囊樣黃斑水腫的眼底自發(fā)熒光分析研究
發(fā)布時間：2019-01-15 06:41
【摘要】：背景與目的 囊樣黃斑水腫(cystoid macular edema, CME)是一種常見的眼底病變,但它不是一類獨立的疾病,而是由多種眼底疾病導(dǎo)致的。目前光學(xué)相干斷層掃描(optical coherence tomography,OCT)和眼底熒光血管造影(fluorescein angiography,FA)是診斷CME的主要方法。眼底自發(fā)熒光(autofluorescence,AF)作為一種快速無創(chuàng)的技術(shù)近十年來得到了快速發(fā)展成為了眼底病方面的熱點。但是由于黃斑部本身具有的色素干擾了眼底自發(fā)熒光的觀察,故臨床上對CME的眼底自發(fā)熒光表現(xiàn)研究較少。本文旨在研究CME的眼底短波自發(fā)熒光(shortwave-autofluorescence,SW-AF)影像特點及其臨床應(yīng)用價值。 方法 橫斷面研究140例(189眼)患者,所有入選患者均有易引起黃斑囊樣水腫的原發(fā)眼病或內(nèi)眼手術(shù)史,其中經(jīng)OCT確診為CME者98例(129眼),OCT檢查無CME者31例(60眼),所有患者散瞳后進(jìn)行SW-AF-紅外光自發(fā)熒光(Infrared-autofluorescence, IR-AF)、FA、OCT檢查,SW-AF圖片的采集在未靜脈注射造影劑的情況下采用共焦掃描激光檢眼鏡對后極部30°范圍進(jìn)行分辨率為512*512像素的掃描,激發(fā)光為488nm藍(lán)光,光柵為500nm,分析CME的SW-AF圖像特點。以O(shè)CT為CME診斷的金標(biāo)準(zhǔn),計算SW-AF診斷試驗的靈敏度、特異度等指標(biāo)；研究CME患眼中SW-AF圖像真陽性與假陰性表現(xiàn)者其ILM-RPE厚度有無區(qū)別：研究CME患眼SW-AF圖像陽性者其圖像中中心凹囊樣高熒光的相對灰度值與中心凹最大ILM-RPE厚度的關(guān)系,分析是否存在相關(guān)性。SW-AF圖像的灰度值測定通過photoshop cs5.0軟件,統(tǒng)計采用SPSS13.0軟件,統(tǒng)計方法包括x2檢驗,獨立樣本t檢驗,相關(guān)分析及一元線性回歸。 結(jié)果 129眼經(jīng)OCT確診為CME的患眼在SW-AF圖像中表現(xiàn)為黃斑中心凹部位一個或數(shù)個囊樣、花瓣樣高熒光,形態(tài)同晚期FFA的囊樣熒光積存相似。CME在IR-AF圖像中只有少數(shù)29眼(22.48%)能體現(xiàn)出囊樣改變,同SW-AF相比,兩者在診斷CME的敏感度上的差異有統(tǒng)計學(xué)意義,P0.001(X2檢驗)。以O(shè)CT作為CME診斷金標(biāo)準(zhǔn),SW-AF診斷CME的敏感度為78.29%,特異度為96.67%,約登指數(shù)0,75,陽性預(yù)測值98.06%,陰性預(yù)測值67.44%,陽性似然比3.61,陰性似然比0.03,符合率84.13%,AUC為0.875,95%可信區(qū)間0.823-0.926,P值0.001,說明該診斷性實驗具有一定的準(zhǔn)確性。SW-AF診斷真陽性的平均中心凹最大ILM-RPE厚度為500.36±132.62um,SW-AF診斷假陰性的平均中心凹最大ILM-RPE厚度為316.35±79.92um,兩組中心凹最大ILM-RPE厚度差異有統(tǒng)計學(xué)意義,P0.001(獨立樣本t檢驗)。以中心凹囊樣高熒光的RGSR值與中心凹最大ILM-RPE厚度值繪制散點圖示兩者存在線性相關(guān)趨勢,行相關(guān)分析示相關(guān)系數(shù)為0.846,兩變量有相關(guān)性,P0.01,回歸分析示r2=0.717,回歸方程Y=0.0003773X+0.633。 結(jié)論 SW-AF是一種快捷安全無創(chuàng)的診斷CME的手段,具有一定的診斷價值,其自發(fā)熒光的表現(xiàn)同中心凹視網(wǎng)膜厚度有關(guān),可以通過對自發(fā)熒光圖像灰度分析來推斷中心凹視網(wǎng)膜厚度。
[Abstract]:Background and objective Cystoid macular edema (cystoid macular edema, CME) is a common fundus disease, but it is not an independent disease, but caused by many fundus diseases. Optical coherence tomography (optical coherence tomography,OCT) and fundus fluorescein angiography (fluorescein angiography,FA) are the main diagnostic methods for CME. Fundus autofluorescence (autofluorescence,AF) as a fast non-invasive technique has been developing rapidly in recent ten years and has become a hot spot in fundus disease. However, the macular pigment interferes with the observation of fundus autofluorescence, so there is little research on the fundus autofluorescence of CME. The purpose of this paper is to study the features of fundus short wave autofluorescence (shortwave-autofluorescence,SW-AF) images of CME and its clinical value. Methods A cross-sectional study of 140 patients (189 eyes) with macular cystic edema was performed. All of them had a history of primary ophthalmopathy or intraocular surgery, including 98 cases of CME diagnosed by OCT (129 eyes, 31 cases without CME, 60 eyes). All patients were examined with SW-AF- infrared autofluorescence (Infrared-autofluorescence, IR-AF) and FA,OCT after mydriasis. In the case of no intravenous injection of contrast media, the SW-AF images were scanned by confocal scanning laser ophthalmoscope at the posterior pole in the range of 30 擄with a resolution of 512 ~ 512pixels. The excitation light was 488nm blue light, and the grating was 500 nm. The characteristics of SW-AF images of CME are analyzed. The sensitivity and specificity of SW-AF diagnostic test were calculated by using OCT as the gold standard for CME diagnosis. To study the difference of ILM-RPE thickness between true positive and false negative SW-AF images in CME eyes: to study the relative gray value of high fluorescence intensity in the concave of CME patients with SW-AF images and the maximum ILM in the fovea. -the relationship between the thickness of RPE, The gray value of SW-AF image was measured by photoshop cs5.0 software, and the statistical method was SPSS13.0 software. The statistical methods included x2 test, independent sample t test, correlation analysis and linear regression. Results 129 eyes with CME diagnosed by OCT showed one or more cysts in the fovea of macula on SW-AF images and petal-like hyperfluorescence. The morphology of CME was similar to that of late FFA. Only 29 eyes (22.48%) of CME showed cystic changes in IR-AF images. Compared with SW-AF, the sensitivity of CME in the diagnosis of CME was significantly different. P0.001 (X2 test). Using OCT as the diagnostic gold standard for CME, the sensitivity and specificity of SW-AF in the diagnosis of CME were 78.29, 96.67, 0.75, 98.06, 67.44 and 3.61, respectively. The negative likelihood ratio was 0.03, the coincidence rate was 84.13 and the AUC was 0.87595% confidence interval 0.823-0.926 (P = 0.001). The results showed that this diagnostic experiment had certain accuracy. The mean maximum ILM-RPE thickness of the true positive SW-AF was 500.36 鹵132.62 um.SW-AF with false negative ILM-RPE thickness was 316.35 鹵79.92 um. There was significant difference in maximum ILM-RPE thickness between the two groups (P0. 001). Using the RGSR value of high fluorescence in the central fovea and the maximum ILM-RPE thickness value of the fovea, there was a linear correlation trend between them. The correlation coefficient was 0.846, the two variables were correlated, P0.01, and the regression analysis showed that r20.717, the correlation coefficient was 0.846, and the regression analysis showed that the correlation coefficient was 0.846. The regression equation was 0.0003773X 0.633. Conclusion SW-AF is a fast, safe and noninvasive method for the diagnosis of CME, and its autofluorescence is related to the thickness of the central fovea retina. The thickness of the foveal retina can be inferred by analyzing the gray level of the autofluorescence image.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R774.5
本文編號：2408935
[Abstract]:Background and objective Cystoid macular edema (cystoid macular edema, CME) is a common fundus disease, but it is not an independent disease, but caused by many fundus diseases. Optical coherence tomography (optical coherence tomography,OCT) and fundus fluorescein angiography (fluorescein angiography,FA) are the main diagnostic methods for CME. Fundus autofluorescence (autofluorescence,AF) as a fast non-invasive technique has been developing rapidly in recent ten years and has become a hot spot in fundus disease. However, the macular pigment interferes with the observation of fundus autofluorescence, so there is little research on the fundus autofluorescence of CME. The purpose of this paper is to study the features of fundus short wave autofluorescence (shortwave-autofluorescence,SW-AF) images of CME and its clinical value. Methods A cross-sectional study of 140 patients (189 eyes) with macular cystic edema was performed. All of them had a history of primary ophthalmopathy or intraocular surgery, including 98 cases of CME diagnosed by OCT (129 eyes, 31 cases without CME, 60 eyes). All patients were examined with SW-AF- infrared autofluorescence (Infrared-autofluorescence, IR-AF) and FA,OCT after mydriasis. In the case of no intravenous injection of contrast media, the SW-AF images were scanned by confocal scanning laser ophthalmoscope at the posterior pole in the range of 30 擄with a resolution of 512 ~ 512pixels. The excitation light was 488nm blue light, and the grating was 500 nm. The characteristics of SW-AF images of CME are analyzed. The sensitivity and specificity of SW-AF diagnostic test were calculated by using OCT as the gold standard for CME diagnosis. To study the difference of ILM-RPE thickness between true positive and false negative SW-AF images in CME eyes: to study the relative gray value of high fluorescence intensity in the concave of CME patients with SW-AF images and the maximum ILM in the fovea. -the relationship between the thickness of RPE, The gray value of SW-AF image was measured by photoshop cs5.0 software, and the statistical method was SPSS13.0 software. The statistical methods included x2 test, independent sample t test, correlation analysis and linear regression. Results 129 eyes with CME diagnosed by OCT showed one or more cysts in the fovea of macula on SW-AF images and petal-like hyperfluorescence. The morphology of CME was similar to that of late FFA. Only 29 eyes (22.48%) of CME showed cystic changes in IR-AF images. Compared with SW-AF, the sensitivity of CME in the diagnosis of CME was significantly different. P0.001 (X2 test). Using OCT as the diagnostic gold standard for CME, the sensitivity and specificity of SW-AF in the diagnosis of CME were 78.29, 96.67, 0.75, 98.06, 67.44 and 3.61, respectively. The negative likelihood ratio was 0.03, the coincidence rate was 84.13 and the AUC was 0.87595% confidence interval 0.823-0.926 (P = 0.001). The results showed that this diagnostic experiment had certain accuracy. The mean maximum ILM-RPE thickness of the true positive SW-AF was 500.36 鹵132.62 um.SW-AF with false negative ILM-RPE thickness was 316.35 鹵79.92 um. There was significant difference in maximum ILM-RPE thickness between the two groups (P0. 001). Using the RGSR value of high fluorescence in the central fovea and the maximum ILM-RPE thickness value of the fovea, there was a linear correlation trend between them. The correlation coefficient was 0.846, the two variables were correlated, P0.01, and the regression analysis showed that r20.717, the correlation coefficient was 0.846, and the regression analysis showed that the correlation coefficient was 0.846. The regression equation was 0.0003773X 0.633. Conclusion SW-AF is a fast, safe and noninvasive method for the diagnosis of CME, and its autofluorescence is related to the thickness of the central fovea retina. The thickness of the foveal retina can be inferred by analyzing the gray level of the autofluorescence image.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R774.5
【共引文獻(xiàn)】
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相關(guān)碩士學(xué)位論文 前1條
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