CAJ | 학술논문

目的观察孔源性视网膜脱离修复术后黄斑区视网膜形态及术后视力恢复情况并研究影响术后视力的相关因素.方法收集行玻璃体手术或巩膜扣带术成功复位病例,所有病例病程少于1个月,按术前视网膜脱离是否累及黄斑区进行分类,术前和术后均行眼科常规检查和光学相干断层扫描(OCT)检查,随访半年.结果共收集孔源性视网膜脱离101只眼,其中脱离累及黄斑区为78只眼.行玻璃体手术为36只眼,巩膜扣带术为65只眼,术后半年内均未发生并发症.术后一个月时复查OCT,在玻璃体手术组和巩膜扣带术组分别有55.56％和72.31％的患眼存在黄斑区视网膜形态异常,其中神经上皮层下积液多见.两种手术方式对术后黄斑区视网膜形态有影响(x2=23.65,P＜0.01).在巩膜扣带术组,术前视网膜脱离是否累及黄斑对术后黄斑区视网膜形态有影响(x2=30.331,P＜0.01),对术后视力提高程度有影响(F =8.150,P＜0.01).结论视网膜脱离修复术的手术方式对术后黄斑区视网膜形态有影响.行巩膜扣带术病例如术前视网膜脱离累及黄斑,术后出现黄斑区视网膜形态异常的可能性大,术后视力恢复差.
목적 관찰공원성시망막탈리수복술후황반구시망막형태급술후시력회복정황병연구영향술후시력적상관인소.방법 수집행파리체수술혹공막구대술성공복위병례,소유병례병정소우1개월,안술전시망막탈리시부루급황반구진행분류,술전화술후균행안과상규검사화광학상간단층소묘(OCT)검사,수방반년.결과 공수집공원성시망막탈리101지안,기중탈리루급황반구위78지안.행파리체수술위36지안,공막구대술위65지안,술후반년내균미발생병발증.술후일개월시복사OCT,재파리체수술조화공막구대술조분별유55.56％화72.31％적환안존재황반구시망막형태이상,기중신경상피층하적액다견.량충수술방식대술후황반구시망막형태유영향(x2=23.65,P＜0.01).재공막구대술조,술전시망막탈리시부루급황반대술후황반구시망막형태유영향(x2=30.331,P＜0.01),대술후시력제고정도유영향(F =8.150,P＜0.01).결론 시망막탈리수복술적수술방식대술후황반구시망막형태유영향.행공막구대술병례여술전시망막탈리루급황반,술후출현황반구시망막형태이상적가능성대,술후시력회복차.
Objective To observe and evaluate postoperative macular morphologic feature and visual acuity in patients who underwent pars plana vitrectomy or scleral buckling for repairing of primary rhegmatogenous retinal detachment (RRD).Methods A prospective,observational case series of 101 consecutive patients who underwent primary,uncomplicated,recent onset rhegmatogenous retinal detachment repaired by pars plana vitrectomy or scleral buckling were performed in our hospital from 2004 to 2009.Among the total,the number of the patients with macula-off RRD was 78 (77.23％).Patients (36 eyes) in one group were treated with vitrectomy and noble gas filled,and patients (65 eyes) in another group were treated with scleral buckling surgery.Both group underwent full clinical examination as well as optical coherence tomography (OCT) preoperatively and at 1,6 months after surgery.The data was evaluated by t test,x2-squared test and Logistic regression.Results There were no operative or postoperative complications.All retinal detachments were reattached and the macular were normal by binocular indirect ophthalmoscope postoperatively.At 1 month after surgery,OCT examinations showed 55.56％ abnormality in vitrectomy group and 72.31％ in scleral buckling surgery group.Accumulation of subretinal fluid at the fovea was found in most patients.The surgical mode was related with postoperative macular feature.There was a statistically relevant relation between preoperative macular involvement and the postoperative morphologic feature of macular,improvement of best-corrected visual acuity (BCVA) in scleral buckling surgery group.Conclusions Postoperative macular morphologic feature is significantly better in vitrectomy group.In scleral buckling surgery group,the postoperative feature of macula and visual acuity are related with macular spare or macular involvement preoperatively.