目的：开发细胞级高分辨率、结构与功能一体化的双模态全视场光学相干层析系统(full-field optical coherence tomography,FFOCT)，实现角膜缘组织的双模态FFOCT成像。方法：基于Linnik干涉成像原理，利用高数值孔径显微物镜(NA=0.8)及高速平面互补金属氧化物半导体(complementary metal oxide semiconductor,CMOS)相机，设计搭建高分辨率的组织静态结构和内源动态功能成像一体化双模态FFOCT系统；构建基于四相位调制结构影像提取及时域干涉信号动态频谱分析的功能影像重建算法；对人供体角膜缘组织开展各深度层的双模式FFOCT成像有效性验证。结果：搭建的双模态FFOCT成像系统可实现横向分辨率0.5 μ m，轴向分辨率1.7 μ m，成像视野320 μ m×320 μ m，相机采集速度100 Hz。系统实现角膜缘组织无外源标记情况下的细胞级分辨率三维结构和内源功能成像，FFOCT静态结构影像清晰显示角膜缘上皮、Vogt栅栏、隐窝、基质、血管及淋巴管等结构，FFOCT动态功能影像突出显示了代谢活跃细胞(角膜缘上皮细胞、免疫细胞等)。结论：双模态FFOCT高分辨率成像系统可提供角膜缘微观结构和活细胞无标记内源功能可视化信息，将为角膜缘疾病的研究及临床诊疗提供全新的成像分析技术。
Objective: To develop a cellular-level, high-resolution, integrated dual-modal full-field optical coherence tomography (FFOCT) system capable of simultaneously imaging the structure and function of limbus tissue. Methods: Utilizing the Linnik interference imaging principle, a high-resolution dual-modal FFOCT system was designed and constructed using a high numerical aperture (NA=0.8) microscope objective and a high-speed flat CMOS camera. A functional imaging reconstruction algorithm based on four-phase modulation structure image extraction and dynamic frequency spectrum analysis of temporal interference signals was developed. The effectiveness of dual-mode FFOCT imaging at various depth layers of human corneal limbal tissue was validated. Results: The constructed dual-modal FFOCT imaging system achieved lateral resolution of 0.5 μ m, axial resolution of 1.7 μ m, imaging field of view of 320 μ m × 320 μ m, and camera acquisition speed of 100 Hz. The system enabled cellular-level resolution three-dimensional structural and intrinsic functional imaging of corneal limbal tissue without exogenous labeling. Static structural FFOCT images clearly displayed limbal epithelium, palisades of Vogt, crypts, stroma, blood vessels, and lymphatic vessels, while dynamic functional FFOCT images highlighted metabolically active cells (limbal epithelial cells, immune cells, etc.). Conclusion: The dual-modal FFOCT high-resolution imaging system provides visualization of corneal limbal microstructural and live cell intrinsic functional information without labeling, offering a novel imaging analysis technique for research and clinical diagnosis and treatment of limbal diseases.
接触镜在全球的应用日益广泛，配适方法的不断进步是目前接触镜安全性、舒适性不断提高的原因之一。在接触镜适配过程中，越来越多的先进影像技术被运用于指导接触镜的配适，这些技术的出现简化了接触镜适配的过程，为临床医生进行简便、准确、个性化的接触镜适配提供了帮助，也为接触镜的个性化设计提供了参考数据。
Contact lens has been widely applied worldwide, and the advancement of fitting strategy is one of the reasons which improve the safety and comfort of contact lens fitting. During the contact lens fitting procedure, more and more ophthalmic imaging modalities have been applied to guide the contact lens fitting. These techniques simplify the contact lens fitting procedure, help optometrists accurately perform the customize contact lens fitting, and assist the personalized contact lens design technique.
慢性中心性浆液性脉络膜视网膜病变(cCSC)以广泛的脉络膜视网膜异常为特征，包括脉络膜血管扩张及其引发的弥漫性视网膜色素上皮病变和浆液性视网膜脱离，常累及黄斑区，引起视功能损害。传统观点认为其可能由急性CSC演变而来，但近期研究显示两者在临床上存在明显差异。其病情反复、迁延，预后较差。随着光学相干断层扫描血管造影(OCTA)、超广角成像和en face重建成像等新多模式影像(MMI)技术的出现和人工智能及机器学习的发展，更多有意义的cCSC影像学特征不断出现。文章详细介绍了cCSC在眼底成像、眼底自发荧光(FAF)、光学相干断层扫描(OCT)、眼底荧光素血管造影(FFA)、吲哚菁绿血管造影和OCTA等影像技术中的表现，并探讨了人工智能在识别CSC分类及其OCT 生物标志物等方面的应用。不同影像技术在cCSC的诊断和研究中各有优势，如FAF可能是评估疾病进展及变化的有效手段，OCT可更直观地观察视网膜结构的改变，FFA是识别渗漏点的重要检查手段，而OCTA可能是评估脉络膜微循环的的最佳手段等。这些MMI研究进展为深入了解cCSC的病理生理机制及临床特征提供了重要线索，有助于提高诊断的准确性和效率，改善患者的预后和生活质量。
Chronic central serous chorioretinopathy (cCSC) is characterized by extensive retinochoroidal abnormalities. This includes difuse retinal pigment epitheliopathy and serous retinal detachment associated with choroidal vasodilatation, ofen involving the macula and cause visual impairment. It was originally considered that it might evolve from acute CSC, but recent studies have shown significant clinical differences between the two. It tends to recur, be prolonged, and have an unfavorable prognosis. With the advent of new multimodal imaging (MMI) techniques such as optical coherence tomography angiography (OCTA), ultra-wide-feld imaging, and en face reconstruction imaging, along with the advancement of artificial intelligence and machine learning, more significant cCSC imaging characteristics have been constantly emerging. Tis article provides a comprehensive overview of cCSC’s imaging features across various modalities, including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), fuorescein angiography (FFA), indocyanine green angiography, and OCTA. It also explores the application of artifcial intelligence in identifying CSC classifications and OCT biomarkers. Different imaging techniques have their own advantages in the diagnosis and study of cCSC, such as FAF being an efective means to assess disease progression and changes, OCT providing a more intuitive observation of retinal structural changes, FFA being an important tool for identifying leakage points, and OCTA possibly being the best means to assess choroidal microcirculation. Tese MMI research advancements ofer crucial insights for clinicians, aiding in more accurate diagnosis and efective treatment, thereby potentially improving patient outcomes and quality of life.
目的：评估炎非感染性葡萄膜炎继发炎性脉络膜新生血管(inflammatory choroidal neovascularization, iCNV)的临床特征及眼底多模式影像表现。方法：采用回顾性观察性研究，采用眼底荧光素血管造影(fundus fluorescein angiography, FFA)、吲哚菁绿血管造影(Indocyanine green angiography, ICGA)、谱域相干光断层扫描(spectral domain optical coherence tomography, SD-OCT)联合光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)等多种眼底影像学方法，对纳入患者的眼底进行检查，分析非感染性iCNV的面积、分型、位置及形态等影像学特征与临床特征的关系。结果：研究共纳入39例患者，对48只患眼中的51处iCNV病灶进行了评估。纳入患者年龄为(35.28±13.62)岁。其中3例患眼出现多灶性CNV。SD-OCT显示92.16%(47/51)的iCNV为2型CNV，17.65%(9/51)的iCNV出现海绵征，13.72%(7/51)的iCNV伴有局灶脉络膜凹陷。ICGA造影期间，74.50%的iCNV病灶(38/51)伴有弱荧光病灶，25.49%的病例(13/51)显示脉络膜高通透性表现。OCTA enface图像显示iCNV形态多样，包括焦点状(15例，29.41%)、盘状/海扇状(16例，31.37%)、枯树状(9例，17.65%)、星状(9例，17.65%)及弥漫网状(2例，3.92%)。其中，枯树状及星状iCNV提示iCNV为非活动性(P＜0.01)。结论：非感染性iCNV与炎性病灶关系密切，在SD-OCT，ICGA上皆具特征性的影像表现。OCTA能直观地观察到iCNV的形态。这些多模式影像特征为临床医生提供了对于非感染性iCNV重要的鉴别诊断依据，有助于制定有效的诊疗方案。
Objective: To evaluate the clinical characteristics and multimodal imaging features of non-infectious inflammatory choroidal neovascularization (iCNV). Methods: In this study retrospective, observational study, multimodal imaging examinations, including fluorescein angiography (FFA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA), were used to observe the morphology of non-infectious iCNV in patients diagnosed with uveitis. The area of iCNV, CNV types, CNV morphology and other imaging characteristics were further analyzed. Results: A total of 39 patients were included, with 48 affected eyes and 51 iCNV were identified. The average age of the included patients was 35.28±13.62 years. Among the affected eyes, 3 presented with multifocal CNV, and 92.16% of iCNV were classified as type 2 CNV. iCNV exhibited diverse morphologies, including focal-like pattern (15 cases, 29.41%),sea-fan pattern(16 cases, 31.37%), dead-tree pattern CNV(9 cases, 17.65%), stellar pattern (9 cases, 17.65%), and diffuse reticular (2 cases, 3.92%). Notably, tree-like and stellar pattern iCNV showed a significant correlation with non-active CNV (P < 0.01). Conclusions: Non-infectious iCNV is closely related to inflammatory lesions, exhibiting characteristic imaging features on SD-OCT and ICGA. OCTA allows for direct observation of the morphology of iCNV. These multimodal imaging characteristics provide important diagnostic criteria for clinicians, aiding in the formulation of effective treatment plans.
随着多模式影像技术的应用，年龄相关性黄斑变性(age related macular degeneration, AMD)的一种特殊亚型：表皮玻璃疣(cuticular drusen)被发现，其与AMD尤其是非渗出性AMD又称干性(dry)AMD进展密切相关。但目前聚焦于AMD合并表皮玻璃疣的多模式影像特点等的相关文献较少，因此研究和阐明表皮玻璃疣的多模式影像特点、与其他AMD亚型玻璃疣的鉴别诊断、病理生理机制、治疗方法等具有重要的临床意义。运用多模式影像可以看到表皮玻璃疣呈双眼对称的无数散在的大小均匀的黄色视网膜下结节，典型的“星空状”荧光素钠眼底血管造影(fundus fluorescein angiography, FFA)表现， 以及光学相干断 层成像(optical coherence tomography, OCT)中视网膜色素上皮(retinal pigment epithelium, RPE)和Bruch膜之 间的锯齿状隆起。AMD合并表皮玻璃疣患者的分布特点个体差异很大，容易与AMD其他亚型的玻璃疣混淆，需要与硬性玻璃疣、软性玻璃疣、大胶质玻璃疣、Sorsby眼底营养不良(Sorsby's fundus dystrophy , SFD) 等相鉴别。研究表明表皮玻璃疣具有遗传性的类似动脉粥样硬化的发病机制，与RPE分泌的大型脂蛋白颗粒的堆积密切相关。未来可能会有针对补体系统的药物用于延缓表皮玻璃疣相关病变的进展。文章就表皮玻璃疣的临床表现、多模式影像的典型特点、鉴别诊断、遗传学基础、病理生理学发病机制、 并发症以及临床诊疗策略进行综述。
With the application of multimodal imaging techniques, a specific subtype of age-related macular degeneration (AMD),
known as cuticular drusen, has been identified. This subtype is closely associated with the progression of AMD, particularly non-exudative AMD, also referred to as dry AMD. However, there is a scarcity of literature focusing on the multimodal imaging characteristics of AMD combined with cuticular drusen. Therefore, studying and elucidating the multimodal imaging features of cuticular drusen, its differential diagnosis from other AMD subtypes of drusen, pathophysiological mechanisms, and treatment methods holds significant clinical importance. Multimodal imaging reveals cuticular drusenas numerous, symmetrical, evenly sized, yellow subretinal nodules in both eyes, exhibiting a typical "stars-in-the-sky" appearance on fluorescein angiography (FFA) and zigzag elevations between the retinal pigment epithelium (RPE) and Bruch's membrane on optical coherence tomography (OCT). The distribution characteristics of AMD patients with cuticular drusen vary greatly among individuals and can easily be confused with drusen from other AMD subtypes, so the differentiation from hard drusen, soft drusen, large colloidal drusen, and Sorsby's fundus dystrophy (SFD) is necessary. Studies suggest that cuticular drusen have a genetic, atherosclerosis- like pathogenesis which closely related to the accumulation of large lipoprotein particles secreted by the RPE. Future therapies targeting the complement system maybe employed to delay the progression of cuticulardrusen-related lesions. This article reviews the clinical manifestations, typical multimodal imaging features, differential diagnosis, genetic basis, pathophysiological mechanisms, complications, and clinical management strategies of cuticulardrusen.
肥厚型脉络膜谱系疾病(pachychoroid disease, PCD)是一组以病理性脉络膜增厚为共同特征的疾病谱系。其特征性改变包括Haller层脉络膜血管扩张，脉络膜毛细血管层和Sattler层变薄，以及肥厚血管(pachyvessels)上视网膜色素上皮(retinal pigment epithelium, RPE)的异常。PCD主要包括单纯肥厚型脉络膜病变(uncomplicated pachychoroid, UCP)、肥厚型脉络膜色素上皮病变(pachychoroid pigment epitheliopathy, PPE)、中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC)、肥厚型脉络膜新生血管病变(pachychoroid neovasculopathy, PNV)和息肉状脉络膜血管病变(polypoidal choroidal vasculopathy, PCV)。传统眼底检查因单张成像局限于后极部，难以全面评估病变范围。广角影像技术突破了这一局限，其成像范围覆盖后极部至赤道部涡静脉壶腹部(约60°~100°)，而超广角成像更可达后极部至锯齿缘(约 110°~220°)。这一技术的进步不仅扩大了PCD眼底病灶的观察范围，更提升了对脉络膜结构和功能的评估能力，为深化研究PCD的发病机制提供了新的视角。近年来，基于深度学习的人工智能技术在PCD辅助诊断方面取得重要突破，展现出优异的PCD相关疾病识别和分类能力，有助于显著提升基层医疗机构诊断效率，并推动医疗资源优化配置。文章综述了广角眼底影像技术在PCD评估与诊断中的研究进展，旨在为眼科临床工作者和研究者提供最新的技术应用视角，并为进一步探索PCD的病理机制和诊疗方法奠定科学基础。
Pachychoroid disease (PCD) represents a group of disorders characterized by pathological choroidal thickening. The characteristic changes include dilated choroidal vessels in Haller's layer, thinning of the choriocapillaris and Sattler's layer, and retinal pigment epithelium (RPE) abnormalities overlying the pachyvessels. The PCD primarily encompasses uncomplicated pachychoroid (UCP), pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV), and polypoidal choroidal vasculopathy (PCV). Traditional fundus examination is limited to the posterior pole in single-frame imaging, making it challenging to comprehensively evaluate the extent of lesions. Wide-field imaging technology has overcome this limitation, with its imaging range covering from the posterior pole to the ampulla of vortex veins at the equator (approximately 60-100°), while ultra-wide-field imaging can extend from the posterior pole to the pars plana (approximately 110-220°). This technological advancement has not only expanded the observation range of PCD fundus lesions but also enhanced the assessment capabilities of choroidal structure and function, providing new perspectives for investigating PCD pathogenesis. In recent years, deep learning-based artificial intelligence technology has achieved significant breakthroughs in PCD-assisted diagnosis, demonstrating excellent capability in identifying and classifying PCD-related diseases. This has contributed to significantly improving diagnostic efficiency in primary healthcare institutions and optimizing medical resource allocation. This review summarizes the advances in wide-field fundus imaging technologies for the assessment and diagnosis of PCD.
眼底老化是年龄相关性黄斑变性(age-related macular degeneration, AMD)发生和进展的关键因素及病理基础，在组织病理学上主要表现为脉络膜毛细血管萎缩、布鲁赫膜(Bruch's membrane, BrM)增厚以及视网膜色素上皮(retinal pigment epithelium, RPE)异常。BrM增厚可由多种眼底老化沉积物聚集引起，在AMD的病理机制中具有重要作用。其中，基底薄层沉积物(basal laminar deposit, BLamD)代表了RPE基底膜的弥漫性增厚，通常作为一种正常眼底老化改变。而以酯化和未酯化胆固醇等中性脂质为主的RPE基底膜下沉积物，即基底线性沉积物(basal linear deposits, BLinD)和软性玻璃膜疣，均可参与破坏脉络膜与外层视网膜间物质交换稳态，造成外层视网膜缺血、缺氧及氧化应激，是AMD早期重要病理改变。硬性玻璃膜疣主要分布于周边视网膜，多见于正常老化眼底；表皮玻璃膜疣是RPE基底膜局灶性结节状增厚的结果，眼底表现与硬性玻璃膜疣相似，但其主要分布于后极部，数量更多且密度更高。近年来逐渐加深了对视网膜下玻璃膜疣样沉积物(subretinal drusenoid deposit, SDD)的认识和研究，其是位于RPE上方的沉积物，在AMD发病机制中亦具有深刻意义。文章就几种眼底老化相关沉积物(包括硬性玻璃膜及表皮玻璃膜疣)的病理特征和多模态影像学表现进行综述，旨在帮助认识和理解这些沉积物的眼底表现、病理特征和形成机制，以及在AMD发生及进展中的临床意义。
Fundus aging is a key factor and pathological basis for the development and progression of age-related macular degeneration (AMD), which is histopathologically characterized by choroidal capillary atrophy, Bruch’s membrane (BrM) thickening, and abnormalities of retinal pigment epithelium (RPE). BrM thickening can be induced by the aggregation of age-related fundus deposits and plays an essential role in the pathogenesis of AMD. Basal laminar deposits (BLamD) represent diffuse thickening of the basement membrane of RPE, usually considered to be a normal fundus aging. Basal linear deposits (BLinD) and soft drusen, mainly composed of neutral lipids such as esterified and unesterified cholesterol, can disrupt the homeostasis of material exchange between the choroid and the outer retina, resulting in ischemia, hypoxia, and oxidative stress in the outer retina, which are important pathological changes in the early AMD. Hard drusen is mainly distributed in the peripheral retina and is very common in aging fundus; Cuticular drusen are resulted from focal nodular thickening of the basement membrane of RPE, with similar appearance as hard drusen, but mainly distributed in the posterior pole and more numerous and denser. Recently, our understanding of subretinal drusenoid deposits (SDD), deposits above the RPE, has been gradually deepened and it also has profound significance in the pathogenesis of AMD. In this review, we presented the pathologic features and multimodal imaging of age-related fundus deposits (including hard drusen and cuticular drusen), aiming to help recognize and understand the manifestations, pathologic features, and formation mechanisms of these deposits, as well as their clinical significance in the development and progression of AMD.
目的：探讨出血型视网膜大动脉瘤及合并症的红外光反射成像（infrared light reflection, IR）和眼底荧光血管造影（fundus fluorescein angiography, FFA）的影像特征。方法：采用回顾性病例系列研究。收集2010年2月—2024年6月在河南省立眼科医院确诊的出血型视网膜大动脉瘤患者35例35眼，所有眼均行IR联合FFA检查，其中10眼行吲哚菁绿血管造影（indocyanine green angiography, ICGA）检查，分析视网膜大动脉瘤及其合并症的眼底影像学特点。结果：IR检查显示34眼视网膜大动脉瘤体呈囊状反射光。FFA检查显示27眼视网膜大动脉瘤呈囊样强荧光，此外，FFA检查还发现5眼伴视网膜分支静脉阻塞，1眼伴视网膜分支动脉阻塞。FFA组在视网膜大动脉瘤检出率低于IR组(P <0.05)。在10眼出血型视网膜大动脉瘤中，IR组和ICGA组在视网膜大动脉瘤检出率方面比较差异无统计学意义(P >0.05)。结论：IR检查对于出血型视网膜动脉瘤的检测可等效于ICGA检查，IR联合FFA检查适合于出血型视网膜大动脉瘤及合并症的个体化诊断。
Objective: To evaluate the imaging characteristics of infrared light reflection (IR) and fundus fluorescein angiography (FFA) in hemorrhagic retinal artery aneurysm and its complications. Methods: Retrospective case series study was used. The clinic data of 35 patients (35 eyes) were diagnosed in Henan Eye Hosptial from February 2010 to June 2024. All eyes were examinated by IR and FFA, and 10 eyes examinated by indocyanine green angiography (ICGA). The fundus imaging characteristics of hemorrhagic retinal artery aneurysm and its complications was analyzed. Results: The images of IR presented 34 eyes with cystic strong reflex light. FFA showed 27 eyes with cystic strong fluorescence, in addition, FFA revealed 5 eyes with retinal branch vein occlusion and 1 eye with retinal branch artery occlusion. The detection rate of hemorrhagic retinal artery aneurysm in the FFA group was lower than that in the IR group (P =0.038<0.05). There was no significant difference in the detection rate of hemorrhagic retinal artery aneurysm between the IR group and the ICGA group in 10 eyes with hemorrhagic retinal artery aneurysm (P =1.000>0.05). Conclusion: IR examination could be equivalent to ICGA examination for detecting hemorrhagic retinal artery aneurysm, and IR combined with FFA examination is suitable for individualized diagnosis of hemorrhagic retinal artery aneurysm and its complications.
目的：探讨白塞病性葡萄膜炎(Behçet's uveitis, BU)并发视盘新生血管(neovascularization of the optic disc, NVD)和(或)视盘以外视网膜新生血管(retinal neovascularization elsewhere, NVE)的临床及影像特征。方法：回顾性分析2022年1月—2024年9月就诊的BU并发NVD和(或)NVE患者的临床资料和眼底影像学检查结果，包括眼底彩照、荧光素眼底血管造影(fluorescein fundus angiography, FFA)、光学相干断层成像(optical coherence tomography, OCT)和光学相干断层血管成像(OCT angiography, OCTA)。并分析NVD和(或)NVE面积与患眼的改良的眼后段炎症评分以及视网膜血管渗漏评分的相关性。结果：共纳入27例患者(30只眼)，年龄为(27.70±12.58)岁，男女比例约为1:1。3例(11%)患者双眼并发NVD和(或)NVE；25只眼(83%)存在NVD：17只眼(57%)仅有NVD；8只眼(27%)存在NVD和NVE。仅2只眼(7%)存在视网膜无灌注区，7只眼(23%)同时发生玻璃体积血。FFA眼后段炎症评分为(20.93±4.37)分。FFA血管渗漏评分为(7.57±1.25)分。NVD和(或)NVE面积与眼后段炎症评分(rs = 0.403，P = 0.027)及视网膜血管渗漏评分(rs = 0.518，P = 0.003)均呈正相关。FFA与OCTA在检测NVD和NVE上表现完全一致(κ= 1.0)。结论：BU并发NVD和(或)NVE并不罕见，以NVD为主，绝大多数与视网膜无灌注不相关，可能由BU炎症诱发。
Purpose: To investigate the clinical and imaging characteristics of retinal neovascularization of the optic disc (NVD) and/or elsewhere in the retina (retinal neovascularization elsewhere, NVE) in eyes with Behçet's uveitis (BU). Methods: This retrospective analysis reviewed the clinical data and fundus imaging findings of patients diagnosed with BU complicated by NVD and/or NVE from January 2022 to September 2024. Imaging modalities included fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). The study analyzed the correlation between the areas of NVD and/or NVE and the modified posterior segment inflammation scores, as well as retinal vascular leakage scores of the affected eyes. Results: The study included 27 patients (30 eyes) with an average age of (27.70 ± 12.58) years and a gender ratio of approximately 1:1. Bilateral NVD and/or NVE was observed in three patients (11%); 25 eyes (83%) had NVD, of which 17 eyes (57%) had only NVD and 8 eyes (27%) had both NVD and NVE. Two eyes (7%) showed areas of retinal non-perfusion, and seven eyes (23%) had concurrent vitreous hemorrhage. The average score for posterior segment inflammation on FFA was 20.93 ± 4.37, and the average score for vascular leakage was 7.57 ± 1.25. There was a significant positive correlation between the area of NVD and/or NVE and both the inflammation score (rs = 0.403, P = 0.027) and the vascular leakage score (rs = 0.518, P = 0.003). FFA and OCTA showed perfect agreement in detecting NVD and NVE (κ = 1.0). Conclusion: NVD and/or NVE in BU are not uncommon and are predominantly presented as NVD, mostly not associated with retinal nonperfusion, likely induced by inflammatory factors related to BU.
目的：研究IgG4相关性眼病(IgG4-related ophthalmic disease, IgG4-ROD)患者的影像学特征与外周血免疫球蛋白G4(IgG4)水平之间的相关性，为评估IgG4相关性疾病全身性严重程度提供新思路。方法：收集2023年8月—2024年9月在吉林大学第二医院眼科医院经术后组织标本病理确诊的29例IgG4-ROD阳性患者。回顾性分析患者眼眶影像学特点与血清IgG4水平相关性，探讨影像学中特征性表现包括泪腺肿大、三叉神经分支增粗、眼外肌增粗、鼻黏膜类炎症改变、眼睑软组织肥厚，以及其他眶内软组织增生等特征性影像学改变出现比例，并按照累及组织结构情况分级评分，评估特征性影像学改变与血清IgG4水平之间的相关性。结果：29例病理确诊IgG4-ROD患者中，泪腺均受累，占比100%；眼外肌受累17例，占比58.62%；三叉神经分支受累5例(4例眶下神经受累，3例额神经病受累，2例眶下神经与额神经同时受累)，占比17.24%眼睑软组织肥厚24例，占比82.76%鼻黏膜出现类炎症反应15例，占比51.72%；合并眶内其他软组织增生性病变2例，占比6.90%。影像学中特征性受累组织结构分级评分与血清IgG4水平呈正相关(P < 0.05)。结论：IgG4-ROD影像学中特征性组织结构受累及范围与血清IgG4水平明显相关，可以辅助评估IgG4相关性疾病全身性严重程度。
Objective: To investigate the correlation between the imaging characteristics of patients with IgG4-related ophthalmic disease (IgG4-ROD) and the serum immunoglobulin G4 (IgG4) levels, providing new insights for assessing the systemic severity of IgG4-related diseases. Methods: This study collected postoperative tissue samples from 29 patients with histopathologically conffrmed IgG4-ROD at the Ophthalmology Department of Jilin University Second Hospital from August 2023 to September 2024. TTis study retrospectively analyzed the correlation between patients' orbital imaging features and serum IgG4 levels, and explored the proportion of characteristic imaging changes including enlargement of the lacrimal gland, thickening of the trigeminal nerve branches, thickening of the extraocular muscles, inffammatory like changes of the nasal mucous membranes, hypertrophy of the eyelid soft tissues, as well as hyperplasia of other intraorbital soft tissues in the imaging. A grading score for affected tissue structures was established to evaluate the correlation between characteristic imaging changes and serum IgG4 levels. Results: Among the 29 patients diagnosed with IgG4-ROD, lacrimal gland involvement was observed in all patients (100%). Extraocular muscle involvement was present in 17 patients (58.62%). Five patients had involvement of the trigeminal nerve branches (including 4 with infraorbital nerve involvement and 3 with frontal nerve involvement, with 2 patients having simultaneous involvement of both nerves), accounting for 17.24% of the cases. Eyelid soff tissue hypertrophy was observed in 24 patients (82.76%), and nasal mucosal inflammatory responses were noted in 15 patients (51.72%). Additionally, two patients (6.90%) presented with other proliferative lesions within the orbit. The correlation analysis between the grading scores for imaging features and serum IgG4 levels demonstrated a significant positive correlation. Conclusions: The extent of characteristic structural involvement observed in the imaging features of IgG4-ROD is significantly correlated with serum IgG4 levels. TTis correlation can assist in evaluating the systemic severity of IgG4-related diseases and provides clinical evidence supporting the need for comprehensive systemic evaluations, such as PET-CT, in patients whose initial presentation is IgG4-related ophthalmic disease.
