Loidl Max, Enders Christian, Werner Jens Ulrich, Lang Gerhard K, Lang Gabriele E
Klinik für Augenheilkunde, Universitätsklinikum Ulm, Ulm.
Klin Monbl Augenheilkd. 2017 Sep;234(9):1154-1160. doi: 10.1055/s-0043-118224. Epub 2017 Sep 11.
Retinal artery occlusion (RAO) is the most common primary angiopathy of the retina. With an incidence of 0.01 - 0.15%, this it is a rather rare disease, but is associated with irreversible damage to the retina and a poor prognosis for visual acuity. Since the 1960s - when fluorescence angiography (FA) was developed -, there has been little change in diagnostic investigations. FA is still the standard procedure for the assessment of retinal artery occlusions. With the development of OCT angiography (OCT-A), new multimodal imaging procedures have become possible. We used Zeiss AngioPlex-OCT-A technology in combination with the CIRRUS HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) to create 6 × 6 mm and 3 × 3 mm volume scans of the area of non-perfusion in patients with RAO. Qualitative OCT-A analysis was performed on retinal images segmented into the superficial and deep retinal capillary plexus. In addition to this, volumetric scans can be segmented to any specific depth of the retina. On the basis of 4 cases, we demonstrate that OCT-A can be used to evaluate RAO. We present typical OCT-A findings. OCT-A images allow the detection of non-perfused areas in patients with acute and chronic RAO. The zones of reduced vascular perfusion are differently distributed in the superficial and deep retinal capillary plexus. In both acute and chronic cases of RAO, OCT-A offers important information on retinal vascular perfusion. OCT-A can be used in the diagnosis and monitoring of acute and chronic cases of RAO. The advantages of OCT-A are that this technique is non-invasive and allows three dimensional microvascular visualisation within seconds. Although artefacts and the currently limited field of view can make it difficult to interpret OCT-A images reliably, these findings suggest that OCT-A may in future replace FA in the assessment of RAO in most patients.
视网膜动脉阻塞（RAO）是视网膜最常见的原发性血管病变。其发病率为0.01%-0.15%，是一种相当罕见的疾病，但与视网膜的不可逆损伤及视力预后不良相关。自20世纪60年代荧光血管造影（FA）问世以来，诊断检查方面几乎没有变化。FA仍是评估视网膜动脉阻塞的标准方法。随着光学相干断层扫描血管造影（OCT-A）的发展，新的多模态成像方法成为可能。我们使用蔡司AngioPlex-OCT-A技术结合CIRRUS HD-OCT 5000（美国都柏林卡尔蔡司医疗技术公司）对RAO患者的无灌注区域进行6×6mm和3×3mm的容积扫描。对分割为视网膜浅、深层毛细血管丛的视网膜图像进行定性OCT-A分析。除此之外，容积扫描可分割至视网膜的任何特定深度。基于4例病例，我们证明OCT-A可用于评估RAO。我们展示了典型的OCT-A表现。OCT-A图像可检测急性和慢性RAO患者的无灌注区域。视网膜浅、深层毛细血管丛中血管灌注减少的区域分布不同。在RAO的急性和慢性病例中，OCT-A均可提供有关视网膜血管灌注的重要信息。OCT-A可用于RAO急性和慢性病例的诊断及监测。OCT-A的优点是该技术是非侵入性的，且能在数秒内实现三维微血管可视化。尽管伪像和目前有限的视野可能使可靠解读OCT-A图像变得困难，但这些发现表明，在大多数患者的RAO评估中，OCT-A未来可能会取代FA。
