Clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis

AIM: To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis. METHODS:A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae. Local and systemic antifungal therapy more than one week for all patients, corneal ulcer enlarge or no shrink. Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm. Anterior segment optical coherence tomography (AS-OCT)examine the depth of corneal ulcer between 1/3-1/2, infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis. Complete removal lesions until transparent of stoma, make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva. Continued antifungal therapy. The vision, fungal recurrence, conjunctival flap rollback or desquamate were analysed. ' RESULTS:Ten patients had success done this surgery, the corneal ulcer was not enlarge and healing afteroperation. 7 cases were bridging conjunctival flap and 3cases were single conjunctival flap. Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery, while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap, no conjunctival flap desquamate. CONCLUSION: It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.

Sirius、Oculyzer、AS-OCT和A超测量近视患者角膜最薄点厚度的比较

目的:比较Sirius、Oculyzer、AS-OCT和A超对近视患者角膜最薄点厚度测量结果的差异性、相关性和一致性,为临床的应用提供参考。方法:选取2016-03/04在武警陕西省总队医院眼科近视眼激光部行飞秒激光辅助LASIK患者81例162眼,用Sirius、Oculyzer、AS-OCT和A超四种仪器分别测量以上患者的角膜最薄点厚度,对其进行统计学分析。结果:A超、Sirius、Oculyzer、AS-OCT测量结果分别为537.91±24.12、538.12±22.64、538.20±23.74、527.04±23.11μm(P<0.01)。AS-OCT的测量结果明显小于其他三种方法测量结果,A超、Sirius、Oculyzer之间无差异。将A超、Sirius、Oculyzer、AS-OCT测得的角膜厚度最薄点数值进行两两相关分析,表明四种方法测量角膜最薄点厚度均有高度相关性(r=0.920、0.914、0.951、0.908、0.929、0.919,均P<0.001)。A超分别与Sirius、Oculyzer、AS-OCT测量角膜最薄点厚度在95%CI为-18.77~18.33、-19.79~19.19、-3.79~25.53μm,结合Bland-Altman图,提示Sirius、Oculyzer、AS-OCT分别与A超间均具有较好的一致性。结论:与A超测得的角膜最薄点厚度结果相比,AS-OCT测量的结果偏薄。四种方法测量的角膜厚度最薄点值具有高度的相关性及一致性,但95%的一致性界限较宽,临床使用中两者可以相互参考,不能替换。

Anterior and posterior segment structural features of acute primary angle-closure eyes:date based on AS-OCT and SS-OCT

Background:To measure the anterior and posterior segment structural features of acute primary angle-closure(APAC)eyes.Methods:A total of 36 subjects with unilateral APAC were recruited in this study.The ocular biometric characteristics were measured by anterior segment optical coherence tomography(AS-OCT)and swept source optical coherence tomography(SS-OCT),respectively at baseline,2 weeks,and 1 month after surgical intervention.Results:At baseline,when compared with the fellow eyes,APAC-affected eyes showed significantly greater corneal thickness(P=0.004),shallower anterior chamber depth(ACD)(P<0.001),smaller anterior chamber area(ACA)(P=0.013),angle opening distance at 750μm from the scleral spur(AOD750)(P=0.002),trabecular-iris space area at 750μm from the scleral spur(TISA750)(P=0.033),angle recess area(ARA)(P=0.014),and iris area(IARE)(P=0.003),less iris curvature(ICURVE)(P=0.003),and larger lens vault(LV)(P=0.030).After intervention,the corneal thickness was significantly decreased at 1 month(P<0.001),while ACD,ACA,and AOD750 were significantly increased at 2 weeks and 1 month(all P<0.017).Changes in ACD were correlated with decreasing LV(P<0.05).The posterior segment parameters did not change over the 4-week period.Conclusions:When compared with the fellow eyes,APAC-affected eyes had greater corneal thickness,shallower anterior chamber,narrower angle,less ICURVE,and larger LV.After intervention,the corneal thickness was decreased,while the shallower anterior chamber was relieved to some extent.

AS-OCT测量眼前节虹膜参数可重复性研究

目的 评估使用眼前节光学相干断层成像术（AS-OCT）定量测量虹膜参数的可重复性.方法 横断面研究.对2013年1月至2015年1月在汕头国际眼科中心共纳入受试者105名,平均年龄48.5岁（24～67岁）.分为房角开放（50名受试者）和房角关闭（55名受试者）两组.采用AS-OCT的眼前节单线扫描模式,使用自编程图像处理软件定量测量AS-OCT影像的虹膜参数,包括虹膜厚度,虹膜体积和虹膜曲度.先由一名检查者在不同时间对受试者进行2次检查.再由第二位独立检查者对受试者进行第三次检查.测量不分先后顺序,测量结果双盲.运用组内相关系数（ICC）,变异系数（COV）来评估测量者间和测量者内的可重复性.结果 房角开放眼的虹膜厚度,虹膜面积和虹膜曲度的平均值±标准差分别为（0.40±0.05） mm,（1.67±0.24） mm2和（0.18±0.12） mm;房角关闭眼的虹膜参数分别为（0.42±0.04） mm,（1.62±0.25） mrn2和（0.25±0.11）mm.在房角开放眼组,测量者内和测量者间得出的虹膜厚度,虹膜面积,虹膜曲度的ICC值为0.865～0.982.在房角关闭眼组的ICC值为0.875～0.948.结论 使用AS-OCT定量测量房角开放和房角关闭眼的虹膜参数均可获得高度可重复性。

AS-OCT和A超测量中央角膜厚度的比较

目的比较眼前节光学相干断层扫描仪(anterior segment optical coherence tomography, AS-OCT)与A超角膜测厚仪测量中央角膜厚度(central corneal thickness,CCT)的差异,为临床检查提供参考。方法回顾性分析2017年5～8月,经角膜屈光手术治疗的近视患者81例157只眼的临床资料。分别采用AS-OCT和A超测量患者的中央角膜厚度。对两组检测数据进行统计学分析,采用配对t检验比较两种仪器测量中央角膜厚度的差异,并采用Pearson相关分析和Bland-Altman分析评价测量结果的相关性和一致性。结果 AS-OCT和A超测量的中央角膜厚度值分别为(529.6±28.9)μm和(546.2±31.5)μm。配对t检验显示两种仪器测量结果差异有统计学意义(P<0. 001),差值均数为16.6μm。Pearson相关分析表示两种仪器测量结果显著相关(r=0. 978,P<0.001),回归分析显示CCT_(AS-OCT)=38.58+0.9CCT_(USP) A超。Bland-Altman分析显示两种仪器测量结果具有良好的一致性。结论 AS-OCT与A超测量中央角膜厚度的结果相关性高,但AS-OCT测量值较A超偏小,两种测量方式之间存在差异。因此,临床实践中两种仪器获得的测量值不能直接互换。

Corneal flap morphological analysis using anterior segment optical coherence tomography in laser in situ keratomileusis with femtosecond lasers versus mechanical microkeratome

AIM: To assess and compare the flap morphology using anterior segment optical coherence tomography (AS-OCT) in laser in situ keratomileusis (LASIK) with Femto LDV femtosecond lasers versus Hansatome mechanical Microkeratome. METHODS: AS-OCT (Visante) was used to compare 1 month postoperatively the morphology of the flaps created with Femto LDV femtosecond lasers or Hansatome Microkeratome. The intendedfiap thickness was 110 mu m and 160 mu m respectively. The thickness of twenty-five points across each flap, which were 0mm, 1.5mm, 2.5mm, and 3.5mm to the corneal vertex on the horizontal, vertical, 45 degrees and 135 degrees meridian respectively, was evaluated. RESULTS: One month postoperative, the central flap thickness in the Femto LDV group was 107.43 +/- 4.70 mu m, while 125.90 +/- 17.50 mu m in the Hansatome group. The difference between the actual and the expectedfiap thickness was 5.61 +/- 3.84 mu m and 31.52 +/- 12.27 mu m, respectively. The Hansatome group had presented a statistically significant result (P<0.001). Flap morphology showed a more regular planar shape in the Femto LDV group and a meniscus shape in the Hansatome group. CONCLUSION: AS-OCT is a direct and fast procedure to assess the flap morphology. The morphology by AS-OCT showed that the flaps created with Femto LDV femtosecond laser were more accurate and regular than the flaps created with Hansatome microkeratome.

Repeatability and agreement of two anterior segment OCT in myopic patients before implantable collamer lenses implantation

AIM: To evaluate the intra-operator repeatability of time domain and swept-source Fourier domain anterior segment optical coherence tomography(AS-OCT), namely, Visante ASOCT and Casia SS-1000 OCT, in measuring the preoperative parameters of implantable collamer lens(ICL) in myopic eyes, as well as the agreement between the two devices.METHODS: A total of 97 eyes from 49 myopes were investigated in this prospective case series study. The anterior chamber depth(ACD), angle-to-angle distance(ATA), pupil diameter(PD) and crystalline lens rise(CLR) in all subjects were measured for three times during one session by the same operator. The repeatability was evaluated using the within-subject standard deviation(Sw), repeatability limits and intraclass correlation coefficients(ICC). The agreement between the two systems was evaluated using the Bland-Altman plots and 95% limits of agreement(Lo A).RESULTS: The repeatability limits of Visante AS-OCT in measuring ACD, ATA, PD and CLR were 0.099, 0.141, 0.304, and 0.079 mm, respectively. The repeatability limits of Casia SS-1000 OCT in measuring ACD, ATA, PD, and CLR were 0.105, 0.127, 0.357, and 0.082 mm, respectively. Excellent repeatability could be attained in both devices, with the ICC>0.8 for all the measured variables. The interdevice agreement was excellent(P>0.05) for ACD and ATA, but poor(P<0.05) for PD and CLR.CONCLUSION: Good repeatability can be attained by time domain and swept-source Fourier-domain OCT for all the measured variables. Moreover, interdevice agreement analysis suggests that interchangeable measurements between two devices can be achieved for ACD and ATA, but not for PD and CLR;but the differences in measurements were not clinically significant.

前段光学相干断层扫描在穿透性角膜移植术后移植上皮变化中的应用（英文）

目的:使用前段光学相干断层扫描(AS-OCT)评估在穿透性角膜移植术(PK)后角膜上皮厚度的变化,并确定上皮厚度在移植排斥反应早期检测中的作用。方法:前瞻性比较观察研究。共纳入20例20眼接受穿透性角膜移植术患者做为研究组,对照组16例16眼。术后2wk、1mo和3mo使用AS-OCT测量角膜厚度。术后3mo,与对照组排斥反应和上皮厚度及分布参数进行比较。结果:术后1mo,研究组的上、下、最大和最小上皮厚度值均显著低于术后2wk(P=0.0004,0.0001,0.0001,0.04),术后3mo与1mo相比无显著差异(P=0.4,0.1,0.8)。与术后2wk相比,1mo时上皮厚度的降低明显高于基质厚度(P=0.04)。角膜上皮厚度变化显示,研究组和对照组的角膜上皮厚度分布模式相似,出现明显的角膜水肿。但是,对照组中央角膜厚度(CCT)明显更高。结论:角膜移植术后移植物上皮重塑的定量评估显示,早期变化有助于角膜移植物厚度的显著改善。角膜上皮厚度和分布模式的变化可作为角膜移植排斥反应的指标。

Evaluation of Nasal and Temporal Anterior Chamber Angle with Four Different Techniques

Background: Anterior chamber angle (ACA) can be measured by many different techniques. In order for a technique to be a part of the routine eye examination, it has to be quick and easy in good agreement with gonioscopy both nasally and temporally. Aim: To investigate variation in ACA measurement between gonioscopy, van Herick technique, anterior segment optical coherence tomography (AS-OCT) and Sirius Scheimpflug-Camera both nasally and temporally. Method: The ACA of 50 eyes of 25 healthy subjects was measured with gonioscopy, van Herick technique, AS-OCT and Sirius Scheimpflug-Camera. The angle was measured both nasally and temporally. Results: No statistically significant difference could be found between gonioscopy, van Herick technique and AS-OCT either nasally or temporally. The Sirius Scheimpflug-Camera on the other hand showed statistically significant difference to gonioscopy (p < 0.0001) both nasally (p = 0.03, p = 0.001, p < 0.0001) and temporally (p = 0.0002, p = 0.001, p Conclusion: This study showed good agreement between three of the four techniques. ACA measurements obtained by the Sirius Scheimpflug-Camera should therefore not be considered interchangeable with those obtained by the remaining three methods.

功能不良性滤过泡结膜下分离注射干扰素α-2b疗效观察

目的 评价针刺分离联合结膜下注射干扰素α-2b治疗青光眼小梁切除术后早期功能不良性滤过泡的有效性和安全性.方法 对23例（27只眼）小梁切除术后早期发生的功能不良性滤过泡行针刺分离联合干扰素α-2b结膜下注射,随访时间6个月以上,采用Van Buskirk裂隙灯显微镜分型法和Leung前节-OCT检查法相结合评估滤过泡治疗前后的形态和功能.结果 功能不良性滤过泡的发生时间为术后（51.04±23.09）d（19～89d）.治疗前患眼眼压为（22.77±8.65）mmHg（10～45mmHg））,随访终点眼压为（16.68±3.37）mmHg（7.70～21mmHg）,两者差异有统计学意义（P=0.002）.治疗的完全成功率为66.67%（18只眼）,条件成功率为25.93%为（7只眼）,总有效率为92.6%.治疗的主要并发症为滤过泡区结膜下出血（37%）和结膜破裂（22.22%）,治疗后无明显远期并发症.结论 针刺分离联合滤过区结膜下注射干扰素α-2b是治疗功能不良性滤过泡安全有效的方法,采用AS-OCT能客观、及时评估功能不良性滤过泡的形态和功能变化.

多区域融合注意力网络模型下的核性白内障分类

目的核性白内障是主要致盲和导致视觉损害的眼科疾病,早期干预和白内障手术可以有效改善患者的视力和生活质量。眼前节光学相干断层成像图像(anterior segment optical coherence tomography,AS-OCT)能够非接触、客观和快速地获取白内障混浊信息。临床研究已经发现在AS-OCT图像中核性白内障严重程度与核性区域像素特征,如均值存在强相关性和高可重复性。但目前基于AS-OCT图像的自动核性白内障分类工作较少且分类结果还有较大提升空间。为此,本文提出一种新颖的多区域融合注意力网络(multi-region fusion attention network,MRA-Net)对AS-OCT图像中的核性白内障严重程度进行精准分类。方法在提出的多区域融合注意力模型中,本文设计了一个多区域融合注意力模块(multi-region fusion attention,MRA),对不同核性区域特征表示进行融合来增强分类结果;另外,本文验证了以人和眼为单位的AS-OCT图像数据集拆分方式对核性白内障分类结果的影响。结果在一个自建的AS-OCT图像数据集上结果表明,本文模型的总体分类准确率为87.78%,比对比方法至少提高了1%。在10种分类算法上的结果表明:以眼为单位的AS-OCT数据集优于以人为单位的AS-OCT数据集的分类结果,F1和Kappa评价指标分别最大提升了4.03%和8%。结论本文模型考虑了特征图不同区域特征分布的差异性,使核性白内障分类更加准确;不同数据集拆分方式的结果表明,考虑到同一个人两只眼的核性白内障严重程度相似,建议白内障的AS-OCT图像数据集拆分以人为单位。

Evaluation of implanted perforated lacrimal punctal plugs using anterior segment optical coherence tomography

Purpose:Evaluation of the patency and position of perforated lacrimal punctal plugs implanted for treating punctal stenosis together with quantitative assessment of the precorneal tear film using anterior segment optical coherence tomography(AS-OCT).Methods:In a prospective study,the lower punctum of 54 eyes of 29 patients implanted with perforated punctal plugs were examined using AS-OCT during the early postoperative period.Preoperative tear meniscus height(TMH)and tear meniscus area(TMA)were evaluated.Postoperatively,the patency of the plug,its position,TMH and TMA were evaluated,and the results were correlated with postoperative epiphora.Munk scale was used for epiphora grading.Results:Using AS-OCT,48(88.9%)plugs were found in proper position while 6(11.1%)were rotated.The lumen of the plugs was completely patent in 47(87%)plugs,partially obstructed in 2(3.7%)plugs and completely occluded in 5(9.2%)plugs.There was a statistically significant postoperative decrease of TMH and TMA(P<0.001)and postoperative epiphora Munk score(P<0.001).Conclusion:AS-OCT is a valuable,reliable,and noninvasive investigative tool that can detect the proper positioning,patency,and contents of the implanted perforated lacrimal punctal plugs in addition to measurement of TMH and TMA.