健康青少年视网膜厚度的定量化测量

目的旨在建立温州地区健康青少年视网膜厚度的正常数值范围,并同国内外相关研究进行分析比较,以指导临床实践。方法使用视网膜厚度分析仪(retinal thick-ness analyzer,RTA)的视网膜厚度模式对健康青少年120只眼的后极部(21°×21°)视网膜厚度进行测量。对5位受检者进行可重复性评估。结果后极部平均视网膜厚度为(172±16)μm,中心凹平均视网膜厚度为(148±18)μm。同一天测量得到同一被测者检查可重复性的误差为±5%,相当于±9μm。结论后极部视网膜厚度地形图与解剖学结构相吻合。视网膜厚度最大值出现在中央凹旁区,并从视盘到中央凹的上下方呈“C”字型变化。采用RTA进行视网膜厚度测量的可重复性好,证明该设备对于黄斑疾病的视网膜厚度改变的检测有价值。这种检查对于早期、准确诊断和监测黄斑水肿以及其他视网膜疾病,评价临床的疗效有较大意义。本结果与以往活体和组织学研究的成人后极部视网膜厚度的结果相符合,提示人眼视网膜厚度发育较早完成。     

继发于圆形视网膜裂孔的视网膜脱离临床分析

目的探讨继发于圆形视网膜裂孔的视网膜脱离临床特点、手术方式及治疗效果。方法对67例(73只眼)继发于圆形视网膜裂孔的视网膜脱离患者临床资料进行回顾性分析,分析患者年龄、性别、屈光状态、术前视力、视网膜裂孔数量分布、视网膜脱离范围、玻璃体后脱离以及手术方式、手术效果、术后视力。结果患者平均年龄30.12岁,以女性(64.17%)和近视(87.37%)为主,46只眼(63.01%)不伴有玻璃体后脱离。对侧眼视网膜变性和圆形裂孔31只眼(42.46%)。71只眼行巩膜扣带术。2只眼行玻璃体切割术。手术复位71只眼(97.26%)。结论继发于圆形视网膜裂孔的视网膜脱离多发于女性患者尤其是女性近视患者,病情进展缓慢,多不伴有玻璃体后脱离,由于双眼同时发病概率较高,必须常规进行对侧眼检查。巩膜扣带术是治疗该类病变的有效方法。     

屈光不正性弱视患者视网膜厚度的变化

目的:探讨视网膜厚度分析仪(retinalthicknessanalyzer,RTA)对弱视患者的诊断价值。方法:采用RTA测量正常人6例11眼及弱视患者22例31眼,眼后极部视网膜厚度值及厚度地形图,所得数据经SPSS统计软件包进行分析。结果:正常人平均视网膜厚度为172.4±13.4μm,鼻侧较颞侧厚(P<0.05),其中黄斑上方为177.1±9.0μm,黄斑下方为169.9±11.0μm;鼻侧为180.5±1.3μm,颞侧为161.0±9.2μm。弱视患者平均视网膜厚度为176.4±7.4μm。在黄斑中心凹X5区,弱视明显厚于正常人。黄斑上方为178.7±20.2μm,黄斑下方为173.4±26.2μm;鼻侧为177.3±9.6μm,颞侧为173.4±6.2μm。结论:正常眼鼻侧视网膜明显较颞侧厚。弱视眼在黄斑中心凹X5区视网膜厚度明显较正常眼厚。     

视网膜复位术后非屈光性视物变形患者的黄斑光学相干断层成像术检查

目的　应用光学相干断层成像术 (opticalcoherencetomography ,OCT)研究巩膜扣带术后非屈光性视物变形患者的黄斑复位情况 ,探讨视物变形的原因和预后。方法　选择 82例 ( 82眼 )原发性裂孔性视网膜脱离患者 ,均经巩膜扣带术获得视网膜解剖复位但主诉视物变形 ,验光后无法矫正 ,利用OCT对黄斑区进行经中心凹水平和垂直线形扫描。结果　OCT检查患眼黄斑区有神经上皮下积液、神经上皮水肿、神经上皮变薄、黄斑前膜、黄斑下膜和黄斑区视网膜下出血 6种异常表现。其中 ,神经上皮下积液共 67眼 ( 82 % ) ,脱离高度平均为 ( 12 1± 10 1 3 6) μm ,脱离范围从 2 46μm到整个扫描区神经上皮下积液 ;神经上皮水肿共 11眼 ,中心凹处神经上皮厚度平均为 ( 3 64± 5 8) μm ;神经上皮变薄共 9眼 ,中心凹处神经上皮厚度平均 ( 92± 13 84) μm。 结论　OCT不仅能够精确的检测巩膜扣带术后黄斑复位情况 ,解释非屈光性视物变形的原因 ,而且能够对术后黄斑进行定量测定和随访 ,对病情预后有重要意义     

孔源性视网膜脱离成功复位后中心凹形态与视力的关系

目的 评价孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)巩膜扣带术后黄斑中心凹形态与最佳矫正视力(Best-corrected visual acuity, BCVA)的关系.方法 回顾性连续病例观察研究.对象为73例(73只眼)RRD患者,男39例(53.4％),女34例(46.6％),平均年龄(46.6±11.2)岁,均行巩膜冷凝扣带术成功视网膜复位.其中孔源性视网膜脱离累及黄斑者48只眼,未累及黄斑者25只眼.术后利用SD-OCT (spectral domain-optical coherence tomography)扫描患眼后极部视网膜评估黄斑中心凹的结构.评价患者成功术后中心凹形态与BCVA的关系.结果 SD-OCT扫描发现术后黄斑中心凹视网膜异常眼59只眼(80.8％).黄斑中心凹持续视网膜下液者47只眼(64.4％),黄斑前膜16只眼(21.9％),视网膜水肿11只眼(15.1％),感光细胞内外节(IS/OS)连接中断或消失33只眼(45.2％).31只眼视网膜下液全部吸收,平均吸收时间(5.8±2.6)个月.其中IS/OS连接中断或消失均出现在术前视网膜脱离累及黄斑眼中.伴有视网膜下液、黄斑前膜和视网膜水肿眼的术后最佳矫正视力与无上述视网膜异常眼之间差异无统计学意义.术后最佳矫正视力IS/OS连接完好眼显著优于IS/OS连接中断或消失眼(P ＜0.001).Logistic回归分析显示患者中心凹IS/OS连接形态显著影响术后最佳矫正视力(r=0.835,P＜0.001),其余中心凹异常未见显著影响.结论 孔源性视网膜脱离巩膜扣带术后,视网膜下液吸收缓慢,约需6个月.术后感光细胞层内外节形态与术后视力显著相关,其异常形态可能为术后视力不全恢复的决定性因素.     

充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离

目的 观察充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离的疗效.方法 回顾分析我科经充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离13例(13眼)孔源性视网膜脱离或合并增生性玻璃体视网膜病变(PVR),其中PVR A级3眼,B级6眼,C1级3眼,C2级1眼;黄斑部脱离4眼.眼轴长度21.45-28.47 mm.前次手术采用单纯巩膜外加压8眼,环扎联合加压3眼,环扎联合加压、注气2眼.患眼于本次术中玻璃体腔内注入纯全氟丙烷(C3F8)气体0.5-1.0ml,术后严密观察,保持适当体位,确保气泡封闭裂孔.结果 手术后随访2-13月,12眼视网膜完全复位.1眼因PVR进展视网膜下液增多,视网膜未复位,后行玻璃体手术.手术后9眼视力提高,3眼视力不变,1眼视力下降.结论 巩膜扣带术后残留视网膜脱离可以通过充气性视网膜固定术获得视网膜解剖复位,视力改善.     

视网膜脱离巩膜扣带术后眼底血流的共焦扫描激光多普勒视网膜血流图分析

目的观察视网膜脱离(retinaldetachment,RD)以及巩膜扣带术(scleralbucking,SB)对视网膜和视乳头血流的影响。方法52例52眼单眼RD接受常规SB,手术方式包括巩膜环扎术、巩膜外冷冻术、眼内注气,应用共焦扫描激光多普勒视网膜血流分析仪(Heidelbergretinalflowmeter,HRF)检测术前患眼和对侧健眼的视网膜和视乳头血流灌注情况。术后随访3m。结果RD组眼底血流检测参数普遍低于健眼,SB后视乳头大血管的血流量、血流速术后各组低于健眼及术前组,颞侧视乳头盘沿的血流量、血流速术后各组低于健眼,鼻侧视乳头盘沿的血流量术后各组低于健眼(P<0.05)。结论RD眼眼底血流明显下降,其对视乳头和视网膜的血流量影响最大,在对眼底各部位影响方面,以对视乳头大血管三项指标的影响最大。而术后视网膜复位并没有改善其眼底血流,这可能是RD术后视功能的恢复不理想的一个重要原因。     

高度近视与近视视网膜脱离眼周边视网膜光敏感度的状态分布

目的:观察高度近视与近视视网膜脱离眼(RD)的视网膜周边部视功能状态分布特点—90°视网膜光敏感度,为预防性治疗视网膜脱离提供依据。方法:采用Octopus101中的周边低视力程序(LVP),对高度近视360例的视网膜周边部视功能状态-90°视网膜平均光敏感度(MS)、四象限光敏感度、四象限视野绝对暗点、平均视野绝对暗点进行定性定量检测,并分别与高度近视性视网膜脱离对侧眼161例、高度近视性视网膜脱离眼118例、正常眼108例、中低度近视视网膜脱离眼41例及其对侧眼54例进行对比分析,共计842例。结果:高度近视眼平均光敏感度(21.3±5.4)dB,视力0.56±0.37;高度近视视网膜脱离对侧眼(20.4±5.2)dB,视力0.55±0.40;正常对照眼(27.6±3.6)dB,视力1.00±0.00;高度近视视网膜脱离眼(14.1±5.7)dB,视力0.19±0.26;中低度近视视网膜脱离眼(15.6±5.7)dB,视力0.27±0.32;中低度近视视网膜脱离对侧眼(23.3±4.9)dB,视力0.87±0.27。视力和平均光敏感度在高近组与高度近视视网膜脱离对侧眼,在高度近视视网膜脱离与中低度近视视网膜脱离的差异无统计学意义。高度近视眼视野平均绝对暗点(9.3±8.7)个,高度近视视网膜脱离对侧眼(10.5±8.2)个,正常对照眼(4.6±4.5)个,高度近视视网膜脱离眼(19.8±11.0)个,中低度近视视网膜脱离眼(17.5±12.0)个,中低度近视视网膜脱离对侧眼(7.2±6.0)个。平均视野绝对暗点在高度近视组与高度近视视网膜脱离对侧眼和中低度近视视网膜脱离对侧眼,在高度近视视网膜脱离与中低度近视视网膜脱离的差异无统计学意义。结论:高度近视眼已经存在明显周边部视网膜光敏感度的严重损害,与视网膜脱离高危眼在发生视网膜脱离之前相似;高度近视眼和中低度近视视网膜脱离手术成功复位后,周边部视网膜光敏感度仍会降低,且中心视力仍呈不可逆降低;与正常人群、中低度近视有着明显的功能和结构的差异。     

单纯巩膜扣带术治疗硅油填充眼视网膜脱离

目的　探讨单纯巩膜扣带术治疗硅油填充眼复发性视网膜脱离的临床疗效。方法　选取我院行玻璃体切割联合眼内硅油填充术后复发性视网膜脱离 2 1例 2 1眼 ,采用单纯巩膜扣带术 ,术中放出少许硅油调整至正常眼压。结果2 0眼视网膜复位 ,1眼 2月后视网膜脱离复发 ,行硅油取出、膜剥离再次硅油填充术后视网膜复位。 2 1例最终视力较术前提高 ,随访 3～ 2 4个月 ,视网膜复位好。结论　单纯巩膜扣带术治疗硅油填充眼视网膜脱离中的部分病例具有一定价值 ,特别是对未合并广泛前部和 (或 )后部增生性视网膜病变的下方象限或周边部裂孔引起的视网膜脱离有较好的治疗效果 ,不一定需再行玻璃体切割术     

巩膜扣带术后黄斑区视网膜下液吸收过程的动态观察

目的观察巩膜扣带术成功的患者黄斑区视网膜下液吸收过程,分析该过程与视功能的相关性。设计前瞻性病例观察系列。研究对象孔源性视网膜脱离波及黄斑区行巩膜扣带术成功的34例35眼。方法对行巩膜外扣带手术并一次获得成功的患者进行术后3天、15天,2个月、6个月的随访。主要进行眼底检查、黄斑区OCT扫描和散瞳验光。主要指标OCT图像和最佳矫正视力。结果术后3天、15天、2个月和6个月OCT检查视网膜下液完全吸收分别为3眼(8.57%)、5眼(14.29%)、9眼(25.71%)和23眼(65.71%)。在随访期间所有眼残留视网膜下液均逐渐减少。残留视网膜下液者在持续吸收过程中,平均视力变化程度为(0.124±0.013);视网膜下液完全吸收者平均视力变化程度为0.019±0.006(t=35.26,P=0.000)。结论巩膜扣带术后视网膜平伏的患者黄斑区仍残留微量的视网膜下液,该液体缓慢的吸收可能是术后半年内患者视力仍逐步回升的主要因素。     

不同手术方式治疗复杂视网膜脱离的对比观察

目的：对比玻璃体切除与玻璃体切除联合下方巩膜外垫压治疗复杂视网膜脱离的效果。方法：选取复杂视网膜脱离病例100例100眼,均病程≥1mo,合并下方周边视网膜裂孔,脱离区视网膜增殖、至少有一处皱襞。随机分成两组：治疗组50眼采取玻璃体切除联合下方巩膜外垫压治疗;对照组50眼采取单纯玻璃体切除治疗,比较两组视网膜解剖复位、矫正视力、术后1 wk黄斑中央凹厚度及术后并发症情况。结果：治疗组视网膜解剖复位有49眼（98％）,对照组视网膜复位42眼（84％）,差异有统计学意义（χ2＝4．2605,P＜0．05）;治疗组术后矫正视力：0．254±0．238,对照组术后最佳矫正视力：0．219±0．229,差异无统计学意义（ t＝1.8879,P＞0．05）;术后1wk,黄斑中央凹厚度：治疗组272±32.21μm,对照组316±33．46μm,差异有统计学意义（ t＝12．597,P＜0．01）;术后1wk内治疗组共有12眼（24％）眼压超过30mmHg,对照组有4眼（8％）眼压超过30mmHg,差异有统计学意义（χ2＝4．7619,P＜0．05）,术后1mo两组患者眼压均能控制在21 mmHg以下。结论：对于复杂视网膜脱离,采取玻璃体切除联合下方巩膜外垫压治疗安全、操作准确,相对于单纯玻璃体切除手术更有助于术后视网膜的解剖复位和黄斑水肿的早期消退。     

Assessment of retinal nerve fiber layer thickness with NFA-GDx following successful scleral buckling surgery

PURPOSE: To assess the effect of retinal detachment (RD) on retinal nerve fiber layer (RNFL) thickness by using a scanning laser polarimeter (NFA-GDx) after successful scleral buckling surgery for the treatment of rhegmatogenous RD. METHODS: Consecutive patients who had successful scleral buckling surgery in one eye were assessed for RNFL thickness by using NFA-GDx prospectively. Fellow healthy eyes of the patients formed the control group. Eyes with RD surgery were compared with the control group with respect to three variables (superior average, inferior average, and average thickness) of NFA-GDx by using two-sampled t-test. Additionally, a possible effect of duration of RD on RNFL thickness was assessed with a correlation test. RESULTS: The study group consisted of 16 patients with a mean age of 49.8 years. The mean duration of RD was 28 days. Although the retardation values in operated eyes were less than that of the control eyes, the difference was not statistically significant (p > 0.05). However, these three values were seen to increase with increased duration of detachment and this correlation was statistically significant (R > 0.5, p < 0.03). CONCLUSIONS: RD seemed to cause minimal or no change in RNFL thickness as determined by GDx variables. The positive correlation between RNFL thickness and duration of RD, however, may be because of the proliferated Muller cells in eyes with RD, which may be responsible for some of the retardation measurements, which may be even more prominent in longstanding RD cases. This needs to be supported by further studies in larger patient groups with longer duration of RD and with histopathologic studies.     

Posterior pole retinal thickness measurements by the retinal thickness analyzer in healthy Chinese subjects

PURPOSE: To assess retinal thickness at the posterior pole in healthy Chinese subjects with the retinal thickness analyzer (RTA). METHODS: Retinal thicknesses at the posterior pole and fovea were measured by the RTA in 331 eyes of 178 healthy Chinese subjects. Retinal thicknesses as a function of sex, age, refractive errors, and axial length were also evaluated. RESULTS: The average thickness of the foveal area +/- SD was 158.6 +/- 24.8 microm, the average thickness of the perifoveal region (600-2,500 microm from fovea) +/- SD was 174 +/- 25.2 microm, and the average thickness of the posterior pole region (600-6,000 microm from fovea) +/- SD was 171.9 +/- 25.3 microm. There was no significant difference in retinal thicknesses of the foveal, perifoveal, and posterior pole regions in either right or left eyes or as a function of different spherical equivalents. Moreover, there was no significant difference of foveal thickness between males and females. Greater retinal thicknesses of the foveal, perifoveal, and posterior pole regions were associated with age of older than 40 years and axial length of < 24 mm, and greater perifoveal and posterior pole thicknesses were found for females. Furthermore, there were no significant correlations between age, refractive errors, and axial lengths with retinal thicknesses. CONCLUSION: Retinal thicknesses of the posterior pole region differed by age, axial length, and sex, but there was no effect of laterality or different spherical equivalents. The RTA is a fast and noninvasive technology to assess retinal conditions with thickening or thinning in the fovea and posterior pole.     

巩膜扣带术治疗视网膜脱离118例临床分析

目的 对原发怍（孔源性）视网膜脱离行巩膜扣带术治疗并对其效果进行评价。方法 对118例118眼原发性视网膜脱离病人行巩膜扣带术治疗。术中直接检眼镜定位，放视网膜下液，巩膜外液氮冷凝，巩膜扣带或环扎术。结果 术后随访1周至半年，视网膜裂孔封闭、完全复位107眼（90．68％），视力提高90眼（76.27％）。结论 巩膜扣带术是治疗原发性视网膜脱离常用有效的方法。     

屈光参差性弱视患者黄斑区视网膜厚度及微血管系统的变化:基于OCTA的研究

目的　使用光学相干断层扫描血管成像（OCTA）检测屈光参差性弱视儿童黄斑区视网膜厚度及微血管系统的差异,探究屈光参差性弱视的发病机制。方法　纳入2020年6月至12月在南昌大学第二附属医院儿童眼科门诊就诊的4~14岁屈光参差性弱视儿童41例及正常视力儿童22例,将屈光参差性弱视患儿的弱视眼纳入为弱视眼组,非弱视眼纳入为对侧眼组,正常视力儿童的右眼为正常对照组。使用OCTA扫描三组入选眼的眼底黄斑部3 mm×3 mm的范围,经ImageJ处理后获得浅层视网膜毛细血管丛血流密度(SCPVD)和深层视网膜毛细血管丛血流密度(DCPVD),采用ETDRS分区扫描模式扫描黄斑部,得出黄斑部以黄斑中心凹为中心,直径分别为1 mm圆形（中心区）及>1~3 mm、>3~6 mm环形区的视网膜厚度。分析比较三组之间黄斑区SCPVD、DCPVD及视网膜厚度之间的差异。结果　弱视眼组、对侧眼组和正常对照组入选眼的SCPVD分别为(25.01±6.00)%、(29.34±4.23)%和(30.16±2.90)%,DCPVD分别为(27.87±4.12)%、(30.30±2.72)%和(30.65±2.38)%,弱视眼组的SCPVD和DCPVD均较对侧眼组、正常对照组明显降低,差异均具有统计学意义(均为P<0.05),对侧眼组入选眼的SCPVD和DCPVD与正常对照组相比差异均无统计学意义(均为P=1.00)。弱视眼组、对侧眼组和正常对照组入选眼黄斑中心区视网膜厚度分别为（265.78±21.10）μm、（260.94±18.97）μm和（263.59±14.71）μm,三组间黄斑中心区视网膜厚度差异均无统计学意义（均为P>0.05）;弱视眼组、对侧眼组和正常对照组入选眼黄斑区平均视网膜厚度分别为(321.13±10.83)μm、(316.19±11.80)μm和(314.85±10.81)μm,弱视眼组入选眼黄斑区平均视网膜厚度均较对侧眼组、正常对照组明显增厚,差异均具有统计学意义(均为P＜0.05),对侧眼组与正常对照组入选眼的平均视网膜厚度差异无统计学意义（P=0.77）。结论　屈光参差性弱视患儿的弱视眼黄斑区视网膜厚度及微血管系统均存在异常,提示黄斑区视网膜参与屈光参差性弱视的发病过程。     

Scleral buckling combined with vitrectomy for the management of rhegmatogenous retinal detachment associated with inferior retinal breaks

AIM: The use of adjunctive scleral buckling during vitrectomy for retinal detachment associated with inferior breaks has been the recent focus of some debate. It has been suggested that any benefit might be outweighed by potential complications associated with buckling surgery. The purpose of this study was to compare the success rate of vitrectomy, gas, and supplementary scleral buckling with the results of two recently published case series suggesting that acceptable results in inferior break detachments can be achieved with vitrectomy and gas alone. METHODS: A retrospective analysis of 60 consecutive patients with inferior break retinal detachments was conducted. All patients underwent vitrectomy, gas, and scleral buckling. In all cases, fellow eyes were examined under anaesthesia for retinal breaks if posterior vitreous detachment (PVD) had occurred at the time of presentation. Demographics, preoperative, and postoperative complications and outcome were recorded. RESULTS: Primary retinal attachment at 3 months was achieved in 95% of patients. This exceeds success rates of published data of patients who underwent vitrectomy and gas without buckling (81-89%). In patients with PVD in the fellow eye, 53% had horseshoe tears and all were treated with cryopexy. No sight-threatening complications occurred, but five patients developed minor buckle-related complications postoperatively. CONCLUSION: Supplementary scleral buckling is a safe procedure that improves and enhances primary success rates in inferior break detachments over vitrectomy and gas without buckling. There is a high rate of PVD-related breaks requiring treatment in the fellow eyes.     

不放液巩膜外加压术治疗陈旧性视网膜脱离

目的:探讨不放液巩膜外加压术治疗陈旧性视网膜脱离的临床疗效。方法:回顾性分析不放液单纯巩膜外加压术治疗32例32眼陈旧性视网膜脱离的临床病例资料,观察术后最佳矫正视力、手术并发症和视网膜复位情况。结果:术后随访6～12(平均9.2)mo,最佳矫正视力>0.1者17例17眼,2例2眼术后短期内眼压升高,首次手术解剖复位30例30眼,成功率94%。2例2眼术后视网膜下增殖继续发展,行玻璃体切除术后视网膜复位。结论:不放液巩膜外加压术对视网膜下增殖不严重的陈旧性视网膜脱离简单有效。     

无晶状体眼视网膜脱离玻璃体切除术的临床观察

目的:观察玻璃体切除术或联合巩膜外环扎术治疗无晶状体眼视网膜脱离的临床效果。方法:回顾性分析在我院行玻璃体切除术或联合巩膜外环扎术治疗的无晶状体眼视网膜脱离患者37例(37眼),探讨无晶状体眼视网膜脱离眼的临床特点,观察其治疗效果。结果:37眼中视网膜全脱离25眼,脱离范围三个象限者12眼;29眼周边可见两个以上的裂孔,且多为圆孔;PVR分级:C1~C3级24眼,D1~D3级13眼。所有患者均行玻璃体切除术,26眼术中行硅油填充,另11眼行C3F8填充,其中13眼联合巩膜外环扎术。除1例患者视网膜脱离复发放弃治疗外,余眼视力均有不同程度的提高。结论:无晶状体眼视网膜脱离一般发生较晚,PVR分级多在C级以上,临床上需行玻璃体切除术治疗,术后视力恢复不佳。早期发现是无晶状体眼视网膜脱离临床治疗的关键因素。     

原发性急性闭角型青光眼视网膜神经纤维层厚度变化研究

目的 观察原发性急性闭角型青光眼(APACG)首次发作后6个月内视网膜神经纤维层厚度(RNFLT)变化规律.方法 用光学相干断层扫描仪(OCT)测量首次单侧发作的APACG患者(24例)在眼压控制后3 d内、2周、1月、3月和6月时的双眼RNFLT,比较双眼各时间点RNFLT.对侧眼在发作眼眼压控制后3d内及6月时的RNFLT与正常人(55名55只眼)比较.结果 发作眼平均RNFLT在眼压控制后3 d内(121.49±23.84)μm,较对侧眼明显增加(P＜0.01);2周(107.22±24.72)μm和1月(93.58±18.37)μm与对侧眼的差异无统计学意义(P=0.31和0.08);3月(84.10±19.89)μm和6月(78.98±19.17)μm较对侧眼明显减少(P＜0.01).发作眼不同时间点的RNFLT变化均有统计学意义(P＜0.01～0.048).对侧眼在发作眼眼压控制后3 d内及6月的RNFLT和正常人比较差异无统计学意义(P=0.13～0.98).结论 APACG发作后RNFL厚度即有明显增加,发作后2周至1个月RNFL厚度趋向正常,1个月后RNFL厚度逐渐变薄,至术后6个月RNFL厚度较对侧眼和正常人明显减少.     

Electroretinogram changes after scleral buckling surgery of retinal detachment

Objective To observe changes in visual function after a single scleral buckling surgery for rhegmatogenous retinal detachment (RD) by using ERG (electroretinogram). Methods One eye from 56 patients with rhegmatogenous RD was chosen. Forty-three corresponding normal fellow eyes from these patients were chosen as controls. Single scleral buckling surgery was carried out and a full-field ERG was performed before the surgery, and 1 and 6 months after surgery. Results The mean amplitude of ERG decreased and the latency (except for the a-wave) was delayed in the eye with a retinal detachment, and wavelets of the oscillatory potential decreased or were completely lacking. One month after surgery, the amplitudes of the a and b waves were noticeably improved (except for the 30 Hz flicker responses), but the latency (except for the a-wave) was still delayed. The ratio of b/a (mixed response) increased 1 month after surgery, with no further changes thereafter. The amplitude of the scotopic b wave was 58.1% of the control eyes, while the 30 Hz flicker responses was only 45.8% of controls; the difference between the two responses was significant (P < 0.001). The number of oscillatory potential wavelets increased, but the total amplitude of the oscillatory potentials did not exhibit any obvious changes during the follow-up period (P = 0.20). In the 41 patients whose detachment involved the macula preoperatively, the amplitude of the 30 Hz flicker responses improved significantly after surgery (P = 0.037). Six months after the operation, the wave amplitudes were not significantly different from 1 month after surgery, but there was a tendency toward a decrease in the latency. Conclusions After reattachment of the retina, visual function showed dramatic improvement 1 month after the surgery. The postreceptoral responses recovered more than the a-wave. The rod system recovered more quickly and completely than the cone system during the follow-up period. The incomplete recovery observed by using ERGs indicates that there is irreversible damage that likely occurs following retinal detachment and surgery.