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要約 目的:網膜中心動脈閉塞症(CRAO)の摘出眼球の病理所見では,網膜内層の浮腫と内顆粒層(INL)の菲薄化が示されている。今回急性期CRAO患者で,異なる発症時間での光干渉断層像(OCT)所見による網膜構造の変化を調べた。
対象と方法:対象は急性期CRAO患者9名9眼。平均年齢は71.2歳,女性5名。発症からOCT撮像時間は5分〜72時間(中央値7時間)。中心窩網膜厚(CFT),中心窩から上方,下方,鼻側,耳側500μmの網膜厚,および4方向のINL厚をOCTで測定し,平均値を健眼と比較した。
結果:網膜内層の高輝度化は全症例で確認された。CFTは患眼と健眼で有意差はなかった。中心窩から500μmの網膜厚は全症例で有意に健眼より肥厚した(406μm vs 230μm,t検定,p=0.017)。全症例のINL厚の平均値は有意に健眼より薄かった(14.9μm vs 33.1μm,t検定,p=0.003)。
結論:急性期CRAOではまず網膜内層の高輝度化と浮腫がみられ,その後INLの菲薄化がみられる。INLの菲薄化は急性期CRAOの内層の虚血を示す,重要な画像上のバイオマーカーである。
Abstract Purpose:Pathologic findings of enucleated eyes with central retinal artery occlusion(CRAO)show edema of the inner retinal layer and thinning of the inner nuclear layer(INL). In this study, we investigated changes in retinal structure using optical coherence tomography(OCT)at different onset times in patients with acute CRAO.
Patients:Nine eyes of nine patients diagnosed with acute CRAO, which included five females with average age of 71.2 years and symptom onsets of 5 minutes to 72 hours)Observations:The central foveal thickness(CFT), the retinal thickness at 500 μm above, below, nasally, and temporally from the fovea, and the INL thickness at four directions were measured using Spectralis, and the average values of the affected eyes were compared with those of the contralateral eye in each patients.
Results:Hyperreflectivity of the inner retina was confirmed in all cases. There was no significant difference in CFT between the affected and contralateral eyes. The retinal thickness 500 μm from the fovea increased was significantly thicker than that of the contralateral eye in all the cases(406 μm vs 230 μm, t test p=0.017). The mean value of the INL was significantly thinner than that of the contralateral eye(14.9 μm vs 33.1 μm, p=0.003).
Conclusion:In acute CRAO, hyperreflectivity and edema in the inner retinal layer are observed first, and subsequently thinning of the INL appeared. INL thinning is an important biomarker of inner retinal ischemia in acute CRAO.
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