特发性黄斑区视网膜前膜对视力影响的临床观察

目的 探讨特发性黄斑区视网膜前膜(idiopathic macular epiretina membranes,IMEM)对视力的影响.方法 经视力、直间接眼底镜及光相干断层成像(optical coherence tomography,OCT)检查确诊的IMEM患者75例共86只眼,分析不同IMEM形态与视力的关系.结果 86只眼最佳矫正视力0.01～1.0(0.50±0.30),其中≤0.3为27只眼,占31.40%;0.3～0.7为38只眼,占44.19%;0.8～1.0为21只眼,占24.42%.OCT检查IMEM与视网膜的位置关系有两种:39只眼(45.35%)前膜与视网膜紧密粘连和47只眼(54.65%)部分粘连;视网膜神经上皮层表现为:50只眼(66.67%)黄斑中心凹出现囊腔,13只眼出现假性黄斑裂孔(15.1%).86只眼黄斑区中心凹厚度为101～685(313.34±132.15)μm,对全部患眼视力与所对应的黄斑中心凹厚度进行相关分析显示二者存在负相关(r=-0.37,P=0.001<0.05),即黄斑中心凹越厚视力越差.结论 由IMEM牵拉引起的黄斑区水肿增厚与视力损害具有直接关系.     

光学相干断层扫描在特发性黄斑前膜手术前后的临床应用

目的　评价光学相干断层扫描 (OCT)在特发性黄斑前膜 (IMEM)手术前后的临床应用价值。方法　 3 6只患眼行玻璃体切割联合黄斑前膜剥膜、气液交换手术。手术前后行裂隙灯显微镜、眼底照相及OCT检查。术后随访平均 8 5 ( 3～ 14 )个月。结果　术前 15眼 ( 4 2 % )OCT图像表现为与视网膜内层局灶黏附的条带状强反光 ,其大部与视网膜内层分离 ;另 2 1眼 ( 5 8% )表现为与视网膜内表面完全紧密粘连的增强增宽的反光带或局部反光团。IMEM可伴黄斑全层裂孔、板层裂孔、假性裂孔、黄斑囊样水肿或视网膜神经上皮层浅脱离。术者根据OCT所示指导剥膜过程。术后视网膜表面异常反光条带或反光团均消失 ,黄斑中心凹平均厚度由术前 419μm± 10 5 μm( 2 65 5～ 689μm)降低为 3 0 0 μm± 65 μm( 185～ 5 11μm)。 12眼 ( 3 2 % )黄斑中心凹曲线术后达到或接近正常形态 ,2 4眼 ( 67% )黄斑中心凹曲线仍不存在 ,呈浅平或略前凸。结论　OCT在IMEM术前定量评估手术指征、监测病情变化以及术后评价手术疗效等方面具有重要的临床应用价值。     

3D光学相干断层扫描在特发性黄斑前膜诊治中的应用

目的应用3D光学相干断层扫描（OCT）观察特发性黄斑前膜（IMEM）的形态特征及其对视力的影响。方法应用3D—OCT观察42例（46只眼）IMEM患者的OCT图像,分析黄斑中心凹形态、中心凹厚度与视力的关系。结果在42例（46只眼）IMEM患者的3D-OCT图像中表现为黄斑区视网膜表面厚薄不一的高反光带,绝大多数伴不同程度的黄斑中心凹厚度增加,黄斑中心凹越厚,视力越差。34只眼（73．9％）OCT图像表现为与视网膜内层局灶性粘附的条带状强反光,大部分与视网膜内层分离,另12只眼（26．1％）表现为与视网膜内层完全紧密粘连的增强增宽的反光带。结论3D-OCT可以精确测量黄斑视网膜厚度,客观而全面地提供视网膜各层之间以及厚度变化的信息,从而初步评价IMEM与视力的关系,为IMEM提供更有参考价值的手术指征并指导手术操作。     

糖尿病性黄斑水肿的光学相干断层成像

目的：观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical colnerence tomographly,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系。方法：对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查。结果：10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚。DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0．60,P=0．000)。结论：DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差。     

糖尿病性黄斑水肿的光学相干断层成像

目的:观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical coherence tomography,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系.方法:对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查.结果:10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚.DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0.60,P=0.000).结论:DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差.     

特发性黄斑前膜三维光学相干断层扫描图像特征

目的观察特发性黄斑前膜（IERM）的三维光学相干断层扫描（3D-OCT）图像的形态特征,探讨3D-OCT对IERM的诊断价值。方法回顾性分析2009年1月至5月间确诊为IERM的患者35例（40只眼）,行视力、裂隙灯、眼底彩照和OCT检查。OCT检查采用TOPCON3D-OCT1000MARKII,扫描速度27000A扫描/s,扫描面积6.0mm&#215;6.0mm,扫描模式128&#215;512,分析中心凹厚度、中心凹形态及感光细胞（IS/OS）情况。结果IERM的3D-OCT图像表现为视网膜表面薄厚不一的高反光带,绝大多数伴程度不同的中心凹厚度增加。在40只眼中,弥漫性水肿或囊肿20只眼,假性黄斑裂孔3只眼,板层裂孔3只眼,玻璃体黄斑牵拉4只眼,中心凹形态正常者10只眼。结论3D-OCT可提供更多的IERM中心凹形态的信息,在IERM确诊方面有很高的灵敏性。     

光学相干断层扫描仪在我国眼科临床的应用(二)

1 OCT在视网膜前膜诊断及术后随访中的应用。OCT由于其独特的横截面成像技术，可以清楚地观察视网膜前膜各层的病理改变，并进行精确的测量。用OCT对特发性黄斑视网膜前膜进行检查可以观察到主要有4种图像特征：①视网膜前膜伴黄斑水肿，中心凹凹陷变浅或消失，神经上皮层下方为一暗区，视网膜内层见光带增强的前膜；②增生性视网膜前膜，黄斑中心凹厚度明显增加，神经上皮间或神经上皮下也可有暗区(水肿)，视网膜内层见光带增强增宽的前膜，亦可见前膜呈团块状向玻璃体腔凸起；③视网膜前膜伴假性黄斑裂孔形成，黄斑中心凹厚度增加或正常，中心凹呈陡峭状改变，周围视网膜厚度增加，可见光带增强的前膜；④视网膜前膜伴板层黄斑裂孔形成，中心凹神经上皮层部分缺失，中心凹周围的视网膜内层可见光带增强的前膜。利用OCT可以测量视网膜前膜黄斑中心凹视网膜厚度，并与视力进行相关分析，结果表明黄斑中心凹视网膜越厚，视力越差。     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

多波长激光治疗糖尿病性视网膜病变临床观察

目的探讨多波长激光光凝对糖尿病性视网膜病变的疗效。方法30例（52只眼）糖尿病性视网膜病变行荧光素眼底血管造影（FFA）及黄斑区相干光断层扫描（OCT）,对重度非增生性及增生性糖尿病性视网膜病变分别进行绿光、黄光、红光激光光凝。黄斑水肿患者同时行黄斑格栅光凝,分4次进行泛视网膜光凝。光凝后观察视力、黄斑中心凹厚度及FFA情况。结果随访6个月,35只眼视力不同程度提高,14只眼视力维持激光治疗前的水平,3只眼因黄斑水肿加重视力下降,激光治疗前OCT显示黄斑部中央凹平均厚度为（430．35±98．53）μm,治疗后6个月平均厚度（178．48±42．56）μm。结论多波长激光治疗糖尿病视网膜病变能有效提高或保存患眼视功能。     

特发性黄斑前膜在频域相干光断层扫描下的临床观察

目的观察特发性黄斑前膜的频域相干光断层扫描（OCT）特征以及与患者视力的相互关系。方法收集2010年10月至2013年6月在我院门诊确诊的特发性黄斑前膜患者的临床资料,共182例（212只眼）,年龄35~88岁,平均（66.08±9.25）岁,所有患者均进行最佳矫正视力、眼底和OCT检查。根据OCT检查所见对黄斑前膜进行分类,分析中心凹形态及黄斑部视网膜神经上皮层体积与视力的关系,采用SPSS13.0软件对患者的各项OCT检查结果进行统计学分析。结果 （1）特发性黄斑前膜的OCT图像特征表现为视网膜神经上皮层表面厚薄不一的高反光带,部分与视网膜内表面完全紧密粘连或分离。黄斑前膜的中心凹形态改变有5种表现,中心凹正常型33只眼（15.7%）,伴有板层裂孔17只眼（8.0%）,伴有假性黄斑裂孔16只眼（7.5%）,伴有弥漫水肿121只眼（57.0%）,伴有囊样水肿25只眼（11.8%）。（2）中心凹正常组与其它中心凹形态组的视网膜神经上皮层体积比较,差异有统计学意义（P〈0.05）。（3）黄斑部视网膜神经上皮层体积与视力呈负相关（r=0.029,P〈0.01）。结论黄斑前膜患者视力与黄斑部视网膜神经上皮层体积具有负相关性,0CT作为黄斑前膜可靠的诊断方法,在临床上可以减少漏诊,并可以为手术提供更详细的信息。     

Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

OBjectives:To study the characteristics of optical coherence tomography(OCT) in idiopathic macular epiretinal membranes(IMEM)and the relationship between the thickness of fovea and the vision of affected eyes.Methods:A total of 67 cases(73 eyes)with clinical diagnisis of IMEM using direct indirect ophthalmoscope,three mirror contact lens,fundus color photography or nfundus fluorescein angiography(FFA) were examined with OCT.Results:Epiretinal membranes(ERMs)with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes,ERMs withmacular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7eyes.Based on OCT,the ERMs were clearly and partially seperated from the retinal (27 eyes,38.36%),the retinal thickness of the fovea was the thickest in the proliferative ERMs and the thinnest in the ERMs with laminar macular holes.The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454,P=0.000).Conclusion:There were four types of images of OCT in IMEM:ERMs with macular edema,proliferative ERMs,ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT,the poorer the vision acuity in the affected eyes with ERMs.     

Prevalence and associations of epiretinal membranes in latinos: the Los Angeles Latino Eye Study

PURPOSE: To determine age- and gender-specific prevalence and associations of epiretinal membranes (ERMs) in adult Latinos. METHODS: The Los Angeles Latino Eye Study (LALES) is a population-based study of eye disease among Latinos aged 40 or more years. Complete ophthalmic examinations included stereoscopic fundus photography. Masked photographic grading was used to identify and classify ERMs as cellophane macular reflex (CMR) without retinal folds or preretinal macular fibrosis (PMF) with folds. RESULTS: Of the 6142 persons examined at the clinic, 5982 (97%) had gradable retinal photographs. The mean age of the participants was 54.7 +/- 10.7 years; 58% were women. ERMs were present in 18.5% (95% confidence interval [CI]: 17.5%-19.5%) of the participants. Of the participants with ERMs, 19.9% had bilateral ERMs. The prevalence of ERMs increased from 10.1% in persons 40 to 49 years of age to 35.7% in those aged 70 to 79 years and was 22.5% in persons aged 80 years or more. The prevalence was similar in men and women. CMR was present in 16.3% (95% CI: 15.3%-17.2%) and PMF in 2.2% (95% CI: 1.9%-2.6%). Retinal folds involved the fovea in 11% of PMF cases. On average, eyes with central PMF had poorer visual acuity than did eyes without (P < 0.0002). Epiretinal membranes (ERMs) were present in 71% of eyes with macular holes. ERMs were also more common in individuals who had undergone cataract surgery (39.9%), those with proliferative diabetic retinopathy (25.7%), and those with any retinal disease (27.5%). CONCLUSIONS: ERMs occur frequently in Latinos, often bilaterally. The associations of ERMs with proliferative retinopathy, retinal lesions, macular holes, and cataract surgery were confirmed. Central PMF is associated with reduced visual acuity.     

玻璃体不全后脱离所致视网膜病变的光学相干断层扫描观察

目的分析玻璃体不全后脱离的光学相干断层扫描(optical coherence tomography,OCT)图像特征,探讨玻璃体不全后脱离与所引发的玻璃体视网膜病变的关系。方法对81例(86只眼)玻璃体不全后脱离患者进行眼科常规检查、B型超声检查和OCT检查,并对所获得的OCT图像进行分析,观察玻璃体视网膜界面的异常图像特征。结果27只眼显示特发性玻璃体黄斑牵引综合征;25只眼显示特发性黄斑前膜;25只眼显示后界膜牵拉导致特发性黄斑板层裂孔及全层黄斑裂孔形成;9只眼显示玻璃体后界膜与黄斑部及视盘周视网膜神经上皮层多处牵拉粘连。结论OCT能够直观的显示玻璃体不全后脱离与所引发的黄斑部视网膜病变的进展变化,并可进行定量、定性分析与鉴别诊断。     

特发性黄斑裂孔的光学相干断层扫描图像特征

目的 观察特发性黄斑裂孔的光学相干断层扫描(optical coherence tomography,OCT)图像的形态特征。 方法 对65例直接检眼镜或三面镜检查诊断为特发性黄斑裂孔的患者的70只患眼进行OCT、眼底彩色照相和/或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,结合临床特征对OCT图像进行分析。 结果 70只眼中,1,2,3,4期黄斑裂孔分别为11,12,36,11只眼。OCT图像特征1期者表现为黄斑中心凹变浅或消失,神经上皮层浅脱离,中心凹平均厚度为(324.55±139.92)μm;2期者为视网膜表层部分缺失伴小的视网膜组织全层缺损,裂孔的表面有一个可贴附的盖,裂孔平均孔径为(241.75±107.08)μm;3期者为神经上皮层全层缺损,游离盖或无盖,裂孔周围可伴有不同程度囊样水肿,裂孔孔径为(699.78±160.99)μm;4期者图像特征与3期相似,但伴黄斑区和视盘玻璃体后脱离,裂孔孔径(631.36±243.46)μm。 结论 OCT能直观、清晰地显示特发性黄斑裂孔的横截面形态特征,同时能精确地测量裂孔的大小。 (中华眼底病杂志, 1999, 15: 205-208)     

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier.

PURPOSE: To study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood-ocular barrier. METHODS: Sixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately. OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. RESULTS: Latanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. CONCLUSIONS: It is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood-ocular barrier.     

Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms

PURPOSE: To determine the correlation between the tomographic features and the visual functions of eyes with diabetic macular edema. METHODS: Optical coherence tomographic (OCT) images and multifocal electroretinograms were obtained from 45 eyes of 25 patients with diabetic macular edema and from 21 eyes of 21 normal subjects. RESULTS: The OCT images showed cystoid macular edema in 18 eyes and diffuse retinal swelling without cystoid edema in the other 27 eyes. The fovea was significantly thicker in eyes with cystoid macular edema and in those with diffuse retinal swelling than in normal eyes. The fovea of eyes with cystoid edema was significantly thicker than the fovea of eyes with diffuse swelling. The best-corrected visual acuity and the electrical response density from the macular area were significantly reduced in eyes with diabetic macular edema, particularly in those with cystoid edema. The best-corrected visual acuity and macular response density of the multifocal ERGs were inversely correlated, and the implicit times were directly correlated with foveal thickness. CONCLUSION: The visual acuity was correlated significantly with morphological changes revealed by OCT and with multifocal ERGs. The combination of OCT and multifocal ERGs may provide objective criteria for the evaluation and assessment of diabetic macular edema.