裂孔性视网膜脱离手术后黄斑区光相干断层扫描检查的临床意义

目的 了解光相干断层扫描(optical coherence tomography, OCT)对检测巩膜扣带术后黄斑形态改变及与视功能的意义。 方法 应用Zeiss-Humphrey OCT检查仪对68例(70只眼)巩膜扣带术复位成功的患者黄斑区进行经中心凹水平、垂直扫描，观察黄斑形态。 结果 70只受检眼中，黄斑区结构正常22只眼，神经上皮平均厚度为(146.47±20.59)μm，黄斑结构异常48只眼，检测异常率为68.6%，其中黄斑区视网膜神经上皮下较多残液“间隙”存留19只眼，局限性残液存留9只眼；黄斑区视网膜水肿8只眼，神经上皮变薄4只眼，黄斑区、后极部视网膜下增生4只眼，黄斑、后极部视网膜前膜4只眼。OCT黄斑结构正常组，手术后2周视力≥0.3者：6只眼，3个月时有14只眼；黄斑水肿组8只眼，手术后2周视力≥0.3者：1只眼，3个月时有2只眼；视网膜神经上皮下残存液体，手术后2周视力≥0.3者5只眼，3个月时有23只眼，说明巩膜扣带术后的黄斑结构变化与手术后视功能存在一定关系。随访3个月时，黄斑正常组、神经上皮脱离组和其它病变组视力在03以上所占的比例差异有显著性的意义(χ2=18.91, P＜0.01)。 结论 OCT能精确地探查视网膜复位术后黄斑结构的变化，并且能较好地解释患眼视功能变化。 (中华眼底病杂志, 2002, 18: 266-268)

The significance of optical coherence tomography of macula after retinal reattachment

Objective To verify the significance of the morphological changes of the macula and its relationship to visual function by using optical coherence tomography (OCT) after scleral buckling procdure. Methods The macula of retinae of 68 patients (70 eyes) with reattached retinae after scleral buckling operation for retinal detachment were examined by OCT to scan the macula through fovea vertically and horizontally. Results Among the 70 eyes, 22 eyes revealed normal macula with thickness of neurosensory retina meant (146.47±20.59)μm. In the other 48 eyes (68.60%) with abnormal macula, 19 eyes showed extensive subretinal interspace, 9 eyes showed local subretinal interspace, 8 eyes showed macula edema, 4 eyes showed thin macula, 4 eyes showed subretinal proliferation and 4 eye showed epiretinal membrane over macula. In the normal macular structure group under the OCT, the visual acuity (VA) of the operated eyes was more than 0.3 in 6 eyes 2 weeks after operation and in 14 eyes 3 mons after operation. In the macula edema group, the VA was more than 0.3 in 1 eye 2 weeks after opoeration and 2 eyes 3 mons after operation. In the subretinal interspace group, the VA was more than 0.3 in 5 eyes 2 weeks after operation and in 23 eyes 3 mons after operation. The proportions of the numbers of operated eyes with the VA more than 0.3 after 3 mons of the operation in macular normal group subretinal interspace group and other macular disease group were significantly different (χ2=18.91, P＜0.01). Conclusion OCT can precisely detect the structural changes of macula after retinal reattachment and assess visual function after surgery of retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 266-268)