玻璃体切割手术眼内灌注液中肾上腺素对手术后视网膜血管管径和黄斑厚度的影响

The effect of epinephrine in intraocular irrigation solution on retinal vascular caliber and macular thickness

目的观察玻璃体切割手术眼内灌注液中肾上腺素对手术后视网膜血管管径和黄斑厚度的影响。方法前瞻性临床对照研究。行玻璃体切割手术的黄斑裂孔患者32例32只眼纳入研究。其中，男性14例14只眼，女性18例18只眼。平均年龄（64．0±4．5）岁。所有患者手术前后均行裸眼视力、矫正视力、裂隙灯显微镜、间接检眼镜、眼底彩色照相、光相干断层扫描（OCT）检查。手术前1周，采用同一像素标准采集同一患眼以视盘为中心的彩色眼底像1张。应用IVON计算机图像分析软件，测量距视盘边缘0．5～1．0个视盘直径范围内所有可测量的小动脉和小静脉。测量结果以视网膜中央动脉等效管径（CRAE）、视网膜中央静脉等效管径（CRVE）表示。以黄斑区视网膜内界面与视网膜色素上皮间的距离为黄斑厚度。按照距黄斑中心凹〈3、3～6mm距离将黄斑分为黄斑内环、外环。根据玻璃体灌注液中是否含有肾上腺素，将患眼分为肾上腺素组、无肾上腺素组，每组均为16只眼。肾上腺素组眼内灌注液中肾上腺素浓度为1：1000。肾上腺素组、无肾上腺素组患眼CRAE、CRVE比较，差异无统计学意义（P〉0．05）；黄斑内环、外环厚度比较，差异无统计学意义（P〉0．05）。手术后平均随访时间3．5个月。对比观察手术前与手术后1、3个月患眼CRAE、CRVE，黄斑内环、外环厚度变化。结果手术后1、3个月，肾上腺素组患眼CRAE（t=0．322、0．148）、CRVE（t=0．317、0．005）与手术前比较，差异均无统计学意义（P〉0．05）；无肾上腺素组患眼CRAE（t=0．226、0．137）、CRVE（t=0．284、0．151）与手术前比较，差异均无统计学意义（P〉0．05）。两组患眼间CRAE（t=0．624、0．424）、CRVE（t=0．015、0．041）比较，差异均无统计学意义（P〉0．05）。肾上腺素组患眼黄斑内环（t=0．322、0．148）、外环（t=0．317、0．005）厚度与手术前比较，差异均无统计学意义（P〉0．05）；无肾上腺素组患眼黄斑内环（t=0．226、0．137）、外环（t=0．284、0．151）厚度与手术前比较，差异均无统计学意义（P〉0．05）。两组患眼间黄斑内环（t=1．568、0．373）、外环（t=1．697、0．536）厚度比较，差异均无统计学意义（P〉0．05）。结论玻璃体切割手术眼内灌注液中1：1000肾上腺素浓度对黄斑裂孔患者手术后视网膜血管管径、黄斑厚度无明显影响。

Objective To observe the effect of epinephrine in intraocular irrigation solution on retinal vascular caliber and macular thickness. Methods A prospective control study. 32 eyes of 32 patients with macular hole who underwent vitrectomy were enrolled in this study. The patients including 14 males （14 eyes） and 27 females （18 eyes）, with the average age of （64.0 4 4.5）years. Uncorrected visual acuity, corrected visual acuity, slit lamp biomicroscopy, indirect ophthalmoscopy, fundus color photography and optical coherence tomography were performed in all patients. Retinal vascular caliber located in 0.5 - 1.0 disc diameter from optic disk was measured from digital fundus photographs and summarized as central retinal artery （CRAE） and vein （CRVE） equivalents in all eyes at baseline and at the 1 month, 3 months follow-up visit. The macular thickness is the distance from retinal interface of inner plexiform layer to retinal pigment epithelium layer. The macula was divided into inner ring （〈3 mm） and outer ring （3 - 6 mm） according to the distance from the fovea. The patients were divided into experiment group （include epinephrine in intraocular irrigation solution, 1：1000） and control group （without epineohrine in intraocular irrigation solution）, 16 eyes in each group. The difference of CRAE and CRVE between two groups was not significant （P〈0.05）. The difference of macular thickness between inner ring and outer ring was not significant （P〉0.0,5）. The average follow-up was 3. ,5 months. CRAE, CRVE and macular thickness in i,mer ring and outer ring before and 1 month, 3 months after surgery were comparatively analyzed. Results The differences of CRAE and CRVE before and 1, 3 months after surgery both in experiment group （tCRAE= 0.322, 0. 148; tCRVE 0. 317,0. 00,5） and control group （tCRXE 0.226,0.137; tCRVE = 0. 284 , 0. 1,51） were not significant （P〉0.05）. Tbe differences of CRAE （t = 0. 624 , 0. 424 ） and CRVE （1=0.01,5,0.041） between experiment group and control group also were not significant （P2〉 0.05）. The differences of macular dliekness in inner ring and outer ring before and 1, 3 months after surgery both in experiment group （tinner =0.322,0. 148;t =0.317,0.005） and control group （tinner =0.226,0. 137;t =0.284,0. 1,51） were not significant （P〉0.05）. The differences of macular thickness in inner ring （t 1.568, 0.373） and outer ring （t 1. 697,0. ,536） between experinaent group and control group also were not significant （P2〉 0.0S）. Conclusion Epinephrine （1：1000） in intraocular irrigation solution has no effect on retinal vascular caliber and macular thickness in patients witb macular hole.