无需使用造影剂的宽域毛细血管造影

摘要

目的 评估毛细血管异常形态在常见视网膜病变的早期诊断、治疗和随访中的作用.方法 系列病例研究.收集糖尿病视网膜病变、视网膜静脉阻塞、中心性浆液性视网膜病变、年龄相关性黄斑变性和代谢综合征的患者130例,以及37例健康志愿者.对这些研究对象采用视网膜功能成像仪(RFI)拍摄无创伤性毛细血管的灌注(nCPM)图像.图像经过处理,使用像素值的变化来分析血管中红细胞的运动.结果 由RFI产生的nCPMs图像可显示微血管的详细形态,该功能与目前的金标准眼底荧光素血管造影(FFA)显示的微血管的细节相同.成像结果可以清楚地显示视网膜的新生血管和毛细血管无灌注区;同时清晰地显示黄斑中心凹无血管区(FAZ)的范围,并发现糖尿病视网膜病变患者的FAZ直径较正常对照组大[(641.5±82.3)μm vs.(463.7±105.0)μm,P＜0.01];并且可以发现FFA无法显示的血管异常形态,如分流和血管环路.结论 基于追踪红细胞的运动来作为血管造影剂的活体视网膜毛细血管造影是一种非侵入性、舒适、安全和可重复应用的血管造影手段,可用于视网膜疾病的早期诊断、治疗指导以及随访.%Objective Assessment of capillary abnormalities facilitates early diagnosis, treatment, and follow-up of common retinal pathologies.Methods Case series study.Multiple series of nCPM images were acquired from 130 patients with diabetic retinopathy,vein occlusion,central serous retinopathy,age-related macular degeneration,or metabolic syndrome,as well as from 37 healthy subjects.All the subjects underwent retinal function imager (RFI) test, and perfusion maps (nCPMs) were abtained.Then pixel value distribution parameters were analyzed to locate RBC motion.Results The RFI yielded nCPMs demonstrating microvascular morphology including capillaries in exquisite detail.Maps from the same subject were highly reproducible in repeated measurements, in as much detail and often better than that revealed by the very best fluorescein angiography.In patients, neovascularization and capillary nonperfusion areas were clearly observed.Foveal avascular zones (FAZ) were sharply delineated and were larger in patients with diabetic retinopathy than in controls (FAZ diameter: 641.5±82.3 versus 463.7±105.0 μm;P＜0.01).Also visible were abnormal vascular patterns, such as shunts and vascular loops.Conclusion Optical imaging of retinal capillaries in human patients based on motion contrast is noninvasive, comfortable, safe, and can be repeated as often as required for early diagnosis, treatment guidance, and follow up of retinal disease progression.