中心性浆液性脉络膜视网膜病变光感受器层频域光学相干断层扫描的观察  

Use of spectral-domain optical coherence tomography for observing the foveal photoreceptorlayer in central serous chorioretinopathy

作　　者：牟晓月[1] 孙祖华[1] 贾晓林[1] 孙心铨[2] 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 [2]北京中日友好医院眼科孙心铨,北京100029

出　　处：《中华眼视光学与视觉科学杂志》2011年第3期169-172,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：目的观察中心性浆液性脉络膜视网膜病变（CSC）患眼光感受器层的频域光学相干断层扫描（Spectralis OCT）的图像特征，研究CSC患眼光感受器外节带形态及外核层厚度与最佳矫正视力（BCVA）的关系。方法前瞻性病例对照研究。对23例（24眼）CSC患者及18例（18眼）正常对照者的黄斑部进行Spectralis OCT检查，观察CSC患眼光感受器层的形态特征；测量两组中心凹外核层的厚度（CTONL）。根据外节带的形态将CSC组分成光感受器外节保存型和外节萎缩型，比较各类型间CTONL以及BCVA的差异．并分析CSC患眼CTONL和BCVA的关系.各组间CTONL、BCVA的比较采用独立样本t检验；CSC组BCVA与CTONL的关系采用Pearson相关分析；CSC组病程与BCVA以及CTONL的关系采用Spearman秩相关分析。结果24只CSC眼Spectralis OCT示，17眼（71％）为光感受器外节保存型，7眼（29％）为外节萎缩型。对照眼和CSC眼CTONL分别为（114．8±15．6）μm和（73．6±19．6）μm，两组间差异有统计学意义（t=7．274，P〈0．01）。其中，CSC组中外节保存型、外节萎缩型的CTONL分别为（82．1±14．6）μm和（53．0±14．1）μm，两组间差异有统计学意义（t=4．482，P〈0．01）。CSC组中外节保存型和外节萎缩型的BCVA分别为4．86±0．14和4．50±0．26，两组间差异有统计学意义（t=4．294，P〈0．01）。CSC组的BCVA与CTONL呈正相关（r=0．918，P〈0．01）。CSC患眼的病程与CTONL、BCVA均呈负相关（r=-0．994、-0．989，P〈0．01）。结论CSC眼BCVA与光感受器CTONL及外节带的形态有关，外节保存型的BCVA明显好于外节萎缩型，外核层越薄，外节萎缩越多，BCVA越差。光感受器层的精细观察对视力预后的评估有一定的临床意义。Objective To observe the features of the foveal photoreeeptor layer in eyes with central serous chorioretinopathy （CSC） using spectral-domain optical coherence tomography （Spectralis OCT）; to analyze the relationship between best corrected visual acuity （BCVA）, the morphology of the outer segments （OS） and the thickness of the outer nuclear layer. Methods This was a prospective case control study. The morphology of the outer segments was observed and central thickness of outer nuclear layer （CTONL） at the central fovea was measured in 24 consecutive CSC eyes of 23 patients and 18 normal control eyes of 18 normal people on Spectralis OCT images. The eyes of CSC patients were divided into two groups based on the morphology of the outer segment： the preserved outer segement group and the atrophy group. The correlation between BCVA and CTONL in these groups was evaluated separately. An independent samples t test was used to compare CTONL and the average BCVA of the goups. A Pearson correlation test was used for the correlation between CTONL and BCVA in the CSC patient group. A Spearman rank correlation test was used for the correlation between symptom duration and CTONL in the CSC patient group. Results The outer segment band of the serous detached fovea was preserved well in 17 eyes （71%）, and atrophic in 7 eves （29%）. The average CTONL was （73.6±19.6）μm in the CSC group, which was significantlyless than that [（l14.8±15.6）μm] in the normal group （t=7.274, P〈0.01）. The average CTONL was （53.0±14.1）μm in the atrophic subgroup, which was significantly thinner than that [（82.1±14.6）μm] in the preserved group （t=4.482, P〈0.01）. The BCVA was 4.86＋0.14 in the atrophic group, which was significantly less than that （4.50±0.26） in the preserved group （t=4.294, P〈0.01）. BCVA was positively correlated with CTONL （r=0.918, P〈0.01）. The course of the disease was negatively correlated with CTONL and BCVA （r=-0.994, -0.989, P〈0.01 for both）.

关 键 词：脉络膜视网膜炎 浆液性 中心性 光感受器 体层摄影术 光学相干 外核层 

分 类 号：R774.1[医药卫生—眼科]