OCT联合眼部B超对白内障术前眼底检查价值评估

Evaluation of optical coherence tomography combined with ophthalmic B-type ultrasound in fundus examination before cataract surgeries

目的:探讨光学相干断层扫描(OCT)联合眼部B超对白内障患者术前眼底检查的临床价值。方法:通过常规检眼镜、眼部B超及OCT对176例278眼白内障患者术前进行眼底病检查,计算三种检查方法对眼底病的阳性检出率,并利用McN emar检验对数据进行配对分析,比较不同检查方法对眼底病诊断的价值。结果:常规检眼镜检出眼底病32眼(眼底病阳性率为11.5%),眼部B超检出眼底病18眼(6.5%),其中晶状体严重混浊患者有6眼(2.2%),OCT检出眼底病51眼(18.3%),OCT联合眼部B超眼底病阳性病例为57眼(20.5%)。OCT检出眼底病阳性率与B超、常规检眼镜及OCT联合眼部B超检出的眼底病阳性率在α=0.05水平均具有显著性差异。结论:三种检查方法比较OCT的价值较大,对黄斑区病变检查灵敏度高,但在患者晶状体严重混浊时,OCT无法获取眼底黄斑区视网膜结构,而眼部B超很好弥补OCT眼底检查的"盲区",两者联合使用,对眼底病的准确诊断以及术后视力恢复预测价值最大。

AIM： To investigate the clinical value of optical coherence tomography （ OCT ） combined with ophthalmic B- type ultrasound in fundus examination before cataract surgeries. METHODS：Conventional ophthalmoscope, ophthalmic B-type ultrasound and OCT were used to exam the fundus of 176 cataract patients （278 eyes）. The positive rate of fundus diseases by the three methods was calculated, and then McNemar test was used to analyze the data in pairs and the values of the three methods on diagnosis of fundus diseases were investigated. RESULTS：Thirty-two eyes were diagnosed with fundus diseases by conventional ophthalmoscope with positive rate of 11. 5%, 18 eyes （ 6. 5%） by ophthalmic B-type ultrasound, 6 eyes （2. 2%） of those 18 eyes were serious lens turbidity. Fifty-one eyes （18. 3%） were diagnosed with fundus diseases by OCT and 57 eyes （ 20. 5%） by OCT combined with ophthalmic B-type ultrasound. The positive rate of fundus disease detected by OCT had significant difference at the level of α= 0. 05 compared with those by ophthalmic B - type ultrasound, conventional ophthalmoscope and OCT combined with ophthalmic B-type ultrasound. CONCLUSION： OCT is more valuable and more sensitive on detecting macular diseases than the other two. However, the structure of retinal layer of the patients who had serious lens turbidity cannot be observed, which can be remedied by ophthalmic B-type ultrasound. The examination of OCT combined with ophthalmic B-type ultrasound is the most valuable one on accurate and early diagnosis of fundus diseases and the prediction of the visual acuity after surgeries.