中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2011年
6期
508-515
,共8页
禹海%夏国英%高明宏%于静%张艳鹰
禹海%夏國英%高明宏%于靜%張豔鷹
우해%하국영%고명굉%우정%장염응
体层摄影术,光学相干%中心性浆液性脉络膜视网膜病变%光感受器%色素上皮,眼
體層攝影術,光學相榦%中心性漿液性脈絡膜視網膜病變%光感受器%色素上皮,眼
체층섭영술,광학상간%중심성장액성맥락막시망막병변%광감수기%색소상피,안
Tomography,optical coherence%Central serous chorioretinopathy%Photoreceptors%Pigment epithelium of eye
目的 研究急性浆液性脉络膜视网膜病变(CSC)的频域相干光断层扫描(OCT)图像特征.方法 回顾性病例系列研究.对29例(29只眼)急性CSC患者的临床资料进行回顾性分析.所有患者均应用频域OCT三维切面观察黄斑部视网膜显微结构变化,测量黄斑中心凹外核层厚度及光感受器细胞层内外节长度,分析其与最佳矫正logMAR视力的关系.CSC患者组与正常对照组间黄斑中心凹外核层厚度比较采用Mann-Whitney U检验,CSC患者组光感受器细胞层规则和不规则眼与正常对照组间内外节长度比较采用Kruskal-Wallis H检验,CSC患者光感受器细胞层内外节是否均匀与最佳矫正logMAR视力间的相关性采用Spearman相关分析法.结果 29例(29只眼)患者均有黄斑部视网膜浆液性脱离,黄斑中心凹外核层形态无明显变化,厚度(96.94±23.72)μm,与正常对照组(104.15±11.90)μm比较,差异无统计学意义(U＝43.61,P=0.33).光感受器细胞全层厚度均匀一致者11只眼(31.9%),光感受器细胞全层厚度均匀一致伴内外节缺损者6只眼(20.7%),内外节厚薄不均者4只眼(13.8%),内外节明显凸起增厚者6只眼(20.7%),内节与外节剥离者2只眼(6.9%);但CSC患者组光感受器细胞层规则和不规则眼与正常对照组间内外节长度差异无统计学意义(χ2=5.483,P=0.06),可能与观察样本量较少有关.有86.2%的CSC患眼出现视网膜素色上皮(RPE)异常,包括RPE脱离21只眼(72.4%),RPE不规则凸起10只眼(34.5%),RPE层颗粒状沉积6只眼(20.7%),RPE缺损3只眼(10.3%).5例同时行荧光素眼底血管造影检查,有3例荧光素渗漏点在RPE凸起部.患者光感受器细胞层内外节是否均匀与最佳矫正logMAR视力显著相关(r=0.382,P=0.026),与病程无显著相关性(r=0.294,P=0.057);RPE脱离和RPE凸起与最佳矫正logMAR视力间无显著相关性(r=0.234,P=0.127).结论 频域OCT能清晰显示急性CSC患者的细微病理结构改变,是诊断及判断急性CSC患者预后的可靠手段.(中华眼科杂志,2011,47:508-515)
目的 研究急性漿液性脈絡膜視網膜病變(CSC)的頻域相榦光斷層掃描(OCT)圖像特徵.方法 迴顧性病例繫列研究.對29例(29隻眼)急性CSC患者的臨床資料進行迴顧性分析.所有患者均應用頻域OCT三維切麵觀察黃斑部視網膜顯微結構變化,測量黃斑中心凹外覈層厚度及光感受器細胞層內外節長度,分析其與最佳矯正logMAR視力的關繫.CSC患者組與正常對照組間黃斑中心凹外覈層厚度比較採用Mann-Whitney U檢驗,CSC患者組光感受器細胞層規則和不規則眼與正常對照組間內外節長度比較採用Kruskal-Wallis H檢驗,CSC患者光感受器細胞層內外節是否均勻與最佳矯正logMAR視力間的相關性採用Spearman相關分析法.結果 29例(29隻眼)患者均有黃斑部視網膜漿液性脫離,黃斑中心凹外覈層形態無明顯變化,厚度(96.94±23.72)μm,與正常對照組(104.15±11.90)μm比較,差異無統計學意義(U＝43.61,P=0.33).光感受器細胞全層厚度均勻一緻者11隻眼(31.9%),光感受器細胞全層厚度均勻一緻伴內外節缺損者6隻眼(20.7%),內外節厚薄不均者4隻眼(13.8%),內外節明顯凸起增厚者6隻眼(20.7%),內節與外節剝離者2隻眼(6.9%);但CSC患者組光感受器細胞層規則和不規則眼與正常對照組間內外節長度差異無統計學意義(χ2=5.483,P=0.06),可能與觀察樣本量較少有關.有86.2%的CSC患眼齣現視網膜素色上皮(RPE)異常,包括RPE脫離21隻眼(72.4%),RPE不規則凸起10隻眼(34.5%),RPE層顆粒狀沉積6隻眼(20.7%),RPE缺損3隻眼(10.3%).5例同時行熒光素眼底血管造影檢查,有3例熒光素滲漏點在RPE凸起部.患者光感受器細胞層內外節是否均勻與最佳矯正logMAR視力顯著相關(r=0.382,P=0.026),與病程無顯著相關性(r=0.294,P=0.057);RPE脫離和RPE凸起與最佳矯正logMAR視力間無顯著相關性(r=0.234,P=0.127).結論 頻域OCT能清晰顯示急性CSC患者的細微病理結構改變,是診斷及判斷急性CSC患者預後的可靠手段.(中華眼科雜誌,2011,47:508-515)
목적 연구급성장액성맥락막시망막병변(CSC)적빈역상간광단층소묘(OCT)도상특정.방법 회고성병례계렬연구.대29례(29지안)급성CSC환자적림상자료진행회고성분석.소유환자균응용빈역OCT삼유절면관찰황반부시망막현미결구변화,측량황반중심요외핵층후도급광감수기세포층내외절장도,분석기여최가교정logMAR시력적관계.CSC환자조여정상대조조간황반중심요외핵층후도비교채용Mann-Whitney U검험,CSC환자조광감수기세포층규칙화불규칙안여정상대조조간내외절장도비교채용Kruskal-Wallis H검험,CSC환자광감수기세포층내외절시부균균여최가교정logMAR시력간적상관성채용Spearman상관분석법.결과 29례(29지안)환자균유황반부시망막장액성탈리,황반중심요외핵층형태무명현변화,후도(96.94±23.72)μm,여정상대조조(104.15±11.90)μm비교,차이무통계학의의(U＝43.61,P=0.33).광감수기세포전층후도균균일치자11지안(31.9%),광감수기세포전층후도균균일치반내외절결손자6지안(20.7%),내외절후박불균자4지안(13.8%),내외절명현철기증후자6지안(20.7%),내절여외절박리자2지안(6.9%);단CSC환자조광감수기세포층규칙화불규칙안여정상대조조간내외절장도차이무통계학의의(χ2=5.483,P=0.06),가능여관찰양본량교소유관.유86.2%적CSC환안출현시망막소색상피(RPE)이상,포괄RPE탈리21지안(72.4%),RPE불규칙철기10지안(34.5%),RPE층과립상침적6지안(20.7%),RPE결손3지안(10.3%).5례동시행형광소안저혈관조영검사,유3례형광소삼루점재RPE철기부.환자광감수기세포층내외절시부균균여최가교정logMAR시력현저상관(r=0.382,P=0.026),여병정무현저상관성(r=0.294,P=0.057);RPE탈리화RPE철기여최가교정logMAR시력간무현저상관성(r=0.234,P=0.127).결론 빈역OCT능청석현시급성CSC환자적세미병리결구개변,시진단급판단급성CSC환자예후적가고수단.(중화안과잡지,2011,47:508-515)
Objective To describe the pathologic changes of macular in acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT). Methods It was a retrospective case series study. This study included 29 eyes of 29 patients with CSC. The fundus examination was conducted followed by SD-OCT to observe foveal microstructure changes. We evaluated the correlation between the thickness of the outer nuclear layer (ONL), the length of photoreceptors and best-corrected visual acuity (BCVA). Results Serous retinal detachment was found in all 29 eyes with SD-OCT. There was no obvious morphology change in ONL, the thickness of ONL was (96.94±23.72) μm and did not different from that in normal control eyes (104.15±11.90) μm. The thickness of photoreceptors was uniform in 11 eyes (31.9%), uniform but with defects in 6 eyes (20.7%), uneven in 4 eyes (13.8%), protruding of outer segments (OS) was observed in 6 eyes (20.7%) and flaking OS in 2 eyes (6.9%). The length from external limiting membrane to the longest outer segment in CSC eyes was 84 (52 to 148) μm and was not statistically different from that in normal eyes (69 to 82)μm. Morphology changes of retinal pigment epithelium (RPE) were found in 25 eyes, including pigment epithelial detachment of RPE (PED) in 21 eyes (72.4%), small bulge of RPE in 10 eyes (34.5%), granular deposition epi-RPE in 6 eyes (20.7%), defects of RPE in 3 eyes(10.3%). Fluorescein angiography (FA) was performed in 5 eyes and bulging RPE detected by SD-OCT seemed to correspond precisely to the leakage point on FA in 3 eyes. Age, course of disease and thickness of the ONL did not influence BCVA (logMAR). Uneven of thickness of OS was negative prognostic factors for BCVA (r=0.382,P=0.026). Conclusions SD-OCT can demonstrate finer pathologic changes in acute CSC. Furthermore, 3-D image allows localization of these pathologic features to specific site using ELM line as landmark. SD-OCT is a valuable tool for the diagnosis and for predicting visual recovery in CSC.
