视网膜脱离复位后OCT形态学改变与视力的相关性研究

Study on the correlation between morphological changes and visual acuity in OCT after retinal detachment and reduction

目的:探讨累及黄斑的孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的术后OCT形态学改变与最佳矫正视力的相关性。方法:本研究为回顾性临床研究。选取通过手术视网膜均解剖复位成功的累及黄斑的RRD患者52例(52眼)。收集并记录患眼术前及术后末次随诊时黄斑中心凹1 mm范围内形态学改变:黄斑平均视网膜厚度(Macular fovea retinal average thickness,MFRAT)、椭圆体带破坏累计长度(ellipsoid zone damage length,EZDL)、外界膜破坏累计长度(External limiting membrane damage length,ELMDL)、黄斑中心凹下脉络膜厚度(sub-foveal choroidal thickness,SFCT)及最佳矫正视力(best corrected visual acuity,BCVA)。分别分析术后MFRAT、EZDL、ELMDL、SFCT与LogMAR BCVA的相关性。根据术后患眼的EZDL分为EZDL一组(≤500μm)及EZDL二组(>500μm),分析两组术后LogMAR BCVA的差异。根据手术后患眼的ELMDL分为ELMDL一组(≤500μm)及ELMDL二组(>500μm),分析两组手术后LogMAR BCVA的差异。结果:术前MFRAT、EZDL、ELMDL、LogMAR BCVA分别为(909.23±504.82)μm、(887.06±301.97)μm、(885.56±301.88)μm、(1.54±0.50),术后MFRAT、EZDL、ELMDL、LogMAR BCVA分别为(278.35±104.81)μm、(635.06±406.19)μm、(594.94±454.69)μm、(0.60±0.34),术前与术后相比较,差异均有统计学意义(t=9.000、t=4.174、t=4.915、t=15.346,P<0.001)。术后MFRAT、SFCT与LogMAR BCVA无相关性(r=0.205、r=-0.22,P均>0.05)。术后EZDL、ELMDL与LogMAR BCVA有相关性(r=0.527、r=0.475,P均<0.001)。EZDL一组LogMAR BCVA(0.40±0.19)低于EZDL二组(0.72±0.36),差异有统计学意义(t=-3.628,P=0.001)。ELMDL一组LogMAR BCVA(0.41±0.19)低于ELMDL二组(0.71±0.37),差异有统计学意义(t=-3.426,P=0.001)。结论:累及黄斑的RRD患眼在视网膜复位后视网膜OCT形态部分恢复,视力提高。视网膜椭圆体带及外界膜的完整性是影响术后视力恢复的重要因素。

Objective:To explore the correlation between the morphological changes of OCT and optimal retinal detachment(rhegmatogenous retinal detachment)after surgery involving macular tissue.Methods:This study was a retrospective clinical study.A total of 52 cases(52 eyes)of RRD patients with macular involvement were selected.Morphological changes within 1 mm of macular fovea were collected and recorded before and after the last follow-up:Macular fovea retinal average thickness(MFRAT),ellipsoid zone damage length(ellipsoid zone damage length,EZDL),External limiting membrane damage length(ELMDL),sub-foveal choroidal thickness(sub-foveal choroidal thickness,SFCT)and best corrected visual acuity(BCVA).The correlation between MFRAT,EZDL,ELMDL,SFCT and LogMAR BCVA was analyzed.According to the EZDL of the affected eye,the patients were divided into EZDL group 1(≤500μm)and EZDL group 2(>500μm),and the differences of LogMAR BCVA between the two groups were analyzed.According to the ELMDL of the affected eye after surgery,the patients were divided into ELMDL group 1(≤500μm)and ELMDL group 2(>500μm),and the difference of LogMAR BCVA between the two groups after surgery was analyzed.Results:The preoperative MFRAT,EZDL,ELMDL and LogMAR BCVA were(909.23±504.82)μm,(887.06±301.97)μm,(885.56±301.88)μm and(1.54±0.50),respectively.MFRAT,EZDL,ELMDL and LogMAR BCVA were(278.35±104.81)μm,(635.06±406.19)μm,(594.94±454.69)μm and(0.60±0.34),respectively.The differences were statistically significant(t=9.000,t=4.174,t=4.915,t=15.346,P<0.001).There was no correlation between MFRAT,SFCT and LogMAR BCVA(r=0.205,r=-0.22,P>0.05).EZDL and ELMDL were correlated with LogMAR BCVA(r=0.527,r=0.475,P<0.001).The LogMAR BCVA of EZDL group(0.40±0.19)was lower than that of EZDL group(0.72±0.36),and the difference was statistically significant(t=-3.628,P=0.001).The LogMAR BCVA of ELMDL group(0.41±0.19)was lower than that of ELMDL group(0.71±0.37),and the difference was statistically significant(t=-3.426,P=0.001).Conclusions:Retinal OCT morphology is partially restored and visual acuity is improved in macular-involved eyes with RRD.The integrity of retinal ellipsoid band and outer membrane is an important factor affect ing postoperative visual acuity recovery.