Hemoglobin Video Imaging Provides Novel In Vivo High-Resolution Imaging and Quantification of Human Aqueous Outflow in Patients with Glaucoma
Hemoglobin Video Imaging Provides Novel In Vivo High-Resolution Imaging and Quantification of Human Aqueous Outflow in Patients with Glaucoma
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DOI：
10.1016/j.ogla.2019.04.001
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发表时间：
2019-09-01
影响因子：
2.9
通讯作者：
Martin, Keith R.
中科院分区：
文献类型：
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作者：
Khatib, Tasneem Z.;Meyer, Paul A. R.;Martin, Keith R.
目的：目前可用的临床工具很难实现对人体房水流出动态的无创、详细测量。我们使用血红蛋白视频成像 (HVI) 开发了一种对人体房水流出物进行无创实时成像和量化的技术。设计：一项描述房水静脉特征的前瞻性观察研究和一项开发量化参数的试点前瞻性介入可行性研究。参与者：从剑桥大学医院 NHS 基金会信托青光眼诊所招募患者。观察性研究包括 30 只眼睛，试点介入可行性研究是对 8 只接受选择性激光小梁成形术 (SLT) 的眼睛进行的。我们的 SLT 方案还包括使用毛果芸香碱和阿普可乐定滴眼液。方法：参与者在日常就诊的同时接受 HVI。主要结果指标：巩膜外静脉内水柱横截面积 (CSA) 的变化与干预前后眼压 (IOP) 降低和视野平均偏差 (MD) 变化相关。使用自相关分析计算房水静脉中红细胞对比度和像素强度的波动，以比较干预前后的流速。结果：血红蛋白视频成像可以直接观察进入血管系统的房水流量。房水集中在层流静脉柱内。血流是脉动的，并且可以观察到通过球压或房水静脉压缩的血流波动。实施我们的 SLT 方案后，水柱显着增加（n = 13；P < 0.05）。这与 10P 减少程度（n = 13；Pearson 相关系数 0.7；P = 0.007）和干预后观察到的 MD 改善程度相关（n = 8；Pearson 相关系数 0.75；P = 0.03）。自相关分析表明，干预后房水静脉的衰减速度更快，表明流速增加。结论：血红蛋白视频成像可以纳入常规临床裂隙灯检查中，以实时详细评估和量化房水流出。它有潜力用于帮助针对性治疗干预，以改善房水流出，并进一步加深我们对青光眼发病机制中房水流出失调的理解。 (C) 2019 年，美国眼科学会。
Purpose: Noninvasive, detailed measurement of the dynamics of human aqueous outflow is difficult to achieve with currently available clinical tools. We used hemoglobin video imaging (HVI) to develop a technique to image and quantify human aqueous outflow noninvasively and in real time.Design: A prospective observational study to describe characteristics of aqueous veins and a pilot prospective interventional feasibility study to develop quantification parameters.Participants: Patients were recruited from the Cambridge University Hospitals NHS Foundation Trust Glaucoma clinic. The observational study included 30 eyes, and the pilot interventional feasibility study was performed on 8 eyes undergoing selective laser trabeculoplasty (SLT). Our SLT protocol also included the installation of pilocarpine and apraclonidine eye drops.Methods: Participants underwent HVI alongside their usual clinic visit.Main Outcome Measures: The change in cross-sectional area (CSA) of the aqueous column within episcleral veins was correlated with intraocular pressure (IOP) reduction and change in visual field mean deviation (MD) before and after intervention. Fluctuations in contrast and pixel intensity of red blood cells in an aqueous vein were calculated to compare the flow rate before and after intervention using autocorrelation analysis.Results: Hemoglobin video imaging enables the direct observation of aqueous flow into the vascular system. Aqueous is seen to centralize within a laminar venous column. Flow is pulsatile, and fluctuations of flow through globe pressure or compression of the aqueous vein are observed. There was a significant increase in the aqueous column after the administration of our SLT protocol (n = 13; P < 0.05). This correlated with the degree of 10P reduction (n = 13; Pearson's correlation coefficient 0.7; P = 0.007) and the improvement in MD observed postintervention (n = 8; Pearson's correlation coefficient 0.75; P = 0.03). Autocorrelation analysis demonstrated a faster rate of decay in an aqueous vein after intervention, indicating an increase in flow rate.Conclusions: Hemoglobin video imaging can be incorporated into a routine clinic slit-lamp examination to allow a detailed assessment and quantification of aqueous outflow in real time. It has the potential to be used to help target therapeutic interventions to improve aqueous outflow and further advance our understanding of aqueous outflow dysregulation in the pathogenesis of glaucoma. (C) 2019 by the American Academy of Ophthalmology.