3D-OCT对视交叉病变黄斑区视网膜神经节细胞复合体损害的诊断价值

Clinical value of 3D-OCT in characteristic changes in the macular ganglion cell complex caused by lesions on the optic chiasm

目的观察蝶鞍区占位性病变对视交叉部的损害导致黄斑区视网膜神经节细胞复合体（mGCC）厚度的特征性改变及其诊断价值。方法回顾性系列病例研究。对11例确诊为蝶鞍部占位病变患者采用Topcon2000型三维光学相干断层扫描仪（3D—OCT）测量mGCC厚度及视盘周围神经纤维厚度。分析mGCC损伤的图像特征和视盘周围神经纤维损伤特征。并对这11例患者采用OCTOPUS101型自动视野计进行视野检查。将3D-OCT检查结果与相应的视野检查结果进行对照，评估两者的符合度。结果所选的11例蝶鞍区占位性病变患者中，2例因瘤体较小尚未侵犯视交叉部视路，视野和mGCC检查结果均未见异常；9例出现以中垂线划界的视野改变，其中7例为双颞侧偏盲，2例为同侧偏盲，肿物分别位于右侧视束起始部位和左侧视交叉后交界处。有视野损害的9例．3D-OCT检查均出现中垂线划界的mGCC环形的萎缩变薄或消失，与视野改变相对应。结论蝶鞍区占位性病变对视交叉部位的损害导致中线划界的双鼻侧mGCC变薄。与视野具有等同的定位作用。

Objective To investigate the characteristic changes in the macular ganglion cell complex （mGCC） caused by damage to the optic chiasm from lesions on the sella turcica and its diagnostic value. Methods Eleven patients with lesions on the sella turcica （diagnosed by CT/MRI/ surgery/pathology） were included in a retrospective serial case study. The thickness map of the mGCC and peripheral retinal nerve fiber layer （RNFL） around the disc were obtained by Topcon 3D-OCT2000. The changes in the mGCC and the RNFL around the disc were investigated and compared with changes in the visual field （Octopus 101 Automated Perimetry）. Results Two of the 11 patients had a normal GCC and perimetry because of the small size of the lesions （too small to cause damage to the optic chiasm）; nine of the 11 patients had hemianopia. In the nine patients, seven had bitemporal hemianopia with lesions at the origin of the right optic tract and two had homonymous hemianopia with the lesion at the terminal section of the left optic tract. Atrophy of the ganglion cell complex （GCC） in the nine cases was located in the nasal portion, which was consistent with the visual field defect in the temporal section. Conclusion Damage to the optic chiasm can cause atrophy of the mGCC in the bilateral nasal portion, which may have the same anatomical diagnostic value as the visual field.