累及黄斑视网膜脱离术后解剖学改变和功能恢复情况(英文)

Anatomic and functional results after macula-off retinal detachment surgery

目的:OCT观察累及黄斑视网膜脱离行巩膜外加压术后5a黄斑情况。分析脱离时间及术后5a黄斑OCT及视功能的相关性。方法:回顾性分析47例47眼,累及黄斑视网膜脱离行巩膜外加压术后5a OCT,视功能及脱离时间,并行统计学分析。结果:视网膜脱离时间<7d的黄斑厚度(226±88μm)较脱离时间>7d黄斑厚度(209±76μm)厚,但无统计学意义。而术后复位的黄斑厚度和视力呈正相关(Pearson correlation test,R=1,P=0.01)。脱离时间<7d组视力(0.53)明显好于脱离时间>7d组视力(0.25),明显统计学差异(ttest,P=0.008)。5例(10%)患者发现黄斑区结构异常,包括4例IS/OS层断裂,同时伴有外界膜的断裂(8.5%),且术后5a平均视力(0.15)低于两组的平均视力。结论:脱离时间的长短严重影响视功能的恢复、术后黄斑的厚度及黄斑结构的改变。累计黄斑视网膜脱离手术尽可能在脱离时间<7d内完成。对于视力恢复较差者,建议行OCT检查。

AIM：To observe the macula structure of the macula-off rhegmatogenous retinal detachment （ RRD ） with optical coherence tomography （ OCT ） 5 years after successful scleral buckling （ SB ） surgery and to analyze the correlation between the duration of macular detachment （ DMD） and postoperative visual acuity with OCT image. METHODS：Forty-seven eyes of 47 patients with macula-off RRD were retro spectively studied and follow-up was carir ed out for a period of 5 years.The correlation among the postoperative best-corrected visual acuity （VA）, the DMD and the microstructural findings with OCT at the fovea were evaluated. RESULTS： The sub-acute RRD （ DMD〈7d ） shows a greater foveal thickness （226.88μm） than the prolonged one （ DMD〉7 days ） （ 209.76μm ） with no statistical difference （P=0.791）.Meanwhile, the sub-acute RRD had better mean final VA 0.53, compared with the prolonged one of 0.25, with significant difference （ Student＇s t-test, P=0.008）.Among 47 eyes, foveal anatomic abnormalities were detected in 5 eyes （10%）;disruption of the junction between the photoreceptor inner and outer segments （ IS/OS） in 4 eyes, and with a disrupted external limiting membrane （ELM） also （8.5%）;and the mean VA of these 5 patients was 0.15 lower after 5 years. CONCLUSION：Sub-acute macula-off RRD has a better impact on the final visual recovery than the prolonged one.Furthermore, the retinal thickness in the fovea was positively correlated to the postoperative VA. The disrupted inner segment/outer segment （ IS/OS） junction could be restored in the patients without disrupted ELM signa ls at the initial examination.The duration of macula-off RRD within 7d had fewer disrupted inner segment/outer segment （ IS/OS ） junction with disrupted ELM signals than those for more than 7d.It is recommended to perform OCT in cases where VA was not improved as expected.