视网膜颞上分支静脉阻塞合并黄斑水肿的SD-OCT特征及视野分析

目的观察颞上视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)合并黄斑水肿的频域光学相干断层扫描(spectral domain-optical coherence tomography,SD-OCT)特征,分析视野改变特点。方法回顾性研究。随机选取2019年2月至11月于承德医学院附属医院眼科确诊为BRVO合并黄斑水肿患者34例(34眼)作为BRVO组,同期健康人16人(29眼)作为正常对照组。两组均行最佳矫正视力、裂隙灯显微镜、眼压、间接检眼镜、荧光素眼底血管造影(fundus fluorescein angiograph,FFA)、SD-OCT、自动静态视野计检查。比较两组采用SD-OCT测量的黄斑各分区视网膜厚度、视野平均光敏度(mean sensitivity,MS)及视野平均缺损(mean defect,MD)。结果BRVO组中,黄斑区视网膜可呈海绵样弥漫型视网膜增厚、黄斑囊样水肿、浆液性视网膜脱离及混合型(前三种模式特征皆有)等多种形态表现。BRVO组黄斑中心凹,黄斑中心内外环的颞侧、上方、鼻侧、下方,共9个区域的视网膜厚度分别为(398.09±106.69)μm、(425.06±99.09)μm、(467.18±89.36)μm、(402.53±94.27)μm、(349.47±61.61)μm、(367.44±98.67)μm、(440.88±79.37)μm、(343.32±47.43)μm、(292.91±40.66)μm,正常对照组相应部位分别为(234.21±12.16)μm、(303.21±14.47)μm、(317.90±13.81)μm、(316.59±15.32)μm、(316.76±13.00)μm、(269.48±14.19)μm、(286.86±11.79)μm、(294.76±12.98)μm、(268.76±13.71)μm,两组间比较差异均有统计学意义(均为P<0.05)。BRVO组、正常对照组下方视野MS分别为(18.71±5.47)dB、(27.17±1.18)dB,差异有统计学意义(P<0.05)。黄斑中心内环上半侧、黄斑中心外环上半侧视网膜厚度与下方视野MD均无相关性(均为P>0.05)。结论BRVO合并的黄斑水肿呈现形态多种、分布广泛的特征,同时具有下方视野损害的特点。

SD-OCT features in patients with superior temporal branch retinal vein occlusion combined with macular edema and relevant analysis of visualfield

Objective　 To observe the characteristics of spectral domain-optical coherence tomography (SD-OCT) and changes of visual field in patients with superior temporal branch retinal vein occlusion (BRVO) combined with macular edema. Methods　Thirty-four patients (34 eyes) who were diagnosed with superior temporal BRVO combined with macular edema at Ophthalmology Department, Affiliated Hospital of Chengde Medical College from February to November 2019 were enrolled, and sixteen healthy volunteers (29 eyes) were randomly selected as control group during the same period. All patients took measurement of best corrected visual acuity, slit lamp microscopy, intraocular pressure measurement, indirect ophthalmoscopy, fundus fluorescein angiograph (FFA), SD-OCT and automatic static visual field examination. The retinal thickness, mean sensitivity (MS) and mean defect (MD) of visual field in each macular area were measured by SD-OCT. Results　 In the BRVO group, macular retina presented multiple morphological manifestations such as spongiform-like diffuse retinal thickening, macular cystoid edema, serous retinal detachment and mixed type (morphological changes of all models). The retinal thickness at central fovea of macula, the temporal side, superior side, nasal side and inferior side of the inner and outer central macular rings were (398.09±106.69) μm, (425.06±99.09)μm, (467.18±89.36) μm, (402.53±94.27) μm, (349.47±61.61) μm, (367.44±98.67) μm, (440.88±79.37) μm, (343.32±47.43) μm, (292.91±40.66) μm in the superior temporal BRVO group, (234.21±12.16) μm, (303.21±14.47) μm, (317.90 ± 13.81) μm, (316.59±15.32) μm, (316.76±13.00) μm, (269.48±14.19) μm, (286.86±11.79) μm, (294.76±12.98) μm, (268.76±13.71) μm in normal control group, respectively, and the differences were statistically significant between the two groups (all P<0.05). The MS at inferior visual field were (18.71±5.47) dB in superior temporal BRVO group and (27.17±1.18) dB in normal control group, respectively, and the difference was statistically significant (P<0.05). There was no correlation of the retinal thickness at superior hemisphere in inner central macular ring and outer central macular ring with MD at inferior visual field (both P>0.05). Conclusion　 The macular edema in patients with superior temporal BRVO presents multiple morphological manifestations and extensive locations as well as damage of inferior visual field.