早期家族性渗出性玻璃体视网膜病变的黄斑特征研究

Evaluation of macular changes in early-stage familial exudative vitreoretinopathy: a cross-sectional,case-control study

目的观察早期家族性渗出性玻璃体视网膜病变(familial exudative vitreoretinopathy,FEVR)患者的黄斑特征,并探讨其有无先天性黄斑发育异常。方法采用横断面研究,共纳入2014年9月至2017年10月在陆军军医大学第一附属医院就诊的FEVR患者31例37眼,对照组30例30眼。应用SD-OCT获取黄斑部图像,测量最佳矫正视力及黄斑中心凹厚度,采用SPSS23.0统计软件作数据分析。结果早期FEVR患者黄斑中心凹厚度与对照组相比,差异无统计学意义。早期FEVR患者黄斑结构异常有11眼(29.7%),均为继发性黄斑结构异常,其中椭圆体带连续性中断较为常见,黄斑结构正常26眼(70.3%),黄斑结构异常组视力低于黄斑结构正常组,差异有统计学意义(P=0.001),黄斑结构正常组视力与对照组相比,差异无统计学意义。结论 FEVR患者无先天性黄斑发育异常,多数患者黄斑结构正常,一旦发生继发性黄斑结构异常,可显著影响视力。OCT是监测FEVR病变进展的重要手段。

Objective To observe the macular changes and investigate the presence of congenital macular dysplasia in patients with familial exudative vitreoretinopathy（FEVR）. Methods This crosssectional,case-control study was conducted among 31 patients with early-stage FEVR（37 eyes） treated in the First Affiliated Hospital of the Army Medical University between September,2014 to October,2017,with 30 healthy subjects（30 eyes） as the control group. All the subjects underwent examinations of the best corrected visual acuity（BCVA）,spectral-domain optical coherencetomography（SD-OCT） and fluorescence fundus angiography（FFA）. Results No significant difference was found in the central foveal thickness between FEVR group and control group. In FEVR group,11 eyes（29. 7%） in 8 cases showed macular abnormalities,which were all secondary abnormalities featuring a disruption of the ellipsoid zone as the most common finding on SD-OCT; 26 eyes（70. 3%） in 25 cases had normal macula. The eyes with macular abnormalities had a significantly lower BCVA than those with normal macular findings（P = 0. 001）. No significant difference was found in the BCVA between the eyes in normal macular group and control group. Conclusion Patients with FEVR do not have congenital developmental abnormalities in the macula,and most of the patients with earlystage FEVR have normal macula. However, secondary macular abnormalities can lead to severe visual impairment,and OCT can serve as an important means to monitor the progression of FEVR.