频域OCT检测不同视网膜脱离复位术后黄斑中心凹视网膜厚度变化与视功能的关系

Macular foveal thickness measured by spectral domain OCT after different retinal detachment surgeries and its relationship with visual function

目的探讨累及黄斑区的孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)患者,行不同手术方式治疗后频域光学相干断层扫描(optical coherence tomography,OCT)检测黄斑中心凹视网膜厚度变化及其与视力的相关性。方法累及黄斑区的RRD患者40例(40眼),其中巩膜外加压术组16例(16眼)、玻璃体切割联合惰性气体填充术组14例(14眼)和玻璃体切割联合硅油填充术组10例(10眼)。术后1周、1个月、3个月、6个月行OCT检查,观察黄斑中心凹视网膜厚度变化,行最佳矫正视力(best-corrected visual acuity,BCVA)检查。比较各组患者黄斑中心凹厚度差异,分析黄斑中心凹厚度与BCVA的相关性。结果术后所有患者视网膜脱离均解剖复位成功。术后1周巩膜外加压术组、玻璃体切割联合惰性气体填充术组、玻璃体切割联合硅油填充术组黄斑中心凹厚度分别为(361.44±88.32)μm、(359.86±89.67)μm、(361.60±84.71)μm,BCVA分别为0.13±0.07、0.14±0.09、0.13±0.08;术后1个月3组患者黄斑中心凹厚度分别为(328.81±90.74)μm、(264.93±28.38)μm、(272.40±26.84)μm,BCVA分别为0.26±0.13、0.45±0.20、0.50±0.12;术后3个月3组患者黄斑中心凹厚度分别为(279.06±57.90)μm、(262.57±34.58)μm、(270.90±30.30)μm,BCVA分别为0.47±0.17、0.49±0.19、0.55±0.14;术后6个月3组患者黄斑中心凹厚度分别为(261.75±47.13)μm、(251.07±24.96)μm、(253.90±22.76)μm,BCVA分别为0.48±0.16、0.56±0.15、0.58±0.13。术后1个月,与巩膜外加压术组相比,玻璃体切割联合惰性气体填充术组、玻璃体切割联合硅油填充术组黄斑中心凹厚度明显降低而BCVA明显提高,各组间差异均有统计学意义(均为P<0.05)。两两比较显示:巩膜外加压术组黄斑中心凹厚度及BCVA术后3个月与术后6个月比较差异无统计学意义(P>0.05),其余各时间段两两比较差异均有统计学意义(均为P<0.05);玻璃体切割联合惰性气体填充术组及玻璃体切割联合硅油填充术组黄斑中心凹厚度及BCVA术后1周与其余各时间段比较差异均有统计学意义(均为P<0.05),其余各时间段两两比较差异均无统计学意义(均为P>0.05)。术后1周、1个月、3个月、6个月各组患者黄斑中心凹厚度与BCVA均呈负相关(均为P<0.05)。结论频域OCT能定量观察RRD患者术后黄斑区的变化;与巩膜外加压术相比,采用玻璃体切割术治疗RRD术后黄斑区视网膜厚度恢复更快;不同的眼内填充物对黄斑区视网膜厚度恢复无影响;RRD术后黄斑区视网膜厚度与视力呈负相关。

Objective To explore the macular foveal thickness changes meas ured by spectral domain optical coherence tomography （OCT） in patients with rhegmat ogenous retinal detachment （RRD） involving the macular area after different retinal de tachment surgeries and its relationship with visual acuity. Methods Forty patients （40 eyes） with RRD involving the macular area underwent different surgeries,inchiding Scleral pressurized surgery in 15 patients （ 16 eyes） ,vitrectomy combined with an inert gas filling in 14 cases （ 14 eyes） and vitrectomy combined with silicone oil tamponade in 10 cases （ 10 eyes）. The foveal retinal thickness was detected by OCT and best correc ted visual acuity （BCVA） was examined at postoperative 1 week, 1 month, 3 months and 5 months. The macular foveal thickness in every group patients was compared. The correlations between macular foveal thickness and BCVA were analyzed. Results All detached retinas were successfully reattached after surgery. At postoperative 1 week, the foveal retinal thickness in Scleral pressurized surgery group, vitrectomy combinedwith an inert gas filling group and vitrectomy combined with silicone oil tamponade group were （ 361.44 ± 88.32 ） um, （ 359.86 ± 89.67 ） um and （ 361.60± 84.71 ） p.m, respectively, BCVA were 0.13 ± 0.07,0.14 ± 0.09,0.13 ± 0.08, respectively ;At postoperative 1 month, the corresponding foveal retinal thickness were （328.81 ± 90. 74 ） um, （264.93 ± 28.38 ） um and （272.40 ±26.84 ） um, respectively, BCVA were 0.26 ± 0. 13,0.45± 0.20 and 0.50 ± 0. 12, respectively; At postoperative 3 months ,the corresponding foveal retinal thickness were（279.06 ±57.90）um, （262.57 ±34.58）um and（270.90 ±30.30）um, respectively, BCVA were 0.47± 0.17,0.49 ± 0.19 and 0.55 ±0.14, respectively;At postoperative 6 months, the corresponding foveal retinal thickness were （ 261.75 ± 47.13 ） p,m, （ 251.07±24.96 ） um and （ 253.90 ± 22.76 ） um, respectively, BCVA were 0.48 ±0.16,0.56 ±0.15 and 0.58 ±0.13 ,respectively. Compared with Scleral buckling surgery group,the foveal thickness at postoperative 1 month decreased but BCVA increased significantly in vitrectomy combined with an inert gas filling group and vitrectomy combined with silicone oil tamponade group, there were statistical differences （ all P 〈 0.05 ）. In Scleral buckling surgery group, the differences of foveal thickness and BCVA between postoperative 3 months and 6 months was not statisti cally significant （P 〉 0.05 ）, pairwise comparisons among the rest of the time period, the differences were statistically signifi cant （ all P 〈 0.05 ） ; In vitrectomy combined with an inert gas filling group and vitrectomy combined with silicone oil tam- ponade group, postoperative one week compared with the rest of the time period, the differences of foveal thickness and BCVA were statistically significant （ all P 〈 0.05 ）, palrwise comparisons among the rest of the time period, the differences was not statistically significant （ all P 〉 0.05 ）. The foveal thickness and BCVA in patients showed a negative correlation at postoperative 1 week, 1 month,3 months and 6 months （ all P 〈 0.05 ）. Conclusion Spectral domain OCT can quantita tively observe the postoperative macular changes in RRD patients;Compared with scleral buckling surgery, the postoperative macular thickness recovery faster in vitrectomy for RRD; The different intraocular filling has no effect on macular thickness recovery,the postoperative macular thickness and visual acuity is negative correlated after RRD surgery.