黄斑水肿的光学相干扫描之形态学分析

Morphology analysis of OCT images of macular edema

目的:用眼科光学相干断层图像(optical coherence tomography,OCT)来分析黄斑囊样水肿(cystoid macular edema,CME)和中心性浆液性视网膜脉络膜病(central serous chorioretinopathy,CSC)引起的黄斑水肿(macular edema,ME)的特征性,对积液特点进行分析,揭示它们和视网膜屏障的关系。方法:在相关OCT图像中选取29例30眼,其中1例是双眼。对选定对象的黄斑区进行断层水平位和垂直位扫描。结果:CME的OCT图像显示:在视网膜神经上皮层(RNFL)中的外核层(outer nuclear layer)到内丛状层(interal plexiform layer)之间出现大小不等的椭圆形蜂房样的低反射暗区,囊泡样,似有囊壁存在;CSC的ME图像显示:在黄斑区的光感受器内外节连接层(IS/OS)和视网膜色素上皮层(RPE)之间有低反射暗区,RNFL隆起,RPE层显示强反射影但其形态和正常黄斑的RPE层相比未发生明显变化。结论:OCT图像是一种断层解剖图,CME的囊样水肿不仅出现在外丛状层,也可以出现在外核层,CME和CSC积液的形态特点证明了视网膜有内外屏障的存在。

AIM： To analyze the characteristic shapes of cystoid macular edema （ CME ） and the macular edema （ ME ） caused by central serous chorioretinopathy （ CSC ） through optical coherence tomography （ OCT ） examination, and to analyze the accumulate liquid in retina to explain their relationships with blood-retina barrier. METHODS： A total of 29 cases （30 eyes） with relative disease were enrolled, including one case with both eyes selected.The macular area of all patients was scanned by OCT horizontally and vertically. RESULTS： The OCT images of CME indicated： there were a lot of low reflection dark regions which had an oval honeycomb structure andcystoid shape; these regions were found between the outer nuclear layer and inner plexiform layer of retinal nerve fiber layer （ RNFL ）; cyst wall appeared to be existed.The OCT images of ME result from CSC indicated： there were low reflection dark regions between photoreceptor inner segment/outer segment （ IS/OS ） junction layer and retinal pigment epithelium （ RPE ） layer; the RNFL was upheaved; RPE presented strong reflection but its shape was not different with that of normal macular. CONCLUSION：The image of OCT is a type of sectional anatomyfigures, the cystoids of CME exist not only in the outer plexiform layer, but also in the outer nuclear layer. The characteristic shapes of accumulated liquid of CME and CSC prove the existence of inner-outer barrier in retina.