Santral Ser

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Santral Seröz Korioretinopatide Fovea Dis
Nükleer Tabaka Kalinliginin Görsel Sonuçlari
Belirlemesi

• HIDETAKA MATSUMOTO, TAKU SATO, SHOJI KISHI
• Jan 21, 2009.
• From the Department of Ophthalmology, Gunma
  University School of
• Medicine, Maebashi, Japan.

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• Santral Seröz Korioretinopati, genellikle
  metamorfopsi ve mikropsiye neden olan makuladaki
  nörosensoriyel retinanin seröz dekolmani ile
  karakterizedir.
• SSKRli çogu hasta makula dekolmanina ragmen iyi
  görme keskinligi vardir. Bazi hastalarda,
  dekolmanlar çözündükten sonra bile görmenin zayif
  oldugu,metamorfopsi ve mikropsinin devam ettigi
  gözlenmistir.

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• Optik koherens tomografi (OCT)deki son
  gelismeler in vivo fotoreseptör anormalliklerinin
  degerlendirilmesine izin vermistir.
• Spektral- domain (SD-OCT), 5 mikron çözünürlük
  ile IS/OS bandini ve dis limitan membrani (ELM)
  ayirir.

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FIGURE 1. Color fundus photograph and optical
coherence tomography (OCT) image of a normal eye.
(Top) Color fundusphotograph of the right eye of
a 32-year-old normal volunteer whose
best-corrected visual acuity (BCVA) is 1.2 with
1.0 diopterof myopia. (Bottom) Cross-sectional
OCT image of the macula with a 6-mm horizontal
line scan through the fovea. Four
highlyreflective lines are detected at the
border of the outer retina and the retinal
pigment epithelium (RPE), including the
externallimiting membrane (ELM), the junction
between the photoreceptor inner and outer
segments (IS/OS), an intermediatereflective line
(IL) between the IS/OS and the RPE, and the RPE
itself. The distance between the internal
limiting membraneand the ELM is approximately
130 m at the central fovea. The IS/OS line is
continuous at the macula.
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METOT

• Retrospektif (1 Temmuz 2007 - 30 Haziran 2008
  kadar Gunma Üniversite Hastanesi)
• 65 hastadan, 67 göz (55 göz 53 erkek ve 12 kadin
  12 göz) SSKR çözünürlügünde, SD-OCT
  kullanilmistir
• Ort.Yas 51,3 (27-78)
• Tüm hastalarin en iyi düzeltilmis görme
  keskinligi (GK), biyomikroskobi,fundus muayenesi
  olmak üzere tam bir göz muayenesi yapilmistir.
• SD-OCT aksiyel çözünürlük 5 mikron ve transvers
  çözünürlük 10 mikron olarak aliniyor. 6 mm
  uzunlugunda 5 hattan olusacak sekilde
  taranmis. Her hatta 4.096 A mod taramalar
  olusturulmus.Tarama süresi 0,76 sn.

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• SD-OCT ile kontrol grubu olarak 10 gönüllü hasta
  (5 erkek ve 5 kadin )
• yas ort 48,5 .( 23-85 )

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• BCVA göre 67 gözü iki gruba ayrilmis.(homojen
  -)(akut/kronik)
• A grubu 1,0 den az 24 göz
• B grubu 1,0 daha iyi olan 43 göz
• C grubu kontrol grubu10 göz

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SD-OCT

• Dis nükleer tabaka kalinligi
• Makulada(2 mm) IS/OS band bütünlügünü.
• Mann-Whitney U testi ile gruplar arasinda
  kiyaslama.
• Ayrica, dis nükleer tabaka ve BCVA arasindaki
  iliskiyi çalismak için Spearmanrank korelasyon
  katsayisi hesaplanmistir.

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FIGURE 2. Color fundus photograph and OCT image
showing central serous chorioretinopathy (CSC).
(Top) Color fundus photographof the left eye of
a 48-year-old woman with CSC. The diameter of the
serous retinal detachment (RD) is approximately
2.5 disc diameters.The BCVA of the left eye is
0.9. (Bottom) Cross-sectional macular OCT image
with a 6-mm horizontal line scan across the
central fovea.The thickness of the outer nuclear
layer (ONL) at the central fovea is approximately
95 m.
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FIGURE 3. Color fundus and OCT image of resolved
CSC. (Top) Color fundus photograph of the left
eye of a 48-year-old womanwith resolved CSC
whose BCVA was 1.2. (Bottom) Cross-sectional
macular image with a 6-mm horizontal line scan
across thecentral fovea. The thickness of ONL at
the central fovea is approximately 105 m. The
junction between the photoreceptor IS/OSis
continuous at the macular area.
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FIGURE 4. Color fundus photograph and OCT image
of CSC. (Top) Color fundus photograph of the left
eye of a 50-year-old manwith CSC. The diameter
of the serous RD is approximately 2.5 disc
diameters. The BCVA of the left eye was 0.6.
(Bottom)Cross-sectional macular OCT image with a
6-mm horizontal line scan across the central
fovea. The thickness of the ONL at thecentral
fovea is approximately 85 m.
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FIGURE 5. Color fundus photograph and OCT image
of resolved CSC. (Top) Color fundus photograph of
the left eye of a50-year-old man with resolved
CSC whose BCVA was 0.7. (Bottom) Cross-sectional
macular image with a 6-mm horizontal linescan
across the central fovea. The thickness of the
ONL at the central fovea is approximately 95 m.
The junction between thephotoreceptor IS/OS is
discontinuous at the macular area.
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ONL IS/OS
A 74.6 22(91.7)
B 103.2 9(20.9)
C 124.9 -
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FIGURE 6. Graph showing the thickness of ONL at
the central fovea in 67 eyes of 65 patients with
resolved CSC compared withtheir BCVA. The
thickness of ONL at the central fovea is
positively correlated with BCVA in 67 eyes with
resolved CSC.(Spearman-rank correlation
coefficient, rs 0.59 P lt .001).
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TARTISMA

• Wang ve ark.ONL ile BCVA iliskisi
• (OCT 20mikron ISOS
  görülememis)
• Eandi ve ark. ONL ile BCVA iliskisi
• (OCT aksiyel 10 mikron,ELM görülmemis)
  (ONLILM-RPE)
• Ojima ve ark. ONL ile BCVA iliskisi
• IS/OS bandi
• ( 21 hasta,27 göz,3 büyük kusur,3 küçük
  kusur,5 kusursuz)

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SONUÇ

• ONL kalinligi ile görsel sonuçlar
  koreledir.Çünkü,ONL koni hücrelerini içeriyor.
• B grubunda IS/OS bütünlügü çogu hastada
  bozulmamis.(80)
• IS/OS bandinda süreksizlik, incelmis ONL ve düsük
  BCVA ile iliskilidir.
• ONL kalinligi IS/OS bandinin bozulmasindan daha
  duyarlidir.

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