玻璃体黄斑牵拉综合征的SD-OCT随访观察

Observation and follow-up of vitreomacular traction with SD-OCT

目的 分析频域光相干断层扫描（SD-OCT）对玻璃体黄斑牵拉综合征（VMT）随访观察资料,并探讨SD-OCT在该类病变随访中的临床意义.方法 回顾性临床病例系列研究.对2011年6月至2013年11月在河北医科大学第二医院眼科诊断明确的98例98只眼VMT的SD-OCT影像进行分析研究,观察随访VMT眼玻璃体黄斑粘连的自然转归,并分析总结其与最佳矫正视力（BCVA）的关系.结果 根据SD-OCT观察到的玻璃体对黄斑区视网膜的牵拉程度,黄斑区视网膜结构改变将VMT分为4级：Ⅰ级为玻璃体不全后脱离,黄斑区玻璃体与视网膜粘连,黄斑结构无异常改变;Ⅱ级为玻璃体不全后脱离,黄斑存在小囊样改变,但中心凹形态基本正常;Ⅲ级为玻璃体不全后脱离,黄斑受牵拉向玻璃体腔隆起、劈裂、囊样改变,中心凹变平坦或隆起;Ⅳ级则为玻璃体不全后脱离,黄斑受宽带状高反射信号玻璃体后皮质牵拉高度隆起,＂峰＂样突入玻璃体腔,黄斑的正常组织结构完全破坏.Ⅰ级19只眼,Ⅱ级23只眼,Ⅲ级27只眼,Ⅳ级29只眼,初诊时Ⅰ级BCVA较其他组为好,随访12个月时4级VMT间玻璃体黄斑粘连解除情况差异无统计学意义（P＞0.05）.结论 SD-OCT不仅能够明确诊断VMT,还可显示黄斑受牵拉程度及显微结构改变;VMT自然转归的SD-OCT随访观察更可为患者及眼科医生的临床决策提供有力依据。

Objective To observe and follow up vitreomacular traction （VMT） with spectral-domain optical coherence tomography （SD-OCT）.Methods Retrospectively collected SD-OCT images, best corrected visual acuity （BCVA） and status of vitreomacular adhesion of 98 subjects （98 eyes） with VMT, and then these data were analyzed in detail.Results According to the severity of vitreomacular traction and structure deformation, SD-OCT images of VMT were classified into 4 categories： class Ⅰ （19 eyes） with vitreomacular adhesion and normal fovea, class Ⅱ （23 eyes） with micro-cystic changes but nearly normal fovea, class Ⅲ （27 eyes） with elevated macula and schisis/cystic fovea, class Ⅳ （29 eyes） with macula tracted forward into vitreous cavity hill-like and completely deformed fovea.At initial diagnosis, BCVA of class Ⅰ was better, while the release rate of vitreomacular adhesion of each class was not statistically different from each other.Conclusions Not only can SD-OCT precisely diagnose VMT, but it can also provide details of vitreous traction and micro-structure changes.Observation of the nature history of VMT with SD-OCT can provide significant evidence for our clinical decisions for VMT.