中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2012年
7期
409-413
,共5页
脉络膜视网膜炎,浆液性,中心性%荧光素,自发性,眼底%体层摄影术,光学相干
脈絡膜視網膜炎,漿液性,中心性%熒光素,自髮性,眼底%體層攝影術,光學相榦
맥락막시망막염,장액성,중심성%형광소,자발성,안저%체층섭영술,광학상간
Chorioretinitis,serous,central%Fluorencein,spontaneous,fundus%Tomography,optical coherence
目的 观察中心性浆液性脉络膜视网膜病变(CSC)患眼眼底自发荧光(FAF)和频域光学相干断层扫描(OCT)图像特征,研究自发荧光和OCT表现与CSC的病程及视力预后的关系.方法 横断面研究.对67例(70眼)CSC患者黄斑部进行自发荧光拍摄和OCT扫描,观察不同病程的患者的病变特征,比较各类表型与病程及最佳矫正视力(BCVA)间的关系.数据比较采用秩和检验.结果 CSC患者的自发荧光图像表现各异:①正常型:7眼(10％),自发荧光图像表现正常,对应OCT显示神经上皮层均拱形向上隆起,与RPE带分离,下方有液性暗区,光感受器外节完整平坦,均匀一致.②单纯增强型:32眼(46％).其中28眼(88％)有神经上皮脱离(SRD),自发荧光主要表现为SRD范围内自发荧光增强,OCT显示神经上皮脱离区外节带表面有不均突起;20眼(62％)伴高荧光颗粒,与眼底所见的黄白色小点基本相对应,对应OCT外节带或RPE表面也有高反射颗粒状样突起.③单纯减弱型:9眼(13％),均伴SRD,对应OCT显示外节带完整平坦,均匀一致.④混合改变型:即自发荧光信号高低相间,22眼(31％).其中17眼(77％)表现自发荧光规则,通常表现为低自发荧光围绕高自发荧光,OCT显示神经上皮层拱形隆起,下方液性暗区,低荧光区对应外节带光滑平坦,高荧光区对应外节带高反射颗粒状突起.正常或单纯减弱、单纯增强、混合改变规则、混合改变不规则等对应的病程,差异均有统计学意义(Z=-5.380、-3.791、-3.416、-4.049、-3.309、-3.421,P＜0.01).对应的BCVA,除了单纯增强组与混合改变规则组相比,差异无统计学意义外(Z=-2.012,P＜0.05),其余对比组间的差异均有统计学意义(Z=-3.792、-2.676、-2.790、-3.128、-3.311,P＜0.01).结论 CSC患者早期可表现为SRD正常自发荧光或低自发荧光.随着病程的延长,自发荧光增强且延续的时间较长,慢性迁延的患者可出现不同程度的低自发荧光带,对应萎缩病灶或流水带;CSC患者的自发荧光图像改变主要与光感受器外节脱落的盘膜变性及RPE细胞的病理改变有关;病程越长,BCVA越差.
目的 觀察中心性漿液性脈絡膜視網膜病變(CSC)患眼眼底自髮熒光(FAF)和頻域光學相榦斷層掃描(OCT)圖像特徵,研究自髮熒光和OCT錶現與CSC的病程及視力預後的關繫.方法 橫斷麵研究.對67例(70眼)CSC患者黃斑部進行自髮熒光拍攝和OCT掃描,觀察不同病程的患者的病變特徵,比較各類錶型與病程及最佳矯正視力(BCVA)間的關繫.數據比較採用秩和檢驗.結果 CSC患者的自髮熒光圖像錶現各異:①正常型:7眼(10％),自髮熒光圖像錶現正常,對應OCT顯示神經上皮層均拱形嚮上隆起,與RPE帶分離,下方有液性暗區,光感受器外節完整平坦,均勻一緻.②單純增彊型:32眼(46％).其中28眼(88％)有神經上皮脫離(SRD),自髮熒光主要錶現為SRD範圍內自髮熒光增彊,OCT顯示神經上皮脫離區外節帶錶麵有不均突起;20眼(62％)伴高熒光顆粒,與眼底所見的黃白色小點基本相對應,對應OCT外節帶或RPE錶麵也有高反射顆粒狀樣突起.③單純減弱型:9眼(13％),均伴SRD,對應OCT顯示外節帶完整平坦,均勻一緻.④混閤改變型:即自髮熒光信號高低相間,22眼(31％).其中17眼(77％)錶現自髮熒光規則,通常錶現為低自髮熒光圍繞高自髮熒光,OCT顯示神經上皮層拱形隆起,下方液性暗區,低熒光區對應外節帶光滑平坦,高熒光區對應外節帶高反射顆粒狀突起.正常或單純減弱、單純增彊、混閤改變規則、混閤改變不規則等對應的病程,差異均有統計學意義(Z=-5.380、-3.791、-3.416、-4.049、-3.309、-3.421,P＜0.01).對應的BCVA,除瞭單純增彊組與混閤改變規則組相比,差異無統計學意義外(Z=-2.012,P＜0.05),其餘對比組間的差異均有統計學意義(Z=-3.792、-2.676、-2.790、-3.128、-3.311,P＜0.01).結論 CSC患者早期可錶現為SRD正常自髮熒光或低自髮熒光.隨著病程的延長,自髮熒光增彊且延續的時間較長,慢性遷延的患者可齣現不同程度的低自髮熒光帶,對應萎縮病竈或流水帶;CSC患者的自髮熒光圖像改變主要與光感受器外節脫落的盤膜變性及RPE細胞的病理改變有關;病程越長,BCVA越差.
목적 관찰중심성장액성맥락막시망막병변(CSC)환안안저자발형광(FAF)화빈역광학상간단층소묘(OCT)도상특정,연구자발형광화OCT표현여CSC적병정급시력예후적관계.방법 횡단면연구.대67례(70안)CSC환자황반부진행자발형광박섭화OCT소묘,관찰불동병정적환자적병변특정,비교각류표형여병정급최가교정시력(BCVA)간적관계.수거비교채용질화검험.결과 CSC환자적자발형광도상표현각이:①정상형:7안(10％),자발형광도상표현정상,대응OCT현시신경상피층균공형향상륭기,여RPE대분리,하방유액성암구,광감수기외절완정평탄,균균일치.②단순증강형:32안(46％).기중28안(88％)유신경상피탈리(SRD),자발형광주요표현위SRD범위내자발형광증강,OCT현시신경상피탈리구외절대표면유불균돌기;20안(62％)반고형광과립,여안저소견적황백색소점기본상대응,대응OCT외절대혹RPE표면야유고반사과립상양돌기.③단순감약형:9안(13％),균반SRD,대응OCT현시외절대완정평탄,균균일치.④혼합개변형:즉자발형광신호고저상간,22안(31％).기중17안(77％)표현자발형광규칙,통상표현위저자발형광위요고자발형광,OCT현시신경상피층공형륭기,하방액성암구,저형광구대응외절대광활평탄,고형광구대응외절대고반사과립상돌기.정상혹단순감약、단순증강、혼합개변규칙、혼합개변불규칙등대응적병정,차이균유통계학의의(Z=-5.380、-3.791、-3.416、-4.049、-3.309、-3.421,P＜0.01).대응적BCVA,제료단순증강조여혼합개변규칙조상비,차이무통계학의의외(Z=-2.012,P＜0.05),기여대비조간적차이균유통계학의의(Z=-3.792、-2.676、-2.790、-3.128、-3.311,P＜0.01).결론 CSC환자조기가표현위SRD정상자발형광혹저자발형광.수착병정적연장,자발형광증강차연속적시간교장,만성천연적환자가출현불동정도적저자발형광대,대응위축병조혹류수대;CSC환자적자발형광도상개변주요여광감수기외절탈락적반막변성급RPE세포적병리개변유관;병정월장,BCVA월차.
Objective To describe fundus autofluorescence (FAF) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy (CSC) and correlate them with the stage of disease as well as the prognosis for visual acuity.Methods In this cross-sectional study,70 eyes of 67 patients with CSC underwent FAF imaging and spectral-domain OCT scans,and routine ophthalmologic examinations as well.The pattern of fundus alterations in various stages of disease detected by FAF and OCT,and their correlation with best corrected visual acuity (BCVA) were evaluated and analyzed.Data were analyzed using a rank-sum test.Results FAF and OCT images showed correlated but not identical findings that were classified into four phenotypic patterns: ①Normal type: 7 eyes (10％) displayed no abnormal FAF signal with consistent OCTs showing the upward arch bulge of the neurosensory layer,separated from the retinal pigment epithelium (RPE),with a dark liquid zone underneath.The outer segments of the photoreceptor layer were intact and flat,and uniformly distributed.②HyperFAF type:observed in 32 eyes (45.7％).Among them,28 eyes (88％) had neurosensory layer detachment (SRD).The FAF imaging mainly displayed an increased presence of fluorophores within the SRD area,while OCT demonstrated uneven processes at the surface of the outer segment band.Twenty eyes (62％) contained granules of hyperFAF that basically correlated with the yellowish-white dots seen in the retina,and highly reflective granule-like processes in the outer segment band or the surface of the RPE layer in OCT.③HypoFAF type:observed in 9 eyes (13％),all with SRD.OCT imaging revealed an intact and flat outer segment band that was uniformly distributed.④Mixed type: alternation of hyper- and hypoautofluorescence,observed in 22 eyes (31％).Seventeen of those eyes (77％) displayed regular FAF,normally appearing as hypoFAF surrounding hyperFAF.OCT displayed the arch bulge of the neurosensory layer,with a dark liquid zone underneath.The corresponding outer segment band of the hypoFAF region was smooth and flat,with highly reflective granule-like processes in the hyperFAF region.There were significant difference between all other groups including Normal AF/hypo AF,hyperAF,regular mixed AF and irregular mixed AF (Z=5.380,-3.791,-3.416,-4.049,-3.309,-3.421,P＜0.01).For the corresponding BCVA,there were statistically significant differences between all types (Z=-3.792,-2.676,-2.790,-3.128,-3.311,P＜0.01),except for the difference between the hyperFAF type and the regular mixed type (Z=-2.012,P＜0.05).Conclusion In the early stages of acute CSC,FAF might display normal or decreased autofluorescence.Over time,there was a time-dependent progressive increase in the intensity of FAF.HypoFAF was known to occur in correlation with atrophy that results from a chronic detachment of the retina in patients with chronic and persistent CSC.In areas with altered FAF,SD-OCT imaging revealed marked morphological abnormalities not only of the RPE cell layer but also of the photoreceptor layer.Poor visual prognosis correlated most strongly with the long-term course of the disease.Thereafter,prompt management is highly recommended for treatment of CSC.
