病理性近视黄斑病变OCT图像特征及其相关因素分析

发布时间：2018-05-02 11:59

本文选题：病理性近视 + 黄斑病变　；参考：《山西医科大学》2010年硕士论文

【摘要】： 目的：观察病理性近视黄斑病变光学相干断层扫描图像特征,明确其黄斑病变类型；分析不同类型黄斑病变之间年龄、屈光度、最佳矫正视力的关系,分析病理性近视黄斑部的病理变化,寻找早期防治的最佳时期和方法。方法：收集病理性近视黄斑病变、仅包含本研究中一种黄斑病变的患者204人210只眼,散瞳后行光学相干断层扫描检查。记录患者年龄、屈光度及最佳矫正视力。观察其黄斑部眼底改变及光学相干断层扫描图像特点,依据其光学相干断层扫描图像特点将病理性近视黄斑病变分为7组,每组30只眼：1组为单纯性黄斑出血组；2组为视网膜劈裂组；3组为黄斑脉络膜新生血管膜组；4组为黄斑裂孔组；5组为视网膜脱离组；6组为视网膜前膜组；7组为黄斑萎缩组。分析各组黄斑病变与年龄、屈光度、矫正视力的关系。结果： 1、病理性近视黄斑病变各组的光学相干断层扫描图像特征：单纯性黄斑出血：视网膜神经上皮层下中度强反射团,其下反射衰减；视网膜劈裂：视网膜神经上皮层间暗腔,其间可见桥状或柱状连接；黄斑脉络膜新生血管膜：神经上皮层下色素上皮层光带水平不规则强反射团；黄斑裂孔：视网膜神经上皮层连续性中断；视网膜脱离：视网膜神经上皮层与色素上皮层间无光反射的暗区,色素上皮层表面光滑；视网膜前膜：视网膜表面膜样反射；黄斑萎缩：视网膜神经上皮层明显变薄,视网膜色素上皮层及脉络膜呈带状高度强反射。 2、病理性近视黄斑病变各组间年龄的关系：1组-7组患者的平均年龄分别为(30.10±7.76)岁、(45.97±11.63)岁、(47.47±12.53)岁、(53.83±11.31)岁、(54.10±10.41)岁、(59.30±12.65)岁、(60.43±11.44)岁。单纯性黄斑出血组平均年龄最小,与各组间均有统计学意义(P0.05)。视网膜劈裂组、黄斑脉络膜新生血管膜组两组间无统计学意义,该两组与其余各组均有统计学意义(P0.05)。黄斑裂孔组、视网膜脱离组与黄斑萎缩组之间有统计学意义(P0.05)。其余各组间无统计学意义。 3、病理性近视黄斑病变各组间屈光度的关系：1组-7组患者的平均屈光度分别为(14.70±3.31)D、(13.04±4.27)D、(13.77±4.75)D、(14.18±4.06)D、(14.50±3.89)D、(14.14±4.67)D、(17.25±3.36)D。黄斑萎缩组屈光度最高,与各组均有统计学意义(P0.05),其余各组之间无统计学意义(P0.05)。 4、病理性近视黄斑病变各组间最佳矫正视力的关系：1组-7组患者的平均最佳矫正视力分别为0.24±0.07、0.32±0.09、0.22±0.09、0.14±0.09、0.07±0.04、0.31±0.09、0.13±0.08。视网膜脱离组平均最佳矫正视力最差,与各组间均有统计学意义(P0.05)。视网膜劈裂和视网膜前膜组平均最佳矫正视力大于0.3,两组间无统计学意义,两组与其余各组均有统计学意义(P0.05)。黄斑出血组、黄斑脉络膜新生血管膜组两组间无统计学意义,与其余各组均有统计学意义(P0.05)。黄斑裂孔组与黄斑萎缩组两组间无统计学意义,与其余各组间均有统计学意义(P0.05)。结论：病理性近视黄斑病变依据光学相干断层扫描图像特征分为七种类型：单纯性黄斑出血、视网膜劈裂、黄斑脉络膜新生血管膜、黄斑裂孔、视网膜脱离、视网膜前膜、黄斑萎缩。各组患者的平均年龄都大于30岁,高度近视患者30岁以后应定期行眼底检查,及早发现眼底病变,随着年龄增加,病变类型不同,单纯性黄斑出血患者平均年龄最小,应早期防治；屈光度越高,病变越严重,各组患者的平均屈光度均大于-13.00D,以黄斑萎缩组最高,因此应早期控制其屈光度,阻止或减轻严重眼底损害出现；黄斑病变越广泛,受损程度越严重,最佳矫正视力越差,对高度近视患者出现不明原因视力下降,应及时进行眼底检查,防止发生更严重黄斑病变。病理性近视黄斑病变根据其光学相干断层扫描图像分类有助于明确病变性质、判断预后及指导治疗。
[Abstract]:Objective : To observe the characteristics of optical coherence tomography ( OCT ) in pathological myopia and to identify the type of macular degeneration .
The relationship between age , power and the best corrected visual acuity between different types of macular degeneration was analyzed , the pathological changes of the yellow spot of pathological myopia were analyzed , and the best time and method for early prevention and treatment were found .

Methods : The pathological myopia macular degeneration was collected . Only 204 patients with macular degeneration in the study were examined by OCT . The age , power and best corrected visual acuity were recorded . The pathological myopia macular degeneration was divided into 7 groups according to their optical coherence tomography image characteristics .
Group 2 was the retinal cleavage group .
Group 3 was a new group of choroidal neovascularization ;
group 4 was macular hole group ;
Group 5 was the retinal detachment group .
Group 6 was the anterior retinal membrane group .
The relationship between macular degeneration and age , diopter and corrected visual acuity was analyzed .

Results :

1 . Optical coherence tomography image characteristics of pathological myopia macular degeneration group : simple macular hemorrhage : moderate intense reflection mass under the subcortical layer of the retina , and its lower reflection attenuation ;
retinoschisis : the dark cavity between the subcortical layers of the retina , with a visible bridge or column connection therebetween ;
macular choroidal neovascularization : irregular intense reflection of the cortical light band in the subcortical subcortical pigment ;
macular hole : continuous disruption of the retinal nerve ;
Retinal detachment : there is no light - reflecting dark area between the retinal nerve epithelial layer and the pigment epithelium layer , and the surface of the pigment epithelial layer is smooth ;
Anterior retinal membrane : retinal surface membrane - like reflex ;
Macular atrophy : The retinal nerve epithelial layer is significantly thinner , and the retinal pigment epithelial layer and the suprachoroidal layer are highly reflective .

There was no significant difference between the two groups ( P 0.05 ) . There was no statistical difference between the two groups ( P 0.05 ) .

3 . The relationship between the diopter among the patients with pathological myopia was ( 14.70 卤 3.31 ) D , ( 13.04 卤 4.27 ) D , ( 13.77 卤 4.75 ) D , ( 14.18 卤 4.06 ) D , ( 14.50 卤 3.89 ) D , ( 14.14 卤 4.67 ) D , ( 17.25 卤 3.36 ) D .

The best corrected visual acuity was 0.24 卤 0.07 , 0.32 卤 0.09 , 0.22 卤 0.09 , 0.14 卤 0.09 , 0.07 卤 0.04 , 0.31 卤 0.09 , 0.13 卤 0.08 in group 1 - 7 . There was no significant difference between the two groups .

Conclusion : The pathological myopia macular degeneration is divided into seven types according to the characteristics of OCT image : simple macular hemorrhage , retinal detachment , macular choroidal neovascularization , macular hole , retinal detachment , anterior retinal membrane and macular degeneration . The average age of patients in each group is greater than 30 years .
The higher the diopter , the more serious the lesion was , the average power of each group was greater than - 13.00D , the highest in the macular atrophy group , so the diopter should be controlled in the early stage , and the occurrence of severe ocular fundus damage should be prevented or alleviated ;
The more extensive the macular degeneration , the more severe the degree of damage , the worse the best corrected vision , the worse visual acuity in the patients with high myopia , and should be examined in a timely manner to prevent more severe macular degeneration . The pathological myopia macular degeneration can help clarify the nature of the lesion , judge the prognosis and guide the treatment according to its optical coherence tomography image classification .

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.5

【参考文献】