【摘要】 目的观察湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)患者频域光学相干断层扫描(spectraldomain optical coherence tomography,SD-OCT)图像特征,探讨光感受器细胞层形态变化与AMD患者视功能的相关性。方法选取44例(59眼)湿性AMD患者为AMD组及25例(35眼)为正常组,进行最佳矫正视力、眼压、裂隙灯、间接眼底镜及SD-OCT检查,AMD组均行眼底荧光血管造影(fundus fluorescein angiography,FFA)检查。观察正常组和AMD组黄斑区OCT图像特征;测量黄斑中心凹视网膜厚度;测量中心凹向鼻侧及颞侧各500μm范围内视网膜外界膜(external limiting membrane,ELM)、光感受器细胞内外节连接(inner/outer segments of photoreceptor,IS/OS)连续性中断的长度,并以此将AMD组分为3组,中断长度≤200μm为(+)组,200~800μm为(±)组,≥800μm为(-)组。分析OCT特征与LogMAR视力的相关性;比较AMD组与正常组中心凹视网膜厚度的差异;分析中心凹视网膜厚度与LogMAR视力的关系;分别比较ELM三组及IS/OS三组间LogMAR视力的差异。结果 AMD组中心凹视网膜厚度(241.64±129.56)μm与正常组(199.34±13.64)μm比较,差异有统计学意义(Z=-2.069,P=0.039)。AMD组中心凹视网膜厚度以199μm为分界,厚度≤199μm组与LogMAR视力呈负相关(r=-0.542,P=0.008);厚度>199μm,与LogMAR视力呈正相关(r=0.659,P=0.000)。ELM三组间LogMAR视力均有明显差异(P=0.000、0.000、0.005)。IS/OS三组间LogMAR视力进行比较,IS/OS(-)与IS/OS(+)、IS/OS(±)组间的差异均有统计学意义(P=0.000、0.000),而IS/OS(+)与IS/OS(±)组间差异无统计学意义(P=0.053)。结论 SD-OCT能清晰显示湿性AMD的视网膜细微结构变化,ELM和IS/OS连续性可作为判断湿性AMD患者视功能的重要指标。更多还原

【Abstract】 Objective To investigate the spectral-domain optical coherence tomography(SDOCT) image characteristics of wet age-related macular degeneration(AMD) and explore the association between photoreceptor cell layer changes and visual acuity(VA).Methods Fifty-nine eyes of 44 cases with wet AMD(AMD group) and 35 normal control eyes of 25 normal people(control group) received examinations of best corrected visual acuity,intraocular pressure,slit lamp microscope,indirect ophthalmoscope and SD-OCT.The AMD group also underwent fundus fluorescein angiography(FFA).The macular SD-OCT morphology was observed and foveal thickness at the central fovea was measured.The lenghth of the external limiting membrane(ELM) and inner segment/outer segment photoreceptor(IS/OS) within 500 μm were evaluated in vertical direction from the fovea,and the continuity was graded and classified into 3 groups using SD-OCT.The group(+) was represented disrupted line less than 200 μm.Those in the group(±) showed focal disrupted line from 200 μm to 800 μm and in the group(-) showed disrupted line more than 800 μm.Correlation coefficients between each characteristic and LogMAR VA were analyzed.The difference of foveal thickness between AMD group and normal group was analyzed.The correlation between foveal thickness and LogMAR VA was evaluated.The average LogMAR VA of the groups were also compared.Results The foveal thickness in AMD group and control group were(241.64±129.56) μm and(199.34±13.64) μm,there was statistical difference(Z=- 2.069,P=0.039).There was a negative correlation with LogMAR VA in eyes with foveal thickness≤199 μm(r=- 0.542,P=0.008) and a positive trend in eyes with foveal thickness>199 μm(r=0.659,P=0.000).There was statistical difference in the three groups of ELM(P=0.000,0.000,0.005).There were statistical difference in LogMAR VA between IS/OS(-) and IS/OS(+),IS/OS(±)(P=0.000,0.000),but no statistical difference between IS/OS(+) and IS/OS(±)(P = 0.053).Conclusion SD-OCT can clearly display the detailed retinal microstructures changes in wet AMD,and the integrity of ELM and IS/OS line are key indexes in evaluating the visual acuity in patients with wet AMD.更多还原