OCT在妊娠期高血压合并渗出性视网膜脱离治疗随诊中的应用

The characteristics of OCT in follow-up of exudative retinal detachment in patients with hypertensive disorder complicating pregnancy

目的探讨妊娠期高血压合并渗出性视网膜脱离治疗过程中光学相干断层扫描（OCT）的成像特征，评价其对病情监测及判断预后的可行性。方法回顾性病例系列研究。研究对象2013年1月至2014年12月南方医科大学附属第三医院眼科确诊并进行随诊治疗的11例（22只眼）妊娠期高血压合并渗出性视网膜脱离的患者。妊娠期高血压患者出现渗出性视网膜脱离立即终止妊娠，经予硫酸镁解痉、硝苯地平降血压、甘露醇利尿脱水及糖皮质激素促进视网膜下积液吸收等治疗。分别在发病时、产后3、7、28d检查患者最佳矫正视力（BCVA），OCT检测黄斑中心视网膜形态及厚度（CRT），对治疗前后BCVA、视网膜神经上皮形态及CRT进行对比分析。结果妊娠期高血压合并渗出性视网膜脱离产后第3、7、28d检查，患眼平均BCVA比治疗前提高，差异有统计学意义（P〈0．05）；产后第3d视力提高明显，妊娠期高血压合并渗出性视网膜脱离OCT检查所有患眼视网膜神经上皮层浆液性脱离、神经上皮层结构破坏；治疗后神经上皮完全复位。结论OCT可明确显示妊娠期高血压渗出性视网膜脱离治疗过程中神经上皮脱离形态、厚度及结构恢复情况，可为妊娠期高血压渗出性视网膜脱离病情监测及预后评价提供有价值的无创的客观指标。

Objective To analyze the optical coherence tomography （OCT） characteristics of exudative retinal detachment in patients with hypertensive disorder complicating pregnancy; to evaluate the possibility of using OCT to monitor the progress and to predict the prognosis in recovering phase of exudative retinal detachment. Methods Retrospective case series.22 eyes of 11 patients with exudative retinal detachment in patients with hypertensive disorder complicating pregnancy disease treated and followed up in our hospital between January 2013 and December 2014 were includ- ed. All patients were given termination of pregnancy immediately when exudative retinal detachment took place and treated with antispasmodic, hypotensor and diuretic （magnesium sulfate, nifedipine and mannitol）. Glucocorticoid was given to enhance the absorption of subretinal fluid. Best corrected visual acuity （BCAV） was checked, and OCT was obtained at the initial visit and 3 days to 1 month periodically after delivery. Follow-up technique was used to make sure the same scan line in every OCT checkup time. BCVA, retinal morphological characteristics and central retinal thickness （CRT） were analyzed before and after the treatment. Results The mean BCVA at 3 days, 7 days and 28 days after treatment improved significantly than that before treatment. The mean BCVA improved significantly in the first 3 days. OCT showed serous retinal detachment and destruction in the outer part of neuro-retina. And all of the destruction recovered after treatment. Conclusions OCT may show the progress of neuro-retinal recovery and CRY changes, thus provide a valuable method to monitor the diagnosis and predict the prognosis of exudative retinal detachment in patients with hypertensive disorder complicating pregnancy.