CAJ | 학술논문

目的应用相干光断层扫描术(OCT)观察合并视网膜劈裂症的高度近视眼白内障患者超声乳化白内障吸除术前后的视网膜厚度变化及其对视力的影响.方法回顾性系列病例研究.对25例(35只眼)合并视网膜劈裂症的高度近视眼白内障患者行超声乳化白内障吸除联合人工晶状体植入术,术后1周、1个月及3个月记录最佳矫正视力(BCVA)并行OCT检查,测量黄斑中心凹视网膜厚度(CFT)以及劈裂最显著处视网膜神经上皮层厚度(MNT).根据术中累积能量复合参数(AECP)大小将35只眼分为高、低AECP组;根据患者眼轴长度将35只眼分为≤28.00 mm组、＞28.00且≤30.00 mm组以及＞30.00 mm组.采用重复测量资料的方差分析、Wilcoxon秩和检验、直线相关分析以及单因素方差分析对数据进行统计分析.结果 35只视网膜劈裂眼术后1周、1个月、3个月的BCVA分别为(0.59±0.38)、(0.57±0.38)及(0.60±0.36),较术前有所提高(F=31.15,P=0.000).术后1周、1个月、3个月的CFT分别为(256.80±199.98)μm、(274.37±246.87)μm及(268.60±238.41)μm,与术前相比,差异均无统计学意义(F=0.99,P=0.420);术后1周、1个月、3个月的MNT分别为(477.71±188.71)μm、(486.60±229.77)μm以及(482.63±208.82)μm,分别与术前相比,差异均无统计学意义(F=0.26,P=0.857).术后3个时间点非中心凹劈裂眼BCVA好于中心凹劈裂眼(Z=-0.580,P=0.048;Z=-2.147,P=0.030;Z=-2.099,P=0.034).不伴有黄斑板层裂孔的中心凹劈裂眼术后3个月BCVA与其CFT呈负相关(r=-0.667,P=0.018).术后3个时间点内,高、低AECP组以及不同眼轴长度组之间术前术后视网膜厚度变化的差异均无统计学意义(Z=-0.314～1.290,P=0.192～0.741;F=0.15～0.62,P=0.545～0.859).结论合并视网膜劈裂症的高度近视眼白内障患者行超声乳化白内障吸除联合人工晶状体植入术,手术对劈裂的视网膜无明显影响,术后能够获得良好的复明效果,其术后视力的恢复与劈裂发生的部位有关. 目的應用相榦光斷層掃描術(OCT)觀察閤併視網膜劈裂癥的高度近視眼白內障患者超聲乳化白內障吸除術前後的視網膜厚度變化及其對視力的影響.方法迴顧性繫列病例研究.對25例(35隻眼)閤併視網膜劈裂癥的高度近視眼白內障患者行超聲乳化白內障吸除聯閤人工晶狀體植入術,術後1週、1箇月及3箇月記錄最佳矯正視力(BCVA)併行OCT檢查,測量黃斑中心凹視網膜厚度(CFT)以及劈裂最顯著處視網膜神經上皮層厚度(MNT).根據術中纍積能量複閤參數(AECP)大小將35隻眼分為高、低AECP組;根據患者眼軸長度將35隻眼分為≤28.00 mm組、＞28.00且≤30.00 mm組以及＞30.00 mm組.採用重複測量資料的方差分析、Wilcoxon秩和檢驗、直線相關分析以及單因素方差分析對數據進行統計分析.結果 35隻視網膜劈裂眼術後1週、1箇月、3箇月的BCVA分彆為(0.59±0.38)、(0.57±0.38)及(0.60±0.36),較術前有所提高(F=31.15,P=0.000).術後1週、1箇月、3箇月的CFT分彆為(256.80±199.98)μm、(274.37±246.87)μm及(268.60±238.41)μm,與術前相比,差異均無統計學意義(F=0.99,P=0.420);術後1週、1箇月、3箇月的MNT分彆為(477.71±188.71)μm、(486.60±229.77)μm以及(482.63±208.82)μm,分彆與術前相比,差異均無統計學意義(F=0.26,P=0.857).術後3箇時間點非中心凹劈裂眼BCVA好于中心凹劈裂眼(Z=-0.580,P=0.048;Z=-2.147,P=0.030;Z=-2.099,P=0.034).不伴有黃斑闆層裂孔的中心凹劈裂眼術後3箇月BCVA與其CFT呈負相關(r=-0.667,P=0.018).術後3箇時間點內,高、低AECP組以及不同眼軸長度組之間術前術後視網膜厚度變化的差異均無統計學意義(Z=-0.314～1.290,P=0.192～0.741;F=0.15～0.62,P=0.545～0.859).結論閤併視網膜劈裂癥的高度近視眼白內障患者行超聲乳化白內障吸除聯閤人工晶狀體植入術,手術對劈裂的視網膜無明顯影響,術後能夠穫得良好的複明效果,其術後視力的恢複與劈裂髮生的部位有關.
목적 응용상간광단층소묘술(OCT)관찰합병시망막벽렬증적고도근시안백내장환자초성유화백내장흡제술전후적시망막후도변화급기대시력적영향.방법 회고성계렬병례연구.대25례(35지안)합병시망막벽렬증적고도근시안백내장환자행초성유화백내장흡제연합인공정상체식입술,술후1주、1개월급3개월기록최가교정시력(BCVA)병행OCT검사,측량황반중심요시망막후도(CFT)이급벽렬최현저처시망막신경상피층후도(MNT).근거술중루적능량복합삼수(AECP)대소장35지안분위고、저AECP조;근거환자안축장도장35지안분위≤28.00 mm조、＞28.00차≤30.00 mm조이급＞30.00 mm조.채용중복측량자료적방차분석、Wilcoxon질화검험、직선상관분석이급단인소방차분석대수거진행통계분석.결과 35지시망막벽렬안술후1주、1개월、3개월적BCVA분별위(0.59±0.38)、(0.57±0.38)급(0.60±0.36),교술전유소제고(F=31.15,P=0.000).술후1주、1개월、3개월적CFT분별위(256.80±199.98)μm、(274.37±246.87)μm급(268.60±238.41)μm,여술전상비,차이균무통계학의의(F=0.99,P=0.420);술후1주、1개월、3개월적MNT분별위(477.71±188.71)μm、(486.60±229.77)μm이급(482.63±208.82)μm,분별여술전상비,차이균무통계학의의(F=0.26,P=0.857).술후3개시간점비중심요벽렬안BCVA호우중심요벽렬안(Z=-0.580,P=0.048;Z=-2.147,P=0.030;Z=-2.099,P=0.034).불반유황반판층렬공적중심요벽렬안술후3개월BCVA여기CFT정부상관(r=-0.667,P=0.018).술후3개시간점내,고、저AECP조이급불동안축장도조지간술전술후시망막후도변화적차이균무통계학의의(Z=-0.314～1.290,P=0.192～0.741;F=0.15～0.62,P=0.545～0.859).결론 합병시망막벽렬증적고도근시안백내장환자행초성유화백내장흡제연합인공정상체식입술,수술대벽렬적시망막무명현영향,술후능구획득량호적복명효과,기술후시력적회복여벽렬발생적부위유관.
Objective To evaluate the changes of the retinal thickness in the highly myopic eyes with retinoschisis after phacoemulsification by optical coherence tomography (OCT) and to analyze their postoperative visual acuity. Methods It was a retrospective case series study. This study included 25 (35eyes) highly myopic patients with retinoschisis. One week, 1 and 3 months after phacoemulsification, the best corrected visual acuity (BCVA) was measured and OCT was performed to evaluate the central foveal thickness (CFT) as well as the maximum neurosensory thickness (MNT). These 35 eyes were divided into low and high accumulated energy complex parameter (AECP) groups, and ≤28.00 mm, ＞ 28. 00 and ≤ 30. 00 mm, ＞ 30. 00 mm groups according to the axial length respectively.Variance analysis of data obtained from repeated measurement, Wilcoxon rank sum test, linear correlation and one-way ANOVA were used to analyze the data. Results According to the location of schisis, the 35 eyes were classified as foveal schisis (20 eyes) and nonfoveal schisis (15 eyes). Among the 35 eyes,there were 30 eyes with outer retinoschisis and 5 with compound schisis. The mean BCVA (logMAR)preoperatively and 1 week, 1 and 3 months postoperatively was 0. 23 ± 0. 24, 0. 59 ± 0. 38,0. 57 ± 0. 38 and 0. 60 ±0. 36 respectively ( F = 31.15, P = 0. 000 ). CFT preoperatively and 1 week, 1 and 3 months postoperatively was (255.46 ± 197.57) μm, (256.80 ± 199.88) μm, (274.37 ±246.87) μm, and (268.60±238.41) μm (F=0.99,P=0.420); while MNT was (473.31 ±175.52) μm, (477.71 ±188.71 ) μm, (486. 60 ± 229. 17 ) μm and (482. 63 ± 208. 82) μm respectively ( F = 0. 26, P = 0. 857).BCVA in eyes with foveoschisis and in eyes with nonfoveal schisis was statistically significantly different at 1 week, 1 and 3 months postoperatively ( Z = - 0. 580, P = 0. 048; Z = - 2. 147, P = 0. 030 and Z =-2. 099,P =0. 034). BCVA (0. 43 ±0. 28) was inversely correlated with CFT (497.42 ±281.49) μm in the eyes with foveoschisis unaccompanied with a macular lamellar hole at 3 months postoperatively ( r =-0. 667, P =0. 018). There were no significant differences in the changes of the thickness of the retina between the groups with different AECP or among the groups with different axial lengths ( Z = - 0. 314-1. 290, P =0. 192-0. 741 and F =0. 15-0. 62, P =0. 545-0. 859). Conclusions Cataract surgery has no significant effect on thickness of the retina in the highly myopic eyes with retinoschisis. The patients with retinoschisis could achieve good visual recovery after phacoemulsification. Postoperative visual acuity is related to the location and degree of retinoschisis. Besides, patients with non-foveal schisis could obtain better visual acuity than those with foveoschisis. Further investigation on the development of retinoschisis and the complications after surgery is required.