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生物医学光子学在糖尿病视网膜病变中的应用进展

朱姗姗 路交 刘鹤南 陈硕 曾柱 钱唯 陈晓隆

朱姗姗, 路交, 刘鹤南, 陈硕, 曾柱, 钱唯, 陈晓隆. 生物医学光子学在糖尿病视网膜病变中的应用进展[J]. 中国光学, 2018, 11(3): 459-474. doi: 10.3788/CO.20181103.0459
引用本文: 朱姗姗, 路交, 刘鹤南, 陈硕, 曾柱, 钱唯, 陈晓隆. 生物医学光子学在糖尿病视网膜病变中的应用进展[J]. 中国光学, 2018, 11(3): 459-474. doi: 10.3788/CO.20181103.0459
ZHU Shan-shan, LU Jiao, LIU He-nan, CHEN Shuo, ZENG Zhu, QIAN Wei, CHEN Xiao-long. Advances in applications of biomedical photonics in diabetic retinopathy[J]. Chinese Optics, 2018, 11(3): 459-474. doi: 10.3788/CO.20181103.0459
Citation: ZHU Shan-shan, LU Jiao, LIU He-nan, CHEN Shuo, ZENG Zhu, QIAN Wei, CHEN Xiao-long. Advances in applications of biomedical photonics in diabetic retinopathy[J]. Chinese Optics, 2018, 11(3): 459-474. doi: 10.3788/CO.20181103.0459

生物医学光子学在糖尿病视网膜病变中的应用进展

doi: 10.3788/CO.20181103.0459
基金项目: 

国家自然科学基金 61605025

国家自然科学基金 61501101

中央高校基本科研业务专项资金 171902001

辽宁省高等学校创新人才支持计划 LR2016031

详细信息
    作者简介:

    朱姗姗(1986—), 女,山东淄博人,博士研究生,2010年于东北大学获得理学硕士学位, 2015年9月开始在东北大学中荷生物医学与信息工程学院就读博士研究生,主要从事生物医学光子学、糖尿病视网膜病变的研究。E-mail: zhu.shanshan111@outlook.com

    刘鹤南(1986—), 男,辽宁沈阳人,医学博士,讲师,主治医师,2007年于中国医科大学获得临床医学学士学位,2010年于中国医科大学获得眼科学硕士学位,2016年于中国医科大学获得眼科学博士学位,2013年至今为中国医科大学附属盛京医院眼科讲师、主治医师,主要从事玻璃体视网膜疾病的临床和基础研究。E-mail:liuhn@sj-hospital.org

    陈硕(1987—), 男,辽宁抚顺人,博士,副教授,硕士生导师,2009年于上海交通大学获得生物医学工程学士学位,2010年于德国海德堡大学获得医学物理硕士学位,2015年于新加坡南洋理工大学获得生物医学工程博士学位,2015年至今为东北大学中荷生物医学与信息工程学院副教授,主要从事生物医学光学成像、生物医学光谱成像等方面的研究。E-mail:chenshuo@bmie.neu.edu.cn

  • 中图分类号: O439

Advances in applications of biomedical photonics in diabetic retinopathy

Funds: 

National Natural Science Foundation of China 61605025

National Natural Science Foundation of China 61501101

the Fundamental Research Funds for the Central Universities 171902001

Program for Innovation Talents in Universities of Liaoning Province LR2016031

More Information
  • 摘要: 随着我国社会经济的发展及国人饮食、生活习惯的改变,糖尿病的发病率呈逐年上升趋势。糖尿病视网膜病变(Diabetic Retinopathy,DR)作为糖尿病最为常见的并发症,已成为视力下降甚至致盲的主要原因之一。通过对其早期诊断和及时治疗,超过50%的患者的视力损伤及致盲可得到预防。因此,研究DR的诊断和治疗方法具有重要的临床意义。由于眼部的结构及光学特性,生物医学光子学技术在DR的临床诊断和治疗中已得到了非常广泛的应用并且具有巨大的发展前景。本文综述了目前临床上用于DR诊断和治疗的主要生物医学光子学技术的原理及其最新应用进展,并分析对比了各个技术的特点,最后总结并展望了生物医学光子学技术在临床DR诊断和治疗的发展趋势。
  • 图  1  眼底相机部分光学系统

    Figure  1.  Part optical system of fundus camera

    图  2  OCT工作原理

    Figure  2.  Working principle of OCT

    表  1  常用的DR临床诊断技术的比较

    Table  1.   Comparison of clinical diagnosis technologies for DR

    DR诊断技术 优点 缺点
    检眼镜 价格低廉、实用、快捷、对黄斑区等细微病变有优势 灵敏度低、需患者高度配合、检查结果无法保存、诊断主观性、不适合大规模筛查
    裂隙灯 价格相对低廉、对黄斑水肿的检查有优势 需散瞳、需加用前置镜或接触镜、不适合大规模筛查
    眼底照相 非侵入性、数字化成像、操作方便快捷、图像客观、成像迅速、可重复、可储存、可传输、适于大规模筛查和远程医疗 需要大量专业人员进行阅片、无法预测眼底尚未发生改变的患者的DR进程、对黄斑水肿引起的视网膜增厚以及发现细微病变没有优越性
    荧光素眼底血管造影 DR诊断的“金标准”、可动态观察视网膜血液循环、血-视网膜屏障、RPE层的生理和病理信息等、能发现微小病变并确定其范围和部位、能确定黄斑部毛细血管无灌注区、发现导致黄斑水肿的毛细血管渗漏、指导视网膜激光光凝治疗 侵入性、造影剂过敏反应、不适合大规模筛查
    OCT 在体、实时、非侵入性、无需散瞳、定量测量显微级别的空间分辨率的视网膜形态、定量测量视网膜厚度、监测黄斑水肿等 费用高、易受屈光介质浑浊、患者运动伪影影响无法获得清晰图像、视网膜检查范围有限、无法确定微小病变
    下载: 导出CSV

    表  2  不同的DR激光治疗技术的比较

    Table  2.   Comparison of different photocoagulation technologies for DR

    DR的激光治疗技术 优点 缺点
    传统激光光凝 连续波激光、单点激光、能量高 完全热坏死治疗、可能造成周边视觉下降、视野缩小、暗适应下降、对比敏感度下降、机动车驾驶能力受损、加重DME、造成永久的中心视力受损、脉络膜新生血管、激光瘢痕扩大等
    Pascal激光光凝 半自动化、多点激光、激光光凝热扩散少、曝光时间短、能量密度低、定位更精准、光斑排列均匀、光凝确切、一次性完成PRP、耗时减少、患者疼痛反应减轻、治疗周期短、周围组织的损伤减小、并发症减少、患者依从性好 对于新生血管的消退、避免其复发的疗效不如传统的氩激光、治疗PDR效果可能不如传统激光
    导航激光光凝 激光光凝和活体眼底成像相结合、可自动定位、可记录、安全性好、患者耐受性好、可重复性、能达到很高的准确性 需大量样本进行长时间的随访来进一步验证其安全性
    SDM 微脉冲、低能量、限制了激光对RPE层的损伤、没有可见的激光斑 操作费时
    视网膜再生疗法 非连续的能量分布的低能倍频纳秒激光脉冲、信号可控制、对RPE层刺激修复而非破坏 需深入的临床研究进一步验证其安全性
    SRT 选择性治疗、保留了完整的视觉 激光斑可见、需深入的临床研究来进一步证实其有效性和安全性
    下载: 导出CSV
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  • 收稿日期:  2018-01-03
  • 修回日期:  2018-03-02
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