视网膜静脉阻塞黄斑水肿的光相干断层扫描观察

目的 观察视网膜静脉阻塞(RVO)黄斑水肿的光相干断层扫描(OCT)图像特征以及与临床的关联,探讨新型频域OCT在RVO患者黄斑水肿形态和定量分析中的临床价值.方法 回顾分析临床确诊的RVO患者91例92只眼的OCT检查资料.其中,视网膜中央静脉阻塞(CRVO)35例35只眼;视网膜分支静脉阻塞(BRVO)56例57只眼.所有患者接受最佳矫正视力(BCVA)、直接或间接检眼镜、裂隙灯显微镜加前置镜检查.其中60例60只眼还接受了荧光素眼底血管造影(FFA)检查.5线扫描(5 Line Raster)模式下通过中心凹的水平+垂直两条扫描线的分析,对黄斑水肿类型和累及层次以及视网膜外层的细微结构进行观察,用软件自带cliaper功能模块手工测量黄斑中心凹厚度(FT)、浆液性视网膜脱离高度、中心凹囊腔的高度和宽度、中心凹囊腔下光感受器层厚度.在立方体(Cube)扫描模式下,采用软件自带的功能模块对黄斑中心厚度(CFT)、黄斑中心凹体积(V)、平均厚度(AT)进行测量.回顾分析时,重点分析黄斑水肿类型、OCT图像特征以及不同黄斑水肿类型与视力的相互关系.结果 RVO患者黄斑水肿表现为弥漫性水肿、囊样水肿、浆液性视网膜脱离、混合性水肿等多种形态.其中,弥漫性水肿表现为视网膜组织增厚,结构疏松,反射轻度降低;囊样水肿表现为视网膜神经上皮层内有单个或多个低反射囊泡,其间又可见组织柱分隔;浆液性视网膜脱离表现为视网膜神经上皮与色素上皮分离,其间有低反射液性空腔;混合性水肿表现为以上几种水肿形式的混合.92只眼中,弥漫性水肿12例12只眼,占13.0%;囊样水肿21例21只眼,占22.8%;浆液性视网膜脱离37例37只眼,占40.2%;混合性水肿58例59只眼,占64.1%.水肿位于外网状层/外核层91例92只眼.占100.0%;位于内核层67例68只眼,占74.2%;位于神经节细胞层23只眼,占25.0%.光感受器内外节连接(r=3.778 6,P=0.000)、外界膜完整性(r=4.462 2,P=0.000)和FT(r=-0.451 3,P=0.000)与其BCVA有相关性;而CFT(r=0.269 7,P=0.121)、V(r=0.052 8,P=0.054)和AT(r=0.060 8,P=0.075)与视力无相关性.结论 RVO所导致的黄斑水肿其形态和层次可表现为多种不同的类型,频域OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关;定量分析在RVO黄斑水肿患者中的价值有待进一步确定.

Abstract：

Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion (RVO), and to explore the application value of Fourier-domain (FD)OCT in RVO macular edema. Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients (60 eyes)also underwent fundus fluorescein angiography. There were 35 patients (35 eyes) with central retinal vein occlusion (CRVO) and 56 patients (57 eyes) with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema, characteristics of OCT images and the relationship between the different type of the edema and vision. Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (sponge-like thickening of the retina with reduced reflectivity) 12 patients ( 12 eyes, 13.0% ), cystoid edema (multi-cyst-like space in the neuro-retina separated by tissue column) 21 patients (21 eyes, 22.8%) and serous retinal detachment (separation of neuro-retina and retinal pigment epithelium by space with low reflectivity) 37 patients (37 eyes, 40. 2%) and mixed edema(mix of the above several edema form) 58 patients (59 eyes, 64.1 %). The edema can happen at different layers of the neuro-retina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients (92 eyes, 100. 0%), inner nuclear layer (INL) in 68 patients (68 eyes, 74.2%) and ganglion cell layer (GCL) in 23 patients (23 eyes, 25.0%).Statistic analysis revealed that BCVA was related to the integrity of IS/OS (r=3. 778 6, P=0. 000), ELM (r=4.462 2, P= 0. 000 ) and FT (r=-0.4513, P=0. 000 ), but not related to CFT (r=0.269 7, P=0.121), V(r=0.0528, P= 0. 054 ) and AT (r=0.0608, P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.

Optical coherence tomography of macular edema in retinal vein occlusion

Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion (RVO), and to explore the application value of Fourier-domain (FD)OCT in RVO macular edema. Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients (60 eyes)also underwent fundus fluorescein angiography. There were 35 patients (35 eyes) with central retinal vein occlusion (CRVO) and 56 patients (57 eyes) with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema, characteristics of OCT images and the relationship between the different type of the edema and vision. Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (sponge-like thickening of the retina with reduced reflectivity) 12 patients ( 12 eyes, 13.0% ), cystoid edema (multi-cyst-like space in the neuro-retina separated by tissue column) 21 patients (21 eyes, 22.8%) and serous retinal detachment (separation of neuro-retina and retinal pigment epithelium by space with low reflectivity) 37 patients (37 eyes, 40. 2%) and mixed edema(mix of the above several edema form) 58 patients (59 eyes, 64.1 %). The edema can happen at different layers of the neuro-retina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients (92 eyes, 100. 0%), inner nuclear layer (INL) in 68 patients (68 eyes, 74.2%) and ganglion cell layer (GCL) in 23 patients (23 eyes, 25.0%).Statistic analysis revealed that BCVA was related to the integrity of IS/OS (r=3. 778 6, P=0. 000), ELM (r=4.462 2, P= 0. 000 ) and FT (r=-0.4513, P=0. 000 ), but not related to CFT (r=0.269 7, P=0.121), V(r=0.0528, P= 0. 054 ) and AT (r=0.0608, P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.