CRAO患者视网膜组织的频域OCT和短波长眼底自发荧光表现特征

Image features of central retinal artery occlusion by spectral-domain OCT and fundus autofluorescence

背景急性期与非急性期视网膜中央动脉阻塞（CRAO）患者眼外层视网膜有不同的组织病理改变，而频域光相干断层扫描（SD-OCT）和短波长眼底自发荧光（SW-AF）为无创性影像检查。 目的探讨CRAO患者视网膜组织的SD-OCT和SW-AF的表现特征。 方法采用回顾性研究方法。采集2012年3月至2014年1月在第四军医大学西京医院确诊的CRAO患者36例38眼的SD-OCT、SW-AF、眼底荧光血管造影（FFA）及彩色眼底像进行对比分析，并研究SD-OCT和SW-AF在急性期和非急性期CRAO诊断和鉴别诊断中的应用价值。 结果CRAO患者38眼中，急性期CRAO者26眼，占68.42%，其中2眼发现后极部有睫状动脉；非急性期CRAO者12眼，占31.58%。SD-OCT揭示急性期CRAO眼视网膜内层水肿、增厚，组织结构模糊，SW-AF强度减弱，且CRAO患者SW-AF异常表现的程度和范围与FFA结果和眼底彩色图像结果吻合。非急性期CRAO眼SD-OCT表现为视网膜内层变薄，组织层次减少，视网膜外层结构及厚度正常，而SW-AF表现特征接近正常眼。 结论SD-OCT可显示急性期和非急性期CRAO视网膜各层的水肿和厚度变化，而SW-AF可提供急性CRAO视网膜病变区的异常信息。作为无创性眼底检查方法，SD-OCT和SW-AF在CRAO的诊断和鉴别诊断中发挥重要作用。

BackgroundCentral retinal artery occlusion （CRAO） usually present different histopathologic changes in the outer retinal layers at acute and non-acute phase.Spectral-domain optical coherence tomography （SD-OCT） and short-wave length fundus autofluorescence （SW-AF） are non-invasive imaging techniques. ObjectiveThis study was to observe the image features of SD-OCT and SW-AF in the eyes with CRAO. MethodsThe images of SD-OCT, SW-AF, fundus fluorescein angiography （FFA） and color fundus picture were retrospectively compared and analyzed in 38 eyes of 36 patients with CRAO, who were diagnosed and examined in Xijing Hospital of Fourth Military Medical University from March 2012 to January 2014.The pragmatic value of SD-OCT and SW-AF in the diagnosis of acute CRAO and non-acute CRAO was evaluated. ResultsAcute CRAO was found in 68.42% patients （26/38）, including 2 eyes with ciliary artery; while non-acute CRAO was included in 31.58% （12/38）. The edema, thickening and structural disorder of the inner layers of retinas were exhibited in SD-OCT images, and SW-AF was weakened in the acute-stage of CRAO, and the range and degree of disease in the SD-OCT and SW-AF were in accordance with that in the FFA and color fundus picture.In addition, in non-acute CRAO, the inner retinal layer was thinning due to the decrease of retinal layers, but the thickness and structure were normal in the outer retinal layer in SD-OCT, and SW-AF image was close to normal. ConclusionsSD-OCT can reveal the edema and thickness changes of retinas in acute and non-acute CRAO eyes, while SW-AF can offer the abnormal information of retinal lesions in acute CRAO eyes.Being noninvasive examination approachs, SD-OCT and SW-AF play important roles in the diagnosis and differential diagnosis of CRAO.