眼科 ›› 2023, Vol. 32 ›› Issue (2): 120-126.doi: 10.13281/j.cnki.issn.1004-4469.2023.02.007

• 论著 • 上一篇    下一篇

眼前节相干光断层扫描在眼表鳞状上皮瘤评估与治疗中的应用

于昊哲1,2   吴文雨2   曾唯珍2   曾司彦2   高爽2   冯云1,2   

  1. 1北京大学医学部医学技术研究院100191;2北京大学第三医院眼科100191
  • 收稿日期:2022-03-05 出版日期:2023-03-25 发布日期:2023-03-25
  • 通讯作者: 冯云,Email:fengyun@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(81700799;82070926)

Application of anterior segment optical coherence tomography in the evaluation and treatment of ocular surface squamous epithelioma

Yu Haozhe1,2, Wu Wenyu2, Zeng Weizhen2, Chan Szyyann2, Gao Shuang2, Feng Yun1,2    

  1. 1 Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; 2 Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-03-05 Online:2023-03-25 Published:2023-03-25
  • Contact: Feng Yun, Email: fengyun@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China (General) (81700799; 82070926)

摘要: 目的 探索高分辨率眼前节相干光断层扫描(HR-OCT)及血管成像(AS-OCTA)对眼表鳞状上皮瘤(OSSN)患者眼表以及血管形态的成像、分析能力与一致性。设计 回顾性病例系列。研究对象 2017年9月至2021年1月北京大学第三医院眼科的OSSN患者7例(7眼)。方法 在治疗前后对OSSN病灶区进行HR-OCT及AS-OCTA的图像采集。由3名高年资眼科医生背靠背于统一显示器下对HR-OCT与AS-OCTA结果进行判读并计算一致性系数(ICC),评估测量的可靠性。主要指标 局部病灶治疗前后的影像学特征及ICC值。结果 HR-OCT观察到治疗前病灶区域正常和异常上皮之间的清晰分界、增厚的高反射性上皮以及病变和下层组织之间的切割平面,高反射性上皮评分者间一致性系数为0.942(95%CI: 0.805-0.989,P<0.001),经手术切除肿物及局部化学治疗后可发现HR-OCT中异常高反光区病变消退;AS-OCTA能够明显识别异常血管,显示病灶处血管呈局灶样或海扇样,部分血管分支成叶脉状或末端膨大形成袢环样结构,血管形态评分者间一致性系数为0.824(P<0.001),经治疗后异常血管分支可消退或部分消退,可残留斑片状无血管区域。此外,HR-OCT与AS-OCTA能够评估广泛侵袭患者的角结膜血管异常。结论 HR-OCT及AS-OCTA可用于观察OSSN病灶及异常血管结构特点,具有良好的成像分析一致性且适用于广泛侵袭患者,是相关血管性眼表疾病非侵入性全面评估与客观监测的潜在有力工具。(眼科,2023,32: 120-126)

关键词: 眼表鳞状上皮瘤, 影像学特征

Abstract: Objective To explore the imaging, analysis ability and consistency of HR-OCT and AS-OCTA in ocular surface squamous epithelioma (OSSN) patients. Design Retrospective case series. Participants Seven OSSN patients who were admitted to Peking University Third Hospital from September 2017 to January 2021 were enrolled. Methods HR-OCT and AS-OCTA images were collected before and after treatment. HR-OCT and AS-OCTA results were interpreted by 3 senior ophthalmologists back-to-back under the same display and the intraclass correlation coefficient (ICC) was calculated to evaluate the reliability of measurement. Main Outcome Measures The characteristics of local lesions and their consistency measured by OCT and AS-OCTA before and after treatment. Results The clear boundary between the normal and abnormal epithelium, thickened hyperreflective epithelium, and the cutting plane between the lesion and the underlying tissue can be observed through HR-OCT. The inter-rater agreement coefficient for hyperreflective epithelial was 0.942 (95% CI: 0.805-0.989, P<0.001). After surgical resection of the tumor and local chemotherapy, the abnormal high reflection area in OCT can be found to disappear. AS-OCTA could clearly identify abnormal vessels, showing focal or scallop-like vessels at the lesion, part of the vessel branches into vein or terminal expansion to form a loop-like structure with an inter-rater agreement coefficient of 0.824 (P<0.001). After treatment, the abnormal vascular branches may be resolved or partially resolved, and patchy avascular areas may remain. In addition, HR-OCT and AS-OCTA are able to assess corneoconjunctival vascular abnormalities in patients with extensive invasion. Conclusions HR-OCT and AS-OCTA can be used to visualize OSSN lesions and vascular structural features with good agreement and are also suitable for patients with extensive invasion, which also the potentially powerful tools for non-invasive comprehensive assessment and objective monitoring of related vascular ocular surface diseases. (Ophthalmol CHN, 2023, 32: 120-126)

Key words:  ocular surface squamous epithelioma, imaging features