特发性黄斑前膜的3D光学相干断层扫描特征

Macular morphological changes in idiopathic epiretinal membrane:A 3D optical coherence tomography study

目的应用3D光学相干断层扫描(OCT)观察特发性黄斑前膜(IERM)的形态特征及其与视力的关系。方法应用3D-OCT观察IERM118例(136眼),分析中心凹形态、中心凹厚度、感光细胞(IS/OS)情况及与视力的关系。结果在136眼中,板层裂孔者18眼,假性黄斑裂孔者19眼,囊肿者7眼,弥漫水肿者57眼,中心凹正常者35眼。弥漫水肿组的视力为0.48±0.28,明显低于中心凹正常组的视力0.75±0.27,2组比较差异有统计学意义(P<0.05)。感光细胞完整组的中心凹厚度为(276±96)μm,不完整组为(467±172)μm,2组比较差异有统计学意义(P<0.05)。感光细胞完整组的视力为0.64±0.28,不完整组的为0.30±0.20,2组比较差异有统计学意义(P<0.05)。结论3D-OCT能提供更多的特发性黄斑前膜中心凹形态的信息,感光细胞完整患者的视力明显好于不完整者。

Objective Time domain optical coherence tomography（OCT） was wildly used in clinic for the diagnosis of idiopathic epiretinal membrane（ IERM ）. Nowadays, spectral domain OCT （3 D-OCT） can provide ultra-high resolution and highspeed imaging in comparison with time domain OCT. Present study was to evaluate the different macular morphological changes of IERM with 3D-OCT and analyze the influence on visual acuity. Methods 118 cases（ 136 eyes） of IERM were reviewed in this study. 3D-OCT scanning was performed on all the patients and the parameters were analyzed. Morphological changes of maeula zone from IERM were recorded. The relationship of 3D-OCT results with visual acuity was evaluated. Results Macular morphological changes were categorised into types of lamellar macular hole （ LMH ） , maeular pseudohole （ MPH ） , foveal cyst （FC） ,macular edema（ME） and normal according to the findings of OCT. Eighteen of 136 eyes were found with LMH, 19 eyes with MPH ,7 eyes with FC ,57 eyes with ME and 35 eyes were normal in studied patients. The visual acuity in ME group was 0.48 ± 0. 28, and that of normal fovea group was 0.75 ±0. 27, showing a significant difference between them （ P 〈 0. 05 ）. The vision acuity from patients with the unintaet IS/OS refractive signal on 3D-OCT was 0. 30 ± 0.20, and that of patients with intact IS/OS refractive signal on 3D-OCT was 0. 64 ＋ 0. 28 with a significant difference between them（P 〈 0. 05 ）. The foveal thickness in the patient with unintact IS/OS refractive signal on 3D-OCT showed a significant difference from patient with intact IS/OS refractive signal on 3D-OCT （467 ± 172 μm vs 276 ±96 μm, P 〈 0. 05 ）. Conclusion Morphological changes in IERM are diverse. Estimation of those changes may be an important prognostic factor in cases of IERM.