B型超声和频域光相干断层扫描在玻璃体后脱离临床诊断中的作用

Diagnosis of posterior vitreous detachment with B-mode ultrasonography and optical coherence tomography

目的比较B型超声和频域光相干断层扫描（SD-OCT）检查在玻璃体后脱离（PVD）临床诊断中的作用。方法前瞻性研究。50岁以上、无明显内眼疾患和手术史、屈光度在±3D以下的患者102例204只眼纳入研究。受检者均行眼科常规检查及B型超声、SD-OCT检查。其中10例患者10只眼接受了玻璃体切割手术治疗。对比观察不同检查方法的PVD检测结果，并将接受玻璃体切割手术患者10例10只眼手术中观察的PVD情况与手术前的B型超声、SD-OCT检查结果进行对比。结果204只眼中，OCT检查结果显示，不同分期的PVD56只眼，占27．50．4；B型超声检查结果显示，98只眼有PVD，占48．0％；B型超声联合SD-OCT检查发现，145只眼显示不同分期的PVD，占71．1％。接受玻璃体切割手术的患者中，7只眼手术前SD-OCT检查没有显示玻璃体后皮质信息，手术中证实有完全PVD；3只眼手术前SD-OCT检查显示PVD，手术中得到证实。5只眼手术前B型超声检查未发现PVD，4只眼手术中发现有PVD，1只眼手术证实无PVD；5只眼B型超声显示PVD，手术中均得到证实有PVD；其中1只眼手术前B型超声、SD-OCT及手术中结果一致显示PVD存在。结论B型超声检查对PVD的检出率明显高于SD-OCT检查；SD-OCT检查对早期PVD的显示明显优于B型超声检查。联合B型超声和SD-OCT检查可以显著提高PVD的临床检出率。

Objective To compare the findings of posterior vitreous detachment （PVD） with B-mode ultrasonography and spectral-domain optical coherence tomography （SD-OCT）, and to find the best way for clinical diagnosis of PVD. Methods This is a prospective case series study based at our hospital between May and September 2012. Patients aged 50 years or older with no obvious ocular pathology, no history of intraocular operation and refractive power within ±3 Diopter were recruited and examined with B-mode ultrasonography and SD-OCT. Posterior hyaloid status were assessed by two experienced technicians respectively. Patients with idiopathic macular pucker and macular hole indicated for vitrectomy were also included, and preoperative findings of posterior vitreous cortex status were compared with intraoperative findings. SPSS software was used for statistical analyses. Results Two hundreds and four eyes of 102 patients met the criteria were examined, in which 10 eyes of 10 patients received 23G vitrectomy. There were 31 males and 71 females. Mean age was （63.2±7.2） years old （ranged from 50 to 80 years old）. Status of posterior vitreous cortex were measured by SD-OCT in 70 eyes （34.3%）, 56 eyes （27.50%） of which manifested different stages of PVD and 14 eyes （6.8%） with attached posterior vitreous cortex （N- PVD）. The other 134 eyes （65.7%） had no findings of posterior vitreous cortex with SD-OCT. B-mode ultrasonography showed 98 eyes （48.0 %） with C-PVD. Combining the results detected by both ultrasound and SD-OCT, altogether 145 eyes （71.1%） were found with different stages of PVD. Comparison of B-mode ultrasonography and SD-OCT to intraoperative findings in 10 operated eyes showed that： seven eyes with no findings in SD-OCT actually had C-PVD; three eyes with PVD in SD-OCT were proved having PVD during operatiom five eyes manifested N-PVD in B-mode ultrasonography, only one of which was proved having N PVD; five eyes with C PVD in B-scan were observed having C PVD. Only one eye had a matched result of C-PVD with three detecting ways. Conclusions Bmode uhrasonography provides a significant higher detection rate of PVD than SD-OCT; SD-OCT has more advantages than ultrasound in detecting the earlier stage of PVD. Combining Bmode ultrasonography and SD-OCT can significantly improve the PVD detection rate and provide considerably more information of PVD.