眼底影像专栏

非感染性葡萄膜炎继发脉络膜新生血管的多模式影像特征

Multimodal imaging features of choroidal neovascularization secondary to non-infectious uveitis

:241-251
 
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.
综述

新生血管性年龄相关性黄斑变性的分子组学研究进展

Research progress in molecular omics of neovascular age-related macular degeneration

:215-222
 
年龄相关性黄斑变性(age-related macular degeneration, AMD)是老年人视力丧失的主要原因之一,其中新生血管性AMD (neovascular AMD, nAMD)以其进展迅速、严重损伤视力的特点,成为全球眼科研究的焦点。随着人口老龄化加剧,nAMD的疾病负担日益沉重,对其发病机制的深入研究和有效治疗策略的探 索迫在眉睫。近年来,高通量组学技术的蓬勃发展为解析nAMD复杂的分子病理机制提供了前所未有的机遇。基因组学、转录组学、蛋白质组学、代谢组学以及多组学整合分析,不仅有助于深入挖掘疾病相关的关键分子、通路和网络,也为发现新的生物标志物和潜在治疗靶点提供了新的视角。文章系统综述了近年来分子组学技术在nAMD研究中的最新进展,重点关注不同组学方法在各类生物样本研究中 的发现,分析多组学整合在揭示疾病机制和筛选生物标志物方面的优势,以期为该领域的未来研究提供参考。

Age-related macular degeneration (AMD) is one of the leading causes of vision loss in elderly population. Among its subtypes, neovascular AMD (nAMD) has become a global focus in ophthalmological research due to its rapid progression and severe vision impairment. With the acceleration of population aging, the disease burden of nAMD is increasingly heavy, making it urgent to conduct in-depth research on its pathogenesis and explore effective therapeutic strategies. In recent years, the rapid development of high-throughput omics technologies has provided unprecedented opportunities to decipher the complex molecular pathological mechanisms of nAMD. Genomics, transcriptomics, proteomics, metabolomics, and multi-omics integration analyses have not only helped to deeply explore disease-related key molecules, pathways, and networks but also provided new perspectives for discovering novel biomarkers and potential therapeutic targets. This review systematically summarizes the recent advances in molecular omics technologies in nAMD research, focusing on findings from different omics approaches across various biological samples, and analyzes the advantages of multi-omics integration in revealing disease mechanisms and screening biomarkers, aiming to provide references for future research in this field.

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.

羊膜移植对于减少碱烧伤后角膜新生血管的临床研究

Clinical Study of the Effect of Amnion Membrane Transplantation on Diminishing Corneal Neovascularization Induced by Alkali Burn

:70-71
 

目的:观察羊膜移植手术对于减少碱烧伤后角膜新生血管的疗效。

方法:回顾性病例对照研究。2006-2010 年期间该院收治的 Ⅲ 度角膜碱烧伤的患者 19 例 23 眼,其中行羊膜移植术(治疗组)11 例 13 眼,未行羊膜移植术(对照组)8 例 10 眼。该两组的年龄和手术外的处理基本匹配。伤后 3 d 治疗组行羊膜移植术。分别在伤后 14、60 d 测量各组角膜新生血管面积。应用 SPSS 12.0 统计学软件将此两组的面积进行配对 t 检验,以 P < 0.05 作为差异有统计学意义。

结果:在烧伤后 14 d 治疗组新生血管面积(62.133 ± 8.571)mm2,明显低于对照组(89.561 ± 9.741)mm2,治疗组较对照组减低 30.6%,两组差异具有统计学意义(P < 0.05)。烧伤后 60 d 治疗组新生血管面积(112.019 ± 17.362)mm2,明显低于对照组(129.481 ± 13.534)mm2,治疗组较对照组减低 13.5%,两组差异具有统计学意义(P < 0.05)。

结论:羊膜移植术能明显抑制碱烧伤所致角膜新生血管的生长。

Purpose: To study the curative effect of amnion membrane transplantation on decreasing corneal neovascularization (CNV) induced by alkali burn.

Methods: It was a non-randomized retrospective case-control study. Among 19 cases (23 eyes) of third-degree alkali burns from 2006 to 2010, 11 cases (13 eyes) were performed with amnion membrane transplantation operation, and others were not. Amnion membrane transplantation was performed at the 3rd day after burn in the treatment group. Ages and treatments beyond surgery of double groups were matched. Areas of CNV in double groups were measured at the 14th day and 60th day after burn.

Results: Area of CNV in the treatment group was (62.133 ± 8.571) mm2 at the 14th day after burn, and was 30.6% lower than that in the control group. Area of CNV in the treatment group was (112.019 ± 17.362) mm2 at the 60th day after burn, and was 13.5% lower than that in the control group. There was statistical significance (P < 0.05).

Conclusion: Amnion membrane transplantation operation can inhibit the growth of corneal neovascularization induced by alkali burn. 

论著

激光诱导的脉络膜新生血管模型构建中的麻醉剂和激光能量选择

Selection of anesthetic agent and laser parameter in laserinduced choroid neovascularization models

:222-228
 
目的:比较水合氯醛和阿佛丁两种药物对小鼠的麻醉作用以及不同激光能量对脉络膜新生血管造模成功率的影响。方法:24只C57/BL6小鼠随机分为3组,分别予以200,300和400 mW的532 nm激光进行视网膜光凝;每组再按1:1分为2个亚组,随机使用4.3%水合氯醛或1.2%阿佛丁进行小鼠腹腔注射麻醉。在激光光凝后第4,7,1 0和1 4天进行视网膜荧光素造影(Fundus Fluorescein Angiography,FFA)、SD-OCT检查,在第1 4天时对脉络膜行IB4染色检查。结果:阿佛丁和水合氯醛诱导小鼠进入麻醉时间长分别为(120±30) s和(150±45) s,持续时间分别为(30±15) min和(50±20) min,差异均有统计学意义(均P=0.0001);发生不可逆性白内障的比率分别为2/24和1/24,麻醉导致的死亡数分别为1和0只,差异均无统计学意义(P =0.551,P =0.300)。200,300和400 mW三个激光能量组的造模成功率分别为9.38%,37.5%和93.75%,差异有统计学意义(P=0.0001)。FFA显示:造模成功的小鼠在4 d时荧光素渗漏达到高峰,随后荧光素溢漏的面积逐渐减小。结论:与阿佛丁相比,水合氯醛对小鼠的麻醉维持时间长且不会增加病死率和不可逆性白内障的发生率;400 mW的532 nm激光能量是诱发CNV的较好设置。
Objective: To compare the narcotic effects of chloral hydrate and avertin in mouse models and the success rate of choroidal neovascularization (CNV) mouse model establishment with different energy hierarchy of laser. Methods: Twenty-four mice were randomized into 3 groups, the 532 nm laser was used with different power levels of 200, 300 and 400 mW for each group. In each group, the chloral hydrate was used for 4 mice and avertin for the other 4 mice at random. On day 4, 7, 10 and 14, all mice were tested by the fundus fluorescein angiography (FFA), SD-OCT, and the choroid was stained with the isolectin B4 conjugated AF488 on day 14. Results: The anesthesia induction time of avertin and chloral hydrate was (120±30) s and (150±45) s, and the duration of anesthesia was (30±15) min and (50±20) min, the differences were statistically significant (all P=0.0001); the incidence of irreversible cataract of avertin models and chloral hydrate models was 2/24 and 1/24, the number of death in two models was 1 and without statistical significance (P=0.551, P=0.300). With the increase of laser energy, the success rate of experiments was also gradually increased, from 9.38%, 37.5% to 93.75% (P=0.0001) in 200, 300 and 400 mW group, respectively. According to the results of FFA, the peak of fluorescence leaking was at day 4 after the laser burning, and was gradually reduced. Conclusion: Compared with avertin chloral hydrate can improve the duration of anesthesia without increasing the risk of cataract and mortality. As for the 532 nm laser, the 400 mW energy could be an optimal parameter for the laser-induced CNV.
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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