频域光学相干断层扫描对中心性浆液性脉络膜视网膜病变的RPE-Bruch膜-脉络膜毛细血管复合体的观察  

Use of spectral-domain optical coherence tomography to observe the RPE-Bruch＇s membrane-choriocapillaris complex in central serous chorioretinopathy

作　　者：贾晓林[1] 孙祖华[1] 林冰[1] 刘逾[1] 刘晓玲[1] 

机构地区：[1]温州医学院附属眼视光医院,浙江温州325027

出　　处：《中华眼视光学与视觉科学杂志》2011年第3期165-168,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金资助项目（30470563）

摘　　要：目的使用频域光学相干断层扫描（Spectralis OCT）观察中心性浆液性脉络膜视网膜病变（CSC）患者视网膜色素上皮（RPE）-Bruch膜．脉络膜毛细血管复合体的影像学特征。方法非干预性、观察性研究。确诊为CSC的连续病例109例（111眼），其中男89例（91眼），女20例（20眼）。所有患者均接受了视力、眼压、裂隙灯显微镜、前置镜、眼底彩照、Spectralis OCT、荧光素眼底血管造影（FFA）检查，部分患者同时行吲哚青绿血管造影检查。在Spectralis OCT的图像上，仔细观察患眼黄斑区视网膜最外层的Bruch膜（BM）高反射带。根据BM反射带是否显现将其分为不可分辨型BM和可分辨型BM两组。可分辨型BM又分为显型BM和隐型BM两型。视网膜色素上皮脱离（PED）分型与BM分型相对应，分为不可分辨型PED、可分辨型PED及显型PED、隐型PED。对分型结果进行计数．求百分比。结果111只患眼的RPE．BM．脉络膜毛细血管复合体的反射带上，100％为可分辨型BM。不同患眼BM的可见程度及范围有一定的差异：BM反射带清晰可见的（显型）99眼（89．8％），不清楚但与正常视网膜区域对比仍然可分辨出BM的（隐型）12眼（10．2％）。CSC慢性期病例的BM的显现较急性期更为广泛，并伴有不同程度的RPE、脉络膜毛细血管层的萎缩。OCT对FFA检查中渗漏点的跟踪扫描显示．所有FFA中标记的渗漏点处在OCT中均可见BM的显现。结论Spectralis OCT图像上,视网膜最外层的高反射外带是由RPE中具有大量皱褶的基底膜、BM和脉络膜毛细血管复合体共同构成，正常的BM不能从复合体的高反射带中分辨出来。CSC患眼中，BM普遍可见．提示RPE与BM相互分离，同时也存在BM与脉络膜毛细血管间的侈开，这将成为CSC影像学乃至病理学的新发现．Objective To investigate the imaging features of the retinal pigment epithelium （RPE）-Bruch＇s membrane （BM）-ehoriocapillaris complex in central serous chorioretinopathy （CSC） with spectral-domain optical coherence tomography （Spectralis OCT）. Methods This was a noninterventional, observational study. One hundred and eleven eyes of 109 consecutive patients （male 89, female 20） diagnosed with CSC were included. All the patients underwent a full ophthalmologic examination, including the visual acuity, slit-lamp microscope, pre-set lens, fundus photography, Spectralis OCT and fundus fluorescein angiography （FFA）. Indocyanine green angiography （ICGA） was performed on some patients. The RPE-BM-choriocapillaris complex, which manifested as a high-reflecting band in Spectralis OCT, was carefully checked. Based on the visibility of BM, it was classified into two types： a visible type or invisible type. The visible type was then classifiedinto an obvious type or occult type. If visible, BM appears thinner and more reflective than the RPE-BM-choriocapillaris complex. Meantime, the pigment epithelial detachment （PED） was classified into different types corresponding to the BM categories. The number of different categories were counted, measured and recorded as percentages. Results The visualization of BM manifested in all 111 eyes （100%）, but differed to the extent for which it was visible. Of the 111 eyes, the BM was obvious in 99 eyes （89.8%）. In the other 12 eyes （10.2%） it was difficult to discriminate, but there were still distinguishable differences from normal RPE-BM-choriocapillaris complexes. The visualization of BM was more obvious and wider in the 27 chronic CSC eyes than in the 84 acute CSC eyes when accompanied by the atrophy of choriocapillaris and RPE. BM was discriminated or visualized at all of the tracking leakage points demonstrated on FFA images. Conclusion BM is sandwiched between the RPE and ehoriocapillaris, and it cannot be distinguished in the normal hi

关 键 词：体层摄影术 光学相干 脉络膜视网膜炎 浆液性 中心性 视网膜脱离 BRUCH膜 毛细血管 脉络膜 

分 类 号：R774.1[医药卫生—眼科]