Developments in ophthalmology最新文献

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Optical Coherence Tomography Angiography of Type 2 Neovascularization in Age-Related Macular Degeneration. 年龄相关性黄斑变性2型新生血管的光学相干断层血管造影。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442777

E. Souied, A. El Ameen, O. Semoun, A. Miere, G. Querques, S. Cohen

Well-defined choroidal neovascularization, known as type 2 neovascularization (NV) or classic NV, is the least representative phenotype of exudative age-related macular degeneration. Clinical aspects of type 2 NV have been widely described in the literature, and to date fluorescein angiography remains the gold standard for imaging age-related macular degeneration at initial presentation. Optical coherence tomography angiography (OCT-A) can be used to image vessels based on flow characteristics without any dye injection. Type 2 NV can be visualized using OCT-A with very typical patterns. A neovascular membrane appears as either a medusa-shaped complex or a glomerulus-shaped lesion in the outer retina and the choriocapillaris layer. Furthermore, in the choriocapillaris layer, the external borders of the lesion appear as a dark ring in most cases, and one or more central feeder vessels that extend deeply into the more profound choroidal layers are visible. Identification of type 2 NV is easily feasible for any clinician using OCT-A, especially in areas where there are normally no vessels, like in subretinal space, if the interpretation rules are respected.

明确的脉络膜新生血管，称为2型新生血管(NV)或典型的NV，是渗出性年龄相关性黄斑变性最不具代表性的表型。2型NV的临床方面已经在文献中得到了广泛的描述，迄今为止，荧光素血管造影仍然是在初始表现时成像年龄相关性黄斑变性的金标准。光学相干断层扫描血管成像(OCT-A)可以在不注入任何染料的情况下根据血流特征对血管进行成像。2型NV可以用OCT-A可视化，具有非常典型的模式。新生血管膜表现为外视网膜和绒毛膜层的水母状复合体或肾小球状病变。此外，在大多数情况下，在绒毛膜层，病变的外边界呈暗环状，可以看到一条或多条延伸到更深层的绒毛膜层的中央供血血管。对于任何使用OCT-A的临床医生来说，识别2型NV是很容易的，特别是在通常没有血管的区域，如视网膜下空间，如果遵守解释规则。

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引用次数: 31

Optical Coherence Tomography Angiography Study of Choroidal Neovascularization Early Response after Treatment. 治疗后脉络膜新生血管早期反应的光学相干断层血管造影研究。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442782

B. Lumbroso, M. Rispoli, M. Savastano, Yali Jia, O. Tan, David Huang

AIMS Study the choroidal neovascularization (CNV) morphological evolution after treatment using optical coherence tomography angiography (OCTA). METHOD We used Optovue XR Avanti, with split-spectrum amplitude-decorrelation angiography algorithm. RESULTS OCT Angiography allows to recognize better the CNV type. In our series all our cases seem to follow a 45 to 60 days cycle, after intra vitreal injection. After each injection a pruning of smaller vessels is seen immediately (after 24 hours) that increases for 6 to 12 days when it reaches a maximum. It is followed by a reopening or new sprouting of the vessels 20 to 50 days later. The later cycles seem longer. Our results on early CNV evolution seem to confirm previous observations of CNV abnormalization and arterialization. Pruning the small peripheral branches seems to strengthen the trunk. In OCTA, closing terminal vessels (anti-VEGF effects) seems to cause an increased flow in trunk after the CNV reactivation.

目的:利用光学相干断层血管成像(OCTA)研究治疗后脉络膜新生血管(CNV)的形态学演变。方法采用Optovue XR Avanti，并结合分谱幅度去相关血管造影算法。结果soct血管造影能更好地识别CNV类型。在我们的研究中，所有病例在玻璃体内注射后似乎都遵循45至60天的周期。每次注射后(24小时后)，可以立即看到较小的血管修剪，当达到最大值时，这种修剪会增加6至12天。20至50天后，这些血管会重新开放或发芽。后一个周期似乎更长。我们关于早期CNV进化的结果似乎证实了之前关于CNV异常和动脉化的观察。修剪周围的小树枝似乎能使树干结实。在OCTA中，关闭末端血管(抗vegf作用)似乎导致CNV再激活后主干血流增加。

引用次数: 38

Sirolimus for Retinal and Uveitic Diseases. 西罗莫司用于视网膜和葡萄膜疾病。

Developments in ophthalmology

Pub Date : 2016-01-01 Epub Date: 2015-10-26 DOI: 10.1159/000438951

Aniruddha Agarwal, Nithya Rajagopalan, Muhammad Hassan, Mohammad Ali Sadiq, Mohamed K Soliman, Rubbia Afridi, Yasir Jamal Sepah, Quan Dong Nguyen

Chronic inflammation plays an important role in the pathogenesis of ocular diseases such as diabetic retinopathy, uveitis and age-related macular degeneration. Activation and proliferation of naïve T cells may result in pathological changes responsible for significant visual morbidity. Sirolimus (earlier termed rapamycin) is a novel drug that inhibits cellular kinases and, thereby, inhibits T-cell proliferation. Preclinical studies in experimental models have shown promising results with the use of this pharmacological agent in various ocular conditions. Subsequently, early phase I/II studies have provided encouraging safety and efficacy data. This chapter focuses on the mechanisms of action, preclinical study results and data from human clinical trials of sirolimus in human eye diseases. Key highlights from ongoing phase III clinical trials are also provided. Sirolimus, thus, appears to be an important addition to the armamentarium of steroid-sparing therapeutic agents that act on various steps in the inflammatory pathway.

慢性炎症在糖尿病视网膜病变、葡萄膜炎、老年性黄斑变性等眼部疾病的发病机制中起着重要作用。naïve T细胞的激活和增殖可能导致导致显著视觉发病率的病理变化。西罗莫司(以前称为雷帕霉素)是一种抑制细胞激酶，从而抑制t细胞增殖的新药。实验模型的临床前研究显示，在各种眼病中使用这种药理学剂有希望的结果。随后，早期I/II期研究提供了令人鼓舞的安全性和有效性数据。本章重点介绍西罗莫司治疗人眼疾病的作用机制、临床前研究结果和人体临床试验数据。还提供了正在进行的III期临床试验的关键亮点。西罗莫司，因此，似乎是一个重要的补充，以类固醇节省治疗剂的武器，作用于炎症途径的各个步骤。

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引用次数: 16

Future Perspectives: Agents on the Horizon. 未来展望:地平线上的代理人。

Developments in ophthalmology

Pub Date : 2016-01-01 Epub Date: 2015-10-26 DOI: 10.1159/000439037

Jose R Maya, Mohammad Ali Sadiq, Aniruddha Agarwal, Peter K Kaiser, Glenn L Stoller, Yasir Jamal Sepah, Quan Dong Nguyen

As demonstrated in the previous chapters of this textbook, retinal pharmacotherapeutics is a rapidly developing area. The enormous burden of disease in an aging population will hopefully be met by significant improvements in our understanding and treatment of disease processes such as age-related macular degeneration (AMD) and diabetic retinopathy. This chapter will provide perspectives on select anti-angiogenic drugs currently in development, as well as therapies directed against the complement cascade for the treatment of AMD, and an anti-inflammatory monoclonal antibody for the treatment of diabetic macular edema, among others, that have not been discussed elsewhere in this book. The mechanism of action of a number of drugs under discussion differs enough to have the potential to control neovascularization in several different ways, potentially allowing for more effective management of this process with fewer treatments.

正如本教材前几章所展示的，视网膜药物治疗是一个快速发展的领域。随着我们对诸如年龄相关性黄斑变性(AMD)和糖尿病视网膜病变等疾病过程的理解和治疗的显著改善，老龄人口中巨大的疾病负担有望得到满足。本章将提供目前正在开发的抗血管生成药物的选择观点，以及针对治疗AMD的补体级联的治疗方法，以及治疗糖尿病性黄斑水肿的抗炎单克隆抗体等，这些在本书的其他地方都没有讨论过。所讨论的许多药物的作用机制差异很大，有可能以几种不同的方式控制新生血管的形成，从而有可能以更少的治疗方法更有效地控制这一过程。

引用次数: 1

Optical Coherence Tomography Angiography Using the Optovue Device. 使用Optovue设备的光学相干断层血管造影。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442770

David Huang, Yali Jia, Simon S. Gao, B. Lumbroso, M. Rispoli

Optovue AngioVue system technology for optical coherence tomography (OCT) angiography is based on the AngioVue Imaging System (Optovue, Inc., Freemont, CA), using split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. This algorithm was developed to minimize scanning time. It detects motion in blood vessel lumen by measuring the variation in reflected OCT signal amplitude between consecutive cross-sectional scans. The novelty of SSADA lies in how the OCT signal is processed to enhance flow detection and reject axial bulk motion noise. Specifically, the algorithm splits the OCT image into different spectral bands, thus increasing the number of usable image frames. Each new frame has a lower axial resolution that is less susceptible to axial eye motion caused by blood pulsation. Optovue AngioVue system technology allows quantitative analysis. It provides numerical data about flow area and non-flow area. It can also generate a flow density map. These metrics may serve as biomarkers in diagnosis and for tracking disease progression or treatment response. Flow area: the software will calculate the drawn area and vessel area in mm(2). It allows for comparison of all measurements for a given participant. Non-flow area: the software shows the non-perfused areas by mouse click selection. Ischemic areas will be shown in yellow. These areas may be saved and matched with others in the study. Flow density tool is able to measure the percentage of vascular areas on en face angiograms. This analysis is based on an ETDRS grid centered on the macula as with the thickness map. This tool works both on inner and outer vascular plexus.

用于光学相干断层扫描(OCT)血管造影的Optovue AngioVue系统技术基于AngioVue成像系统(Optovue, Inc.， Freemont, CA)，使用分谱幅度去相关血管造影(SSADA)算法。该算法是为了最小化扫描时间而开发的。它通过测量连续横断面扫描之间反射OCT信号振幅的变化来检测血管腔内的运动。SSADA的新颖之处在于如何处理OCT信号以增强流量检测并抑制轴向体运动噪声。具体来说，该算法将OCT图像分割成不同的光谱带，从而增加了可用图像帧的数量。每一帧都有较低的轴向分辨率，不太容易受到血液脉动引起的眼轴运动的影响。Optovue AngioVue系统技术允许定量分析。它提供了流面积和非流面积的数值数据。它还可以生成流密度图。这些指标可以作为诊断和跟踪疾病进展或治疗反应的生物标志物。流动面积:软件将计算绘制面积和容器面积，单位为mm(2)。它允许对给定参与者的所有测量值进行比较。非灌注区:通过鼠标点击选择，软件显示非灌注区。缺血区域以黄色显示。这些区域可以保存下来，并与研究中的其他区域相匹配。流量密度工具能够测量血管面积在正面血管造影上的百分比。这种分析是基于以黄斑为中心的ETDRS网格，与厚度图一样。这个工具对内外血管丛都有效。

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引用次数: 134

Swept-Source Optical Coherence Tomography Angio™ (Topcon Corp, Japan): Technology Review. 扫描源光学相干层析成像Angio™(Topcon公司，日本):技术评论。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442771

P. Stanga, E. Tsamis, A. Papayannis, Francesco Stringa, Tim Cole, A. Jalil

Optical coherence tomography (OCT) angiography (OCTA) is a novel, noninvasive, three-dimensional imaging technique that allows for the visualization of intravascular flow in the microvasculature. Swept-source OCT technology utilizes longer-wavelength infrared light than conventional spectral-domain OCT. This enables improved penetration into tissue and imaging through optical opacities and is invisible to the subject. Topcon has recently developed an innovative OCTA algorithm, OCTARA (OCTA Ratio Analysis), which benefits from being paired with swept-source OCT. OCTARA aims to provide improved detection sensitivity of low blood flow and reduced motion artifacts without compromising axial resolution. In this chapter, we describe the implementation of OCTARA with swept-source OCT technology, the technical specifications of acquisition (e.g. the number of scans, area of examination field, etc.) along with the algorithm's function and principles for analysis of B-scan data to achieve angiographic visualization. Examples of OCTA scans performed using the OCTARA algorithm and a comparison of these scans with images obtained using other technologies are also presented.

光学相干断层扫描(OCT)血管造影(OCTA)是一种新颖的、无创的三维成像技术，可以可视化微血管的血管内血流。扫描源OCT技术利用比传统的光谱域OCT波长更长的红外光，这可以通过光学不透明改善对组织的穿透和成像，并且对受试者不可见。Topcon最近开发了一种创新的OCTA算法，OCTARA (OCTA Ratio Analysis)，该算法得益于与扫描源oct配对，OCTARA旨在提高低血流量的检测灵敏度，减少运动伪影，同时不影响轴向分辨率。在本章中，我们描述了使用扫描源OCT技术实现OCTARA，获取技术规范(例如扫描次数，检查区域面积等)以及算法的功能和原理，用于分析b扫描数据以实现血管成像可视化。本文还介绍了使用OCTARA算法进行OCTA扫描的示例，并将这些扫描与使用其他技术获得的图像进行了比较。

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引用次数: 128

Optical Coherence Tomography Angiography of Fibrosis in Age-Related Macular Degeneration. 年龄相关性黄斑变性纤维化的光学相干断层血管造影。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442783

E. Souied, A. Miere, S. Cohen, O. Semoun, G. Querques

PURPOSE To describe the optical coherence tomography angiography (OCTA) features of subretinal fibrosis in the context of exudative age-related macular degeneration. METHODS Patients diagnosed exudative age-related macular degeneration presenting with subretinal fibrosis were imaged by conventional multimodal imaging and OCTA. The patients were divided into the following two groups: group A, for eyes with active exudative features over the last 6 months, and group B, for eyes without any sign of exudation for >6 months. RESULTS In almost all of the patients, a high-flow network was detected inside of the fibrotic scar. We divided the vascular networks into the following three patterns: the pruned vascular tree, tangled network and vascular loop patterns. Furthermore, two types of low-flow structures, for which we coined the terms large flow void and dark halo, were observed. Both active and inactive lesions demonstrated the abovementioned patterns either individually or together. No difference was found between the two groups in the prevalent vascular network pattern of low-flow areas. CONCLUSION OCTA of subretinal fibrosis revealed a perfused, abnormal vascular network, as well as collateral architectural changes in the outer retina and the choriocapillaris layer, in the majority of the studied eyes. These features are associated with both active and inactive fibrotic choroidal neovessels.

目的探讨滤出性老年性黄斑变性视网膜下纤维化的光学相干断层血管造影(OCTA)特征。方法对诊断为渗出性老年性黄斑变性伴视网膜下纤维化的患者进行常规多模态成像和OCTA成像。将患者分为以下两组:A组为近6个月有活动性渗出特征的眼睛，B组为近6个月无任何渗出迹象的眼睛。结果在几乎所有的患者中，在纤维化瘢痕内检测到一个高流量网络。我们将维管网络分为以下三种模式:修剪维管树，缠结网络和维管环模式。此外，我们还观察到两种类型的低流结构，我们将其称为大流空洞和暗晕。活动性和非活动性病变均单独或共同表现出上述模式。两组在低流量区流行的血管网络模式上没有发现差异。结论视网膜下纤维化的octa显示，在大多数研究的眼睛中，外视网膜和绒毛膜毛细血管层有灌注异常的血管网络，以及侧枝结构改变。这些特征与活性和非活性纤维化脉络膜新血管有关。

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引用次数: 17

Optical Coherence Tomography Angiography of Diabetic Retinopathy. 糖尿病视网膜病变的光学相干断层血管造影。

Developments in ophthalmology

Pub Date : 2016-01-01 DOI: 10.1159/000442801

F. Bandello, Eleonora Corbelli, A. Carnevali, L. Pierro, G. Querques

PURPOSE To describe the optical coherence tomography angiography (OCTA) features of diabetic retinopathy. METHODS Literature review and case series. RESULTS Four cases are presented. CONCLUSION OCTA is an effective method for evaluating retinal changes in diabetic retinopathy and represents a novel complement or alternative to fluorescein angiography. Although OCTA should currently be considered an investigational technique, in the near future, it may play key roles in the diagnosis and management of diabetic retinopathy.

目的探讨糖尿病视网膜病变的光学相干断层血管造影(OCTA)特征。方法文献复习和病例分析。结果共4例。结论octa是评估糖尿病视网膜病变视网膜病变的有效方法，是荧光素血管造影的一种新的补充或替代方法。虽然OCTA目前应该被认为是一种研究技术，但在不久的将来，它可能在糖尿病视网膜病变的诊断和治疗中发挥关键作用。

引用次数: 40

Neuroprotection and Retinal Diseases. 神经保护和视网膜疾病。

Developments in ophthalmology

Pub Date : 2016-01-01 Epub Date: 2015-10-26 DOI: 10.1159/000434703

Yannis M Paulus, J Peter Campbell

Neuronal death is the primary cause of vision loss in most retinal diseases. Neuroprotection is the modification of neurons, and/or their surrounding environment, to promote the survival and function of the neurons, especially in environments that would normally be deleterious to their health. Through advances in antioxidative therapy, neurotrophic support and anti-apoptotic therapy, the field of neuroprotection is advancing with the therapeutic hope of improving vision and clinical outcomes for patients.

在大多数视网膜疾病中，神经元死亡是导致视力丧失的主要原因。神经保护是指对神经元和/或其周围环境进行修饰，以促进神经元的存活和功能，特别是在通常对其健康有害的环境中。随着抗氧化治疗、神经营养支持和抗凋亡治疗的进展，神经保护领域正在向前发展，并有望改善患者的视力和临床结果。

引用次数: 5

Routes for Drug Delivery to the Retina: Topical, Transscleral, Suprachoroidal and Intravitreal Gas Phase Delivery. 视网膜给药途径:局部、经巩膜、脉络膜上和玻璃体内气相给药。

Developments in ophthalmology

Pub Date : 2016-01-01 Epub Date: 2015-10-26 DOI: 10.1159/000431193

Norihiro Yamada, Timothy W Olsen

Local drug delivery to the posterior segment, particularly the macula, represents a significant challenge. In this chapter, we review current challenges, barriers and limitations. Due to the local drug delivery to the retina and macula, systemic side effects are limited. In this chapter, we also discuss the historical approaches, key aspects of ideal drug delivery systems, the use of animal models to study pharmacokinetics, and the principles of transscleral, suprachoroidal and gas phase drug delivery.

局部给药后段，特别是黄斑，是一个重大的挑战。在本章中，我们回顾了当前的挑战、障碍和限制。由于局部药物递送到视网膜和黄斑，全身副作用是有限的。在本章中，我们还讨论了历史方法，理想药物传递系统的关键方面，使用动物模型研究药代动力学，以及经巩膜，脉络膜上和气相药物传递的原理。

引用次数: 12

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