RVO合并黄斑水肿光感受器形态学改变与视力相关性的研究

发布时间：2018-07-01 10:24

本文选题：视网膜静脉阻塞 + 黄斑水肿　；参考：《延安大学》2017年硕士论文

【摘要】：目的:运用光学相干断层扫描(OCT)观察视网膜静脉阻塞(RVO)合并黄斑水肿(ME)黄斑区视网膜光感受器的形态学改变,探讨其与视力的相关性,从而总结影响视力的相关因素,为指导临床治疗提供理论依据。方法:回顾性分析55例55眼RVO合并黄斑水肿的患者。记录患者初诊及复诊的最佳矫正视力(BCVA[LogMAR]);运用OCT测量获得光感受器形态学改变的相关数据:初诊时黄斑中心凹视网膜相关结构的厚度,包括中心视网膜厚度(CRT)、感光细胞层厚度(PLT)、外核层厚度(ONLT),及黄斑变形指数(MDI)、黄斑水肿的分布位置;复诊黄斑水肿消退或减轻时黄斑中心凹视网膜相关结构的厚度、黄斑变形指数、光感受器椭圆体带及外界膜的完整性。使用SPSS20.0统计软件对结果进行整理分析。结果:1.初诊时LogMAR视力与CRT、MDI、ONLT有相关性(r=0.512,P=0.000;r=0.315,P=0.019;r=0.439,P=0.001),与黄斑水肿分布的位置有相关性(r=-0.382,P=0.004),与PLT无相关性(r=0.081,P=0.559);经过多重逐步回归分析,初诊LogMAR视力只与初诊CRT存在线性依存关系(β=0.02,P=0.000);2.复诊时LogMAR视力与初诊LogMAR视力、复诊PLT、椭圆体带完整性、外界膜完整性有相关性(r=0.648,P=0.000,r=-0.339,P=0.011;r=0.850,P=0.000;r=-0.754,P=0.000),与复诊CRT、MDI、ONLT无相关关系(r=0.002,P=0.991;r=0.088,P=0.524;r=0.154,P=0.260);经过多重逐步回归分析,复诊视力与初诊视力、椭圆体带完整性、外界膜完整性存在线性依存关系(β=0.650,P=0.000;β=0.298,P=0.000;β=0.247,P=0.000);3.初诊时,黄斑水肿分布于黄斑中心凹与位于黄斑中心一侧或两侧的LogMAR视力分别为:0.68±0.30、1.16±0.66,差异有统计学意义(t=-3.71,P=0.000);4.复诊时,椭圆体带完整组、尚连续组、断裂组的LogMAR视力分别为:0.26±0.15、0.48±0.29、1.53±0.59,各组间差异有统计学意义(P=0.000);再进行LSD两两比较,除椭圆体带完整组和尚连续组之间差异无统计学意义(P=0.107)外,其余组之间差异有统计学意义(均P=0.000)。外界膜完整组与断裂组的LogMAR视力分别为:0.38±0.27、1.42±0.66,差异有统计学意义(t=-0.91,P=0.000)。结论:1.初诊时LogMAR视力与初诊中心视网膜厚度、黄斑变形指数、中心凹外核层厚度相关;与黄斑水肿分布的位置有相关性,越靠近黄斑中心,视力越差;其中,初诊中心视网膜厚度是影响初诊视力的因素;2.复诊时LogMAR视力与初诊LogMAR视力、复诊感光细胞层的厚度相关,与椭圆体带及外界膜完整性相关,椭圆体带和外界膜结构越完整,视力越好。初诊视力、椭圆体带完整性、外界膜完整性是影响复诊视力的因素,其中,初诊视力对复诊视力的影响最大。
[Abstract]:Objective: To observe the morphological changes of retinal photoreceptor in retinal vein occlusion (RVO) combined with macular edema (ME) with optical coherence tomography (OCT), to explore the correlation between the retinal photoreceptor and the visual acuity, and to summarize the related factors affecting the visual acuity, and to provide a theoretical basis for guiding clinical treatment. Methods: a retrospective analysis of 55 eyes of 55 cases of RVO was reviewed. Patients with macular edema. Record the best corrected visual acuity (BCVA[LogMAR]) for early diagnosis and diagnosis; use OCT to measure the morphological changes of the photoreceptor: the thickness of the macular retina related structure at the first visit, including the thickness of the central retina (CRT), the thickness of the photoreceptor layer (PLT), the thickness of the outer nucleus (ONLT), and the macular change. Shape index (MDI), the distribution of macular edema, the thickness of the retina related structure of macular edema, macular degeneration index, the ellipsoid band and the integrity of the outer membrane when the macular edema subsided or reduced. The results were sorted with the SPSS20.0 statistical software. Results: 1. the visual acuity of LogMAR was associated with CRT, MDI, ONLT at first diagnosis. R=0.512, P=0.000; r=0.315, P=0.019; r=0.439, P=0.001) were correlated with the location of macular edema (r=-0.382, P=0.004), and there was no correlation with PLT (r=0.081, P=0.559). After multiple stepwise regression analysis, the first diagnosis LogMAR vision only existed in the linear dependency relationship with the first diagnosis. 2. Visual acuity, PLT, integrity of ellipsoid, correlation of external membrane integrity (r=0.648, P=0.000, r=-0.339, P=0.011; r=0.850, P=0.000; r=-0.754, P=0.000); no correlation with CRT, MDI, ONLT; multiple stepwise regression analysis, visual acuity and primary vision, ellipsoid There was a linear dependence on the integrity of the outer membrane integrity (beta =0.650, P=0.000; beta =0.298, P=0.000; beta =0.247, P=0.000). 3. at the initial diagnosis, macular edema was distributed in the macular fovea and the LogMAR vision at the one or both sides of the macular center, respectively, 0.68 + 0.30,1.16 + 0.66, and the difference was statistically significant (t=-3.71, P=0.000); 4. in the recovery of the ellipsoid zone. In the complete group, the LogMAR vision in the continuous group was 0.26 + 0.15,0.48 + 0.29,1.53 + 0.59, and the difference between the groups was statistically significant (P=0.000), and the difference between the complete group of the ellipsoid band and the continuous group was not statistically significant (P=0.107), and the difference between the other groups was statistically significant (P=0.000). The LogMAR visual acuity of the whole group and the fracture group were 0.38 + 0.27,1.42 + 0.66 respectively. The difference was statistically significant (t=-0.91, P=0.000). Conclusion: 1. at the first diagnosis, the visual acuity of LogMAR is related to the thickness of the retina, the macular deformation index, the thickness of the outer nucleus of the central concave; it is related to the location of the Huang Banshui swelling, the closer to the macular center, the more eyesight The retinal thickness of the first diagnosis center was a factor affecting the first diagnosis of the visual acuity. 2. the visual acuity of LogMAR was related to the thickness of the first diagnosis of LogMAR and the thickness of the photoreceptor layer, which was related to the integrity of the ellipsoid band and external membrane. The better the visual acuity, the integrity of the ellipsoid band and the integrity of the outer membrane, the better the vision, the integrity of the ellipsoid, and the integrity of the outer membrane. Sex is the factor that affects the vision of revisit. Among them, the initial vision is the most important factor.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774

【参考文献】