光学相干断层扫描血管造影(OCTA)在视网膜疾病中的应用新进展
New Progress in Application of Optical Tomography Angiography (OCTA) in Retinal Diseases
摘要: 光学相干断层扫描血管造影(OCTA)是一种新型非侵入性快速血管成像造影技术。本文详细综述了该技术在眼科常见病如年龄相关性黄斑变性(AMD),糖尿病视网膜病变,视网膜动脉和静脉闭塞等中的应用,并将其与目前的荧光血管造影(FA)和吲哚青绿血管造影(ICGA)进行了相关比较,总结了它对视网膜血管疾病的临床应用价值。OCTA能够显示结构和血流的双重信息,但也有其应用的局限性包括相对较小的视野,不能显示血管的渗漏,以及在患者不配合下的图像伪影等。本文将OCTA的特点和不足进行综述,说明在临床实际工作中OCTA在大力推广的同时需要进行进一步的研究。
Abstract: Optical Tomography Angiography (OCTA) is a new non-invasive rapid angiography technique. In this paper, the application of this technique in common ophthalmic diseases such as age-related macular degeneration (AMD), diabetic retinopathy, retinal artery and vein occlusion, etc. is reviewed in detail, and it is compared with the current fluorescence angiography (FA) and indocyanine green angiography (ICGA), and its clinical application value in retinal vascular diseases is summarized. OCTA can display the dual information of structure and blood flow, but it also has its application limitations, including relatively small visual field, inability to display the leakage of blood vessels, and image artifacts when patients do not cooperate. In this paper, the characteristics and shortcomings of OCTA are summarized, which indicates that OCTA needs further research while being vigorously promoted in clinical practice.
文章引用:韩林峰. 光学相干断层扫描血管造影(OCTA)在视网膜疾病中的应用新进展[J]. 眼科学, 2023, 12(2): 77-84. https://doi.org/10.12677/HJO.2023.122011

参考文献

[1] 朱晓红, 赵玥, 姚进. 病理性近视黄斑出血的OCTA影像特征[J]. 国际眼科杂志, 2022, 22(4): 673-676.
[2] 高升, 褚欢欢, 郭建新. OCTA量化分析BRVO黄斑无血流区面积及微血管改变[J]. 医学研究杂志, 2023, 52(4): 148-151.
[3] 谭心格, 高自清. 基于OCTA观察眼底不同分期的2型糖尿病患者黄斑区脉络膜及视网膜血流密度变化[J]. 眼科新进展, 2023, 43(3): 230-233.
[4] 郑玲, 田关源. OCTA对糖尿病患者不同肾功能状态下早期黄斑区视网膜微循环改变的评估价值[J]. 中国医药科学, 2022, 12(2): 19-23.
[5] Shiihara, H., Terasaki, H., Sonoda, S., et al. (2018) Objective Evaluation of Size and Shape of Superficial Foveal Avascular Zone in Normal Subjects by Optical Coherence Tomography Angiography. Scientific Reports, 8, Article No. 10143.
[Google Scholar] [CrossRef] [PubMed]
[6] Liu, C.H., Kao, L.Y., Sun, M.H., et al. (2017) Retinal Vessel Density in Optical Coherence Tomography Angiography in Optic Atrophy after Nonarteritic Anterior Ischemic Optic Neuropathy. Journal of Ophthalmology, 2017, Article ID: 9632647.
[Google Scholar] [CrossRef] [PubMed]
[7] 郭莹, 杨冬妮, 杨世琳, 等. 光学相干断层扫描血管成像在青光眼小梁切除术后评估中的应用[J]. 中国医刊, 2022, 57(9): 988-991.
[8] 薛媛媛, 陈晓隆. OCT和OCTA生物学标志物在糖尿病性黄斑水肿中应用的研究进展[J]. 眼科新进展, 2023, 43(1): 76-81.
[9] 王翠云. 基于OCT和OCTA对康柏西普治疗糖尿病黄斑水肿疗效的观察分析[D]: [硕士学位论文]. 蚌埠: 蚌埠医学院, 2022.
[10] Kansal, V., Colleaux, K. and Rawlings, N. (2022) OCTA Changes Following Loading Phase with Intravitreal Aflibercept for DME. Canadian Journal of Ophthalmology.
[Google Scholar] [CrossRef] [PubMed]
[11] Spaide, R.F., Klancnik, J.J. and Cooney, M.J. (2015) Retinal Vascular Layers Imaged by Fluorescein Angiography and Optical Coherence Tomography Angiography. JAMA Ophthalmology, 133, 45-50.
[Google Scholar] [CrossRef] [PubMed]
[12] 林艾迪, 方丹齐, 吴苇杭, 等. Triton光学相干断层扫描血管成像图像中正常人的中心凹无血管区的自动测量方法[J]. 眼科学报, 2022, 37(1): 1-13.
[13] 张万虎, 刘轩, 李晶明, 等. OCTA与FFA在小鼠脉络膜新生血管模型中应用的比较研究[J]. 眼科新进展, 2021, 41(7): 628-632.
[14] Zeng, Q., Yao, Y., Li, S., et al. (2022) Comparison of Swept-Source OCTA and Indocyanine Green Angiography in central Serous Chorioretinopathy. BMC Ophthalmology, 22, Article No. 380.
[Google Scholar] [CrossRef] [PubMed]
[15] Cui, Y., Zhu, Y., Wang, J.C., et al. (2021) Comparison of Widefield Swept-Source Optical Coherence Tomography Angiography with Ultra-Widefield Colour Fundus Photography and Fluorescein Angiography for Detection of Lesions in Diabetic Retinopathy. British Journal of Ophthalmology, 105, 577-581.
[Google Scholar] [CrossRef] [PubMed]
[16] 龚玉静, 武炳慧, 索琰, 等. 脉络膜新生血管的光学相干断层扫描血管成像和荧光素血管造影的特征分析[J]. 实用临床医药杂志, 2019, 23(22): 14-16.
[17] Sacconi, R., Corbelli, E., Borrelli, E., et al. (2021) Choriocapillaris Flow Impairment Could Predict the Enlargement of Geographic Atrophy Lesion. British Journal of Ophthalmology, 105, 97-102.
[Google Scholar] [CrossRef] [PubMed]
[18] 任旋. 湿性老年性黄斑变性光相干断层扫描血管成像图像特征研究[J]. 当代医学, 2018, 24(26): 149-151.
[19] Khatri, A., Pandey, A., Joshi, K., et al. (2022) Redefining Response in Wet AMD to Anti VEGF Therapy Based on Non-OCTA versus OCTA Evaluation. European Journal of Ophthalmology, 32, 2719-2725.
[Google Scholar] [CrossRef] [PubMed]
[20] Vali, M., Nazari, B., Sadri, S., et al. (2023) CNV-Net: Segmentation, Classification and Activity Score Measurement of Choroidal Neovascularization (CNV) Using Optical Coherence Tomography Angiography (OCTA). Diagnostics, 13, Article 1309.
[Google Scholar] [CrossRef] [PubMed]
[21] 陈开传, 盛敏杰, 李敏, 等. OCTA评估抗VEGF治疗老年性黄斑变性患者视网膜血流密度变化[J]. 同济大学学报(医学版), 2021, 42(3): 333-342.
[22] 杨主敏, 黄星, 刘淑卿, 等. OCTA评价康柏西普对湿性年龄相关性黄斑变性的治疗效果[J]. 贵州医科大学学报, 2021, 46(5): 596-599, 605.
[23] Arrigo, A., Romano, F., Aragona, E., et al. (2020) Optical Coherence Tomography Angiography Can Categorize Different Subgroups of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration. Retina, 40, 2263-2269.
[Google Scholar] [CrossRef
[24] Arrigo, A., Aragona, E., Bordato, A., et al. (2021) Quantitative Optical Coherence Tomography Angiography Parameter Variations after Treatment of Macular Neovascularization Secondary to Age-Related Macular Degeneration. Retina, 41, 1463-1469.
[Google Scholar] [CrossRef
[25] Gigon, A., Vadala, M., Bonfiglio, V., et al. (2022) Early OCTA Changes of Type 3 Macular Neovascularization Following Brolucizumab Intravitreal Injections. Medicina, 58, Article 1180.
[Google Scholar] [CrossRef] [PubMed]
[26] 许厚银, 郎胜坤, 韩国鸽, 等. OCTA和ICGA在息肉样脉络膜血管病变中的应用对比[J]. 国际眼科杂志, 2017, 17(7): 1362-1364.
[27] Inoue, M., Balaratnasingam, C. and Freund, K.B. (2015) Optical Coherence Tomography Angiography of Polypoidal Choroidal Vasculopathy and Polypoidal Choroidal Neovascularization. Retina, 35, 2265-2274.
[Google Scholar] [CrossRef
[28] 林国乔, 施志云. 息肉样脉络膜血管病变吲哚菁绿血管造影、光学相干断层扫描血管成像特征对比[J]. 中国现代药物应用, 2018, 12(19): 76-77.
[29] Fujita, A., Kataoka, K., Takeuchi, J., et al. (2020) Diagnostic Characteristics of Polypoidal Choroidal Vasculopathy Based on B-Scan Swept-Source Optical Coherence Tomography Angiography and Its Interrater Agreement Compared with Indocyanine Green Angiography. Retina, 40, 2296-2303.
[Google Scholar] [CrossRef
[30] Wang, X.N., Cai, X., Li, S.W., et al. (2022) Wide-Field Swept-Source OCTA in the Assessment of Retinal Microvasculature in Early-Stage Diabetic Retinopathy. BMC Ophthalmology, 22, Article No. 473.
[Google Scholar] [CrossRef] [PubMed]
[31] Enders, C., Baeuerle, F., Lang, G.E., et al. (2020) Comparison between Findings in Optical Coherence Tomography Angiography and in Fluorescein Angiography in Patients with Diabetic Retinopathy. Ophthalmologica, 243, 21-26.
[Google Scholar] [CrossRef] [PubMed]
[32] 赵芳, 裴超, 蔡志鹏, 等. 糖尿病视网膜病变患者发病危险因素: 基于SS-OCTA检测指标的分析[J]. 眼科新进展, 2021, 41(7): 643-646.
[33] Alam, M., Zhang, Y., Lim, J.I., et al. (2020) Quantitative Optical Coherence Tomography Angiography Features for Objective Classification and Staging of Diabetic Retinopathy. Retina, 40, 322-332.
[Google Scholar] [CrossRef
[34] 王光鑫, 刘伦, 高健, 等. OCTA观察增生性糖尿病视网膜病变治疗前后不同形态视盘新生血管的变化[J]. 临床眼科杂志, 2021, 29(5): 391-395.
[35] 施彦, 林鹏耀, 华闪闪, 等. 基于光学相干断层扫描血管成像评价康柏西普对糖尿病黄斑水肿黄斑区视网膜微循环的影响[J]. 中国现代医生, 2022, 60(9): 67-70.
[36] 邱奥望, 袁冬青, 朱鸿静, 等. OCTA评估糖尿病视网膜病变患者全视网膜激光光凝后黄斑区血流情况[J]. 国际眼科杂志, 2022, 22(2): 175-181.
[37] 吴子旭, 郑东萍, 潘陆平, 等. 血管造影光相干断层扫描对急性视网膜中央动脉阻塞外层视网膜和脉络膜血流的观察[J]. 中国药物与临床, 2016, 16(7): 1028-1029.
[38] 李萱, 郝晓凤, 罗傑, 等. 运用光学相干断层扫描血管成像技术检测视网膜动脉阻塞患者黄斑区视网膜血流密度与视网膜厚度的临床研究[J]. 中华眼科医学杂志(电子版), 2020, 10(5): 269-274.
[39] Chen, L., Yuan, M., Sun, L., et al. (2020) Evaluation of Microvascular Network with Optical Coherence Tomography Angiography (OCTA) in Branch Retinal Vein Occlusion (BRVO). BMC Ophthalmology, 20, Article No. 154.
[Google Scholar] [CrossRef] [PubMed]
[40] 范玲玲, 刘伦, 陈瑶, 等. OCTA定量分析视网膜静脉阻塞继发黄斑水肿黄斑区微血管及视力相关性[J]. 临床眼科杂志, 2021, 29(3): 212-215.
[41] 司昕, 高磊, 刘广森, 等. OCTA观察BRVO患者黄斑区微血管的改变及其与预后的关系[J]. 国际眼科杂志, 2021, 21(10): 1769-1772.
[42] 金昕, 谭薇, 李燕. 量化OCTA在视网膜静脉阻塞中的应用[J]. 国际眼科杂志, 2021, 21(4): 711-714.
[43] 郑微微, 黄胜海, 郑燕, 等. DART-OCTA对视网膜分支静脉阻塞黄斑区毛细血管灌注的观察研究[J]. 国际眼科杂志, 2022, 22(8): 1391-1395.
[44] Parrulli, S., Corvi, F., Cozzi, M., et al. (2021) Microaneurysms Visualisation Using Five Different Optical Coherence Tomography Angiography Devices Compared to Fluorescein Angiography. British Journal of Ophthalmology, 105, 526-530.
[Google Scholar] [CrossRef] [PubMed]