糖尿病性黄斑水肿的光学相干断层扫描与荧光血管造影图像的对比分析

目的对比分析糖尿病视网膜病变患者的光学相干断层扫描(optical coherence tomography,OCT)与荧光血管造影(fluorescein angiographic,FA)图像。方法回顾性分析不同阶段糖尿病视网膜病变70例患者95眼的OCT和FA图像。结果OCT图像显示视网膜水肿占70.5%,囊样黄斑水肿(cystoid macular edema,CME)占13.7%,浆液性黄斑脱离并发水肿占4.2%,浆液性黄斑脱离并发水肿和CME占2.1%,正常黄斑结构占9.5%。结论OCT为糖尿病视网膜病变黄斑结构的变化提供了依据,特别是对FA未能发现的早期黄斑结构改变的诊断具有重要意义。     

Serous macular detachment in central retinal vein occlusion

PURPOSE: To describe serous macular detachment in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography (OCT). METHODS: This study included 22 eyes of 22 consecutive patients with CRVO. The patients underwent complete ophthalmic examination, including corrected visual acuity measurement, slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, fluorescein angiography, and OCT. RESULTS: Twenty-two patients (22 eyes) with cystoid macular edema associated with CRVO (10 women and 12 men; age range, 48-75 years [average, 62.5 years]) made up the study population. Angiographically, all patients had typical cystoid macular edema. At the time of initial examination, no patient was suspected of having a serous macular detachment associated with CRVO. The mean foveal thickness as determined by OCT was 567.4 microm. In all cases, the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. A serous macular detachment composed of retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues was seen in 18 eyes (81.8%). CONCLUSION: OCT findings in this study showed that serous macular detachment in patients with CRVO occurs more often than previously thought. Our data also showed that noncontact fundus ophthalmoscopy and fluorescein angiography were not sufficient to diagnose serous macular detachment in CRVO.     

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.     

Tractional cystoid macular edema: a subtle variant of the vitreomacular traction syndrome

PURPOSE: To describe clinical characteristics and treatment outcomes in a series of patients with tractional cystoid macular edema, a subtle variant of the vitreomacular traction syndrome. DESIGN: Retrospective, uncontrolled, observational, and interventional case series. METHODS: Patient population: Ten consecutive patients (11 eyes) with multicystoid foveolar thickening caused by localized perifoveal vitreous detachment. EXPERIMENTAL PROCEDURES: Slit-lamp biomicroscopy and fluorescein angiography; confirmation of vitreomacular relationship with B-scan ultrasonography, optical coherence tomography (OCT), or both. Vitrectomy with peeling of posterior hyaloid in 8 eyes with pretreatment visual acuity 相似文献   

合并糖尿病眼底病变患者白内障术后的黄斑水肿和视力观察

目的:探讨合并糖尿病眼底病变患者白内障术后与正常眼底的患者白内障术后的黄斑水肿和视力恢复情况。方法:选取63例63眼白内障患者,其中33例伴有轻至中度糖尿病眼底改变,为糖尿病组;另外30例正常眼底为对照组。相同的术式、手术医生及术后处理。于术前、术后1,6wk及6mo检查视力及眼底情况,于术前、术后6wk行荧光素眼底血管造影检查,观察两组术后黄斑水肿及视力恢复情况。结果:糖尿病患者32例及对照组29例患者完成检查并随访。术后6wk,糖尿病组有24例(75%)出现眼底渗漏,而对照组只有6例(21%);糖尿病组有5例(16%)出现临床型黄斑囊样水肿(CME),对照组有2例(7%)出现临床型CME;术后6mo,两组视力水平差异无显著性,黄斑水肿恢复。结论:白内障术后不管是对正常眼底还是对伴轻中度糖尿病视网膜病变都可发生CME,但视力恢复无明显差异,发生CME予随诊,一般不需处理,多能自行恢复。     

Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy

PURPOSE: To investigate retinal morphology by means of fluorescein angiography (FA) and optical coherence tomography (OCT) in patients who had undergone photodynamic therapy (PDT) with verteporfin at their 3-month-interval examination. METHODS: Sixty patients with predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration were evaluated with FA and OCT 3 months after their last PDT. FA images were evaluated in a masked fashion for staining of and leakage from the lesion and also for cystoid loculation of fluorescein in the macula. OCT was used to evaluate foveal thickness and the presence of subretinal fluid or cystoid spaces within the retina, also in a masked fashion. RESULTS: The median age of the 60 patients was 78 years, and the median visual acuity of the eyes examined was 20/100. The median number of previous PDT sessions was 2. Fluorescein staining was seen in 57 eyes (95%), and fluorescein leakage was seen in 50 eyes (83%). Cystoid loculation of fluorescein was seen in 21 eyes (35%). By OCT, cystoid spaces in the macula were seen in 42 patients (70%), and subretinal fluid was seen in 15 patients (25%). Leakage seen shown by FA was correlated with the OCT finding of cystoid spaces but not with the OCT finding of subretinal fluid. Some patients had leakage during FA that did not have any observable induced OCT abnormality attributable to fluid accumulation. CONCLUSIONS: After PDT leakage from CNV seen during FA is associated with intraretinal fluid, often seen in loculated cystoid spaces, but not with subretinal fluid.     

The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema

PURPOSE: To assess the correlation between the features of optical coherence tomography (OCT) and fluorescein angiography in clinically significant diabetic macular edema. DESIGN: Retrospective observational case series. METHODS: This study involved 145 eyes (91 patients) with clinically significant diabetic macular edema. The fluorescein angiography features were categorized into focal leakage type, diffuse leakage type, and diffuse cystoid leakage type. The OCT features were categorized into four types: type 1, thickening with homogeneous optical reflectivity; type 2, thickening with markedly decreased optical reflectivity in the outer retinal layer; type 3A, foveolar detachment without traction; and type 3B, foveolar detachment with apparent vitreofoveal traction. The correlation between fluorescein angiography types and OCT types were analyzed, and their associations with visual acuity, central foveal thickness. and stages of diabetic retinopathy were evaluated. RESULTS: The prevalence of OCT type 1 was higher in the focal leakage type (73.0%) and in the diffuse leakage type (58.9%) than in the diffuse cystoid leakage type (3.8%) of fluorescein angiography (P <.0001). The prevalence of OCT type 2 and 3A was higher in the diffuse cystoid leakage type (57.7% and 34.6%, respectively) than in the focal leakage type (20.6% and 3.2%) or diffuse leakage type(28.6% and 10.7%; P <.0001). The stages of retinopathy correlated with fluorescein angiography types (P =.016). Optical coherence tomography type 1 and the focal leakage type of fluorescein angiography showed the least foveal thickness and the best visual acuity (P <.05). CONCLUSIONS: There was a significant correlation between the features of OCT and fluorescein angiography in clinically significant diabetic macular edema. The combined data from both OCT and fluorescein angiography may provide a clearer understanding of the anatomic and physiologic characteristics of clinically significant diabetic macular edema.     

Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography

PURPOSE: To assess patients with diabetic macular edema quantitatively using optical coherence tomography (OCT). METHODS: OCT was performed in 14 eyes with diabetic retinopathy and ophthalmoscopic evidence of clinically significant macular edema (CSME) and in 19 diabetic eyes without CSME. Retinal thickness was computed from the tomograms at fovea and other 36 locations throughout the macula. RESULTS: The mean +/- standard deviation foveal thickness was 255.6 +/- 138.9 microm in eyes with CSME, and 174.6 +/- 38.2 microm in eyes without CSME (p = 0.051). Within 2000 microm of the center of the macula, eyes with CSME had significantly thicker retina in the inferior quadrant than those without CSME (p < 0.01). The foveal thickness was correlated with logMAR visual acuity (gamma = 0.68, p < 0.01). OCT identified sponge-like retinal swelling and/or cystoid macular edema in 11 (58%) eyes without CSME, and in 12 (86%) eyes with CSME. CONCLUSIONS: Criteria of CSME seem to be insufficient in really identifying macular edema. OCT may be more sensitive than a clinical examination in assessing diabetic macular edema and is a quantitative tool for documenting changes in macular thickening.     

The correlation between optical coherence tomographic features and severity of retinopathy,macular thickness and visual acuity in diabetic macular edema

Purpose To investigate the correlation between the features of optical coherence tomography (OCT) and the severity of concurrent retinopathy, central macular thickness (CMT), and best-corrected visual acuity in clinically significant diabetic macular edema.Methods In a prospective study, OCT was performed in 55 eyes of 55 patients with clinically significant diabetic macular edema, in 58 eyes of 30 patients with diabetes without retinopathy, and in 40 eyes of 21 healthy control subjects. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; type 3, serous retinal detachment; and type 4, vitreofoveal traction.Results The CMT in eyes with diabetic macular edema was significantly higher than in eyes of healthy controls or in eyes of diabetic patients without retinopathy (P < 0.001). Visual acuity correlated with CMT in diabetic macular edema (r = 0.558, P < 0.001). The prevalence of OCT type 1 was significantly higher in eyes with mild-to-moderate non-proliferative retinopathy (NPDR) than in eyes with severe NPDR to proliferative retinopathy (PDR) (P = 0.0069). The prevalence of OCT types 3 and 4 was significantly higher in eyes with severe NPDR to PDR than in eyes with mild-to-moderate NPDR (P = 0.0056). OCT type 1 showed the least CMT (P < 0.001) and the best visual acuity (P = 0.002).Conclusions There was a significant correlation between OCT patterns of clinically significant diabetic macular edema and severity of retinopathy, CMT, and visual acuity.     

糖尿病性黄斑水肿OCT和FFA形态学分类的对比分析

目的探讨糖尿病性黄斑水肿相干光断层扫描(OCT)和眼底荧光素血管造影(FFA)的形态学特征、分类及相互关系。设计前瞻性病例系列。研究对象临床有意义糖尿病性黄斑水肿(CSME)患者102例177眼。方法分别对CSME组患者进行OCT及FFA检查,观察两种分类之间的相互关系,并与中心凹中心厚度、最佳矫正视力等临床资料进行对比分析。主要指标CSME患者的OCT及FFA类型、中心凹中心厚度、最佳矫正视力。结果FFA分类的局限水肿型在OCT1型中所占的比例为70.6%,高于弥漫水肿型(27.2%)和囊样水肿型(2.2%)(P<0.05)。FFA弥漫水肿型在OCT2型中占47.9%,明显高于局限水肿型(25.0%)和囊样水肿型(27.1%)(P<0.05)。FFA分类的囊样水肿型在OCT3型(3A型 3B型)中占56.8%,明显高于局限水肿型(10.8%)和弥漫水肿型(32.4%)(P<0.05)。OCT1型及FFA局限水肿型的矫正视力最好,黄斑中心凹中心厚度值最小(P<0.05)。结论CSME患者OCT与FFA的形态学类型密切相关。结合两种检查方法,可更加全面地反映CSME患者黄斑区视网膜的变化,为揭示糖尿病性黄斑水肿的病理机制、寻求每种类型的最佳治疗方案提供参考。     

Serous macular detachment in diabetic cystoid macular oedema

PURPOSE: To define serous macular detachment in patients with diabetic cystoid macular oedema (CME). METHODS: This study involved 78 eyes of 58 patients with diabetic CME. The patients underwent complete ophthalmic examination, fluorescein angiography and optical coherence tomography (OCT). Eyes with epiretinal membrane or vitreo-macular traction were not included in the study. Optical coherence tomography-3 was used in all patients and fundi were scanned on the horizontal, vertical and four oblique planes through the centre of the fovea. RESULTS: In all cases the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. With OCT, 24 of 78 eyes (31%) had serous macular detachment as shown by retinal elevation over a non-reflective cavity with minimal shadowing of the underlying tissues. Fluorescein angiography did not show serous macular detachment in any patient. CONCLUSIONS: Our data showed that the incidence of serous macular detachment in diabetic CME was much higher than previously reported. Optical coherence tomography-3 allows an in vivo cross-sectional observation of very subtle serous macular detachment that is difficult to diagnose at the slit-lamp or by fluorescein angiography in patients with diabetic CME.     

糖尿病黄斑病变分型和视力预后

目的 分析317例597只眼糖尿病黄斑病变荧光形态并进行分型,探讨类型和分期与视力预后的关系。 方法 每例均作双眼荧光素眼底血管造影,分析黄斑区荧光素渗漏的来源,形态和范围。黄斑拱环的大小及黄斑区是否有无灌注区存在,有无增生等。 结果 ①597只眼中无渗漏型154只眼占25.8,局部水肿型188只眼占31.5%,弥漫水肿型239只眼占40.0%,缺血型12只眼占2.0%,增生型4只眼占0.7%;②视力预后与分型有密切关系。以视力大于或等于0.5计,无渗漏型占99.4%,局部水肿型占83.0%,弥漫水肿型占28.4%,缺血型占8.4%,增生型无1只眼在0.5以上。黄斑囊样水肿占20.3%。③分期与视力预后,随期数愈高视力预后愈差,视力大于或等于0.5者,1期占96.2%,2期占84.8%,3期占53.2%,4期占37.2%,5期占12.5%。 结论 糖尿病黄斑病变是导致糖尿病患者视力减退的重要因素,不同分型有不同的预后.黄斑水肿和囊样水肿应作激光治疗以阻止视力下降。 (中华眼底病杂志,2000,16:144-146)     

内界膜剥除治疗白内障术后囊样黄斑水肿

目的探讨内界膜(ILM)剥除术治疗人工晶状体植入术后囊样黄斑水肿(CME)的手术效果。对象和方法对于经前置镜和光学相干眼底断层扫描(OCT)确诊,无前部玻璃体牵引因素的人工晶状体植入术后囊样黄斑水肿进行玻璃体切除内界膜剥离术14例(15眼),追踪观察其视力预后、囊样黄斑水肿消失时间。结果术后全部病例的CME迅速改善,消失时间为1~12月,平均2.9月,2月内消失者占80.00%。视力预后与白内障手术到CME发生的时间、CME到ILM剥除术的时间间隔呈负相关关系。结论对于无前部玻璃体牵拉因素的人工晶状体植入术后的CME,早期行内界膜剥除术可以促使CME改善或消失,视力提高。     

Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls

Background

Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6?months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT).

Methods

Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macular thickness was measured in three circular fields (central subfield, inner and outer circle) from the macular maps.

Results

There was no statistically significant difference in VA before surgery, at day 7 or at 6?months, but at 6?weeks there was a significant difference with lower VA in the diabetic group. Six percent of control and 12% of diabetic eyes developed a clinical CME defined as a loss of >5 letters between day 7 and week 6. Incidence of FA leakage was 23% in control and 76% in diabetic eyes. At 6?weeks, 20% of control and 44% of the diabetic eyes had qualitative changes on OCT. A statistically significant increase in thickness was observed for all three macular areas in both groups, part of it remaining at 6?months. There were, however, no differences in central macular thickness between the groups at any visit. Retinal thickening had poor correlation with VA.

Conclusion

The final visual outcome in eyes with mild to moderate retinopathy, without previous ME, is as good as in normal eyes, but an increased frequency of macular changes may protract recovery of full vision. Changes on OCT or FA are often seen without any obvious effect on VA. OCT is as good as FA at detecting a clinical CME, and is the technique recommended for follow-up before FA is considered.     

Tomographic assessment of vitreous surgery for diabetic macular edema

PURPOSE: To evaluate the retinal structure before and after vitrectomy for diabetic macular edema and to assess the correlation between thickness of neurosensory retina and best-corrected visual acuity. METHODS: Tomographic features of 13 eyes (nine patients) with diabetic macular edema were prospectively evaluated with optical coherence tomography before and after vitrectomy. The foveal thickness (the distance between the inner retinal surface and the retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) were measured by optical coherence tomography preoperatively and postoperatively. The correlation of the best-corrected visual acuity with foveal and retinal thickness was determined. RESULTS: All 13 eyes had retinal swelling with low intraretinal reflectivity. In addition to retinal swelling, there were cystoid spaces in five (38%) of 13 eyes, a serous retinal detachment in three (23%), and both cystoid spaces and serous detachment in three (23%). Six months postoperatively, the mean foveal thickness significantly decreased from 630 +/- 170 to 350 +/- 120 microm (P <.01, paired t test) and the mean thickness of neurosensory retina decreased from 540 +/- 160 to 320 +/- 140 microm (P <.01, paired t test). A serous retinal detachment occurred transiently in 3 eyes. Compared with the preoperative level, the postoperative best-corrected visual acuity level improved by more than 2 lines in five of the 13 eyes (38%), remained the same in seven eyes (54%), and decreased in one eye (8%). The postoperative thickness of neurosensory retina at the fovea and best-corrected visual acuity level at the sixth postoperative month had a strong negative correlation (correlation coefficient, -0.76; P <.01, Spearmans rank test). CONCLUSIONS: Vitrectomy was generally effective in treatment of diabetic macular edema. Optical coherence tomography demonstrated the intraretinal changes of macular edema and the process of edema absorption. During the process of macular edema absorption, intraretinal fluid appeared to move into the subretinal space in some cases. Best-corrected visual acuity improvement was greater in eyes with less preoperative increase in thickness of neurosensory retina.     

Posterior cystoid retinal degeneration in central serous chorioretinopathy

PURPOSE: To study the pattern of cystoid retinal changes in the posterior fundi of eyes with chronic central serous chorioretinopathy (CSC) using optical coherence tomography (OCT). METHODS: We retrospectively studied 34 eyes with chronic CSC and cystoid retinal changes at the posterior pole documented by OCT. We analyzed the distribution of cystoid retinal changes with respect to the fovea and chorioretinal lesions. RESULTS: Generally, cystoid retinal changes occurred in the papillomacular region (21 eyes); foveal involvement was observed in 20 eyes. Large cystoid changes in the central macula with concentric perifoveal lesion extension were detected in three eyes. Cystoid changes tended to occur where the retina adhered to subretinal fibrosis, large laser scars, or spontaneous atrophy of the retinal pigment epithelium and the choroid. Visual acuity ranged from 20/20 to 20/400. In nine eyes in which the cystoid changes spared the foveal center, visual acuity was 20/40 or better. CONCLUSION: Cystoid retinal degeneration in eyes with chronic CSC was distributed outside of the fovea and was not necessarily associated with severely reduced visual acuity. "Posterior cystoid retinal degeneration" defines this pathologic pattern appropriately. OCT findings suggest that intraretinal exudation and cystoid changes in chronic CSC develop through the formation of chorioretinal adherences.     

Optical coherence tomography following successful management of endophthalmitis

Optical coherence tomography (OCT) was done in 20 eyes to detect causes of poor visual outcome, at least three months after successful management of endophthalmitis, which obtained clear media and best corrected visual acuity of < 20/40. Only four (20%) eyes had normal foveal contour on OCT. Eleven (55%) eyes showed treatable lesions, including epiretinal membrane with macular thickening in five (25%), epiretinal membrane without macular thickening in three (15%), cystoid macular edema in two (10%) and subfoveal serous detachment in one (5%) eye. Five eyes (25%) had foveal atrophy. OCT was helpful in segregating treatable conditions like cystoid macular edema from nontreatable causes like neurosensory atrophy in the postendophthalmitis patients.     

Relationship between perifoveal capillaries and pathomorphology in macular oedema associated with branch retinal vein occlusion

Purpose

To study the relationship between macular ischaemia on fluorescein angiography (FA) and pathomorphology at the foveal centre delineated by spectral-domain optical coherence tomography (OCT) in macular oedema (MO) associated with branch retinal vein occlusion (BRVO).

Methods

One hundred and five consecutive eyes of 105 patients with MO (centre point thickness (CPT) ≥300 μm) associated with BRVO in which FA using Heidelberg Retinal Angiography 2 and Spectralis OCT were performed on the same day were retrospectively reviewed. We evaluated the foveal pathomorphology using OCT images and the association with macular ischaemia.

Results

Within 1 year from symptom onset, 94 eyes were classified with perfused macula (34 eyes) or non-perfused macula (60 eyes). Eyes with perfused macula had better visual acuity and less CPT than those with non-perfused macula (P=0.024 and P<0.001, respectively). Fourteen eyes with perfused macula had serous retinal detachment (SRD) alone at the presumed foveal centre (SRD type); seven, a sponge-like swelling at that area (retinal swelling type); 11, foveal cystoid spaces alone (cystoid MO (CMO) type), and 2, with both SRD and foveal cystoid spaces (SRD+CMO type). However, 58 eyes with non-perfused macula had foveal cystoid spaces (42 of CMO type and 16 of SRD+CMO type), with a significant association between them (P<0.001). Among 11 eyes with symptoms exceeding 1 year, 6 eyes had perfused macula, and none had the SRD type.

Conclusion

Most eyes without foveal cystoid spaces have perfused macula in MO associated with BRVO.     

Cystoid macular degeneration in chronic central serous chorioretinopathy

PURPOSE: To describe the optical coherence tomography (OCT) and fluorescein angiography findings in the macula of eyes with chronic central serous chorioretinopathy (CSC) and reduced central vision. METHODS: Using OCT, clinical examination, and fluorescein and indocyanine green (ICG) angiography, the authors examined eight eyes of seven patients with CSC, an attached macula, and reduced central vision of 20/200 or worse. All had a history of chronic CSC with resolution of the subretinal fluid in the macular area and poor vision. RESULTS: Patient ages ranged from 55 to 82 years (mean, 66 years). All eight eyes had some parafoveal, patchy RPE atrophy with corresponding transmission hyperfluorescence (window defect) on fluorescein angiography. Five eyes also had a window defect in the foveal area. With OCT, the foveal area revealed variable areas of cystoid change and atrophy in seven of the eight eyes. In four of these eyes, the cystoid changes were not seen on clinical examination or fluorescein angiography. The seven eyes with cystoid changes imaged with OCT had no intraretinal leakage of fluorescein in the foveal region. The authors categorized these eyes as having cystoid macular degeneration (CMD). One other eye had foveal thinning or atrophy without cystoid changes. CONCLUSIONS: Intraretinal cystoid spaces without intraretinal leakage, or CMD, was a common finding in eyes with chronic CSC and reduced central vision after resolution of subretinal fluid. OCT was useful to establish the presence of CMD and foveal atrophy, even when these changes were not clearly evident on clinical examination or fluorescein angiography. Chronic foveal detachment and antecedent intraretinal leakage were proposed to be the mechanisms for the development of the changes. CMD in conjunction with foveal atrophy was an important clinical finding to account for the poor visual outcome in patients with CSC.     

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）