手术中光相干断层扫描在玻璃体视网膜手术中应用的初步观察报告

The preliminary application of intraoperative optical coherence tomography in vitreous retinal surgery

目的观察评估手术中光相干断层扫描（iOCT）技术在玻璃体视网膜手术中的应用价值以及iOCT图像成像质量的影响因素。方法回顾性病例研究。行玻璃体视网膜手术且行iOCT检查的132例患者的132只眼纳入研究。其中，男性46例46只眼，女性86例86只眼；平均年龄61．7岁。玻璃体积血21只眼；黄斑疾病111只眼。以眼轴长度〉26、≤26mm将患眼分为高度近视组、非高度近视组，分别为28、104只眼。所有患眼玻璃体视网膜手术中均行iOCT检查。记录手术开始至iOCT检查时间、iOCT检查时间、图像成像质量；手术中角膜水肿、前房粘弹剂残留、联合白内障超声乳化手术等眼部情况。观察iOCT检查与手术者手术显微镜观察结果的一致性；iOCT检查结果对手术治疗策略的影响；与检查相关的不良反应及并发症发生情况。Logistic多元线性回归分析影响图像成像质量的相关因素。结果获取、未获取iOCT图像者分别为124、8只眼。iOCT检查发现黄斑区形态改变与手术者手术显微镜观察结果不一致者22只眼，占16．7％；因iOCT检查发现而改变手术策略者12只眼，占9．1％。高度近视组患眼iOCT图像成像质量明显低于非高度近视组（x2=17．13，P=0．001）。Logistic多元线性回归分析发现，手术开始至iOCT检查时间、角膜水肿是影响非高度近视组患眼i0CT图像成像质量的相关因素（r=3．75、6．18，P=0．049、0．013）。手术后未见与检查相关的眼内炎等并发症发生。结论iOCT可在玻璃体视网膜手术中实时直观观察到手术显微镜下难以发现的黄斑区形态变化，指导手术者及时调整修正手术方式。高度近视、角膜水肿、手术开始至iOCT检查时间是iOCT图像成像质量的主要影响因素。

Objective To observe the preliminary application of intraoperative optical coherence tomography （iOCT） in vitreous retinal surgery and the influencing factors of the imaging quality. Methods A retrospective case study. A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital. All the subjects were taken vitreous retinal surgery and iOCT scanning. The patients included 46 males and 86 females, with an average age of 61.7 years. 111 cases had maeular diseases and 21 cases had vitreous hemorrhage. Cases are divided into high myopia and non-high myopia group according to ocular axial length （AL）, 28 eyes in high myopia group （AL≥26 mm ）,104 eyes in non-high myopia （AL〈26 mm）. The scanning time, image quality and eye conditions were observed during the operation. The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed. Results The iOCT images were identified in 124 of 132 subjects, while were not identified in 8 eyes. For the macular area morphology change, iOCT tips and surgeon judgment rate was inconsistent in 22 eyes （16.7%）. For the operation guidance value, change the operation rate of 12/132,accounted for 9.1 %. The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups （x2 = 17. 13, P = 0.001）. Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups （r = 3.75, 6.18; P=0. 049, 0. 013）. There were no complications such as endophthalmitis. Conclusions The surgeon can ohserve morphological changes in the macular area through iOCT which is difficult to be observed hy operating microscope and selected reasonable operation method during the surgery. High myopia, corneal edema and operation time affect the image quality.