Tomi Anca
SpitaluL Clinic de Urgenţe Oftalmologice, Bucureşti.
Oftalmologia. 2011;55(2):60-9.
Diagnostic tools for macular disease have developped over the last years due both to the elaboration of new methods of approach and to the improvement of the already existing ones. Fluorescein angiography (FA) is a minimally invasive procedure that involves photographic surveillance of the blood circulation of the retina and choroid, thus offering data on fundus pathology In eyes with AMD (Age Related Macular Degeneration) the assessment through FA is necessary in order to confirm the presence of CNV (Choroidal Neovascular Membrane). Beside that, FA offers details about the size, location and type (occult or classic) of CNV and it is useful in the followup after treatment. OCT (Optical Coherence Tomography) is a modern imagistic method, that is non-invasive, easily repetable and lacks complications. It acquires in vivo images that represent cross-sections of the retina. In the last years it has become an ever more popular diagnostic tool. OCT imaging is able to detect the presence of CNV and of sub- and intraretinal fluid accumulation. During the last decade, the management of neovascular AMD has changed, as anti-VEGF therapy has become the treatment of choice for all subfoveal CNV lesions types (occult and classic). Some clinicians tend to overlook the importance of FA assessment and rely only on visual acuity and OCT imaging for establishing both diagnosis and indication of treatment. Experts in the field say that these two investigations provide complementary information. They agree that the anatomical data offered by OCT imaging should be supported by the proof that an active exudation exists, which can only be provided by FA. At this moment the management of AMD includes both FA and OCT scanning. Several studies have tried to determine which OCT parameters corelate best with the activity of CNV as it appears on FA photographs. Further on, we shall present a few clinical cases that we consider representative for the topic.
在过去几年中，由于新方法的研发以及现有方法的改进，黄斑疾病的诊断工具得到了发展。荧光素血管造影（FA）是一种微创检查，通过对视网膜和脉络膜血液循环进行摄影监测，从而提供眼底病变的数据。在患有年龄相关性黄斑变性（AMD）的眼中，通过FA进行评估对于确认脉络膜新生血管（CNV）的存在是必要的。除此之外，FA还能提供有关CNV的大小、位置和类型（隐匿性或典型性）的详细信息，并且在治疗后的随访中很有用。光学相干断层扫描（OCT）是一种现代成像方法，具有非侵入性、易于重复且无并发症的特点。它能够获取代表视网膜横截面的体内图像。在过去几年中，它已成为越来越受欢迎的诊断工具。OCT成像能够检测到CNV以及视网膜下和视网膜内液体积聚的存在。在过去十年中，新生血管性AMD的治疗方式发生了变化，因为抗血管内皮生长因子（VEGF）疗法已成为所有黄斑中心凹下CNV病变类型（隐匿性和典型性）的首选治疗方法。一些临床医生往往忽视FA评估的重要性，仅依靠视力和OCT成像来进行诊断和确定治疗指征。该领域的专家表示，这两项检查提供互补信息。他们一致认为，OCT成像提供的解剖学数据应得到存在活动性渗出的证据支持，而这只能由FA提供。目前，AMD的治疗包括FA和OCT扫描。多项研究试图确定哪些OCT参数与FA照片上显示的CNV活性最相关。接下来，我们将展示一些我们认为该主题具有代表性的临床病例。
