特发性视网膜前膜患者黄斑区视网膜厚度及显微结构改变与视力的关系  

Relationship of the change of macular thickness and microstructure with visual acuity in eye with idiopathic epiretinal membrane

作　　者：米兰[1] 黄时洲[1] 肖辉[1] 刘杏[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华实验眼科杂志》2013年第5期461-464,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 特发性视网膜前膜（IERM）患者前膜的牵引可引起黄斑区视网膜结构的改变及视力下降,了解两者之间的关系有助于更好地判断疾病的预后. 目的 观察IERM患者黄斑区视网膜厚度及显微结构的改变,分析黄斑区视网膜增厚及中心凹锥体外节尖端（COST）线的完整性与视力的关系.方法 采用回顾性病例分析的方法.收集2011年3-12月在中山大学中山眼科中心确诊的IERM连续病例56例,所有患者均为单眼发病,对侧眼均为正常眼.纳入的患者中男16例,女40例；平均年龄（61.05±6.58）岁.患者双眼均接受频域光学相干断层扫描（SD-OCT）检查,采用黄斑立体程序及高清5线扫描模式进行扫描,记录双眼黄斑厚度地形图中央区（＜1 mm直径）、内环区（1～3 mm直径）、外环区（＞3～6 mm直径）的平均视网膜厚度及COST线状态,比较双眼黄斑各区视网膜平均厚度及中心凹显微结构的差异,分析黄斑区视网膜厚度与视力的相关性,比较IERM患者患眼中COST线完整组与缺失组患者年龄、视力、视网膜厚度的差异. 结果 SD-OCT检查发现IERM患者患眼黄斑中心凹的凹陷变浅或消失,黄斑中央区、内环区和外环区视网膜厚度分别为（446±89）、（418±64）、（328±34）μm,均明显高于对侧正常眼相应区域的（250±22）、（319±17）、（279±17）μm,差异均有统计学意义（t=13.370、9.523、7.769,均P=0.000）.黄斑中央区、内环区和外环区视网膜平均厚度与视力均呈负相关（r=-0.686、-0.653、-0.417,P＜0.05）.IERM眼中COST线完整者20例,缺失者36例.与COST线完整组患者比较,COST线缺失组患者年龄大,视力差,黄斑各区厚度均增加,差异均有统计学意义（t=2.109,P=0.039;t=-4.093,P=0.000;t=6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000）.56例患者的正常对侧眼均未发现COST线缺失. 结论 IERM患者黄斑区视网膜增厚和COST线缺失均可反映IERM眼视功能的损�Background Traction of epiretinal membrane results in macular morphologic change and visual functional impairment in eye with idiopathic epiretinal membrane （IERM）,therefore figuring out their relationship is helpful for evaluation of disease prognosis.Objective This study was to observe the morphological change of macula and microstructure,and analyze the relationship between retina thickness,integrity of cone outer segment tips （COST） line in fovea and visual acuity.Methods This was a retrospective case-observational study.Fifty-six consecutive cases diagnosed as IERM in Zhongshan Ophthalmic Center from March 2011 to December 2011 were enrolled in this study,and all the patients showed unilateral IERM with the normal fellow eyes.Sixteen patients were males and 40 were females,with a mean age of （61.05 ± 6.58） years old.Spectral-domain optical coherence tomography （SD-OCT） examination was performed on the eyes,and Macular Cube （512×128） and HD 5 Line program were selected.Mean retinal thickness of central area （〈1 mm diameter）,inner ring area （1-3 mm diameter） and outer ring area （〉3-6 mm diameter） of macula and the status of COST line （intact or fractured） was recorded.Mean thickness of whole macular areas and the difference of foveal microstructure were compared,and the correlation between retinal thickness and visual acuity was analyzed using Pearson linear correlation analysis.Related parameters including age,visual acuity,retinal thickness were also compared between the continuous COST lines group and the fractured COST lines group by independent sample t test.Results The flatted or disappeared fovea was seen in IERM eyes on the SD-OCT image.Retinal thicknesses were （446±89）μm,（418±64）μm and （328±34）ttm in the central area,inner ring area and outer ring area of macula in the IERM eyes,exhibiting significant increasing in comparison with （250±22） μm,（319±17） μm and （279±17） μm in the normal fellow eyes （t=13.370,9.523,7.769,all P

关 键 词：特发性黄斑前膜 体层摄影术 光学相干断层扫描 影像学 视力 

分 类 号：R774.1[医药卫生—眼科]