外伤性视网膜病变的频域光学相干断层扫描特征研究

发布时间：2018-02-19 22:35

本文关键词： 眼钝挫伤外伤性黄斑裂孔视网膜震荡视网膜下出血光学相干断层扫描　出处：《汕头大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:研究外伤性视网膜病变的频域OCT图像特征和类型,从而更好的指导临床诊断以及探索其发病机制。方法:本研究为回顾性研究。研究对象为汕头大学·香港中文大学联合汕头国际眼科中心(JSIEC)就诊的外伤性视网膜病变患者。对JSIEC的门诊数据库和频域OCT数据库进行检索,测量和分析患者的OCT检查结果。结果:本研究纳入外伤性视网膜病变的患者有138例(138眼),在频域OCT上表现出的外伤性视网膜病变主要有以下几种:1)外伤性黄斑裂孔25例;2)视网膜下出血30例;3)脉络膜破裂32例;4)视网膜萎缩70例;5)内界膜皱褶19例;6)视网膜色素上皮撕裂2例。根据OCT将外伤性黄斑裂孔分为伴孔周视网膜囊样水肿和不伴囊样水肿两种类型,不伴发囊样水肿组多合并有视网膜萎缩或者视网膜下出血(P0.001),且视力较差(1.18 vs 0.87,P=0.077)。中心凹下出血较周边部出血年龄大(30.5 vs 21.7岁,P=0.026),而且出血范围较局限(1.7 vs 3.6视盘直径,P=0.001);脉络膜破裂32例中有26例(81%)合并脉络膜新生血管,其中仅有1例(3%)伴有视网膜下或者网膜内渗出。视网膜震荡主要引起外层视网膜病变,可以分为4种不同的严重程度,严重程度与最佳矫正视力呈正相关(相关系数0.528,P0.001),与中心凹视网膜厚度呈负相关(相关系数-0.521,P0.001)。部分患者还可以发生内层视网膜高反射信号/内层视网膜萎缩、内界膜皱褶、视网膜色素上皮撕裂等病变。发生两种或两种以上视网膜病变类型患者共有47例(34%)。结论:OCT可以将外伤性黄斑裂孔分为伴发孔周视网膜囊样水肿和不伴有视网膜水肿两类,后者多伴有视网膜萎缩或者视网膜下出血。中心凹较周边部视网膜下出血较为局限。OCT可以将视网膜震荡分为四级不同的严重程度,分级与LogMAR最佳矫正视力呈正相关,与中心凹视网膜厚度成负相关。眼钝挫伤还可以引起内层视网膜萎缩、色素上皮撕裂等病变。频域OCT有更高的敏感度,可发现细微的病变,而且可以定量测量,在外伤性视网膜病变的诊断和病情判断中具有重要的价值。
[Abstract]:Objective: to study the characteristics and types of OCT images of traumatic retinopathy in order to guide clinical diagnosis and explore its pathogenesis. Methods: this study was a retrospective study. The subjects were the patients with traumatic retinopathy treated by Shantou University, Chinese University of Hong Kong and Shantou International Ophthalmology Center. The outpatient database and frequency-domain OCT database of JSIEC were searched. OCT findings were measured and analyzed. Results: in this study, 138 patients (138 eyes) with traumatic retinopathy were included. In frequency domain OCT, the main types of traumatic retinopathy were as follows: 1) 25 cases of traumatic macular hole (n = 25)) 30 cases of subretinal hemorrhage (n = 30). Choroidal rupture (n = 32) Retinal atrophy (n = 70) (n = 70) inner boundary membrane fold (n = 19)) retinal pigment epithelium tear (n = 2). According to OCT, traumatic macular holes were divided into two types: retinal cystoid edema with hole and without cystic edema. In the group without cystic edema, retina atrophy or subretinal hemorrhage was associated with P0.001, and the visual acuity was poor 1.18 vs 0.87g / P 0.077. The age of intracentric hemorrhage was 30.5 vs 21.7 years old, and the range of hemorrhage was limited to 1.7 vs 3.6 optic disc diameter. Choroidal neovascularization was found in 26 of 32 cases of choroidal rupture. There is only one case with subretinal or intraretinal exudation. Retinal concussion mainly causes outer retinopathy, which can be divided into four different degrees of severity. The severity was positively correlated with the best corrected visual acuity (correlation coefficient: 0.528, P 0.001), and negatively correlated with the thickness of the fovea retina (correlation coefficient -0.521, P 0.001). Some patients also had hyperreflex signal / retinal atrophy in the inner layer of retina, and a wrinkle in the inner boundary membrane, and a negative correlation was found between the degree of severity and the thickness of the fovea retina. There were 47 patients with two or more types of retinopathy. Conclusion the traumatic macular holes can be classified into two groups by using Oct: retinal cystic edema with or without retinal edema. The concave is more limited than the peripheral subretinal hemorrhage. Oct can divide the concussion into four levels of severity, and the grade is positively correlated with the best corrected visual acuity of LogMAR. Blunt eye contusion can also cause retinal atrophy in the inner layer, laceration of pigment epithelium, etc. Frequency domain OCT has higher sensitivity, can detect subtle lesions, and can be measured quantitatively. It has important value in the diagnosis and diagnosis of traumatic retinopathy.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.1

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