Optical coherence tomography with or without enhanced depth imaging for peripapillary retinal nerve fiber layer and choroidal thickness

AIM：To assess peripapillary retinal nerve fiber layer（RNFL）and choroidal thickness obtained with enhanced depth imaging（EDI）mode compared with those obtained without EDI mode using Heidelberg Spectralis optical coherence tomography（OCT）.METHODS：Fifty eyes of 25 normal healthy subjects and32 eyes of 20 patients with different eye diseases were included in the study.All subjects underwent 3.4 mm diameter peripapillary circular OCT scan centered on the optic disc using both the conventional and the EDI OCT protocols.The visualization of RNFL and choroidoscleral junction was assessed using an ordinal scoring scale.The paired t-test,intraclass correlation coefficient（ICC）,95%limits of agreement（LoA）,and Bland and Altman plots were used to test the agreement of measurements.RESULTS：The visibility score of RNFL obtained with and without EDI was of no significant difference（P=0.532）,the visualization of choroidoscleral junction was better using EDI protocol than conventional protocol（P〈0.001）.Peripapillary RNFL thickness obtained with EDI was slightly thicker than that obtained without EDI（103.25±9.42μm vs 101.87±8.78μm,P=0.010）.The ICC of the two protocols was excellent with the value of 0.867 to 0.924,the 95%LoA of global RNFL thickness was between-10.0 to 7.4μm.Peripapillary choroidal thickness obtained with EDI was slightly thinner than that obtained without EDI（147.23±51.04μm vs 150.90±51.84μm,P〈0.001）.The ICC was also excellent with the value of 0.960 to 0.987,the 95%LoA of global choroidal thickness was between-12.5 to 19.8μm.CONCLUSION：Peripapillary circular OCT scan with or without EDI mode shows comparable results in the measurement of peripapillary RNFL and choroidal thickness.

Standardization of choroidal thickness measurements using enhanced depth imaging optical coherence tomography

AIM: To describe and evaluate a standardized protocol for measuring the choroidal thickness(Ch T) using enhanced depth imaging optical coherence tomography(EDI OCT).METHODS: Single 9 mm EDI OCT line scans across the fovea were used for this study. The protocol used in this study classified the EDI OCT images into four groups based on the appearance of the choroidal-scleral interface and suprachoroidal space. Two evaluation iterations of experiments were performed: first, the protocol was validated in a pilot study of 12 healthy eyes. Afterwards, the applicability of the protocol was tested in 82 eyes of patients with diabetes. Inter-observer and intra-observer agreements on image classifications were performed using Cohen’s kappa coefficient(κ). Intraclass correlation coefficient(ICC) and Bland-Altman’s methodology were used for the measurement of the Ch T.RESULTS: There was a moderate(κ=0.42) and perfect(κ =1) inter- and intra-observer agreements on image classifications from healthy eyes images and substantial(κ =0.66) and almost perfect(κ =0.86) agreements from diabetic eyes images. The proposed protocol showed excellent inter- and intra-observer agreements for the Ch T measurements on both, healthy eyes and diabetic eyes(ICC 】0.90 in all image categories). The Bland-Altman plot showed a relatively large Ch T measurement agreement in the scans that contained less visible choroidal outer boundary. CONCLUSION: A protocol to standardize Ch T measurements in EDI OCT images has been developed;the results obtained using this protocol show that the technique is accurate and reliable for routine clinical practice and research.

Peripapillary choroidal thickness in Chinese children using enhanced depth imaging optical coherence tomography

AIM：To evaluate the peripapillary choroidal thickness（PPCT） in Chinese children,and to analyze the influencing factors.METHODS： PPCT was measured with enhanced depth imaging optical coherence tomography（EDI-OCT） in 70children（53 myopes and 17 non-myopes） aged 7 to 18 y,with spherical equivalent refractive errors between 0.50and-5.87 diopters（D）.Peripapillary choroidal imaging was performed using circular scans of a diameter of 3.4 mm around the optic disc.PPCT was measured by EDI-OCT in six sectors： nasal（N）,superonasal（SN）,superotemporal（ST）,temporal（T）,inferotemporal（IT）and inferonasal（IN）,as well as global RNFL thickness（G）.RESULTS： The mean global PPCT was 165.49±33.76 μm.The temporal,inferonasal,inferotemporal PPCT were significantly thinner than the nasal,superonasal,superotemporal segments PPCT were significantly thinner in the myopic group at temporal,superotemporal and inferotemporal segments.The axial length was significantly associated with the average global（β=-0.419,P =0.014）,superonasal（β=-2.009,P=0.049） and inferonasal（β=-2.000,P=0.049） PPCT.The other factors（gender,age,SE） were not significantly associated with PPCT.CONCLUSION： PPCT was thinner in the myopic group at temporal,superotemporal and inferotemporal segments.The axial length was found to be negatively correlated to PPCT.We need more further studies about the relationship between PPCT and myopia.

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM:To characterize spectral-domain optical coherence tomography(SD-OCT)features of chorioretinal folds in orbital mass imaged using enhanced depth imaging(EDI).METHODS:Prospective observational case-control study was conducted in 20 eyes of 20 patients,the uninvolved eye served as a control.All the patients underwent clinical fundus photography,computed tomography,EDI SDOCT imaging before and after surgery.Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5;the remaining patients underwent tumor excision.Patients were followed 1 to 14mo following surgery(average follow up,5.8mo).RESULTS:Visual acuity prior to surgery ranged from 20/20 to 20/200.Following surgery,5 patients’visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10(range 4 to 26 letters).Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery.Following surgical excision,photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients.CONCLUSION:Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis.Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Detecting early changes in choroidal vascularity and thickness using optical coherence tomography in patients with corneal crosslinking for keratoconus

AIM:To investigate changes in choroidal thickness and vascularity in keratoconus patients treated with corneal crosslinking.METHODS:This study evaluated 28 eyes of 22 patients with keratoconus who underwent corneal crosslinking.The choroidal thicknesses were evaluated on enhanced depth imaging optical coherence tomography at the preoperative and postoperative 3d,1,and 3mo.Choroidal thickness in the four cardinal quadrants and the fovea were evaluated.The choroidal vascularity index was also calculated.RESULTS:There was no significant difference in central choroidal thickness between the preoperative and postoperative 3d,1mo(P>0.05).There was a significant increase in the 3mo(P=0.034)and a significant decrease in the horizontal choroidal vascularity index on the postoperative 3d(P=0.014),there was no statistically significant change in vertical axes and other visits in horizontal sections(P>0.05).CONCLUSION:This study sheds light on choroidal changes in postoperative corneal crosslinking for keratoconus.While it suggests the procedure’s relative safety for submacular choroid,more extensive research is necessary to confirm these findings and their clinical significance.

成年高度近视患者脉络膜厚度及其相关影响因素分析

背景 高度近视的多种眼底并发症均与眼轴增长引起的眼球壁厚度改变有关,但成年人高度近视眼脉络膜厚度与眼轴长度的量化分析研究较少见. 目的 观察成年高度近视患者脉络膜厚度的改变,并分析脉络膜厚度与眼轴长度、年龄及屈光度的关系.方法 采用前瞻性队列研究方法,纳入2012年12月至2013年5月在武汉大学人民医院就诊的成年高度近视患者75例75眼作为高度近视组,纳入同期年龄和性别相匹配的健康志愿者70例70眼作为正常对照组.采用频域光学相干断层扫描（SD-OCT）的加强深度扫描（EDI）技术,以6 mm的扫描线对黄斑部进行0±176;扫描,测量黄斑中心凹下及由中心凹向鼻侧和颞侧2 500 μm的脉络膜厚度值,共测量11个子午线,每个子午线间隔500 μm,比较两个组间脉络膜厚度和眼轴长度的差异,分析脉络膜厚度与眼轴长度、年龄及屈光度的关系.结果 高度近视组受检眼中心凹下脉络膜厚度值和平均黄斑部脉络膜厚度值分别为（146±177;52） μm和（142±177;63） μm,正常对照组分别为（306±177;60） μm和（271 ±177;71） μm,两个组间差异均有统计学意义（t=-17.130,P=0.000;t=-15.890,P=0.000）.高度近视组颞侧脉络膜最厚,中心凹下厚度次之,鼻侧最薄,而正常对照组以中心凹旁脉络膜最厚,其次为颞侧,鼻侧最薄.高度近视组受检眼各检测点脉络膜均薄于正常对照组.高度近视组患者脉络膜厚度值与眼轴长度呈明显负相关（r=-0.580,P=0.000）,眼轴长度每增加l mm,脉络膜厚度值平均减少17.943 μm. 结论 SD-OCT检测显示,成年高度近视患者脉络膜厚度较健康人明显变薄,且与眼轴长度的变化关系密切,提示脉络膜的病理改变可能在高度近视眼并发症的发生过程中发挥作用.

视网膜脱离成功复位1年以上患眼低视力与黄斑区脉络膜厚度的关系

目的使用深部增强成像频域光学相干断层扫描(enhanced depth imaging spectral domain optical coherence tomography,EDI SD-OCT)观察孔源性视网膜脱离成功复位1 a以上低视力患眼黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),分析其与低视力的关系。方法将南昌爱尔眼科医院2010年1月到2014年3月孔源性视网膜脱离成功复位术后1 a以上最佳矫正视力(best corrected visual acuity,BCVA)<0.3的患者72例(72眼)纳入研究。行双眼BCVA及EDI SD-OCT扫描SFCT检查。分析患眼与对侧健眼术后末次随访的BCVA与SFCT的相关性。结果患眼术后末次随访SD-OCT检查显示,72眼中,黄斑中心凹正常者3眼(4.2%);外层视网膜微结构异常者69眼(95.8%)。患眼术后末次随访BCVA,转换为5分记录视力为3.59±0.51,同期健眼为4.94±0.11;患眼术后末次随访SFCT为(164.47±62.95)μm,对侧健眼SFCT为(235.47±42.40)μm;患眼与对侧健眼术后末次随访BCVA、SFCT差异均有统计学意义(均为P<0.05)。患眼术后末次随访BCVA与SFCT有相关性(P<0.05)。患眼黄斑区外层视网膜微结构异常眼与正常眼的BCVA、SFCT差异均无统计学意义(均为P>0.05)。结论孔源性视网膜脱离成功复位术后1 a以上低视力眼的SFCT薄,且与BCVA存在相关性;其视力的恢复可能要晚于EDI SD-OCT下观察到的外层视网膜微结构的恢复。

脉络膜厚度在糖尿病视网膜病变诊疗中的重要价值

糖尿病视网膜病变是糖尿病导致的视网膜微血管损害所引起的一系列典型病变,严重影响工作人群视力及生活质量。频域光相干断层扫描技术的发展为阐述糖尿病眼底疾病的发病机制提供了新途径。本文将针对频域光相干断层扫描测量的脉络膜厚度与糖尿病视网膜病变诊疗关系最新研究进行综述。

青少年屈光不正人群中脉络膜厚度的研究

目的 研究青少年屈光不正患者的脉络膜厚度的特点及其与屈光度、眼轴长度等因素的相关性。方法 随机对在屈光门诊完成验光的5∽18岁屈光不正青少年进行了脉络膜厚度和眼轴长度的测量。最终51例102眼患者纳入研究。使用海德堡频域OCT的增强深度成像模式对每眼进行经黄斑中心凹水平方向线性扫描。分别测量该扫描线上5个位点的脉络膜厚度。应用IOL master测量眼轴长度。结果 51例患者年龄为（10.04±2.78）岁,屈光度为（-1.61±1.82）D,眼轴长度为（24.14±1.14）mm。扫描线上脉络膜厚度由颞侧向鼻侧逐渐变薄。屈光度与眼轴长度呈显著负相关（R2=0.562）,各位点的脉络膜厚度均与屈光度呈显著正相关（P〈0.01）,与眼轴长度则呈显著负相关（P〈0.05）,中心凹鼻侧1 mm处相关性最高。中心凹下的脉络膜厚度与年龄呈显著负相关。结论 后极部脉络膜厚度的改变可能在屈光度及眼轴长度改变相关的病理生理变化中起到重要的作用。

增强成像技术光学相干断层扫描在在体脉络膜结构研究中的应用

增强成像技术光学相干断层扫描(optical coherence tomography,OCT)是一种较新的眼科检查手段,它是在传统OCT的基础上,增加光源的聚焦深度,实现在体的脉络膜成像,对在体脉络膜进行定量测量。这一技术有助于临床医师认识、诊断和治疗脉络膜视网膜疾病。本文就近年来增强成像技术OCT在眼科研究中的应用加以总结。

OCT在检测糖尿病患者脉络膜厚度研究中的进展

脉络膜为外层视网膜提供氧和营养,维持光感受器细胞的代谢活性,其血管系统的正常结构与功能对于视网膜显得尤为重要。所以观察脉络膜形态对于跟踪糖尿病患者的病理变化较有意义。随着高分辨率光学相干断层扫描(optical coherence tomography,OCT)技术的应用,频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)深度增强成像技术(enhanced depth imaging-technique,EDI)可定量测量脉络膜厚度,为诊断及治疗糖尿病视网膜病变提供了新的思路。在此,我们对OCT在检测糖尿病患者脉络膜厚度中的研究进展进行综述。

特发性黄斑裂孔患者黄斑部脉络膜厚度的观察

目的应用增强深部成像的相干光断层扫描（EDI-OCT）技术观察特发性黄斑裂孔（Idiopathic Macular Hole,IMH）患者黄斑部脉络膜厚度,比较患眼、对侧健眼、正常人眼黄斑部脉络膜厚度的变化,分析其相关性。方法临床对照研究。对2013年1-12月在我院眼科就诊的30例单眼特发性黄斑裂孔患者,应用EDI-OCT测量患眼及对侧健眼黄斑部中心凹处脉络膜厚度;并设年龄、性别、屈光度匹配的正常成年人30例作为对照组。采用增强深度扫描模式测定中心凹下脉络膜厚度（subfoveal choroidal thick-ness,SFCT）。结果特发性黄斑裂孔患眼SFCT均值为（182.03±38.28）μm,对侧健眼为（214.97±43.74）μm,正常人眼为（232.60±26.74）μm。特发性黄斑裂孔患者黄斑中心凹处脉络膜厚度较正常人变薄,采用两独立样本t检验,t=-5.93,P=0.000,差异有统计学意义（P〈0.05）;对侧健眼较正常人变薄,采用两独立样本t检验,t=-1.88,P=0.066,差异无统计学意义（P〉0.05）。患眼与对侧眼进行配对t检验,t=-4.13,P=0.015,差异有统计学意义（P〈0.05）。结论 IMH患眼黄斑部脉络膜厚度明显变薄,提示脉络膜血管代谢功能下降,可能与其发病机制有关。对侧健眼变薄,可能为其发病易感因素。

频域光学相干断层扫描增强技术观察糖尿病视网膜病变激光光凝术前后黄斑区脉络膜体积的变化

目的:应用频域光学相干断层扫描增强技术(enhanced-depth imaging optical coherence tomography,O CT)观察糖尿病视网膜病变(d i a b e t i c re t i n o p at hy,D R)在视网膜激光光凝术前后黄斑区脉络膜体积(macular choroidal volume,MCV)的变化情况。方法:经眼底血管造影(fundus fluorescein ang iography,FFA)和光学相干断层扫描(opt ical coherence tomography,O CT)确诊重度非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)和早期增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)伴黄斑水肿(diabetic macular edema,DME)的患者30例(51只眼)纳入研究。所有患眼均先行黄斑区格栅样激光光凝治疗,然后1周后行全视网膜激光光凝术(panretinal photocoagulation,PRP)。治疗前、黄斑区格栅样激光光凝完成后1周及PRP全部治疗完成后1个月和三个月,分别采用频域OCT增强深部成像技术(enhanced-depth imaging,EDI)技术对所有患眼黄斑区脉络膜进行水平扫描,测量计算出MCV值。结果:治疗前MCV值为(6.38±0.69)mm3,黄斑区格栅样激光光凝术后1周MCV值为(7.79±0.70)mm3,较治疗前增大(1.56±0.32)mm3,差异有统计学意义(t=3.265,P<0.05),PRP术后一个月MCV值为(7.01±0.71)mm3,较治疗前增大(1.21±0.31)mm3,差异有统计学意义(t=3.237,P<0.05),PRP术后3个月MCV值为(6.11±0.57)mm3,较治疗前减小(0.87±0.22)mm3,差异有统计学意义(t=3.305,P<0.05)。结论:黄斑区格栅激光后1周及PRP术后1个月DR患者MC V值增大,3个月MC V值减小。OCT-EDI可以无创地、直观地观察到黄斑区脉络膜结构的变化。

EDISD-OCT的眼科应用

频域相干光断层深度增强成像(EDI SD-OCT)是在频域相干光断层成像技术(SD-OCT)的基础上通过深度增强成像,可以清楚的观察脉络膜组织形态的变化及对脉络膜厚度进行测量。目前,对EDI SD-OCT的应用主要是在测量脉络膜厚度上,这样,对许多波及脉络膜的眼部疾病有辅助诊断作用,如:高度近视眼、年龄相关性黄斑变性、青光眼、中心性浆液性脉络膜视网膜病变、各种脉络膜肿瘤等;此外对多种疾病的鉴别诊断和疗效的随诊观察有很大的应用价值。

儿童隐匿性高度近视脉络膜厚度变化及其影响因素研究进展

高度近视是一种严重危害儿童视功能的眼病,因其对眼底造成的不可逆性改变。高度近视需要早发现、早诊断、早治疗,如不及时干预可引起近视进一步加重,甚至失明。但近视的筛查经常遇到患儿近视度数不高,进一步检查发现已有高度近视眼底改变,这种隐匿性的高度近视改变在诊疗过程中极容易被忽视。本文旨在总结近视儿童脉络膜厚度变化及其影响因素文献,为隐匿性高度近视儿童临床研究提供相关证据。

不同屈光状态儿童及青少年的脉络膜参数比较及与眼球生物学参数相关性

目的:比较不同屈光状态儿童及青少年的脉络膜参数,探讨眼球生物学参数与脉络膜参数之间的关系。方法:横断面研究。收集就诊于合肥市第二人民医院眼科3~18岁的121例儿童及青少年眼部资料,均取右眼入组。散瞳验光测量屈光度,计算等效球镜(SER),根据SER分为三组:正视组(-0.500.05)。矫正年龄后三组患者TCA、LA、SA、CT和CVI均有差异(均P<0.001),三组TCA、LA、SA、CT两两比较均有差异(均P<0.001),均正视组中最高,中高度近视组最低。而三组CVI两两比较显示仅中高度近视组明显低于正视组(P=0.014)。多元回归分析表明,SER与LA显著相关(P=0.020),CT是影响眼轴长度(AL)的因素(P=0.028)。结论:较高的近视程度伴随脉络膜LA减少和CVI的下降,提示中心凹下脉络膜血流减少可能与近视进展有关。

原发性房角关闭性疾病患者脉络膜厚度的临床研究

目的:应用频域光学相干断层扫描深度增强成像技术(EDI-OCT)测量并探讨原发性房角关闭性疾病(PACD)患者黄斑区及视盘周围脉络膜厚度的特点及规律,分析脉络膜厚度在PACD发病机制中的作用。方法:前瞻性研究。收集2015-01/2019-12于我院就诊的PACD患者82例155眼,其中可疑原发性房角关闭(PACS)组24例24眼;急性原发性房角关闭(APAC)组28例35眼;慢性原发性房角关闭(CPAC)组30例38眼;原发性闭角型青光眼(PACG)组38例58眼。另收集健康志愿者87例87眼纳入正常对照组。所有研究对象均应用EDI-OCT测量黄斑区及视盘周围脉络膜厚度。结果:PACD各组黄斑区脉络膜厚度均高于正常对照组(P<0.05)。在PACD患者中,除距黄斑中心凹3mm处鼻侧,PACG组黄斑区其余各点位脉络膜厚度均低于PACS组、APAC组、CPAC组(P<0.05)。APAC组黄斑中心凹下脉络膜(357.17±61.49μm)最厚,PACS组(318.04±56.52μm)次之,PACG组最薄(263.55±67.87μm)。除CPAC组,其余各组黄斑中心凹旁1mm处脉络膜厚度均较黄斑中心凹下脉络膜厚度降低(P<0.05)。各组受检者黄斑中心凹旁3mm处脉络膜厚度均低于黄斑中心凹下和黄斑中心凹旁1mm处(P<0.05)。各组受检者视盘周围脉络膜厚度无差异(P>0.05)。结论:PACD患者及正常人黄斑中心凹下脉络膜最厚,离黄斑中心凹越远,脉络膜越薄。黄斑区脉络膜增厚是PACD患者又一特征性解剖结构,可能是诱发青光眼急性发作的重要因素。PACD患者视盘周围脉络膜厚度与正常人相比并无特征性改变。

应用频域相干光断层深度增强成像技术测量正常人眼黄斑区脉络膜厚度的研究

目的应用频域相干光断层深度增强成像技术测量正常人眼黄斑区脉络膜厚度。方法选择2012年2月-2013年2月共116例（116眼）健康志愿者作为研究对象。根据不同年龄，将其分为3组：A组36例，年龄21—40岁；B组41例，年龄41—60岁，C组39例，年龄61～80岁。采用CirrusHD—OCT深度增强成像技术，以长度为6mm的扫描线段对黄斑中心凹行180°方位扫描，测量中心凹下脉络膜厚度及由中心凹向鼻侧及颞侧每隔500μm直至2500μm的脉络膜厚度。并分析脉络膜厚度与年龄的关系。结果黄斑中心凹下脉络膜平均厚度为（275．27±58．20）μm，由中心凹向鼻、颞侧脉络膜厚度逐渐变薄，至鼻侧2．5mm处为（174．21±48．75）μm，颞侧2．5mm处为（233．75±57．64）μm。中心凹下脉络膜厚度与年龄呈负相关（r=-0．74，P〈0．01）。结论频域相干光断层深度增强成像技术可定量测量脉络膜厚度，脉络膜厚度与年龄呈负相关。

关于糖尿病视网膜病变患者脉络膜血管指数的初步研究

目的:探讨并发糖尿病视网膜病变(DR)的2型糖尿病患者与健康人群脉络膜血管指数(CVI)的差异及特点。方法:选取2017-01/12于我院就诊的并发DR的2型糖尿病患者68例68眼作为DR组,同时纳入同期体检的无糖尿病病史健康人群34例34眼作为对照组。通过频域相干光层析深度增强成像术(EDI-OCT)获取受检者黄斑中心凹下脉络膜厚度(SFCT)、黄斑中心凹处视网膜厚度(CRT),并将黄斑区图像进行二值化处理,采用图像分析软件计算黄斑区脉络膜总面积(TCA)、血管区面积(LA)及间质区面积(SA),计算CVI。结果:对照组和DR组受检者TCA(0.53±0.14mm2 vs 0.49±0.15mm2)、LA(0.35±0.09mm2 vs 0.32±0.10mm2)、SA(0.17±0.05mm2 vs 0.17±0.06mm2)及SFCT(347.9±76.9μm vs 325.9±92.9μm)均无差异(P>0.05),但DR组患者CVI明显低于对照组(64.33%±3.25%vs 67.04%±2.46%,P<0.001),二者临界值为63.59%。结论:CVI可以直观反映脉络膜内部结构的变化,较SFCT更加稳定可靠,合并DR的2型糖尿病患者其CVI较健康人群降低。

EDI-OCT在不同类型青光眼中的临床应用

脉络膜厚度与青光眼关系的研究一直受到广泛关注。近年来,越来越多的研究表明,增强深部成像的相干光断层扫描(EDI-OCT)是研究脉络膜活体变化的有效工具之一,在评价各种类型青光眼脉络膜变化方面具有较重要的临床价值。