首页|多模式影像检查对年龄相关性黄斑变性视网膜下玻璃膜疣样沉积的诊断价值及特征分析

多模式影像检查对年龄相关性黄斑变性视网膜下玻璃膜疣样沉积的诊断价值及特征分析

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目的 评估多模式影像检查对年龄相关性黄斑变性(AMD)视网膜下玻璃膜疣样沉积(SDD)的诊断价值,观察其影像特征。方法 前瞻性临床研究。2019年12月至2023年12月于山东省眼科医院经频域光相干断层扫描(SD-OCT)检查确诊的AMD-SDD患者65例104只眼纳入研究。患眼均行最佳矫正视力(BCVA)、免散瞳彩色眼底照相(CFP)、多波长炫彩成像(MC)、超广角眼底成像(UWF)、SD-OCT检查。采用海德堡Spectralis HRA+OCT一体机行MC检查,获得标准MC图像。观察分析SDD的多模式影像特征。采用受试者工作特征曲线下面积评估CFP、MC、UWF检测SDD的灵敏度和特异性。结果 65例104只眼中,男性29例52只眼,女性36例52只眼;单眼、双眼分别为26、39例;年龄(71。74±10。97)岁。AMD早、中、晚期分别为31(29。8%,31/104)、24(23。1%,24/104)、49(47。1%,49/104)只眼。CFP、MC、UWF分别检出SDD 76(73。1%,76/104)、94(90。4%,94/104)、96(92。3%,96/104)只眼。CFP检查示黄斑区SDD边缘模糊。UWF检查示点状、带状SDD分别表现为淡黄色离散沉积和淡黄色交织网状沉积。MC检查示点状SDD呈黄绿色圆形强反射,带状SDD其边缘环绕弱反射,边界清晰。SD-OCT检查示SDD呈强反射信号,位于视网膜色素上皮层和光感受器细胞层之间。点状SDD可突破椭圆体带而致外界膜轻度隆起或中断,表现为圆锥样强反射信号。带状SDD表现为连续"山丘状"突起,几乎不突破椭圆体带。CFP、MC、UWF检测SDD灵敏度、特异性分别为73。1%、90。4%、92。3%和61。1%、94。4%、83。3%。结论 MC和UWF在诊断AMD-SDD方面显示出较高的灵敏度和特异性,优于CFP;而SD-OCT能有效揭示SDD在视网膜下的位置和形态特征。
Diagnostic value and characteristic analysis of multimodal imaging in subretinal drusenoid deposit in age-related macular degeneration
Objective To observe the multi-modal fundus imaging features of subretinal drusenoid deposit(SDD)in age-related macular degeneration(AMD),and observe image features.Methods A prospective clinical study.From December 2019 to December 2023,65 patients(104 eyes)with a diagnosis of AMD-SDD by spectral domain optical coherence tomography(SD-OCT)examination in Shandong Eye Hospital were included.All eyes were examined by best corrected visual acuity(BCVA),traditional color fundus photography(CFP),ultra-wide-angle scanning laser fundus imaging(UWF),multicolor scanning laser fundus imaging(MC)and SD-OCT.The standard MC images were obtained by using Spectralis HRA+OCT for MC examination.The multi-mode image characteristics of SDD were analyzed retrospectively.Area under curve(AUC)was used to evaluate the sensitivity and specificity of CFP,MC and UWF in detecting SDD.Results Among 65 patients with SDD,29 cases of males(52 eyes)and 36 cases of females(52 eyes)was included.There were 26 patients with unilateral SDD and 39 patients with bilateral SDD.The average age was(71.74±10.97)years.The early,middle and late stages of AMD were 31(29.8%,31/104),24(23.1%,24/104),49(47.1%,49/104)eyes,respectively.The SDD detected by CFP,MC and UWF was 76(73.1%,76/104),94(90.4%,94/104),96(92.3%,96/104)eyes.CFP showed that the edge of SDD in the macular area was blurred.UWF showed that the dot and the ribbon SDD were light yellow pale discrete deposits and light yellow interlaced network deposits respectively.MC showed the dot SDD had a strong yellow-green circular reflection,while the edge of the ribbon SDD was surrounded by a weak reflection,and the boundary was clear.SD-OCT showed that SDD had strong reflection signal,which was located between the retinal pigment epithelium layer and the photoreceptor cell layer.The dot SDD could break through the ellipsoid zone and caused slight uplift or interruption of the external membrane,showing a cone-like strong reflection signal.While the ribbon SDD showed a continuous"hill-like"protrusion,which hardly broke through ellipsoid zone.The sensitivity and specificity of CFP,MC and UWF for SDD were 73.1%,90.4%,92.3%and 61.1%,94.4%and 83.3%,respectively.Conclusions MC and UWF show high sensitivity and specificity in diagnosing AMD-SDD,which is superior to CFP.SD-OCT can effectively reveal the location and morphoLogical characteristics of SDD under retina.

Age-related macular degenerationSubretinal drusenoid depositReticular pseudophakicMultimodal imagingDiagnostic value

张稚平、王红艳、谢肖、孟洁、王金艳、何煦、赵思平、刘婷婷

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山东中医药大学第一临床医学院,济南 250014

山东第一医科大学附属眼科研究所山东第一医科大学附属眼科医院(山东省眼科医院),济南 250002

山东第一医科大学眼科学院,济南 250062

山东省眼科学重点实验室-省部共建国家重点实验室培育基地,青岛 266071

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年龄相关性黄斑变性 玻璃膜疣样沉积 网状假性玻璃膜疣 多模式影像 诊断价值

山东第一医科大学青年科学基金培育资助计划白求恩·朗沐中青年眼科科研基金

202201-118BJ-LM2021007J

2024

中华眼底病杂志
中华医学会

中华眼底病杂志

CSTPCD北大核心
影响因子:0.928
ISSN:1005-1015
年,卷(期):2024.40(9)