ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2021-3S-703-711ophthalmology-1647Research ArticleСтатьиОптическая когерентная томография в диагностике и лечении заболеваний роговицыOptical Coherence Tomography for Diagnosis and Treatment of Corneal Diseaseshttps://orcid.org/0000-0001-7198-4498ФисенкоН. В.FisenkoN. V.

Фисенко Наталья Владимировна, кандидат медицинских наук, старший научный сотрудник отдела патологии оптических сред глаза

ул. Россолимо, 11а, б, Москва, 119021

Fisenko Natalia V., PhD, senior researcher of Eye optical system pathology Department

Rossolimo str., 11A, B, Moscow, 119021

natfisenko@mail.ruhttps://orcid.org/0000-0002-1056-4331ОсипянГ. А.OsipyanG. A.

Осипян Григорий Альбертович, кандидат медицинских наук, старший научный сотрудник отдела патологии оптических сред глаза

ул. Россолимо, 11а, б, Москва, 119021

Osipyan Grigoriy A., PhD, senior researcher of Eye optical system pathology Department

Rossolimo str., 11A, B, Moscow, 119021

ФГБНУ «Научно-исследовательский институт глазных болезней»РоссияResearch Institute of Eye DiseasesRussian Federation202122102021183S703711Copyright © Фисенко Н.В., Осипян Г.А., 20212021Фисенко Н.В., Осипян Г.А.Fisenko N.V., Osipyan G.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1647

Оптическая когерентная томография (ОКТ) — современный неинвазивный способ прижизненной визуализации структур переднего и заднего сегмента глаза. В его основе лежит интерферометрический анализ оптических свойств биологических систем с использованием низко когерентного излучения инфракрасного диапазона. В представленной работе описаны физические принципы работы ОКТ-приборов на основе технологий временного метода получения изображений (Time-Domain Optical Coherence Tomography, TD-OCT) и спектральной интерферометрии (Spectral-Domain Optical Coherence Tomography, SD-OCT) с применением преобразования Фурье (Fourier-Domain, FD). В последние годы совершенствование ОКТ направлено на улучшение качества визуализации благодаря использованию различных способов оптической фильтрации. Так, вместо суперлюминесцентного диода в ОКТ-аппаратах последнего поколения установлен лазерный источник излучения с перестраиваемой длиной волны (Swept-Source, SS-OCT), что дает возможность увеличить контрастность изображения. Применение ОКТ в оценке состояния структур переднего сегмента глаза позволяет установить локализацию патологического процесса, оценить скорость его прогрессирования. ОКТ применяют для оценки степени врастания фиброваскулярной ткани в стромальные слои при прогрессирующем птеригиуме, а также для визуализации тканевой инфильтрации при кератитах различной этиологии. ОКТ-пахиметрия в ряде случаев служит наиболее точным методом выявления эктатической деформации роговицы на субклинической стадии. Нередко ОКТ используют у пациентов с буллезной кератопатией при проведении дифференциальной диагностики транзиторного помутнения роговицы, вызванного разреженностью стромы из-за длительного отека ткани и необратимого снижения прозрачности роговицы из-за фиброза. Новым этапом развития ОКТ стало ее применение в кераторефракционной офтальмохирургии. Были разработаны спектральные ОКТ-системы, интегрированные в операционный микроскоп, а также портативные ОКТ-приборы. При помощи интраоперационной ОКТ можно оценить толщину роговичного лоскута и стромального ложа, особенности интерфейса при лазерном in situ кератомилезе (LASIK), выявить динамические изменения состояния ткани во время кросслинкинга роговичного коллагена. Применение интраоперационной ОКТ на начальном этапе кератопластики позволяет выполнить пахиметрию, выявить точную локализацию зон ее истончения, протяженность и глубину помутнения, дефекты десцеметовой мембраны. Полученные данные используют для выбора оптимальной модификации вмешательства, глубины и диаметра трепанации роговичной ткани. Кроме того, визуальный контроль за проведением некоторых этапов кератопластики позволяет снизить риск интра- и послеоперационных осложнений.

Optical coherence tomography (OCT) is a modern non-contact real-time imaging of anterior and posterior eye’s segments. Based on the principle of low-coherence interferometry, it provides the analysis of tissue structures. In this review, we discuss technical aspects of two different OCT platforms: Time-Domain OCT (TD-OCT), and Spectral-Domain (SD-OCT) with the use of Fourier transformation — Fourier-Domain (FD-OCT). Over the last several years, the development of OCT has increased the resolution of images by different ways of optical filtering. The usage of tunable swept laser instead of superluminescent diode in modern Swept-Source OCT (SS-OCT) provides the sufficient quality of image. Anterior segment OCT can detect the pathological changes in different ocular structures and may be a key tool for monitoring of their progression. In pterygium OCT shows the true extent of fibrovascular granulation tissue in stromal layers, whereas in keratitis it provides imaging of corneal infiltration. Frequently, OCT-pachymetry can be advantageous in the detection of subclinical keratectasias. In patients with bullous keratopathy OCT can help to distinguish corneal edema and fibrosis. The new era of OCT is characterized by application of this method in keratorefractive surgery. Microscope-mounted (portable) and microscopeintegrated OCT systems have been developed. During LASIK surgery intraoperative OCT (iOCT) helps to assess flap interface, measure flap and residual bed thickness. It is a useful tool to reveal the structural changes during corneal collagen crosslinking. At the beginning of keratoplasty, iOCT helps to determine the corneal thickness, extent and depth of opacity, Descemet membrane perforation. iOCT guides decision-making regarding keratoplasty modification, depth and diameter of trephination. Furthermore, a real-time visualization of ocular structures during keratoplasty decreases the frequency of intra- and postsurgical complications. 

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The authors declare that there are no conflicts of interest present.