OCT和前置镜在白内障患者术前黄斑病变检查中的诊断价值

Diagnostic value of OCT and anterior mirror in the detection of preoperative macular degeneration of patients with cataract

目的 :对比分析光学相干断层成像(optical coherence tomography,OCT)和前置镜在白内障患者术前黄斑病变检查中的诊断价值。方法 :选取行白内障超声乳化联合人工晶体植入术患者80例(120眼),术前均行裂隙灯下前置镜及OCT扫描检查眼底,以手术检查结果为对照,比较两种方法对黄斑病变及其种类的检出率。结果 :手术检查显示有18例(26眼)患者有黄斑病变(21.67%),OCT对白内障患者术前黄斑病变的检出率明显高于裂隙灯下前置镜的检出率(19.17%vs 7.50%,P<0.01)。OCT检查对白内障患者黄斑病变中的黄斑水肿、黄斑前膜、黄斑渗出、黄斑出血和黄斑裂孔及玻璃膜疣的检出率与裂隙灯下前置镜检查比较,差异无统计学意义(P>0.05),但前者对黄斑病变中的萎缩性年龄相关性黄斑变性、病理性近视脉络膜萎缩等病变的检出率明显高于后者(P<0.05)。结论 :OCT较之裂隙灯下前置镜检查对黄斑部的细微结构具有较高的分辨率,可作为白内障术前筛查黄斑病变的一种检查方法,有利于进一步降低医疗风险。

Objective： To compare and analyze the diagnostic value of optical coherence tomography（OCT） and anterior mirror in the detection of preoperative macular lesions of patients with cataract. Methods： Eighty cases of patients（120 eyes） undergoing phacoemulsification combined with intraocular lens implantation were selected. Before surgery, all the patients were examined with the ophthalmoscope under the slit lamp anterior mirror and OCT scan. The detection rates of macular lesions and their types were compared between the two methods by referencing the results of operation examination. Results： Eighteen patients with macular degeneration were detected by surgical examination（26 eyes, 21.67%）. The detection rate of OCT for macular lesions in patients with cataract was significantly higher than that of the anterior mirror before operation（19.17% vs 7.5%, P〈0.01）. There were no statistical differences between OCT and slit lamp anterior mirror in the detection rate of macular degeneration including macular edema, macular epiretinal membrane, macular effusion, macular hemorrhage and macular hole and glass warts（P〉0.05）. However, the detection rate of OCT for atrophic age-related macular degeneration and pathological myopia choroidal atrophy and other lesions was significantly higher than that of slit lamp（P〈0.05）. Conclusion： Compared with slit lamp, OCT has higher resolution for macular fine structure, and can be used as a method for the screening of macular disease before cataract surgery and is of benefit to further reducing medical risk.