频域光学相干断层扫描在白内障患者术前检查中的应用

Application of Spectral Domain Optical Coherence Tomography in Preoperative Examination of Patients with Cataract

【目的】探讨新一代频域光相干断层扫描(SDOCT)在白内障术前检查中的作用和成效。【方法】随机选取2009年6月至2010年6月在我院行白内障超声乳化及人工晶体植入手术患者共计454例,实验组使用海德堡公司生产的Spectralis HRA-OCT,采用标准快速OCT检查模式,对白内障患者进行术前视网膜检查,获取OCT图像,判断视网膜疾病。对照组采用KOWA眼底相机采集视网膜图像,判断视网膜疾病。对比两种检查方法对视网膜疾病的检出率。【结果】实验组共有312例成功获取OCT图像,占总数67.8%,检查出白内障术前病例共有37例存在不同类型的视网膜疾病,检出率为8.15%,其中有各期黄斑裂孔6例、糖尿病视网膜病变8例、视网膜前膜与高度近视性视网膜病变各4例、黄斑玻璃体牵拉症3例、老年性黄斑变性、视网膜色素变性、黄斑囊样水肿各2例、陈旧性中心性浆液性脉络膜视网膜病变、视网膜色素上皮脱离、结晶样视网膜病变、黄斑下疤痕增殖、视网膜劈裂及视网膜下出血各1例。对照组通过眼底彩照可检查出阳性病例12例,阳性率2.64%,其中有糖尿病视网膜病变8例、视网膜色素变性2例、视网膜结晶样变性1例、视网膜下出血1例。两种方法对视网膜疾病检出率有统计学差异(P<0.05)。【结论】与传统的眼科影像学方法相比,SDOCT可以有效提高白内障术前视网膜疾病的检出率,有利于对白内障预后效果的综合判断。

[Objective] To investigate the role and effectiveness of a new generation Spectral-domain optical coherence tomography（SD-OCT） examination before cataract surgery.[Methods] A total of 454 cases of cataract patients who went through phacoemulsification and intraocular lens implantation surgery in our hospital form June 2009 to June 2010 were chosen randomly.In experimental group,we examined all patients through the Heidelberg Spectralis HRA-OCT,using standard fast mode,obtained OCT images to diagnose retina diseases.In control group,we took color fundus photographs through KOWA fundus camera to determine retina diseases.Two sets of data were compared.Two methods of detection rate of retinal diseases were analyzed.[Results] In experimental group,a total of 312 cases successfully obtained OCT images,accounting for 67.8% of the total.Of all the preoperative cataract patients,37 patients presented with different types of retinal diseases,the detection rate was 8.15%,including 6 cases of macular holes,8 cases of diabetic retinopathy,4 cases of pre-retinal membrane of the macula and high myopic retinopathy respectively,3 cases of macular vitreous traction syndrome,2 cases of age-related macular degeneration,pigmentary degeneration of the retina,cystoid macular edema respectively,and old central serous chorioretinopathy,retinal pigment epithelial detachment,crystal-like retinopathy,scar proliferation under the macular,retinoschisis and retinal hemorrhage in 1 single case.In control group,there were 12 positive cases observed through fundus color photos,the detection rate was 2.64%,including 8 cases of diabetic retinopathy,2 cases of pigmentary degeneration of the retina and 1 case of crystal-like retinopathy,1 case of retinal hemorrhage.Two methods of detection rate of retinal diseases were statistically different（χ2 = 13.842,P 0.05）.[Conclusions] Compared to the traditional ophthalmic imaging examinations,SDOCT can greatly elevate the detection rate of retinal diseases in pre-cataract patients which are so important in the comprehensive prognosis evaluations.