超声诊断黄斑部病变在白内障术前检查中的价值  

B-scan ultrasonography in detecting macular degeneration before cataract surgery

作　　者：杨青华[1] 王丽强[1] 黄一飞[1] 朱婧[2] 陈兵[1] YANG Qinghua WANG Liqiang HUANG Yifei ZHU Jing CHEN Bing(Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China Department of Ophthalmology, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China)

机构地区：[1]解放军总医院眼科,北京100853 [2]解放军总医院第一附属医院眼科,北京100048

出　　处：《解放军医学院学报》2017年第9期820-823,830,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(81170830);国家"973"重点基础研究发展计划(2013CB967001);北京市科技新星项目(Z161100004916132);解放军总医院临床扶持基金(2015FC-TSYS-2011)~~

摘　　要：目的评价超声诊断黄斑部病变的准确性,探讨其在白内障术前检查中的价值。方法本研究为前瞻性研究。选取2014年1月-2015年3月在解放军总医院眼科行超声乳化白内障摘除和人工晶状体植入术的白内障患者228例(228只眼),术前行B型超声对黄斑部球壁形态进行观察,对黄斑区进行频域光相干断层扫描(optical coherence tomography,OCT),以OCT为金标准,评价B型超声诊断黄斑部病变的准确性。根据B型超声观察结果将所有病例分为黄斑病变组和无黄斑病变组,分别于白内障术前及术后1周检查两组患者的最佳矫正视力,并进行比较,评价B型超声预测白内障术后视力恢复的价值。结果术前超声诊断黄斑部病变67例,无黄斑部病变161例。在67例黄斑部病变组,OCT诊断黄斑部病变67例;161例无黄斑病变组中12例经OCT诊断为黄斑异常。黄斑部病变超声诊断与频域OCT的符合率为94.7%(216/228),一致性检验Kappa值为0.879。术前B型超声诊断无黄斑部病变组患者最佳矫正视力平均值为0.21±0.15,与无黄斑病变组视力平均值(0.23±0.17)差异无统计学意义(t=0.443,P=0.617)。术后1周超声诊断黄斑部病变组最佳矫正视力平均值为0.31±0.18,明显低于无黄斑部病变组的0.87±0.23(t=8.44,P<0.01)。结论 B型超声诊断黄斑部病变准确性较高,用于白内障术前检查,可以预测术后矫正视力恢复情况,且经济便捷,具有重要的临床应用价值。Objective To evaluate macular degeneration by B-scan ultrasonography before cataract surgery and examine its diagnostic accuracy comparing with optical coherence tomography（OCT）. Methods It was a prospective study. Totally 228 cases（228 eyes） with cataract who underwent phacoemulsification and foldable lens implantation in Chinese PLA General Hospital from January 2014 to March 2015 were included in this study. Preoperative examinations（the morphology of the macular） were performed in 228 eyes using OCT and B-scan ultrasonography, respectively. All patients were divided into macular degeneration group and nonmacular degeneration group according to the results of B-scan ultrasonography. Then the results of ultrasonography and the diagnosis of OCT in the frequency domain were analyzed and compared, and the best corrected visual acuity of the two groups was compared before and at 1 week after cataract surgery. Results Before surgery, 67 cases were diagnosed as macular degeneration and 161 cases without macular degeneration by ultrasonography. Macular degeneration was diagnosed in 67 cases by OCT in macular degeneration group. For 161 cases in non-macular degeneration group, macular degeneration was diagnosed in 12 cases by OCT. The concordance rate between two examinations for macular degeneration was 94.7%（216/228）, and the preoperative ultrasound diagnosis was highly consistent with OCT（Kappa=0.879）. Before surgery, the best corrected visual acuity（BCVA） of the patients in macular degeneration group was 0.21±0.15, which was not significantly different with 0.23±0.17 in the patients without macular degeneration（t=0.443, P=0.443）. A week after the surgery, BCVA in patients of macular degeneration group was significantly lower than that in patients without macular degeneration group（0.31±0.18 vs 0.87±0.23, P〈0.01）. Conclusion The accuracy of B-scan ultrasonography in diagnosis of macular degeneration is high, which can be used to predict the correct vision before cataract surgery

关 键 词：白内障 超声检查 诊断技术 眼科 黄斑病变 

分 类 号：R776.1[医药卫生—眼科]