摘要目的 观察黄斑脉络膜凹陷的临床特征.方法 经频域高清光相干断层扫描(HD-OCT)检查确诊为黄斑脉络膜凹陷的22例患者22只眼纳入研究.其中,男性12例,占54.50％;女性10例,占45.50％.年龄21～82岁,平均年龄(41.44±13.17)岁.均为单眼发病,右眼9只,左眼13只.所有患眼均行矫正视力、裂隙灯显微镜联合前置镜、眼底彩色照相、HD-OCT及荧光素眼底血管造影(FFA)检查.观察分析患眼的临床表现及伴随疾病的发生情况.随访3～12个月者17只眼.随访期间重复行HD-OCT检查,了解患眼凹陷病灶的变化情况.结果 22只眼中,有眼前黑影、视物变形等症状18只眼,占81.80％;无症状4只眼,占18.20％.患眼矫正视力0.3～1.2,伴中高度近视12只眼,占54.54％.眼底检查发现,黄斑区可见黄白色渗出12只眼,占54.54％;黄白色渗出伴出血9只眼,占40.91％;黄斑灰黄反光晕1只眼,占4.55％.HD-OCT检查发现,所有患眼黄斑凹陷层次为视网膜色素上皮(RPE)层,光感受器外节/RPE复合体(OPR)层均消失.伴其内的外界膜(ELM)、光感受器内外节连接(IS/OS)层向外凹陷13只眼,占59.09％;ELM、IS/OS层消失9只眼,占40.91％.22只眼中,仅见单个脉络膜凹陷病灶10只眼,占45.45％;伴特发性黄斑脉络膜新生血管、点状内层脉络膜炎各4只眼,分别占18.18％;伴息肉样脉络膜血管病变、黄斑前膜、中心性浆液性脉络膜视网膜病变各1只眼,分别占4.55％.FFA检查发现,单个凹陷病灶患眼表现为早期弱荧光,晚期片状强荧光,无明显荧光渗漏.所有患眼随访期间凹陷病灶大小、形态无明显变化.结论 黄斑脉络膜凹陷好发于中年近视者,可与多种眼病伴发;凹陷层次均位于RPE层,OPR层均消失.其病情较稳定,发展缓慢.

abstractsObjective To observe the clinical characterisitics of choroidal excavation in the macula.Methods A total of 22 patients (22 eyes) with choroidal excavation diagnosed by spectral domain high definition optical coherence tomography (HD-OCT) were enrolled in this study.The patients included 12 males (54.50％) and 57 females (45.50％).The age was ranged from 21 to 82 years old,with an average of (41.44±13.17) years.All the patients were affected unilaterally,including 9 right eyes and 13 left eyes.The corrected vision,slit lamp microscope with preset lens,fundus photography,HD-OCT and fluorescence fundus angiography (FFA)were measured for all patients.The clinical characterisitics and concomitant diseases were observed.Seventeen eyes were followed for a period between 3 to 12 months.The lesions change were evaluated by HD-OCT.Results There were 18 eyes (81.8％) with symptoms of micropsia and metamorphopsia,4 eyes (18.2％) without symptoms.The corrected vision was ranged from 0.3 to 1.2,12eyes (54.54％) with moderate or high myopia.Fundus examination presents yellowish-white exudation in 12 eyes (54.54 ％),yellowish-white exudation accompanied with hemorrhage in 9 eyes (40.91 ％),grayish yellow reflex halo in 1 eye (4.55 ％).HD-OCT showed that the retinal pigment epithelium (RPE) layer was involved in the excavation,and the photoreceptor outer segment and pigment junction (OPR) layer was disappeared in all eyes.The external limiting membrane and the photoreceptor inner segment/outer segment junction layer were preserved in 13 eyes (59.09％) and disappeared in 9 eyes (40.91％).There were 10eyes (18.18％) with a single lesion,4 eyes (18.18％) with idiopathic choroidal neovascularization,4 eyes (18.18 ％) with punctate inner choroidopathy,1 eye (4.55 ％) with polypoidal choroidal vasculopathy,1 eye (4.55％) with macular preretinal menbrance,1 eye (4.55％) with central serous chorioretinopathy.FFA showed hypofluorescence in early phase,hyperfluorescence in late phase,without obvious leakage.There was no noticeable changes in size and morphological changes in the follow-up period.Conclusions Choroidal excavation in the macula occurs mostly in middle-aged people with myopia.It can be associated with many fundus diseases.The excavation is located in RPE layer,and OPR layer disappeared.Choroidal excavation in the macula develops slowly.