3D-OCT对白内障术前黄斑病变的诊断价值

Value of 3D-OCT in the diagnosis of macular disease before cataract surgery

目的:探讨白内障超声乳化吸除术前行3D-OCT检查对黄斑病变诊断的价值。方法:回顾性分析2015-06/12期间我院收治的423例512眼白内障患者的临床资料,所有患者均行超声乳化白内障吸除术联合人工晶状体植入术。术前行眼底常规检查外,还采用Topcon 3D-OCT 2000进行黄斑区检查,比较两者的黄斑病变检出率,并对白内障合并黄斑病变的危险因素进行统计学分析。结果:患者305例384眼(72.1%)成功获取黄斑区OCT图像,其中显示黄斑病变133例146眼,检出率为28.5%(95%CI:27.64%~29.40%);术前眼底常规检查发现黄斑病变35例37眼,检出率为7.2%(95%CI:6.72%~7.74%);3D-OCT黄斑病变检出率显著高于常规眼底检查(χ2=79.05,P<0.01)。女性、年龄>65岁、患眼手术史、高度近视是白内障合并黄斑病变的危险因素,其相对危险度分别为1.705(95%CI:1.091~2.664)、1.893(95%CI:1.219~2.939)、6.593(95%CI:2.027~21.447)和5.130(95%CI:2.841~9.263),且白内障合并黄斑病变的风险随年龄增加呈增长趋势。结论:3D-OCT在白内障术前检查中,对黄斑病变的检出具有较高的灵敏度,尤其是对于女性、年龄>65岁、合并高度近视、有患眼手术史的白内障患者,3D-OCT可作为术前常规检查。

AIM ： To investigate the value of 3D- optical coherence tomography （OCT） in the diagnosis of macular disease before phacoemulsification. METHODS： Clinical records of 423 cataract patients （ 512 eyes ） who underwent phacoemulsification combined with intraocular lens implantation in our hospital from June to December in 2015 were retrospectively analyzed. In addition to preoperative routine examination of fundus, Topcon 3D-OCT 2000 was used to examine the macula, the detection rate of macular disease was compared, risk factors of cataract combined with macular disease were analyzed. RESULTS. The OCT image results of 305 cases （384 eyes, 72. 1%） were successfully obtained, 133 cases showed macular disease （146 eyes）, the detection rate was 28. 5% （95% CI： 27. 64%-29.40%）; the macular disease of 35 cases （37 eyes） were detected by routine examination of fundus before operation, the detection rate was 7.2% （95% CI： 6.72% - 7.74% ） ; the detection rate of 3D-OCT was significantly higher than routine examination of fundus for macular disease （X = 79.05, P〈 0.01 ）. Female, over 65 years old, surgical history of diseased eye, and high myopia were risk factors of cataract combined with macular disease, the relative risk was 1.705 （95% C/：1. 091,2. 664）, 1. 893 （95% C/：1. 219, 2. 939）, 6.593 （95% C1：2. 027,21. 447） and 95% CI： 5. 130 （2. 841,9. 263） respectively, the risk of cataract combined with macular disease showed an increasing trend with rising age. CONCLUSION ： In preoperative examination of cataract patients, 3D-OCT has higher sensitivity in the detection of macular disease, especially for women, over 65 years old, high myopia and surgical history of diseased eye, 3D- OCT can be used as a routine preoperative examination.