视网膜中央静脉阻塞致黄斑水肿的频域OCT形态表现

Spectral-domain OCT features of macular edema induced by central retinal vein occlusion

背景黄斑水肿是视网膜中央静脉阻塞（CRVO）视力损害的重要原因。频域OCT（SD-OCT）提高了扫描速度和图像的清晰度，有助于眼科医师了解黄斑水肿的形态改变和病理机制。目的利用SD-OCT观察分析CRVO性黄斑水肿的形态改变。方法回顾性分析2008年3月-2009年8月在北京协和医院眼科经视力、眼压、裂隙灯、间接检眼镜、荧光素眼底血管造影（FFA）和SD-OCT检查确诊的CRVO患者资料。通过SD-OCT检查，分析黄斑区的形态改变。结果黄斑水肿的平均厚度为（527．5±218．2）μm，主要表现为囊样水肿55眼（84．6％），浆液性脱离15眼（23．1％）和神经上皮水肿增厚10眼（15．4％），以上3种形态可以合并出现。囊样水肿中心凹旁的囊腔可位于内核层、外丛状层和外核层，且内节／外节（IS／OS）层信号多有减弱或不连续。CME中合并不完全玻璃体后脱离（PVD）者占14．5％，神经上皮水肿增厚合并不完全PVD者占10．0％，差异无统计学意义（X^2=0．000，P=1．000），黄斑浆液性脱离的范围平均为1838．4μm×l428．1μm×190．1μm，且其中不完全PVD的发生率较高（X^2=4．266，P=0．039）。结论SD-OCT可以发现黄斑水肿区的细微形态特征，区分水肿所在的层面，观察IS／OS层的情况；黄斑浆液性脱离与不完全PVD有关。

Background Cystoid macular edema （CME） is an important cause of visual impairment of central retinal vein occlusion（CRVO）. Spectral-Domain optical coherence tomography（SD-OCT） has increased speed and higher resolution,offering a better chance of understanding the morphological changes and pathogenesis of CME. Objective This study w, as to survey the morphologic features of macular edema associated with CRVO by SD-OCT. Methods Clinical data of the patients with CRVO diagnosed in Department of Ophthalmology,Peking Union Medical College Hospital from March 2008 to August 2009 were retrospectively analyzed. SD-OCT features of maeular edema induced by CRVO were analyzed and recorded. Results The average macular foveal thickness was （527.5± 218.2） μm in macular edemas eyes. Main morphological changes included 55 cases（ 84.6% ） of CME, 15 cases of （23. 1% ） serous maeular detachment（SMD） , and 10 cases（ 15.4% ） of simple macular edema, and these findings occurred at the same time in some eyes. Cystoid spaces in the parafovea/ region were seen in the inner nuclear layer, outer plexiform layer and outer nuclear layer, and discontinuous or weak inner segment/outer segment （IS/OS） line was often seen in CME. The incidence of CME associated with incomplete posterior vitreous detachment（PVD） was 14.5% ,and that of neural epithelial edema associated with incomplete PVD was 10.0%, showing an insignificant difference between them（x^2 =0. 000 ,P= 1. 000）. The average area of SMD was 1838.4 μm Х1428. 1 μmХ 190. 1 μm, and the incidence of partial PVD was higher（x^2 = 4. 266,P= 0. 039）. Conclusion SD-OCT can reveal the micro- morphological change of macular zone in macular edema eye. SD-OCT enabled visualization of its spatial extent in each retinal layer and the condition of IS/OS layer. Serous macular edema is related with partial PVD.