综述

肥厚型脉络膜谱系疾病的广角眼底影像研究进展

Advances in wide-field fundus imaging for pachychoroid disease

:179-188
 
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.
综述

急性渗出性多形性卵黄样黄斑病变临床研究进展

Clinical research progress on acute exudative polymorphous vitelliform maculopathy

:171-178
 
急性渗出性多形性卵黄样黄斑病变(acute exudative polymorphous vitelliform maculopathy, AEPVM)是一种在临床较为罕见的眼底疾病,主要表现为黄斑区神经上皮脱离以及后极部卵黄样物质的沉积。至今,其具体发病机制仍未完全明确,但可能与全身感染、自身免疫反应或副肿瘤综合征等因素密切相关。在临床表现上,患者往往会出现轻微视力减退或畏光等症状,眼底后极部可见斑点状黄白色病灶,这些病灶在自发荧光中呈现相对较高的自发荧光。荧光素眼底血管造影时,病灶区域通常不会出现荧光素渗漏现象。OCT检查能够揭示椭圆体带的显著增厚以及神经上皮层内囊腔样改变。迄今为止,对于这一疾病的治疗尚未有确立的方案。文章综述了AEPVM的临床表现、影像学特征、诊断及鉴别诊断、发病机制以及治疗方面的最新研究进展。急性渗出性多形性卵黄样黄斑病变的自然病程复杂多样,其诊断与鉴别诊断仍面临重大挑战,深入掌握该疾病的临床表现与影像学特征,对于未来深化对其发病机制的理解及开发有效治疗策略具有重要意义。
Acute Exudative Polymorphous Vitelliform Maculopathy (AEPVM) is a clinically rare fundus disease characterized primarily by neurosensory detachment in the macular area and accumulation of vitelliform material in the posterior pole. The exact cause is unclear and may be related to systemic infections, autoimmune responses, or paraneoplastic syndromes. Clinical manifestations usually include mild vision loss or photophobia, and yellow-white deposits can be seen in the posterior pole of the fundus, exhibiting relatively higher autofluorescence in spontaneous fluorescence. Fundus fluorescein angiography typically does not show leakage of fluorescein in the lesion area. Optical coherence tomography (OCT)examination can reveal thickening of the ellipsoid zone and cystic changes within the neurosensory layer. Currently, there is no explicit treatment plan. This article reviews the clinical presentation, imaging characteristics, diagnosis and differential diagnosis, pathogenesis, and treatment-related research progress of acute exudative polymorphous vitelliform maculopathy. In summary, the natural course of acute exudative polymorphous vitelliform maculopathy is complex and diverse, and its diagnosis and differential diagnosis remain challenging. A deeper understanding of the clinical presentations and imaging characteristics of acute exudative polymorphous vitelliform maculopathy will facilitate further research and exploration to clarify its pathological mechanisms and identify effective treatment methods in the future.
综述

眼底老化相关沉积物的病理、多模态影像及临床意义

Pathology, multimodal imaging and clinical significance of age-related fundus deposits

:155-170
 
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.
综述

先天性静止性夜盲疾病谱及其基因型—表型研究现状与进展

Congenital stationary night blindness: an update and review of the disease spectrum and genotype-phenotype correlations

:144-154
 
CSNB是一组高度异质的遗传性视网膜疾病(inherited retinal disease, IRD),主要由视网膜光感受器细胞和双极细胞间的信号传导障碍引发。其主要临床特征为静止性夜盲和暗适应功能障碍,常伴有早发性近视、眼球震颤、斜视和远视等症状,ERG在CSNB的诊断、分型及治疗指导中起着至关重要的作用。尽管CSNB发病率低,属于罕见病,但其真实发病率可能被低估,部分原因在于其症状轻微、眼底表现多不明显,且临床常忽视视网膜功能检查,导致较高的漏诊和误诊率。随着分子遗传学技术的进步,大量研究揭示了CSNB不同基因缺陷的致病机制,特别是与早发近视的关联机制,这些研究同也增加了对视网膜信号传导和近视发病机制的理解。然而,CSNB的基因治疗仍处于早期阶段。本综述旨在全面探讨CSNB的疾病谱,包括不同类型患者的临床表现、影像学和功能学表型特征,以及相关遗传学致病机制,并总结基因型与表型的关联。同时,综述最新研究成果与未来发展方向,旨在提高国内学者对CSNB的认识,为临床诊断和治疗提供参考,并为后续研究提供新思路。
Congenital Stationary Night Blindness (CSNB) represents a group of highly heterogeneous inherited retinal diseases (IRDs) primarily caused by impaired signal transmission between photoreceptor cells and bipolar cells in the retina. The main clinical features include stationary night blindness and dark adaptation dysfunction, often accompanied by early-onset myopia, nystagmus, strabismus, and hyperopia. Electroretinography (ERG) plays a crucial role in the diagnosis, classification, and therapeutic management of CSNB. Although CSNB is classified as a rare disease due to its low incidence, its true prevalence is likely underestimated, partly because of its mild symptoms, inconspicuous fundus manifestations, and frequent oversight of retinal function tests in clinical practice, leading to high rates of underdiagnosis and misdiagnosis. With advances in molecular genetics, extensive research has elucidated the pathogenic mechanisms of various genetic defects in CSNB, particularly those associated with early-onset myopia. These studies have also enhanced our understanding of retinal signal transduction and the pathogenesis of myopia. However, gene therapy for CSNB remains in its early stages. This review aims to comprehensively explore the disease spectrum of CSNB, including clinical manifestations, imaging and functional phenotypic characteristics across different subtypes, and associated genetic pathogenic mechanisms. We also summarize genotype-phenotype correlations, review the latest research advancements, and discuss future directions. By doing so, this review seeks to improve the understanding of CSNB among domestic researchers, provide guidance for clinical diagnosis and treatment, and offer new insights for future research.
综述

视盘倾斜综合征研究现状及进展

Research status and progress of tilted optic disc syndrome

:135-143
 
视盘倾斜综合征(tilted disc syndrome, TDS)是一种以视盘形态和位置异常为主要特征的先天性眼底异常。其典型表现为视盘呈椭圆形、向下或向鼻侧倾斜,并伴随着周围脉络膜和视网膜色素上皮的发育异常。这些解剖结构的改变对患者的视功能产生深远的影响,并可能导致一系列眼部并发症的发生,如视盘旁高反射卵圆样团块状结构、脉络膜血管病变以及黄斑区病变等。在TDS的诊断过程中,通常依赖于眼底检查、光学相干断层扫描以及视野检查等多种方法的结合,以全面评估视盘的形态和功能。尽管TDS的研究已有多年,但其确切的发病机制尚不完全明确。现有研究表明,遗传因素、发育异常以及环境因素可能在TDS的发生中发挥重要作用。此外,TDS与其他眼部疾病之间的关系也是当前研究的热点问题。例如近视性视盘倾斜、视盘水肿、青光眼、视神经肿瘤等疾病在临床上常常需要与其进行鉴别诊断,以确保患者能够获得准确的诊断和适当的治疗。文章旨在全面回顾TDS的研究进展,包括其定义、流行病学特征、病理生理机制、相关视功能异常、诊断方法以及相关并发症,以期使临床医生更好地理解这一疾病的特征和机制,从而为患者的临床管理和治疗方案提供更为全面的指导。
Tilted disc syndrome (TDS) is a congenital retinal abnormality characterized primarily by the abnormal shape and position of the optic disc. Its typical presentation includes an oval-shaped optic disc that is tilted downward or nasally, accompanied by developmental anomalies of the surrounding choroid and retinal pigment epithelium. These anatomical changes can have profound effects on the visual function of patients and may lead to a range of ocular complications, such as peripapillary hyper reflective ovoid mass-like structures (PHOMS), choroidal vascular lesions, and macular region pathologies. In the diagnostic process of TDS, a combination of methods is typically employed, including fundus examination, optical coherence tomography (OCT), and visual field testing, to comprehensively assess the morphology and function of the optic disc. Despite years of research on TDS, its exact pathogenesis remains not fully understood. Existing studies suggest that genetic factors, developmental abnormalities, and environmental influences may play significant roles in the occurrence of TDS. Furthermore, the relationship between TDS and other ocular diseases is also a current area of research interest. For instance, conditions such as myopic tilted disc, optic edema, papilledema and optic nerve tumors often require differential diagnosis in clinical practice to ensure that patients receive accurate diagnoses and appropriate treatments. This review aims to provide a comprehensive overview of the research progress on TDS, including its definition, epidemiological characteristics, pathophysiological mechanisms, associated visual function abnormalities, diagnostic methods, and related complications. The goal is to enhance clinical understanding of the features and mechanisms of this condition, thereby providing more comprehensive guidance for the clinical management and treatment strategies for patients.
论著

出血型视网膜大动脉瘤及合并症的红外光反射成像和眼底血管造影的影像特征

The imaging characteristics of infrared light reflection and fundus angiography in hemorrhagic retinal artery aneurysm and its complications

:127-134
 
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(<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(>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 (=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 (=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.
论著

玻璃体切除术联合地塞米松玻璃体内植入剂治疗黄斑前膜的临床疗效分析

Clinical analysis of vitrectomy combined with dexamethasone intraveal implant in the treatment of epiretinal membrane

:113-126
 
目的:对比玻璃体切割术(pars plana vitrectomy, PPV)联合或不联合注射地塞米松玻璃体内植入剂(dexamethasone intraveal implant, DEX)治疗特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)的临床疗效。
方法: 采用回顾性研究设计,收集2022年1月—2023年6月于惠州市中心人民医院就诊,被
诊断为IMEM(Gass 2期)并行PPV联合phaco+IOL植入的患者49例(49只眼)。根据其治疗方案分为非联合注射DEX组(25例共25只眼)及联合注射DEX组(24例共24只眼)。记录所有患者术前术后的最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度(central macular thickness, CMT)、平均神经节细胞层(ganglion cell layer, GCL)厚度,椭圆体带(ellipsoidal zone, EZ)完整性。使用OCTA测量视网膜浅层毛细血管层(superficial capillary plexus, SCP)、中心区域血管密度(vessel densities, VDs)及中心凹无血管区(foveal avascular zone, FAZ)面积。使用非接触性眼压计测量患者眼压。随访至术后6个月,记录上述指标,其中BCVA及CMT随访至1年。使用SPSS 29.0软件进行数据的统计分析(独立样本t检验、Mann-Whitney U检验、Pearson χ2检验等)。使用重复测量方差检验分析各项指标的时间差异及交互差异性。采用线性回归分析CMT、平均GCL厚度、EZ完整性、VDs、FAZ面积及联合注射DEX与BCVA的相关性。
结果:本研
究两组间性别、年龄、眼压及术前各项指标差异均无统计学意义(P>0.05)。两种术式均能改善黄斑区结构、功能及微循环障碍,术后的BCVA在两组患者中均较术前有所改善,且持续至术后6个月,CMT的变化趋势同BCVA有高度一致性,而平均GCL厚度于术后3个月时开始恢复,而SCP中心凹VDs及FAZ面积于术后6个月时才有明显恢复,两种术式术后以上各指标均具有时间差异及交互差异性(P≤0.015),且6个月内联合注射DEX组表现更佳(P=0.036)。相较于非联合注射DEX组,只有联合注射DEX组在术后6个月时,EZ完整性的改善具有统计学意义(P=0.009)。但随访至1年时,两组之间BCVA及CMT差异均无统计学意义(P=0.079)。术后6个月内BCVA的改善与术后6个月的CMT、平均GCL厚度、SCP中心凹VDs、FAZ面积的改善及EZ完整性及是否注射DEX与术后6个月内BCVA的改善均有相关性。随访期间两组患者均未发生眼内炎、玻璃体积血、视网膜脱离等眼部或全身严重并发症。
结论:微创玻璃体切割术联合
玻璃体内注射DEX治疗相较于非联合注射DEX治疗组在6个月内疗效更佳。联合单次注射DEX治疗方案与非联合注射DEX治疗方案相比,在手术1年后对BCVA及CMT的改善无明显差异。
Objective: To analyze the efficacy and safety of minimally invasive vitrectomy (PPV) with or without intraoperative injection of dexamethasone intravitreal implant (DEX) for the treatment of Idiopathic Macular Epiretinal Membrane (IMEM), by comparing the relevant indicators.
Methods: A retrospective study design was used to collect 49 patients (49 eyes) who were diagnosed with IMEM (Gass2) and underwent surgical treatment(PPV+phaco+IOL implantation) at Huizhou Central People’s Hospital from January 2022 to June 2023. According to their treatment plan, they were divided into a non-combined injection DEX group (25 cases, 25 eyes) and a combined injection DEX group (24 cases,24 eyes). All patients underwent comprehensive optometry before and after surgery, and their best corrected visual acuity (BCVA) was recorded. Scan the central macular thickness (CMT) within 6x6mm of the macular area, while scanning the average ganglion cell layer (GCL) thickness. Record whether the elliptical zone (EZ) within 1x1mm of the macular area is complete and continuous. Use OCTA mode to scan the superficial capillary layer (SCP) of the retina within a range of 6x6mm, and record the measurements of vascular density (VDs) in the central area and the area of the foveal avascular zone (FAZ). Measure the patient's intraocular pressure using a non-contact tonometer. Follow up for 6 months and record the above indicators, with BCVA and CMT followed up for 1 year. Perform statistical analysis of data using SPSS 29.0 software (Independent sample t-test, Mann Whitney U-test and Pearson χ2-test). Use repeated measures ANOVA to analyze the time differences and interaction differences of various indicators. Linear regression analysis was used to examine the correlation between CMT, mean GCL thickness, EZ integrity, VDs, FAZ area, and combined injection of DEX with BCVA.
Results: There were no statistically significant differences in gender, age, intraocular pressure, and preoperative indicators between the two groups (P>0.05). Both surgical methods can improve the structure, function, and microcirculation disorders in the macular area. The postoperative BCVA in both groups of patients improved compared to before, and persisted until 6 months after surgery. The trend of CMT changes was highly consistent with BCVA, while the average GCL thickness began to recover at 3 months after surgery. The SCP fovea VDs and FAZ area did not show significant recovery until 6 months after surgery. Both surgical methods showed time differences and interaction differences in the above indicators after surgery (P=0.015), and the combined injection of DEX group performed better within 6 months (P=0.036). Compared to the non combined injection of DEX group, only the combined injection of DEX group showed statistically significant improvement in EZ integrity at 6 months after surgery (P=0.009). However, at 1 year of follow-up, there was no statistically significant difference in BCVA and CMT between the two groups (P≥0.079). The improvement of BCVA within 6 months after surgery is correlated with the improvement of CMT, average GCL thickness, SCP fovea VDs, FAZ area, EZ integrity, and injection of DEX within 6 months after surgery. During this study, no serious ocular or systemic complications such as endophthalmitis, vitreous hemorrhage, or retinal detachment occurred in either group of patients at each follow-up time point.
Conclusions: The efficacy of PPV combined with intravitreal injection of DEX is better within 6 months compared to the non-combined injection of DEX treatment group. There was no significant difference in the improvement of BCVA and CMT after one year of surgery between the combined single injection DEX treatment regimen and the non-combined injection DEX treatment regimen.
论著

白塞病性葡萄膜炎并发视网膜新生血管的临床及影像学特征分析

Clinical and imaging characteristics of retinal neovascularization secondary to Behçet's uveitis

:103-112
 

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.
专家共识

荧光素眼底血管造影操作规范专家共识

Expert consensus on standardized practice for fundus fluorescein angiography

:96-102
 
荧光素眼底血管造影(fundus fluorescein angiography, FFA)是眼底疾病诊疗不可或缺的检查技术。虽然开展已有半个世纪,但临床工作者在FFA操作的规范性、科学性、安全性和结果同质性仍有不少顾虑和问题,同时缺乏相关指南和共识可供参考。中国微循环学会眼微循环专业委员会眼影像学组专家就FFA操作规范达成本共识,就开展FFA的条件和配置、适应证和禁忌证、检查前准备、检查操作程序、不良反应及处理、造影后患者告知和处理、造影报告等方面为FFA临床操作工作者提供建议和指导,以期在临床实践中获取良好眼底影像、减少不良反应、提高检查质量效率。
Fundus fluorescein angiography (FFA) is an indispensable examination for the diagnosis and treatment of ocular fundus diseases. Although FFA has been carried out for half a century, clinicians still have many concerns and problems in the standardization, scientificity, safety and result homogeneity of FFA practice, and there is a lack of relevant guidelines and consensus for reference. The experts of the Ophthalmic Imaging Group of the Ocular Microcirculation Division of the Chinese Society of Microcirculation reached a consensus on the standardized practice of FFA, providing suggestions and guidance for FFA operators about the clinical conditions and configurations, indications and contraindications, pre-examination preparation, examination procedures, adverse reactions and treatment, patient notification, and angiography reports, in order to obtain good fundus images, reduce adverse reactions, and improve the quality and efficiency of FFA examinations in clinical practice.
述评

眼底疾病临床创新研究模式:六要素,三个一

Clinical innovation research model for fundus diseases: 6 elements, 3 ones

:85-95
 
“六要素,三个一”是眼底影像基础阅片工作中进行眼底疾病临床创新性研究的模式要点,即在眼底阅片过程中捕捉到1个异常的病例后,通过积累病例、提炼特征、文献检索、寻同查异,进而扩展到1组病例,最后通过思辨创新,提出或完善1种新的疾病或疾病表征。近二十年来,在此模式的指导下,团队在眼底疾病研究工作中取得了一些原创性的成果:比如息肉状脉络膜血管病变的认识及其在国人新生血管性年龄相关性黄斑变性中发病比例第一,提出点状内层脉络膜病变病灶国际分期和命名新亚型,年龄相关的吲哚菁绿血管造影晚期散在弱荧光点揭示潴留性视网膜色素上皮脱离的发病机制,发现急性黄斑神经视网膜病变是登革热患者视力下降的主要原因,在全球最大的持续性鳞状黄斑病变的病例系列中明确病灶层次等创新性成果。“六要素”框架规范眼底影像研究流程,强调研究过程的严谨性与渐进性,且多次循环后衍生发散出更多研究线索和思路,极大拓展研究深度和广度。“三个一”路径体现了研究的层次性,从个体现象(点)到群体规律(线),最终构建疾病认知的立体网络(面);指导眼底异常影像征象、罕见病、新病种研究,加速疾病谱系完善。以“六要素”为纲,以“三个一”为略,将继续推动眼底疾病临床研究的创新与突破。
The "6 Elements, 3 Ones" constitutes a methodological framework for conducting innovative clinical research of ocular fundus diseases in foundational fundus imaging interpretation. This model emphasizes: 1) identifying a single abnormal case during routine fundus evaluation; 2) systematically expanding this observation into a case series through case accumulation, feature extraction, literature review, and comparative analysis; and 3) ultimately proposing or refining novel disease entities or manifestations through critical thinking and innovation. Over the past two decades, guided by this paradigm, our research team has achieved several original breakthroughs in fundus imaging studies, including: establishing polypoidal choroidal vasculopathy as the predominant subtype of neovascular age-related macular degeneration in Chinese populations; proposing an international staging system and novel subtypes for punctate inner choroidopathy; elucidating the pathogenesis of retentional retinal pigment epithelial detachment through the sign of age-related scattered hypofluorescent spots on late-phase indocyanine green angiography; identifying acute macular neuroretinopathy as the primary cause of vision loss in dengue fever patients; and precisely localizing lesion in the world's largest case series of persistent placoid maculopathy. The "6 Elements" framework standardizes fundus disease research protocols, emphasizing methodological rigor and progressive investigation while generating multiple research trajectories through iterative cycles, thereby expanding both the depth and breadth of scientific inquiry. The "3 Ones" pathway embodies hierarchical research progression - transitioning from individual phenomena (point observations) to population-level patterns (linear correlations), ultimately constructing a multidimensional disease cognition network (planar integration). This approach guides investigations ranging from signs of common disease to rare disorders and novel disease entities, accelerating the refinement of disease taxonomies. By adhering to the "6 Elements" as the structural framework and implementing the "3 Ones" as the strategic pathway, we will continue to advance innovation and achieve breakthroughs in clinical fundus disease researches.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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