黄斑区脉络膜厚度与孔源性视网膜脱离成功手术复位后视力的相关性

The correlation between choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment

目的观察黄斑区脉络膜厚度与非高度近视孔源性视网膜脱离（RRD）成功手术复位后视力的相关性。方法行手术治疗后视网膜均成功复位的非高度近视RRD患者53例53只眼纳入研究。手术前后所有患者双眼同时行最佳矫正视力（BcVA）及频域光相干断层扫描（OCT）检查。取穿过黄斑中心凹横向与纵向的两扫描切面图像进行黄斑中心凹形态分析，并测量黄斑中心凹厚度（CFT）及脉络膜厚度。分析不同黄斑中心凹形态、CFT、脉络膜厚度与患眼手术后BCVA的相关性。根据手术后患眼的脉络膜厚度分为脉络膜厚度≤150．00μm组及脉络膜厚度〉150．00μm 组，分析两组手术后BCVA提高程度的差异。随访期间观察患眼光感受器内外节连接（IS／OS）及外界膜连接状态，将IS／OS及外界膜中断患眼分为重建及未重建两种状态，对比分析两种状态下手术后BCVA、CFT及脉络膜厚度的差异。结果末次随访时，患眼平均BCVA为0．52±0．47。频域OCT检查显示，患眼平均CFT为（207．45±63．63）μm，平均脉络膜厚度为（175．46±62．68）μm。患眼手术后BCVA与IS／OS连接形态、脉络膜厚度有明显相关性（r=4．92、4．63，P〈0．05）；与手术后外界膜连接状态以及是否存在视网膜下液、视网膜前膜、黄斑水肿和CFT无相关性（r=0．24、1．20、0．30、0．03、0．14，P〉0．05）。脉络膜厚度〉150．00μm组手术后2周～3个月BCVA提高程度较脉络膜厚度≤150．00μm组更大，差异有统计学意义（t=-2．318，P〈0．05）。IS／OS重建及未重建患眼比较，平均BCVA、平均脉络膜厚度间差异有统计学意义（t=-5．253、2．396，P〈0．05）；平均CFT间差异无统计学意义（t=1．454，P〉0．05）。外界膜重建及未重建患眼比较，平均BCVA、平均脉络膜厚度间差异有统计学意义（t=-5．940、3．563，P〈0．05）；平均CFT间差异无统计学意义（t=1．117，P〉0．05）。结论黄斑区脉络膜厚度与非高度近视RRD成功手术复位后BCVA有明显相关性。

Objective To investigate the relationship of choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment （RRD） in eyes without high myopia. Methods Fifty-three eyes of 53 patients with RRD and without highly myopic eyes after anatomically successful surgical repair were enrolled in this study. The preoperative and postoperative best-corrected visual acuities （BCVA） were recorded. Spectral domain-optical coherence tomography （OCT） was used to assess the postoperative foveal structure, central foveal thicknesses （CFT） and choroidal thickness. The correlation between the postoperative BCVA and abnormality of the fovea, CFT and choroidal thickness was evaluated. According to the postoperative thickness of the choroid, the patients were divided into ≤150.00μm group and 〉150.00 μm group; the improvement of postoperative BCVA in the two groups was analyzed. The state of inside and outside section （IS/OS） and the external limiting membrane （ELM） was divided into reconstructed and un-reconstructed categories. The postoperative BCVA, CFT and choroidal thickness of two types were comparatively analyzed. Results At the last time of follow up, the mean BCVA was 0.52± 0.47. The results of spectral domain OCT showed that the mean CFT was （207.45 ± 63.63） and mean choroidal thickness was （175.46 ± 62.68） μm. The postoperative BCVA correlated positively with IS/OS junction and choroidal thickness （r=4.92, 4.63; P〈0.05）, but was insignificantly associated with ELMjunction, whether subretinal fluids were present or not, whether epiretinal membrane was affected or not, whether there was macular edema or not and CFT （r=0.9.4, 1.20, 0.30, 0.03, 0.14; P〉0.05）. Two weeks to three months after surgery, the improvement of BCVA in 〉150.00 μm group was significantly higher than that in ≤ 150. 00 μm group （t=- 2.318, P〈0.05）. Compared the reconstructed with un reconstructed IS/OS eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different （t=- 5. 253, 2. 396; P〈0.05）. The difference of mean CFT was not statistically significant （t- 1. 454, P〉0.05）. Compared the reconstructed with un-reconstructed ELM eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different （t = -5. 940, 3. 563;P〈0. 05）. The difference of mean CFT was not statistically significant （t=1. 117, P〉 0.05）. Conclusion The choroidal thickness has a significant correlation with visual acuity after successful repair of RRD in eyes without high myopia.