钝挫伤后外伤性视网膜病变的频域光相干断层扫描的流行病学特征研究

Microstrucural Changes in Traumatic Retinopathy Detected by Spectral Domain Optical Coherence Tomography

目的研究外伤性视网膜病变的频域光相干断层扫描(Optical Coherence Tomography,OCT)图像特征和类型,从而更好的指导临床诊断以及探索其发病机制。方法本研究为回顾性研究。研究对象为汕头大学·香港中文大学联合汕头国际眼科中心就诊的钝挫伤引起的外伤性视网膜病变患者。对我院门诊数据库和频域OCT数据库进行检索,测量和分析患者的OCT检查结果。结果本研究纳入外伤性视网膜病变的患者有138例(138眼),在频域OCT显示的病变特征主要有以下几种:1)外伤性黄斑裂孔25例(18.1%),表现为黄斑中心凹神经上皮全层缺损,伴或不伴有裂孔边缘囊样水肿;2)视网膜下出血30例(21.7%),表现为视网膜神经上皮和视网膜色素上皮之间的中高反射信号,其后光带衰减;3)脉络膜破裂32例(23.2%),表现为脉络膜和视网膜色素上皮光带断裂;4)视网膜萎缩70例(50.7%),表现为光感受器内外节层中断、外核层变薄甚至消失;5)内界膜皱褶19例(13.8%),表现为内界膜表面波浪状改变;6)视网膜色素上皮撕裂2例(1.4%),表现为视网膜色素上皮连续性中断,边缘翘起。发生两种或两种以上视网膜病变类型患者共有47例(34%)。结论眼钝挫伤可以引起视网膜震荡、外伤性黄斑裂孔、色素上皮撕裂等病变。频域OCT有高敏感性、高分辨率、定量测量等优点,在外伤性视网膜病变的诊断和病情判断中具有重要的价值。

Objective To examine the microstructural changes in traumatic retinopathy by using spectral domain optical coherence tomography(OCT),so as to help the diagnosis of traumatic retinopathy and explore the pathological mechanisms.Methods This retrospective study collected and analyzed the data of patients who were admitted to the Joint Shantou International Eye Center(JSIEC)for traumatic retinopathy.In addition to demographic data of the patients,all OCT images were retrieved and analysed.Results The patient population consisted of a total of 138 cases.Of them,25(18.1%)eyes were identified as traumatic macular hole,showing a full-thickness defect of neurosensory retia at fovea with or without intraretinal cysts;30(21.7%)eyes were diagnosed as subretinal hemorrhage,showing high signal between neurosensory retina and retinal pigment epithelium followed by a shadowing effect;32(23.2%)eyes were identified as choroidal rupture,showing disruption of choroid/retinal pigment epithelium layer with hyperreflective signal there;70 eyes(50.7%)were identified as retinal atrophy,showing disruption of photoreceptor layer,thinning or disappear of outer nuclear layer;19(13.8%)eyes were shown as inner limiting membrane fold,accounting for;two(1.4%)eyes showed retinal pigment epithelium tear.Of all the cases,47(34%)had two or more types of morphological changes in the same eye.Conclusions Traumatic retinopathy may be shown as macular hole,subretinal hemorrhage,choroidal rupture,atrophy of outer retina and so on.Spectral domain OCT is a valuable tool in the diagnosis of traumatic retinopathy with its high resolution and sensitivity,and quantitative measurement.