The Eye Center, Eugene, Oregon, and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon.
Ophthalmic Consultants of Boston, Boston, Massachusetts.
Ophthalmology. 2019 Sep;126(9):1315-1323. doi: 10.1016/j.ophtha.2019.03.044. Epub 2019 Apr 4.
To review the published literature on the use of swept-source (SS) OCT for evaluating the lamina cribrosa in glaucoma.
A PubMed and Cochrane Library literature search initially conducted on March 3, 2017, and updated on June 26, 2018, yielded a total of 64 articles. Articles that were reviews or that were not published in English were excluded, and 29 were found to fit the inclusion criteria. The panel methodologist then assigned a level of evidence rating to each study. Fifteen studies were rated level III, 14 studies were rated level II, and no studies were rated level I.
Different aspects of the lamina cribrosa were studied using SS-OCT, including the anterior lamina cribrosa curvature, anterior lamina cribrosa depth, anterior lamina cribrosa insertions, laminar thickness, focal lamina cribrosa defects (FLCDs), and lamina cribrosa microarchitecture. In general, imaging of the anterior lamina can be achieved reliably, although shadowing from blood vessels at the neuroretinal rim remains an issue. Imaging of the posterior lamina can be achieved with varying levels of success. In glaucoma, there is posterior migration of the anterior lamina cribrosa insertions as well as increased thinning and posterior curvature of the lamina cribrosa. Focal lamina cribrosa defects appear more commonly in glaucoma, and this may hint at the pathogenesis of axonal damage. In addition, there may be remodeling of the microarchitecture of the lamina, resulting in more variable laminar pores. There are limited studies comparing SS-OCT with spectral-domain (SD) OCT with regard to imaging of the lamina, but the difference in image quality between enhanced depth imaging (EDI) with SD-OCT and SS-OCT seems minimal.
Imaging of the lamina cribrosa using SS-OCT has demonstrated that the lamina cribrosa is likely biomechanically active and that significant changes occur in glaucoma. The diagnostic utility of SS-OCT for lamina cribrosa imaging is promising, but standardized nomenclature, automated measurements, and longitudinal studies with larger and more diverse sample sizes are needed.
回顾关于应用扫频源（SS）光学相干断层扫描（OCT）评估青光眼视盘筛板的文献。
2017 年 3 月 3 日首次进行了 PubMed 和 Cochrane 图书馆文献检索，并于 2018 年 6 月 26 日更新，共获得 64 篇文章。排除了综述或非英文发表的文章，共发现 29 篇符合纳入标准。小组方法学家随后对每项研究进行了证据水平评级。15 项研究被评为 III 级，14 项研究被评为 II 级，没有研究被评为 I 级。
使用 SS-OCT 研究了视盘筛板的不同方面，包括前部视盘筛板曲率、前部视盘筛板深度、前部视盘筛板插入、筛板厚度、局灶性视盘筛板缺陷（FLCD）和视盘筛板微观结构。一般来说，前部视盘的成像可以可靠地实现，尽管神经视网膜边缘血管的阴影仍然是一个问题。后部视盘的成像可以在不同程度上实现。在青光眼患者中，前部视盘筛板插入处向后迁移，筛板变薄和向后弯曲。局灶性视盘筛板缺陷在青光眼患者中更为常见，这可能提示轴突损伤的发病机制。此外，可能存在筛板微观结构的重塑，导致更可变的筛板孔。关于 SS-OCT 与光谱域（SD）OCT 对视盘成像的比较，研究有限，但 SD-OCT 增强深度成像（EDI）与 SS-OCT 之间的图像质量差异似乎很小。
使用 SS-OCT 对视盘筛板进行成像表明，筛板可能具有生物力学活性，并且在青光眼患者中会发生明显的变化。SS-OCT 对视盘筛板成像的诊断效用很有前景，但需要标准化的命名法、自动化测量以及具有更大和更多样化样本量的纵向研究。
