Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

bjectives: To study the characteristics of optical coherence tomography (OCT)inopathic macular epiretinal membranes (IMEM) and the relationship between thethickness offovea and the vision of affected eyes.Methods:A total of 67 cases (73 eyes) with clinical diagnosis of IMEM using direct,indirect ophthalmoscope, three mirror contact lens, fundus color photography or fundusfluorescein angiography (FFA)were examined with OCTResults: Epiretinal membranes (ERMs) with macular edema were found in 32 eyes,proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMswith laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly andpartially seperated from the retinal (27 eyes, 38.36% ), the retinal thickness of thefovea was the thickest in the proliferative ERMs and the thinnest in the ERMs withlaminar macular holes. The statistical analysis showed there was a negative correlationbetween the thickness of fovea and visual acuity ( r ＝ - 0. 454, P ＝ 0. 000).Conclusion:There were four types of images of OCT in IMEM: ERMs with macularedema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminarmacular hole; and the thicker the fovea under the OCT, the poorer the vision acuity in the affected eyes with ERMs.

Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Post-operative visual outcomes based on morphological staging of idiopathic epiretinal membranes on OCT

AIM:To evaluate the recently described optical coherence tomography(OCT)based classification of epiretinal membrane(ERM)and its usefulness in predicting the functional outcome.METHODS:A retrospective observational review of OCT scans of patients with the diagnosis of idiopathic ERM was carried out from January 2016 to June 2021.All consecutive images diagnosed with any stage of idiopathic ERM and fulfilled the eligibility criteria were included in the analysis.ERM was identified on OCT scans as a thin hyperreflective layer over the inner layers of retina.OCT scans of patients with ERM who underwent vitrectomy,were independently staged as per the new classification by two independent retinal surgeons to form a consensus on stage.Best corrected visual acuity(BCVA)in logMAR scale and central subfield thickness(CST)on pre-and post-operative spectral domain OCT scans were the variables noted for all patients at the time of diagnosis and at 6 and 12 mo follow up visit after undergoing intervention.Partial correlation coefficient was computed between BCVA(logMAR)and CST by ERM stage adjusting by baseline measures.RESULTS:Clinical charts of 74 patients with idiopathic ERM were assessed.Clinically significant improvement in BCVA overtime was observed with significant difference in median visual acuity of patients with StageⅡ-ⅣERM with P<0.001.The median CST of all patients with stageⅡ-ⅣERM showed similar consistent improvement with P<0.001 from baseline to 12^(th)month.Our results showed not only gain in visual acuity but also shift from baseline to anatomical normalization of CST in stageⅡ.We found a decrease in CST with difference of 166μm and 151μm in stageⅢand stageⅣrespectively.Our results remained consistent with the hypothesis of improved visual outcomes with all stages of ERM with adjusted moderate linear correlation between visual acuity and CST in stageⅡ-Ⅳ(r>0.3).CONCLUSION:Equally significant visual outcomes of patients with ERM stagedⅡ-Ⅳand therefore can be counselled for improved visual acuity after surgical removal of ERM with improvement up to 5 lines on Snellen's chart from the baseline.

Importance of 3-D image reconstruction of spectraldomain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema

AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.

Retinal pigment epithelium–Bruch’s membrane volume in grading of age-related macular degeneration

AIM:To assess the agreement of optical coherence tomography(OCT)algorithm-based retinal pigment epithelium–Bruch’s membrane complex volume(RBV)with fundus photograph-based age-related macular degeneration(AMD)grading.METHODS:Digital color fundus photographs(CFPs)and spectral domain OCT images were acquired from 96 elderly subjects.CFPs were graded according to Age-Related Eye Disease Study(AREDS)classification.OCT image segmentation and RBV data calculation were done with OrionTM software.Univariate and multivariate analyses were performed to find out whether AMD lesion features associated with higher RBVs.RESULTS:RBV correlated with AMD grading(rs=0.338,P=0.001),the correlation was slightly stronger in early AMD(n=52;rs=0.432,P=0.001).RBV was higher in subjects with early AMD compared with those with no AMD lesions evident in fundus photographs(1.05±0.20 vs 0.96±0.13 mm3,P=0.023).In multivariate analysis higher RBVs were associated significantly with higher total drusen(β=0.388,P=0.027)and pigmentation areas(β=0.319,P=0.020)in fundus photographs,whereas depigmentation area(β=-0.295,P=0.015)associated with lower RBV.CONCLUSION:RBV correlate with AMD grading status,with a stronger association in patients with moderate,non-late AMD grades.This effect is driven mostly by lesions with drusen or pigmentation.Lesions with depigmentation tend to have lower values.RBV is more comprehensive measurement of the key area of AMD pathogenesis,compared to sole drusen volume analysis.RBV measurements are independent on grader variations and offer a possibility to quantify early and middle grade AMD lesions in a research setting,but may not substitute fundus photograph-based grading in the whole range of AMD spectrum.

Impact of OCT scan-patterns in identifying morphological features of lamellar macular holes and macular pseudoholes

AIM:To evaluate the impact of the optical coherence tomography(OCT)scan patterns on the detection of the features associated with lamellar macular hole(LMH)and macular pseudohole(MPH).METHODS:This is a retrospective analysis of 100 consecutive eyes with LMH(n=41)and MPH(n=59)having at least three of the following OCT features,which include mandatory criteria for the diagnosis of LMH and MPH:Epiretinal membrane,epiretinal proliferation,verticalization,intraretinal cystoid spaces,foveoschisis,irregular foveal contour,foveal cavity with undermined edges,and ellipsoid line disruption.Primary outcome measurement was the detection frequency of the features in three different OCT scan patterns:1)volume scan;2)six radial scans(R6);and 3)vertical and horizontal radial scans(R2).RESULTS:Of the total eight features,the maximal detection frequency was found as 4.45±1.45,4.35±1.47,and 3.70±1.59,by the volume,R6 and R2,respectively.R2 was inferior to the other patterns in detection of the total features(P<0.001),whereas R6 and volume patterns were found comparable(P=0.312).CONCLUSION:The physician should be aware that the selection of the OCT-scan pattern may influence the detection of mandatory morphological criteria for the diagnosis of LMH and MPH.

Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography

AIM:To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and nondiabetic patients with epiretinal membrane(ERM)with the help of optical coherence tomography angiography(OCT-A)and compare them with healthy control subjects.METHODS:In this prospective,cross-sectional study,a total of 165 eyes were evaluated,including 50 eyes of patients with diabetic ERM,54 eyes of idiopathic ERM(iERM)patients,and 61 eyes of healthy controls.Macula and disc angiography was performed by OCT-A.Macular vessel density(VD)ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region.Statistical calculations were evaluated at the 95%confidence interval.RESULTS:Macula superficial VD values of ERM cases were lower than that in the control group,while foveal VD was higher in ERM cases.Macula deep VD values of ERM cases were lower in all quadrants,except the fovea.The width of the foveal avascular zone(FAZ)area was significantly lower in the ERM groups,and the FAZ width was lowest in iERM group.Macula superficial VD ratio was significantly higher in the ERM groups,but there was no significant difference between ERM groups.Macula deep VD ratio was significantly higher in the iERM group than in the control group.CONCLUSION:Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation,as well as their effect on retinal vascular structures.If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A,then,OCT-A can be used as a guide for ERM prognosis.

Comparison of retinal nerve fiber layer and macular thickness measurements with Stratus OCT and OPKO/OTI OCT devices in healthy subjects

AIM: To compare retinal nerve fiber layer(RNFL) and macular thickness measurements obtained with the Stratus optical coherence tomography(OCT) and OPKO/OTI OCT devices.METHODS: Included in the study were 59 eyes of 30 participants. All measurements for each eye were done on the same day with both devices. Student’s paired t-tests were used to compare the central macular thickness and RNFL measurements of the Stratus OCT and OPKO/OTI OCT. Pearson correlation was used to assess the relationship between the devices. Coefficient of variation(COV) was calculated to assess intersession repeatability.RESULTS: Using both the Stratus OCT and OPKO/OTI OCT, respectively, the measured mean average RNFL thicknesses were 98.9±11.1 μm and 115.1±9.6 μm(P =0.001),and the measured mean central retinal thicknesses(CRT)were 196.2 ±18.8 μm and 204.5 ±21.1 μm(P 【0.001).Measured by the two devices, the RNFL thickness values were correlated in all quadrants, as were the retinal thickness values except the inferior outer sector. COV for average RNFL and CRT thickness were 2.9% and 4.6%for Stratus OCT, and 2.1% and 4.2% for OPKO/OTI OCT,respectively.CONCLUSION: We found good reproducibility of RNFL and retina thickness measurements for both Stratus OCT and OPKO/OTI OCT devices. However, even though the two OCT systems provided statistically correlated results,the values for both RNFL and macular thickness were statistically different. RNFL and macular thickness measurements with the OPKO/OTI OCT were higher than that of the Stratus OCT; therefore, the two OCT systems cannot be used interchangeably for the measurements of RNFL and macular thickness.

Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema

Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.

Relationship between full-thickness macular hole and retinal break/lattice degeneration

Background: The purpose is to investigate the relationship between full-thickness macular hole(MH) and retinal break(RB) and/or lattice degeneration.Methods: Patients diagnosed as full-thickness MH and referred to Dr. Lin Lu from January 2009 to December 2013 were evaluated. All patients underwent general ophthalmologic examinations, fundus examination and optical coherence tomography(OCT). The RB and/or lattice degeneration were recorded.Results: Totally 183 eyes of 167 patients were included. The sex ratio of men to women was 1:2.88. A total of 17 eyes were pseudophakic and 166 eyes were phakic. RB and/or lattice degeneration were found in 62 eyes(33.88%). The prevalence of RB and/or lattice degeneration was similar between men and women(P=0.344>0.05). There was no statistical difference between the pseudophakic eyes and phakic eyes(P=0.138>0.05). All of the RB and/or lattice degeneration were located near or anterior to the equator. The inferior quadrants and the vertical meridian were af ected more often than the superior quadrants and the horizontal meridian.Conclusions: We identified a high incidence of RB/lattice degeneration in cases of full-thickness MH. Carefully examination of the peripheral retina and prophylactic treatment of RB and/or lattice degeneration are critical.

OCT和OCTA在特发性黄斑前膜术后视力预测中的研究进展

特发性黄斑前膜(IERM)是指一类没有任何已知其他眼病的黄斑前膜,多发于50岁以上的中老年人。随着IERM的进展,会引起黄斑区视网膜结构和功能的改变,引起视力下降、视物变形等症状。目前关于IERM的发病机制尚不明确,手术是主要的治疗方式,但对于手术时机尚未标准化,术后的视力恢复结局也存在差异。光学相干断层扫描(OCT)和OCT血管成像(OCTA)作为一种无创、快速的检测手段,可观察黄斑区视网膜微结构和血流变化,已经在临床中广泛应用。利用OCT和OCTA各参数去预测术后视力已经成为IERM的研究热点。本文就OCT与OCTA各参数和IERM术后视力预测的相关研究现状进行综述,以期为临床工作者确定手术时机,权衡手术收益和风险时提供依据。

OCT和OCTA生物学标志物在糖尿病性黄斑水肿预后和监测中的应用

糖尿病性黄斑水肿(DME)是糖尿病视网膜病变(DR)的并发症,也是DR患者视力下降和失明的主要原因。光学相干断层扫描(OCT)和光学相干断层扫描血管造影(OCTA)作为无创、非侵入性评估视网膜各层微结构和微血管病理改变的主要检查手段,是检测和评估DME的常用方法。随着OCT和OCTA技术的不断发展,各种参数被赋予生物标志物的作用,例如中央凹厚度(CST)、黄斑部平均厚度(CAT)和黄斑部容积(CV)、视网膜内层结构紊乱(DRIL)、高反射灶(HRF)和中央凹下神经视网膜脱落(SND)等,广泛运用于临床。OCT可以直观显示黄斑区视网膜及脉络膜的层次变化和细微结构,而OCTA更常运用于微血管改变。本文就OCT及OCTA相关生物学标志物在DME中预后和监测的作用进行阐述,同时检测结果中可见的生物学标志物可以为DME的监测和治疗策略提供新思路,并为DR和DME的发病机制提供新的见解。

视网膜静脉阻塞继发黄斑水肿中OCT生物标志物的研究进展

视网膜静脉阻塞(RVO)是第二常见的致盲性视网膜血管性疾病,其继发的黄斑水肿(ME)是导致中心视力损害的重要原因。光学相干断层扫描(OCT)可生成高分辨率的组织横截面图像,清楚地显示视网膜和脉络膜的各层结构,OCT生物标志物对RVO-ME的早期精准诊断、疾病发展的预示及视力预后的判断具有重要意义。文章对OCT下RVO-ME的视网膜厚度、视网膜内层结构紊乱、视网膜内层超反射率、外界膜及椭圆体带的完整性、中央凹第三高反射带、高反射点、急性黄斑旁中心中层视网膜病变、中界膜征、浆液性视网膜脱离高度、黄斑体积以及脉络膜厚度等生物标志物进行综述,以期为RVO-ME病情评估、治疗方案的制定以及视功能的预后判断提供客观依据。

不同抗VEGF药物治疗糖尿病性黄斑水肿的疗效及其与OCT分型的关系

目的:探究不同抗血管内皮生长因子(VEGF)药物治疗糖尿病性黄斑水肿(DME)临床疗效,并分析其与光学相干断层扫描(OCT)分型的关系。方法:选取45例进行雷珠单抗治疗的DME患者(本院于2020-02/2022-02收治)作为雷珠单抗组,同期45例进行康柏西普治疗的DME患者作为康柏西普组。其中雷珠单抗组给予视网膜光凝术联合雷珠单抗治疗,康柏西普组给予视网膜光凝术联合康柏西普治疗。比较两组患者症状改善情况(黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间),血清白细胞介素-6(IL-6)、VEGF水平,黄斑中心凹视网膜厚度(CMT)、最佳矫正视力(BCVA)水平及并发症发生情况,并分析其临床疗效与不同OCT分型的关系。结果:两组黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后血清IL-6、VEGF、BCVA值均明显降低(P<0.01),但组间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后CMT均明显降低(P<0.05),且与雷珠单抗组比较,康柏西普组明显降低(P<0.01);两组患者并发症发生率比较无明显差异(P>0.05);浆液性视网膜脱离(SRD)、黄斑囊样水肿(CME)、视网膜弥漫性增厚(DRT)型患者总有效率比较有明显差异(P<0.05),其中DRT型最高,SRD型最低。结论:康柏西普与雷珠单抗治疗DME均可有效改善患者临床症状,减轻炎症反应,且对DRT型DME患者治疗效果更好,但是康柏西普能够更好地降低CMT水平。

SD-OCT参数评估黄斑裂孔内界膜撕除术后视力改善的应用价值

目的:分析频域光学相干断层扫描(SD-OCT)参数评估黄斑裂孔内界膜撕除术后视力改善情况的应用价值。方法:回顾性分析2019-05/2021-02于我院行玻璃体切除+内界膜撕除+长效气体填充术治疗的特发性黄斑裂孔(IMH)患者82例82眼的临床资料,分析术后3mo IMH闭合情况与SD-OCT参数的相关性,并评估影响术后视力改善不良的危险因素。结果:Spearman秩相关分析显示,术后3mo IMH闭合情况与术前外界膜(ELM)缺损直径呈正相关(r_(s)=0.308,P<0.05),与术前黄斑裂孔指数(MHI)呈负相关(r_(s)=-0.266,P<0.05)。Logistic回归分析显示,术前MHI≥0.5是影响术后视力改善不良的保护因素(OR=0.691,P<0.05)。结论:SD-OCT可通过检测术前MHI及ELM缺损直径等参数预测手术疗效,对判断视功能改善情况有利。

地塞米松玻璃体内植入剂治疗RVO继发不同OCT类型黄斑水肿

目的:评估地塞米松玻璃体内植入剂(DEX-I)治疗视网膜静脉阻塞(RVO)继发不同类型黄斑水肿的疗效。方法:回顾性研究。收集2019-07/2020-06在大连市第三人民医院诊断为RVO-ME并接受DEX-I(0.7mg)为初始治疗的患者46例46眼,根据光学相干断层扫描成像(OCT)形态特征分为弥漫性视网膜增厚型(DRT型,13例13眼)、黄斑囊样水肿型(CME型,22例22眼)、浆液性视网膜脱离型(SRD型,11例11眼)。分别于治疗前、治疗后1、2、3mo观察并比较3种黄斑水肿分型患者最佳矫正视力(BCVA)和中心凹视网膜厚度(CRT)情况。结果:与治疗前比较,DRT型、CME型、SRD型患者BCVA治疗后1、2、3mo均显著改善,CRT均显著降低(均P<0.017)。治疗后3mo,DRT型和SRD型患者BCVA(0.21±0.12、0.22±0.10LogMAR)均显著优于CME型(0.45±0.14LogMAR,均P<0.017),CRT(254.08±49.07、248.92±44.19μm)均显著低于CME型(314.70±92.66μm,均P<0.017)。结论:DEX-I治疗RVO继发各种OCT类型黄斑水肿均有效,CME型治疗反应相较DRT型和SRD型差。

基于OCT不同分期的特发性黄斑前膜患者手术前后视力及黄斑区微结构变化

目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)剥除、空气填充,其中59眼联合白内障超声乳化摘除、人工晶体植入术。依据2017年IMEM分期标准分为A组21眼(2期),B组39眼(3期),C组22眼(4期)。分别于术前及术后3个月行最佳矫正视力(BCVA)、光学相干断层成像(OCT)检查。结果3组术后BCVA(LogMAR)较术前均降低(P均<0.05)。术前3组比较BCVA(LogMAR)差异无统计学意义(P>0.05);术后3组BCVA(LogMAR)比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05)。A组术后黄斑中心凹厚度(CMT)较术前差异无统计学意义(P=0.393);B组和C组术后CMT较术前均降低(P均<0.01)。术前3组CMT比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05);术后3组CMT比较差异有统计学意义(P<0.01),A组和B组、A组和C组比较差异均有统计学意义(P均<0.01),B组和C组比较差异无统计学意义(P>0.05)。82眼术后BCVA(LogMAR)与术前BCVA(LogMAR)、术前CMT、术后CMT均呈正相关(P均<0.01)。En face OCT发现7眼黄斑区可见同心圆状改变,B扫描呈柱状或锯齿状改变。结论特发性黄斑前膜患者OCT分期越早,术后视力及黄斑微结构恢复越好。应用OCT进行分期可以为手术时机选择及预后判断提供重要的依据。

黄斑前膜分级法对特发性黄斑前膜手术效果的评估:基于OCT图像的研究

目的根据OCT检查结果对特发性黄斑前膜进行分级,评估其预判患者术后视力恢复的应用价值。方法选取2013年2月至2016年5月在深圳市眼科医院接受手术治疗的29例(30眼)特发性黄斑前膜患者为研究对象,根据术前OCT检查显示的黄斑中心凹形态变化将该病分为4级。各级患者均进行微创玻璃体切割术剥除黄斑前膜,术后6个月对所有患者进行检查,分析各级患者最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)情况。结果随着分级增高,患者的黄斑中心凹形态改变越紊乱,黄斑前膜出现和中心凹部丢失也越明显。各级患者术前与术后的Log MAR BCVA比较差异均有统计学意义(均为P<0.01)。各级患者术前及术后的Log MAR BCVA随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.05)。提示特发性黄斑前膜分级越高患者的视力越差。特发性黄斑前膜Ⅱ级患者术前和术后Log MAR BCVA差值最大,且与其他各级比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜Ⅱ级患者的BCVA在术后的改善程度最大。除Ⅲ级患者外,其余各级患者术前与术后CFT比较,差异均无统计学意义(均为P>0.05)。术前及术后各级患者间的CFT随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P<0.001)。提示特发性黄斑前膜分级越高患者的黄斑厚度越高。结论基于OCT检查图像对特发性黄斑前膜患者进行分级,不仅有助于预判患者术后视力和CFT的恢复情况,还有利于特发性黄斑前膜患者手术时机的选择。

基于SD-OCT建立新的前膜分级法评估IMEM对年龄相关性白内障患者术后视功能的影响

目的:在单纯白内障术前,根据频域光学相干断层扫描技术(SD-OCT)显示年龄相关性白内障合并特发性黄斑前膜(IMEM)的患眼黄斑中心凹内部精细结构的紊乱程度建立新的IMEM分级法,评估其用于预测年龄相关性白内障患者的视功能预后的价值。方法:选取2017-10/2018-11在暨南大学附属深圳市眼科医院因年龄相关性白内障单纯行超声乳化白内障摘除联合人工晶状体植入术,术前眼底检查发现合并IMEM者64例80眼,根据SD-OCT显示的IMEM对黄斑中心凹内部精细结构的破坏程度将IMEM分为4级。对合并各级IMEM的患者术前、术后3mo的最佳矫正视力(BCVA,LogMAR)、平均视敏度(MS)、黄斑中心凹厚度(CMT)、黄斑前膜进展率进行对比分析。结果:在SD-OCT图像上,随着合并的IMEM分级的增高,前膜越明显,患者的黄斑中心凹凹部丢失和内部结构紊乱越严重。白内障术前及术后3mo的患眼BCVA随着所合并的IMEM分级升高而增加(F=37.72、26.43,均P<0.001)。白内障术前及术后3mo的患眼MS随着所合并的IMEM分级升高而降低(F=43.77、28.96,均P<0.001)。术后3mo CMT的改变和黄斑前膜进展率并不一致,合并各级IMEM的患眼CMT与术前均无差异(P>0.05),但黄斑前膜进展率呈显著上升趋势(χ2趋势=12.59,P<0.001)。结论:借助于SD-OCT对年龄相关性白内障合并的IMEM进行新的精细分级,可以更精准地预测该类患者单纯行白内障手术术后的视功能恢复情况。

特发性黄斑裂孔OCT影像与术后早期视力恢复的相关性研究

目的研究特发性黄斑裂孔(idiopathic macular holes,IMH)患者术前光学相干断层扫描技术(optical coherence tomography,OCT)测量的相关参数与术后早期视力恢复的相关性。方法收集24例(25眼)IMH患者,均行玻璃体切割+内界膜剥离+玻璃体内注气术,术前、术后12周均行最佳矫正视力(best corrected visual acuity,BCVA)检查,术前1周内OCT影像上直接测量裂孔最大高度,通过Image-Pro Plus 6.0软件测量黄斑裂孔最小径、基底径及外界膜光感受器断裂点与视网膜色素上皮层的最大垂直高度,并计算黄斑孔指数(macular hole index,MHI)、牵拉孔指数(tractional hole index,THI)、黄斑孔指数'(macular hole index',MHI')及牵拉孔指数'(tractional hole index',THI'),应用SPSS 22.0软件包进行Spearman相关性分析,得出各参数与术后12周时BCVA的相关性,受试者工作特征曲线拟合分析得出MHI、THI、MHI'、THI'界值。结果IMH患者术后12周BCVA较术前明显提高且差异有统计学意义(P=0.000)。相关性分析结果表明:术后12周BCVA与术前MHI、THI、MHI'、THI'具有相关性(均为P<0.05)。MHI≥0.705组术后12周时BCVA平均为0.297,好于MHI<0.705组的0.103(P=0.023);THI≥1.425组术后12周时BCVA平均为0.288,好于THI<1.425组的0.163(P=0.001)。结论THI≥1.425或MHI≥0.705者术后12周时能获得较好的BCVA,可作为预测IMH患者术后早期视力恢复情况的指标。