本文選題：中心性漿液性脈絡(luò)膜視網(wǎng)膜病變　切入點：多功能影像學(xué)改變　出處：《復(fù)旦大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：目的：通過en face OCT和OCT血管成像(SSADA),觀察中心性漿液性脈絡(luò)膜視網(wǎng)膜病變(CSC)中視網(wǎng)膜色素上皮和脈絡(luò)膜血管的形態(tài)改變以及脈絡(luò)膜毛細(xì)血管的血流情況,結(jié)合眼底自發(fā)熒光(FAF)、眼底近紅外熒光(NIA)、頻域光學(xué)相干層析成像(SD-OCT)、眼底熒光血管造影(FFA)、眼底吲哚青綠血管造影(ICGA)等多功能影像學(xué)改變,推測該疾病可能的病理生理機制。方法：臨床確診為初發(fā)中心性漿液性脈絡(luò)膜視網(wǎng)膜病變的病例,經(jīng)眼底彩色照相、眼底自發(fā)熒光、眼底近紅外熒光、頻域光學(xué)相干層析成像、眼底熒光血管造影、眼底吲哚青綠血管造影、en face OCT和OCT血管成像檢查,觀察CSC的視網(wǎng)膜神經(jīng)上皮、色素上皮和脈絡(luò)膜血管的形態(tài)改變,以及脈絡(luò)膜的血流情況。結(jié)果：FAF在神經(jīng)上皮脫離區(qū)表現(xiàn)為低熒光,造影顯示的滲漏點既可表現(xiàn)為熒光增強,也可表現(xiàn)為熒光減低。NIA具有與FAF相似的表現(xiàn)。SD-OCT可清晰地觀察到視網(wǎng)膜神經(jīng)上皮及色素上皮脫離(PED),一些病例還可見到視網(wǎng)膜外層脫落的光感受器外節(jié)膜盤。滲漏點型是FFA最常見的形式,還可觀察到PED和視網(wǎng)膜色素上皮(RPE)萎縮帶。ICGA可見造影早期和中期的多灶性強熒光,晚期出現(xiàn)典型的脈絡(luò)膜高熒光斑,伴有弱熒光的大血管影。在en face OCT中,RPE層面缺失信號的區(qū)域即為脫離或丟失的部分。RPE破壞的部位與SD-OCT、FFA及ICGA均有所對應(yīng)。無論是PED還是RPE脫失,其RPE下的脈絡(luò)膜毛細(xì)血管幾乎均可呈現(xiàn)擴張狀態(tài)。脈絡(luò)膜Sattler層和Haller層血管往往表現(xiàn)局灶型或彌漫型擴張,且兩者可不完全一致。OCT血管成像(SSADA)發(fā)現(xiàn)CSC患眼中脈絡(luò)膜毛細(xì)血管血流增加,且其增加的程度和范圍均可高于en face OCT所觀察到的結(jié)果。結(jié)論：FAF可用于區(qū)分急性與慢性復(fù)發(fā)性CSC,指導(dǎo)CSC判斷預(yù)后,還可幫助醫(yī)師判斷患者是否能從激光治療中獲益。NIA較FAF檢查更為敏感,能更好地反映黃斑部RPE細(xì)胞的吞噬和代謝功能。FFA中顯示的滲漏點對于后續(xù)激光光凝或光動力學(xué)治療都具有重要的指導(dǎo)作用。ICGA顯示,CSC患者的脈絡(luò)膜血管通透性過高,但其在識別脈絡(luò)膜特定形態(tài)改變時仍有一定的相對局限性。en faceOCT所提供的形態(tài)學(xué)圖像可在同一區(qū)域內(nèi)逐層觀察視網(wǎng)膜至脈絡(luò)膜的結(jié)構(gòu),對于病變的位置、形態(tài)及范圍都有著良好的呈現(xiàn),有助于疾病進展程度及治療效果的評價。它對于脈絡(luò)膜結(jié)構(gòu)的觀察更優(yōu)于橫斷面OCT掃描圖像,可觀察到脈絡(luò)膜血管的擴張,以及細(xì)胞外液的積聚,并且對于脈絡(luò)膜新生血管的觀察也提供了另一種診斷和處理CNV的非侵入性方法。OCT血管成像(SSADA)可獲取脈絡(luò)膜的血流情況,并且可將其所代表的功能與en face OCT所顯示的結(jié)構(gòu)完全同步呈現(xiàn),且其敏感性高于en face OCT。CSC的脈絡(luò)膜血流增強可能在血管擴張之前發(fā)生,即血管擴張可能是血流增強所造成的后果。en face OCT對CSC的RPE和脈絡(luò)膜血管形態(tài)的分析,以及OCT血管成像(SSADA)對脈絡(luò)膜毛細(xì)血管血流的分析,正是本研究創(chuàng)新的核心之所在。
[Abstract]:Objective: through the en face and OCT OCT angiography (SSADA), observation of central serous chorioretinopathy (CSC) blood vessels in retinal pigment epithelium and choroidal morphology and choroidal capillaries, combined with fundus autofluorescence (FAF), fundus near-infrared fluorescence (NIA), frequency domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and other functional imaging changes, speculated that the pathophysiology of the disease may. Methods: the clinical diagnosis of primary central serous chorioretinopathy cases by fundus photography, fundus autofluorescence, fundus near infrared fluorescence spectral domain optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography, en face OCT and OCT angiography, observe the retinal pigment CSC. Change of vascular endothelial and choroidal morphology, blood flow and choroid. Results: FAF in the neuroepithelium showed low fluorescence angiography showed the leakage points which can be showed fluorescence enhancement, can be expressed as.NIA and FAF have similar fluorescence reduced the performance of the.SD-OCT can be clearly observed in the retinal nerve epithelium and pigment epithelial detachment (PED), some cases can also see out segment of photoreceptor outer retina detachment. The leakage point type FFA is the most common form, also can be observed in PED and retinal pigment epithelium (RPE) atrophic strong fluorescence with early and mid.ICGA angiography visible multifocal choroidal, late high the typical fluorescence spots, with weak fluorescence of the great vessels in en face OCT. In RPE, the area is the lack of signal part and SD-OCT part of.RPE from damage or loss, corresponding to both FFA and ICGA. The PED RPE or depigmentation, choroidal capillary under the RPE almost can exhibit expansion. Choroidal Sattler layer and Haller layer of vascular often focal or diffuse dilatation, and they can not completely consistent with.OCT angiography (SSADA) findings in patients with CSC and choroidal capillary blood flow increases, and the increase of the degree and scope of en face OCT can be higher than the observed results. Conclusion: FAF can be used to distinguish between acute and chronic recurrent CSC guidance CSC prognosis, can also help the physician to determine whether patients can benefit from laser treatment.NIA is more sensitive than FAF examination, can better reflect the leakage point shows the macular RPE cell phagocytosis and the metabolic function in.FFA has important guiding role of.ICGA display for subsequent laser photocoagulation or photodynamic therapy, choroidal vascular permeability in CSC patients is high, but in the specific recognition of choroid The morphological changes are relatively limited in the structure of the.En morphological image provided by faceOCT layers to observe the retinal and choroidal in the same area for certain, the lesion location, shape and range have a good presentation, evaluation contributes to disease progression and therapeutic effect. It is for the observation choroidal structure is better than that of axial OCT scanning images, can be observed in choroidal vascular dilatation, and the accumulation of extracellular fluid, and observed for choroidal neovascularization also provides a non-invasive method for.OCT angiography another diagnosis and treatment of CNV (SSADA) for choroidal blood flow. And the structural function and en face OCT is displayed completely synchronized presentation, choroidal blood flow and its sensitivity is higher than that of en face OCT.CSC enhancement may occur in vascular dilatation before vascular expansion It can be the consequences of blood flow enhancement..en face OCT analysis of CSC RPE and choroidal vessels morphology, and OCT angiography (SSADA) for choroidal capillary blood flow analysis is the core of this research.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R774.1

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