拟诊黄斑微小锥细胞损伤初步研究

Macular minimal cone damage

目的对一组视力下降而眼底及荧光素眼底血管造影(FFA)正常,只有频域相干光断层扫描(FD-OCT)才能发现的黄斑中心凹微小病变的患者进行归纳总结。设计回顾性病例分析。研究对象北京同仁医院眼科门诊12例(13眼)符合要求者。方法询问上述患者病史,并行视力、眼底彩色照相、FFA、FD-OCT、多焦视网膜电图(mfERG)、视野等检查。主要指标OCT图像上视网膜形态学改变。结果 4例患者有光损伤或手术史,8例病因未明。视力:0.06～0.2者3眼,0.3～0.5者3眼,0.6～1.0者7眼。患眼眼前节正常,5眼(38.5%)黃斑中心有一小黄色斑,其余正常。FFA正常。FD-OCT示患眼黄斑中心凹曲线正常,厚度正常,仅在黄斑中心凹处,视网膜内外感光层(IS/OS层)及外节与色素上皮绒毛连接部有极局限缺失区,范围<300μm,外界膜及视网膜色素上皮层正常。mfERG检查7例,4例正常3,例3眼中,1眼振幅密度中度下降,2眼轻度下降。视野检查4例,中心视野均正常。结论对由多种因素引起的视力下降而眼底及FFA正常,只有FD-OCT显示黄斑中心凹处视网膜有微小改变的一类疾病拟诊为黄斑微小锥细胞损伤。

Objective To analyze and study the clinical characteristics of a series of patients who complained of visual decline with minimal fovea lesions which couldn＇t be detected by fundus photography and FFA （fundus fluorescein angiography） examinations, but could be revealed by frequency domain optical coherent tomography （FD-OCT）. Design Retrospective case series. Participants 12 cases （13 eyes） of out-patients in Tongren Hospital were included into analyses. Methods Medical history of the patients were recorded and visual acuity （VA）, fundus photos, FFA, FD-OCT, multifocal eleetroretinogram （mfERG）, visual field examinations were performed. Main Outcome Measures Retinal morphological changes on OCT images. Results The causative factors such as light damage, history of surgery were found in 4 cases. No risk factors were found in the other 8 cases. VA varied from 0.06 to 0.2 in 3 eyes, from 0.3 to 0.5 in 3 eyes, from 0.6 to 1.0 in 7 eyes. The anterior segment was normal in affected eyes. There was a small yellow spot in center of macular in 5 eyes （38.5%）, while maeular in the other cases was normal. FFA exams were normal. FD-OCT revealed the affected eyes had normal macular curve and thickness, but a localized defect area （〈300 um ） in IS/OS layer and outer segment which connecting pigment process of RPE. RPE layer and external limiting membrane were normal. MfERG showed normal in 4 cases, minimal decline of amplitude in 2 cases （2 eyes） and moderate decline in 1 case. Visual field showed no central seotoma. Conclusion The series of minimal fovea lesions caused by a variety of factors with normal fundus and FFA, but detected by FD-OCT could be denominated as macular minimal cone damage.