The hallmark of the recent latest advances in diagnostic fundus imaging technology is combination of complex hierarchical levels and depths, as well as wide-angle imaging, ultra-wide imaging. The clinical application of wide-angle and ultra-wide imaging, not only can reevaluate the role of the peripheral retina, the classification types and treatment modalities of central retinal vein occlusion, and enhance the reliability of diabetic retinopathy screening, improve the classification and therapeutic decision of diabetic retinopathy, and but also can help guide and improve laser photocoagulation. However we must clearly recognize that the dominant role of ophthalmologists in the diagnosis of ocular fundus diseases cannot be replaced by any advanced fundus imaging technology including wide-angle imaging. We emphasize to use the three factors of cognitive performance (technology, knowledge and thinking) to improve the diagnosis of ocular fundus diseases in China.
Optical coherence tomography (OCT) has developed from time-doma in into Fourier-domain OCT (FD-OCT) which indicates clearer details and higher resolution of images. FD-OCT can indicate the structure and pathological changes of each retinal layer, and reveal the retinal external limiting membranes and changes of inner- and outer-segment of visual cells by 3D solid reconstruction. FD-OCT not only provide detailed information of the images for the clinical diagnosis, but also help us investigting the characteristics and pthological mechanisms of ocular fundus diseases, which lead us to a new era of technology of observation on ocualr fundus diseases. In the application, we should pay attention to the significance of different colors of OCT images, and focus on the cohenrence of the position in the image acquistion during the follow-up period. Dynamic observation on the lesions by FD-OCT and aggregated anaylsis of resutls of several imageological examination would be the development direction of imageological examination of ocular fundus diseases.
Ultra-wide-field fluorescein angiography (UWFA) is a novel breakthrough in ocular fundus imaging technology, which can capture a single, high-resolution, 200° wide image of the ocular fundus that traditional fluorescein angiography cannot reach. This technology has important impacts on the screening, diagnosis, staging, treatment and follow-up of vascular diseases involving peripheral retina (such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, uveitis and so on).
In recent years, more and more new diagnostic and examining techniques are popularized, which improves the level of ocular fundus disease diagnosis and treatment. Because of the uneven distribution of diagnostic and therapeutic instruments resources, low level of application techniques, and different professional level of the doctors, the improvement and development of the application of the equipments and level of the diagnosis and treatment were inhibited. Appropriate understanding and applying basic diagnostic techniques of ocular fundus disease and comprehensive promoting the professionalsprime; levels are an urgent problem needs to be solved.
ObjectiveTo analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. ResultsThe κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). ConclusionThe comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.
Purpose To investigate the association between the macular volume and thickness, as assessed by optical coherence tomography (OCT), with refraction state and axial length (AL) in children. Methods A total of 100 normal children whose right eyes were randomly selected were divided into five groups due to their refraction, comprising hyperopia, emmetropia, low myopia, moderate myopia, high myopia. The AL of the eyes was measured by IOL mas ter measuring machine. Then the macular volume and thickness were measured by OCT. Results Children with high myopia have smaller macular volume and thinner parafoveal retinal thickness (especially out-ring macular). The minimum thickness and average thickness of the fovea were not significantly different among the five groups. The macular volume ,total average macular thickness and quadrant-specific macular thickness(except the nasal inner quadrants) were positively associated with refraction and negatively associated with AL, while t here were no correlation between minimum foveal thickness, the average foveal th ickness and refraction or AL. Conclusions In Chinese children, increasing axial length was associated with reduced macular volume and thickness (except the foveal region and the nasal inner quadrant). (Chin J Ocul Fundus Dis,2008,24:114-117)
【摘要】目的探讨实时超声弹性成像在淋巴结疾病诊断中的应用价值。 方法分析2008年2月4月27例淋巴结疾病患者的65个淋巴结病灶超声弹性图表现,弹性图分级为0~Ⅳ级,弹性图分型为Ⅰ~Ⅲ型。所有淋巴结均经术后病理学或细针抽吸细胞学检查证实,或经随访证实。结果转移性淋巴结弹性分级较高,≥Ⅲ级11/13,占84.62％;淋巴瘤性淋巴结弹性分级较低,≤Ⅱ级16/21,占76.19％。转移性淋巴结中Ⅱ型7/13,占53.85％,转移性淋巴结占全部Ⅱb型的54.55%(6/11);淋巴瘤性淋巴结中Ⅱ型13/21,占61.90％,淋巴瘤性淋巴结占全部Ⅱa型的73.33％(11/15);反应性淋巴结占全部Ⅰa型的68.18％(15/22)。结论实时超声弹性成像能为淋巴结疾病的诊断提供一定信息,弹性图分级对鉴别良恶性淋巴结有统计学意义,分型对于鉴别特定类型淋巴结疾病有一定提示作用。