手术中光相干断层扫描在黄斑疾病玻璃体切割联合内界膜剥除手术中的应用

The evaluation of assistant effect of intraoperative optical coherence tomography in vitreous retinal surgery for macular disease

目的观察评估手术中OCT(iOCT)在黄斑疾病玻璃体切割联合内界膜剥除手术中的应用价值。方法回顾性系列病例研究。2015年6月至2016年9月在温州医科大学附属眼视光医院杭州院区因黄斑疾病行玻璃体切割联合内界膜剥除的71例患者71只眼纳入研究。其中,男性24例24只眼,女性47例47只眼;年龄25~78岁,平均年龄(63.35±10.01)岁。所有患者均为单眼发病,包括特发性黄斑裂孔26只眼、特发性黄斑前膜42只眼、玻璃体黄斑牵拉综合征3只眼。由同一眼科医生于23G微创玻璃体切割联合吲哚青绿染色辅助剥除黄斑区内界膜手术中行iOCT检查,记录内界膜剥除前后患眼黄斑区发生的形态变化。对比分析iOCT与手术者显微镜下观察结果。同时记录因iOCT结果而改变原定手术治疗策略的病例。结果71只眼中,iOCT与手术者显微镜下判断一致者63只眼(90.14%),非一致者8只眼(11.27%)。iOCT与手术者显微镜下判断非一致者中,特发性黄斑裂孔5只眼(62.50%)、特发性黄斑前膜2只眼(25.00%)、玻璃体黄斑牵拉综合征1只眼(12.50%)。71只眼中,因iOCT结果而发生手术治疗策略改变8只眼(11.27%)。其中,特发性黄斑裂孔5只眼(62.50%)、特发性黄斑前膜2只眼(25.00%)、玻璃体黄斑牵拉综合征1只眼(12.50%)。治疗策略的改变主要为更改眼内填充物及再次剥膜。结论iOCT在黄斑疾病玻璃体切割联合内界膜剥除手术中可以及时发现手术显微镜下难以察觉的细微形态变化,指导手术者及时调整修正手术方式。

Objective To evaluate the assistant effect of intraoperative OCT (iOCT) in vitreous retinal surgery for macular disease. Methods A retrospective case study. A total of 71 patients (71 eyes) with macular disease who underwent vitrectomy in Eye Hospital of Wenzhou Medical University at Hangzhou from June 2015 to September 2016 were collected. There were 24 males (24 eyes) and 47 females (47 eyes), aged from 25 to 78 years, with the mean age of 63.35±10.01 years. Among 71 eyes, there were 26 eyes with idiopathic macular hole, 42 eyes with idiopathic epiretinal membrane, 3 eyes with vitreomacular traction syndrome. The examination of iOCT was performed on the patients during 23G minimally invasive vitreoretinal surgery combined with internal limiting membrane peeling. Use observational method to compare the difference between result of iOCT and observation under the microscope, record the change of treatment strategy. Results Eight eyes (11.27%) iOCT results were different from the surgeon’s observation, which including 5 eyes (62.50%) with idiopathic macular hole, 2 eyes (25.00%) with idiopathic epiretinal membrane, 1 eye (12.50%) with vitreomacular traction syndrome. The treatment strategy was changed in 8 eyes (11.27%) based on iOCT result, which including 5 eyes (62.50%) with idiopathic macular hole, 2 eyes (25.00%) with idiopathic epiretinal membrane, 1 eye (12.50%) with vitreomacular traction syndrome. Conclusions iOCT can help the surgeon find some subtle morphological changes which can hardly be seen by eyes. The surgeon can change and optimize the treatment strategy based on the result of iOCT.