OCT血管成像术在病理性近视黄斑新生血管病变诊疗中的应用价值  

Clinical values of OCT angiography in imaging of chroidal neovascularization in pathological myopic macuiopathy

作　　者：李倩[1] 陈长征[1] 苏钰[1] 易佐慧子[1] 

机构地区：[1]武汉大学人民医院湖北省人民医院眼科中心,430060

出　　处：《中华实验眼科杂志》2016年第12期1102-1106,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景病理性近视合并黄斑区新生血管严重影响视功能，以往的检查方法为荧光素眼底血管造影（FFA）和频域OCT（SD-OCT），前者为有创检查，后者不能显示眼底各层面的血管形态。OCT血管成像术（OCTA）是一种新的无创检查方法，可显示眼底多个层面的新生血管形态，其临床价值有待评估。目的评估OCTA在病理性近视黄斑新生血管病变诊疗中的应用价值。方法采用前瞻性系列病例观察方法，纳入2015年1-10月在武汉大学人民医院眼科中心经FFA确诊的病理性近视黄斑新生血管病变患者40例42眼，患眼屈光度为（-10．5±3．74）D。所有患者均行常规眼科检查及影像学检查，包括眼底照相、FFA、SD-OCT及OCTA，OCTA的扫描区域分别为黄斑区3mm×3mm、6mm×6mm范围。经患者的知情同意，35例患者接受雷珠单抗注射液玻璃体腔注射，分别于注射后1d、1周及每个月复查OCT及OCTA，注射后1个月复查FFA，共随访1～6个月，评估OCTA在监测病情变化中的临床应用价值。结果40例42眼FFA均显示造影晚期黄斑区脉络膜新生血管（CNV）渗漏，OCT均可见突破视网膜色素上皮层的异常脉络膜血管网的高反射信号，OCTA显示所有患眼均呈现脉络膜毛细血管层清晰的团状异常血管信号，其中31例31眼可在视网膜外层观察到异常的团状血管形态，清晰度均优于FFA。接受雷珠单抗注射液玻璃体腔注射的35例35眼注射后1周OCTA显示视网膜外层及脉络膜毛细血管层CNV面积缩小，于注射后1个月时病情稳定。7例7眼复发再次接受雷珠单抗注射液玻璃体腔注射后CNV高信号影面积较前缩小。结论OCTA能够在视网膜外层和脉络膜血管层面清晰显示病理性近视黄斑新生血管病变的CNV形态。OCTA在雷珠单抗注射液玻璃体腔注射后1周即可观察到CNV的明显变化，在CNV的病情监测方面有重要的临床价值。Background Myopic maculopathy leads to visual function damage. Conventional methods for the identification of choroidal neovascularization （CNV） of myopic maculopathy are fundus fluorescine angiography （FFA） and spectral-domain OCT （SD-OCT） ,but FFA is an invasive process and SD-OCT is incapable to image CNV well. OCT angiography （OCTA） , a novel and non-invasive vascular technique, appears to be dominant in enface imaging of CNV,however, its clinical value remains to be evaluated. Objective This study was to evaluate the application of OCTA in imaging CNV of myopic maculopathy. Methods A prospective serial cases-observational study was performed. Forty-two eyes of 40 patients of myopic maculopathy were included in Ophthalmic Center, Renmin Hospital of Wuhan University from January to October 2015, with the diopter （ - 10.5 ± 3.74 ） D. Comperehensive optical and imaginal examinations were carried out in all the eyes, including fundus photography, FFA,SD-OCT and OCTA. Ranibizumab （0.5 mg/0. 05 ml） was intravitreally injected in 35 eyes of 35 patients under the informed consent and SD-OCT and OCTA were examined 1 day, 1 week and subsequent each month after injection. FFA was examined 1 month after injection. The patients were followed-up for 1-6 months to evaluate the clinical values of OCTA in monitoring the CNV of myopic maculopathy. This study followed the Helsinki Declaration and was approved by the Ethics Committee of Renmin Hospital of Wuhan University. Written informed consent was obtained from each patient prior to any medical examination. Results All the affected eyes showed dye leakage in CNV lesions by FFA and high reflection signal of abnormal choroidal vascular network throughout retinal pigment epithelium by SD-OCT. Clusters of high signal CNV image was clearly visible in the lesions by OCTA, and these signals were able to be displayed on both choriocapillary layer and outer layer of retina more clearly than FFA in 31 eyes of 31 patients. In 35 eyes of 35 patients received int

关 键 词：光学相干断层扫描 病理性近视/并发症 黄斑 荧光素眼底血管造影 脉络膜新生血管 前瞻性研究 OCT血管成像术 

分 类 号：R778.11[医药卫生—眼科] R774.5[医药卫生—临床医学]