Optical Coherence Tomography-Aided Differential Diagnosis and Treatment of Irregular Corneas

光学相干断层扫描辅助不规则角膜的鉴别诊断和治疗

• 批准号: 10222700
• 负责人: Yan Li
• 金额: $ 37.35万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222700
• 关键词: 3-Dimensional; Abbreviations; Ablation; Affect; Algorithms; Anterior; Basement membrane; Cicatrix; Classification; Clinical; Clinical Research; Clinical Trials; Collagen; Complication; Computer software; Contact Lenses; Cornea; Corneal Topography; Corneal dystrophy; Crystalline Lens; Decision Trees; Detection; Diagnostic; Differential Diagnosis; Disease; Early Diagnosis; Epithelial; Eye; Glossary; Goals; Guidelines; Imaging technology; In Situ; Keratoconus; Lasers; Longitudinal Studies; Maps; Masks; Measurement; Measures; Medical; Methods; Monitor; Operative Surgical Procedures; Optical Coherence Tomography; Outcome; Outcome Measure; Output; Pathological Dilatation; Patients; Pattern; Penetrating Keratoplasty; Procedures; Process; Radial Keratotomy; Reproducibility; Resolution; Risk Factors; Severities; Severity of illness; Shapes; Staging; Stromal Change; Surface; System; Technology; Testing; Thick; Thinness; Time; United States Food and Drug Administration; Vision; Visit; Visual Acuity; base; corneal epithelium; corneal scar; crosslink; detection sensitivity; eye dryness; improved; indexing; keratomileusis; mathematical analysis; novel; novel strategies; optical imaging; primary outcome; prototype

PROJECT SUMMARY To see well, the cornea must maintain near perfect clarity and shape. Several disease processes can distort corneal shape and degrade vision. These include ectasia/keratoconus (stromal thinning and bulging), primary epithelial deformation (contact lens-related warpage, dry eye, epithelial basement membrane dystrophy), and stromal changes (scar, stromal dystrophy, surgery). Some of these conditions can appear similar on standard anterior topography and yet require very different treatments. Therefore a goal of this project is to use optical coherence tomography (OCT), a 3-dimensional imaging technology with micrometer-level resolution, to differentiate between different types of corneal shape irregularities. The unique ability of OCT to measure epithelial thickness and posterior topography will be used to develop new metrics for staging and monitoring of ectasia and primary epithelial deformation. We will also improve the treatment of corneal stromal irregularities by combining OCT planning and topography-guided excimer laser ablation, which has only recently become available in the U.S. Our overall goal is to improve the early detection, differential diagnosis, staging, monitoring, and treatment of irregular corneas by using advanced optical imaging and laser technologies to achieve the following Specific Aims: (1) Develop an OCT-based system to classify and evaluate corneal shape irregularities. Standard corneal topography only measures the anterior corneal surface and cannot by itself differentiate between different causes of irregularities. In a cross-sectional clinical study, we will develop mathematical analyses of OCT maps of corneal anterior and posterior topography, epithelium, and pachymetry to improve the early detection, classification, and staging of irregularities including ectasia, epithelial deformations, and stromal changes. (2) Develop OCT metrics for more sensitive detection of keratoconus progression. Standard anterior topographic parameters such as maximum keratometry have poor reproducibility and poor detection sensitivity in early disease. Our preliminary results show that OCT epithelial and posterior topographic measurements are more sensitive to early keratoconus and have better repeatability. This could enable more timely identification of patients who need collagen crosslinking to stabilize the cornea. Early detection of progression will be tested in a longitudinal study of patients with subclinical keratoconus. (3) Develop OCT-and-topography guided phototherapeutic keratectomy (PTK) for irregular corneas. We have demonstrated that transepithelial PTK with OCT planning can significantly improve vision for patients with scarred or irregular corneas. We propose to further improve operative results using the newly available topography-guided excimer laser, which has been approved for laser-assisted in situ keratomileusis (LASIK) in normal eyes but has not yet been tested in PTK. We plan to conduct a clinical trial of OCT-and-topography guided PTK for patients with corneal scars, stromal dystrophies, and other irregularities.

项目概要 为了看得清楚，角膜必须保持近乎完美的清晰度和形状。几种疾病过程可能会扭曲 角膜形状和视力下降。这些包括扩张/圆锥角膜（基质变薄和膨出）、原发性角膜扩张/圆锥角膜（基质变薄和膨出） 上皮变形（隐形眼镜相关的翘曲、干眼、上皮基底膜营养不良），以及 基质变化（疤痕、基质营养不良、手术）。其中一些条件在标准上可能看起来相似 前部地形，但需要非常不同的治疗。因此，该项目的目标是使用光学 相干断层扫描 (OCT) 是一种具有微米级分辨率的 3 维成像技术， 区分不同类型的角膜形状不规则性。 OCT 独特的测量能力 上皮厚度和后部地形将用于开发用于分期和监测的新指标 扩张和原发上皮变形。我们还将改善角膜基质不规则的治疗 通过结合 OCT 规划和地形引导准分子激光消融，最近才成为 在美国可用。我们的总体目标是改善早期检测、鉴别诊断、分期、 通过使用先进的光学成像和激光技术来监测和治疗不规则角膜 实现以下具体目标： (1)开发基于OCT的系统来分类和评估角膜形状不规则性。标准角膜 地形图仅测量角膜前表面，本身不能区分不同的角膜 不正常现象的原因。在横断面临床研究中，我们将对 OCT 图进行数学分析 角膜前部和后部地形、上皮和厚度测量以改善早期检测， 不规则现象的分类和分期，包括扩张、上皮变形和基质变化。 (2) 开发 OCT 指标以更灵敏地检测圆锥角膜进展。标准前路 最大角膜曲率等地形参数重复性差，检测灵敏度差 在疾病早期。我们的初步结果表明 OCT 上皮和后部地形测量结果 对早期圆锥角膜更加敏感，并且具有更好的重复性。这可以实现更及时的识别 需要胶原蛋白交联来稳定角膜的患者。将测试早期检测进展 对亚临床圆锥角膜患者进行的纵向研究。 (3) 开发针对不规则角膜的 OCT 和地形引导光疗性角膜切除术 (PTK)。我们 已经证明，跨上皮 PTK 结合 OCT 计划可以显着改善患有以下疾病的患者的视力 角膜有疤痕或不规则。我们建议使用新可用的技术进一步改善操作结果 地形引导准分子激光，已被批准用于激光辅助原位角膜磨镶术 (LASIK) 正常眼睛，但尚未在 PTK 中进行测试。我们计划进行 OCT 和地形图的临床试验 针对患有角膜疤痕、基质营养不良和其他不规则现象的患者进行引导 PTK。