两种波长自发荧光在眼底疾病诊断中的应用

Application of two wavelength autofluorescence in diagnosis of fundus diseases

目的应用Spectralis OCT联合激光共焦扫描检眼镜对比观察蓝光自发荧光(blue light fundus autofluorescence,BL-FAF,激发光488nm,滤光片>500nm)和近红外波长自发荧光(near-infrared fundus autofluorescence,NIR-FAF,激发光787nm,滤光片>800nm)在眼底疾病诊断中的应用价值。方法选取我院眼科门诊眼底相关疾病患者22例(其中视网膜静脉阻塞5例、中心性渗出脉络膜视网膜炎3例、糖尿病性视网膜病变2例、特发性息肉状脉络膜血管病变2例、高度近视病理性脉络膜新生血管2例、小柳原田病1例、黄斑裂孔2例、青光眼1例、单纯高度近视1例、正常人群3例)共38眼进行BL-FAF、NIA-AF和Spectralis OCT检查,部分患者行眼底照相。眼底荧光血管造影及吲哚菁绿血管造影检查。按病变类型进行分组研究。结果 NIR-FAF显示病变而BL-FAF没有显示病变的有16眼,其中包括视网膜出血2眼、视网膜渗出1眼、玻璃膜疣5眼、黄斑水肿2眼、神经上皮层脱离或恢复2眼、脉络膜新生血管1眼、小柳原田病治疗后2眼、黄斑孔1眼;BL-FAF显示病变而NIR-FAF没有显示病变的有9眼,其中包括视网膜出血2眼、视网膜渗出2眼、玻璃膜疣1眼、CNV3眼、单纯高度近视眼外核层视网膜劈裂1眼。NIR-FAF对累及外界膜、光感受器内节与外节连接带及色素上皮与Bruch膜复合体范围内病变成像优于BL-FAF,NIR-FAF在确定某些疾病的病变范围上优于BL-FAF,而BL-FAF对于累及外核层、外丛状层及视网膜浅层的病变优于NIR-FAF。结论自发荧光由于其易操作性、有效性和无创性,已经越来越多的应用到临床实践。激光共焦扫描检眼镜多种成像模式联合Spect-ralis OCT更有利于眼底疾病的理解和诊断。

Objective To investigate and compare the application of blue light fundus autofluorescence（BL-FAF;Excitation light 488 nm,filter 500 nm）and near infrared fundus autofluorescence（NIR-FAF;Excitation light 787 nm,filter 800 nm）with Spectralis optical coherence tomography（OCT）and confocal scanning laser ophthalmoscope in patients with fundus diseases.Methods Ophthalmoscopic examination,BL-FAF,NIR-FAF and Spectralis OCT were performed on 38 eyes of 22 patients in ophthalmologic department of our hospital,including 5 cases with retinal vein occlusion,3 cases with central exudative chorioretinopathy,2 cases with diabetic retinopathy,2 cases with idiopathic polyiform choroidal vasculopathy,2 cases with choroidal neovascularization in high myopia,1 case with Vogt-Koyanagi-Harada,2 cases with macular hole,1case with glaucoma,1 case with pure high myopia,and 3 normal people.In addition,partial patients had fundus photograghy,fundus fluorescein angiography and indocyanine green angiography.According to different pathological changes,several groups were divided for study.Results There were 16 eyes with pathological lesions revealed by NIR-FAF but not by BL-FAF,including retinal hemorrhage（2 eyes）,retinal exudation（1 eye）,drusen（5 eyes）,macular edema（2 eyes）,neuroepithelial detachment or recovery（2 eyes）,choroidal neovascularization（1 eye）,vogt-koyanagi-Harada disease after therapy（2 eyes）,macular hole（1 eye）.There were 9 eyes with pathological lesions revealed by BL-FAF but not by NIR-FAF,including retinal hemorrhage（2 eyes）,retinal exudation（2 eyes）,drusen（1 eye）,choroidal neovascularization（3 eyes）,simple high myopic eye with retinal split at outer nuclear layer（1 eye）.If the lesions involved outer limiting membrane,photoreceptor inner segment/outer segment junction and retinal pigment epithelium-Bruch complex,NIR-FAF is superior to BL-FAF to reveal the pathological lesions and define its location.Otherwise,compare with NIR-FAF,BL-FAF has advantage on outer nuclear layer,outer plexiform layer and superficial layer of the retina imaging.Conclusions For its simple,efficient,and noninvasive nature,autofluorescence has been used more and more in clinical experience.Confocal scanning laser ophthalmoscope with multiple imaging models combined with Spectralis OCT is more benefit for understanding and diagnosis of retinal diseases.