不同手术方式治疗孔源性视网膜脱离术后OCT的对比观察

Different optical coherence tomography findings in the macula after vitrectomy or buckle surgery for rhegmatogenous retinal detachments

目的观察比较累及黄斑的孔源性视网膜脱离行巩膜扣带术和玻璃体切割术后黄斑区OCT的变化。方法孔源性视网膜脱离患者34例34眼根据病情分为2组，A组22例22眼行巩膜扣带术。B组12例（12眼）行玻璃体切割联合眼内激光、惰性气体充填。术后1m、3m、6m、12m行眼部全面检查和OCT检查，平均随访12m。比较两组术后OCT形态变化，中心凹厚度及最佳矫正视力，并行统计学处理。结果（1）术后1月间接眼底镜检查所有患眼视网膜成功复位。（2）OCT观察到A组术后有神经上皮下积液、色素上皮局限脱离两种形态。其中神经上皮下积液包括中心凹处和旁中心凹处，术后1m12例占55％，3m9例占41％，6m6例占28％，12m2例占9％。2例色素上皮脱离发生在术后1m，分别于术后6m，15m消失。B组仅有1例术后1m时发现中心凹处神经上皮下积液，术后2m复查时消失。（3）OCT测量术后1m时的中心凹厚度值平均为A组（282．27±87．65）μm，B组（171.33±17．00）μm，两组比较差异有显著性（P=0．04）。A组随时间延长，中心凹厚度逐渐减小，至12m时恢复正常。B组随时间延长，厚度值无明显变化。（4）术后1mA组矫正视力低于B组，差异有显著性（P=0．001），A组随时间延长矫正视力逐渐缓慢提高。B组术后3m就达最佳矫正视力，6m后有下降趋势。（5）A组术后并发硅胶海绵脱出并感染2例，结膜下血肿2例。B组并发白内障5例。结论OCT显示玻璃体切割术后早期黄斑区形态即恢复正常，而巩膜扣带术后部分患者黄斑下亚临床积液可以持续存在数月之久。残余黄斑下积液可能是巩膜扣带术后视力延迟恢复的部分原因。

Objective To compare and observe optical coherence tomography （OCT）findings in the macula after vitrectomy or buckle surgery for macula-off rhegmatogenous retinal detachment. Methods 34 patients with a spontaneous rhegmatogenous retinal detachment were devided into 2 groups, group A （22 eyes） and group B （12 eyes）. Patients in group A were treated with episcleral buckle. Patients in group B were treated with vitrectomy, endolaser and noble gas filling. Patients were examined at 1,3, 6, and 12 months after surgery with a complete ophthalmic examination as well as OCT. Mean follow-up was 12months. Optical coherence tomography findings were compared between two groups. The thinkness of the central fovea and best-corrected visual acuity（BCVA） were statistically analyzed. Results Indirect ophthalmoscopy indicated that all retinal detachments were reattached at 1 month postoperatively. Postoperative OCT examination at 1 month after buckle surgery showed accumulation of subretinal fluid in 55% of patients （n=12） at the fovea or adjacent area. Fluid was still present in 28% of cases （n=6） at 6 months and in 9% of cases （n=2） even at 12 months. OCT examination at 1 month after vitrectomy showed subfoveal fluid in 1 cases and disappeared at 2 months. Topical detachment of retinal pigment epithelium（RPE） was founded in 2 cases of group A and disappeared after 6 and 15 months. The postoperative foveal retinal thickness of group A （282.27 ± 87.65μm ）at 1 month was significantly thicker than that of group B （171.33 ± 17.00μm）; P=0.04. The foveal retinal thickness of group A gradually decreased until 12months; but it remained unchanged in group B during the follow-up. At 1 month, the postoperative BCVA of group A was significantly lower than that of group B ,after than it improved gradually, but in group B it decreased after 3months.The postoperative complications included silica ge rejection with infection and subconjunctiva hematom in group A and complicated cataract in group B. Conclusions Complete foveal reattachment occurs without delay after vitrectomy, whereas subfoveal fluid may persist subclinically for several months in patients operated with a buckle. The residual foveal detachment may explain, in part, the delayed visual acuity improvement after successful scleral buckling.