中心性浆液性脉络膜视网膜病变的现代影像学观察

发布时间：2018-03-23 00:23

本文选题：中心性浆液性脉络膜视网膜病变　切入点：多功能影像学改变　出处：《复旦大学》2014年博士论文　论文类型：学位论文

【摘要】：目的：通过en face OCT和OCT血管成像(SSADA),观察中心性浆液性脉络膜视网膜病变(CSC)中视网膜色素上皮和脉络膜血管的形态改变以及脉络膜毛细血管的血流情况,结合眼底自发荧光(FAF)、眼底近红外荧光(NIA)、频域光学相干层析成像(SD-OCT)、眼底荧光血管造影(FFA)、眼底吲哚青绿血管造影(ICGA)等多功能影像学改变,推测该疾病可能的病理生理机制。方法：临床确诊为初发中心性浆液性脉络膜视网膜病变的病例,经眼底彩色照相、眼底自发荧光、眼底近红外荧光、频域光学相干层析成像、眼底荧光血管造影、眼底吲哚青绿血管造影、en face OCT和OCT血管成像检查,观察CSC的视网膜神经上皮、色素上皮和脉络膜血管的形态改变,以及脉络膜的血流情况。结果：FAF在神经上皮脱离区表现为低荧光,造影显示的渗漏点既可表现为荧光增强,也可表现为荧光减低。NIA具有与FAF相似的表现。SD-OCT可清晰地观察到视网膜神经上皮及色素上皮脱离(PED),一些病例还可见到视网膜外层脱落的光感受器外节膜盘。渗漏点型是FFA最常见的形式,还可观察到PED和视网膜色素上皮(RPE)萎缩带。ICGA可见造影早期和中期的多灶性强荧光,晚期出现典型的脉络膜高荧光斑,伴有弱荧光的大血管影。在en face OCT中,RPE层面缺失信号的区域即为脱离或丢失的部分。RPE破坏的部位与SD-OCT、FFA及ICGA均有所对应。无论是PED还是RPE脱失,其RPE下的脉络膜毛细血管几乎均可呈现扩张状态。脉络膜Sattler层和Haller层血管往往表现局灶型或弥漫型扩张,且两者可不完全一致。OCT血管成像(SSADA)发现CSC患眼中脉络膜毛细血管血流增加,且其增加的程度和范围均可高于en face OCT所观察到的结果。结论：FAF可用于区分急性与慢性复发性CSC,指导CSC判断预后,还可帮助医师判断患者是否能从激光治疗中获益。NIA较FAF检查更为敏感,能更好地反映黄斑部RPE细胞的吞噬和代谢功能。FFA中显示的渗漏点对于后续激光光凝或光动力学治疗都具有重要的指导作用。ICGA显示,CSC患者的脉络膜血管通透性过高,但其在识别脉络膜特定形态改变时仍有一定的相对局限性。en faceOCT所提供的形态学图像可在同一区域内逐层观察视网膜至脉络膜的结构,对于病变的位置、形态及范围都有着良好的呈现,有助于疾病进展程度及治疗效果的评价。它对于脉络膜结构的观察更优于横断面OCT扫描图像,可观察到脉络膜血管的扩张,以及细胞外液的积聚,并且对于脉络膜新生血管的观察也提供了另一种诊断和处理CNV的非侵入性方法。OCT血管成像(SSADA)可获取脉络膜的血流情况,并且可将其所代表的功能与en face OCT所显示的结构完全同步呈现,且其敏感性高于en face OCT。CSC的脉络膜血流增强可能在血管扩张之前发生,即血管扩张可能是血流增强所造成的后果。en face OCT对CSC的RPE和脉络膜血管形态的分析,以及OCT血管成像(SSADA)对脉络膜毛细血管血流的分析,正是本研究创新的核心之所在。
[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.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R774.1

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