特发性黄斑裂孔患者玻璃体后脱离的相干光断层成像特征

目的 观察特发性黄斑裂孔患者玻璃体后脱离的相干光断层成像（optical coherence tomography,OCT)特征,探讨裂孔的发生与玻璃体后脱离间的关系。方法 对临床确诊的特发性黄斑裂孔患者193例（223只眼）进行OCT检查,分析其玻璃体后脱离的发生及发展。结果 按Gass分期标准,I-Ⅳ期裂孔分别为21,74,97有31只眼,在Ⅰ,Ⅱ,Ⅲ期裂孔眼中,OCT图像显示玻璃体与视网膜分离者分别有15（71．4％）,38（51．4％）及46只眼（47．4％）。其表现形式有3种：（1）黄斑中心凹周围视网膜与玻璃体发生分离,但中心凹部相连,此处视网膜神经上皮层被牵起,层间出现囊腔;（2）玻璃体附着于未完全游离的视网膜裂孔盖处,使盖膜牵引上翘;（3）玻璃体完全与后极部视网膜分离,表现可见与其平行的玻璃体后介膜。这3种表现形式分别于Ⅰ,Ⅱ,Ⅲ期裂孔。在随诊的部分患眼中,OCT图像显示出I期进展至Ⅲ期裂孔的过程,并见玻璃体后脱离的裂孔自行愈合现象。在组合的OCT图像中,显示黄斑中心凹部与视乳头和颞侧视网膜之间脱离的玻璃体事 于现凹隆圆顶盖样图形。结论 OCT检测结果证实玻璃体与黄斑中心凹发生分离的过程与黄斑裂孔进展的过程相一致,提示黄斑裂孔的形成及发展与玻璃体后脱离的发生密切相关。

The observation on detachment of posterior hyaloid membrane in idiopathic macular holes by optical coherence tomography

OBJECTIVE: To investigate the relationship of the detachment of posterior hyaloid membrane and idiopathic macular hole by optical coherence tomography (OCT). METHODS: Fundus examination after dilatation of pupil and OCT were performed on 223 eyes of 193 patients with idiopathic macular hole. All macular holes were graded according to the classification proposed by Gass. RESULTS: According to Gass classification, there were 21 eyes of stage I macular hole, 74 eyes of stage II, 97 eyes of stage III and 31 eyes of stage IV. OCT showed the detachment of posterior hyaloid membrane in 15 eyes (71.4%) in stage I, 38 eyes (51.4%) in stage II and 46 eyes (47.4%) in stage III. There were three kinds of imaging characteristics: (1) Perifoveal detachment of posterior hyaloid membrane (hyporeflective band) with a cyst (hyporeflective cavity) in the center of fovea and the elevating or flattening of fovea by the traction of posterior hyaloid. (2) The posterior hyaloid (hyporeflective band) adhered to the partially detached operculum (hyporeflective band) that was pulled forward. (3) The complete detachment of posterior hyaloid from the retina was seen. In some cases, the OCT image showed the development of macular hole from stage I to stage III. A scan along the papillomacular axis showed that the posterior vitreous detachment was dome shaped with the adhesion to fovea and disc. CONCLUSIONS: The occurrence of posterior hyaloid detachment at the fovea is in accordance with the formation of macular hole.