激光笔所致黄斑光损伤的OCT图像特征

目的描述激光笔所致黄斑光损伤患者黄斑区光学相干断层扫描（OCT）图像特征。方法回顾性研究。收集2014年4月至2016年3月在温州医科大学附属眼视光医院眼底内科就诊的激光笔照射后引起黄斑光损伤的患者共13例（16眼），其中男11例，女2例，年龄8～25岁。初诊和随访时对这些患者进行OCT黄斑扫描检查并分析。结果绿色激光笔5例，红色激光笔3例，其余5例不详。照射时间多在2 s内，病程2 d～10个月，其中，8例病程小于1周。视力0.08～1.0。5例患者首诊后失访，其余8例患者随访时间为5 d～9个月。1例诊断为光损伤性黄斑区视网膜前出血，其OCT表现为中心凹处内界膜下高反射团块。1例诊断为黄斑光损伤性脉络膜新生血管（CNV），其OCT表现为中心凹下视网膜色素上皮层隆起，其下呈高反射，伴有神经上皮层脱离。其余11例OCT图像特征为黄斑中心凹处肌样体带、椭圆体带、嵌合体带断裂，外界膜连续，断裂处可见高反射颗粒或团块，可伴有或不伴有外核层反射增强、神经上皮层浅脱离；随访OCT图像特征为黄斑中心凹处肌样体带、椭圆体带、嵌合体带断裂持续存在，且断裂范围较前一致，外界膜连续，断裂处高反射颗粒或团块逐渐减小或消失，外核层反射正常，神经上皮脱离恢复。8例患者初诊和末次就诊时视力无变化。结论激光笔照射会导致黄斑光损伤，除了可引起黄斑出血和CNV以外，大部分黄斑光损伤OCT有特征性改变，黄斑中心凹处肌样体带、椭圆体带、嵌合体带不可逆性断裂，但不会累及外界膜。

Optical coherence tomography characteristics of macular injury from laser spot irradiation

Objective To describe the characteristics of optical coherence tomography (OCT) in patients with macular injury from laser spot irradiation.Methods This was a retrospective study.A total of 16 eyes of 13 patients (11 males and 2 females) were included in the study.Patients were 8-25 years old.Heidelberg OCT was performed on patients who had sustained macular injury because of laser spot surgery irradiation from April 2014 to March 2016 at the Eye Hospital of Wenzhou Medical University.The first visit and follow-up visits took place at the Eye Hospital.Results Five patients were spot irradiated by green laser,3 patients were spot irradiated by red laser,and the injury to the other 5 patients was unknown.Irradiating time was almost 2 seconds with a follow-up duration from 2 days to 10 months but most irradiation occurred within the span of one week.Visual acuity was 0.08-1.0.Five patients dropped out,and the other 8 patients were followed-up for 5 days to 10 months.One eye was diagnosed with preretinal hemorrhage in the macula,and the OCT of this patient showed a highly reflective mass under the inner limiting membrane of the fovea.One eye was diagnosed with choroidal neovascularization (CNV),and the OCT of this patient showed a high reflection under the uplift of the retinal pigment epithelium (RPE) with neuroepithelium detachment.The other 11 patients were in an early stage of laser spot irradiation injury to the macula.The OCT images of the myoid zone,ellipsoid zone and interdigitation zone of the fovea showed disruptions but the external limiting membrane was good.In the zone of disruptions,highly reflective granules were visible,accompanied or not accompanied by an enhancement of the outer nuclear layer reflection and neuroepithelial detachment.In the late stage,the disruptions in the myoid,ellipsoid and interdigitation zones of the fovea were still evident and the external limiting membrane remained normal.The highly reflective granules had gradually decreased or disappeared,the reflection of the outer nuclear layer was normal,and the neuroepithelial detachment had recovered.No patient had a change in visual acuity between the first and last follow-up visits.Conclusion Laser spot irradiation can lead to macular injury,hemorrhage and CNV in the macula.The OCT images of almost all of the patients showed irreversible disruptions to the myoid,ellipsoid and interdigitation zones of the fovea,a permanent decrease in vision,and a normal external limiting membrane.