湿性老年性黄斑变性光相干断层扫描血管成像图像特征观察  

Image Characteristics in Wet Age-Related Macular Degeneration with Optical Coherence Tomography Angiography

作　　者：梁超群[1] 陈长征[1] 易佐慧子[1] 苏钰[1] 

机构地区：[1]武汉大学人民医院眼科中心,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2017年第4期632-636,共5页Medical Journal of Wuhan University

摘　　要：目的:观察利用光相干断层扫描血管成像技术(OCTA)对湿性老年性黄斑变性(wet-AMD)患者进行抗血管内皮生长因子(VEGF)治疗前后的图像特征。方法:将2015年1月至6月来我院眼科中心就诊,经全面的眼科检查,包括糖尿病视网膜病变早期治疗研究(ETDRS)视力表测定最佳矫正视力(BCVA)、裂隙灯检查前节、非接触式眼压计测量眼压、直接眼底镜检查眼底,并行眼底彩色照相、荧光素眼底血管造影(FFA)、光学相干断层扫描成像(OCT)、OCTA等检查确诊为wet-AMD患者28例(28眼)纳入研究,包括初发或复发脉络膜新生血管(CNV)患者。经玻璃体腔注射抗VEGF药物治疗后,每月随访一次并行BCVA、裂隙灯、眼压、眼底镜、眼底彩色照相、OCT、OCTA检查,随访3-6个月,末次随访时行FFA检查,比较初次及末次随访时OCTA图像特征,并与FFA及OCT图像进行对比分析。结果:初次随访时28眼FFA均发现新生血管性渗漏,OCT平扫28眼均发现中心凹下或中心凹旁异常高信号团块,13眼伴有视网膜下或视网膜色素上皮层下积液。OCTA扫描结果显示浅层、深层视网膜毛细血管均未见明显异常,28眼外层视网膜、脉络膜毛细血管层均发现异常血流信号,其中9眼观察到结构清晰的新生血管,5眼在脉络膜毛细血管层发现新生血管病灶主干血管异常增粗。抗VEGF治疗后末次随访FFA发现11眼渗漏减轻,17眼渗漏无明显变化;OCT平扫12眼病灶变小,16眼病灶稳定。OCTA扫描15眼异常血流信号面积缩小,13眼病灶稳定。OCTA可清晰显示CNV结构,与FFA、OCT相比更直观,敏感性更高。结论:OCTA无需注射造影剂即可由浅入深地观察视网膜、脉络膜毛细血管,较传统FFA、OCT检查,更清晰直观显示CNV结构,用于wet-AMD诊断及随访观察,无创直观,安全性、实用性高。Objective： To observe the image characteristics of patients with wet age-related macular degeneration （wet-AMD） before and after anti-VEGF threapy with optical coherence tomography angiography （OCTA）. Methods： After a comprehensive examination of the affected eyes, inclu- ding measuring the best corrected visual acuity（BCVA） with early treatment of diabetic retinopathy （ETDRS） visual acuity chart, slit lamp examination, non-contact tonometer, ophthalmo- scope, fundus color photography, fundus fluorescein angiograph （FFA）, optical coherence tomography（OCT） and OCTA, 28 eyes of 28 patients with CNV secondary to wet-AMD referred to the department of ophthalmology in our hospital from January to June 2015 were included in this study. Patients were aged from 54 to 82 years, with the mean of （68.19--＋_8.41） years. After in- travitreal anti-VEGF therapy, BCVA, slit lamp examination, non-contact tonometer, ophthal- moscope, fundus color photography, OCT and OCTA were assessed monthly for 3 to 6 months, FFA were examed at the last follow-up. The FFA, OCT and OCTA image features of the first and last follow-up were analyzed. Results： At the first follow-up, 28 eyes with active subfoveal or iuxtafoveal CNV were confirmed by fluorescein dye leakage in FFA, high signal mass were found in all these affected eyes with OCT cross line scan, 13 eyes had subretinal fluid, intraretinal fluid, or sub-RPE fluid. In all these eyes, OCTA showed there was no obvious abnormality in the su- perficial and deep retinal capillaries. It seemed that CNV lesions did not destroy these two layers. But all the 28 eyes found abnormal blood flow signals in the outer retina （originally avascular region） and choroid capillary layer. Nine eyes were observed with clear blood vessel structures of CNV, 5 of them were found with large diameter of the trunk vessels and anastomotic connections at the outer border of the neovascularization. After anti-VEGF treatment, lesions dye leakage in FFA of 11 eyes were reduced, an

关 键 词：老年黄斑变性 光相干断层扫描 血管成像 荧光素眼底血管造影 

分 类 号：R770.43[医药卫生—眼科]