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1 Trends of Optical Coherence Tomography in Ophthalmology Yoshiaki YASUNO A series of research articles published in early days of optical coherence tomography OCT suggests that OCT was intended to be applied to the clinical ophthalmology even when the inventors were working for pure engineering aspects of OCT. This article describes the brief history of optical coherence tomography OCT from two perspectives of technology and its application. This history will provide us a case study of one of the best-practiced research project of medical-optical technology. Key words: optical coherence tomography, ophthalmology, biomedical optics OCT; optical coherence tomography 1 OCT OCT OCT OCT OCT OCT OCT X CT MRI 2 OCT 10 mm OCT OCT A- 3 OCT OCT TD-OCT OCT FD-OCT OCT A- 4 OCT mm OCT OCT Computational Optics Group yasuno@optlab2.bk.tsukuba.ac.jp 538 2
2 1. OCT OCT OCT OCT 1991 MIT 1 OCT 3 OCT OCT MIT Fujimoto Harvard Medical School Schuman Pliafito Huang MIT OCT in vivo in vivo OCT 10 OCT OCT OCT mm OCT 24 mm OCT mm OCT OCT en face OCT OCT OCT FD-OCT OCT OCT OCT OCT 2. OCT OCT OCT 2 24 mm OCT 5 cm OCT 830 nm OCT nm FD- OCT 11 NFL 539 3
3 (a) N T NFL IPL GCL INL OPL ONL ELM ELS OST RPE Choroid 1 OCT in vivo (b) (a) 1050-nm NFL GCL IPL INL OPL ONL ELM ELS OST RPE (b) 830-nm nm FD-OCT a 830 nm FD-OCT b nm FD-OCT a OCT b GCL IPL INL OPL ONL ELM ELS OST RPE choroid OCT ELS OCT IS/OS inner segment-outer segment junction OCT RPE ELS OST RPE RPE complex RPE RPE OCT RPE 830 nm OCT 830 nm FD-OCT 12 a b OCT 830 nm 830 nm OCT in vivo 1050 nm OCT 1050 nm nm a 830 nm b FD-OCT in vivo RPE 1050 nm OCT 1050 nm OCT 830 nm OCT 4 PCV nm FD-OCT nm FD-OCT 830 nm 1050 nm OCT 1050 nm OCT
4 (a) (b) (c) (d) 図 4 ポリープ状脈絡膜新生血管症例の眼底 OCT 像 a b : 1050 nm OCT で撮影されたもの c d : a b と 同部位を 830 nm OCT で撮影したもの 文献 14 より改変 ることが可能であることを示唆している 現在 1050 nm の臨床用眼底 OCT は 一社一製品が発 図 nm OCT で撮影された線維柱帯切除術の手術痕 ブレブ a b d は OCT の水平 en face 垂直断層 c は同部位を撮影した前眼部写真 売されているのみである しかし すでに他社からもプロ トタイプ機とそれを用いた臨床研究結果が公表されてお は眼圧を下げることで緑内障の進行を抑制するための手術 り 近い将来には 830 nm OCT を置き換えることが期待さ である ここで ブレブの構造は長期にわたり維持され れている 長期間眼圧加工機能が維持される必要がある しかし ブ レブは いうなれば 眼球に人為的に作成された傷であ 4. OCT による前眼部画像化 り 自然治癒が起こる 近年ではマイトマイシン C などの 前眼部はその画像化条件が眼底と大きく異なる まず 薬剤を使用してこの創傷治癒を遅らせるという手法がとら 被計測対照である組織が人体の表面付近に存在する ま れているが やはり 長期的には創傷治癒が起こる そこ た 組織の一部は強膜に覆われており プローブ光は強く で ブレブの様子を定期的にモニターし 必要に応じて再 散乱を受ける このため 前眼部 OCT は眼底よりも長波 介入を行う必要がある その手段として前眼部 OCT が有 長な 1310 nm 帯域のプローブ光を用いて実装されること 効であることが知られている nm では 830 nm 1050 nm に比べれば光 図 5 は 1310 nm FD-OCT で撮影されたブレブの断層像を が水に強く吸収されるが やはり 水の吸収は極小であ 示している M で示された部分に小嚢胞 I で示された部 る また 波長が長いため生体組織の散乱の影響を受けに 分にブレブの水隙があることがみてとれる このようなブ くく より深部までの画像化が可能である レブの内部構造は前眼部 OCT の導入以前は可視化するこ が多い 前眼部の OCT には大きく分けて 2 つの用途がある 一 つは イメージング装置としての眼を検査するという用途 とができなかった 今後 OCT を利用した緑内障手術の 最適化プロトコルの開発が望まれる である この用途では 角膜の形状を三次元的にイメージ ングし その形態を解析することで光学系としての眼の異 本稿で示したように OCT はその始まりから医療応用 常を評価する この評価は 特に円錐角膜の検出に有効な を強く意識した技術であった OCT を単なる技術として ことが知られている とらえた場合 それは 数ある低コヒーレンス干渉計のバ もう一つの用途が 眼の表面付近の異常と人為的に作ら リ エ ー シ ョ ン の ひ と つ に す ぎ な い そ う だ と すれ ば れた構造の評価である 前者は翼状片などの表面疾患であ OCT の発明 とは一体何だったのであろうか それは り 後者は線維柱帯切除術などで外科的に形成される機能 OCT という名称の発明だったのではないだろうか 低コ をもった構造である 線維柱帯切除術は緑内障手術のひと ヒーレンス干渉計の 干渉計 の英語表記である interfer- つであり 前眼部強膜と結膜の間にブレブとよばれるリ ometer とは interference meter であり つまり 光干 ザーバー構造を構築するものである これにより 前眼房 渉を計測する装置 という意味である 一方 OCT の tomo- 内の房水の一部がブレブに流出し 眼圧を減少させること graphy はギリシャ語で 断層 を表す tomos に 記録 を ができる 高い眼圧は視神経にストレスを与え緑内障を進 表す-graphy を繋げることで生まれた単語である つまり 行させることが知られている つまり 線維柱帯切除術と tomography は試料の断層を記録することを目的とした技 43 巻 12 号
5 OCT OCT OCT OCT OCT OCT 1 D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito and J. G. Fujimoto: Optical coherence tomography, Science, J. G. Fujimoto and W. Drexler: Introduction to optical coherence tomography, Optical Coherence Tomography Technology and Applications, eds. J. G. Fujimoto and W. Drexler Springer, 2008 pp A. Rollins, S. Yazdanfar, M. Kulkarni, R. Ung-Arunyawee and J. Izatt: In vivo video rate optical coherence tomography, Opt. Express, N. Nassif, B. Cense, B. Park, M. Pierce, S. Yun, B. Bouma, G. Tearney, T. Chen and J. de Boer: In vivo high-resolution videorate spectral-domain optical coherence tomography of the human retina and optic nerve, Opt. Express, M. C. Pierce, J. Strasswimmer, B. H. Park, B. Cense and J. F. de Boer: Advances in optical coherence tomography imaging for dermatology, J. Invest. Dermatol., L. L. Otis, M. J. Everett, U. S. Sathyam and B. W. 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Yamanari, M. Miura, S. Kim, T. Yatagai and Y. Yasuno: Three-dimensional visualization of choroidal vessels by using standard and ultra-high resolution scattering optical coherence angiography, Opt. Express, S. Makita, Y. Hong, M. Yamanari, T. Yatagai and Y. Yasuno: Optical coherence angiography, Opt. Express, Y. Yasuno, Y. Hong, S. Makita, M. Yamanari, M. Akiba, M. Miura and T. Yatagai: In vivo high-contrast imaging of deep posterior eye by 1-mm swept source optical coherence tomography and scattering optical coherence angiography, Opt. Express, Y. Yasuno, M. Miura, K. Kawana, S. Makita, M. Sato, F. Okamoto, M. Yamanari, T. Iwasaki, T. Yatagai and T. Oshika: Visualization of sub-retinal pigment epithelium morphologies of exudative macular diseases by high-penetration optical coherence tomography, Invest. Ophthalmol. Vis. Sci., S. Radhakrishnan, A. M. Rollins, J. E. Roth, S. Yazdanfar, V. Westphal, D. S. Bardenstein and J. A. 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Hitzenberger: Imaging of polarization properties of human retina in vivo with phase resolved transversal PS-OCT, Opt. Express, M. Yamanari, S. Makita, Y. Lim and Y. Yasuno: Full-range polarization-sensitive swept-source optical coherence tomography by simultaneous transversal and spectral modulation, Opt. Express, B. Park, M. C. Pierce, B. Cense, S.-H. Yun, M. Mujat, G. Tearney, B. Bouma and J. de Boer: Real-time fiber-based multifunctional spectral-domain optical coherence tomography at 1.3 mm, Opt. Express, Y. Lim, Y.-J. Hong, L. Duan, M. Yamanari and Y. Yasuno: Passive component based multifunctional Jones matrix swept source optical coherence tomography for Doppler and polarization imaging, Opt. Lett., M. J. Ju, Y.-J. Hong, S. Makita, Y. Lim, K. Kurokawa, L. Duan, M. Miura, S. Tang and Y. Yasuno: Advanced multi-contrast Jones matrix optical coherence tomography for Doppler and polarization sensitive imaging, Opt. Express, Y.-J. Hong, M. Miura, M.-J Ju, S. Makita, T. Iwasaki and Y. Yasuno: Simultaneous investigation of vascular and retinal pigment epithelium pathologies of exudative macular diseases by multifunctional optical coherence tomography, Invest. Ophthalmol. Vis. Sci.,
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