视网膜脉络膜深层扫描在老年性黄斑变性患者诊断中的作用

Role of retinal choroidal deep scan in diagnosis of age-related macular degeneration

目的探讨视网膜脉络膜深层成像的频域光学相干断层扫描(optical coherence tomography,OCT)在老年性黄斑变性疾病诊断中的价值。方法收集本院眼科中心2013年10月至2014年6月收治的30例(60眼)经过眼底荧光血管造影(fundus fluorescein angiography,FFA)检查确诊的老年性黄斑变性患者为病例组,将病例组又分为湿性型14例、干性型16例。选取同期健康人群30例(60眼)作为对照组。OCT检测各组黄斑区视网膜神经纤维层(nerve fiber layer of macular,MNFL)厚度、视网膜神经上皮层(retinal nerve epithelium,RNE)厚度值、视网膜色素上皮(retinal pigment epithelial,RPE)层厚度值与脉络膜毛细血管复合层厚度之比值(RPE/CC)。采用统计学方法比较各组指标差异。结果病例组的MNFL在各个角度的扫描平均值为(60.1±18.2)μm,显著高于对照组(27.9±7.3)μm,差异有显著统计学意义(P<0.001)。病例组的RNE平均值为(274.6±21.5)μm,显著高于对照组(239.8±22.5)μm,差异有显著统计学意义(P<0.001)。病例组的RPE/CC平均值为(111.3±18.2)μm,显著高于对照组的(77.1±13.2)μm,差异有显著统计学意义(P<0.001)。湿性型老年性黄斑变性患者的MNFL(81.8±19.5)μm、RNE(298.6±20.8)μm、RPE/CC(128.8±19.6)μm,均显著高于干性型的(41.3±15.6)μm、(256.7±17.2)μm、(92.4±16.3)μm,差异均有统计学意义(均为P<0.05)。结论老年性黄斑变性患者的MNFL、RNE、RPE/CC均发生显著变化,OCT检测可以作为病变情况进展的有效监测手段。

Objective To investigate the value of optical coherence tomography （OCT） with deep imaging of retina and choroid in the diagnosis of age-related macular degeneration （AMD）. Methods Thirty patients （ 60 eyes） with AMD diagnosed by fun- dus fluorescein angiography（FFA） in our hospital form October 2013 to June 2014 were collected,and divided into wet AMD （ 14 cases）, dry AMD （ 16 cases）. Thirty healthy people（ 60 eyes） was selected as control group. The macular retinal nerve fiber layer （MNFL） thickness, retinal nerve epithelial （ RNE ） thickness, ratio of retinal pigment epi- thelial layer thickness and choroidal capillary composite layer thickness （RPE/CC） were detected by OCT. The differences of the indexes were compared by statistical methods. Results The MNFL thickness at all scanning angles in AMD group was （60. 1 ± 18.2 ） μm, which was significantly higher than that in control group （ 27.9± 7.3 ） μm, the differ- ence was statistically significant （ P 〈 0. 001 ）. The RNE thickness in AMD group was （274.6 ± 21.5 ）μm, which was significantly higher than that in control group （ 239.8 ± 22.5 ） μm, the difference was statisti- cally significant（P 〈0.001 ）. RPE/CC value in AMD group was（ 111.3 ± 18.2） μm,which was significantly higher than that in control group（ 77.1 ± 13.2 ）μm, the difference was statistically significant （P 〈 0. 001 ）. MNFL thickenss, RNE thickness and RPE/CC value in wet AMD were（81.8 ± 19.5）μm, （298.6 ±20.8） μm and （ 128.8± 19.6）μm,respectively,which were sig- nificantly higher than those in dry AMD [ （ 41.3 ±15.6 ） μm, （ 256.7 ± 17.2 ） ∽tm, （ 92.4 ± 16.3 ） μm ], the differences were sta- tistically significant （ all P 〈 0.05 ）. Conclusion MNFL thickness, RNE thickness, and RPE/CC are changed obviously in AMD patients, and OCT examination can be used as an effective method for monitoring disease progression.