应用光学相干断层扫描检测急性原发性房角关闭后黄斑区的改变

Macular alterations after acute primary angle closure: optical coherence tomography study

目的利用光学相干断层扫描(optical coherence tomography,OCT)检测急性原发性房角关闭(acute primary angle closure,APAC)后黄斑区的变化。方法选取2005年1月至2007年5月于抚顺市眼病医院就诊的APAC患者44例(88眼)为研究对象。分别于发病后2周和4周利用OCT测量并比较患眼及对侧眼的黄斑厚度和黄斑部体积。结果发病后2周,患眼的黄斑中心凹、黄斑颞外侧、黄斑颞内侧、黄斑外上侧、黄斑内上侧、黄斑外下侧的厚度与对侧眼比较均增加(P<0.05),患眼的黄斑颞内侧、黄斑内上侧、黄斑颞外侧、黄斑外上侧、黄斑鼻外侧、黄斑外下侧以及黄斑整体的体积与对侧眼比较均增大(P<0.05)。发病后4周,除黄斑中心凹最低处,患眼黄斑各部分的厚度与对侧眼比较均无显著差异(P>0.05)。同时,大部分患眼黄斑各部分的体积与对侧眼比较亦无显著差异(P>0.05)。发病后2周及4周,对侧眼的黄斑在各区域的厚度和体积均无明显变化(P>0.05),而患眼的黄斑颞内侧、黄斑内上侧、黄斑鼻内侧、黄斑颞外侧及黄斑外上侧的厚度和体积在发病后2周和4周均减小(P<0.05)。此外,除黄斑内下侧,黄斑其他部分的体积在发病后2周和4周均变小(P<0.05)。结论黄斑部区域在APAC后受到明显影响;疾病缓解后,黄斑部厚度和体积显著增加,但随着时间的延长,其又呈逐渐下降趋势;APAC后黄斑部功能的变化尚需进一步研究。

Objective To investigate the macula changes after an episode of acute primary angle closure （APAC） by using optical coherence tomography （OCT）. Method 88 eyes of 44 consecutive patients with an episode of unilateral APAC in Fushun City Eye Hospital From January 2005 to May 2007 were enrolled. 2 and 4 weeks after the attack, macula thickness and macula volume of the attacked eyes and fellow eyes were evaluated by OCT. The macula thickness and macula volume of the attacked eyes and fellow eyes were measured by OCT after 2 and 4 weeks respectively. Result 2 weeks after attack, the thickness of fovea,＆amp;nbsp;temporal inner macular, superior inner macula, temporal outer macula, superior outer macula and inferior outer macula of the attack eyes were thicker than the fellow eyes （P 〈 0.05）; the volume of fovea, temporal inner macula, superior inner macula, temporal outer macula, superior outer macular, nasal outer macula, inferior outer macula and total macula volume of the attack eyes were larger than the fellow eyes （P 〈 0.05）. whereas 4 weeks after attack, the thickness of all macular sections of the attacked eyes was the same as the fellow eyes （P 〉 0.05）, which was also true for volume for almost all macular sections except fovea （P 〉 0.05）. Whether the thickness or the volume of all sections of the fellow eyes, no changes had been found between 2 and 4 weeks after attack （P 〉 0.05）. For the attack eyes, the thickness of temporal inner macula, superior inner macula nasal inner macula, temporal outer macula and superior outer macula became thinner during follow up （P 〈 0.05）; the volume of all sections became smaller during follow up except the volume of inferior inner macula （P 〈 0.05）. Conclusion This study demonstrated that macular area have been affected after an episode of APAC, macular thickness and volume increase just after remission, and decrease over time.