超广角眼底成像评估掺钦钇铝石榴石激光消融治疗有症状Weiss环的疗效

Ultra-widefield imaging evaluating the efficacy of yttrium aluminum garnet laser treatment for symptomatic Weiss ring

目的初步评佔超广角眼底成像(UWFI)观察Weiss环(玻璃体漂浮物)的可行性以及掺钕钇铝石榴石(Nd:YAG)激光消融治疗有症状Weiss环的冇效性及安全性方法回顾性临床研究。2016年3月至2019年12月于广州爱尔眼科医院接受诊治的有症状Weiss环68例患者80只眼纳入研究。其中,男性32例39只眼,女性36例41只眼;平均年龄(53.7±10.8)岁。患眼均行裂隙灯M微镜联合90 D前置镜、UWFI检查:,通过画图记录玻璃体漂浮物位置及形态。患眼均行Nd:YAG激光消融治疗。治疗后3个月,对患者进行问卷调查,评估主观症状改善情况将合计得分10、7〜9,3〜6、矣2分者分別定义为治愈、显著改善、部分改善、无改善。应用测M软件Gauge 1.0手动测量UWH图像上玻璃体漂浮物长径、周长及面积。设置视盘直径为I Unit(U),作为标准化参考值UWFI未显示且前置镜检查未发现漂浮物者记录为0治疗前后玻璃体漂浮物变化比较行Wilcoxon秩和检验;其治疗前后大小变化与患者治疗后主观症状改善评分行Spearman等级相关分析。结果治疗后,80只眼中,UWFI上不可见玻璃体漂浮物59只眼(73.8%,59/80)治疗前,玻璃体漂浮物周长为1.84(1.07,2.64)U,长径为1.17(0.84.1.66)U,面积为0.18(0.08,0.30)U2;治疗后周长为0.00(0.00,0.23)U,长径为0.00(0.00,0.23)U,面积为0.00(0.00,0.01)U2。治疗前后漂浮物周长、径长、面积比较,差异均有统计学意义(Z=-7.722,-7.560、-7.655,P<0.001)。问卷调查结果显示,患者主观症状治愈、显著改善、部分改善分別为49(61.3%,49/80)、25(31.2%,25/80)、6(7.5%,6/80)只眼相关性分析结果显示,患者主观症状改善程度与治疗前后UWFI上玻璃体漂浮物周长(r=0.812),长径(a=0.796)、面积(r=0.791)大小变化值均具有相关性(PC0.01)随访期间,所有患眼均未发生眼压升高或视力下降等并发症<,结论UWFI可客观对Weiss环进行成像,结合测量软件可对其大小进行相对性M化Nd:YAG激光消融治疗有症状Weiss环安全有效。

Objective To preliminarily evaluate the feasibility of ultra-wide-angle fundus imaging(UWFI)to observe the Weiss ring(vitreous floats)and the effectiveness and safety of neodymium-doped yttrium aluminum garnet(Nd:YAG)laser ablation in the treatment of symptomatic Weiss ring.Methods A retrospective clinical study.From March 2016 to December 2019,80 eyes of 68 patients with symptomatic Weiss ring who were diagnosed and treated at Guangzhou Aier Eye Hospital were included in the study.Among them,there were 39 eyes in 32 males and 41 eyes in 36 females;the average age was 53.7+10.8 years old.All the affected eyes were examined by slit lamp microscope combined with 90 D front lens and UWFI.The position and shape of the vitreous floating objects by drawing pictures were recorded.All the affected eyes underwent Nd:YAG laser ablation treatment.Three months after treatment,a questionnaire survey was conducted on the patients to assess the improvement of subjective symptoms.Those with a total score of 10,7-9,3-6,and points were defined as cured,significant improvement,partial improvement,and no improvement,respectively.The measurement software Gauge 1.0 was used to manually measure the long diameter,circumference and area of the vitreous float on the UWFI image.The diameter of the optic disc to 1 Unit(U)was set as a standardized reference value.Those who did not show UWFI and no floating objects were found on the front mirror were recorded as 0.The changes of vitreous floats before and after treatment were compared by Wilcoxon rank sum test;the changes in their size before and after treatment and the patients’subjective symptom improvement scores after treatment were analyzed by Spearman rank correlation.Results After treatment,in 80 eyes,there were no vitreous floats in 59 eyes(73.8%,59/80)on UWFI.Before treatment,the circumference of the vitreous float was 1.84(1.07,2.64)U,the long diameter was 1.17(0.84,1.66)U,and the area was 0.18(0.08,0.30)U2;after treatment,the circumference was 0.00(0.00,0.23)U,The long diameter is 0.00(0.00,0.23)U,and the area was 0.00(0.00,0.01)U2.There were statistically significant differences in the perimeter,diameter,and area of floating objects before and after treatment(Z=-7.122,-7.560,-7.655;P<0.001).The results of the questionnaire survey showed that the patient's subjective symptoms were cured,significantly improved,and partially improved in 49(61.3%,49/80),25(31.2%,25/80),and 6(7.5%,6/80)eyes,respectively.The results of correlation analysis showed that the degree of improvement of the patient's subjective symptoms was related to the circumference(r=0.812),long diameter(r=0.796),and area(r=0.791)of the vitreous float on UWFI before and after treatment(Р<0.01).During the follow-up period,no complications such as increased intraocular pressure or decreased vision occurred.Conclusions UWFI can objectively image the Weiss ring,and its size can be quantified relatively to the measurement software.Nd:YAG laser ablation treatment of symptomatic Weiss ring is safe and effective.