本文選題：視網(wǎng)膜靜脈阻塞 + 黃斑水腫��； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:運用光學(xué)相干斷層掃描(OCT)觀察視網(wǎng)膜靜脈阻塞(RVO)合并黃斑水腫(ME)黃斑區(qū)視網(wǎng)膜光感受器的形態(tài)學(xué)改變,探討其與視力的相關(guān)性,從而總結(jié)影響視力的相關(guān)因素,為指導(dǎo)臨床治療提供理論依據(jù)。方法:回顧性分析55例55眼RVO合并黃斑水腫的患者。記錄患者初診及復(fù)診的最佳矯正視力(BCVA[LogMAR]);運用OCT測量獲得光感受器形態(tài)學(xué)改變的相關(guān)數(shù)據(jù):初診時黃斑中心凹視網(wǎng)膜相關(guān)結(jié)構(gòu)的厚度,包括中心視網(wǎng)膜厚度(CRT)、感光細胞層厚度(PLT)、外核層厚度(ONLT),及黃斑變形指數(shù)(MDI)、黃斑水腫的分布位置;復(fù)診黃斑水腫消退或減輕時黃斑中心凹視網(wǎng)膜相關(guān)結(jié)構(gòu)的厚度、黃斑變形指數(shù)、光感受器橢圓體帶及外界膜的完整性。使用SPSS20.0統(tǒng)計軟件對結(jié)果進行整理分析。結(jié)果:1.初診時LogMAR視力與CRT、MDI、ONLT有相關(guān)性(r=0.512,P=0.000;r=0.315,P=0.019;r=0.439,P=0.001),與黃斑水腫分布的位置有相關(guān)性(r=-0.382,P=0.004),與PLT無相關(guān)性(r=0.081,P=0.559);經(jīng)過多重逐步回歸分析,初診LogMAR視力只與初診CRT存在線性依存關(guān)系(β=0.02,P=0.000);2.復(fù)診時LogMAR視力與初診LogMAR視力、復(fù)診PLT、橢圓體帶完整性、外界膜完整性有相關(guān)性(r=0.648,P=0.000,r=-0.339,P=0.011;r=0.850,P=0.000;r=-0.754,P=0.000),與復(fù)診CRT、MDI、ONLT無相關(guān)關(guān)系(r=0.002,P=0.991;r=0.088,P=0.524;r=0.154,P=0.260);經(jīng)過多重逐步回歸分析,復(fù)診視力與初診視力、橢圓體帶完整性、外界膜完整性存在線性依存關(guān)系(β=0.650,P=0.000;β=0.298,P=0.000;β=0.247,P=0.000);3.初診時,黃斑水腫分布于黃斑中心凹與位于黃斑中心一側(cè)或兩側(cè)的LogMAR視力分別為:0.68±0.30、1.16±0.66,差異有統(tǒng)計學(xué)意義(t=-3.71,P=0.000);4.復(fù)診時,橢圓體帶完整組、尚連續(xù)組、斷裂組的LogMAR視力分別為:0.26±0.15、0.48±0.29、1.53±0.59,各組間差異有統(tǒng)計學(xué)意義(P=0.000);再進行LSD兩兩比較,除橢圓體帶完整組和尚連續(xù)組之間差異無統(tǒng)計學(xué)意義(P=0.107)外,其余組之間差異有統(tǒng)計學(xué)意義(均P=0.000)。外界膜完整組與斷裂組的LogMAR視力分別為:0.38±0.27、1.42±0.66,差異有統(tǒng)計學(xué)意義(t=-0.91,P=0.000)。結(jié)論:1.初診時LogMAR視力與初診中心視網(wǎng)膜厚度、黃斑變形指數(shù)、中心凹外核層厚度相關(guān);與黃斑水腫分布的位置有相關(guān)性,越靠近黃斑中心,視力越差;其中,初診中心視網(wǎng)膜厚度是影響初診視力的因素;2.復(fù)診時LogMAR視力與初診LogMAR視力、復(fù)診感光細胞層的厚度相關(guān),與橢圓體帶及外界膜完整性相關(guān),橢圓體帶和外界膜結(jié)構(gòu)越完整,視力越好。初診視力、橢圓體帶完整性、外界膜完整性是影響復(fù)診視力的因素,其中,初診視力對復(fù)診視力的影響最大。
[Abstract]:Objective: To observe the morphological changes of retinal photoreceptor in retinal vein occlusion (RVO) combined with macular edema (ME) with optical coherence tomography (OCT), to explore the correlation between the retinal photoreceptor and the visual acuity, and to summarize the related factors affecting the visual acuity, and to provide a theoretical basis for guiding clinical treatment. Methods: a retrospective analysis of 55 eyes of 55 cases of RVO was reviewed. Patients with macular edema. Record the best corrected visual acuity (BCVA[LogMAR]) for early diagnosis and diagnosis; use OCT to measure the morphological changes of the photoreceptor: the thickness of the macular retina related structure at the first visit, including the thickness of the central retina (CRT), the thickness of the photoreceptor layer (PLT), the thickness of the outer nucleus (ONLT), and the macular change. Shape index (MDI), the distribution of macular edema, the thickness of the retina related structure of macular edema, macular degeneration index, the ellipsoid band and the integrity of the outer membrane when the macular edema subsided or reduced. The results were sorted with the SPSS20.0 statistical software. Results: 1. the visual acuity of LogMAR was associated with CRT, MDI, ONLT at first diagnosis. R=0.512, P=0.000; r=0.315, P=0.019; r=0.439, P=0.001) were correlated with the location of macular edema (r=-0.382, P=0.004), and there was no correlation with PLT (r=0.081, P=0.559). After multiple stepwise regression analysis, the first diagnosis LogMAR vision only existed in the linear dependency relationship with the first diagnosis. 2. Visual acuity, PLT, integrity of ellipsoid, correlation of external membrane integrity (r=0.648, P=0.000, r=-0.339, P=0.011; r=0.850, P=0.000; r=-0.754, P=0.000); no correlation with CRT, MDI, ONLT; multiple stepwise regression analysis, visual acuity and primary vision, ellipsoid There was a linear dependence on the integrity of the outer membrane integrity (beta =0.650, P=0.000; beta =0.298, P=0.000; beta =0.247, P=0.000). 3. at the initial diagnosis, macular edema was distributed in the macular fovea and the LogMAR vision at the one or both sides of the macular center, respectively, 0.68 + 0.30,1.16 + 0.66, and the difference was statistically significant (t=-3.71, P=0.000); 4. in the recovery of the ellipsoid zone. In the complete group, the LogMAR vision in the continuous group was 0.26 + 0.15,0.48 + 0.29,1.53 + 0.59, and the difference between the groups was statistically significant (P=0.000), and the difference between the complete group of the ellipsoid band and the continuous group was not statistically significant (P=0.107), and the difference between the other groups was statistically significant (P=0.000). The LogMAR visual acuity of the whole group and the fracture group were 0.38 + 0.27,1.42 + 0.66 respectively. The difference was statistically significant (t=-0.91, P=0.000). Conclusion: 1. at the first diagnosis, the visual acuity of LogMAR is related to the thickness of the retina, the macular deformation index, the thickness of the outer nucleus of the central concave; it is related to the location of the Huang Banshui swelling, the closer to the macular center, the more eyesight The retinal thickness of the first diagnosis center was a factor affecting the first diagnosis of the visual acuity. 2. the visual acuity of LogMAR was related to the thickness of the first diagnosis of LogMAR and the thickness of the photoreceptor layer, which was related to the integrity of the ellipsoid band and external membrane. The better the visual acuity, the integrity of the ellipsoid band and the integrity of the outer membrane, the better the vision, the integrity of the ellipsoid, and the integrity of the outer membrane. Sex is the factor that affects the vision of revisit. Among them, the initial vision is the most important factor.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R774

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