孔源性视网膜脱离的超广角眼底自发荧光特征

Ultra-wide-field autofluorescence characteristic in non-traumatic rhegmatogenous retinal detachment

目的:观察非外伤性孔源性视网膜脱离(RRD)手术前后超广角眼底自发荧光(UWAF)的表现及其变化,评估视网膜功能恢复情况。方法:对2017年9月至2018年5月在武汉大学人民医院眼科中心检查确诊的RRD行巩膜外加压或玻璃体切除手术的患者共21例21只眼纳入研究。分为2组,病灶范围累及黄斑的RRD为A组,未累及黄斑的为B组。所有患眼术前1 d和术后1月分别进行Optos 200Tx超广角彩照和UWAF检查以及光相干断层检查(OCT)。结果:所有RRD患眼术前脱离区域均表现为低荧光;脱离边界表现为高荧光,A组占76%,B组占50%;A组12%患眼黄斑区荧光正常,35%患眼表现为高荧光,53%患眼表现为低荧光,B组黄斑区荧光均表现正常。术后1月,A组59%患眼和B组所有患眼脱离复位区域均表现为正常荧光;A组29%患眼脱离复位区表现为低荧光,12%患眼表现为高荧光;A组35%患眼脱离边界变成不连续高荧光线;A组47%患眼黄斑区荧光正常,18%患眼表现为高荧光,35%患眼表现为颗粒状荧光。结论:UWAF检查可以更加全面观察RRD患眼手术前后自发荧光表现及变化,结合OCT的使用,可客观评估视网膜脱离术后视网膜功能恢复情况,进而帮助临床医生更好地进行术后随访。

Objective:To observe the abnormalities of ultra-wide-field autofluorescence(UWAF)in patients with non-traumatic rhegmatogenous retinal detachment(RRD)before and after surgery,and to evaluate functional recovery of the retina.Methods:This is a retrospective clinical description study.Twenty-one patients(21 eyes)who underwent successful scleral buckling or vitrectomy for RRD confirmed in Renmin Hospital of Wuhan University from September 2017 to May 2018 were enrolled in the study.The patients were divided into two groups.The cases with RRD involving macula lutea were in group A,whereas those with macula-sparing RRD were in group B.Optos 200 Tx ultrawide fundus photography,UWAF and optical coherence tomography(OCT)were performed in all eyes one day before surgery and one month after surgery.Results:All patients with RRD demonstrated hypofluorescence over the area of bullous retinal detachment.A hyperfluorescent leading edge to the retinal detachment was observed preoperatively in 76%of eyes in group A and 50%of eyes in group B.Preoperative UWAF through the fovea of group A eyes was normal with 12%,hypofluorescent with53%or hyperfluorescent with 35%,and the fluorescence of macular area in group B was normal.One month after surgery,59%of the eyes in group A and all the eyes in group B showed normal fluorescence.In group A,29%showed hypofluorescence and 12%showed hyperfluorescence in the area of reattached retina.In group A,35%of the hyperfluorescent leading edge to the retinal detachment became discontinuous hyperfluorescence lines.Postoperative UWAF through the fovea of group A eyes was normal with 47%,hyperfluorescent with 18%,and granular autofluorescent with 35%.Conclusion:UWAF can more comprehensively observe the autofluorescent manifestations and changes of RRD patients before and after surgery.Combined with the OCT,it can objectively evaluate the recovery of retinal function after retinal detachment surgery,and then help clinicians to conduct postoperative follow-up.