光学相干断层扫描在视网膜脱离手术疗效评价中的应用

The application of optical coherence tomography scan in retinal detachment surgery

目的：探讨在视网膜脱离手术疗效评价中应用光学相干断层扫描（OCT）的价值。方法对50例50眼裂孔源性视网膜脱离波及黄斑部患者进行冷凝、巩膜外垫压＋环扎和放出视网膜下液手术，手术前及手术后1w、1M、3M、6M、12M进行OCT 检查，定量检测黄斑中心凹下积液高度、黄斑部视网膜神经上皮厚度。结果随访时间为13～21（16．26±2．59）个月，平均黄斑中心凹下积液高度手术前为（735．88±532．86）μm，手术后1 w为（150．54±188．43）μm，两者差异有统计学意义（t ＝7．3231， P＜0．05）；平均黄斑部视网膜神经上皮厚度手术前为（132．12±56．89）μm，手术后1 w为（109．18±40．93）μm ，两者差异有统计学意义（t＝2．3142， P＜0．05）；手术后1w 间接检眼镜下视网膜复位47例（94％），OCT仅显示15例（30％）黄斑中心凹下积液高度为0，此时33例脱盲（矫正视力≥0．05）（66．0％）；手术后12 M OCT显示47例（94．0％）黄斑中心凹下积液高度为0，此时48例脱盲（96．0％）。结论 OCT能定量测量黄斑中心凹下积液高度，客观评价视网膜脱离手术后疗效，为视网膜脱离手术后的治疗提供依据。

Objective To evaluate the efficacy of applying optical coherence tomography （ OCT） in retinal detachment surgery.Methods The surgery was performed by using scleral buckling ±cerclage on 50 eyes of 50 pa-tients with macular-off rhegmatogenous retinal detachment .The submacular fluid height and foveal retinal thickness were measured by OCT examination before surgery and at 1 week, 1, 3, 6 and 12 months after the surgery .Results The average submacular fluid height decreased from （735.88 ±532.86 ）μm to （150.54 ±188.43 ）μm postoperative-ly（t=7.3231,P 〈0.05） with a follow-up ranged from 13 to 21（16.26 ±2.59）months .The averages of foveal reti-nal thickness were （132.12 ±56.89 ）μm and （109.18 ±40.93 ）μm respectively, before and 1 w after the operation （t=2.3142, P〈0.05）.Retinal reattachment was found in 47 cases（94.0%） 1 w after the surgery under ophthal-moscope examination and the submacular fluid was totally absorbed in 15 cases（30.0%）.As a result, 33 cases （66.0%） got rid of blindness（the best-corrected visual acuity ≥0.05）.OCT showed that no foveal fluid was found in 47 cases（94.0%） 12 months after the operation and 48 cases（96.0%） got rid of blindness.Conclusion OCT can quantitatively measure the submacular fluid height of central macular , objectively evaluate the effects of retinal detachment surgery and provide the evidences for the postoperative treatment