OCT定性定量视网膜静脉阻塞性黄斑水肿

To define the quality and quantity ofmacular edema in retinal vein occlusion using OCT

目的强调OCT多个扫描及分析程序联合应用，定性定量分析视网膜静脉阻塞所致黄斑水肿（RVOME）的性质与程度的作用。方法对36例36只跟视网膜中央静脉、分支静脉及半侧静脉阻塞波及黄斑的患眼进行OCT检查：作经过黄斑中心凹多径线线性扫描，成比例处理程序定性分析；作黄斑厚度地形图扫描，容积与厚度分析程序定量研究，记录黄斑中心凹，黄斑中心1mm直径圆形区域视网膜平均厚度及其容积和黄斑总容积等参数，研究这些参数与最佳矫正视力的关系。结果OCT定性分析发现RVOME有6种基本改变即视网膜神经上皮下积液、黄斑囊样水肿、视网膜海绵样肿胀、象限性视网膜厚度变薄、神经上皮浆液性脱离、黄斑前膜等，一眼常同时发生以上2-3种改变。OCT定量研究发现36只眼RVOME黄斑地形图中白、红、黄、绿、蓝颜色分布不一，象限性视网膜厚度变薄患者，受累黄斑区域呈纯蓝色样改变；中心凹，中心凹1mm直径圆形区域视网膜平均厚度及其容积，黄斑总容积分别为（447．61±197．47）μm^3，（451．78±192．19）μm^3，（0．35±0．15）μm^3及（10．20±3．53）μm^3，它们分别都与最佳矫正视力呈直线负相关趋势，但P值均大于0．05。结论OCT定性分析可以发现RVOME黄斑区视网膜内及视网膜下出血、水肿、液体积聚、囊腔形成等细微形态特征；OCT定量研究可以得到黄斑区总体及局部水肿分布图及中心凹，中心凹1mm直径圆形区域视网膜平均厚度及其容积和黄斑总容积等多个水肿严重程度的判定指标。多个扫描和分析程序联合应用可以快速全面评判黄斑水肿的性质与程度，减少RVOME漏诊、量化疗效和随访观察的指标。但与糖尿病性黄斑水肿不同，RVOME中心凹，中心凹1mm直径圆形区域视网膜平均厚度及其容积和黄斑总容积等参数与最佳矫正视力之间无统计学意义关系。

Objective To emphasize the function of combining more than one program of scan and analysis of OCT to estimate the quality and quantity of macular edema in retinal vein occlusion （RVOME） Methods 36 eyes of various types of retinal vein occlusion with macular edema underwent OCT.First,using the Line scan of 4 direction crossing the central fovea and Proportion analysis to define the quality of RVOME. Second,using the Maeular thickness map scan and Thickness /volume analysis to define the quantity of RVOME.Record the data of the retinal thickness of the fovea, the area of I millimeter diameter of the macular center and the macular volume of this 1 millimeter diameter and the total macular volume.Results There are 6 common OCT images in RVOME：the subretinal fluid collection, the macular cystoid edema, the sponge-like retinal swelling,the retinal thickness thinner in quadrant,the serous retinal detachment and the epiretinal membranes.The average retinal thickness at the central fovea was （447.61 ±197.47）μm,the area of 1 millimetre diameter of the macular center was （451.78± 192.19 ）μ m and its volume was （0.35± 0.15 ）μm^3, the total macular volume was（ 10.20± 3.53 ）μm^3.Conclusions The combination of more than one program of scan and analysis of OCT can define the quality and quantity of macular edema in RVOME fast and comprehensively, avoiding missing the diagnosis of RVOME, and getting the accurate data to study the result of treatment in follow up.