OCTA在眼底病诊治应用中的注意事项  

Optical coherence tomography angiography for retinal diseases:pearls and pitfalls

作　　者：游启生 You Qisheng(Kresge Eye Institute,Wayne State University,Detroit MI 48021,USA)

机构地区：[1]美国韦恩州立大学克雷斯格眼科研究所,密歇根州底特律市48021

出　　处：《眼科》2022年第2期81-88,共8页Ophthalmology in China

摘　　要：相干光断层扫描血管成像(optical coherence tomography angiography,OCTA)利用流动的血细胞作为内在的光学对比剂来实现血流显影,具有无创、便捷、高分辨、定量分析不同深度层次眼部血流的优势,但扫描范围局限,无法显现血管壁的着染和渗漏,可能存在伪影干扰。不同OCTA设备之间成像原理和算法不同,结果不能直接对比。识别OCTA图像中的伪影如投射伪影、阴影伪影、分层伪影等对正确解读OCTA图像至关重要。OCTA提升了对眼底疾病的认识和诊治的精准度。可在糖尿病患者出现临床可见的视网膜病变之前即检测到视网膜微血管改变;可测量不同层次视网膜的缺血程度,有助于判定糖尿病患者的视力预后和指导治疗;检测视网膜新生血管比有经验的眼底病医师临床检查更敏感,可测量视网膜新生血管的面积,并用于监测治疗反应。在年龄相关性黄斑变性的诊治中,OCTA可检测出无渗漏型的脉络膜新生血管;其测量的脉络膜毛细血管丢失与地图样萎缩的发生发展显著相关。Optical coherence tomography angiography(OCTA)uses flowing blood cells as intrinsic motion contrast to produce depth-resolved images of blood flow in a rapid non-invasive fashion.Its limitations include limited field of view,unable to show vessel wall infiltration and leakage,imaging artifacts,and poor agreement of OCTA measurements among different devices.It is critical to recognize the artifacts while interpreting OCTA images.OCTA improved our understanding and clinical management of retinal diseases.OCTA is able to detect microvascular changes in diabetic patients before clinical retinopathy is detectable and quantify capillary dropout in different retinal plexus,which is significantly associated with visual prognosis and treatment requirement.OCTA can sensitively detect clinically unsuspected retinal neovascularization that is missed by experienced retinal specialist in diabetic patients.OCTA measured retinal neovascularization area is useful in monitoring treatment reaction in diabetic patients.For the first time,OCTA enable us to detect non-exudative choroidal neovascularization in vivo in patients with age-related macular degeneration.OCTA quantified choriocapillaris defect is significantly associated with the development and progression of geographic atrophy.

关 键 词：相干光断层扫描血管成像 糖尿病视网膜病变 年龄相关性黄斑变性 

分 类 号：R77[医药卫生—眼科]