炫彩多色共焦眼底层析激光成像联合扫频光相干断层扫描成像对病理性近视漆裂纹及牵拉条纹的诊断价值  

The diagnostic value of multicolor scanning laser imaging combined with swept-source optical coherence tomography for lacquer cracks and myopia stretch lines of pathological myopia

作　　者：华怡红 陈秋莹 周皓[1] 王凯[1] 孙豪龙 王卫峻[1] 樊莹[1] Hua Yihong;Chen Qiuying;Zhou Hao;Wang Kai;Sun Haolong;Wang Weijun;Fan Ying(Department of Ophthalmology,The First People’s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai Key Laboratory of Ocular Fundus Diseases,Shanghai 200080,China)

机构地区：[1]上海交通大学附属上海市第一人民医院,上海市眼底病重点实验室,200080

出　　处：《中华眼底病杂志》2019年第5期435-440,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察分析炫彩多色共焦眼底层析激光成像联合扫频OCT(SS-OCT)成像对病理性近视漆裂纹及牵拉条纹(MSL)的诊断价值。方法观察性研究。2017年5月至2018年1月在上海交通大学附属上海市第一人民医院高度近视专科门诊就诊的病理性近视患者58例83只眼纳入研究。其中,男性20例30只眼,女性38例53只眼。年龄24~70岁,平均年龄(50.65±12.02)岁。患眼平均BCVA0.37±0.32,平均等效球镜度数(?11.38±4.96)D,平均眼轴长度(28.91±2.15)mm。所有患者采用海德堡眼底血管造影仪行FFA和ICGA检查,采集FFA、ICGA、红外线(IR)、自身荧光(AF)像。采用SS-OCT进行双眼黄斑中心凹及视盘扫描,范围9 mm×9 mm,采集B-scan像、无赤光像、彩色眼底像;采用炫彩多色共焦眼底层析激光成像技术,以黄斑为中心拍摄30°×30°大小的炫彩标准图像和红外反射像。所有影像资料由三位眼底病医生分别进行独立阅片,并行一致性检验。漆裂纹的明确诊断以FFA线性强荧光影和ICGA晚期线性弱荧光影为标准,MSL则以FFA和ICGA同时表现为弱荧光线状影为诊断标准。计算不同影像模式对病理性近视漆裂纹及MSL的检出率,并行准确性检验。筛选检出率最高的影像模式联合SS-OCT进一步检验检出率。结果三位眼底病医师阅片结果经一致性检验,其阅片诊断结果一致性较好(Kappa=0.938,P<0.01)。炫彩标准图像、SS-OCT无赤光像、SS-OCT彩色眼底像、IR像、AF像对眼底漆裂纹及MSL病灶的检出率依次递减;其检出阳性率分别为77.1%、73.1%、72.3%、72.3%、49.4%。炫彩标准图像检验一致性(Kappa=0.520,P<0.01)和检验准确性(受试者工作特征曲线下面积为0.750)最佳。采用炫彩标准图像联合SS-OCT鉴别诊断漆裂纹和MSL,漆裂纹的检出阳性率为91.7%,漆裂纹+MSL的检出阳性率为93.3%,MSL的检出阳性率为91.2%。在SS-OCT B-scan像中,漆裂纹主要表现为RPE条带模糊不均,局部变薄透见,椭�Objective To analyze the diagnostic value of multicolor scanning laser imaging (confocal scanning laser ophthalmoscopy, cSLO) combined with swept-source optical coherence tomography (SS-OCT) for lacquer cracks (LC) and myopia stretch lines (MSL) of pathological myopia. Methods A observational study. A total of 83 eyes of 58 patients with pathological myopia were recruited from May 2017 to January 2018 in Department of Ophthalmology of The First People’s Hospital Affiliated to Shanghai Jiao Tong University. Among 58 patients, 20 were males (30 eyes) and 38 were females (53 eyes). The mean age was 50.65±12.02 (range from 24 to 70) years old;the average BCVA was 0.37±0.32;the average diopter was ?11.38±4.96 D;and the average axial length was 28.91±2.15 mm. All participants underwent FFA and ICGA examination to obtain FFA, ICGA, infrared light reflection (IR) and autofluorescence (AF) images. SS-OCT was applied for scanning macular and optic disc at 9 mm × 9 mm range. cSLO was performed with macular as the center. All images were inspected carefully by three independent observers and the consistency test was detect. LC were diagnosed as hyperreflective line in FFA and hypofluorescent linear lesions in late ICGA. MSL were defined as both hypofluorescent linear lesions in FFA and late ICGA. The accuracy of each inspection item in the diagnosis of LC was detected. The optimal technique was applied with SS-OCT to further explore the detection rate of LC. Results The intra-observer reproducibility was good to excellent for all measurements (Kappa=0.938, P<0.01). The positive detection rate of LC and MSL was highest in the standard images of cSLO (77.1%), followed by SS-OCT red free (73.1%), fundus photography (72.3%), IR (72.3%) and AF (49.4%). The cSLO was optimal in the test consistency (Kappa=0.520, P<0.01) and accuracy (the area under the receiver operating characteristic was 0.750). SS-OCT and cSLO were jointly applied to diagnosis of LC and MSL in high myopia. The positive detection rate of LC, MSL and LC+MSL

关 键 词：近视 退行性/诊断 显微镜检查 共焦 体层摄影术 光学相干 

分 类 号：R778.11[医药卫生—眼科]