白内障术前频域相干光断层扫描对黄斑疾病诊断价值的探讨

目的探讨白内障术前频域相干光断层扫描（SD-OCT）对黄斑疾病的诊断价值。方法随机选取2012年1～10月在本院准备行白内障超声乳化联合人工晶状体植入手术患者共418例（418眼），分别采用双目间接检眼镜及海德堡公司生产的Spectralis OCT对所有患者进行术前黄斑区视网膜检查，判断黄斑疾病。术后1～2d再行检眼镜及OCT检查随访，阳性病例及疑似病例于术后1周进行荧光素眼底血管造影（FFA）或吲哚青绿血管造影（ICGA）检查。对比检眼镜与OCT2种检查方法在白内障术前对黄斑疾病的检出率。结果术后最终确诊为黄斑疾病42例。白内障术前，289例成功获取OCT图像，占总数69．14％，其中36例显示有不同类型的黄斑疾病，检出率为85．71％；206例通过双目间接检眼镜可查见眼底，其中14例显示有黄斑病变，检出率为33．33％。2种方法在白内障术前对黄斑疾病检出率差异有统计学意义（P〈0．01）。结论与传统的双目间接检眼镜相比，SD-OCT可以大大提高白内障术前黄斑疾病的检出率，有利于对白内障术后预后效果的判断。SD．OCT在白内障术前对黄斑疾病的诊断具有较高的临床价值，可广泛应用于白内障术前检杏。

Discussion about spectral domain optical coherence tomography before cataract surgery in the diagnosis of macular diseases

Objective To explore the clinical value of spectral-domain optical coherence tomography （SD-OCT） examination before cataract surgery in the diagnosis of macular diseases. Methods A total of 418 cases of cataract patients（418 eyes） who underwent phacoemulsification and intraocular lens implantation surgery in our hospital from January to October in 2012 were chosen randomly. All patients with cataract underwent preoperative macular examination by using binocular indirect ophthalmoscope and Heidelberg Spectralis OCT. One to two days after the operation, ophthalmoscope and OCT examination were conducted again. For positive cases and suspected cases, fluorescein fundus angiography （FFA） or indocyanine green angiography （ICGA） examination was performed after 1 week. The detection rate of macular disease of the two methods before cataract surgery were analyzed. Results In 418 cases of patients, 42 cases were diagnosed as macular diseases eventually. Before cataract surgery, a total of 289 cases successfully obtained OCT images,accounting for 69.14% of the total patients. Of all preoperative cataract patients,36 cases presented with different types of macular diseases, with the detection rate of 85.71%. A total of 206 cases of fundus could be seen by binocular indirect ophthalmoscope, among which 14 positive cases were observed. The detection rate was 33.33%. The detection rate of macular diseases between the two methods were statistically different （P 〈 0.01 ）. Conclusions Compared to the traditional binocular indirect ophthalmoscope, SD-OCT can greatly increase the detection rate of macular diseases in pre-cataract patients, which is important in the comprehensive prognosis evaluations. SD-OCT can be widely used in examination of macular diseases before cataract surgery. （Chin J Ophthalmol and Otorhinolaryngol ,2014 ,14 ：96- 99）