脉络膜骨瘤的频域光相干断层扫描观察

Spectral domain-optical coherence tomography analysis of choroid osteoma

目的观察脉络膜骨瘤的频域光相干断层扫描（OCT）图像特征以及与视力的关联。方法回顾分析临床确诊脉络膜骨瘤的14例18只眼的频域OCT检查资料。所有患者均接受视力、直接和（或）间接检眼镜、裂隙灯显微镜联合前置镜检查、荧光素眼底血管造影、B型超声和（或）CT检查后确诊。频域OCT检查时，所有患眼通过黄斑中心凹的水平和垂直扫描以及瘤体的最大横径和垂直径扫描共4条扫描线进行扫描。对视网膜细微结构及脉络膜瘤体形态进行观察，观察黄斑区视网膜结构变化和脉络膜骨瘤的频域OCT图像特征，分析脉络膜骨瘤的频域OCT图像特征与视力的相互关系。结果6只患眼肿瘤病灶表现为强反射，占33．3％；5只患眼肿瘤病灶表现为中反射，占27．8％；3只患眼肿瘤病灶表现为弱反射，占16．7％；4只患眼肿瘤病灶表现为混合反射，占22．2％。患眼黄斑中心凹神经上皮厚度为50．2～245．1μm，平均中心凹神经上皮厚度为（130．2±58．3）μm。肿瘤横径为5．6～15．8mm，平均横径为（7．8士2．9）mm；垂直径为4．6～12．8mm，平均垂直径为（6．5±2．5）mm。肿瘤的横径、垂直径、黄斑中心凹神经上皮厚度与视力无相关性（r=0．262、0．229、0．137，P=0．284、0．294、0．362）。是否累及黄斑中心凹、光感受器内外节连接（IS／0s）的完整性与视力相关（r=-3．838、-4．559，P=0．0015、0．0003）。是否合并脉络膜新生血管（CNV）及浆液性视网膜脱离与视力无相关性（r=-0．144、0．411，P=0．684、0．687）。结论脉络膜骨瘤病灶的频域OCT图像可表现为强、中、弱及混合反射，以强、中反射为主。肿瘤的横径、垂直径、中心凹神经上皮厚度、是否合并CNV及浆液性视网膜脱离与视力无相关性，是否累及中心凹、is／OS的完整性和视力相关。

Objective To observe the image characteristics of eyes with choroidal osteoma using enhanced spectral domain optical Cirrus coherence tomography （SD-OCT）, and to explore their relationship with visual acuity. Methods The records and SD-OCT images of 14 patients （18 eyes） diagnosed with choroidal osteoma at this hospital were reviewed retrospectively. All patients received examinations of best corrected visual acuity （BCVA）, direct or indirect ophthalmoscope, slit lamp ophthalmoscope, fundus fluorescein angiography, B scan and/or computerized tomography. Subtle structure changes of the retina and choroidal osteoma were observed by four lines of the horizontal, the vertical scanning lines through the foveal and the tumor basal diameter under the model of five Line Raster. The correlation between the retinal and choroidal morphology and visual acuity was evaluated. Results The choroidal features of SD-OCT image of choroidal osteoma can be categorized into hyper-reflective in six eyes （33.3 % ）, isoreflective in five eyes （27.8%）, hypo-reflective in three eyes （16.7%） and mixing-reflective in four eyes （22.2o//oo）. The foveal thickness ranged from 50.2 to 245.1 ~tm, and the average foveal thickness was （130.2~58.3） ~tm. The horizontal and vertical diameters of choroidal osteoma ranged from 5.6 to 15.8 mm and 4.6 to 12.8 mm respectively. The average horizontal and vertical diameters of choroidal osteoma were （7.8 4-2.9） mm and （6.5~2.5） mm respectively. The statistical analysis revealed that BCVA was not related to the horizontal, vertical diameters of choroidal osteoma or the foveal thickness （r=0. 262, 0.229, 0. 137~ P=0.284, 0. 294, 0. 362）. BCVA was related to the involvement of fovea and the integrity of photoreceptor inner/ outer segment junction （IS/OS） （r=--3. 838, --4. 559; P=0. 001 5, 0. 000 3）, but not related to macular choroidal neovascularization （CNV） or serous retinal detachment （r=--0. 144, 0. 411; P= 0. 684, 0. 687）. Conclusions The main SD-OCT image characteristics of eyes with choroidal osteoma was hyper-reflective and isoreflective. BCVA was not related to the horizontal, the vertical diameters of choroidal osteoma, the foveal thickness, macular CNV or serous retinal detachment. It was related to the involvement of fovea and the integrity of IS/OS.