间接脉络膜破裂伤患眼光相干断层扫描图像特征

目的 观察间接脉络膜破裂伤患眼的光相干断层扫描（OCT）图像特征。方法 临床确诊为间接脉络膜破裂伤患者15例16只眼纳入研究。其中，男性11例12只眼，女性4例4只眼。年龄19～57岁，平均年龄（37.5±11.6）岁。病程2 d～43年。双眼1例，单眼14例。急性期6例6只眼，愈合期9例10只眼。急性期患者平均病程（7.17±4.62） d，愈合期患者平均病程（7.93±13.64）年。16只眼脉络膜破裂位置均位于后极部，其中累及中心凹区13只眼，多发性破裂4只眼。所有患者均行OCT检查。OCT表现分为Ⅰ、Ⅱ型。Ⅰ型表现为视网膜色素上皮（RPE）脉络膜毛细血管复合体向眼球内隆起；Ⅱ型表现为RPE脉络膜反光带向眼球外凹陷。观察患眼的OCT分型情况，光感受器内外节连接（IS/OS）层、RPE层的反光带完整性以及脉络膜、RPE脉络膜毛细血管复合体的形态。结果 急性期6只眼中，Ⅰ型4只眼，占66.67%；Ⅱ型5只眼，占83.33%。同时具备Ⅰ、Ⅱ型OCT表现3只眼，占50.00%。表现为IS/OS反光带模糊或消失6只眼，占100.00%；表现为RPE反光带中断5只眼，占83.33%；表现为脉络膜局部变薄4只眼，占66.67%。伴发黄斑裂孔2只眼，伴发黄斑区神经上皮脱离2只眼。愈合期10只眼中，Ⅰ型2只眼，占20.00%；Ⅱ型8只眼，占80.00%。表现为IS/OS反光带模糊或消失7只眼，占70.00%；表现为RPE反光带中断1只眼，占10.00%；表现为脉络膜局部变薄7只眼，占70.00%。继发脉络膜新生血管1只眼，伴发黄斑裂孔2只眼，伴发神经上皮层萎缩3只眼。急性期Ⅰ型OCT表现所占比例明显高于愈合期，急性期与愈合期Ⅰ型OCT表现所占比例比较，差异有统计学意义（P=0.001）。急性期RPE反光带中断所占比例明显高于愈合期，急性期与愈合期RPE反光带中断所占比例比较，差异也有统计学意义（P=0.002）。结论 间接脉络膜破裂伤患眼OCT主要表现为RPE脉络膜毛细血管复合体向眼球内隆起或向眼球外凹陷，IS/OS反光带模糊或消失，RPE反光带中断或减弱，脉络膜局部变薄。

Image features of eyes with indirect choroidal rupture on optical coherence tomography

Objective To observe the image features of eyes with indirect choroidal rupture on optical coherence tomography (OCT). Methods Fifteen patients (16 eyes) with indirect choroidal rupture were included in this study. There were 11 males (12 eyes) and 4 females (4 eyes). The mean age was (37.5±11.6) years old with a range from 19 to 57 years old. The disease course was ranged from 2 days to 43 years. One patient had bilateral lesions and 14 patients had unilateral lesions. Six patients (6 eyes) were in the acute stage, and 9 patients (10 eyes) were in the recovery stage. Average course of disease was (7.17±4.62) years in acute stage, and (7.93±13.64) years in recovery stage. Choroidal rupture locations of all the 16 eyes were in the posterior pole. Among them, 13 eyes involved foveal area, and 4 eyes with multiple fractures. OCT was used to measure the integrity of the reflective band on the photoreceptor inner segment/outer segment (IS/OS) junction layer as well as the retinal pigment epithelium (RPE), and the blood capillary complex in choroid and RPE for all patients. According to the literature, OCT reflection bands of the RPE and choriocapillaris complex can bent inward (type Ⅰ) or outward (type Ⅱ) to the center of the eyeballs with choroidal rupture. Results For the 6 eyes in acute stage, 4 eyes were typeⅠ (66.67%) and 5 eyes were typeⅡ (83.33%). Three eyes (50.00%) had both typeⅠand typeⅡ OCT features. All 6 eyes (100.00%) had fuzzy or disappeared IS/OS reflective band, 5 eyes (83.33%) showed interrupted RPE reflection band, 4 eyes (66.67%) showed focal choroidal thinning. Two eyes were accompanied with macular hole and 2 eyes were with neural epithelium separated from the macular area. Among the 10 eyes during the recovery stage, 2 eyes (20.00%) were typeⅠand 8 eyes (80.00%) were type Ⅱ. Seven eyes (70.00%) had fuzzy or disappeared IS/OS reflective band, 1 eye (10.00%) showed interrupted RPE reflection band, 7 eyes (70.00%) showed focal choroidal thinning. One eye had secondary choroidal neovascularization, 2 eyes had macular hole, and 3 eyes had neural epithelium shrinkage. The proportion of typeⅠwas significantly higher in the acute stage than that in the recovery stage, and the difference was significant (P=0.001). The proportion of interrupted RPE reflection band in acute stage was also significantly higher than that of the recovery stage, and the difference was statistically significant (P=0.002). Conclusion Injury eyes with indirect choroidal rupture mainly showed RPE choroid blood capillary complex extruding inward or outward the eyeball, fuzzy or disappeared IS/OS reflective band, RPE reflective band interruption or reduced, and focal choroidal thinning.