New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; Faculty of Physics, Ludwig-Maximilians-University Munich, Munich, Germany.
Ophthalmology. 2014 Mar;121(3):719-26. doi: 10.1016/j.ophtha.2013.10.014. Epub 2013 Nov 26.
OBJECTIVE: To characterize en face features of the retinal pigment epithelium (RPE) and choroid in eyes with chronic central serous chorioretinopathy (CSCR) using a high-speed, enhanced-depth swept-source optical coherence tomography (SS-OCT) prototype. DESIGN: Consecutive patients with chronic CSCR were prospectively examined with SS-OCT. PARTICIPANTS: Fifteen eyes of 13 patients. METHODS: Three-dimensional 6×6 mm macular cube raster scans were obtained with SS-OCT operating at 1050 nm wavelength and 100000 A-lines/sec with 6 μm axial resolution. Segmentation of the RPE generated a reference surface; en face SS-OCT images of the RPE and choroid were extracted at varying depths every 3.5 μm (1 pixel). Abnormal features were characterized by systematic analysis of multimodal fundus imaging, including color photographs, fundus autofluorescence, fluorescein angiography, and indocyanine-green angiography (ICGA). MAIN OUTCOME MEASURES: En face SS-OCT morphology of the RPE and individual choroidal layers. RESULTS: En face SS-OCT imaging at the RPE level revealed absence of signal corresponding to RPE detachment or RPE loss in 15 of 15 (100%) eyes. En face SS-OCT imaging at the choriocapillaris level showed focally enlarged vessels in 8 of 15 eyes (53%). At the level of Sattler's layer, en face SS-OCT documented focal choroidal dilation in 8 of 15 eyes (53%) and diffuse choroidal dilation in 7 of 15 eyes (47%). At the level of Haller's layer, these same features were observed in 3 of 15 eyes (20%) and 12 of 15 eyes (80%), respectively. In all affected eyes, these choroidal vascular abnormalities were seen just below areas of RPE abnormalities. In 2 eyes with secondary choroidal neovascularization (CNV), distinct en face SS-OCT features corresponded to the neovascular lesions. CONCLUSIONS: High-speed, enhanced-depth SS-OCT at 1050 nm wavelength enables the visualization of pathologic features of the RPE and choroid in eyes with chronic CSCR not usually appreciated with standard spectral domain (SD) OCT. En face SS-OCT imaging seems to be a useful tool in the identification of CNV without the use of angiography. This in vivo documentation of the RPE and choroidal vasculature at variable depths may help elucidate the pathophysiology of disease and can contribute to the diagnosis and management of chronic CSCR.
目的：利用高速、增强深度扫频源光学相干断层扫描（SS-OCT）原型对慢性中心性浆液性脉络膜视网膜病变（CSCR）患者的视网膜色素上皮（RPE）和脉络膜进行 En face 特征描述。
设计：对慢性 CSCR 患者进行前瞻性 SS-OCT 检查。
参与者：13 名患者的 15 只眼。
方法：使用 1050nm 波长和 100000A-lines/sec 的 SS-OCT 对 3×6mm 黄斑立方格子扫描进行三维扫描，轴向分辨率为 6μm。RPE 分割生成参考表面；每隔 3.5μm（1 像素）从 RPE 和脉络膜的 En face SS-OCT 图像中提取不同深度的图像。通过对多模态眼底成像（包括彩色照片、眼底自发荧光、荧光素血管造影和吲哚青绿血管造影（ICGA））进行系统分析，对异常特征进行特征描述。
主要观察指标：RPE 和各个脉络膜层的 En face SS-OCT 形态。
结果：在 15 只眼中的 15 只眼（100%）中，RPE 水平的 En face SS-OCT 成像显示没有信号对应于 RPE 脱离或 RPE 丢失。在脉络膜毛细血管层的 En face SS-OCT 成像中，8 只眼（53%）显示出局部扩大的血管。在 Sattler 层的水平，En face SS-OCT 记录了 8 只眼（53%）的局灶性脉络膜扩张和 7 只眼（47%）的弥漫性脉络膜扩张。在 Haller 层的水平，同样的特征分别出现在 3 只眼（20%）和 12 只眼（80%）中。在所有受影响的眼中，这些脉络膜血管异常都出现在 RPE 异常区域下方。在 2 只患有继发性脉络膜新生血管（CNV）的眼中，明显的 En face SS-OCT 特征与新生血管病变相对应。
结论：1050nm 波长的高速、增强深度 SS-OCT 能够可视化慢性 CSCR 患者的 RPE 和脉络膜的病理特征，而这些特征通常在标准光谱域（SD）OCT 中无法观察到。En face SS-OCT 成像似乎是一种无需血管造影即可识别 CNV 的有用工具。这种对 RPE 和脉络膜血管的可变深度的体内可视化可能有助于阐明疾病的病理生理学，并有助于慢性 CSCR 的诊断和管理。
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