囊样黄斑水肿的眼底自发荧光分析研究
发布时间：2019-01-15 06:41
【摘要】：背景与目的 囊样黄斑水肿(cystoid macular edema, CME)是一种常见的眼底病变,但它不是一类独立的疾病,而是由多种眼底疾病导致的。目前光学相干断层扫描(optical coherence tomography,OCT)和眼底荧光血管造影(fluorescein angiography,FA)是诊断CME的主要方法。眼底自发荧光(autofluorescence,AF)作为一种快速无创的技术近十年来得到了快速发展成为了眼底病方面的热点。但是由于黄斑部本身具有的色素干扰了眼底自发荧光的观察,故临床上对CME的眼底自发荧光表现研究较少。本文旨在研究CME的眼底短波自发荧光(shortwave-autofluorescence,SW-AF)影像特点及其临床应用价值。 方法 横断面研究140例(189眼)患者,所有入选患者均有易引起黄斑囊样水肿的原发眼病或内眼手术史,其中经OCT确诊为CME者98例(129眼),OCT检查无CME者31例(60眼),所有患者散瞳后进行SW-AF-红外光自发荧光(Infrared-autofluorescence, IR-AF)、FA、OCT检查,SW-AF图片的采集在未静脉注射造影剂的情况下采用共焦扫描激光检眼镜对后极部30°范围进行分辨率为512*512像素的扫描,激发光为488nm蓝光,光栅为500nm,分析CME的SW-AF图像特点。以OCT为CME诊断的金标准,计算SW-AF诊断试验的灵敏度、特异度等指标；研究CME患眼中SW-AF图像真阳性与假阴性表现者其ILM-RPE厚度有无区别：研究CME患眼SW-AF图像阳性者其图像中中心凹囊样高荧光的相对灰度值与中心凹最大ILM-RPE厚度的关系,分析是否存在相关性。SW-AF图像的灰度值测定通过photoshop cs5.0软件,统计采用SPSS13.0软件,统计方法包括x2检验,独立样本t检验,相关分析及一元线性回归。 结果 129眼经OCT确诊为CME的患眼在SW-AF图像中表现为黄斑中心凹部位一个或数个囊样、花瓣样高荧光,形态同晚期FFA的囊样荧光积存相似。CME在IR-AF图像中只有少数29眼(22.48%)能体现出囊样改变,同SW-AF相比,两者在诊断CME的敏感度上的差异有统计学意义,P0.001(X2检验)。以OCT作为CME诊断金标准,SW-AF诊断CME的敏感度为78.29%,特异度为96.67%,约登指数0,75,阳性预测值98.06%,阴性预测值67.44%,阳性似然比3.61,阴性似然比0.03,符合率84.13%,AUC为0.875,95%可信区间0.823-0.926,P值0.001,说明该诊断性实验具有一定的准确性。SW-AF诊断真阳性的平均中心凹最大ILM-RPE厚度为500.36±132.62um,SW-AF诊断假阴性的平均中心凹最大ILM-RPE厚度为316.35±79.92um,两组中心凹最大ILM-RPE厚度差异有统计学意义,P0.001(独立样本t检验)。以中心凹囊样高荧光的RGSR值与中心凹最大ILM-RPE厚度值绘制散点图示两者存在线性相关趋势,行相关分析示相关系数为0.846,两变量有相关性,P0.01,回归分析示r2=0.717,回归方程Y=0.0003773X+0.633。 结论 SW-AF是一种快捷安全无创的诊断CME的手段,具有一定的诊断价值,其自发荧光的表现同中心凹视网膜厚度有关,可以通过对自发荧光图像灰度分析来推断中心凹视网膜厚度。
[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 掳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 卤132.62 um.SW-AF with false negative ILM-RPE thickness was 316.35 卤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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.5
本文编号：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 掳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 卤132.62 um.SW-AF with false negative ILM-RPE thickness was 316.35 卤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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.5
【共引文献】
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