利用OCT观察流行性出血性结膜炎的临床研究

摘要

目的：利用光学相干断层扫描技术( optical coherence tomography,OCT)观察流行性出血性结膜炎治疗前后结膜厚度及形态变化。　　方法：使用 OCT 对上海中医药大学附属普陀医院眼科2013-05/12收治的初发1~2 d的29例36眼流行性出血性结膜炎患者进行球结膜厚度测量及形态学观察,并在治疗7,14 d后复诊时再次测量患者的球结膜厚度并观察球结膜形态变化。　　结果：患者29例36眼中,治疗7 d流行性出血性结膜炎治愈(27眼)患者中治疗前球结膜全层厚度(344.00±59-91μm)较治疗后球结膜全层厚度(230.19±22.16μm)更厚,差异有统计学意义(t=11.75,P<0.01)；治疗前球结膜上皮层厚度(56.52±6.19μm)较治疗后球结膜上皮层厚度(51.37±5.53μm)更厚,差异有统计学意义( t=4.61, P<0.01)；治疗前球结膜固有层厚度(287.11±60.56μm)较治疗后球结膜固有层厚度(178.81±20.20μm)更厚,差异有统计学意义(t=10.69,P<0.01)。治疗14d,36眼全部治愈,治疗前球结膜全层厚度(361.39±65.56μm)较治疗后(233.44±22.57μm)更厚,差异有统计学意义( t=14-45,P<0.01)；治疗前球结膜上皮层厚度(55.50±6-72μm)较治疗后(46.67±5.24μm)更厚,差异有统计学意义( t=10.06, P<0.01)；治疗前球结膜固有层厚度(305.61±66.02μm)较治疗后(186.78±21.82μm)更厚,差异有统计学意义(t=13.11,P<0.01)。　　结论：利用OCT能测量流行性出血性结膜炎的球结膜厚度,并发现流行性出血性结膜炎患者球结膜上皮层、固有层和全层厚度都明显增厚,并且随着疾病的转归球结膜下积液和球结膜层间积液、固有层水肿首先消失,为流行性出血性结膜炎的临床治疗提供评价±据。%AIM: To observe thickness and morphological changes of bulbar conjunctiva pre- and post epidemic hemorrhagic conjunctivitis ( EHC ) therapy by optical coherence tomography ( OCT) . METHODS: Observed morphological changes and measured the bulbar conjunctiva thicknesses of 29 cases (36 eyes) of incipient (1-2d) EHC patients, who were received and treated by department of ophthalmology, the Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine from May 2013 to December 2013, by OCT. Then measured the thickness again on 7, 14d after the therapy. RESULTS: Among 29 patients (36 eyes), 7d after the EHC therapy, in 27 cured eyes, the full-thickness ( before 344. 00±59. 91μm, after 230. 19±22. 16μm, t=11. 75, P<0-01); epithelial thickness ( before 56. 52±6. 19μm, after 51. 37±5. 53μm, t=4. 61, P<0. 01); and stromal thickness (before 287. 11±60. 56μm, after 178. 81±20. 20μm, t=10. 69, P<0. 01) of patients' bulbar conjunctiva were thicker than values measured after therapy with significant difference. Significant difference was also found for full-thickness ( before 361. 39±65. 56μm, after 233. 44±22. 57μm, the difference was statistically significant, t=14. 45, P<0. 01);epithelial thickness ( before 55. 50±6. 72μm, after 46. 67±5-24μm, t=10. 06, P<0. 01) and stromal thickness ( before 305. 61±66. 02μm, after 186. 78±21. 82μm, t=13. 11, P<0-01 ) of patients' bulbar conjunctiva between values measured before and 14d after therapy. CONCLUSION: The OCT is able to measure the thickness of bulbar conjunctiva in EHC patients. An significant increase was found in full, epithelial and stromal thickness of EHC patients' bulbar conjunctiva. With recovery from the disease, subepithelial fluid, interlaminar fluid and edema of the bulbar conjunctival stroma faded away firstly, which provide references for clinical therapies of the EHC.