激光致黄斑损伤的临床特点及治疗预后

Investigate of the clinical characteristics and treatment prognosis of laser-induced macular injury

目的探讨激光导致黄斑损伤的临床特点及治疗预后。方法回顾性病例研究。分析我院眼科2016年12月至2019年6月住院诊治的因激光照射导致黄斑损伤的病例6例(6只眼)。其中男性5例(5只眼),女性1例(1只眼)。年龄(21.3±4.8)岁,其中18岁以下青少年患者1例(1只眼)(16.7%)。记录患者入院时最佳矫正视力(BCVA)、眼底情况、黄斑相干光层析成像术(OCT),根据病情予抗炎、止血、消肿等治疗,必要时予手术。出院后随访BCVA及黄斑OCT。结果6例(6只眼)均为右眼。伤后BCVA≥指数且<0.1者2例;≥0.1且<0.2者3例,≥0.2且<0.3者1例。形成黄斑裂孔6例,行玻璃体黄斑手术5例。术后视力提高3例,不变1例,降低1例。内科治疗1例视力提高1例。≥0.1且<0.3者5例;≥0.3且<0.5者1例。IS/OS层全部受损,断裂3例,连续欠完整3例。结论激光导致黄斑损伤的早期,黄斑区可出现水肿、出血,随着水肿的逐渐吸收,部分患者黄斑形成板层裂孔,随后逐渐形成全层裂孔,部分可形成黄斑下瘢痕。本研究术后视力提高可能与黄斑区水肿逐渐消退相关,然而因IS/OS的永久断裂,部分病例术后视力即使有小幅度提高也均不明显。

Objective To investigate the clinical characteristics and treatment prognosis of laser-induced macular injury.Methods 6 patients(6 eyes)with macular injury caused by laser irradiation were retrospectively analyzed.Among them,5 cases(5 eyes)were male and 1 case(1 eye)was female.The age was 21.3±4.8 years old,including 1 case and 1 eye(16.7%)under 18 years old.The best corrected visual acuity,fundus condition and macular optical coherence tomography(OCT)were recorded at the time of admission.Anti inflammatory,hemostatic and detumescence treatments were given according to the patient's condition,and surgery was performed if necessary.Best corrected visual acuity and macular OCT were followed up after discharge.Results 6 eyes of 6 cases were all right eyes.The best corrected visual acuity(BCVA)≥index and<0.12 cases after injury;3 cases were≥0.1 and<0.2,1 cases were≥0.2 and<0.3.Macular hole was formed in 6 cases and vitrectomy was performed in 5 cases.After treatment,the best corrected visual acuity improved in 5 cases,decreased in 1 case,≥0.1 and<0.35 cases;1 case was≥0.3 and<0.5.The inner segment/outer segment(IS/OS)layer was damaged in all cases,including 3 cases of rupture and 3 cases of continuous incomplete.Conclusions in the early stage of laser-induced macular injury,macular edema and hemorrhage may appear.With the gradual absorption of edema,lamellar holes may be formed in some patients,followed by full-thickness holes,and some may form submacular scars.In this study,the improvement of visual acuity may be related to the gradual regression of macular edema.However,due to the permanent rupture of IS/OS,the improvement of visual acuity in some cases is not obvious even if there is a small increase.