B型超声和光学相干断层扫描在老年玻璃体后脱离临床诊断中的价值

Diagnosis value of B-mode ultrasonography versus optical coherence tomography for senile posterior vitreous detachment

目的：比较B型超声和频域光学相干断层扫描（ SD-OCT）检查在老年玻璃体后脱离（ PVD）临床诊断中的作用。方法2015年5月至9月随机选取＞60岁、无明显内眼疾患和手术史、屈光度在＜±3 D的门诊以眼前黑影飘动为主诉患者62例70只眼纳入研究。对比观察B型超声、SD-OCT不同检查方法的PVD检测结果。结果 B型超声检查结果显示完全性PVD 39例43眼，占61.4％；不完全性PVD 23例27眼，占38.6％。 OCT检查结果显示不完全性PVD 19例23眼，占32.8％；与B型超声检查病例显示结果相一致。 OCT检查结果未显示PVD的43例47眼，占67.1％。 OCT检查结果显示PVD者均为不完全性PVD。全部病例OCT检查有11眼（15.7％）为视网膜前膜；有4眼（5.7％）为黄斑裂孔；有6眼（8.6％）为玻璃体黄斑牵引的患者；9眼（12.8％）早期老年性黄斑变性。结论 B型超声检查对老年PVD的检出率明显高于SD-OCT检查；SD-OCT检查对早期不完全性PVD的显示明显优于B型超声检查。联合B型超声和SD-OCT检查可以显著提高PVD的临床检出率。

Objective To compare the roles of B-mode ultrasonography and spectral-domain optical coherence tomography （SD-OCT） in the diagnosis of senile posterior vitreous detachment （PVD）.Methods A total of 62 old patients （over 60 years old, 70 eyes）, with no obvious eye diseases or surgery history , refractive power within ±3 Diopter, and main complaint of flickering shadows , who admitted in Outpatient Department of our hospital from May to September 2015 were randomly enrolled in this study .All the patients underwent routine eye examination , B-mode ultrasonography , and SD-OCT, and the results of B-mode ultrasonography and SD-OCT were compared for the diagnosis of PVD .Results B-mode ultrasound results showed there were 39 cases of complete PVD （43 eyes, 61.4%） and 23 cases of incomplete PVD （27 eyes, 38.6%）.OCT showed 19 cases were incomplete PVD （23 eyes, 32.8%）, which was consistent with the results of B-mode ultrasound examination.OCT indicated that there were 43 cases （47 eyes, 67.1%） having no PVD, and all identified PVD were incomplete PVD .OCT results indicated that there were 11 eyes （15.7%） of macular epiretinal membrane, 4 eyes （5.7%） of macular hole, and 6 eyes （8.6%） of vitreomacular traction, and 9 eyes （12.8） of early age-related macular degeneration .Conclusion B-mode ultrasonography provides a significant higher detection rate of senile PVD than SD-OCT.But SD-OCT has more advantages than ultrasound in detecting the early incomplete PVD .Combination of B-mode ultrasonography and SD-OCT significantly improves the detection rate of PVD .