Xiao Hui, Liu Xing, Zhong Yi-min, Guo Xin-xing, Mi Lan, Li Mei
State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center, Sun Yat-sun University,Guangzhou 510060, China.
State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center, Sun Yat-sun University,Guangzhou 510060, China. Email:
Zhonghua Yan Ke Za Zhi. 2013 Dec;49(12):1069-74.
To observe the fundus features of nanophthalmos with or without secondary glaucoma using spectral domain optical coherence tomography (SD-OCT).
It was a retrospective case-series study. Twenty-three eyes of 12 patients (6 female, 6 male) who were clinically identified to be nanophthalmos (axial length ≤ 20.0 mm) in Zhongshan Ophthalmic Center from June 2008 to December 2010 and twenty-three eyes of 23 age and sex matched normal controls were included in this study. All patients underwent ophthalmological examinations including best-corrected visual acuity, refraction, slit-lamp biomicroscopy and fundus examination, Goldmann applanation tonometry, A-scan and B-scan ultrasound examinations, ultrasound biomicroscopy, fundus photography and spectral domain optical coherence tomography (SD-OCT). All examinations were carried out with natural pupil. The fundus features detected by OCT were compared between nanophthalmos and normal controls, and among nanophthalmos with or without secondary glaucoma.Independent-samples t test was used to analyze the difference of retinal thickness between nanophthalmoic eyes and controls and also between nanophthalmoic eyes with and without secondary glaucoma. Pearson correlation analysis was used to analyze the correlation between axial length and macular retinal thickness.
The average age of 12 patients was (25.0 ± 13.1) years, and the mean axial length was (17.30 ± 1.66) mm. Thirteen eyes suffered from secondary glaucoma because of angle closure with average intraocular pressure (IOP) of (28.62 ± 9.18) mm Hg (1 mm Hg = 0.133 kPa). The average IOP of the other 10 eyes without secondary glaucoma was (14.96 ± 3.21) mm Hg.OCT images revealed thickening of the retina in macular fovea, with residual retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, and broadened outer nuclear layer in 23 eyes with nanophthalmos. Pre-retinal folds were seen in 5 eyes with macular cysts.Shallow serous retinal detachment was found in 3 eyes, 2 of which showed focal thickening of retinal pigment epithelium as leopard spots. The cup were not obvious and retina around optic nerve head was thickened in 10 eyes without secondary glaucoma and 4 eyes with secondary early glaucoma, which seemed to be pseudopapilloedema. The other 9 eyes with secondary late glaucoma revealed enlarged cup . The mean macular foveal thickness of nanophthalmic eyes[ (335.65 ± 91.45) µm] was significantly thickened than normal control group [(192.72 ± 11.18) µm] (t = 10.50, P = 0.000) . The mean macular foveal thickness of nanophthalmos with glaucoma [(323.70 ± 104.09) µm] was thinner than those without glaucoma [(403.50 ± 130.24) µm] (t = 3.50, P = 0.002). Macular foveal thickness were negatively related with axial length in both nanophthalmos with and without secondary glaucoma (R = -0.797, P = 0.001).
Macular hypoplasia and crowded optic nerve head are two important characteristic of fundus appearances in nanophthamos.SD-OCT can clearly reveal the changes of macular retina and optic nerve head. SD-OCT will be a very useful tool to help diagnose nanophthamos and evaluate its possible complications.
采用频域光学相干断层扫描（SD - OCT）观察小眼球合并或不合并继发性青光眼的眼底特征。
这是一项回顾性病例系列研究。纳入2008年6月至2010年12月在中山大学中山眼科中心临床确诊为小眼球（眼轴长度≤20.0 mm）的12例患者（6例女性，6例男性）的23只眼，以及23例年龄和性别相匹配的正常对照者的23只眼。所有患者均接受眼科检查，包括最佳矫正视力、验光、裂隙灯生物显微镜检查和眼底检查、Goldmann压平眼压测量、A超和B超检查、超声生物显微镜检查、眼底照相和频域光学相干断层扫描（SD - OCT）。所有检查均在自然瞳孔下进行。比较小眼球组与正常对照组以及合并或不合并继发性青光眼的小眼球组之间OCT检测到的眼底特征。采用独立样本t检验分析小眼球眼与对照组之间以及合并和不合并继发性青光眼的小眼球眼之间视网膜厚度的差异。采用Pearson相关分析分析眼轴长度与黄斑视网膜厚度之间的相关性。
12例患者的平均年龄为（25.0±13.1）岁，平均眼轴长度为（17.30±1.66）mm。13只眼因房角关闭继发青光眼，平均眼压（IOP）为（28.62±9.18）mmHg（1 mmHg = 0.133 kPa）。另外10只未继发青光眼的眼平均眼压为（14.96±3.21）mmHg。OCT图像显示，23只小眼球眼中黄斑中心凹视网膜增厚，保留视网膜神经纤维层、神经节细胞层、内丛状层、内核层、外丛状层，外核层增宽。5只眼出现黄斑囊肿伴视网膜前皱褶。3只眼发现浅浆液性视网膜脱离，其中2只眼视网膜色素上皮有豹纹状局灶性增厚。10只未继发青光眼的眼和4只继发早期青光眼的眼中视盘杯不明显，视神经乳头周围视网膜增厚，似假性视乳头水肿。另外9只继发晚期青光眼的眼杯盘增大。小眼球眼的平均黄斑中心凹厚度[（335.65±91.45）μm]明显厚于正常对照组[（192.72±11.18）μm]（t = 10.50，P = 0.000）。合并青光眼的小眼球眼的平均黄斑中心凹厚度[（323.70±104.09）μm]薄于未合并青光眼的小眼球眼[（403.50±130.24）μm]（t = 3.50，P = 0.002）。合并和不合并继发性青光眼的小眼球眼中黄斑中心凹厚度均与眼轴长度呈负相关（R = -0.797，P = 0.001）。
黄斑发育不全和视神经乳头拥挤是小眼球眼底外观的两个重要特征。SD - OCT能清晰显示黄斑视网膜和视神经乳头的变化。SD - OCT将是帮助诊断小眼球并评估其可能并发症的非常有用的工具。
