CAJ | 학술논문

背景特发性视网膜前膜(IERM)患者前膜的牵引可引起黄斑区视网膜结构的改变及视力下降,了解两者之间的关系有助于更好地判断疾病的预后. 目的观察IERM患者黄斑区视网膜厚度及显微结构的改变,分析黄斑区视网膜增厚及中心凹锥体外节尖端(COST)线的完整性与视力的关系.方法采用回顾性病例分析的方法.收集2011年3-12月在中山大学中山眼科中心确诊的IERM连续病例56例,所有患者均为单眼发病,对侧眼均为正常眼.纳入的患者中男16例,女40例；平均年龄(61.05±6.58)岁.患者双眼均接受频域光学相干断层扫描(SD-OCT)检查,采用黄斑立体程序及高清5线扫描模式进行扫描,记录双眼黄斑厚度地形图中央区(＜1 mm直径)、内环区(1～3 mm直径)、外环区(＞3～6 mm直径)的平均视网膜厚度及COST线状态,比较双眼黄斑各区视网膜平均厚度及中心凹显微结构的差异,分析黄斑区视网膜厚度与视力的相关性,比较IERM患者患眼中COST线完整组与缺失组患者年龄、视力、视网膜厚度的差异. 结果 SD-OCT检查发现IERM患者患眼黄斑中心凹的凹陷变浅或消失,黄斑中央区、内环区和外环区视网膜厚度分别为(446±89)、(418±64)、(328±34)μm,均明显高于对侧正常眼相应区域的(250±22)、(319±17)、(279±17)μm,差异均有统计学意义(t=13.370、9.523、7.769,均P=0.000).黄斑中央区、内环区和外环区视网膜平均厚度与视力均呈负相关(r=-0.686、-0.653、-0.417,P＜0.05).IERM眼中COST线完整者20例,缺失者36例.与COST线完整组患者比较,COST线缺失组患者年龄大,视力差,黄斑各区厚度均增加,差异均有统计学意义(t=2.109,P=0.039;t=-4.093,P=0.000;t=6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000).56例患者的正常对侧眼均未发现COST线缺失. 结论 IERM患者黄斑区视网膜增厚和COST线缺失均可反映IERM眼视功能的损害程度,COST线的缺损可能是光感受器损害的早期标志,与视网膜增厚的进展一致,COST线缺损更多见于年龄较大的患者. 揹景特髮性視網膜前膜(IERM)患者前膜的牽引可引起黃斑區視網膜結構的改變及視力下降,瞭解兩者之間的關繫有助于更好地判斷疾病的預後. 目的觀察IERM患者黃斑區視網膜厚度及顯微結構的改變,分析黃斑區視網膜增厚及中心凹錐體外節尖耑(COST)線的完整性與視力的關繫.方法採用迴顧性病例分析的方法.收集2011年3-12月在中山大學中山眼科中心確診的IERM連續病例56例,所有患者均為單眼髮病,對側眼均為正常眼.納入的患者中男16例,女40例；平均年齡(61.05±6.58)歲.患者雙眼均接受頻域光學相榦斷層掃描(SD-OCT)檢查,採用黃斑立體程序及高清5線掃描模式進行掃描,記錄雙眼黃斑厚度地形圖中央區(＜1 mm直徑)、內環區(1～3 mm直徑)、外環區(＞3～6 mm直徑)的平均視網膜厚度及COST線狀態,比較雙眼黃斑各區視網膜平均厚度及中心凹顯微結構的差異,分析黃斑區視網膜厚度與視力的相關性,比較IERM患者患眼中COST線完整組與缺失組患者年齡、視力、視網膜厚度的差異. 結果 SD-OCT檢查髮現IERM患者患眼黃斑中心凹的凹陷變淺或消失,黃斑中央區、內環區和外環區視網膜厚度分彆為(446±89)、(418±64)、(328±34)μm,均明顯高于對側正常眼相應區域的(250±22)、(319±17)、(279±17)μm,差異均有統計學意義(t=13.370、9.523、7.769,均P=0.000).黃斑中央區、內環區和外環區視網膜平均厚度與視力均呈負相關(r=-0.686、-0.653、-0.417,P＜0.05).IERM眼中COST線完整者20例,缺失者36例.與COST線完整組患者比較,COST線缺失組患者年齡大,視力差,黃斑各區厚度均增加,差異均有統計學意義(t=2.109,P=0.039;t=-4.093,P=0.000;t=6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000).56例患者的正常對側眼均未髮現COST線缺失. 結論 IERM患者黃斑區視網膜增厚和COST線缺失均可反映IERM眼視功能的損害程度,COST線的缺損可能是光感受器損害的早期標誌,與視網膜增厚的進展一緻,COST線缺損更多見于年齡較大的患者.
배경 특발성시망막전막(IERM)환자전막적견인가인기황반구시망막결구적개변급시력하강,료해량자지간적관계유조우경호지판단질병적예후. 목적 관찰IERM환자황반구시망막후도급현미결구적개변,분석황반구시망막증후급중심요추체외절첨단(COST)선적완정성여시력적관계.방법 채용회고성병례분석적방법.수집2011년3-12월재중산대학중산안과중심학진적IERM련속병례56례,소유환자균위단안발병,대측안균위정상안.납입적환자중남16례,녀40례；평균년령(61.05±6.58)세.환자쌍안균접수빈역광학상간단층소묘(SD-OCT)검사,채용황반입체정서급고청5선소묘모식진행소묘,기록쌍안황반후도지형도중앙구(＜1 mm직경)、내배구(1～3 mm직경)、외배구(＞3～6 mm직경)적평균시망막후도급COST선상태,비교쌍안황반각구시망막평균후도급중심요현미결구적차이,분석황반구시망막후도여시력적상관성,비교IERM환자환안중COST선완정조여결실조환자년령、시력、시망막후도적차이. 결과 SD-OCT검사발현IERM환자환안황반중심요적요함변천혹소실,황반중앙구、내배구화외배구시망막후도분별위(446±89)、(418±64)、(328±34)μm,균명현고우대측정상안상응구역적(250±22)、(319±17)、(279±17)μm,차이균유통계학의의(t=13.370、9.523、7.769,균P=0.000).황반중앙구、내배구화외배구시망막평균후도여시력균정부상관(r=-0.686、-0.653、-0.417,P＜0.05).IERM안중COST선완정자20례,결실자36례.여COST선완정조환자비교,COST선결실조환자년령대,시력차,황반각구후도균증가,차이균유통계학의의(t=2.109,P=0.039;t=-4.093,P=0.000;t=6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000).56례환자적정상대측안균미발현COST선결실. 결론 IERM환자황반구시망막증후화COST선결실균가반영IERM안시공능적손해정도,COST선적결손가능시광감수기손해적조기표지,여시망막증후적진전일치,COST선결손경다견우년령교대적환자.
Background Traction of epiretinal membrane results in macular morphologic change and visual functional impairment in eye with idiopathic epiretinal membrane (IERM),therefore figuring out their relationship is helpful for evaluation of disease prognosis.Objective This study was to observe the morphological change of macula and microstructure,and analyze the relationship between retina thickness,integrity of cone outer segment tips (COST) line in fovea and visual acuity.Methods This was a retrospective case-observational study.Fifty-six consecutive cases diagnosed as IERM in Zhongshan Ophthalmic Center from March 2011 to December 2011 were enrolled in this study,and all the patients showed unilateral IERM with the normal fellow eyes.Sixteen patients were males and 40 were females,with a mean age of (61.05 ± 6.58) years old.Spectral-domain optical coherence tomography (SD-OCT) examination was performed on the eyes,and Macular Cube (512×128) and HD 5 Line program were selected.Mean retinal thickness of central area (＜1 mm diameter),inner ring area (1-3 mm diameter) and outer ring area (＞3-6 mm diameter) of macula and the status of COST line (intact or fractured) was recorded.Mean thickness of whole macular areas and the difference of foveal microstructure were compared,and the correlation between retinal thickness and visual acuity was analyzed using Pearson linear correlation analysis.Related parameters including age,visual acuity,retinal thickness were also compared between the continuous COST lines group and the fractured COST lines group by independent sample t test.Results The flatted or disappeared fovea was seen in IERM eyes on the SD-OCT image.Retinal thicknesses were (446±89)μm,(418±64)μm and (328±34)ttm in the central area,inner ring area and outer ring area of macula in the IERM eyes,exhibiting significant increasing in comparison with (250±22) μm,(319±17) μm and (279±17) μm in the normal fellow eyes (t=13.370,9.523,7.769,all P =0.000).Significantly negative correlations were found between the visual acuity and the central macular thickness,inner ring thickness or outer ring thickness (r=-0.686,-0.653,-0.417,P＜0.05).In the IERM eyes,COST band was intact in 20 eyes and lack in 36 eyes.Compared with COST band intact group,aging,worse vision and increased retinal thickness were seen in the COST band absent group (t =2.109,P =0.039 ; t =-4.093,P =0.000 ; t =6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000).COST band was clear in all the normal fellow eyes on the SD-OCT image.Conclusions Increase of macular thickness and disruption of COST band reflect the visual function damage in IERM eye.Deficiency of COST band on OCT image seems to be an early indication of photoreceptor damage.Incomplete fovea COST band is often seen in older patients.