中华眼底病杂志

中华眼底病杂志

对光相干断层扫描血管成像的再认识

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作为一项无创、快捷的新影像学技术,OCT血管成像(OCTA)已投入到眼底疾病、青光眼和神经眼科临床应用超过4年。其最有价值和最有效的应用在于对黄斑区新生血管性疾病的检测,对各种脉络膜新生血管性疾病的诊断有很大优势,并能分层观察病变血流信息,在很大程度上改变了我们对黄斑部疾病的诊疗思路和路径。在拍摄OCTA图像方面,操作者应有正规培训,保证图像的信号强度良好,以得到质量高、伪迹少的OCTA图像。在OCTA报告方面,拍摄者提供给医生的报告应当显示医生想要了解的层面的血流信息。由于技术原因,OCTA还难以观察到视网膜血管弓以外的区域。尽管如此,OCTA现有默认的扫描模式已能提供视网膜血管弓内血流改变的大量信息,为评估视网膜重要区域的结构功能改变发挥重要作用。期待未来扫频光源OCTA能带给我们更多有关脉络膜血管的血流信息,相信也是新一代OCTA会有突破的一个关键点。

As a new and non-invasive imaging technology, optical coherence tomography angiography (OCTA) has been using in ocular fundus diseases, glaucoma and neuro-ophthalmic disorders for more than 4 years. The most valuable and efficient application of OCTA is in detecting neovascular diseases in the macula. The big advantage of OCTA is for diagnosing all kinds of choroidal neovascularization. OCTA can observe blood flow information in different layers of the retina. To a large extent, it changes our diagnostic thinking and pathway in macular diseases. Before acquiring OCTA image, the operator should be well trained to ensure to get high quality images with good signal strength and less artifact. OCTA report should show the segmentation slab that the ophthalmologist wants to see. So far, OCTA has difficulty to reach peripheral retina with default setting. Even so, OCTA has provided much information of blood flow within retinal vascular arcade for evaluating structural and functional changes. We are expecting that the swept source OCTA could give us better observation of the choroidal blood flow. That should be the breakthrough of the new generation of OCTA.

关键词: 体层摄影术,光学相干; 脉络膜新生血管化/诊断; 述评

Key words: Tomography, optical coherence; Choroidal neovascularization/diagnosis; Editorial

引用本文: 王敏. 对光相干断层扫描血管成像的再认识. 中华眼底病杂志, 2019, 35(1): 1-2. doi: 10.3760/cma.j.issn.1005-1015.2019.01.001 复制

1. 中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病专业委员会. 我国眼底相干光层析血管成像术的操作和阅片规范(2017年)[J]. 中华眼科杂志, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn.0412-4081.2017.10.003.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association; Professional Committee of Fundus Diseases, Ophthalmologist Branch of Chinese Doctors Association. Standards for operations and reading of coherent optical tomography angiography in China (2017)[J]. Chin J Ophthalmol, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn.0412-4081.2017.10.003.
2. Gao SS, Jia Y, Zhang M, et al. Optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 27-36. DOI: 10.1167/iovs.15-19043.
3. Wirth MA, Freiberg F, Pfau M, et al. Optical coherence tomography angiography in age-related macular degeneration: persistence of vascular network in quiescent choroidal neovascularization[J]. Acta Ophthalmol, 2017, 95(4): 428-430. DOI: 10.1111/aos.13226.
4. Wang M, Zhou Y, Gao SS, et al. Evaluating polypoidal choroidal vasculopathy with optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 526-532. DOI: 10.1167/iovs.15-18955.
5. de Carlo TE, Rosenblatt A, Goldstein M, et al. Vascularization of irregular retinal pigment epithelial detachments in chronic central serous chorioretinopathy evaluated with OCT angiography[J]. Ophthalmic Surg Lasers Imaging Retina, 2016, 47(2): 128-133. DOI: 10.3928/23258160-20160126-05.
6. Yanagi Y, Mohla A, Lee WK, et al. Prevalence and risk factors for nonexudative neovascularization in fellow eyes of patients with unilateral age-related macular degeneration and polypoidal choroidal vasculopathy[J]. Invest Ophthalmol Vis Sci, 2017, 58(9): 3488-3495. DOI: 10.1167/iovs.16-21167.
7. Roisman L, Zhang Q, Wang RK, et al. Optical coherence tomography angiography of asymptomatic neovascularization in intermediate age-related macular degeneration[J]. Ophthalmology, 2016, 123(6): 1309-1319. DOI: 10.1016/j.ophtha.2016.01.044.