Department of Ophthalmology, Seoul National University College of Medicine, Seongnam, Korea.
JAMA Ophthalmol. 2013 Jul;131(7):880-90. doi: 10.1001/jamaophthalmol.2013.172.
The value of imaging modalities remains unknown in occult macular dystrophy (OMD) because they have not been compared in previous studies to our knowledge. Furthermore, because most OMD imaging studies have been limited to a single imaging modality, information about retinal pathologic characteristics simultaneously obtained using multimodal imaging has not been provided for OMD to date.
To investigate the clinical and retinal pathologic features of OMD using multimodal imaging and to assess their value in OMD.
Retrospective imaging study in an academic research setting.
Forty-six eyes from 25 Korean patients diagnosed as having OMD.
Detailed retinal morphologic abnormalities were evaluated using spectral-domain optical coherence tomography (SD-OCT), fundus infrared (IR) reflectance, autofluorescence (AF), and IR-AF imaging.
Quantitative and qualitative morphologic features were evaluated for their association with visual and electrophysiologic function.
All eyes showed abnormal outer retinal structures in the macula as assessed by SD-OCT. Abnormal round dark macular areas were detected with dark fundus IR reflectance imaging in 36 of 46 eyes (78%). This area corresponded to the area of photoreceptor disruption revealed by SD-OCT and was associated with visual acuity, perimetric results, and multifocal electroretinography responses. In 6 of 18 eyes (33%), IR-AF imaging showed central hypoautofluorescence within normal hyperautofluorescence. In 2 of 18 eyes (11%), fundus AF showed weak hyperautofluorescence. Progression of photoreceptor disruption was identifiable on SD-OCT, and hyporeflectance in IR images became more evident in eyes showing OMD progression.
Across multimodal imaging, SD-OCT was most valuable for diagnosis and for determining the outer retinal pathologic features of OMD. Outer retinal pathologic changes manifested different morphologic abnormalities, indicating that OMD is a heterogeneous disease. Fundus IR reflectance imaging is an easy and helpful adjunct for the diagnosis and detection of OMD progression.
据我们所知，在隐匿性黄斑营养不良（OMD）中，影像学方式的价值尚不清楚，因为在之前的研究中尚未对其进行比较。此外，由于大多数 OMD 影像学研究仅限于单一的影像学方式，因此迄今为止尚未提供有关使用多模态成像同时获得的视网膜病理特征的信息。
使用多模态成像研究 OMD 的临床和视网膜病理特征，并评估其在 OMD 中的价值。
在学术研究环境中进行的回顾性成像研究。
25 名韩国患者的 46 只眼被诊断为 OMD。
使用频域光学相干断层扫描（SD-OCT）、眼底红外（IR）反射率、自发荧光（AF）和 IR-AF 成像评估详细的视网膜形态异常。
评估定量和定性形态特征与视觉和电生理功能的关系。
所有眼睛的 SD-OCT 均显示黄斑区外视网膜结构异常。46 只眼中的 36 只（78%）通过眼底 IR 反射率成像检测到圆形暗黄斑区。该区域与 SD-OCT 显示的光感受器破坏相对应，与视力、视野结果和多焦视网膜电图反应相关。在 18 只眼中的 6 只（33%）中，IR-AF 成像显示正常高自发荧光内的中央低自发荧光。在 18 只眼中的 2 只（11%）中，眼底 AF 显示弱高自发荧光。SD-OCT 可识别光感受器破坏的进展，在显示 OMD 进展的眼中，IR 图像中的低反射率变得更加明显。
在多模态成像中，SD-OCT 对诊断和确定 OMD 的外视网膜病理特征最有价值。外视网膜病理变化表现出不同的形态异常，表明 OMD 是一种异质性疾病。眼底 IR 反射率成像对于诊断和检测 OMD 进展是一种简单且有用的辅助手段。
