眼科OCT检查.ppt

RTVue100TheNextGenerationOCT PrinciplesofOCTTechnology OpticalCoherenceTomography OCT usesaprinciplecalledlowcoherenceinterferometrytoderivedepthinformationofvariousretinalstructuresThisisperformedbycomparingthetimedifferenceinreflectedlightfromtheretinaatvariousdepthswithareference standard Differencesbetweenthereflectedlightandthereferencestandardprovidestructuralinformationintheformofan A scan PrinciplesofOCTTechnology AnA scanistheintensityofreflectedlightatvariousretinaldepthsatasingleretinallocationCombiningmanyA scansproducesaB scan A scan A scan B scan A scans RetinalDepth ReflectanceIntensity FourierDomainOCT RTVue100 OpticalCoherenceTomography OCT providescrosssectionalimagingoftheretinaSpectrometryandFourierDomainmethodsallowhighspeeddatacapture 26 000Ascanspersecond Broad bandlightsourceprovideshighdepthresolution 5microns TheEvolutionofOCTTechnology 65xfaster2xresolution ZeissOCT1and2 1996 ZeissStratus2002 OptoVueRTVue2006 26 000 400 100 16 10 5 Speed A scanspersec Resolution mm FourierdomainOCT TimedomainOCT EvolutionofCommercialOCT 1996 2002 2006 OCT1 TimeDomain StratusOCT TimeDomain RTVue FourierDomain TimeDomainOCT SLD Lens Detector DataAcquisitionProcessing Combineslightfromreferencewithreflectedlightfromretina DistancedeterminesdepthinAscan Referencemirrormovesbackandforth ScanningmirrordirectsSLDbeamonretina Interferometer BroadbandLightSource CreatesA scan1pixelatatime FinalA scan ProcessrepeatedmanytimestocreateB scan SlidecourtesyofDr YiminWang USC FourierDomainOCT SLD Spectrometeranalyzessignalbywavelength FFT Gratingsplitssignalbywavelength BroadbandLightSource Referencemirrorstationary Combineslightfromreferencewithreflectedlightfromretina Interferometer Spectralinterferogram FouriertransformconvertssignaltotypicalA scan EntireA scancreatedatasingletime SlidecourtesyofDr YiminWang USC ProcessrepeatedmanytimestocreateB scan FourierDomainOCTSimultaneousEntireA scanatonce2048pixelsperAscan26 000Ascanspersecond1024A scansin0 04secFasterthaneyemovements TimeDomainOCTSequential1pixelatatime1024pixelsperA scan400Ascanspersecond512A scansin1 28secSlowerthaneyemovements Higherspeed higherdefinitionandhighersignal 1024A scansin0 04sec Smallbloodvessels IS OS Choroidalvessels SlidecourtesyofDr DavidHuang USC FourierDomainOCT HighspeedreduceseyemotionartifactspresentintimedomainOCTHighresolutionprovidesprecisedetail allowsmorestructurestobeseenLargerscanningareasallowdatarichmaps accurateregistrationforchangeanalysis3 Dscanningimprovesclinicalutility HighSpeedallows3 Dscanning B scansprovidehighresolutiondetail RetinalLayerswithRTVue Histology ILM NFL GCL IPL INL OPL ONL PRIS OS RPE Choriocapillarisandchoroid Fovea Parafovea Temporal Nasal Maculathicknessmaprevealsedema RPEElevationmaprevealsdrusen CNV RPEElevationmaprevealsCNV ChangeAnalysisformacula GlaucomaAnalysis RNFLThicknessMapNeuralretinalrimCupareaRNFLTSNITgraphat3 45mmcircle Measuringtheganglioncells InnerretinallayerprovidesGanglioncellassessment Axons nervefiberlayerCellBody ganglioncelllayerDendrites innerplexiformlayer ImagescourtesyofDr OuTan USC Ganglioncelllayerinmaculaanalyzedforglaucoma InnerRetinaSegmentationProvidesthicknessof RNFLlayerGanglioncelllayerInnerplexiformlayer NormalvsGlaucoma Normal Glaucoma Cup Rim RNFL InnerRetinaMaculaMap RetinaExamples Normal Rodconedystrophy ImagescourtesyofDr JenniferLim USC Courtesy MichaelTurano CRAColumbiaUniversity CystoidMaculaEdema Courtesy MichaelTurano CRAColumbiaUniversity horizontal vertical DiabeticRetinopathy ImagescourtesyofDr Tano OsakaUniversity CentralRetinalVeinOcclusion ImagescourtesyofDr Tano OsakaUniversity horizontal vertical AMD ClassicCNV ImagescourtesyofDr Tano OsakaUniversity IdiopathicCNV ImagescourtesyofDr Tano OsakaUniversity horizontal vertical MaculaHole ImagescourtesyofDr Tano OsakaUniversity Courtesy MichaelTurano CRAColumbiaUniversity DiabeticMaculaEdemawithEpiretinalMembrane CentralSerousChorioretinopathywithPED earlyphaseFA 56yearoldFemale Sub retinalfluid PED ImagescourtesyofDr Tano OsakaUniversity Operculum Courtesy MichaelTurano CRAColumbiaUniversity Stage3FullThicknessMacularHole CentralSerousChorioretinopathy ImagescourtesyofDr Tano OsakaUniversity EpiretinalMembrane ImagescourtesyofDr Tano OsakaUniversity RetinitisPigmentosa ImagescourtesyofDr Tano OsakaUniversity Courtesy MichaelTurano CRAColumbiaUniversity VitreomacularTractionSyndromewithCME PatientMB NeovascularAMD FundusPhotograph FA CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientMB NeovascularAMD Fluidaccumulation CNV CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientMB NeovascularAMD FullRetinalThicknessMap RPEElevationMap RPEelevationduetoCNV Largeareaofabnormallythickretinafromintraretinalfluidaccumulation CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientWB NeovascularAMD FundusPhotograph FA 86yearoldmale CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientWB NeovascularAMD CNV Date 1 10 07 3 DEvaluationrevealsextentofCNV CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientWB NeovascularAMD FullRetinalThicknessMap RPEElevationMap RPE choroiddisruptionidentifiespresenceofCNV Someabnormalthickeningandthinning CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientWB NeovascularAMD 1 10 07 2 23 07 B scancomparison FullretinalThickness RPEElevation Treatment2 7 Lucentis2 14 PDT ThinningofretinaandimprovementinRPEinresponsetotreatment CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientED NeovascularAMD 84yearoldmale initialexam12 13 2006 FAshowsleakagejustsuperiortofovea Fullretinalthicknessshowsnothickening RPEelevationmapclearlyshowsareaofCNVsuperiortofovea FA Fullretinalthicknessmap RPEelevationmap CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientED NeovascularAMD InitialExam 12 13 2006 Follow upExam 3 20 2007 RPE Choroidshowssomereductioninheight butoverallretinalthicknessincreasesduetointra retinalfluidaccumulation Treatment1 17 Macugen3 14 Macugen CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientED NeovascularAMD CasecourtesyofDr NalinMehta ColoradoRetinaCenter TotalRetinalThicknessincreases RPEelevationdecreases PatientWW AMD 76yearoldmale Drusen PEDs CasecourtesyofDr NalinMehta ColoradoRetinaCenter PatientWW AMD FullRetinalThicknessMap RPEElevationMap LocalizedelevationsreveallocationofPEDandDrusen FullRetinalthicknessmapnormal CasecourtesyofDr NalinMehta ColoradoRetinaCenter ComparisonofStratusOCTtoRTVueOCT Comparison RTVue Stratus FourierDomainOCT26 000Ascanspersecond5 mdepthresolutionRetinaAssessmentDenseFullRetinalThicknessmapRPEelevationmap3 DmaculascansGlaucomaAssessmentRNFLmapInnerRetinalThicknessmap Ganglioncellassessment axon cellbody dendrites Opticdisc RTVueis65timesfasterRTVuehastwicethedepthresolution TimeDomainOCT400Ascanspersecond10 mdepthresolutionRetinaAssessmentSparseretinalthicknessmapforretina 97 interpolated GlaucomaAssessmentRNFLringforglaucoma TSNITcurve ComparisonofStratusOCTtoRTVueOCT GlaucomaComparison RTVue Stratus DataCaptured 9510Ascans pixels Time 370msecAreacovered 4mmdiametercircle RTVuehas97 moredataRTVueisover5timesfaster DataCaptured256Ascans pixels Time 1 92secondsAreaCovered ringat3 45mmdiameter ProvidesCupAreaRimAreaRNFLMapTSNITgraph ProvidesTSNITgraph RTVueprovidescomprehensiveglaucomainformation Plus RTVuehasexclusiveRetinalGanglionCelllayerassessment DataCaptured 14 810Ascans pixels Time 570msecAreacovered 7x7mm ProvidesInnerRetinaMapGanglioncellassessmentinmacula NoComparison RTVueprovidesdirectganglioncellinformationInnerretinaanalysis RNFLGanglioncellbodyInnerplexiformlayer RTVuecanprovide3 DimagingoftheopticdiscandRNFL NoComparison DataCaptured 51 712Ascans pixels Time 2secondsAreacovered 4x4mm Provides3Dmap RTVueprovides3DimageofopticdiscandparapapillaryRNFL ComparisonofStratusOCTtoRTVueOCT RetinaComparison RTVue Stratus DataCaptured 19 496Ascans pixels Time 780msecAreacovered 5x5mm RTVuehas96 moredataRTVueisover2 4timesfaster DataCaptured768Ascans pixels Time 1 9secondsAreaCovered circle6mmdiameter ProvidesDenseRetinalthicknessmap ProvidesSparseRetinalthicknessmap97 interpolatedbetweenlines RTVueprovidesmoredataandamoredetailedthicknessmap RTVuehas3Dimagingofthemacula DataCaptured 51 7212Ascans pixels Time 2secondsAreacovered 4x4mm Provides3Dmapofthemacula NoComparison RTVueprovides3 DimageofmaculaforacomprehensivereviewofB scansoverlargearea Plus RTVuehasRPEelevationmapforDrusenandCNV DataCaptured 19 496Ascans pixels Time 780msecAreacovered 5x5mm ProvidesRPEElevationmap RTVueRPEelevationmaprevealslocationandextentofDrusenandCNVwhichismissedbyretinalthicknessmaps NoComparison RTVueDetails ScanSpeed 26 000AscanspersecondDepthResolution 5micronsTransverseResolution 15micronsFrameRate 256