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目的 :应用光学相干断层扫描 (opticalcoherencetomography ,OCT)定量分析玻璃体牵拉与黄斑裂孔形成的关系。探讨OCT检查对诊断特发性黄斑裂孔的意义。方法 :OCT显示为玻璃体黄斑中心凹牵拉的 18例 ( 2 0眼 )患者进行随访。垂直和水平线性OCT经过黄斑中心凹 ,分析OCT图像 ,测量黄斑厚度及玻璃体后脱离 ,定量分析黄斑裂孔与玻璃体牵拉的关系。结果 :平均年龄为 63 2± 8 4岁 ( 5 0～ 77岁 ) ,男性 2例 ,女性 16例。临床诊断为临界黄斑裂孔 9眼 ,黄斑囊肿 2眼 ,玻璃体黄斑牵拉 3眼 ,黄斑囊样水肿 3眼 ,视网膜前膜 1眼及诊断不详 2眼。首次OCT图像显示玻璃体后皮质粘连在黄斑中心凹处 ,中心凹变平或隆起 ,神经上皮间呈低反射的囊肿。未形成裂孔眼的玻璃体后脱离逐渐增加 ,中心凹的隆起度亦随之增加。随访视力显著下降 (P =0 0 0 1,配对T检验 ) ;视力与黄斑的隆起度呈负相关 (r2 =0 5 3 ,P =0 0 0 3 ,Pearson相关分析 )。 2 0眼中 8眼 ( 4 0 % )形成黄斑裂孔 ,板层裂孔 1眼 ,Ⅱ期裂孔 5眼 ,Ⅲ期裂孔 2眼。裂孔形成组与未形成组的视力、黄斑厚度及玻璃体后脱离的差异不显著 (P >0 0 5 )。结论 :OCT对分析、诊断、监测玻璃体黄斑牵拉具有非常有意义的临床价值。玻璃体黄斑中心凹牵拉是裂孔形成的原因之一
Objective: To quantitatively analyze the relationship between vitreous traction and macular hole formation by optical coherence tomography (OCT). To explore the significance of OCT in the diagnosis of idiopathic macular hole. Methods: OCT was performed in 18 patients (20 eyes) with macular fovea traction. Vertical and horizontal linear OCT through the foveal fossa, OCT image analysis, measurement of macular thickness and posterior vitreous detachment, quantitative analysis of macular hole and vitreous traction relationship. Results: The average age was 63 2 ± 8 4 years old (ranged from 50 to 77 years). There were 2 males and 16 females. Clinical diagnosis of critical macular hole in 9 eyes, macular cyst in 2 eyes, vitreous macular traction in 3 eyes, cystoid macular edema in 3 eyes, anterior retinal membrane and 2 eyes with unknown diagnosis. The first OCT images showed vitreous posterior cortical adhesions in the fovea, foveal flat or bulge, low-reflex cysts between the neural epithelium. The vitreous without detachment increased gradually after detachment, and the elevation of the fovea increased. Follow-up visual acuity decreased significantly (P = 0 0 0 1, paired T test); visual acuity and macular uplift was negatively correlated (r2 = 0 53, P = 0 0 03, Pearson correlation analysis). There were 8 macular holes (40%) in 20 eyes with macular hole, one lamella hole, five lamellar II, and three lamellar II. There was no significant difference in visual acuity, macular thickness and posterior vitreous detachment between the group of formed hippocampus and the group of non-formed (P> 0.05). Conclusion: OCT has very significant clinical value for the analysis, diagnosis and monitoring of vitreous macular traction. Vitreous foveal fovea is one of the reasons for the formation of a fissure