视网膜脱离术前和术后黄斑区改变的光学相干断层扫描评估

目的:观察黄斑区受累及的孔源性视网膜脱离行巩膜扣带术后黄斑区的结构,并分析其与术后视力的关系.方法:术前视网膜脱离已累及黄斑区的41人纳入本次研究,均经间接眼底镜下巩膜外加压术联合或不联合环扎术视网膜成功复位,分别于术后1周、1、3、6、12个月行最佳矫正视力、眼底检查和光学相干断层扫描(OCT)检查,并进行统计学分析.结果:术后1周时,最佳矫正视力在0.05～0.50(P=0.019),OCT显示黄斑区视网膜下液完全吸收者占9.7%,好转者占41.5%,与术前相比差异有显著性(P=0.008);术后1个月时,与术后1周相比从视力恢复(P=0.084)和OCT检查视网膜下液的吸收情况上均无显著差异(P=0.053);术后3个月时,最佳矫正视力在0.1～0.6,提高2行以上者占75.6%;术后12个月时,最佳矫正视力在0.15～1.00,提高2行以上者占92.7%,与术后3月时相比,差异有显著性(P=0.025),与术后6月时相比差异无显著性(P=0.21),黄斑区网膜下液完全吸收者占95.1%,另2例也有显著好转,与术后6个月时相比差异有显著性(P=0.0019).结论:OCT的检查能够揭示临床眼底检查不能发现"亚临床型黄斑区视网膜脱离"的存在,进而为预测术前视网膜脱离已累及黄斑区的患者术后视力恢复进程以及病情解释提供帮助.

Evaluation of macular changes before and after successful retinal detachment surgery using optical coherence tomography

Objective:To investigate foveal architecture after routine retinal detachment surgery for macular-off retinal detachment(RD) and analyze the correlation of it and visual acuity. Methods:41 eyes of 41 patients with macular-off RD underwent best-corrected visual acuity(BCVA) measurement and optical coherence tomography(OCT) scan through the fovea before surgery and 1 week,1,3,6,12 months after surgery. Statistical analysis of the data was performed. Results:1 week after surgery, BCVA was 0.05~0.50(P = 0.019), and 41.5 percent of patients showed subfoveal fluid reduction on OCT(P = 0.008). At 1 month, there was no obvious change on BCVA(P = 0.084) and subfoveal fluid(P = 0.053). At 3 month, the average BCVA was 0.1~0.6, which improved above 2 lines was 75.6%. At 12 months, the average BCVA was 0.15~1.00, which improved above 2 lines was 92.7%, and subfoveal fluid was absorbed completely in 95.1% patients. There was statistic different between group of 12 months after surgery and 6 months after surgery(P = 0.0019). Conclusion:Infra-clinical foveal detachment could be detected in the patients with successful retinal reattachment surgery by OCT examination. It could provide the forecast for visual acuity prognosis of the patients with macular-off retinal detachment.