玻璃体切除术中应用光学相干断层扫描成像术的手术策略选择

Selection of surgical strategy for application of intraoperative optical coherence tomography in vitrectomysurgery

目的探讨光学相干断层扫描成像术(OCT)在玻璃体切除术中手术策略选择的应用。方法回顾性病例系列研究。连续收集郑州大学第一附属医院2021年10月至2022年4月无缝整合术中OCT辅助下行玻璃体切除术的77例(82眼)纳入研究, 所有患者均获得可用于分析的术中OCT图像。记录手术医生根据术中OCT检查所做出的手术策略调整过程。结果术中做出手术策略调整者29眼(35.37%), 包括增加视网膜激光治疗18眼(21.95%)、增加剥除视网膜前膜操作7眼(8.54%)、发现并处理脱离区视网膜未完全复位2眼(2.44%)、发现并处理隐蔽性黄斑孔引起的视网膜脱离1眼(1.22%)、处理周边残余玻璃体牵引3眼(3.66%)。结论术中OCT可扩大常规OCT检查的眼底范围, 弥补术前检查的不足;能够发现显微镜直观下难以察觉的眼底病变并在处理眼底病变的过程中提供有益的手术指导。

ObjectiveTo investigate the application of intraoperative optical coherence tomography(iOCT)in the selection of surgical strategy in vitrectomy.MethodsThis was a retrospective case series study.Total of 82 eyes of 77 patients who underwent vitrectomy with i0CT from Oct.2021 to Apr.2022 in the First Affiliated Hospital of Zhengzhou University were included in the study,and all patients obtained iOCT images that could be used for analysis.The surgical strategy adjustment process was made by the surgeon according to the ioCT examination.ResultsA total of 29 eyes(35.37%)underwent surgical strategy adjustment during the operation,including those increased retinal laser treatment in 18 eyes(21.95%),increased epiretinal membrane removal in 7 eyes(8.54%),found and treated 2 eyes(2.44%)with incomplete retinal reposition in the detachment area,found and treated retinal detachment caused by occult macular hole in 1 eye(1.22%),and 3 eyes(3.66%)with peripheral residual vitreous traction were treated.ConclusionIntraoperative OCT can expand the fundus scope of routine OCT examination and make up for the deficiency of preoperative examination.Intraoperative OCT can detect fundus lesions that are difficult to detect under the microscope and provide useful surgical guidance in the process of dealing with fundus lesions.