谱域光学相干断层扫描对孔源性视网膜脱离术后黄斑微结构的观察

Observation of the macular microstructure after rhegmatogenous retinal detachment surgery with spectral domain OCT

目的运用谱域光学相干断层扫描仪对孔源性视网膜脱离（RRD）术后患者的视网膜结构进行观察。方法在我院眼科行RRD复位术后1年以上的患者17例（17眼），包括行玻璃体切除术8例，巩膜外环扎外加压术8例，玻璃体切除联合巩膜外环扎1例。17例中，巩膜外冷凝12例，眼内光凝5例。OCT检查观察视网膜结构变化。并用SPSS19．0软件进行统计学分析及独立样本t检验。结果发现10只眼有黄斑区的组织结构异常（58．82％），这些异常包括视网膜变薄2例（11．76％），视网膜前膜6例（35．29％），视网膜水肿2例（11．76％），板层视网膜裂孔1例（5．88％）、脉络膜视网膜萎缩1例（5．88％）、感光细胞内节和外节（IS／OS）连接线的异常4例（包括IS／OS连接线断裂及萎缩）（23．53％）、视网膜外界膜断裂2例（11．76％），外核层高反射点2例（11．76％）。在视网膜脱离累及黄斑的患者中，视网膜前膜和感光细胞IS／OS连接线异常所占的比例均为50％，比例较高。结论OCT因其能够清晰观察黄斑微结构改变，为RRD术后视力预后评估及随访治疗提供了极大方便。

Objective To observe macular retinal structure changes in patients after sucessfully rhegmatogenous retinal detachment （RRD） surgeries with spectral domain optical coherence tomography （OCT）. Methods 17 eyes of 17 patients of RRD with reattachment of retina over 1 year after surgeries was included from Department of Ophthalmology of our Hospital . 8 cases underwent vitrectomy,8 cases under- went scleral buckle. 1 patient underwent vitrectomy combined with scleral buckle. There were 12 cases with transcleral cryosurgery , 5 cases with intraocular photocoagulation. OCT examination was used to observe the changes of retinal structure. Indepent t test was used statistical analysis by SPSS19.0 software. Results 10 eyes showed abnormal macular structure （ 58.82% ）, attenuation of the retina in 2 cases （ 11.76% ）, epiretinal membrane in 6 cases （35.29%）, retinal edema in 2 cases （ 11.76% ）, lamellar retinal hole in 1 cases （5.88%）, chorioretinal atrophy in 1 cases （5.88%）, IS/OS junction line abnormalities in 4 cases （including IS/OS junction line disruption and atrophy） （23.53%）, external limiting membrane disruption in 2 cases（ 11.76% ）, outer nuclear layer hyperreflective point in 2 cases （ 11.76% ）. Higher proportion of epiretinal membranes and IS/OS junction line abnormalities （50%） were found in cases of retinal detach- ment with macular involvement. Conclusion OCT can clearly show the macular microstructure changes af- ter RRD surgery, which provides great convenience for follow-up and prognostic assessment of visual acuity.