视网膜脱离术后黄斑水肿定量测量与分析

Quantitative assessment of macular edema after retinal reattachment

目的 研究视网膜脱离 (RetinaldetachmentRD)术后黄斑水肿情况。方法 应用视网膜厚度分析仪 (RTA)对5 8例 (5 8眼 )孔源性RD手术成功眼黄斑区视网膜厚度进行测量 ,并与术前患眼屈光度 ,视网膜裂孔大小、位置及术中是否行视网膜外放液情况进行对比。结果 经RTA测量及观察证实 ,RD术后黄斑水肿发生率为 31% ;术前屈光度 <- 6 .0D者术后黄斑水肿发生率为 31.8% ,而≥ - 6 .0D为 30 .6 % ,二者差异无显著性 (P >0 .0 5 ) ;术中行视网膜下液外放液术后黄斑水肿发生率为 33.3% ,而术中未行外放液者为 30 .6 % ,二者差异无显著性 (P >0 .0 5 ) ;视网膜裂孔位于上方象限的黄斑水肿发生率为 38.7% ,位于下方象限其发生率为 2 2 .2 % ,二者差异有显著性 (P <0 .0 1) ;上方裂孔大于 3PD者黄斑水肿发生率 19.4 % ,而小于 1PD者为 3.2 % ,二者差异有显著性 (P <0 .0 1)。结论 通过RTA可精确测量并观察黄斑水肿发生情况 ,且RD术后黄斑水肿的发生率与视网膜裂孔大小及位置有关 ,而与术前患眼屈光度及术中是否行视网膜下液外放液无关。视网膜血液循环障碍。

Objective To investigate the macular edema after retinal reattachment(RD).Methods We quantitatively measured the macular thickness of 58 postoperative patients(58 eyes) with rhegamatogenous RD who were operated successfully by retinal thickress analyzer(RTA),and compared with the conditions which including:macular detachement and macular attachment;the size and the site of holes;and subretinal fluid draining. Results Identified with RTA,the occuring rate of macular edema after retinal reattachment was 31%;31.8% and 30.6% in the patients whose diopter was less or more than -6.0D before surgery, (P>0.05);the occurring rate of macular edema was 33.3% and 30.6% in the patients who whether or not underwent subretinal fluid draining respectively(P>0.05);it was also found 38.7% eyes with macular edema that had superior quadrant holes,and 22.2%eyes had inferior quadrant holes(P<0.01),the size of 19.4% holes were bigger than 3PD and 3.2% holes were less than 1PD (P<0.01).Conclusion We could measure and observe macular edema accurately by applying RTA.The size and site of holes correlated well with CME after retinal surgery,but macular edema did not relate with the diopter of the eyes and subretinal fluid draining.The occurring mechanisms of macular edema are obstacle of blood circulation,intraocular inflammatory reaction by cryotreatment and the following macular epimembrane.