招飞医学选拔中黄斑中心凹毛细血管化1例并文献复习

Macular-foveal capillary in medical selection of flight cadets selection: A case report and literature review

摘要

背景 黄斑中心凹毛细血管化（macular-foveal capillarization，MFC）是一种中心凹无血管区（foveal avascular zone，FAZ）异常血管化的病理现象，可由先天性或获得性因素导致，也可见于视力正常的健康人群。 目的 报道招飞医学选拔中发现的视力正常青少年MFC一例并进行文献复习，旨在为招飞医学选拔提供参考经验。 方法 使用超广角眼底照相、相干光断层成像（optical coherence tomography，OCT）及相干光层析血管成像（optical coherence tomography angiography，OCTA）进行视网膜结构检查，使用多焦视网膜电图（multifocal electroretinogram，mfERG）、Rabin锥对比度视力、视野等进行视功能检查。 结果 该学员18岁，男，眼底检查可见黄斑中心凹反光减弱、中心凹无血管区面积减小；OCT及OCTA可见黄斑中心凹发育不良，毛细血管穿过黄斑中心凹区域与周围视网膜毛细血管网络相连；多焦视网膜电图可见中心峰值降低。 结论 招飞医学选拔中，在常规视力检查基础上，积极采用眼底检查及OCT、OCTA等新技术、新设备辅助检查，可有效发现潜在影响高性能飞行视功能的眼底微结构异常，对提升选拔的科学性与精准性具有重要价值。

Abstract

Background Macular-foveal capillarization (MFC), characterized by abnormal vascularization within the foveal avascular zone (FAZ), arises from congenital or acquired factors and may occur in healthy individuals with normal vision. Objective To report a case of MFC identified during flight cadets' medical selection in an adolescent with normal vision and review relevant literature, so as to provide reference for air force medical selection. Methods The candidate underwent routine fundus examination. Retinal structure was assessed using ultra-wide-angle fundus photography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Visual function was evaluated with multifocal electroretinogram (mfERG), Rabin cone contrast testing and visual field testing. Results This 18-year-old male cadet exhibited diminished foveal reflex and reduced area of the FAZ upon fundus examination. OCT/OCTA demonstrated foveal hypoplasia, with capillaries traversing the foveal center connecting to the surrounding retinal capillary network. mfERG showed a reduced central peak response. Conclusion In the medical selection for flight pilot candidates, in addition to routine visual acuity examinations, the active use of fundus examinations as well as new technologies and equipment such as OCT and OCTA for auxiliary assessments can effectively identify potential microstructural abnormalities in the fundus that may affect visual performance during high-performance flight. This approach holds significant value in enhancing the scientific rigor and precision of the selection process.

关键词

招飞 / 医学选拔 / 黄斑中心凹毛细血管化 / 中心凹无血管区 / 光学相干光断层成像

Key words

flight cadets' medical selection / macular-foveal capillary / foveal avascular zone / optical coherence tomography

黄斑中心凹毛细血管化(macular-foveal capillarization，MFC)是一种中心凹无血管区(foveal avascular zone，FAZ)异常血管化的病理现象，可因先天性或获得性因素导致，可见于视力正常的健康人群。本文报道了1例招收飞行学员医学选拔中通过多模态影像技术确诊先天性MFC，并发现其视觉电生理异常，旨在探讨此类先天异常改变的筛查策略，为优化招飞医学选拔提供依据。

1 病例资料

患者，男，18岁，参加招收飞行学员医学选拔定选阶段学员。眼科体格检查裸眼视力(兰道特环形视力表，“C”字表)双眼1.0，眼压双眼16 mmHg，角膜、前房及晶体等眼前节检查未见异常，双眼眼底可见视盘边清色正，黄斑中心凹不明显、中心凹反光点消失、中心凹无血管区面积减小(图1A)。相干光断层成像(optical coherence tomography，OCT)及相干光层析血管成像(optical coherence tomography angiography，OCTA)检查可见黄斑中心凹形态发育不良，凹陷变浅、内层视网膜结构移位不完全、外核层增宽、中心凹网膜厚度330 μm，黄斑中心凹无血管区毛细血管生长(图1B)。多焦视网膜电图(multifocal electroretino-gram，mfERG)可见中心峰值降低(图2A)；色觉检查(假同色图法，俞自萍版)及Rabin锥对比度视力检查正常(图2B)。

基金资助

国家自然科学基金青年科学基金项目(C类)(82101082)