Optical coherence tomography of age-related macular degeneration and choroidal neovascularization
Optical coherence tomography of age-related macular degeneration and choroidal neovascularization
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DOI：
10.1016/s0161-6420(96)30512-5
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发表时间：
1996-08-01
期刊：
影响因子：
13.7
通讯作者：
Fujimoto, JG
中科院分区：
文献类型：
--
作者：
Hee, MR;Baumal, CR;Fujimoto, JG
目的：作者使用光学相干断层扫描（OCT）（一种视网膜横断面成像新技术）对患有非渗出性和渗出性年龄相关性黄斑变性（AMD）的眼睛进行形态学研究。在未经治疗的渗出性 AMD 患者中，将 OCT 与荧光素血管造影在脉络膜新生血管 (CNV) 的识别和分类方面进行比较。方法：光学相干断层扫描成像类似于超声，不同之处在于使用光而不是声音，可以通过非接触式和非侵入性测量实现更高的纵向分辨率。对 391 例临床诊断为 AMD 的患者进行光学相干断层扫描，并与常规临床检查进行比较，以确定不同病变的横截面形态并制定 CNV 分类方案。然后对 86 名患有渗出性 AMD 且未接受激光治疗的患者的 90 只眼睛的光学相干断层扫描和荧光素血管造影进行独立审查和关联。结果：色素改变、软性玻璃膜疣以及神经感觉视网膜和视网膜色素上皮的脱离在 OCT 上都有明显的表现。视网膜下和视网膜内液体引起视网膜厚度或高度的变化，这些变化可以直接从图像中量化。脉络膜新生血管在断层扫描中明显表现为反射层增厚和破碎，对应于视网膜色素上皮和脉络膜毛细血管。在新血管形成过程中以及激光光凝治疗后观察到该层反射的变化。经典 CNV 在 OCT 上始终呈现明确的边界，而隐匿性 CNV 具有可变的横截面外观。结论：光学相干断层扫描可用于定量评估视网膜下和视网膜内液体，评估可能的新生血管参与的中心凹下，以及监测激光光凝前后的 CNV。光学相干断层扫描无法检测浆液性色素上皮脱离下方的 CNV。光学相干断层扫描可能具有准确定义血管造影隐匿性 CNV 子集中边界的潜力。
Objective: The authors used optical coherence tomography (OCT), a new technique for cross-sectional imaging of the retina, to morphologically study eyes with nonexudative and exudative age-related macular degeneration (AMD). In patients with untreated exudative AMD, OCT was compared with fluorescein angiography in the identification and classification of choroidal neovascularization (CNV).Methods: Optical coherence tomography imaging is analogous to ultrasound, except that the use of light rather than sound enables higher longitudinal resolution with a noncontact and noninvasive measurement. Optical coherence tomography was performed on 391 patients with the clinical diagnosis of AMD and was compared with conventional clinical examination to establish the cross-sectional morphology of different lesions and to develop a classification scheme for CNV. Optical coherence tomograms and fluorescein angiograms then were reviewed and correlated independently in 90 eyes of 86 patients who had exudative AMD without previous laser treatment.Results: Pigmentary changes, soft drusen, and detachments of the neurosensory retina and retinal pigment epithelium all had distinct presentations on OCT. Subretinal and intraretinal fluid caused changes in retinal thickness or elevation that could be quantified directly from the images. Choroidal neovascularization was evident in the tomograms as a thickening and fragmentation of a reflective layer, which corresponded to the retinal pigment epithelium and choriocapillaris. Changes in the reflection from this layer were observed during the progression of neovascularization, and after laser photocoagulation treatment. Classic CNV consistently presented with well-defined boundaries on OCT, whereas occult CNV had a variable cross-sectional appearance.Conclusions: Optical coherence tomography was useful in quantitatively evaluating subretinal and intraretinal fluid, assessing possible subfoveal involvement of neovascularization, and in monitoring CNV before and after laser photocoagulation. Optical coherence tomography was unable to detect CNV beneath serous pigment epithelial detachments. Optical coherence tomography may have potential in accurately defining the boundaries in a subset of angiographically occult CNV.