 94,240 ± 83,218 ± 78,181 ± 83 and 173 ± 75 μm at preoperative and postoperative follow-up time points,respectively. OCTA showed that 21 cases had deep retinal and choroidal neovascularization before treatment.14( 66. 7%) eyes had CNV completely closed,4( 19. 0%) eyes had CNV partially closed,3( 14. 3%) eyes had CNV unclosed,and 6( 28. 6%) eyes had RPE damage at 3 months after treatment. Conclusions OCTA can accurately detect the choroidal and retinal microvascular lesions and neovascularization in patients with CEC,and guide clinical treatment.OCTA is noninvasive and convenient. It has advantages in diagnosis and follow-up of CEC.
Objective To observe the imaging features of OCTA in different stages of central exudative chorioretinopathy( CEC) and evaluate its role in diagnosis of CEC. Methods The study included 21 patients with CEC diagnosed by fundus examination,fluorescein fundus angiography( FFA) and optical coherence tomography( OCT) from January2017 to June 2018. The clinical data was retrospectively analyzed,including visual acuity,refractive examination,fundus color image coherence tomography( OCT) and OCT angiography( OCTA). All patients were treated with intravitreal injection of Lucentis. Results All patients were followed up for more than 6 months. OCTA images can show the choroidal and retinal capillary vessels,choroidal neovascularization,and retinal pigment epithelium damage. The OCTA images of 14 CEC patients showed that the neovascularization was located under RPE,5 CEC patients showed that the neovascularization was located above RPE,and 2 CEC patients showed that the neovascularization was located above and under the RPE layer.BCVA of patients was 0. 38 ± 0. 42 before treatment,BCVA increased to 0. 67 ± 0. 36 on average in 1 month,0. 73 ± 0. 46 in 2 months,0. 76 ± 0. 32 in 3 months,0. 78 ± 0. 41 in 4 months after treatment. BCVA was significantly higher after treatment. There was significant difference in central retinal thickness( CFT) between before and after treatment. The mean values of CFT were 456 ± 94,240 ± 83,218 ± 78,181 ± 83 and 173 ± 75 μm at preoperative and postoperative follow-up time points,respectively. OCTA showed that 21 cases had deep retinal and choroidal neovascularization before treatment.14( 66. 7%) eyes had CNV completely closed,4( 19. 0%) eyes had CNV partially closed,3( 14. 3%) eyes had CNV unclosed,and 6( 28. 6%) eyes had RPE damage at 3 months after treatment. Conclusions OCTA can accurately detect the choroidal and retinal microvascular lesions and neovascularization in patients with CEC,and guide clinical treatment.OCTA is noninvasive and convenient. It has advantages in diagnosis and follow-up of CEC.
引文
[1]徐朝阳,刘光辉,郑永征,等.中心性渗出性脉络膜视网膜病变的长期随访研究[J].临床眼科杂志,2017,25(6):508-511.
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[5]刘青,艾明.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)[J].眼科新进展,2017,37(1):52-55.
[6]庄海容,刘平,胡学政.中心性渗出性脉络膜视网膜病变的FFA与OCT对比分析[J].哈尔滨医科大学学报,2015,49(4):328-330,334.
[7] Murro V,Mucciolo DP,Giorgio D,et al. OCTA Imaging of choroidal neovascularization treated using photodynamic therapy in a young patient with best macular dystrophy[J]. Ophthalmic Surg Lasers Imaging Retina,2018,49(12):969-973.
[8] Eladawi N,Elmogy M,Khalifa F,et al. Farly diabetic retinopathy diagnosis bases on local retinal blood vessel analysis in optical conherence tomography angiography(OCTA)images. Med Phys,2018,45(10):4582-4599.
[2]张聪,刘东宁,徐丽.玻璃体内注射Lucentis治疗中心性渗出性脉络膜视网膜病变的临床疗效[J].眼科新进展,2014,34(9):864-867.
[3] de Carlo TE,Romano A,Waheed NK,et al. A review of optical coherence tomography angiography(OCTA)[J]. Int J Retina Vitreous,2015,1:5.
[4] He SZ,Wang W,Li XL,et al. Optical coherence tomography features of central exudative chorioretinopathy[J]. Zhonghua Yan Ke Za Zhi,2003,39(11):669-672.
[5]刘青,艾明.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)[J].眼科新进展,2017,37(1):52-55.
[6]庄海容,刘平,胡学政.中心性渗出性脉络膜视网膜病变的FFA与OCT对比分析[J].哈尔滨医科大学学报,2015,49(4):328-330,334.
[7] Murro V,Mucciolo DP,Giorgio D,et al. OCTA Imaging of choroidal neovascularization treated using photodynamic therapy in a young patient with best macular dystrophy[J]. Ophthalmic Surg Lasers Imaging Retina,2018,49(12):969-973.
[8] Eladawi N,Elmogy M,Khalifa F,et al. Farly diabetic retinopathy diagnosis bases on local retinal blood vessel analysis in optical conherence tomography angiography(OCTA)images. Med Phys,2018,45(10):4582-4599.