18例特发性低眼压性黄斑病变患者临床分析

摘要

目的 观察特发性低眼压性黄斑病变患者的临床特点.方法 回顾性病例研究.2012年8月至2017年12月在温州医科大学附属第二医院眼科确诊的特发性低眼压性黄斑病变患者18例18只眼纳入研究.其中,男性8例8只眼,女性10例10只眼;均为单眼.所有患者均行BCVA、验光、裂隙灯显微镜、眼底彩色照相、UBM、B型超声、OCT、FFA检查,以及眼轴长度(AL)测量.BCVA记录时转换为logMAR视力.对比观察患眼、对侧健康眼检查结果.患眼及对侧健康眼眼压、屈光度、AL比较行配对t检验.结果 18只患眼中,logMAR BCVA＜ 1.0、1.0～2.0分别为6、10只眼;光感2只眼.平均屈光度(+2.32±1.78) D;平均眼压(5.18±1.38) mmHg(1 mmHg=0.133 kPa);平均AL(20.92±1.61) mm.患眼、对侧健康眼平均眼压(t=21.6,P＜0.000)、平均屈光度(t=5.9,P=0.002)、AL(t=9.13,P＜0.000)比较,差异均有统计学意义.眼前节炎症13只眼(72.22％),未见浅层巩膜充血.所有患眼均可见后极部视网膜、脉络膜皱褶样改变;视盘水肿13只眼,视网膜静脉纡曲、扩张14只眼;黄斑隆起7只眼.UBM、房角镜检查,所有患眼房角开放,无房角劈裂;睫状体后囊肿6只眼.B型超声检查,所有患眼眼球壁增厚;视盘结节状影5只眼.OCT检查,所有患眼视网膜、脉络膜可见明显锯齿状皱褶样改变,且脉络膜皱褶更明显.FFA检查,视盘周边荧光素渗漏13只眼;黄斑、后极部视网膜未见异常荧光素渗漏.结论 特发性低眼压性黄斑病变临床表现多样;OCT示后极部视网膜、脉络膜锯齿状皱褶样改变为其典型特征.%Objective To summarize the clinical features in idiopathic hypotony maculopathy.Methods A retrospective case series study.Eighteen eyes of 18 patients who were diagnosed with idiopathic hypotony maculopathy were enrolled in the Second Affiliated Hospital of Wenzhou Medical University from August 2012 to December 2017.There were 8 males (8 eyes) and 10 females (10 eyes).All patients underwent examinations including BCVA,optometry,slit lamp microscope,fundus color photography,UBM,B-mode ultrasound,OCT,FFA and axial length (AL).BCVA was recorded with logMAR acuity.The results of affected eyes and contralateral healthy eyes were compared.Paired t test was performed to compare the intraocular pressure (IOP),diopter and AL of the affected eyes and contralateral healthy eyes.Results Among 18 eyes,there were 6 eyes with logMAR BCVA＜ 1.0,10 eyes with logMAR BCVA 1.0-2.0,2 eyes with light perception.The average diopter was +2.32± 1.78 D.The average IOP was 5.18± 1.38 mmHg (1 mmHg=0.133 kPa).The average AL was 20.92± 1.61 mm.The differences of IOP (t=21.6,P＜ 0.000),diopter (t=5.9,P=0.002) and AL (t=9.13,P＜0.000) between the affected eyes and contralateral healthy eyes were significant.The inflammatory reaction in the anterior segment was observed in 13 eyes (72.22％).In the posterior segment,all the eyes were documented with chorioretinal folds,optic disc swelling and retinal phlebectasia were also demonstrated in 14 eyes,while with macular uplift in 7 eyes.In the UBM and gonioscope examination,the angle chamber was open in all patients with ciliary body cyst in 6 eyes,while no ciliary body detachment was detected.All eyes had been examined with B-scan ultrasound and found the increasing thickness of eye ball in all eyes,and nodular changes in the optic papilla in 5 eyes.The chorioretinal folds were further confirmed by OCT with the appearance of the gear shape,much more obviously in the chomid than that in retina.In the FFA,fluorescein leakage was found around the optic disc in 13 eyes at the late stage,while there was no obvious abnormal leakage in the macular or poster part of retina.Conclusions Idiopathic hypotony maculopathy could present with various clinical manifestations.The choroiretinal folds is typical clinical sign.