黄斑部病变手术后解剖结构变化的客观评价

The objective evaluation of the postoperative changes of anatomical structures in macular diseases

目的 探讨黄斑部手术后解剖结构改变的客观评价方法。 方法 对 31例 (31只眼 )各种黄斑病变 ,包括黄斑裂孔 (idiopathic macular hole,IMH) 15只眼 ,单纯黄斑前膜 (epiretinal membranes ,ERMs) 8只眼 ,老年黄斑变性 (age related macular degeneration,AMD) 4只眼 ,特发性黄斑下新生血管膜4只眼。术前术后进行眼底检查、眼底照相、荧光素眼底血管造影 (fundus fluorescein angiography ,FFA)以及光学相干断层成像术检查 (optical coherence tomography,OCT) ,将各种检查结果进行比较及评价。 结果 眼底检查、照相显示所有黄斑裂孔封闭 ,但 OCT发现 2例未完全闭合 ,1例黄斑区神经上皮变薄 ;FFA发现 5例视网膜色素上皮 (retinal pigment epithelium,RPE)缺损。对于 ERM、黄斑下新生血管膜 ,检眼镜检查难确定是否已完全清除 ,FFA显示新生血管膜消失及不同程度的 RPE损害 ;OCT能清楚显示 ERM、新生血管膜消失 ,3例同时见神经上皮层变薄。 结论 常规的各种眼底检查可在一定程度上对黄斑疾患手术后的解剖结构进行评价 ,OCT则能清楚、精确地显示黄斑部的各种病变 ,尤其对手术后黄斑部各种组织结构的改变能更精确、更全面地进行评价。

Objective To evaluate different methods in determining the postoperative changes of anatomical structures in macular diseases. Methods Thirty-one eyes of 31 cases of macular diseases, were studied among them there were 15 eyes with idiopathic macular hole (IMH),and the others included 8 eyes with macular epiretinal membranes(ERMs), 4 eyes with age related macular degeneration(AMD) and 4 eyes with idiopathic submacular neovascularizations(SRNV). All cases were examined with retinoscope or retinography, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) pre- and postoperatively. Results Funduscopy showed that all of the 15 IMHs were closed after operation, but OCT showed that among them 2 affected eyes still had partial retinal detachment at the macular hole edge in one quadrant and the sensory layer in macular area became thinner in 1 affected eye. FFA revealed damage of retinal pigment epithelium (RPE) in 5 cases. As for the ERMs and SRNV, funduscopy could not identify wether they were completely removed or not after operation. FFA indicated that SRNV and SRNV were completely removed and the damage of RPE. OCT discovered that the ERMs and SRNV were completely removed and the sensory layer became thinner in 3 eyes. Conclusion The combination of funduscopy , FFA and OCT can get the whole view of macular diseases and their postoperative anatomical evaluation.