三维光学相干断层扫描在高度近视黄斑裂孔视网膜脱离复位术后的应用

目的探讨三维光学相干断层扫描（3D-OCT）在高度近视黄斑裂孔视网膜脱离复位术后的应用价值。方法应用3D-OCT观察12例12眼高度近视黄斑裂孔视网膜脱离术后黄斑裂孔的愈合状况。手术采用玻璃体切割、气液交换、硅油填充复位视网膜,术中黄斑裂孔均不行激光封闭。9例均行晶状体切除,保留晶状体前囊膜。术后1周,1、2、3、4、5、6个月应用3D-OCT观察黄斑裂孔愈合情况。黄斑裂孔未完全愈合者,在3D-OCT定位模式引导下确认裂孔位置,给予激光封闭。结果随访6～24个月,6例术后1～4个月黄斑裂孔愈合,其中2例术后1.5～2个月出现黄斑前膜;6例术后黄斑裂孔未完全愈合,其中4例黄斑裂孔边缘翘起,在3D-OCT定位模式引导下激光封闭未愈合黄斑裂孔边缘。所有患者在确认黄斑裂孔愈合后2～5个月行硅油取出术,硅油取出眼已随访3～20个月,视网膜在位。结论 3D-OCT可清晰观察黄斑裂孔全周的愈合状况。

Application of three-dimension optical coherence tomography in retinal reattachment surgery with high myopia with macular hole

Background A large range of retina area around the macular can be clearly observed by three-dimension optical coherence tomography （3D-OCT）.Application of 3D-OCT positioning mode in high myopia with leopard-like fundus can help us to locate the edge of macular hole and further make the medical regimen.Objective Present study was to evaluate the application value of 3D-OCT in the eyes received retinal reattachment surgery following high myopia associated with macular hole.Methods This is a diagnostic test study.Twelve eyes of 12 patients with retinal detachment induced by high myopia associated with macular hole were recruited.All these patients underwent regular vitrectomy with silicone oil tamponade.Recovery of macular hole was examined using 3D-OCT before vitrectomy and 1 week,1,2,3,4,5,6 months after vitrectomy.Lensectomy and preserving anterior capsular membrane was performed in 9 of the 12 eyes.3D-OCT-guaided laser photocoagulation was utilized in the eyes with unclosed macular hole following the surgery.Written informed consent was obtained from all of the patients before operation.Results The follow-up duration was 6 to 24 months.3D-OCT showed that macular hole was closed in 6 eyes in 1 to 4 months after operation.In 1.5 to 2 months after vitrectomy,epi-macular membrane was found in 2 eyes,and the macular hole was incompletely closed in 6 eyes,of which 4 edge tilted of the macular hole,but these hole were closed by the 3D-OCT-guaided photocoagulation.Silicon-oil in vitreous cavity was removed in 2 to 5 months duration after surgery.No secondary retinal detachment during follow-up duration of 3 to 20 months.Conclusion 3D-OCT can clearly display the reparation of macular hole after vitrectomy.