Cornut P-L, Bieber J, Beccat S, Fortoul V, Poli M, Feldman A, Denis P, Burillon C
Service d'ophtalmologie, université Lyon-1, hospices civils de Lyon, hôpital Edouard-Herriot, CHU de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
J Fr Ophtalmol. 2012 Oct;35(8):606-13. doi: 10.1016/j.jfo.2012.04.008. Epub 2012 Jul 21.
Retinal artery occlusions are a straightforward, essentially clinical diagnosis. The role of spectral domain ocular coherence tomography (SD-OCT) in this condition is not well described.
Anoxic retinal edema develops in the acute phase of retinal artery occlusion (RAO) followed by a regressive phase giving way to retinal atrophy. The purpose of the study was to determine dynamics of theses retinal changes in central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) using spectral domain optical coherence tomography (SD-OCT).
A prospective study of patients hospitalized at Hôpital Edouard-Herriot de Lyon between June and September 2009 was performed after patient education and informed consent. Retinal thickness of patients with central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or cilio-retinal artery occlusion was measured centered on the macula or on the site of occlusion with spectral domain optical coherence tomography (SD-OCT) using Cirrus(®) (Carl Zeiss Meditec, Germany) upon admission, throughout hospitalization, at 1 month and at 3 months. Thickness and reflectivity of the various retinal layers were compared with the fellow eye.
Fourteen patients were included (seven CRAO, six BRAO and one cilio-retinal artery occlusion). SD-OCT in the acute phase showed retinal thickening and increased reflectivity confined to the inner retinal layers supplied by the retinal circulation with decreased reflectivity from the photoreceptor and retinal pigment epithelial layers secondary to a shadowing effect in the affected area. These changes subsequently resolved at 1 month and gave way to a marked thinning of the inner retinal layers by 3 months. In one case of CRAO associated with an ophthalmic artery occlusion and consequent occlusion of the ciliary circulation as well, initial OCT revealed complete retinal thickening involving both the inner and outer layers.
This study demonstrates that the anoxic intracellular edema resulting from retinal artery occlusions (RAO) observed histologically appears on OCT as a thickening of the inner retinal layers in the acute stage of the condition, giving way to atrophic areas starting at approximately 1 month ("pseudonormalization") and becoming clearly atrophic at 3 months.
SD-OCT is useful in the diagnosis of RAO, especially if the patient is seen later in the disease process, when the ischemic retinal whitening is no longer present on fundus exam.
视网膜动脉阻塞是一种直接基于临床的诊断。光谱域光学相干断层扫描（SD - OCT）在这种疾病中的作用尚未得到充分描述。
视网膜动脉阻塞（RAO）急性期会出现缺氧性视网膜水肿，随后进入消退期，最终发展为视网膜萎缩。本研究的目的是利用光谱域光学相干断层扫描（SD - OCT）确定视网膜中央动脉阻塞（CRAO）和视网膜分支动脉阻塞（BRAO）时这些视网膜变化的动态过程。
2009年6月至9月期间，在里昂爱德华·埃里奥医院住院的患者在接受患者教育并获得知情同意后进行了一项前瞻性研究。使用德国卡尔·蔡司医疗技术公司的Cirrus（®）光谱域光学相干断层扫描（SD - OCT），在黄斑中心或阻塞部位测量视网膜中央动脉阻塞（CRAO）、视网膜分支动脉阻塞（BRAO）或睫状视网膜动脉阻塞患者的视网膜厚度，测量时间为入院时、整个住院期间、1个月和3个月。将各视网膜层的厚度和反射率与对侧眼进行比较。
纳入14例患者（7例CRAO、6例BRAO和1例睫状视网膜动脉阻塞）。急性期的SD - OCT显示视网膜增厚，反射率增加局限于由视网膜循环供应的视网膜内层，而由于受影响区域的遮蔽效应，光感受器和视网膜色素上皮层的反射率降低。这些变化随后在1个月时消退，到3个月时视网膜内层明显变薄。在1例与眼动脉阻塞相关且睫状循环随之阻塞的CRAO病例中，最初的OCT显示视网膜全层增厚，累及内层和外层。
本研究表明，组织学上观察到的视网膜动脉阻塞（RAO）导致的缺氧性细胞内水肿在OCT上表现为疾病急性期视网膜内层增厚，大约1个月时开始出现萎缩区域（“假性正常化”），3个月时明显萎缩。
SD - OCT对RAO的诊断有用，特别是在疾病后期就诊的患者中，此时眼底检查中缺血性视网膜变白已不存在。
