视网膜脱离术后亚临床性视网膜下液的光学相干断层扫描特征

Macular Morphological Changes of Persistent Subclinical Subretinal Fluid after Scleral Buckle Surgery: An Optical Coherence Tomography Study

目的探讨孔源性视网膜脱离术后亚临床性视网膜下液的黄斑区光学相干断层扫描(optical coherence tomography,OCT)表现。方法对孔源性视网膜脱离巩膜扣带术后临床视网膜复位但视力恢复不佳或有视物变形症状患者19例21眼,应用3DOCT在其黄斑部行范围为6mm×6mm×1.7mm、分辨率为512×128的三维扫描检查。分析患者黄斑部的OCT表现,包括中心凹神经上皮厚度、神经上皮脱离情况、感光细胞内外节(inner segment/outer segment,IS/OS)结合部情况等。结果 3DOCT检查显示15眼存在黄斑区亚临床性视网膜下液,均为术前黄斑脱离的患者。其中14眼神经上皮的IS/OS结合部反光信号完整且增厚增强,2眼可见中心凹外色素上皮层的高反射隆起,2眼可见视网膜前膜反射信号。15眼中,7眼神经上皮断续脱离。7例患者进行了多次OCT随访,时间为术后3～12个月,神经上皮脱离最终全部消失,最佳矫正视力恢复到0.7～1.2。结论 3DOCT能发现临床视网膜复位患者的亚临床性视网膜下液并确定脱离范围,大多数患者表现为神经上皮浅脱离,IS/OS结合部反光信号完整且增厚增强。

Objective To evaluate macular morphological changes by spectral domain optical coherence tomography （3D OCT） in patients with persistent subclinical subretinal fluid after successful scleral buckle surgeries. Methods Totally 19 cases （21 eyes） with incomplete visual acuity recovery or metamorphosis were reviewed. 3D OCT was performed in the macula （size： 6 mm ×6 mm × 1.7 mm; resolution： 512× 128）. The morphological changes of macula including thickness of foveal neuroepithelium, neuroepithelial detachment, inner segment/outer segment （IS/OS） junction were recorded. Results 3D OCT showed persistent subclinical subre- tinal fluid in 15 eyes, and all of them occurred in patients with preoperative macular detachment. Also, 14 of 15 eyes showed disruption of the photoreceptor IS/OS junction, 2 showed irregularity of retinal pigment epithelium reflection signal, and 2 showed thin epiretinal membrane. Seven of these 15 eyes showed discontinuous retinal de- tachment. During the 3- to 12- month continuous follow-up for 7 eyes, the neuroepithelial detachment finally dis- appeared, and the best corrected visual acuity returned to 0. 7-1.2. Conclusions 3 D OCT can demonstrate are- as of persistent subclinical subretinal fluid after successful scleral buckle surgeries. Most patients have neural epithelium shallow detachment as well as complete and enhanced IS/OS junction signal.