高度近视致单纯黄斑出血与继发CNV的黄斑出血之OCT图像鉴别

The differential diagnosis of submacular hemorrhage with or without choroidal neovascularization in highly myopia eyes by OCT

目的观察高度近视所致单纯黄斑出血与继发脉络膜新生血管形成(CNV)的黄斑出血在相干光断层扫描(OCT)上的图像特征。设计回顾性病例系列。研究对象47例(47眼)高度近视黄斑出血的患者。方法回顾性研究2009年7月-2013年5月就诊,并行最佳矫正视力、眼底彩照、荧光素眼底血管造影(FFA)、眼底自发荧光(FAF)、相干光断层扫描(OCT)检查的47例高度近视黄斑出血患者的47眼,对其视力及光学影像图像特征进行分析。主要指标OCT,自发荧光结果及视力。结果 47眼高度近视黄斑出血中,通过FFA及吲哚青绿血管造影(ICGA)明确诊断继发于CNV的黄斑出血27眼,单纯的黄斑区出血20眼。继发于CNV的黄斑出血OCT图像特征为黄斑中心凹下较高反射信号的团块状影位于视网膜色素上皮(RPE)层之下,RPE层结构破坏、隆起,及RPE层上的中高反射信号影;单纯黄斑出血,其OCT图像特征为黄斑中心凹隆起,神经上皮层下三角形稍高反射信号影,其后信号略减弱,RPE层反射条带完整。继发于CNV的黄斑出血组,24/27眼IS/OS破坏,3/27眼IS/OS完整,仅表现IS/OS的隆起;而单纯黄斑出血组,7/20眼IS/OS破坏,13/20眼IS/OS完整(χ2=14.86,P=0.000)。FAF检查在继发于CNV的黄斑出血组可呈小片状中央弱自发荧光,周围环以强自发荧光或正常荧光;而在单纯黄斑出血组,自发荧光可呈正常或片状弱自发荧光。结论 OCT和眼底自发荧光检查可明确分辨高度近视黄斑出血是继发于CNV还是单纯黄斑出血。

Objective To evaluate and analysis the optical imaging characteristics of submacular hemorrhage in highly myopia with or without choroidal neovaseularization by optical coherence tomography （OCT）. Design Retrospective case series. Participants Forty-seven highly myopia patients （47 eyes） with submacular hemorrhage. Methods Fluorescence fundus angiography （FFA）, fundus autofluorescence （FAF）, OCT and best corrected visual acuity （BCVA） were performed on 47 highly myopia eyes with submacular hem- orrhage. Main Outcome Measures hnaging of OCT and FAF, BCVA. Results In the 47 eyes, 27 eyes with choroidal neovasculariza- tion （CNV） （CNV group）, 20 eyes without choroidal neovascularization （simple hemorrhage group） according to FFA and ICGA. The characteristics of OCT images in CNV group were spindle shape with strong or medium reflection, sticking out upwards from retinal pig- ment epithelial （RPE） layers. Simple submacular bleeding without CNV showed protruded medium reflection area under the neuroep- ithelial layer without disruption of RPE layer. In CNV group, the inner segment/outer segment （IS/OS） line of photoreceptors was intact in OCT only in 3/27 eyes and destroyed in 24/27 eyes; However, in the simple hemorrhage group, the IS/OS line of photoreceptors was intact in 13/20 eyes and destroyed in 7/20 eyes ~v2=14.86,P=0.000）. In the CNV group, hypoantofluorescence was present at the area of the bleeding combined with the hyperantofluoreseence around it; in the simple hemorrhage group, hypoautofluorescence was present at the area of the bleeding. Conclusion Submaeular hemorrhage in highly myopia eye could be divided into two forms： submaeular hemor- rhage with choroidal neovaseularization and simple submacular bleeding, which can be differentiated by OCT and FAF.