视网膜中央静脉阻塞黄斑损害的两种影像检查的观察

目的探讨视网膜中央静脉阻塞(centralretinalveinocclusion,CRVO)所致黄斑损害的光学相干断层成像(opticalcoherencetomography,OCT)的图像特征与眼底荧光血管造影(fundusfluoresceinangiography,FFA)的关系。设计回顾性研究。研究对象33例33眼的视网膜中央静脉阻塞患者。方法对33例33眼的视网膜中央静脉阻塞患者进行OCT和FFA检查。采用OCT对黄斑水肿的高度进行了测量。结果4眼OCT表现为弥漫黄斑水肿,其FFA表现为黄斑拱环毛细血管轻度扩张渗漏;21眼OCT表现为黄斑囊样水肿,其FFA表现为13眼为典型的花瓣样黄斑囊样水肿,另8眼毛细血管扩张,拱环结构破坏,荧光素渗漏显著;3眼OCT表现为神经上皮脱离伴有黄斑水肿,其FFA表现为毛细血管扩张,荧光素渗漏;4眼OCT表现为视网膜内和/或视网膜下大量出血,其FFA检查表现为黄斑拱环破坏,结构不清,有出血遮挡;1眼OCT黄斑中心凹形态大致正常,其FFA检查表现为黄斑区荧光素轻度渗漏。结论OCT对于黄斑组织结构改变的敏感性优于FFA,并且能精确地分析和追踪观察黄斑水肿的病程演变。而FFA在OCT表现正常时,仍能反映出色素上皮屏障的破坏。因此,OCT和FFA两种检查各有优缺点,同时采用可更加全面地了解CRVO所致黄斑损害情况。

Characteristics of macular lesions on optical coherence tomography and fundus fluorescein angiography in patients with central retinal vein occlusion

Objectives To investigate the characteristics of macular lesions in patients with central vein occlusion (CRVO) on optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Design Retrospective case series. Participants 33 patients (33 eyes) with CRVO. Methord Thirty-three eyes of 33 patients with the clinical diagnosis of CRVO were examined by OCT and FFA. Results Four eyes showed diffused macular edema on OCT, fluoresscein dye leakage from perifoveal retinal capillaries on FFA. Classic CME were observed on OCT in 21 eyes, but only 13 eyes showed classic CME on flouresscein angiography. Prominent dye leakage from the dilated macular capillaries were observed in the other 8 eyes. Neural retina detachment were shown on OCT in 3 eyes,fluorescein dye leakage and retinal capillary dilation were seen on FFA. introreinal and /subretinal hemorrhages were seen on OCT in 4 eyes, macular arch destruc- tion and fluorescein dye occlusion were detectd on FFA. The macular in 1 eye showed relatively normal stucture on OCT images, but mild dye leakage from the dilated macular capillaries on FFA. Conclusion Oct was more sensitive for small structure lesions than FFA, and was very useful for the follow-up of progression of macular changes. When OCT images of macular edema were normal, the lesions of retinal pigment epithelium maybe observed on FFA. Each metnod has its own advantage. So, a combined examination of the two methods coule be more helpful in the understanding of macular edema.