板层裂孔和玻璃体黄斑界面的重新定义:超高分辨率的光学相干断层扫描研究

Objectives: To define optical coherence tomographic (OCT)-criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). Design: Retrospective observational case series. Participants: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. Methods: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. Main Outcome Measures: Standard and ultrahigh-resolution OCT images. Results: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37% ). Twelve of 19 eyes (63% ) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53% ) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89% ) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25% ) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. Conclusions: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting cautionwhen performing vitrectomy on lamellar holes.

超高分辨率光学相干断层扫描仪在非渗出性年龄相关性黄斑变性病变中的应用

Aim: To describe the appearance of the non-exudative forms of age related macular degeneration (AMD) as imaged by ultrahigh resolution optical coherence tomography (UHR-OCT). Methods: A UHR-OCT ophthalmic imaging system, which utilises a femtosecond laser light source capable of approximately 3 μm axial resolution, was employed to obtain retinal cross sectional images of patients with non-exudative AMD. Observational studies of the resulting retinal images were performed. Results: 52 eyes of 42 patients with the clinical diagnosis of non-exudative AMD were imaged using the UHR-OCT system. 47 of the 52 (90%) eyes had the clinical diagnosis of drusen and/or retinal pigment epithelial (RPE) changes. In these patients, three patterns of drusen were apparent on UHR-OCT: (1) distinct RPE excrescences, (2) a saw toothed pattern of the RPE, and (3) nodular drusen. On UHR-OCT, three eyes (6%) with a clinical diagnosis of non-exudative AMD had evidence of fluid under the retina or RPE. Two of these three patients had findings suspicious for subclinical choroidal neovascularisation on UHR-OCT. Conclusion: With the increased resolution of UHR-OCT compared to standard OCT, the involvement of the outer retinal layers are more clearly defined. UHR-OCT may allow for the detection of early exudative changes not visible clinically or by angiography.

原发性近中心凹的视网膜毛细血管扩张症:超高分辨率的光学相干断层成像术的新发现

Objective: To investigate the capabilities of ultrahighreso-lution optical coherence tomography (UHR OCT); to compare with the commercially available OCT standard-resolution system, StratusOCT, for imaging of idiopathic juxtafoveal retinal telangiectasis (IJT); and to demonstrate that UHROCT provides additional information on disease morphology, pathogenesis, and management. Design: Retrospective, observational, interventional case series. Participants: Nineteen eyes of 10 patients diagnosed with IJT in at least one eye. Method: All patients were imaged with UHR OCT and StratusOCT at the same visit. A subset of patients was also imaged before and after treatment of IJT. Main Outcome Measures: Ultrahigh-and standard-resolution cross-sectional tomograms of IJT pathology. Results: Using both standard-and ultrahigh-resolution OCT, we identified the following features of IJT: (1) a lack of correlation between retinal thickening on OCT and leakage on fluorescein angiography, (2) loss and disruption of the photoreceptor layer, (3) cystlike structures in the foveola and within internal retinal layers such as the inner nuclear or ganglion cell layers, (4) a unique internal limiting membrane draping across the foveola related to an underlying loss of tissue, (5) intraretinal neovascularization near the fovea, and (6) central intraretinal deposits and plaques. In 63%of cases, the presence of abnormal vessels and a discontinuity of the photoreceptor layer correlatedwith visual acuity. Conclusions: Ultrahigh-resolution OCT improves visualization of the retinal pathology associated with IJT and allows identification of new features associated with it. Some of these features, such as discontinuity of the photoreceptor layer, are revealed only by UHR OCT.

超高分辨率和标准分辨率OCT在显示黄斑裂孔病理及修复中的比较研究

Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UHR OCT provides addi tional information on disease morphology, pathogenesis, and management; and to u se UHR OCT as a baseline for improving the interpretation of the standard reso lution images. Design Observational and interventional case series. Participants Twenty nine eyes of 24 patients clinically diagnosed with macular hole in at l east one eye. Methods A UHR OCT system has been developed and employed in a ter tiary care ophthalmology clinic. Using a femtosecond laser as the lowcoherence light source, this new UHR OCT system can achieve an unprecedented 3 μm axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR OCT and standard 10 μm resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the populati on before and after macular hole surgery. Main outcome measures Ultrahigh and s tandard reso lution cross sectional OCT images of macular hole pathologies. R esults Both UHR OCT and standard resolution OCT exhibited comparable performan ce in differentiating various stages of macular holes. The UHR OCT provided imp roved imaging of finer intraretinal structures, such as the external limiting me mbrane and photoreceptor inner segment (IS) and outer segment (OS), and identifi cation of the anatomy of successful surgical repair. The improved resolution of UHR OCT enabled imaging of previously unidentified changes in photoreceptor mor phology associated with macular hole pathology and postoperative repair. Visuali zation of the junction between the photoreceptor IS and OS was found to be an im portant indicator of photoreceptor integrity for both standard resolution and U HR OCT images. Conclusions Ultrahigh resolution optical coherence tomography i mproves the visualization of the macular hole architectural morphology. The incr eased resolution of UHR OCT enables the visualization of photoreceptor morpholo gy associated with macular holes. This promises to lead to a better understandin g of the pathogenesis of macular holes, the causes of visual loss secondary to m acular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh resolu tion optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR OCT images. Comparisons of UHR OCT images with standard resolution OCT images can establish a baseline for the better in terpretation of clinical standard resolution OCT images. The ability to visuali ze photoreceptors and their integrity or impairment is an indicator of macular h ole progression and surgical outcome.