OCT在孔源性视网膜脱离患者术后中的应用

Application of OCT in Postoperation of Patients with Rhegmatogenous Retinal Detachment

目的探讨光学相干断层扫描(OCT)在孔源性视网膜脱离(RRD)患者术后中的应用价值。方法选取2014年6月至2017年6月我院收治的RRD患者120例(120只患眼,120只健康眼)为研究对象,均行巩膜扣带手术,术后行全面眼科检查测定最佳矫正视力(BCVA),并在术后3d、2周、1个月、3个月、6个月随诊时对双眼进行OCT检查,测量其黄斑中心凹视网膜厚度、黄斑区视网膜下积液(SMF)高度及光感受器内外连接(IS/OS)交界线、视网膜外界膜(ELM)等微结构改变,分析术后黄斑区微结构改变与其视力预后的关系。结果术前OCT可见IS/OS与ELM层断裂,光感受器外节反光带不规则或增粗,术后IS/OS、ELM形态主要为IS/OS、ELM连续,IS/OS断裂、ELM连续,IS/OS连续、ELM断裂,IS/OS、ELM均断裂;术后2周患眼BCVA有不同程度提高,且术后3个月、6个月BCVA较术前明显提高(P<0.05);术前患眼SMF高度、黄斑中心凹视网膜厚度高于对侧健康眼(P<0.01),术后3d、2周、1个月、3个月患眼黄斑中心凹视网膜厚度低于术前,但仍高于对侧健康眼(P<0.01),术后6个月差异无统计学意义(P>0.05);术前SMF高度、黄斑中心凹视网膜厚度与术后6个月患眼BCVA呈负相关(P<0.05)。结论 OCT在RRD术后有较高应用价值,可较好评价其黄斑中心凹视网膜厚度、SMF、IS/OS、ELM等微结构,值得在临床推广实践。

Objective To explore the application values of optical coherence tomography(OCT)in postoperation of patients with rhegmatogenous retinal detachment(RRD).Methods A total of 120 cases of RRD patients(120 affected eyes,120 healthy eyes)admitted to our hospital from June 2014 to June 2017 were enrolled in this study and were given the scleral buckling surgery.The best corrected visual acuity(BCVA)was determined by comprehensive ophthalmoscopy after operation,and the OCT was performed on both eyes at the follow-up of 3 d,2 weeks,1 month,3 months and 6 months after operation.The macular foveal retinal thickness,subretinal macular fluid(SMF)height and the photoreceptor inner segment/outer segment(IS/OS)borderline and the external limiting membrane(ELM)and other microstructures were measured.And the relationship between macular microstructure changes and visual acuity prognosis after operation was analyzed.Results The preoperative OCT showed that the IS/OS and ELM layers were ruptured,and the photoreceptor outer reflection band was irregular or thickening.The postoperative IS/OS and ELM morphology were mainly continuous IS/OS and ELM,ruptured IS/OS and continuous ELM,continuous IS/OS and ruptured ELM,and ruptured IS/OS and ELM.The BCVA of affected eyes was increased with different degree at 2 w after operation,and the BCVA at 3 months and 6 months after operation was significantly higher than that before operation(P<0.05).The preoperative SMF height and the macular foveal retinal thickness of the affected eyes were higher than those of the contralateral healthy eyes(P<0.01),and the macular foveal retinal thickness at 3 d,2 weeks,1 month and 3 months after operation was lower than that before operation but was still higher than that of contralateral healthy eyes(P<0.01),but there was no significant difference at 6 months after operation(P >0.05).Preoperative SMF height,macular foveal retinal thickness were negatively correlated with the BCVA of affected eyes at 6 months after operation(P<0.05).Conclusion OCT in the postoperation of RRD has high application values,which can evaluate its macular foveal retinal thickness,SMF,IS/OS,ELM and other microstructures,and it is worthy of clinical promotion and practice.