光相干断层扫描在观察特发性黄斑裂孔 病程进展中的应用

目的应用光相干断层扫描（OCT）对临床诊断为Ⅰ～Ⅳ期特发性黄斑裂孔患眼进行随诊观察，了解其裂孔进展过程及与玻璃体后分离的相互关系。方法按Gass的临床分期标准，结合OCT图像特征，诊断特发性黄斑裂孔Ⅰ～Ⅳ期未行手术治疗的72只眼，进行OCT随诊检查。结果Ⅰ～Ⅳ期裂孔分别为23、19、11、19只眼，随诊时间最长43个月（平均13.4个月），每只眼OCT检查次数2～10次（平均4.7次），在随诊期间，Ⅰ期裂孔23只眼，9只眼(39.1%)进展为Ⅱ～Ⅲ期裂孔,2只眼玻璃体后脱离（PVD）后中心凹曲线恢复正常；Ⅱ期裂孔19只眼，13只眼(68.4%)进展为Ⅲ～Ⅳ期裂孔,有1只眼PVD后裂孔自行愈合；Ⅲ期裂孔11只眼，5只眼(45.5%)进展为Ⅳ期裂孔，1只眼12个月后裂孔部分自行愈合。OCT图像显示，玻璃体从黄斑中心凹周围开始与视网膜分离，直至完全后脱离的过程与黄斑裂孔进展过程一致。在随诊期间，15只眼因病程进展接受手术治疗。结论黄斑裂孔形成和发展与玻璃体后脱离的发生密切相关。OCT可直观显示黄斑裂孔的进展变化，对提供IMH的分期诊断和手术指征有较大帮助。(中华眼底病杂志,2005,21:79-82)     

特发性黄斑裂孔发病机制探讨

目的 根据OCT图像,探讨特发性黄斑裂孔的发病机制.方法 观察特发性黄斑裂孔59例65只眼的OCT图像.Ⅰ期裂孔6例6只眼;Ⅱ期裂孔22例24只眼,其中Ⅱ期裂孔的早期10例10只眼,Ⅱ期裂孔的晚期12例14只眼;Ⅲ期裂孔21例25只眼;Ⅳ期裂孔10例10只眼.结果 Ⅰ期裂孔中有4/6可观察到黄斑前双凸型玻璃体后脱离对中心凹的牵拉.Ⅱ期裂孔的早期中有9/10可观察到黄斑前双凸型玻璃体后脱离对中心凹的牵拉;Ⅱ期的晚期中有10/14可观察到裂孔盖膜,这些盖膜中有8/10可观察到含有部分撕脱下来的视网膜神经组织.Ⅲ期裂孔中有16/25及Ⅳ期裂孔中有7/10可观察到内界膜增厚,反光增强,部分患眼还可观察到合并有视网膜前膜的形成.结论 特发性黄斑裂孔Ⅰ期和Ⅱ期的主要发病机制是中心凹玻璃体前后方向的牵拉,而Ⅲ期和Ⅳ期的主要发病机制是内界膜的收缩.     

玻璃体黄斑中心凹牵拉的光学相干断层扫描分析

目的 :应用光学相干断层扫描 (opticalcoherencetomography ,OCT)定量分析玻璃体牵拉与黄斑裂孔形成的关系。探讨OCT检查对诊断特发性黄斑裂孔的意义。方法 :OCT显示为玻璃体黄斑中心凹牵拉的 18例 ( 2 0眼 )患者进行随访。垂直和水平线性OCT经过黄斑中心凹 ,分析OCT图像 ,测量黄斑厚度及玻璃体后脱离 ,定量分析黄斑裂孔与玻璃体牵拉的关系。结果 :平均年龄为 63 2± 8 4岁 ( 5 0～ 77岁 ) ,男性 2例 ,女性 16例。临床诊断为临界黄斑裂孔 9眼 ,黄斑囊肿 2眼 ,玻璃体黄斑牵拉 3眼 ,黄斑囊样水肿 3眼 ,视网膜前膜 1眼及诊断不详 2眼。首次OCT图像显示玻璃体后皮质粘连在黄斑中心凹处 ,中心凹变平或隆起 ,神经上皮间呈低反射的囊肿。未形成裂孔眼的玻璃体后脱离逐渐增加 ,中心凹的隆起度亦随之增加。随访视力显著下降 (P =0 0 0 1,配对T检验 ) ;视力与黄斑的隆起度呈负相关 (r2 =0 5 3 ,P =0 0 0 3 ,Pearson相关分析 )。 2 0眼中 8眼 ( 4 0 % )形成黄斑裂孔 ,板层裂孔 1眼 ,Ⅱ期裂孔 5眼 ,Ⅲ期裂孔 2眼。裂孔形成组与未形成组的视力、黄斑厚度及玻璃体后脱离的差异不显著 (P >0 0 5 )。结论 :OCT对分析、诊断、监测玻璃体黄斑牵拉具有非常有意义的临床价值。玻璃体黄斑中心凹牵拉是裂孔形成的原因之一     

特发性黄斑裂孔的光学相干断层成像分析

目的：采用光学相干断层扫描（optical coherence tomography,OCT）观察特发性黄斑裂孔（idiopathic macular hole,IMH）各期的图像特征及演变过程。方法：对199只眼（170例，其中29例双眼患者）IMH的OCT图像进行回顾性观察分析，进行随访观察。结果：Ⅰ期裂孔１６只眼（８％），表现为黄斑中心凹视网膜不同程度的囊样变性（７５％）或浅脱离（１５％）；Ⅱ期裂孔２０只眼（１０%）,OCT示黄斑中心凹旁中心破裂（８５％）和中心破裂（１５％）；Ⅲ期裂孔１２１只眼（６１％），表现为黄斑中心凹神经上皮层全层缺失；Ⅳ期裂孔、板层裂孔及双眼黄斑裂孔分别为２３只眼（１２％）、１９只眼（１０％）、２９只眼（１７％）。结论：OCT图像对观察IMH各期特征及演进过程具有重要的临床应用价值。     

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)     

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。     

中心凹周玻璃体脱离是原发性黄斑裂孔形成的主要病因

目的：评价在有早期原发性黄斑裂孔形成的眼内后玻璃体皮质与后部视网膜之间的关系。方法：对患有一期或二期原发黄斑裂孔的26例连续患者的26只眼，进行全部眼科检查、接触镜生物显微镜检查和B超检查或玻璃体视网膜手术或二者都施行。在曾施行手术眼中，于导致后玻璃体脱离之前，用一尖端为硅的套管细心地检查后玻璃体皮质层。结果：26只眼中的25只眼（96％），经一种或多种检查技术显示中心凹周玻璃体局限性浅脱离，典型地延伸至血管弓水平。在这25只眼中，后玻璃体膜分离在4只眼中（16％）可用生物显微镜查见；在23只眼（100％）于手术中查见。有一期孔的6只眼中全部及有二期孔而无盖的13只眼中12只眼（92％），在中心凹明显可见持久性玻璃体粘连。结论：这些所见提示，局限性中心凹周玻璃体脱离（年龄相关性后玻璃体脱离的早期）是原发性黄斑裂孔形成的主要致病事件。我们假定后玻璃体从中心周视网膜的脱离，由于对中心凹施加前牵拉以及将伴发眼球转动的有力玻璃体牵拉局限到中心凹，导致中心凹裂开。     

单眼黄斑裂孔患者对侧伴旁中心凹玻璃体后脱离眼的黄斑裂孔发生率

中心凹玻璃体结合处与黄斑裂孔的形成有着很密切的关系。近20年来，随着相干光断层扫描（OCT）技术及数字影像技术的发展，有数据证实，旁中心凹的玻璃体后脱离参与黄斑裂孔的形成过程。此项回顾性病例系列研究旨在预测单眼患有特发性黄斑全层裂孔的患者，其伴有旁中心凹玻璃体后脱离的对侧眼黄斑裂孔的形成率。本研究纳入单眼特发性黄斑全层裂孔伴对侧眼旁中心凹玻璃体后脱离及早期中心凹视网膜内损伤的患者。     

特发性黄斑裂孔的OCT诊断标准

目的 观察特发性黄斑裂孔的光学相干断层扫描(Optical Coherence Tomography，OCr)图像特征。总结Gass分期的诊断标准。方法 对133例(143只眼)临床诊断为特发性黄斑裂孔的患者进行OCT检查。根据Gass分期的原则进行分期。结果依据Gass分期的原则，将143只患眼分为4期，各期OCT图像特征如下：Ⅰ期：共29只眼，黄斑中心凹轮廓变浅或消失，中心凹下可见低反射区，其中14只眼发现伴有黄斑前膜增生，7只眼伴有玻璃体黄斑牵引；Ⅱ期：共17只眼，神经上皮全层破裂形成孔，孔表面有可以贴附的孔盖；Ⅲ期：共83只眼，神经上皮全层破裂，孔盖游离或未见孔盖，伴不同程度裂孔周围囊样水肿；Ⅳ期：共14只眼，裂孔形态与Ⅲ期相似，但合并玻璃体后脱离。结论 OCT能直观、形象地显示特发性黄斑裂孔的形态特征，比较准确地进行分期，在特发性黄斑裂孔的诊断及术式选择等方面有重要作用。     

急性特发性全层黄斑裂孔治疗中中央凹黄斑裂孔旁组织分离的效果

目的：评估对病程短于1年的特发性黄斑裂孔接受扁平部玻璃体切割术患者进行中央凹旁组织分离（PTD）的功效。方法：对连续104例急性特发性黄斑裂孔患者的107只眼进行扁平部核心玻璃体切割术。一组进行常规PTD，另一组不试剥视网膜前组织。随访超过6个月（随访时间6－36个月）。结果：总体上看所有眼中95只眼的黄斑裂孔（89％）被封闭。91只眼（85％）的Snellen字母表视力上升2行或更多。术后视力≥0．4达到79只眼（74％）。25只眼（23％），发生－过性眼压升高（≥30mmHg)。6只眼（6％）发生视网膜脱离。1只眼有视网膜角素上皮改变，且1例患者报告有周边视野缺损。用PTD和不用PTD之间，任何测量结果的差异均无显著性。结论：本系列中对急性特发性黄斑裂孔进行扁平部核心玻璃体切割术眼进行PTD证实其无有益的或不良效果。     

Vitreoretinal tomography and foveolar traction in macular hole development and macular pseudohole]

OBJECT: To clarify the morphologic features and foveolar traction in macular hole development and macular pseudohole. METHODS: The vitreoretinal tomography of idiopathic macular holes and macular pseudoholes was observed with optical coherence tomography (OCT). RESULTS: In stage 1 and 2, foveolar intraretinal splitting was evident. The posterior hyaloid membrane was detected in 7 of 10 eyes with stage 1 and 2 holes. Dome-shaped vitreoretinal separation was seen in 6 of 7 eyes in which the posterior hyaloid membranes were detected. A complete posterior vitreous detachment was seen around a stage 3 hole. In the macular pseudohole with preretinal membrane, there was anterior and central displacement of the inner retina in the perifoveal region, resulting in a U-shaped deformation of the macular lesion. In contrast, the structure of the central fovea was virtually intact. CONCLUSIONS: On the basis of the OCT findings, the intraretinal splitting and the cyst formation are important features in the development of a macular hole. The dome-shaped vitreoretinal separation in the early stages of macular holes suggests that the posterior hyaloid membrane may not be taut but slack, and would not cause a tractional force continuously even in early-stage macular holes.     

Mapping posterior vitreous detachment by optical coherence tomography in eyes with idiopathic macular hole

PURPOSE: To determine the relationship between posterior vitreous detachment and idiopathic macular hole. DESIGN: Observational case series. METHODS: In a prospective study, the posterior hyaloid face was scanned from the posterior pole to the far periphery by optical coherence tomography in 25 eyes (22 patients) with an idiopathic macular hole (stage 1 = 1, stage 2 = 7, stage 3 = 10, and stage 4 = 7), and a map of the posterior vitreous detachment was constructed. RESULTS: One eye with a stage 1 macular hole had a posterior vitreous detachment confined to the vascular arcade, but attached to the fovea. In all seven eyes at stage 2, the detached posterior hyaloid enlarged upward beyond the superior vascular arcade, but stopped at the margin of inferior vascular arcade. In two cases, the posterior vitreous detachment also extended temporally and superonasally. In all cases, the vitreous face remained attached to the fovea. Six of the 10 eyes at stage 3 had larger partial posterior vitreous detachment that extended not only upward, but also beyond the inferior vascular arcade, while in the other four eyes, the size and position of the posterior vitreous detachment was similar to stage 2 macular holes. However, unlike stage 2, the posterior vitreous detachment included the fovea in all eyes. All seven eyes with a stage 4 macular hole had complete posterior vitreous detachment that extended to the far periphery in all directions. CONCLUSION: There is a close correlation between the stage of the macular hole and the degree of posterior vitreous detachment. This close correlation suggests that progression of idiopathic macular hole is related to enlargement of the posterior vitreous detachment.     

Evaluation vitreous body in idiopathic macular holes--biomicroscropic and ultrasonographic picture

AIM OF THE STUDY: The aim of our study was to estimate the state of the vitreous body and the vitreoretinal interface in patients with idiopathic macular holes. MATERIAL AND METHODS: We examined 36 patients (41 eyes), 34 women and 2 men aged 65-72 with idiopathic macular holes. State of the hole (classified by Gass) was established on the biomicroscopical examination using Goldmann lens and double aspheric Volk lenses (+60.0, +90.0 D), ultrasonography Compuscan UAB 1000 Storz and fluorescein angiography. RESULTS: We classified stage 2 macular hole in 7 eyes (17%), stage 3 in 28 eyes (68%) and stage 4 in 6 eyes (15%). In the slit lamp examination we revealed partial posterior hyaloid detachment with posterior hyaloid membrane still attached at optic nerve head in 5 eyes, vitreomacular separation in 3 eyes, and vitreofoveal separation of posterior hyaloid membrane with the presence of focal condensation of the posterior hyaloid membrane in front of the fovea--operculum in 11 eyes, in stage 3 macular hole. In 8 eyes we observed lacunaes, and vitreoretinal tractions in 6. Ultrasonography was slightly more effective in revealing vitreomacular and partial PVD separation than biomicroscopical examination. In the case of vtireoretinal tractions or lacunaes, ultrasonography was worse than slit lamp examination. CONCLUSIONS: The exact evaluation of condition of the vitreous body and vitreo-retinal relationships are crucial for a further surgical treatment.     

Prefoveolar Membrane in Macular Hole Opercula Formation

Purpose To better understand the process of macular hole opercula formation by both optical coherence tomography and intraoperative observations.Methods Seventy-nine eyes of 71 consecutive patients with stages 1 to 3 idiopathic macular holes were studied using optical coherence tomography (OCT). In eyes with stage 1 or 2 holes undergoing vitrectomy, meticulous observation of the posterior hyaloid and the macular hole was carried out before and after peeling of the posterior hyaloid.Results In 6 of 12 eyes with stage 1 holes, OCT showed tiny steps on the anterior wall of the foveal cyst, connecting to the detached posterior hyaloid face. In eyes with stage 2 holes, opercula were incompletely detached and connected to the hole edge. In eyes with stage 1 holes that were operated on, a small semitransparent opacity was noted at the posterior hyaloid face after peeling of the posterior hyaloid in the absence of defects of the anterior wall of the cyst. In 10 of 12 eyes with stage 2 holes undergoing vitrectomy, the size of the foveal opening remained unchanged after peeling of the posterior hyaloid, and a semitransparent opacity was observed at the detached hyaloid face. All opercula in stage 3 holes that were clearly imaged by OCT were positioned above the plane of the posterior hyaloid face.Conclusions These findings suggest that the anterior wall of an evolving macular hole is composed of two layers: a prefoveolar membrane and the inner retinal layer. The prefoveolar membrane may play an important role in both persistent vitreofoveal adhesion and macular hole opercula formation. Jpn J Ophthalmol 2004;48:478–485 © Japanese Ophthalmological Society 2004     

黄斑裂孔的光学相干断层成像分析

目的 探讨黄斑裂孔的光学相干断层成像（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征及ＯＣＴ临床应用价值。方法 １９９８年９～１２月临床诊断为黄斑裂孔者共３５例（３８只眼）。经双眼散瞳后进行ＯＣＴ检查,对获取的图像进行分析和测量。结果 １例（１只眼）ＯＣＴ显示为玻璃牵引：１例（１只眼）为黄斑前膜所致的性裂孔：３３例（３６只眼）为黄斑裂孔,其中３例累及双眼。３６只眼中,板层黄     

Macular hole development in fellow eyes of patients with unilateral macular hole

PURPOSE: To determine the incidence of developing an idiopathic full-thickness macular hole in fellow eyes that have vitreofoveal attachments and perifoveal vitreous detachment in patients with unilateral idiopathic macular hole. DESIGN: Retrospective cross-sectional observational study. METHODS: The fellow eyes of 201 patients with full-thickness macular holes were examined by optical coherence tomography (OCT). A subset of 58 fellow eyes with vitreofoveal attachments and perifoveal vitreous detachment was observed during follow-up, and the changes in the vitreofoveal attachment within 24 months from the initial OCT examination were investigated. RESULTS: In the 58 eyes, the vitreofoveal relationship changed in 27 eyes. Among the 27 eyes, three eyes developed a full-thickness macular hole, and the other 24 eyes developed a posterior vitreous detachment only over the fovea or a complete posterior vitreous detachment without macular hole formation. The vitreofoveal relationship did not change in 31 eyes during the 24-month period. CONCLUSION: From an analysis of the changes in the vitreoretinal relationship identified by OCT, three (11%) of 27 fellow eyes in patients with unilateral idiopathic macular hole developed a full-thickness macular hole.     

Stage 3 macular hole: role of optical coherence tomography and of B-scan ultrasonography

PURPOSE: To analyze the various aspects of Stage 3 macular hole with optical coherence tomography (OCT) and B-scan ultrasonography. DESIGN: Observational case series. METHODS: Patients referred for full-thickness macular hole were prospectively screened with OCT and B-scan ultrasonography. OCT examination analyzed the diameter of the hole, the posterior hyaloid, the surrounding retina, and the inconstant presence of a pseudo-operculum. B-scan ultrasonography permitted the distinction between stage 3 and stage 4 holes, based on the detachment of the posterior hyaloid. RESULTS: The study included 62 eyes with stage 3 holes. On OCT, the typical aspect with a hyaloid detached from the macular area was observed in 37% of the eyes (group 3C). In 42% of the eyes (group 3B), a focal adherence was visible at the margin of the hole, as in stage 2 macular hole, but the hole was long-standing, large, and noneccentric. In 21% of the eyes, the hyaloid was not visible anterior to the retina but was still adherent to it (group 3A). In the absence of B-scan ultrasonography, these OCT features could be confused with a stage 4 macular hole. No difference in the size of the hole was observed between subgroups. CONCLUSION: OCT can show various aspects of stage 3 macular holes. B-scan ultrasonography was useful for assessing the location of the posterior hyaloid and to distinguish stage 3 from stage 4 macular holes. These features may provide additional information on the pathogenesis of macular hole and may have therapeutic implications.     

Macular retinoschisis in highly myopic eyes

PURPOSE: To describe the characteristics and evolution of macular retinoschisis in high myopia observed by optical coherence tomography (OCT). DESIGN: A consecutive, retrospective, observational case series. METHODS: Twenty-one highly myopic eyes (mean refractive error, -15.2, range -6 to -25) of 17 patients presenting with the unusual feature of macular thickening without a macular hole and associated with a posterior staphyloma were examined by biomicroscopy and OCT. Ten patients (13 eyes) were followed up for 12 months or more. RESULTS: On biomicroscopy, the macula of all 21 eyes had a microcystic appearance without macular hole. In all eyes, OCT showed that retinal thickening was mainly due to an extensive hyporeflective space splitting the neuroretina into a thick inner layer and a thin outer layer. We called this condition outer retinoschisis. In six cases, inner splitting, termed inner retinoschisis, was also present. The macular profile exhibited a foveal cyst in 10 eyes, a lamellar hole in six, and a foveal detachment in six. In four of the 21 eyes, a hyperreflective preretinal structure resembling the posterior hyaloid was stretched over the retinoschisis, causing foveal traction. Two of these four eyes subsequently evolved into a full-thickness macular hole. CONCLUSION: Macular retinoschisis is not uncommon in highly myopic eyes with staphyloma and is better characterized by OCT than by biomicroscopy. Intraretinal splitting occurs in both the outer and inner layers of the retina, leading to the formation of cystoid spaces. In most cases, the condition is fairly stable in terms of visual acuity and retinal thickness and change occurs slowly over time. However, a macular hole may occur when the retinoschisis is associated with tangential traction of the posterior hyaloid.