视网膜断层扫描检查黄斑水肿的临床意义  

Clinical investigation of the Heidelberg retina tomograph Ⅱ in assessment of macular edema

作　　者：周丹[1] 魏文斌[1] 刘妍[1] 田蓓[1] 汪东生[1] 赵明[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心,100730

出　　处：《中华眼科杂志》2008年第10期892-898,共7页Chinese Journal of Ophthalmology

摘　　要：目的评价海德堡视网膜断层扫描仪（HRTⅡ）的视网膜软件模块（HRTⅡ-RM）检测黄斑水肿的临床意义。方法比较性临床研究。对2005年10月至2006年1月间就诊的65例（126只眼）视网膜静脉阻塞和非增生期糖尿病视网膜病变患者，依据其荧光素眼底血管造影（FFA）结果，分为黄斑水肿组和无黄斑水肿组。采用HRTⅡ检查黄斑水肿眼的病变形态特征及视网膜中心部和外环部水肿指数（e值）变化，分别记录为e1和e2。将入选眼e值与视网膜神经上皮层厚度、最佳矫正视力、多焦视网膜电图一阶反应的N1波和P1波的潜伏期和振幅密度进行相关性分析。结果HRT Ⅱ-RM扫描可分辨出不同类型的黄斑水肿，包括囊样、局部及弥漫水肿。有无黄斑水肿组间e值差异有统计学意义（e1：t=-19．238，e2：t=-12．436；均P〈0．01）。e1和e2诊断黄斑水肿的最佳临界值分别为1．475和1．411，敏感性为92．9％和91．8％，特异性为97．6％和95．1％。视网膜厚度值与e值有相关性（e1：r=0．816，e2：r=0．587；均P〈0．01）；最佳矫正视力与e值有相关性（视网膜中心部r=-0．658，视网膜外环部r=-0．640；均P〈0．01）；多焦视网膜电图N1波潜伏期与e值有相关性（视网膜中心部r=0．266，视网膜外环部r=0．312；均P〈0．01）；N，波振幅密度与e值有相关性（视网膜中心部r=-0．609，视网膜外环部r=-0．586；均P〈0．01）；P．波潜伏期与e值有相关性（视网膜中心部r=0．529，视网膜外环部r=0．431；均P〈0．01）；P，波振幅密度与e值有相关性（视网膜中心部r=-0．783，视网膜外环部r=-0．714；均P〈0．01）。结论应用HRTⅡ-RM检测黄斑水肿患者，不仅能反映病变局部形态学改变特征，而且可显示其定量指标e值的变化，这均与视网膜的功能变化有关，可应用于临床检测黄斑水肿患者。Objective To evaluate the significance of detecting macular edema by the Retina Module of the Heidelberg retina tomograph Ⅱ （ HRT Ⅱ ）. Methods Comparative clinical study, One hundred and twenty-six eyes were divided into two groups according to FFA results, one with macular edema and the other without macular edema. Morphological changes in macular edema were observed by HRT Ⅱ and e （ edema index） in two areas of each eye were determined. E value in these two groups and the correlation of e with retinal thiekness, BCVA, amplitude and latency of N1 and P1 by multifocal electroretinogram were analyzed. Results HRT Ⅱ -RM scan could distinguish different kinds of macular edema （ cystoid, local and diffused ） and the difference of e between these two groups was significant （ e1 ： t = - 19. 238, e2 ： t = -12.436;P〈0.01）. The best critical value of e was 1.475 and 1.411 （e1 = 1.475,e2 = 1.411）. The sensitivity of e was 92. 9% and 91.8% （ e1 = 92. 9%, e2 = 91.8% ）. The specificity of e was 97. 6% and 95.1% （e1 =97.6% ,e2 =95. 1% ）. The correlation coefficient between e and retinal thickness was 0. 816 and0.587 （ e1 ：r =O. 816,e2：r =0. 587 ;P 〈0. 01） ; was -0. 658 and-0.640 （e1：r= -0.658,e2：r= -0. 640;P 〈0. 01） between e and BCVA;was 0. 266 and 0. 312 （e1 ：r =0. 266,e2：r =0. 312;P 〈0. 01 ） between e and latency of N1 ; was - 0. 609 and - 0. 586 （ e1 ： r = - 0. 609, e2 ： r = - 0. 586 ; P 〈 0. 01 ） between e and amplitude of N1 ;was 0. 529 and 0. 431 （ e1 ：r = 0. 529, e2：r = 0. 431 ; P 〈 0.01 ） between e and latency of P1 and was - 0. 783 and - 0. 714 （ e1 ： r = - 0. 783, e2 ： r = - 0. 714 ; P 〈 0. 01 ） between e and amplitude of P1, respectively. Conclusions There are characteristic changes in the appearance of macular edema as examined by HRT 11 -RM. The quantitative index e value also shows remarkable changes. HRT Ⅱ -RM not only detects morphological changes, but also relates to functional changes. This method is capab

关 键 词：视网膜 体层摄影术 黄斑水肿 囊样 

分 类 号：R686[医药卫生—骨科学]