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目的 观察特发性黄斑裂孔的光学相干断层扫描 (OpticalCoherenceTomography ,OCT)图像特征 ,总结Gass分期的诊断标准。方法 对 13 3例 (14 3只眼 )临床诊断为特发性黄斑裂孔的患者进行OCT检查 ,根据Gass分期的原则进行分期。结果 依据Gass分期的原则 ,将 14 3只患眼分为 4期 ,各期OCT图像特征如下 :Ⅰ期 :共 2 9只眼 ,黄斑中心凹轮廓变浅或消失 ,中心凹下可见低反射区 ,其中 14只眼发现伴有黄斑前膜增生 ,7只眼伴有玻璃体黄斑牵引 ;Ⅱ期 :共 17只眼 ,神经上皮全层破裂形成孔 ,孔表面有可以贴附的孔盖 ;Ⅲ期 :共 83只眼 ,神经上皮全层破裂 ,孔盖游离或未见孔盖 ,伴不同程度裂孔周围囊样水肿 ;Ⅳ期 :共 14只眼 ,裂孔形态与Ⅲ期相似 ,但合并玻璃体后脱离。结论 OCT能直观、形象地显示特发性黄斑裂孔的形态特征 ,比较准确地进行分期 ,在特发性黄斑裂孔的诊断及术式选择等方面有重要作用。
Objective To observe the characteristics of optical coherence tomography (OCT) in idiopathic macular holes and summarize the diagnostic criteria of Gass staging. Methods One hundred and thirty-three patients (143 eyes) with clinically diagnosed idiopathic macular hole were examined by OCT and staged according to the principle of Gass staging. Results According to the principle of Gass staging, 14 3 eyes were divided into 4 phases. The characteristics of OCT images in each stage were as follows: stage Ⅰ: a total of 29 eyes, the foveal outline faded or disappeared, , Of which 14 eyes were found with pre-macular hyperplasia, 7 eyes with vitreous traction; Ⅱ: a total of 17 eyes, the entire layer of neural epithelium rupture to form holes, hole surface can be attached to the hole cover; Ⅲ : A total of 83 eyes, full of nerve epithelial rupture, the hole cover or no hole cover, with varying degrees of cystic edema around the hole; Ⅳ: a total of 14 eyes, the shape of the hole and Ⅲ similar, but the combined vitreous detachment . Conclusions OCT can directly and vividly display the morphological characteristics of idiopathic macular holes and perform staging more accurately. It plays an important role in the diagnosis and surgical choice of idiopathic macular holes.