CAJ | 학술논문

目的分析频域光相干断层扫描(SD-OCT)对玻璃体黄斑牵拉综合征(VMT)随访观察资料,并探讨SD-OCT在该类病变随访中的临床意义.方法回顾性临床病例系列研究.对2011年6月至2013年11月在河北医科大学第二医院眼科诊断明确的98例98只眼VMT的SD-OCT影像进行分析研究,观察随访VMT眼玻璃体黄斑粘连的自然转归,并分析总结其与最佳矫正视力(BCVA)的关系.结果根据SD-OCT观察到的玻璃体对黄斑区视网膜的牵拉程度,黄斑区视网膜结构改变将VMT分为4级:Ⅰ级为玻璃体不全后脱离,黄斑区玻璃体与视网膜粘连,黄斑结构无异常改变;Ⅱ级为玻璃体不全后脱离,黄斑存在小囊样改变,但中心凹形态基本正常;Ⅲ级为玻璃体不全后脱离,黄斑受牵拉向玻璃体腔隆起、劈裂、囊样改变,中心凹变平坦或隆起;Ⅳ级则为玻璃体不全后脱离,黄斑受宽带状高反射信号玻璃体后皮质牵拉高度隆起,"峰"样突入玻璃体腔,黄斑的正常组织结构完全破坏.Ⅰ级19只眼,Ⅱ级23只眼,Ⅲ级27只眼,Ⅳ级29只眼,初诊时Ⅰ级BCVA较其他组为好,随访12个月时4级VMT间玻璃体黄斑粘连解除情况差异无统计学意义(P＞0.05).结论 SD-OCT不仅能够明确诊断VMT,还可显示黄斑受牵拉程度及显微结构改变;VMT自然转归的SD-OCT随访观察更可为患者及眼科医生的临床决策提供有力依据.
목적 분석빈역광상간단층소묘(SD-OCT)대파리체황반견랍종합정(VMT)수방관찰자료,병탐토SD-OCT재해류병변수방중적림상의의.방법 회고성림상병례계렬연구.대2011년6월지2013년11월재하북의과대학제이의원안과진단명학적98례98지안VMT적SD-OCT영상진행분석연구,관찰수방VMT안파리체황반점련적자연전귀,병분석총결기여최가교정시력(BCVA)적관계.결과 근거SD-OCT관찰도적파리체대황반구시망막적견랍정도,황반구시망막결구개변장VMT분위4급:Ⅰ급위파리체불전후탈리,황반구파리체여시망막점련,황반결구무이상개변;Ⅱ급위파리체불전후탈리,황반존재소낭양개변,단중심요형태기본정상;Ⅲ급위파리체불전후탈리,황반수견랍향파리체강륭기、벽렬、낭양개변,중심요변평탄혹륭기;Ⅳ급칙위파리체불전후탈리,황반수관대상고반사신호파리체후피질견랍고도륭기,"봉"양돌입파리체강,황반적정상조직결구완전파배.Ⅰ급19지안,Ⅱ급23지안,Ⅲ급27지안,Ⅳ급29지안,초진시Ⅰ급BCVA교기타조위호,수방12개월시4급VMT간파리체황반점련해제정황차이무통계학의의(P＞0.05).결론 SD-OCT불부능구명학진단VMT,환가현시황반수견랍정도급현미결구개변;VMT자연전귀적SD-OCT수방관찰경가위환자급안과의생적림상결책제공유력의거.
Objective To observe and follow up vitreomacular traction (VMT) with spectral-domain optical coherence tomography (SD-OCT).Methods Retrospectively collected SD-OCT images, best corrected visual acuity (BCVA) and status of vitreomacular adhesion of 98 subjects (98 eyes) with VMT, and then these data were analyzed in detail.Results According to the severity of vitreomacular traction and structure deformation, SD-OCT images of VMT were classified into 4 categories: class Ⅰ (19 eyes) with vitreomacular adhesion and normal fovea, class Ⅱ (23 eyes) with micro-cystic changes but nearly normal fovea, class Ⅲ (27 eyes) with elevated macula and schisis/cystic fovea, class Ⅳ (29 eyes) with macula tracted forward into vitreous cavity hill-like and completely deformed fovea.At initial diagnosis, BCVA of class Ⅰ was better, while the release rate of vitreomacular adhesion of each class was not statistically different from each other.Conclusions Not only can SD-OCT precisely diagnose VMT, but it can also provide details of vitreous traction and micro-structure changes.Observation of the nature history of VMT with SD-OCT can provide significant evidence for our clinical decisions for VMT.