CAJ | 학술논문

目的使用频域光学相干断层扫描(Speetralis OCT)观察中心性浆液性脉络膜视网膜病变(CSC)患者视网膜色素上皮(RPE)-Bmch膜-脉络膜毛细血管复合体的影像学特征.方法非干预性、观察性研究.确诊为CSC的连续病例109例(111眼),其中男89例(91眼),女20例(20眼).所有患者均接受了视力、眼压、裂隙灯显微镜、前置镜、眼底彩照、Spectralis OCT、荧光素眼底血管造影(FFA)检查,部分患者同时行吲哚青绿血管造影检查.在Speetralis OCT的图像上,仔细观察患眼黄斑区视网膜最外层的Bruch膜(BM)高反射带.根据BM反射带是否显现将其分为不可分辨型BM和可分辨型BM两组.可分辨型BM义分为显型BM和隐型BM两型.视网膜色素上皮脱离(PED)分型与BM分型相对应,分为不可分辨型PED、可分辨型PED及显型PED、隐型PED.对分型结果进行计数,求百分比.结果 111只患眼的RPE-BM-脉络膜毛细血管复合体的反射带上,100%为可分辨型BM.不同患眼BM的可见程度及范嗣有一定的差异:BM反射带清晰可见的(显型)99眼(89.8%),不清楚但与正常视网膜区域对比仍然可分辨出BM的(隐型)12眼(10.2%).CSC慢性期病例的BM的显现较急性期更为广泛,并伴有不同程度的RPE、脉络膜毛细血管层的萎缩.OCT对FFA检查中渗漏点的跟踪扫描显示,所有FFA中标记的渗漏点处在OCT中均可见BM的显现.结论 Speetralis OCT图像上,视网膜最外层的高反射外带是由RPE中具有大量皱褶的基底膜、BM和脉络膜毛细血管复合体共同构成,正常的BM不能从复合体的高反射带中分辨出来.CSC患眼中,BM普遍可见,提示RPE与BM相互分离,同时也存在BM与脉络膜毛细血管间的侈开,这将成为CSC影像学乃至病理学的新发现.
목적 사용빈역광학상간단층소묘(Speetralis OCT)관찰중심성장액성맥락막시망막병변(CSC)환자시망막색소상피(RPE)-Bmch막-맥락막모세혈관복합체적영상학특정.방법 비간예성、관찰성연구.학진위CSC적련속병례109례(111안),기중남89례(91안),녀20례(20안).소유환자균접수료시력、안압、렬극등현미경、전치경、안저채조、Spectralis OCT、형광소안저혈관조영(FFA)검사,부분환자동시행신타청록혈관조영검사.재Speetralis OCT적도상상,자세관찰환안황반구시망막최외층적Bruch막(BM)고반사대.근거BM반사대시부현현장기분위불가분변형BM화가분변형BM량조.가분변형BM의분위현형BM화은형BM량형.시망막색소상피탈리(PED)분형여BM분형상대응,분위불가분변형PED、가분변형PED급현형PED、은형PED.대분형결과진행계수,구백분비.결과 111지환안적RPE-BM-맥락막모세혈관복합체적반사대상,100%위가분변형BM.불동환안BM적가견정도급범사유일정적차이:BM반사대청석가견적(현형)99안(89.8%),불청초단여정상시망막구역대비잉연가분변출BM적(은형)12안(10.2%).CSC만성기병례적BM적현현교급성기경위엄범,병반유불동정도적RPE、맥락막모세혈관층적위축.OCT대FFA검사중삼루점적근종소묘현시,소유FFA중표기적삼루점처재OCT중균가견BM적현현.결론 Speetralis OCT도상상,시망막최외층적고반사외대시유RPE중구유대량추습적기저막、BM화맥락막모세혈관복합체공동구성,정상적BM불능종복합체적고반사대중분변출래.CSC환안중,BM보편가견,제시RPE여BM상호분리,동시야존재BM여맥락막모세혈관간적치개,저장성위CSC영상학내지병이학적신발현.
Objective To investigate the imaging features of the retinal pigment epithelium (RPE)-Bruch's membrane (BM)-choriocapillaris complex in central serous chorioretinopathy (CSC) with spectral-domain optical coherence tomography (Spectralis OCT). Methods This was a noninterventional, observational study. One hundred and eleven eyes of 109 consecutive patients (male 89, female 20) diagnosed with CSC were included. All the patients underwent a full ophthalmologic examination, including the visual acuity, slit-lamp microscope, pre-set lens, fundus photography, Spectralis OCT and fundus fluorescein angiography (FFA). Indocyanine green angiography (ICGA) was performed on some patients. The RPE-BM-choriocapillaris complex, which manifested as a high-reflecting band in Spectralis OCT, was carefully checked. Based on the visibility of BM, it was classified into two types: a visible type or invisible type. The visible type was then classified into an obvious type or occult type. If visible, BM appears thinner and more reflective than the RPE-BM-choriocapillaris complex. Meantime, the pigment epithelial detachment (PED) was classified into different types corresponding to the BM categories. The number of different categories were counted, measured and recorded as percentages. Results The visualization of BM manifested in all 11 eyes (100%), but differed to the extent for which it was visible. Of the 111 eyes, the BM was obvious in 99 eyes (89.8%). In the other 12 eyes (10.2%) it was difficult to discriminate, but there were still distinguishable differences from normal RPE-BM-choriocapillaris complexes. The visualization of BM was more obvious and wider in the 27 chronic CSC eyes than in the 84 acute CSC eyes when accompanied by the atrophy of choriocapillaris and RPE. BM was discriminated or visualized at all of the tracking leakage points demonstrated on FFA images. Conclusion BM is sandwiched between the RPE and choriocapillaris, and it cannot be distinguished in the normal high-reflecting band of the complex in a Spectralis OCT image. Visualization of BM in the RPE-BM-choriocapillaris complex demonstrates a detachment not only between BM and the RPE, but also perhaps between BM and the choriocapillaris. This discovery may offer new morphological and pathological evidence for central serous chorioretinopathy.