中心性浆液性脉络膜视网膜病变OCT浆液性脱离区测量及其与视力的关系

目的 探讨频域相干光断层扫描（SD-OCT）在中心性浆液性脉络膜视网膜病变（CSC）中的应用并对CSC浆液性脱离区各项定量指标的测量结果与患者视力的关系进行分析。设计 回顾性病例系列。研究对象 2010年11月至2011年3月在华中科技大学同济医学院附属同济医院眼科就诊并确诊为CSC的患者34例（37眼）。方法 所有患者均应用Spectralis OCT进行检查，观察视网膜浆液性脱离区形态学特征并根据不同形态进行视力分析，进一步用黄斑地形图分析软件测量黄斑部1、3 、6 mm 9个分区视网膜厚度及体积，测量浆液性脱离区脱离的高度和脱离宽度，采用SPSS17.0软件对OCT检查指标与患者的视力进行相关性分析。主要指标 视网膜浆液性脱离区形态学特征；1、3、6 mm 9个分区视网膜厚度及体积；浆液性脱离区脱离的高度和脱离宽度；患者视力。结果 SD-OCT图像示，所有患眼中出现单纯神经上皮层脱离22眼，单纯视网膜色素上皮层脱离者0眼，视网膜神经上皮层合并色素上皮层脱离者13眼，未见脱离者2眼；患者视力与1 mm视网膜厚度和体积、浆液性脱离区高度、 浆液性脱离区宽度均显著相关（r值分别为-0.406、-0.405、-0.438、-0.389，P均<0.05），与3 mm四个分区的视网膜厚度及鼻侧和颞侧的体积高度相关（与上方、鼻侧、下方、颞侧的厚度，与鼻侧、 颞侧的体积之间的r值分别为-0.481、-0.462、-0.332、-0.358、-0.461、-0.357，P均<0.05），与6 mm鼻侧和上方视网膜厚度及体积有一定的相关性（r分别为 -0.428、-0.466、-0.429、-0.468，P均<0.01），与3 mm的上方、下方体积及6 mm颞侧和下方视网膜厚度及体积相关性不大（P均>0.05）；单纯神经上皮层脱离组(0.50±0.26)与视网膜神经上皮层合并色素上皮层脱离组(0.48±0.15)视力比较无显著差异（P=0.759）。结论 SD-OCT不仅能对CSC患者进行无创伤性的检查、鉴别其视网膜组织形态改变，还可对其病变进行定量的追踪观察辅助疗效评价，对判断患者的视力预后及随访病情变化有一定的指导意义。

The clinical measurments of serous detachment using optical coherence tomography and its relationship with visual acuity in central serous chorioretinopathy

Objective To investigate the clinical applications of spectral domain-optical coherence tomography（SD-OCT） in the central serous chorioretinophthy（CSC） and to analyze the relation between the visual acuity and measurements of the serous detachment of CSC.Design Retrospective case series.Participants Thirty-seven eyes of 34 patients with CSC in Tongji hospital from Nov.2010 to March.2011.Methods All patients were examined with Spectralis OCT.Retinal morphological features were observed.The macular retinal thickness and volume at 1,3,and 6 mm（9 partitions） were measured with macular topographic map analysis software.Then the serous detachment height and detachment width were measured manually.Finally,we use SPSS17.0 software to analyze the correlation of the measurements with the vision.Main Outcome Measures The retinal morphological features,the macular retinal thickness and volume at 1,3,6 mm（9 partitions）,the serous detachment height and detachment width,and visual acuity.Results Images from SD-OCT showed the pure nerve layer detachment in 22 eyes,the nerve layer detachment merged with retinal pigment epithelium detachment（PED） in 13 eyes,and no detachment in 2 eyes;Statistical analysis shows that the correlations between the vision and inspected parameters were different.There were significant correlation between the visions and the retina thickness,the volume at 1 mm,the serous detachment height and the detachment width（r=-0.406,-0.405,-0.438,-0.389,P all0.05）;between the visions and the retina thickness at four partitions,the volume at the nasal,the temporal partition in 3mm（r=-0.481,-0.462,-0.332,-0.358,-0.461,-0.357,P all 0.05）;between the visions and the retina thickness at the nasal,the above partition,and the volume at 6 mm（r=-0.428,-0.466,-0.429,-0.468,P all 0.01）.The volume of the above,the below partition at 3 mm and the thickness and volume of the temporal,the below partition at 6 mm had a little correlation with the visions（P all 0.05）;the vision of pure nerve layer detachment group（0.50±0.26） was not significantly different from that of the nerve layer detachment merged with PED group（0.48±0.15）（P= 0.759）.Conclusion SD-OCT can provide noninvasive inspection to patients with CSC,it can not only identify the change of the retinal tissue but also offer the quantitative tracking observation and assist the effect assessment,which is helpful to follow up condition changes and predict the prognosis.