非增生型糖尿病视网膜病变黄斑水肿患者黄斑区谱域光学相干断层扫描中高反射信号的特征分析  

Characteristics of hyperreflective foci in SD-OCT of macular area in patients with DME of non-proliferative diabetic retinopathy

作　　者：刘广峰[1] 蔺洁[2] 范颖[1] 顾铮[1] 高新晓[1] 朱岩[1] 孟忻[1] 王华[1] 贾宇颂[1] 付秀稳[1] 汪军[1] 

机构地区：[1]首都医科大学附属北京安贞医院眼科,北京市100029 [2]首都医科大学附属北京安贞医院心肺血管疾病研究所动脉粥样硬化研究室,北京市100029

出　　处：《眼科新进展》2013年第4期331-334,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81170793)~~

摘　　要：目的观察非增生型糖尿病视网膜病变黄斑水肿(diabetic macular edema,DME)患者的黄斑区谱域光学相干断层扫描(spectra-l domain optical coherece tomography,SD-OCT)中高反射信号(hyperreflectvie foci,HF)的临床特征。方法 NPDR伴发黄斑水肿患者34例(47眼)纳入研究,所有受检者均行最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯显微镜、裂隙灯前置镜检查,彩色眼底照相、红外眼底照相、眼底荧光血管造影(fundus fluorescein angiography,FFA)和SD-OCT检查,依据FFA的结果分为局灶水肿组、弥漫水肿组和囊样水肿组。分析各组患者黄斑区OCT中HF的分布特征。结果 FFA检查47眼中局灶水肿27眼、弥漫水肿12眼、囊样水肿8眼。各类型黄斑水肿的SD-OCT图像特征如下:局灶水肿组HF主要分布在水肿的周围,硬性渗出或环形渗出的内侧;弥漫水肿组:在弥漫水肿的黄斑区各个区域都可以看到广泛的HF,分布于视网膜各个层次,甚至是内界膜表面。在水肿的视网膜局部出现囊腔样改变时,其囊腔中或其周围多见HF。囊样水肿组:囊样水肿的囊壁处有较多HF。黄斑囊样水肿中可见视网膜外层IS/OS层和外界膜层之间HF沉着。结论 HF在不同类型DME的SD-OCT中分布的特点表明HF是血管内脂蛋白或蛋白质渗出形成,HF是硬性渗出的前体,标志着早期的视网膜血管壁的损害。Objective To investigate clinical characteristics of hyperreflectvie foci（HF）in spectral-domain optical coherence tomography（SD-OCT）of macular area in patients with diabetic macular edema（DME）accompanied by non-proliferative diabetic retinopathy（NPDR）.Methods 37 patients（47 eyes）with DME accompanied by NPDR were recruited.Examinations including best corrected visual acuity（BCVA）,slit-lamp microscopy,slit-lamp preset lens,fundus colorized photography,Infrared fundus photography,fundus fluorescein angiography（FFA）,and SD-OCT were performed on all patients.According to FFA results,the patients were divided into 3 groups：the focal DME group,the diffuse DME group and the cystoid DME group.Characteristics of distribution of HF in each group were then analyzed.Results FFA results showed that among the 47 eyes,27 were in the focal DME group,12 were the diffuse DME group and 8 were the cystoid DME group.SD-OCT results showed：HF in the focal DME group was around the edema,inner side of the hard exudation or annular exudation;HF in the diffuse DME group could be seen in every part of the macular area and every level of the retina,even in the internal limiting membrane（ILM）,It was also seen in or around the cystic cavity,when there were cystoid changes on part of the edematous retina.HF in the cystoid DME group was observed mainly on the cyst wall of cystoid edema.HF deposits was observed also between the IS/OS layer and the external layer in cystoid DME.Conclusion SD-OCT results of the 3 groups indicate that HF may be exudation of intravascular lipoprotein or protein.HF is precursor of hard exudation and signal of damage in retinal vascular wall.

关 键 词：黄斑水肿 高反射信号 频域OCT 

分 类 号：R774.1[医药卫生—眼科]