眼底病学术会议

前部缺血性视神经病变的荧光素眼底血管造影
与光相干断层成像的对比分析

韩梅;王兰惠;解士勇;时冀川;张树立;韩颖;宋秋颖

目的分析前部缺血性视神经病变（AION）患者的荧光素眼底血管造影（FFA）与光相干断层成像（OCT）的表现特点。方法对37例（38眼）的AION患者组及27例（27眼）的正常对照组，采用FFA、视野、眼底彩色照相、OCT检查。结果 AION组患者有男性23例（24眼）、女性14例（14眼），年龄38～77岁，平均（53.29±9.08）岁，视力0.01～1.5，37例进行30°视野检查显示：6眼视野全部缺损，5眼鼻侧视野缺损，4眼颞侧视野缺损，7眼上方视野缺损，15眼下方视野缺损。35例进行FFA检查显示：除发现早期视盘充盈迟缓，晚期视盘呈高荧光渗漏以外，还发现在黄斑区围绕拱环出现强荧光渗漏，其中7例出现局部强荧光渗漏，11例出现弥漫强荧光渗漏，1例在盘斑间出现散在点状遮蔽荧光（硬性渗出），16例未发现黄斑区荧光渗漏。38例进行OCT检查显示：29例整个视盘隆起、生理凹陷几乎消失，3例表现为视盘鼻侧隆起，6例整个视盘隆起、生理凹陷变窄；14例发现盘斑间神经上皮层组织增厚，8例发现盘斑间神经上皮隆起、下方有液性暗区、可见色素上皮层（RPE）/脉络膜毛细血管光带，16例黄斑区及盘斑间各层组织反射正常。正常对照组有男性17例（17眼）、女性10例（10眼），年龄38～77岁，平均（52.89±8.35）岁。两组年龄比较，经统计学检验，差异无显著性（t=0.18，P＞0.05）。两组视盘隆起高度比较AION组为（648.16±143.70）μm，正常对照组为（288.15±71.05）μm，经统计学检验，差异有统计学意义（t=13.32，P=0.000）。两组黄斑中心凹处神经上皮层厚度比较AION组为(191.13±64.85) μm，正常对照组为(160.59±13.71) μm经统计学检验，差异有统计学意义（t=2.82，P=0.000）。两组盘斑间神经上皮层最大厚度比较AION组为（315.29±47.04）μm，正常对照组为（277.11±18.12）μm，经统计学检验，差异有统计学意义（t=4.55，P=0.000）。两组平均视网膜神经纤维层厚度比较AION组为（233.35±70.86）μm，正常对照组为（127.43±12.45）μm，经统计学检验，差异有统计学意义（t=7.06，P=0.000）。两组视盘颞侧视网膜神经纤维层厚度比较AION组为（185.73±102.93）μm，正常对照组为（89.87±12.86）μm，经统计学检验，差异有非常显著性（t=4.34，P=0.000）。视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、平均视网膜神经纤维层厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系（r=-0.418，r=-0.427，r=-0.443，r=-0.474，P＜0.05）；与视盘隆起高度呈负相关关系，但差异无统计学意义（r=-0.25，P=0.13）。结论 AION患者早期眼底改变除有视盘水肿外，还有盘周视网膜神经纤维层水肿、增厚，黄斑区神经上皮层增厚，盘斑间视网膜神经上皮层浆液性脱离。通过FFA及OCT检查将对AION有更深入的认识。
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作者单位: 300020天津市眼科医院

Comparison of fluorescence fundus angiography with optical coherence tomography in anterior ischemic optic neuropathy

Han Mei, Wang Lanhui, Xie Shiyong,Shi Jichuan, Zhang Shuli, Han Ying, Song Qiuying

Objective To analyse and compare character of fluorescence fundus angiography (FFA) and optical coherence tomography (OCT) in anterior ischemic optic neuropathy (AION). Methods Totally 37 patients (38 eyes) with AION and 27 patients (27 eyes) in the control group were examined by FFA, fundus chromophotograph, field of vision and OCT. Results There were 23 males (24 eyes) and 14 females (14 eyes) in AION group. They were aged between 38 to 77, with an average of 53.29±9.08. Their visual acuity ranged between 0.011.5. Results of 30°field of vision (37 patients) showed that 6 eyes had full defect, 5 eyes nasal defect, 4 eyes temporal defect, 7 eyes superior defect, 15 eyes inferior defect. FFA (35 eyes) showed that hyperfluorescence appeared at the perifoveal arcade, apart from delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage, including 7 eyes with local hyperfluorescence leakage, 11 eyes with scatter hyperfluorescence leakage, 1 eye with spotshaped blocked fluorescence (hard exudation) between optic disc and macula, 16 eyes without fluorescence leakage in macula. OCT (38 eyes) showed that 29 eyes had whole optic papilla swelling and physiological depression nearly disappeared; 3 eyes had nasal optic papilla swelling; 6 eyes whole optic papilla swelling and physiological depression narrow; 14 eyes neuroepithelial layer thickening between optic disc and macula; 8 eyes neuroepithelial layer eminence and subretinal fluidity area opaca, RPE and choroidal capillary layer normal; 16 eyes tissue of macula and optic disc normal. There were 17 males (17 eyes) and 10 females (10 eyes) in control group. They were aged from 38 to 77, with an average of 52.89±8.35. The age of two groups had no statistical difference (P＞0.05). The elevated height of optic disc had significant difference in two groups (AION group: 648.16±143.70μm. Control group: 288.15±71.05μm. t=13.32，P=0.000). The neuroepithelial layer thickness of macula fovea had significant difference in two groups (AION group: 191.13±64.85μm. Control group: 160.59±13.71μm. t=2.82，P=0.000). The neuroepithelial layer maximum thickness between optic disc and macula had significant difference in two groups (AION group: 315.29±47.04μm. Control group: 277.11±18.12μm. t=4.55，P=0.000). The average retinal nerve fiber layer thickness had significant difference in two groups (AION group: 233.35±70.86μm. Control group: 127.43±12.45μm. t=7.06，P=0.000). The retinal nerve fiber layer thickness of temporal optic disc had significant difference in two groups (AION group: 185.73±102.93μm. Control group: 89.87±12.86μm. t=4.34，P=0.000). Visual acuity had significant negative correlation with the neuroepithelial layer thickness of macula fovea, the neuroepithelial layer maximum thickness between optic disc and macula, the average retinal nerve fiber layer thickness, the retinal nerve fiber layer thickness of temporal optic disc (r=0.418，r=0.427，r=0.443，r=0.474，P＜0.05). Visual acuity had negative correlation with the elevated height of the optic disc, but the correlation is not significant (r=0.25，P=0.13). Conclusions The fundus sign had peripapillary retinal nerve fiber layer swelling and thickening, the macular neuroepithelial layer thickening, and the retinal neuroepithelial layer serous detachment between optic disc and macula, apart from optic papilla swelling. We will have a further knowledge of d AION through FFA and OCT.
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Tianjin Eye Hospital