孔源性视网膜脱离玻璃体切割术后脉络膜厚度的相关研究

Choroidal thickness changes after vitrectomy in patients with rhegmatogenous retinal detachment

目的应用光学相干断层扫描成像(optical coherence tomography,OCT)观察孔源性视网膜脱离(rhegmatogenous retinal detachments,RRD)玻璃体切割(pars plana vitrectomy,PPV)术后黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SCT)的变化及其对视力预后的影响。方法回顾性病例分析,收纳2016年至2019年就诊于保定市第一中心医院RRD行PPV术后成功复位者,共63例63只眼纳入研究,同时取对侧健眼为正常对照组。所有受检者行23 G PPV联合硅油眼内填充;均于PPV术后3个月行硅油取出术。分别于PPV术前和硅油取出术后3 d、3个月行logMAR最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯显微镜、间接检眼镜、彩色眼底照相、OCT检查,观察BCVA、SCT和黄斑区微结构改变,同时分析SCT变化与术后BCVA的相关性。结果RRD组硅油取出术后3 d、3个月,患眼logMAR BCVA分别为0.56±0.20、0.39±0.18;较手术前(0.81±0.39)明显改善,差异有统计学意义(F=42.663,P<0.05)。术前BCVA与术后3个月BCVA呈正相关(r=0.732,P<0.05)。硅油取出术后3 d RRD组SCT(303.32±25.68)μm,与术前及硅油取出术后3个月比较,差异有统计学意义(t=3.658、4.027,P<0.05)。硅油取出术后3个月SCT(272.02±17.11)μm,与术前比较,差异无统计学意义(t=2.071,P=0.093)。相关性分析结果显示,RRD患者SCT与BCVA无关(r=-0.023、-0.31,P=0.569、0.784)。结论孔源性视网膜脱离复位术后早期SCT增加,后期逐渐下降,且变化与术后BCVA无相关性。

Objective To evaluate the changes in subfoveal choroidal thickness(SCT)in patients with rhegmatogenous retinal detachment using optical coherence tomography(OCT)and analyze the correlation between SCT and visual outcomes.Methods 63 consecutive patients with rhegmatogenous retinal detachment after anatomically successful treated with vitrectomy were selected.The unaffected fellow eye was used as a control for additional comparison.All patients underwent a comprehensive ophthalmologic examination,including the measurement of best corrected visual acuity(BCVA),binocular indirect ophthalmoscopy and contact lens slit-lamp biomicroscopy,fundusphotography and OCT examination.The differences of SCT between the groups were analyzed.The correlative analysis was performed to investigate the relationship between SCT and BCVA.Results Compared with baseline,the logMAR BCVA was significantly increased.The postoperative BCVA was positively related to preoperative BCVA(P<0.05).Compared with preoperative,the SCT at 3 days after surgery in RRD group was significantly increased.The SCT was negatively related to BCVA.Conclusion Our results indicate that the SCT is significantly increased in RRD at 3 days after surgery,then the SCT gradually decreased.The SCT was not correlated with the final BCVA.