BJO专栏

角膜塑形镜对近视儿童脉络膜厚度和脉络膜轮廓的长期影响

Long-term effect of orthokeratology on choroidal thickness and choroidal contour in myopic children

:63-74
 
目的:调查角膜塑形镜对近视儿童脉络膜厚度和脉络膜轮廓的长期影响。方法:受试者来自一项2年的随机对照试验。研究对象为年龄8~12岁、等效球镜在-1.00~-6.00 D的儿童(n=80),这些研究对象被随机分配到对照组(n=40)和角膜塑形镜组(n=40)。本研究在基线和1、6、12、18、24个月的随访中收集光学相干断层扫描图像(optical coherence tomography,OCT),然后基于OCT图像计算脉络膜厚度和脉络膜轮廓。在这些随访点也同时测量了眼轴长度(axial length,AL)和其他眼生物学参数。结果:在2年内,对照组的脉络膜厚度随时间变薄,脉络膜轮廓变得更加后凸(均P<0.001)。角膜塑形镜可以改善脉络膜厚度(均P<0.001),并在所有随访中维持脉络膜轮廓不后凸(均P<0.05)。在角膜塑形镜组中,脉络膜轮廓在颞侧的变化小于鼻侧(P=0.008),而脉络膜厚度在颞侧以黄斑中心凹为中心、直径3 mm线性扫描区域的增厚更明显(P<0.001)。2年内脉络膜厚度的变化与对照组中2年内AL变化呈负相关(r=-0.52,P<0.001),然而,这一规律被角膜塑形镜打破(r=-0.05 P=0.342)。在多变量回归模型中校正其他变量后,角膜塑形镜对脉络膜厚度的影响是稳定的。结论:角膜塑形镜可以改善脉络膜厚度并维持脉络膜轮廓,但这种效果在长期内趋于减弱。
Objective: To investigate the long-term effect of orthokeratology on the choroidal thickness and choroidal contour in myopic children. Methods:Subjects were from a conducted 2-year Randomized Clinical Trial. Children (n=80) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were randomly assigned to the control group (n=40) and ortho-k group (n=40). OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits, then the choroidal thickness and choroid contour were calculated. Axial length (AL) and other ocular biometrics were also measured. Results: During two years, in the control group, the choroidal thickness became thinning and the choroidal contour became prolate with time at all visits (all P<0.001). Ortho-k can improve the choroidal thickness (all P<0.001) and maintain the choroidal contour at all visits (all P<0.05). In the ortho-k group, the choroidal contour was less changed in the temporal than nasal (P=0.008), and the choroidal thickness was more thickening in the temporal 3 mm (P<0.001). Two-year change in choroidal thickness was significantly associated with the two-year AL change in the control group (r=-0.52, P<0.001), however, this trend was broken by ortho-k (r=-0.05, P=0.342). After being adjusted by other variables in the multivariable regression model, the effect of ortho-k on choroidal thickness was stable. Conclusions: In a short term, ortho-k can improve the choroidal thickness and maintain the choroidal contour, but this effect diminished in a long term. Further study with larger sample size and longer follow-up is warranted to refine this issue.
综述

息肉状脉络膜血管病变发生大出血的危险因素和治疗进展

Risk factors and treatment progress in massive hemorrhage secondary to polypoidal choroidal vasculopathy

:19-26
 
息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是亚洲人群中常见的致盲性眼病,发生大出血并发症后严重危害视力且预后差。PCV大出血包括视网膜下出血(subretinal hemorrhage,SRH)和玻璃体积血(vitreous hemorrhage,VH)。SRH的危险因素包括较长病程、簇型PCV、息肉状病灶不消退、合并视网膜色素上皮脱离;其治疗方式包括抗血管内皮生长因子药物、光动力疗法、激光、玻璃体腔注气、眼内注射组织纤溶酶原激活剂、玻璃体切割术或联合治疗等方式,其中,黄斑中心凹是否受累和出血时间是影响治疗方式选择的主要因素。发病年龄较大、白细胞计数较高、天门氨酸转移酶和丙氨酸转氨酶的比值较高、活化部分凝血活酶时间较长、曾行光动力疗法、有玻璃体腔注药治疗史、SRH面积大、出现视网膜色素上皮脱离的PCV患者发生VH的风险高。浓厚的VH通常需行玻璃体切割术,其手术时机和手术方式的选择是临床关注的焦点。鉴于目前PCV大出血的危险因素尚不完全明确、治疗方面也尚未形成共识,需要开展相关临床研究,提供更多依据。
Polypoidal choroidal vasculopathy (PCV) is a common blinding disease in Asian populations. Massive hemorrhage complications secondary to PCV include subretinal hemorrhage (SRH) and vitreous hemorrhage (VH). The risk factors for SRH include a long duration, clustered PCV, non-regression of polyp lesions and presented with retinal pigment epithelial detachment. The treatments for SRH include anti-vascular endothelial growth factor drugs, photodynamic therapy, laser, vitreous pneumatic displacement, intravenously injected tissue plasminogen activator, vitrectomy and combination therapy. Whether macular fovea is involved and the time since bleeding onset are the main factors afecting the choice of treatment for SRH. Older age of onset, higher white blood cell count, higher aspartate amino transferase and alanine amino transferase ratio, longer activated partial thromboplastin time retinal pigment epithelium detachment, photodynamic therapy history, intravitreal injection history larger SRH area and presented with retinal pigment epithelial detachment were associated with higher risk of VH. PCV patients with massive VH should be treated with vitrectomy, while the timing and technique of operation should be paid atention to. At present, the risk factors of PCV massive bleeding are not completely clear, and its treatment methods are diverse, which requires a large number of studies to prove its effectiveness and establish expert diagnosis and treatment consensus.
综述

肥厚型脉络膜谱系疾病与脉络膜、涡静脉、巩膜改变的研究进展

Research progress of pachychoroid disease spectrum and changes in the choroid, vortex veins and sclera

:693-699
 
肥厚型脉络膜谱系疾病(pachychoroid disease spectrum,PCD)包括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)、息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)、局灶性脉络膜凹陷(focal choroidal excavation,FCE)和盘周肥厚型脉络膜综合征(peripapillary pachychoroid syndrome,PPS)。有学者将PCD看作脉络膜功能障碍引发的一系列连续疾病过程,但关于PCD的发病机制、形态改变尚未明确。该文对PCD的脉络膜、涡静脉及巩膜相关改变做一综述。

Pachychoroid disease spectrum include pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, and peripapillary pachychoroid syndrome. Currently, some scholars regard pachychoroid disease spectrum as a series of continuous disease processes caused by choroidal dysfunction, but the pathogenesis and morphological changes of pachychoroid disease spectrum are not yet clear. This paper reviews the changes of choroid, vortex veins and sclera in pachychoroid disease spectrum.

综述

脉络膜在近视发展中的调控作用及其机制

The regulatory role and mechanism of choroid in the development of myopia

:657-665
 
近年来,随着现代社会生活节奏的加快以及电子产品的普及,近视逐渐呈现低龄化、高发病率的趋势,成为不容忽视的公共卫生问题。动物和人类研究均发现,在近视的发展过程中,脉络膜表现出变薄的现象,并伴有血流量减少,这些变化与近视度数增加和眼轴增长呈正相关。研究表明,脉络膜厚度的变化不仅发生在近视初期,而是在近视进展阶段持续发生。此外,脉络膜血流量的调节也与近视的发生和发展密切相关,可能通过神经机制及生长因子的作用影响眼球的生长。光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)技术在探索近视进程中的脉络膜变化和血管功能方面展现了巨大的潜力。它能够提供无创性的脉络膜结构和血流信息,对于理解脉络膜在近视调控中的作用至关重要。未来的研究应当结合先进的OCTA技术,进一步探讨脉络膜在不同阶段近视中的具体变化及其背后的机制,特别是脉络膜血流调节与眼球生长之间的关系。深化对脉络膜在近视调控中作用的理解,将有助于开发有效的预防和控制措施,为近视防控策略提供理论依据。
In recent years, with the acceleration of the pace of life in modern society and the popularization of electronic products, myopia has gradually affected younger individuals and has a higher incidence rate, becoming a public health problem that cannot be ignored. Both animal and human studies have found that during the development of myopia, the choroid exhibits thinning and is accompanied by reduced blood perfusion. These changes are positively correlated with increased myopia and axial growth. Studies have shown that changes in choroidal thickness not only occur in the early stages of myopia, but also continue to occur in the progression stage of myopia. In addition, the regulation of choroidal blood flow is also closely related to the occurrence and development of myopia, which may affect the growth of the eyeball through the action of neural mechanisms and growth factors. Optical coherence tomography angiography (OCTA) technology has shown great potential in exploring choroidal changes and vascular function in the progression of myopia. It can provide non-invasive information on choroidal structure and blood flow, which is crucial for understanding the role of the choroid in the regulation of myopia. Future research should combine advanced OCTA technology to further explore the specific changes in the choroid in different stages of myopia and the underlying mechanisms, especially the relationship between choroidal blood flow regulation and eyeball growth. A better understanding of the role of choroid in myopia regulation will aid in developing effective prevention and control measures, providing a solid theoretical foundation for myopia prevention strategies.
综述

正常眼的脉络膜血管系统研究进展

Research progress on choroidal vascular system in healthy eyes

:365-373
 
脉络膜是视网膜的主要血供来源,脉络膜血管系统为眼内最大、最重要的血管系统,在给外层视网膜供血方面起着至关重要的作用。脉络膜是一个动态、多功能性结构,其生理性特性受多种因素影响。这些因素包括年龄、性别、解剖位置、眼轴长度、昼夜节律与饮酒等。脉络膜涡静脉根据解剖学位置可分为眼内、巩膜内和眼外三大部分,又进一步分为脉络膜静脉、壶腹前部、壶腹、壶腹后部、巩膜入口、巩膜内通道、巩膜出口和巩膜外涡静脉八个区域。在正常眼中,涡静脉的类型不仅限于传统认知中出口位于赤道部近睫状体平坦部的涡静脉,研究发现还存在出口位于后极部的后极部涡静脉。根据涡静脉的形态及解剖特点,涡静脉又分为四类:缺失型涡静脉、不完整型涡静脉、完整型涡静脉、完整型涡静脉伴壶腹。文章旨在阐述正常人眼的脉络膜血流及涡静脉解剖基础,以深入了解正常状态下的脉络膜特征,这不仅有助于辨别脉络膜的病理性变化,且对脉络膜相关眼部疾病的诊断与鉴别诊断有重要价值。
The choroid is the primary source of blood supply for the retina. As the largest and most important vascular system within the eye, the choroidal vasculature plays a crucial role in providing blood to the outer retina. The choroid is a dynamic, multifunctional structure whose physiological characteristics are influenced by a variety of factors. These factors include age, gender, anatomical location, axial length of the eye, circadian rhythm, and alcohol consumption, among others. Choroidal vortex veins can be anatomically divided into three main parts: intraocular, scleral, and extraocular. Furthermore, they can be subdivided into eight distinct regions: choroidal veins, pre-ampulla, ampulla, post-ampulla, scleral entrance, intrascleral canal, scleral exit, and extrascleral vortex vein. In the healthy eye, the types of vortex veins are not limited to the traditionally recognized veins with exits near the ciliary body pars plana in the equatorial region. Recent research has revealed the existence of posterior vortex veins with exits in the posterior pole of the eye. Based on the morphology and anatomical characteristics of vortex veins, they can be further classified into four types:absent vortex veins, incomplete vortex veins, complete vortex veins, complete vortex veins with ampulla. This paper aims to elucidate the blood flow and vortex veins anatomical foundation of the choroid in normal human eyes. Understanding these characteristics in a healthy state will aid in identifying pathological changes in the choroid, which is of significant value for the diagnosis and differential diagnosis of ocular diseases.
论著

远视儿童短期使用 1% 阿托品凝胶后脉络膜厚度的变化

Choroidal thickness changes in hyperopia children after short-term use of 1% atropine gel

:564-570
 
目的:评估远视儿童使用1%阿托品凝胶1周后脉络膜厚度(choroidal thickness,CT)的变化。方法:选择42例4~7岁的远视儿童,予每天使用1%阿托品凝胶两次,持续7d。使用光学相干断层成像扫描测量视网膜及CT,并分析使用1%阿托品凝胶前后中心凹以及距中心凹处间隔1.0 mm的上、下、鼻和颞侧(最多3.0mm)CT的变化。结果:在远视儿童中,基线CT随位置而变化(F=27.08, P<0.05),与中心凹相比,鼻侧及距中心凹上方2 mm、3 mm及距中心凹颞侧3 mm处的CT较薄(P<0.05)。使用1%阿托品凝胶后,中央凹及旁中心凹CT改变比较差异无统计学意义(P>0.05)。使用1%阿托品凝胶前后视网膜厚度无明显变化(P>0.05)。结论:短期使用1%阿托品凝胶并没有改变远视儿童的脉络膜和视网膜厚度。
Objective: To assess changes of choroidal thickness (CT) in hyperopia children after 1 week using of 1% atropine.Methods: A total of 42 hyperopia children aged 4–7 years were included into the study.A single drop of 1% atropinegel was used twice a daily for 7 days in the subjects.The thickness of retina and choroid was measured by OCT, and the changes before and after using 1% atropine gel were analyzed at the subfovea and at 1.0 mm intervals (up to3.0 mm) from the fovea at superior, inferior, nasal, and temporal locations. Results: In the hyperopia children, baselineCT parameters were varied with the location(F=27.08,P<0.05).Compared with the fovea, the CT at the nasal side,2 mm and 3 mm above the fovea and 3 mm from the temporal side of the fovea were thinner (P<0.05).After using 1%atropine gel, there was no significant difference in the CT changes of subfoveal choroidal thickness and other sites ofparafovea (P> 0.05). There was no significant change in retinal thickness before and after using 1% atropine gel (P > 0.05).Conclusion: No changes were found in the thickness of choroid and retina in hyperopia children after short-term use of1% atropine gel.
眼底影像专栏

慢性中心性浆液性脉络膜视网膜病变的多模式影像研究进展

Research progress of multimodal imaging in chronic central serous chorioretinopathy

:261-271
 
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.
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

息肉状脉络膜血管病变的临床病理研究现状

Research status of clinicopathologic studies of polypoidal choroidal vasculopathy

:196-201
 
息肉状脉络膜血管病变(polypoidal  choroidal vasculopathy, PCV)是中国人新生血管性年龄相关性黄斑变性的(age-related macular degeneration, AMD)主要亚型。PCV与典型的新生血管性AMD在流行病学、临床表现、影像学特征和自然病程方面存在一定差异。近年来的研究表明,除了传统的玻璃膜疣驱动机制外,PCV可能与肥厚脉络膜机制相关,后者在亚洲人群中更为常见。深入的病理学探索将有助于揭示PCV的发病机制,并探索PCV与其他脉络膜疾病之间的内在联系。由于PCV患者眼球标本的稀缺,现有的病理学研究较少,且结果之间存在一定差异。文章通过介绍笔者最新的临床病理研究结果,并结合历年来国内外的研究,总结了关于PCV病灶所在的层次、起源及血管内皮生长因子(vascular endothelial growth factor, VEGF)表达水平的争议问题,阐明了PCV的临床病理研究现状。第一,PCV病灶的层次。临床上,OCT成像显示PCV病灶位于视网膜色素上皮(retinal pigment epithelium, RPE)与Bruch膜的高反射线之间,属于I型脉络膜新生血管的特殊亚型。部分病理学研究认为PCV病灶位于Bruch膜内,但实际上PCV病灶更准确地位于RPE基底膜下。第二,异常分支血管网(branching vascular networks, BVN)的起源。尸体眼标本的病理分析表明,BVN起源于脉络膜动脉,且动脉穿过Bruch膜后,转变为薄壁毛细血管形成I型脉络膜新生血管。少数研究指出PCV可能由静脉扩张形成,并存在脉络膜静脉的淤滞。第三,VEGF在PCV病灶中的表达。VEGF是新生血管性AMD的关键致病因子,一些研究表明PCV病灶中VEGF表达升高,提示PCV可能与新生血管性AMD具有相似的发病机制,但也有研究发现PCV病灶中的VEGF表达为阴性,提示PCV的机制可能不完全依赖于VEGF。综上,PCV的病理特征具有复杂性,既有与新生血管性AMD相似的表现,也有肥厚脉络膜的特征。随着眼球捐献意识的提高,未来有望获得更多宝贵的眼球标本,为进一步探索PCV的发病机制提供支持,并为其临床诊断和治疗提供更有效的策略。
Polypoidal choroidal vasculopathy (PCV) is the main subtype of neovascular age-related macular degeneration (AMD) in China.  PCV differs from typical neovascular AMD in terms of epidemiology, clinical presentation, imaging features, and natural disease course. Recent studies suggest that, in addition to the traditional drusen-driven mechanism, PCV may also be associated with pachychoroid mechanism, which is particularly more common in Asian populations. In-depth pathological research will help uncover the pathogenesis of PCV and explore the intrinsic connections between PCV and other choroidal diseases. Due to the rarity of eye specimens from PCV patients, there is limited pathological research, and results can vary. Herein, this article summarize the controversial issues regarding the location level, origin, and the vascular endothelial growth factor (VEGF) expression of PCV lesions by introducing our latest clinicopathologic study on PCV and combining with previous studies in China and worldwide. First, the layer of PCV lesions. Clinically, OCT imaging shows that PCV lesions are located between the retinal pigment epithelium (RPE) and the hyperreflective line of Bruch membrane, making them a special subtype of type I choroidal neovascularization. Some pathological studies suggest that PCV lesions are located within Bruch membrane, but in fact, PCV lesions are more accurately located beneath the RPE basement membrane. Second, the origin of the branching vascular networks (BVN). Pathological analysis of postmortem eye specimens indicates that BVN originates from choroidal arteries, and after passing through Bruch membrane, they transform into thin-walled capillaries, forming type I choroidal neovascularization. A few studies suggest that PCV may result from dilation of choroidal vein, accompanied with vein stasis. Third, VEGF expression in PCV lesions. VEGF is a key pathogenic factor in neovascular AMD. Some studies show increased VEGF expression in PCV lesions, suggesting that PCV may share a similar pathogenic mechanism with neovascular AMD. However, other studies have found negative VEGF expression in PCV lesions, indicating that the mechanism of PCV may not be entirely dependent on VEGF. In conclusion, the pathological features of PCV are complex, showing both similarities to neovascular AMD and characteristics of pachychoroid. With the increasing awareness of eye donation, more valuable eye specimens are expected to be obtained in the future, providing support for further ex;ploration of the pathogenesis of PCV and offering more effective strategies for its clinical diagnosis and treatment.
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.
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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