特发性黄斑前膜在频域相干光断层扫描下的临床观察

目的观察特发性黄斑前膜的频域相干光断层扫描（OCT）特征以及与患者视力的相互关系。方法收集2010年10月至2013年6月在我院门诊确诊的特发性黄斑前膜患者的临床资料,共182例（212只眼）,年龄35~88岁,平均（66.08±9.25）岁,所有患者均进行最佳矫正视力、眼底和OCT检查。根据OCT检查所见对黄斑前膜进行分类,分析中心凹形态及黄斑部视网膜神经上皮层体积与视力的关系,采用SPSS13.0软件对患者的各项OCT检查结果进行统计学分析。结果 （1）特发性黄斑前膜的OCT图像特征表现为视网膜神经上皮层表面厚薄不一的高反光带,部分与视网膜内表面完全紧密粘连或分离。黄斑前膜的中心凹形态改变有5种表现,中心凹正常型33只眼（15.7%）,伴有板层裂孔17只眼（8.0%）,伴有假性黄斑裂孔16只眼（7.5%）,伴有弥漫水肿121只眼（57.0%）,伴有囊样水肿25只眼（11.8%）。（2）中心凹正常组与其它中心凹形态组的视网膜神经上皮层体积比较,差异有统计学意义（P〈0.05）。（3）黄斑部视网膜神经上皮层体积与视力呈负相关（r=0.029,P〈0.01）。结论黄斑前膜患者视力与黄斑部视网膜神经上皮层体积具有负相关性,0CT作为黄斑前膜可靠的诊断方法,在临床上可以减少漏诊,并可以为手术提供更详细的信息。

Observations of idiopathic epiretinal membrane by spectral domain optical coherence tomography

Objective To observe morphological changes in macular idiopathic epiretinal membrane（ IERM） using Fourier-domain optical coherence tomography（ FD-OCT）,and to correlate those morphological changes to patients＇ best corrected visual acuity（ BCVA）. Methods Records of 182 IMEM patients（ 212 eyes） who were diagnosed in our hospital between October 2010 and June 2013 were reviewed. Results of fundus examination,macular OCT scan,and visual acuity were collected. Foveal morphology and macular volume were correlated to visual acuity. Results Macular epiretinal membrane was visible on OCT images as a high reflective band with varied thickness. The IERM may partially connect to or separate from the inner surface of the retina. Foveal morphological changes can be categorized into 5 types,namely,laminar macular holes（ LMH）,macular pseudoholes（ MPH）,cystoid macular edema（ CME）,diffuse macular edema（ DME）,and normal according to the findings of OCT. LMH were found in 17 eyes（8.0%）,MPH in 16 eyes（7.5%）,CME in 25 eyes（ 11. 8%）,DME in 121 eyes（ 57. 0%）,and normal in 33 eyes（ 15. 7%）. The macular volume was9. 56 ± 1. 84 mm3,and there was a significant difference between normal and all other patients. Negative correlation between BCVA and macular volume（ r = 0. 029,P〈 0. 01） was noted. Conclusion OCT is a reliable method to diagnose ERM. It can reduce the risk of missed diagnose and provide more detailed information before surgery.