本文關鍵詞： 眼鈍挫傷 外傷性黃斑裂孔 視網膜震蕩 視網膜下出血 光學相干斷層掃描　出處：《汕頭大學》2011年碩士論文　論文類型：學位論文

【摘要】：目的:研究外傷性視網膜病變的頻域OCT圖像特征和類型,從而更好的指導臨床診斷以及探索其發(fā)病機制。 方法:本研究為回顧性研究。研究對象為汕頭大學·香港中文大學聯合汕頭國際眼科中心(JSIEC)就診的外傷性視網膜病變患者。對JSIEC的門診數據庫和頻域OCT數據庫進行檢索,測量和分析患者的OCT檢查結果。 結果:本研究納入外傷性視網膜病變的患者有138例(138眼),在頻域OCT上表現出的外傷性視網膜病變主要有以下幾種:1)外傷性黃斑裂孔25例;2)視網膜下出血30例;3)脈絡膜破裂32例;4)視網膜萎縮70例;5)內界膜皺褶19例;6)視網膜色素上皮撕裂2例。根據OCT將外傷性黃斑裂孔分為伴孔周視網膜囊樣水腫和不伴囊樣水腫兩種類型,不伴發(fā)囊樣水腫組多合并有視網膜萎縮或者視網膜下出血(P0.001),且視力較差(1.18 vs 0.87,P=0.077)。中心凹下出血較周邊部出血年齡大(30.5 vs 21.7歲,P=0.026),而且出血范圍較局限(1.7 vs 3.6視盤直徑,P=0.001);脈絡膜破裂32例中有26例(81%)合并脈絡膜新生血管,其中僅有1例(3%)伴有視網膜下或者網膜內滲出。視網膜震蕩主要引起外層視網膜病變,可以分為4種不同的嚴重程度,嚴重程度與最佳矯正視力呈正相關(相關系數0.528,P0.001),與中心凹視網膜厚度呈負相關(相關系數-0.521,P0.001)。部分患者還可以發(fā)生內層視網膜高反射信號/內層視網膜萎縮、內界膜皺褶、視網膜色素上皮撕裂等病變。發(fā)生兩種或兩種以上視網膜病變類型患者共有47例(34%)。 結論:OCT可以將外傷性黃斑裂孔分為伴發(fā)孔周視網膜囊樣水腫和不伴有視網膜水腫兩類,后者多伴有視網膜萎縮或者視網膜下出血。中心凹較周邊部視網膜下出血較為局限。OCT可以將視網膜震蕩分為四級不同的嚴重程度,分級與LogMAR最佳矯正視力呈正相關,與中心凹視網膜厚度成負相關。眼鈍挫傷還可以引起內層視網膜萎縮、色素上皮撕裂等病變。頻域OCT有更高的敏感度,可發(fā)現細微的病變,而且可以定量測量,在外傷性視網膜病變的診斷和病情判斷中具有重要的價值。
[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.
【學位授予單位】：汕頭大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R774.1

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