电光性视网膜病变的初步临床研究

Early clinical study of electric retinopathy

目的应用光学相干断层扫描(optical coherence tomography,OCT)仪观察电焊弧光对电焊工人视网膜组织结构的损坏情况。方法收集电焊工人41例82眼和正常健康自愿者30例60眼,分别对受试者进行视力、矫正视力、裂隙灯眼前节检查、裂隙灯+90D前置镜进行眼底检查、电脑全自动视野计检查、高分辨率OCT等检查。结果试验组裸眼视力:0.1～0.2者2眼,0.3～0.4者4眼,0.5～0.6者7眼,0.7～0.9者18眼,≥1.0者51眼,试验组41例82眼中,除1例双眼裸眼视力0.4,矫正视力只能达到0.7外,其他所有患者的矫正视力均能达到1.0。对照组裸眼视力:0.1～0.2者1眼,0.3～0.4者3眼,0.5～0.6者6眼,0.7～0.9者15眼,≥1.0者35眼,对照组中所有受试对象的矫正视力均能达到1.0。2组受试对象的视力分布比较,差异无统计学意义(P>0.05)。试验组常规眼底检查发现黄斑区出现圆形或椭圆形、边界不清的暗黄色改变者22眼(占26.8%),其中双眼改变的9例18眼,单眼改变的4例4眼。试验组41例82眼中有64眼的OCT出现程度不等感光细胞层损伤,发生率为78.0%,表现为:感光细胞内外节连接带断裂、缺损,严重者色素上皮层内层缺损。正常对照组均未见有明显的视网膜光感受器细胞损伤改变。结论电焊弧光可以导致视网膜感光细胞层的损害和缺失,OCT相当于活体显微镜,可以直接观察到视网膜感光细胞的损伤范围和深度。

Objective To investigate whether the welding arc can cause damage of welder’s retinal tissue structure with optical coherence tomography （OCT）.Methods Forty-one welders （82 eyes） and 30 normal healthy volunteers （60 eyes） were chosen.Following examinations were made for everyone：visual acuity,corrected visual acuity,slit-lamp front-end examination,slit-lamp ＋90 D lens in front fundus examination,automatic perimeter examination,high-resolution OCT and other inspections.Results The uncorrected visual acuity in trial group were from 0.1 to 0.2 in 2 eyes,from 0.3 to 0.4 in 4 eyes,from 0.5 to 0.6 in 7 eyes,from 0.7 to 0.9 in 18 eyes,1.0 or more in 51 eyes,and the corrected visual acuity of 2 eyes in one case whose uncorrected visual acuity was 0.4,only reached 0.7,the corrected visual acuity of other eyes were more than 1.0.The uncorrected visual acuity in control group was from 0.1 to 0.2 in 1 eye,from 0.3 to 0.4 in 3 eyes,from 0.5 to 0.6 in 6 eyes,from 0.7 to 0.9 in 15 eyes,1.0 or more in 35 eyes,and the corrected visual acuity of all eyes were more than 1.0.There was no statistical difference in visual acuity between two groups （P0.05）.With fundus examination,some rounded or oval dark-yellow changes with obscure boundary in macular area were found in 22 eyes in trail group,in which 9 cases （18 eyes） with binocular changes,4 cases （4 eyes） with monocular changes.OCT showed the varying degrees of photoreceptor cell layer occurred damage appeared in 64 eyes,the damage included the inner and outer segment of photoreceptor cells were broken and defected,the serious appearance was inner layer defect of retinal pigment epithelium,and the incidence rate was 78.0%.For the normal control group,there was not significant damage in retinal photoreceptor cells.Conclusions The welding arc can cause the damage and missing of retinal photoreceptor cell layer,OCT is as same as in vivo microscopy,can direct observe the scope and depth of retinal photoreceptor cells injury.