湿性年龄相关性黄斑变性眼中外层视网膜管状结构的OCT特征及其临床意义
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摘要
目的观察湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)患者的黄斑部外层视网膜管状结构(outer retinal tubulation,ORT)的OCT特征并分析其临床意义。方法回顾性分析经临床确诊的390例(478眼)湿性AMD患者的黄斑部OCT图像,对ORT的发生率、形态、大小、数量、位置及经抗血管内皮生长因子治疗后的形态变化进行分析总结。结果 478眼中有38眼黄斑部存在ORT,ORT发生率为7.95%;ORT主要存在于外层视网膜,表现为圆形或椭圆形高反射环,其内呈低反射或点状高反射;ORT的长度为73~3230μm,高度为73~183μm,每张OCT图像可见1~4个ORT。38眼中15眼曾接受玻璃体内注射抗血管内皮生长因子药物治疗,治疗后2~4个月黄斑部视网膜水肿减轻或消失,大多数患者ORT大小、位置无明显变化,仅1眼ORT内高反射物质较治疗前减少。结论部分湿性AMD患者黄斑部可见ORT,这些结构不同于视网膜囊样水肿,抗新生血管药物治疗后结构变化不明显或无变化。
Objective To observe the optical coherence tomography(OCT) image characteristics of outer retinal tubulation( ORT) in wet age-related macular degeneration( AMD) eyes and analyze its clinical significance. Methods A total of four hundreds and seventy-eight eyes of 390 patients with wet AMD were examined with spectral-domain OCT. The prevalence,shape,size,number,distribution and morphologic changes after anti-vascular endothelial growth factor(anti-VEGF) therapy of ORT in the 478 eyes were analyzed. Results The ORT structures were detected in 38 eyes out of 478 AMD eyes. The prevalence of ORT was 7. 95%. ORT were located in the outer nuclear layer of the retina,it appeared as round or ovoid structures with hyper reflective borders and contains hyporeflective or hyperreflective material within their lumen. The height of ORT structures ranged from 73 μm to 183 μm,and the width on horizontal OCT B-scan sections ranged from 73 μm to 3230 μm. Fifteen eyes of 38 eyes with ORT were injected antiVEGF. In eyes undergoing anti-VEGF therapy,the macular edema was reduced or disappeared from 2 months to 4 months,ORT remained stable over time,and the hyperreflective material was reduced in only one eye. Conclusion ORT can be detected in eyes of wet AMD patients. ORT is different from cystoid macular edema in remaining stable after anti-VEGF therapy while the latter usually being resolved.
Objective To observe the optical coherence tomography(OCT) image characteristics of outer retinal tubulation( ORT) in wet age-related macular degeneration( AMD) eyes and analyze its clinical significance. Methods A total of four hundreds and seventy-eight eyes of 390 patients with wet AMD were examined with spectral-domain OCT. The prevalence,shape,size,number,distribution and morphologic changes after anti-vascular endothelial growth factor(anti-VEGF) therapy of ORT in the 478 eyes were analyzed. Results The ORT structures were detected in 38 eyes out of 478 AMD eyes. The prevalence of ORT was 7. 95%. ORT were located in the outer nuclear layer of the retina,it appeared as round or ovoid structures with hyper reflective borders and contains hyporeflective or hyperreflective material within their lumen. The height of ORT structures ranged from 73 μm to 183 μm,and the width on horizontal OCT B-scan sections ranged from 73 μm to 3230 μm. Fifteen eyes of 38 eyes with ORT were injected antiVEGF. In eyes undergoing anti-VEGF therapy,the macular edema was reduced or disappeared from 2 months to 4 months,ORT remained stable over time,and the hyperreflective material was reduced in only one eye. Conclusion ORT can be detected in eyes of wet AMD patients. ORT is different from cystoid macular edema in remaining stable after anti-VEGF therapy while the latter usually being resolved.
引文
1 Goldberg NR,Greenberg JP,Laud K,Tsang S,Freund KB.Outer retinal tubulation in degenerative retinal disorders[J].Retina,2013,33(9):1871-1876.
2 Wolff B,Matet A,Vasseur V,Sahel JA,Mauget-Fasse M.En face OCT imaging for the diagnosis of outer retinal tubulations in age-related macular degeneration[J].J Ophthalmol,2012,2012:542417.
3 杨佳,王慧娟,张红.湿性年龄相关性黄斑变性OCT图像特征临床观察[J].临床眼科杂志,2013,21(1):7-11.
4 中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制定委员会.中国老年性黄斑变性临床诊断治疗路径[J].中华眼底病杂志,2013,29(4):343-355.
5 黎晓新.普及推广“中国老年性黄斑变性临床诊断治疗路径”,规范老年性黄斑变性的诊断治疗[J].中华眼底病杂志,2013,29(4):341-342.
6 马臻,王海燕,王雨生,张鹏,胡丹,孙董洁,等.光动力疗法联合玻璃体腔注射抗新生血管内皮生长因子单克隆抗体bevacizumab治疗渗出型老年性黄斑变性的疗效观察[J].中华眼底病杂志,2013,29(4):356-361.
7 Lalwani GA,Rosenfeld PJ,Fung AE,Dubovy SR,Michels S,Feuer W,et al.A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration:year 2 of the PrONTO Study[J].Am J Ophthalmol,2009,148(1):43-58.
8 Zweifel SA,Engelbert M,Laud K,Margolis R,Spaide RF,Freund KB.Outer retinal tubulation:A novel optical coherence tomography finding[J].Arch Ophthalmol,2009,127(12):1596-1602.
9 Curcio CA,Medeiros NE,Millican CL.Photoreceptor loss in age-related macular degeneration[J].Invest Ophthalmol Vis Sci,1996,37(7):1236-1249.
10 俞笳,邓国华.年龄相关性黄斑变性[M]//姜春晖,主编.频域光学相干视网膜断层扫描仪.上海:复旦大学出版社,2011:59-75.
11 Iriyama A,Aihara Y,Yanagi Y.Outer retinal tubulation in inherited retinal degenerative disease[J].Retina,2013,33(7):1462-1465.
12 Jung JJ,Freund KB.Long-term follow-up of outer retinal tubulation documented by eye-tracked and En face spectral-domain optical coherence tomography[J].Arch Ophthalmol,2012,130(12):1618-1619.
2 Wolff B,Matet A,Vasseur V,Sahel JA,Mauget-Fasse M.En face OCT imaging for the diagnosis of outer retinal tubulations in age-related macular degeneration[J].J Ophthalmol,2012,2012:542417.
3 杨佳,王慧娟,张红.湿性年龄相关性黄斑变性OCT图像特征临床观察[J].临床眼科杂志,2013,21(1):7-11.
4 中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制定委员会.中国老年性黄斑变性临床诊断治疗路径[J].中华眼底病杂志,2013,29(4):343-355.
5 黎晓新.普及推广“中国老年性黄斑变性临床诊断治疗路径”,规范老年性黄斑变性的诊断治疗[J].中华眼底病杂志,2013,29(4):341-342.
6 马臻,王海燕,王雨生,张鹏,胡丹,孙董洁,等.光动力疗法联合玻璃体腔注射抗新生血管内皮生长因子单克隆抗体bevacizumab治疗渗出型老年性黄斑变性的疗效观察[J].中华眼底病杂志,2013,29(4):356-361.
7 Lalwani GA,Rosenfeld PJ,Fung AE,Dubovy SR,Michels S,Feuer W,et al.A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration:year 2 of the PrONTO Study[J].Am J Ophthalmol,2009,148(1):43-58.
8 Zweifel SA,Engelbert M,Laud K,Margolis R,Spaide RF,Freund KB.Outer retinal tubulation:A novel optical coherence tomography finding[J].Arch Ophthalmol,2009,127(12):1596-1602.
9 Curcio CA,Medeiros NE,Millican CL.Photoreceptor loss in age-related macular degeneration[J].Invest Ophthalmol Vis Sci,1996,37(7):1236-1249.
10 俞笳,邓国华.年龄相关性黄斑变性[M]//姜春晖,主编.频域光学相干视网膜断层扫描仪.上海:复旦大学出版社,2011:59-75.
11 Iriyama A,Aihara Y,Yanagi Y.Outer retinal tubulation in inherited retinal degenerative disease[J].Retina,2013,33(7):1462-1465.
12 Jung JJ,Freund KB.Long-term follow-up of outer retinal tubulation documented by eye-tracked and En face spectral-domain optical coherence tomography[J].Arch Ophthalmol,2012,130(12):1618-1619.