恶性高血压性视网膜病变的光学相干断层扫描观察

目的　评价使用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）对恶性高血压性视网膜病变疗效观察的有效性。方法　对２６例（３１眼）恶性高血压性视网膜病变患者的资料进行回顾性分析，对比分析治疗前及治疗后１５ｄ、１个月、３个月时的视力、视盘周围视网膜神经纤维层厚度、黄斑区视网膜神经上皮层厚度和黄斑区６ｍｍ直径神经上皮总体容积的变化。结果　与治疗前相比，治疗后１５ｄ视力提高者２２眼，治疗后１个月为２６眼，治疗后３个月为２９眼。患者视盘周围视网膜神经纤维层厚度及黄斑区视网膜神经上皮层厚度治疗前为（３９３．２０±１８．０５）μｍ和（４８６．５８±６９．００）μｍ，治疗后１５ｄ、１个月、３个月分别为（３６３．２０±２６．８０）μｍ和（３９２．１３±３０．６５）μｍ、（３４２．７５±２５．８２）μｍ和（３１５．０３±２２．３３）μｍ、（３０５．６４±２３．３８）μｍ和（２１３．８７±２５．６８）μｍ；黄斑区６ｍｍ直径神经上皮总体容积治疗前为（１７．０４±３．３１）ｍｍ３，治疗后１５ｄ、１个月、３个月分别为（１１．０７±２．０２）ｍｍ３、（９．３６±０．９３）ｍｍ３、（８．４２±０．７５）ｍｍ３；各指标与治疗前比较差异均具有统计学意义（均为Ｐ＜０．０５），治疗后各时间点间两两比较差异亦均有统计学意义（均为Ｐ＜０．０５）。结论　恶性高血压性视网膜病变的视盘周围视网膜神经纤维层厚度、黄斑区视网膜神经上皮层厚度和黄斑区６ｍｍ直径神经上皮总体容积变化与其病变程度相关，ＯＣＴ对恶性高血压性视网膜病变疗效评价具有重要意义，能够为病情的追踪和指导用药提供客观依据。

Observation of optical coherence tomography in malignant hypertensive retinopathy

Objective To observe the clinical effects of malignant hypertensive retinopathy with optical coherence tomography ( OCT) . Methods Twenty-six patients (31 eyes) with malignant hypertensive retinopathy were retrospectively analyzed. The visual acuity,retinal nerve fiber layer thickness around the optic disc, macular retinal neuroepithelial layer thickness and total volume of macular neuroepithelium with diameter of 3 mm were examined by OCT before and 15 days,l month,3 months after treatment. Results Compared with that before treatment , the visual acuity after treatment was improved in 22 eyes,26 eyes and 29 eyes at 15 days,l month and 3 months after treatment,respectively. The retinal nerve fiber layer thickness around the optic disc and macular retinal neuroepithelial layer thickness before treatment were ( 393 . 20 + 18. 05 ) Vm and (486. 58 +69. 00) Vm, respectively, which at 15 days after treatment were ( 363. 20 + 26. 80 ) ym and ( 392. 13 + 30. 65 ) ym , respectively , which at 3 months after treatment were ( 342. 75 + 25. 82) ym and ( 315. 03 + 22. 33) ym ,respectively , which at 6 months after treatment were ( 305. 64 +23. 38 ) ym and ( 213. 87 + 25 . 68 ) ym , respectively. The total volume of macular neuroepithelium before treatment was ( 17. 04 + 3. 31) mm3 . which at 15 days ,1 month and 3 months after treatment were ( 11. 07 + 2. 02) mm3 . (9. 36 + 0. 93) mm3 . ( 8 . 42 + 0. 75 ) mm3 , respectively. There were statistical differences in above all indexes before and after treatment ( all P < 0. 05 ) . and there were statistical differences in above all indexes between each two time points after treatment ( all P < 0. 05 ) . Conclusion The changes of retinal nerve fiber layer thickness around the optic disc ,macular retinal neuroepithelial layer thickness and total volume of macular neuroepithelium are associated with the severity of malignant hypertensive retinopathy. OCT is helpful to evaluate the clinical effects of malignant hypertensive retinopathy , provides the objective basis for tracking the disease and guiding therapy.