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: 10407569
• 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 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10407569
• 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.

项目摘要 为了好看，角膜必须保持几乎完美的清晰度和形状。几个疾病过程会扭曲 角膜形状和降解视觉。这些包括ectasia/peratoconus（基质变薄和膨胀），主要 上皮变形（与隐形眼镜相关的扭曲，干眼，上皮地下膜营养不良）和 基质变化（疤痕，基质营养不良，手术）。这些条件中的一些可能在标准上看起来相似 前地形，但需要非常不同的治疗方法。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三维成像技术， 区分不同类型的角膜形状不规则。 OCT测量的独特能力 上皮厚度和后地形将用于开发新的指标，用于分期和监测 源自和原发性上皮变形。我们还将改善角膜基质不规则的治疗 通过结合OCT计划和地形引导的准分子激光消融，直到最近才成为 美国可用 通过使用先进的光学成像和激光技术来监测和处理不规则角膜 实现以下特定目标： （1）开发一个基于OCT的系统来对角膜形状的不规则性进行分类和评估。标准角膜 地形仅测量前角膜表面，并且本身不能区分不同 不规则的原因。在一项横断面临床研究中，我们将开发OCT地图的数学分析 角膜前和后地形，上皮和pachymetry，以改善早期检测 分类和分期的不规则性，包括ect症，上皮变形和基质变化。 （2）开发OCT指标，以更敏感地检测圆锥角膜进展。标准前 地形参数（例如最大角膜测量法）的可重复性差，检测灵敏度差 在早期疾病中。我们的初步结果表明，OCT上皮和后地形测量是 对早期圆锥角膜更敏感，具有更好的可重复性。这可以使更及时的身份证明 需要胶原蛋白交联以稳定角膜的患者。将测试进展的早期检测 在一项亚临床角膜结构患者的纵向研究中。 （3）发展为不规则角膜的Oct和剧集引导的光疗疗法角膜切除术（PTK）。我们 已经证明，具有OCT计划的transepithialial PTK可以显着改善 疤痕或不规则角膜。我们建议使用新的可用 地形引导的准分子激光器已被批准用于激光辅助的原位角化瘤（LASIK） 正常的眼睛，但尚未在PTK中进行测试。我们计划进行十月和剧本的临床试验 角膜疤痕，基质营养不良和其他不规则性患者的PTK引导性PTK。