视网膜中央动脉阻塞患眼治疗前后黄斑中心凹视网膜和脉络膜厚度变化

摘要

目的 观察视网膜中央动脉阻塞(CRAO)患眼治疗前后黄斑中心凹视网膜厚度(CRT)和脉络膜厚度(SFCT)变化.方法 回顾性病例分析.经荧光素眼底血管造影(FFA)检查确诊的CRAO患者34例34只眼纳入研究.其中,男性18例18只眼,女性16例16只眼.平均年龄(61.42±14.09)岁;平均发病时间(2.64±3.73)d;平均入院治疗时间(11.92±4.95)d.平均眼轴长度(AL) (23.53±2.04) mm.均行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、眼底彩色照相、FFA、频域光相干断层扫描(OCT)检查以及AL测量.BCVA记录时换算为最小分辨角对数(logMAR)视力.根据患眼BCVA、眼底改变以及频域OCT、FFA检查结果,将患者分为不完全型、次全型、完全型,并据此分组,分别为15例15只眼、8例8只眼、11例11只眼.采用德国Heidelberg公司频域OCT仪增强深部成像技术测量患眼及对侧健康眼SFCT和CRT.治疗后随访1个月,平均随访时间(34.71±6.82)d.对比观察治疗前后SFCT、CRT、BCVA变化;同时分析治疗后BCVA与治疗前CRT的相关性.结果 治疗后1个月,不完全型组、次全型组、完全型组logMAR BCVA均较治疗前提高,差异有统计学意义(t=3.74、3.61、3.26,P=0.004、0.009、0.017).治疗前,完全型组、次全型组、不完全型组对侧健康眼平均CRT分别为(215.00±19.85)、(224.00±22.79)、(214.00±8.21) μm,平均SFCT分别为(264.54±121.71)、(266.50±58.17)、(261.86±90.95) μm;患眼平均CRT分别为(353.18±60.26)、(280.14±11.08)、(266.63±19.65) μm,平均SFCT分别(233.72±111.35)、(237.75±53.30)、(259.86±98.14) μrn.与对侧健康眼比较,三组患眼平均CRT均增厚,差异有统计学意义(t=8.274,3.694,11.577,P＜0.001、0.008、＜0.001);完全型组患眼平均SFCT降低,差异有统计学意义(t=2.138,P=0.048).三组患眼之间平均CRT比较,差异有统计学意义(F=1 2.02,P＜0.001);平均SFCT比较,差异无统计学意义(F=0.178,P=0.838).治疗后1个月,完全型组、次全型组、不完全型组患眼平均CRT分别为(231.18±49.28)、(219.16±21.34)、(217.86±24.98) μm,平均SFCT分别为(239.81±109.57)、(241.86±42.81)、(260.57±91.67)μm.与治疗前比较,三组患眼平均CRT均降低,差异有统计学意义(t=13.032,3.711,4.970,P＜0.001、0.008、0.003);平均SFCT差异均无统计学意义(t=-0.785,-0.202,-0.078,P=0.466、0.845、0.940).相关性分析结果显示,治疗后BCVA与治疗前CRT呈正相关(比值比=0.578,P=0.002).结论 CRAO患者初始CRT增厚,治疗后恢复正常;治疗后BCVA与治疗前CRT呈正相关.%Objective To observe the center retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) in eyes with central retinal artery occlusion (CRAO) before and after treatment.Methods A total of 34 patients (34 eyes) diagnosed with CRAO by fundus fluorescence angiography (FFA) were retrospectively analyzed.There were 18 males (18 eyes) and 16 females (16 eyes).The average age was (61.42± 14.09) years.The mean onset time was (2.64±3.73) days.The mean hospitalization time was (11.92 ±4.95) days.The mean axial length (AL) was (23.53 ± 2.04) mm.The best-corrected visual acuity (BCVA),slit-lamp biomicroscopy,indirect ophthalmoscopy,fundus color photography,fundus fluorescein angiography,spectral domain optical coherence tomography (OCT) and AL measurement were performed.BCVA was converted to the logarithm of the minimum angle of resolution (logMAR).According to FFA,visual loss and the results of OCT,patients were divided into 3 groups:incomplete CRAO (15 eyes),subtotal CRAO (8 eyes),total CRAO (11 eyes).SFCT and CRT in affected and the fellow eye were measured by OCT for enhanced deep imaging.Follow up lasted for 1 month after treatment,with an average follow-up of (34.71 ± 6.82) days.The changes of S FCT,CRT,and BCVA before and after treatment were observed.The correlation between BCVA after treatment and pretreatment CRT was also analyzed.Results After 1 month of follow-up,the logMAR BCVA in incomplete group,subtotal group and total group were significantly higher than before treatment (t=3.74,3.61,3.26;P=0.004,0.009,0.017).Before treatment,the average CRT of the contralateral eyes in the total,subtotal and incomplete group were (215.00± 19.85),(224.00±22.79),(214.00±8.21) μtm,and the mean SFCT were (264.54± 121.71),(266.50±58.17),(261.86±90.95) μm.The average CRT of the affected eyes were (353.18±60.26),(280.14± 11.08),(266.63±19.65) μtm,and the average SFCT were (233.72± 111.35),(237.75 ± 53.30),(259.86±98.14) mm.Compared with the fellow eyes,the average CRT in the 3 groups were thickened,and the difference were statistically significant (t=8.274,3.694,11.577;P＜0.001,0.008,＜0.001);the average SFCT in the total group was decreased,the difference was statistically significant (t=-2.138,P=0.048).The mean CRT among the 3 groups of eyes was statistically significant (F=1 2.02,P＜ 0.001).There was no significant difference in the average SFCT (F=0.178,P=0.838).After 1 month follow-up,the mean CRT in the total,subtotal and incomplete group were (231.18 ± 49.28),(219.16± 21.34),(217.86± 24.98) μm,and the average SFCT were (239.81 ± 109.57),(241.86±42.81),(260.57±91.67) μan.Compared with before treatment,the average CRT in the three groups of eyes were decreased,the difference were statistically significant (t=13.032,3.711,4.970;P＜0.001,0.008,0.003);the difference in mean SFCT were not statistically significant (t=-0.785,-0.202,-0.078;P=0.466,0.845,0.940).Correlation analysis showed that BCVA after treatment was positively correlated with pretreatment CRT (odds ratio=0.578,P=0.002).Conclusion CRAO resulted in CRT in the preliminary stage and became thinner after receiving treatments.There exists a positive correlation between visual outcome and CRT before receiving treatments.