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光相干断层扫描技术在眼表鳞状上皮瘤诊疗中的应用及展望
李育霖
张弘 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20190709-00302
Application and prospect of optical coherence tomography in the diagnosis and management of ocular surface squamous neoplasia
Li Yulin
Zhang Hong
Authors Info & Affiliations
Li Yulin
Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Zhang Hong
Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
·
DOI： 10.3760/cma.j.cn115989-20190709-00302
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摘要

眼前节光相干断层扫描技术(AS-OCT)作为一种无创性检查手段，具有检测肿瘤性上皮病变的巨大潜力。依据AS-OCT上的特征性表现，可在多种眼表疾病中检测出眼表鳞状上皮瘤(OSSN)的存在，其诊断效果堪比病理组织活检。随着技术的发展，AS-OCT成像模式已从时域OCT发展到具有更高外显率和分辨率的频域OCT，其呈现的高质量图像有助于精细辨别OSSN的良恶性，提高OSSN的检出率，完善眼表肿瘤的鉴别诊断，从而提高OSSN的诊断效率。此外，在监测OSSN复发及化疗评估等临床管理阶段，AS-OCT可辅助优化治疗方案，有效监测疾病的转归。本文就OSSN的形态学表现、OSSN各种辅助检查的优劣性、AS-OCT的发展、OSSN在AS-OCT上的特异表现、AS-OCT在非典型OSSN中的应用、AS-OCT在OSSN诊疗中的应用及局限性进行综述。

眼表鳞状上皮瘤;光相干断层扫描技术;诊疗
ABSTRACT

As a non-invasive examination method, anterior segment optical coherence tomography (AS-OCT) has huge potential in detecting neoplastic epithelial lesion.With AS-OCT, detection and differentiation of ocular surface squamous neoplasia (OSSN) within ocular surface pathologies can be achieved and the diagnosis rate is comparable to that of biopsy.With the development of technology, AS-OCT imaging mode has developed from time-domain OCT to spectral-domain OCT with higher penetrance and resolution, the high-quality images of which are helpful to distinguish the benign and malignant OSSN, enhance the detection rate of OSSN, improve the differentiation of ocular surface tumors, and thus improve the diagnostic accuracy of OSSN.In addition, AS-OCT can help optimize the treatment regimen and effectively monitor the outcome of the disease in the clinical management stage, such as monitoring the recurrence of OSSN and evaluating chemotherapy.In this article, the morphological features of OSSN, the advantages and disadvantages of OSSN auxiliary examinations, the development of AS-OCT, the specific manifestation of OSSN on AS-OCT, the application of OCT in atypical OSSN, as well as the value and limitation of AS-OCT in the diagnosis and management of OSSN were reviewed.

Ocular surface squamous neoplasia;Optical coherence tomography;Management
Zhang Hong, Email: mocdef.3ab6165450540831
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引用本文

李育霖,张弘. 光相干断层扫描技术在眼表鳞状上皮瘤诊疗中的应用及展望[J]. 中华实验眼科杂志,2021,39(02)：161-165.

DOI:10.3760/cma.j.cn115989-20190709-00302

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1995年，Lee和Hirst [ 1 ]首次提出眼表鳞状上皮瘤(ocular surface squamous neoplasia，OSSN)这一概念，以概述眼表肿瘤性鳞状上皮异常这一系列疾病。OSSN传统的确诊方式依赖组织病理学检查，依据其上皮鳞状病变的程度可为分为良性病变、交界性病变及癌性病变，包括鳞状发育不良、原位鳞状细胞癌和浸润性鳞状细胞癌等 [ 2 ]。OSSN的典型表现为单侧睑裂区角膜缘处的血管化肿块。实际临床中OSSN的表现往往并不典型，裂隙灯显微镜检查较难与其他眼表疾病区分。随着对该疾病认识的不断深入，许多研究者发现OSSN还较常与翼状胬肉、眼表的慢性炎症等多种疾病共存 [ 3 ]。以翼状胬肉为例，近10年研究翼状胬肉与OSSN共生情况的文献表明，OSSN在翼状胬肉中的发生率为0.65%～9.80% [ 4 , 5 , 6 ]。流行病学统计结果显示，OSSN和翼状胬肉的全球发病率分别为每年0.03～3.40例/十万人和每年1 000～33 000例/十万人 [ 4 , 5 ]。如取上述共生比率1%进行统计，OSSN的发病率可达每年10～330例/十万人，这一数据表明OSSN在各类眼表疾病中实际发病情况可能被严重低估，而单纯通过裂隙灯显微镜检查极易漏诊。临床中有待寻找一种高效的检查手段以完善OSSN的诊断与治疗。眼前节光相干断层扫描(anterior segment optical coherence tomography，AS-OCT)作为一种非侵入性成像技术，拥有明确检测肿瘤性上皮病变的巨大潜力 [ 2 ]。研究表明，依据OSSN在OCT上呈现的特征性图像而做出的临床诊断，其准确率堪比病理组织活检 [ 3 ]，其应用价值在提高OSSN检出率、监测化疗进程、监测术后肿物复发等方面均有所体现。AS-OCT正在迅速成为OSSN诊疗中的必备法宝。本文就AS-OCT在OSSN诊疗中的应用、该技术的诊疗价值及其未来发展的潜在方向进行综述。
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张弘，Email： mocdef.3ab6165450540831
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