视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构改变与视力的相关性分析

目的　观察视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构的光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）特征，探讨黄斑区微结构的改变与视力的关系。方法　采用ＯＣＴ对４６例（４６眼）视网膜静脉阻塞合并黄斑水肿患者进行黄斑区微结构检查，分析黄斑水肿形态，对不同形态黄斑水肿的患者进行比较，以患眼作为黄斑水肿组，对侧眼作为对照组，分析黄斑区微结构各参数与视力的相关性。结果　ＯＣＴ扫描结果显示４６眼视网膜静脉阻塞合并黄斑水肿的患者黄斑区微结构表现为３种形态，１２眼为黄斑囊样水肿，１０眼为浆液性神经上皮层脱离，２４眼为混合型水肿即黄斑囊样水肿伴浆液性神经上皮层脱离。对照组黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积分别为（１８０．８１±１３．３５）μｍ、（２３８．７２±１６．７５）μｍ及（０．１７±０．０３）ｍｍ３，而黄斑水肿组分别为（５４１．２６±１２５．６８）μｍ、（４７３．６１±１３３．４２）μｍ及（０．３８±０．１４）ｍｍ３，两组比较差异均有统计学意义（均为Ｐ＝０．０００）。根据患者黄斑区微结构形态表现分组研究发现，浆液性神经上皮层脱离患者ＢＣＶＡ最好，为（０．５３±０．０９）ＬｏｇＭＡＲ，其次为黄斑囊样水肿患者（０．６４±０．１６）ＬｏｇＭＡＲ，而混合型患者最差（１．０２±０．２４）ＬｏｇＭＡＲ，３组之间差异有统计学意义（Ｐ＝０．００８）。浆液性神经上皮层脱离患者中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积最小，其次为黄斑囊样水肿患者，而混合型患者３个指标均最大，３组之间差异均有统计学意义（均为Ｐ＝０．０００）。对黄斑部微结构的改变与ＢＣＶＡ进行相关性分析发现:黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜容积、ＩＳ／ＯＳ断裂长度及外界膜断裂长度与ＢＣＶＡ（ＬｏｇＭＡＲ）均呈正相关（ｒ＝０．５４６，Ｐ＝０．０００；ｒ＝０．５８２，Ｐ＝０．０００；ｒ＝０．５２３，Ｐ＝０．０００；ｒ＝０．８３４，Ｐ＝０．０００；ｒ＝０．７５８，Ｐ＝０．０００）。黄斑水肿形态与ＢＣＶＡ呈正相关（ｒ＝０．６４１，Ｐ＝０．０００），单纯的浆液性神经上皮层脱离患者ＢＣＶＡ最好，混合型的患者病变最重，ＢＣＶＡ也最差。结论　视网膜静脉阻塞所致的黄斑水肿表现形态不同，ＯＣＴ可以对黄斑部微结构改变进行定量分析，黄斑区形态改变与视力密切相关。

Macular microstructure changes in retinal vein occlusion and its correlation with visual acuity

Objective To observes the macular microstructure characteristics and qualitative analysis on macular edema in retinal vein occlusion ( RVO) by optical coherence tomography ( OCT) , and explore the relationship between macular microstructure changes and visual acuity. Methods Forty-six eyes of 46 patients with macular edema induced by RVO were analyzed. Macular microstructures were recorded and the manifestations of macular edema were analyzed by OCT. The comparison was taken by different macular edema marufestation to investigate the relationship between macular microstructure parameters and visual acuity. The affected eyes were set as macular edema group , and the contralateral eyes were set as the control group. Results The 46 eyes of 46 patients with macular edema induced by RVO were divided into three types by macular morphological manifestation: 10 eyes ( 21. 7% ) with serous macular detachment , 12 eyes ( 26. 1% ) with cystoid macular edema . and 24 eyes with mixed edema. The central foveal thickness, average thickness of subfoveal I millimeter diameter and average cube volume in the contrl group were ( 180. 81 + 13. 35 ) ym, ( 238. 72 + 16. 75 ) Vm and ( 0. 17 + 0. 03 ) mm3 , respectively , which in the macular edema group were ( 541. 26 + 125. 68) ym , ( 473. 61 + 133. 42 ) ym and ( 0. 38 + 0. 14 ) mm3 , respectively , there were statistical differences between two groups ( all P = 0. 000) . The best corrected visual acuity in patients with serous epithelial detachment, cystoid macular edema and mixed edema were ( 0. 53 + 0. 09 ) LogMAR , ( 0. 64 + 0. 16) LogMAR and ( 1. 02 + 0. 24 ) LogMAR , respectively , there was statistical difference ( P = 0. 008 ) . By comparsion between different type of macular edema . BCVA. central foveal thickness , average thickness of subfoveal I millimeter diameter , average cube volume in serous macular detachment group were nunimum .the next was cystoid macular edema group , the nuxed group was maximum. the difference of these three groups was statistical significant( all P = 0. 000 ) . Central foveal thickness , average thickness of subfoveal I millimeter diameter , average cube volume . inner segment/outer segment ( IS/OS ) and external limiting membrance were positive related to BCVA ( r = 0. 546 ,P = 0. 000 ;r = 0. 582 ,P = 0. 000 ;r = 0. 523 .P = 0. 000 ;r = 0. 834 .P = 0. 000 ;r = 0. 758 .P = 0. 000 ) . Macular morphological manifestation was also positive related to BCVA ( r = 0. 641 .P = 0. 000 ) . Conclusion Macular edema by RVO show different morphological marufestation , OCT can qualitative analyze macular microstructures . and some changes are related to visual acuity.