视网膜中央动脉阻塞的光相干断层扫描 病理形态学改变

目的观察视网膜中央动脉阻塞（CRAO）的光相干断层扫描（OCT）病理形态学改变特征。方法通过检眼镜、荧光素眼底血管造影(FFA)检查确诊的CRAO患者53例（53只眼）进行OCT检查，所有患者发病2周内。OCT检查采用水平或垂直线性扫描，扫描部位为黄斑区、后极部视网膜、视盘及出血、渗出等相应病灶部位。结果CRAO的OCT活体病理改变的图像特征包括黄斑区及后极部全层视网膜厚度增加、反射增强，光感受器暗区增宽（水肿）；黄斑中心凹水肿或囊样水肿；后极部视网膜出血及棉絮斑可有不同的OCT表现；视盘边缘隆起，呈水肿改变；其中4例患者伴有睫状视网膜动脉，在睫状视网视膜动脉供应区视网膜结构正常。结论OCT可以无创伤地在活体上观察CRAO的视网膜组织病理改变，特别适用于不允许进行FFA检查的高龄或合并全身病的CRAO患者，其独特的OCT图像病理改变可以为临床即时诊断提供客观依据。(中华眼底病杂志,2005,21:74-78)

The pathological changes of central retinal artery occlusion with Optical coherence tomography

Objective To observe the pathological changes of central retinal artery occlusion (CRAO) by optical coherence tomography (OCT). Methods Fifty-three eyes of 53 patients who were diagnosed as CRAO in our center between January 2001 to January 2004 underwent the examination by OCT. The intervals between the disease onset and OCT examination were less than 2 weeks. The scan modes of OCT were horizontal or vertical line scan. The locations of scanning were macular, posterior pole of retina, optical papilla and the focus of bleeding or exudation. Results The OCT pathological changes of CRAO in vivo includes increase of retinal thickness and reflex of retina, width of dark layer of photoreceptor (edema), edema or cystoid edema of fovea, retinal bleeding, cotton-wool spot and papilla edema. Four patients who had ciliary retinal artery showed normal retinal structure in the supply region of ciliary retinal artery. Conclusion OCT can display the pathological changes of retinal tissues in CRAO in vivo, especially on the old patients or the patients with systemic disease who were contraindicated by FFA. The unique OCT image of pathological changes of CRAO supply the objective signs for the instant clinical diagnosis.