巩膜扣带术后黄斑区光学相干断层扫描与视力预后的分析

Correlative analysis of visual recovery and macular reattachment observing by optical coherence tomography after scleral buckling surgery

目的对累及黄斑区的孔源性视网膜脱离行巩膜扣带术手术成功眼后极部进行OCT扫描，并分析其与术后视力的关系。方法28例28只眼视网膜脱离已累及黄斑区者，经间接检查眼镜下巩膜外加压术联合或不联合环扎术，视网膜均成功复位，分别于术后1周、1、3、6、12个月行最佳矫正视力、眼底照相、光学相干断层扫描（OCT）检查，并进行统计分析。结果最佳矫正视力提高2行以上者于术后1周、3月、6月、12月分别为53．57％、60．71％、78．57％、85．71％、88．46％，最佳矫正视力（BCVA）术后1周视力较术前明显提高（P=0．001），术后1月与术后1周差异无统计学意义（P=0．124）；术后3月与术后1月差异有统计学意义（P=0．033）；术后6月与术后3月差异无统计学意义（P=0．206）；术后12个月与术后6个月差异无统计学意义（P=0．243），但与术后3个月差异有统计学意义（P=0．011）。OCT扫描测量黄斑区神经上皮层厚度＋视网膜下液高度于术后1周、1月、3月、6月、12月分别为（507．89±144．37）μm、（389．89±104．47）μm、（298．15±97．35）μm、（264．00±82．26）μm、（230．57±58．71）μm；术后1月与1周（P=0．000）、术后3月与1月（P=0．000）、术后6月与3月（P=0．001）差异均有统计学意义，而术后6月和12月则无明显变化（P=0．088）。视网膜神经上皮下积液，随着时间的延长，积液不断吸收，至术后12月时达92．31％视网膜神经上皮下积液完全吸收。结论OCT能清晰地显示视网膜脱离术后黄斑区微观形态结构的变化，黄斑区解剖复位需要较长时间，可以较好地解释术后视力的恢复过程。

Objective To observe the macular histomorphological changes and visual acuity （VA） of the macula-Off rhegmatogenous retinal detachment （RRD） with optical coherence tomography （OCT） after scleral buckling. Methods Twenty-eight eyes of 28 patients with macule-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 the operation. The relationships between images with visual acuity were analyzed. Results The percent of the patients whose BCVA improved 2 lines that 1 week, 1, 3, 6, 12 months after the operation was respectively 53.57%, 60.71%, 78.57%, 85.71%, 88.46%. There were significantly differences of the BCVA between 1 week and 1 month （P =0.000）, 1 month and 3 months （P =0.000）, 6 months and 3 months （P =0.001） after the operation. The retinal neuroepithelial thickness ＋ subretianl fluid that 1 week, 1, 3, 6, 12months after the operation were respectively 507.89± 144.37/am, 389.89±104.47/am, 298.15±97.35/am, 264.00±82.26/am, 230.57±58.71/am. There were significantly difference between 1 week and 1 month （P =0.001）, 1 month and 3 months （P =0.033）, 12 months and 3 months after the operation （P =0.011）. There were no significantly difference between 6 months and 12 months after the opera- tion （P =0.088）. The subretinal fluid was gradually absorbed after surgery. The percent of the patients whose subretinal fluid was completely absorbed was 92.31%. Conclusions OCT can be used to ob- serve the macular histomorphological changes after rhegmatogenous retinal detachment surgery. The macula reattachment completely and the visual acuity may be needed more time for recovering.