不同病变时期Best卵黄样黄斑营养不良的光相干断层扫描图像特征  

Optical coherence tomography features of Best vitelliform macular dystrophy at different stages

作　　者：欧阳艳玲[1] 张勇进[1] 徐格致[1] 刘卫[1] 俞笳[1] 薛莹[1] 陈倩[1] 姜春晖[1] 黎蕾[1] 黄欣[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2012年第4期342-345,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：基金项目：上海市卫生局科研课题计划（2007005）

摘　　要：目的 观察不同病变时期Best卵黄样黄斑营养不良（BVMD）的光相干断层扫描（OCT）图像特征。方法 临床确诊为BVMD的28例患者56只眼纳入研究。所有患者常规行最佳矫正视力、裂隙灯显微镜、直接检眼镜、前置镜、眼底照相、眼电图、荧光素眼底血管造影检查。56只眼中，0期8只眼，Ⅰ期2只眼，Ⅱ期10只眼，Ⅱa期12只眼，Ⅲ期6只眼，Ⅳa期6只眼，Ⅳb期5只眼，Ⅳc期7只眼。患者同时行OCT检查，观察不同病变时期的OCT图像特征。结果 OCT检查发现，0期患眼黄斑区未见明显异常。Ⅰ期患眼黄斑区结构正常，视网膜色素上皮（RPE）下小团块强反射病灶，可见浆液性视网膜脱离。Ⅱ、Ⅱa期患眼RPE-脉络膜毛细血管复合体（ORCC）呈弥漫性增厚隆起信号增强，黄色物质位于光感受器细胞内外节连接（IS/OS）与RPE层之间；Ⅱa期患眼RPE-ORCC增厚区域小，呈圆锥样隆起有弱反射区围绕。Ⅲ期患眼病灶上半部分表现为弱反射区，下半部分黄色物质表现为强反射并堆积于IS/OS与RPE层之间。Ⅳa期患眼病灶处神经感觉层下为无反射区，边界清晰，其下RPE-ORCC变薄，IS/OS光带及外界膜缺失。Ⅳb期患眼纤维化病灶RPE层增厚、隆起，呈强反射，视网膜神经上皮变薄和其上方广泛的IS/OS光带缺失。Ⅳc期患眼RPE连续性中断，可伴有黄斑部水肿。结论 BVMD病灶中的黄色物质位于IS/OS与RPE层间，表现为强反射。Ⅱa期-Ⅳ期BVMD患眼的OCT典型图像特征为外核层与RPE层之间大小不一的腔隙样弱反射区伴或不伴有同一区间锥形强反射灶。Objective To observe the optical coherence tomography （OCT） features of Best vitelliform macular dystrophy （BVMD） at different stages.Methods Twenty-eight BVMD patients （56 eyes） were enrolled in this study. All the patients were examined for visual acuity, slit-lamp microscopy, direct ophthalmoscope, fundus photography, electrooculogram, fundus fluorescein angiography （FFA） and OCT. Fifty-six eyes were classified into stage 0 （eight eyes）、Ⅰ （two eyes）、Ⅱ（10 eyes）、Ⅱa （12 eyes）、Ⅲ （six eyes） 、Ⅳa （six eyes）、Ⅳb （five eyes） and Ⅳc （seven eyes） accordingly. The OCT features of BVMD at different stages were observed.Results The OCT results showed that the macular area was normal in eyes of stage 0; disturbance of retinal pigment epithelium （RPE） and subretinal hyporeflective area were found in eyes of stage I; the location of the yellowish material between RPE and the inner segment and outer segment （IS/OS） with normal appearance in RPE and IS/OS interface were found in eyes of stage Ⅱ. In all the other progressing stages from Ⅱa、Ⅲ and Ⅳ, the vitelliform material appeared as a thicker highly reflective lesion located between the outer nuclear layer and RPE layer, usually accompanied by optical hyporeflective lesion. Images of stage Ⅳc were in similar appearance besides edema of retina. OCT images of Ⅳb stage were demonstrated atrophy of retinal layer and IS/OS loss with fibrosis. Conclusions OCT demonstrated the location of the yellowish material between RPE and IS/OS. Optical hyporeflective lesion between the outer nuclear layer and RPE layer accompanied thicker highly reflected lesion might be the characteristic image in stages II a to IV of BVMD.

关 键 词：黄斑变性/诊断 体层摄影术 光学相干 诊断显像 

分 类 号：R774.5[医药卫生—眼科] R770.43[医药卫生—临床医学]