B型超声和光学相干断层扫描在老年玻璃体后脱离临床诊断中的价值

Diagnosis value of B-mode ultrasonography versus optical coherence tomography for senile posterior vitreous detachment

摘要:

目的 比较B型超声和频域光学相干断层扫描(SD-OCT)检查在老年玻璃体后脱离(PVD)临床诊断中的作用。方法 2015年5月至9月随机选取＞60岁、无明显内眼疾患和手术史、屈光度在<±3 D的门诊以眼前黑影飘动为主诉患者62例70只眼纳入研究。对比观察B型超声、SD-OCT不同检查方法的PVD检测结果。结果 B型超声检查结果显示完全性PVD 39例43眼，占61.4%；不完全性PVD 23例27眼，占38.6%。OCT检查结果显示不完全性PVD 19例23眼，占32.8%；与B型超声检查病例显示结果相一致。OCT检查结果未显示PVD的43例47眼，占67.1%。OCT检查结果显示PVD者均为不完全性PVD。全部病例OCT检查有11眼（15.7%）为视网膜前膜；有4眼(5.7%)为黄斑裂孔；有6眼（8.6%）为玻璃体黄斑牵引的患者；9眼(12.8%)早期老年性黄斑变性。结论 B型超声检查对老年PVD的检出率明显高于SD-OCT检查;SD-OCT检查对早期不完全性PVD的显示明显优于B型超声检查。联合B型超声和SD-OCT检查可以显著提高PVD的临床检出率。

Abstract:

Objective To compare the roles of B-mode ultrasonography and spectral-domain optical coherence tomography (SD-OCT) in the diagnosis of senile posterior vitreous detachment (PVD). Methods A total of 62 old patients (over 60 years old, 70 eyes), with no obvious eye diseases or surgery history, refractive power within ±3 Diopter, and main complaint of flickering shadows, who admitted in Outpatient Department of our hospital from May to September 2015 were randomly enrolled in this study. All the patients underwent routine eye examination, B-mode ultrasonography, and SD-OCT, and the results of B-mode ultrasonography and SD-OCT were compared for the diagnosis of PVD. Results B-mode ultrasound results showed there were 39 cases of complete PVD (43 eyes, 61.4%) and 23 cases of incomplete PVD (27 eyes, 38.6%). OCT showed 19 cases were incomplete PVD (23 eyes, 32.8%), which was consistent with the results of B-mode ultrasound examination. OCT indicated that there were 43 cases (47 eyes, 67.1%) having no PVD, and all identified PVD were incomplete PVD. OCT results indicated that there were 11 eyes (15.7%) of macular epiretinal membrane, 4 eyes (5.7%) of macular hole, and 6 eyes (8.6%) of vitreomacular traction, and 9 eyes (12.8) of early age-related macular degeneration. Conclusion B-mode ultrasonography provides a significant higher detection rate of senile PVD than SD-OCT. But SD-OCT has more advantages than ultrasound in detecting the early incomplete PVD. Combination of B-mode ultrasonography and SD-OCT significantly improves the detection rate of PVD.