黄斑视网膜前膜光学相干断层扫描观察及与其他检查的对比  

Comparative study of optical coherence tomography and other examinations in patients with macular pucker

作　　者：王欣[1] 张惠蓉[1] 刘峰[1] 李爱军[1] 鹿欣荣[1] 

机构地区：[1]北京大学第三医院；北京大学眼科中心,北京100083

出　　处：《中国实用眼科杂志》2007年第5期471-474,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的应用光学相干断层扫描（Optical Coherence Tomography,OCT）观察黄斑视网膜前膜的形态。方法应用光学相干断层扫描仪观察黄斑视网膜前膜的形态150例。海德堡视网膜断层扫描仪（Heidelberg Retina Tomography,HRT-Ⅱ）黄斑模块检查30例,部分眼作了荧光造影,部分眼做了玻璃体切除术和视网膜前膜剥离术,术前术后均做了OCT检查观察手术效果。同时用OCT测量前膜厚度及黄斑中心凹的厚度。结果1.150例中男性56例,女性94例.年龄27～85岁,平均（65.76±9.46）岁。右眼65例,左眼85例。视网膜前膜的形态有以下几种：①黄斑部视网膜增厚,表面有膜形成,牵拉视网膜形成皱褶。视网膜内形成大小不同的液腔。②视网膜表面可清晰看见膜的反射面,有的局限增厚呈块状突起于视网膜表面,视网膜受牵拉弥漫增厚。视网膜内囊腔形成。③黄斑中心凹形成假孔或板层孔,孔的边缘锐利,孔的底部尚有部分神经组织残留或孔的表面被膜掩盖。④因膜的牵拉视网膜内形成大的解离腔。⑤视网膜厚度没有明显变化,仅见视网膜表面不平呈锯齿样改变,中心凹曲线变平。2.150例检查了视网膜前膜的厚度,最厚的膜为269μm,最薄的膜为46μm。平均膜厚度为（84.40±41.42）μm。3.前膜黄斑中心增厚,150例检查了黄斑中心厚度,中心厚度范围为107～780μm。平均（341.08±137.15）μm。正常黄斑中心厚度为（155±28.21）μm。结论光学相干断层扫描技术是非侵入性,安全,可靠,是精确测量前膜厚度的一种好方法.可用来鉴别黄斑裂孔和假孔及黄斑水肿。作为术前预测手术效果和观察术后黄斑组织恢复情况的手段。通过OCT及HRT-Ⅱ对视网膜前膜的对比观察,发挥各自的优势,提高早期前膜的检出率。Objective To observe the morphological changes of macular pucker with the use of optical coherence tomography （OCT） and other examinations. Methods 150 eyes of 150 consecutive patients with clinical diagnosis of macular pucker were examined with OCT. In these patients, 30 cases were examined by HRT-II macular model, some were performed fundus fluorescein angiography （FFA）, some underwent vitrectomy and membrane peeling. OCT examination was performed for assessing surgery effects and measuring thickness of the membranes and macular fovea pre- and postoperatively. Results 1 ,There were five types of images in macular pucker： ①Macular retina thickened, membranes appeared on the surface of retina, wrinkles and intraretinal fluid presented for vitreomacular traction. ② Reflection interface was seen obviously, local retina thickened and some extruded from the retina, then the retinas were thickening diffusely, the foveal cyst formed. ③ Macular pseudohole or laminar macular hole formed, with sharpened rims, and with some neural tissue remained in the bottom or the membranes on the surface of the holes. ④Gross intraretinal cyst formed because of the traction of the macular pucker. ⑤ There were no changes about the retinal thickness, only jagged retinal surface and flattened foveal curve could be seen. 2. The thickness of 150 membranes waved from 46Bin to 269Bm, averaged （84.40 ± 41.42）μm. 3. The 150 foveal thickness increased, waving from 107μm to 780μm （averaged 341.08 ± 137.15Bin）. The reference value of nomal foveal thickness is （155 ± 28.21）Bin. Conclusions OCT is not only a useful, safe and not aggressive tool for measuring membrane thickness and identifying macular pseudohole, macular hole and macular edema, but also an unusual case of predicting surgery effects before surgery and following a favorable course after surgical management. Simultaneously, by the comparasion and combination of OCT and HRT-II, we can detected macular pucker more early and exactly.

关 键 词：黄斑前膜 光学相干断层扫描 

分 类 号：R774.5[医药卫生—眼科]