相干光断层扫描对视网膜脱离复位术后视力恢复的评估

Assessment of visual acuity with optical coherence tomography after retinal detachment surgery

目的通过相干光断层扫描（OCT）观察孔源性视网膜脱离行巩膜扣带术后黄斑区的结构，分析其与视力变化的关系。设计回顾性病例系列。研究对象绵阳市中心医院孔源性视网膜脱离已累及黄斑区，经行巩膜扣带术视网膜成功复位的41例（41眼）患者。方法分别于术后1周，1、3、6、12个月行最佳矫正视力、眼底检查，OCT检查。对术后6个月OCT检查视网膜下液完全吸收者，第9个月增加一次最佳矫正视力、眼底检查，OCT检查。主要指标最佳矫正视力，OCT表现。结果（1）术后1周，1、3、6、12个月最佳矫正视力≥0_3者分别为3眼（7．32％）、8眼（19．51％）、22眼（53．66％）、28眼（68．29％）、31眼（75．61％）；各时间点OCT检查黄斑区视网膜下液完全吸收者分别为2眼（4．88％）、11眼（26．83％）、21眼（51．22％）、37眼（90．24％）、40眼（97．56％）。（2）OCT显示首次黄斑区视网膜下液完全吸收者，较之前一次检查时间最佳矫正视力提高2行以上者35眼（85．37％），差异有统计学意义（P=0．008）；术后6个月内OCT示黄斑区视网膜下液完全吸收的37眼，其后1～3个月最佳矫正视力再提高2行以上者22眼（59．46％），而黄斑区视网膜下液完全吸收3个月之后复查时，最佳矫正视力较黄斑区视网膜下液完全吸收3个月内提高均未超过1行，两者比较差异有统计学意义（P=0．032）。结论OCT检查可更好地判断黄斑区视钢膜的解剖复位；视网膜脱离术后解剖复位（黄斑区视网膜下液完全吸收）后功能恢复多在3个月内。

Objective To observe macular structure with optical coherence tomography（OCT） and analyze its relation with change of visual acuity in patients undergone scleral buckling surgery for rhegmatogenous retinal detachment. Design Retrospective case series. Participants 41 patients （41 eyes） from Mianyang Cental Hospital undergone scleral buckling surgery for rhegmatogenous retinal detachment involving macular. Method Best corrected visual acuity （BCVA）, fundus examination and OCT were performed in post-sugery 1 week, 1 month, 3 months, 6 months, 12 months. On post-surgery 9 months, BCVA, fundus and OCT were carried out to those patients whose sub-retinal fluid was completely absorbed showed by OCT examination on post-surgery 6 months. Main Outcome Measures BCVA and OCT findings. Results （1） BCVA ≥0.3 was found in 3 eyes （7.32%）, 8 eyes （19.51%）, 22 eyes （53.66%）, 28 eyes （68.29%） and 31 eyes （75.61%） in post-surgery 1 week, 1 month, 3 months, 6 months, 12 months respectively. Sub-retinal fluid was found completely absorbed by OCT in 2 eyes （4.88%）, 11 eyes （26.83%）, 21 eyes （51.22%）, 37 eyes （90.24%） and 40 eyes （97.56%） respectively. （2） BCVA improved more than 2 lines than last examinotion when OCT showed sub-retinal fluid completely absorbed was found in 35 eyes （85.37%） （P=0.008）. For 37 eyes whose sub-retinal fluid was completely absorbed in post-surgery 6 months after surgery, BCVA was improved more than 2 lines in 22 eyes （59.46%） within 1 month to 3 months thereafter, and none of them improved more than 1 line after 3 months thereafter（P=0.032）. Conclusion OCT examinatin is a good method to determine anatomical restoration of macular. Vision improvement can be reached mostly within 3 months after anatomical restoration of macular.