中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2014年
4期
343-347
,共5页
视网膜脱离/外科学%体层摄影术,光学相干%中央凹/病理生理学%巩膜扣带术
視網膜脫離/外科學%體層攝影術,光學相榦%中央凹/病理生理學%鞏膜釦帶術
시망막탈리/외과학%체층섭영술,광학상간%중앙요/병리생이학%공막구대술
Retinal detachment/surgery%Tomography,optical coherence%Fovea centralis/physiopathology%Scleral buckling
目的 观察累及黄斑的孔源性视网膜脱离(RRD)患眼巩膜扣带手术前后黄斑微结构改变及其与视力预后的相关性.方法 回顾性临床研究.累及黄斑的RRD并行巩膜扣带手术治疗的患者43例43只眼纳入研究.手术前及手术后3d,1、3、6个月,患眼均行最佳矫正视力(BCVA)检查;患眼及对侧健康眼同时行频域光相干断层扫描(SD-OCT)检查.测量视网膜下液(SRF)高度、中心凹神经上皮层及外核层(ONL)厚度,观察黄斑区视网膜外界膜(ELM)、光感受器内外节连接(IS/OS)交界线及中间线等微结构改变,分析其与手术后6个月BCVA的关系.结果 手术前患眼平均BCVA为1.18±0.93.脱离的视网膜表现为中心凹形态存在且神经上皮层无明显水肿、神经上皮层弥漫性水肿伴ONL为主的层间囊样液腔、神经上皮层弥漫性水肿伴层间囊样液腔合并外层视网膜波浪样改变等3种形态.SRF高度为(885.05±493.28) μm.患眼与对侧健康眼中心凹神经上皮层、ONL厚度比较,差异均有统计学意义(t=2.642、1.895,P＜0.05).手术后3d,所有患眼神经上皮层积液明显吸收,囊样液腔消失,视网膜复位.手术后3d,1、3、6个月,SRF检出率分别为100.0％、93.0％、77.8％、46.5％;SRF高度分别为(219.00±117.02)、(163.51±72.83)、(101.27±64.47)、(55.69±21.15) μm.SRF残留呈弥漫性、中心凹下多量水泡样、中心凹下单一水泡样等3种形态.手术后3d,1、3、6个月,患眼与对侧健康眼中心凹神经上皮层、ONL厚度比较,除手术后6个月患眼与对侧健康眼中心凹神经上皮层厚度之间的差异无统计学意义外(t=-2.186,P=0.570),其余时间点患眼与对侧健康眼中心凹神经上皮层(t=-10.658、-8.550、-6.955)、ONL厚度(t=-6.240、-5.424、-3.326、-3.323)之间的差异均有统计学意义(P＜0.05).光感受器损伤表现为E1LM、IS/OS交界线及中间线均不连续;ELM连续,IS/OS交界线及中间线断裂;ELM、IS/OS交界线连续,中间线不连续;ELM、IS/OS交界线及中间线均连续等4种形态.手术后3d,1、3、6个月,患眼BCVA均较手术前明显提高,差异均有统计学意义(t=-3.12、-4.89、-5.03、-4.53,P＜0.05).IS/OS连续与IS/OS断裂患眼手术后6个月BCVA比较,差异有统计学意义(t=2.609,P＜0.05).手术前SRF高度、黄斑中心凹神经上皮层厚度及ONL厚度均与手术后6个月BCVA有相关性(r=0.817、0.028、0.521,P＜0.05).结论 累及黄斑的RRD患眼巩膜扣带手术前存在SRF,中心凹神经上皮层及ONL厚度均明显变薄;手术后SRF持续存在,中心凹神经上皮层及ONL厚度仍较薄,ELM、IS/OS交界线及中间线可断裂.手术前存在的SRF及已降低的中心凹神经上皮层、ONL厚度均与手术后视力恢复缓慢有关.
目的 觀察纍及黃斑的孔源性視網膜脫離(RRD)患眼鞏膜釦帶手術前後黃斑微結構改變及其與視力預後的相關性.方法 迴顧性臨床研究.纍及黃斑的RRD併行鞏膜釦帶手術治療的患者43例43隻眼納入研究.手術前及手術後3d,1、3、6箇月,患眼均行最佳矯正視力(BCVA)檢查;患眼及對側健康眼同時行頻域光相榦斷層掃描(SD-OCT)檢查.測量視網膜下液(SRF)高度、中心凹神經上皮層及外覈層(ONL)厚度,觀察黃斑區視網膜外界膜(ELM)、光感受器內外節連接(IS/OS)交界線及中間線等微結構改變,分析其與手術後6箇月BCVA的關繫.結果 手術前患眼平均BCVA為1.18±0.93.脫離的視網膜錶現為中心凹形態存在且神經上皮層無明顯水腫、神經上皮層瀰漫性水腫伴ONL為主的層間囊樣液腔、神經上皮層瀰漫性水腫伴層間囊樣液腔閤併外層視網膜波浪樣改變等3種形態.SRF高度為(885.05±493.28) μm.患眼與對側健康眼中心凹神經上皮層、ONL厚度比較,差異均有統計學意義(t=2.642、1.895,P＜0.05).手術後3d,所有患眼神經上皮層積液明顯吸收,囊樣液腔消失,視網膜複位.手術後3d,1、3、6箇月,SRF檢齣率分彆為100.0％、93.0％、77.8％、46.5％;SRF高度分彆為(219.00±117.02)、(163.51±72.83)、(101.27±64.47)、(55.69±21.15) μm.SRF殘留呈瀰漫性、中心凹下多量水泡樣、中心凹下單一水泡樣等3種形態.手術後3d,1、3、6箇月,患眼與對側健康眼中心凹神經上皮層、ONL厚度比較,除手術後6箇月患眼與對側健康眼中心凹神經上皮層厚度之間的差異無統計學意義外(t=-2.186,P=0.570),其餘時間點患眼與對側健康眼中心凹神經上皮層(t=-10.658、-8.550、-6.955)、ONL厚度(t=-6.240、-5.424、-3.326、-3.323)之間的差異均有統計學意義(P＜0.05).光感受器損傷錶現為E1LM、IS/OS交界線及中間線均不連續;ELM連續,IS/OS交界線及中間線斷裂;ELM、IS/OS交界線連續,中間線不連續;ELM、IS/OS交界線及中間線均連續等4種形態.手術後3d,1、3、6箇月,患眼BCVA均較手術前明顯提高,差異均有統計學意義(t=-3.12、-4.89、-5.03、-4.53,P＜0.05).IS/OS連續與IS/OS斷裂患眼手術後6箇月BCVA比較,差異有統計學意義(t=2.609,P＜0.05).手術前SRF高度、黃斑中心凹神經上皮層厚度及ONL厚度均與手術後6箇月BCVA有相關性(r=0.817、0.028、0.521,P＜0.05).結論 纍及黃斑的RRD患眼鞏膜釦帶手術前存在SRF,中心凹神經上皮層及ONL厚度均明顯變薄;手術後SRF持續存在,中心凹神經上皮層及ONL厚度仍較薄,ELM、IS/OS交界線及中間線可斷裂.手術前存在的SRF及已降低的中心凹神經上皮層、ONL厚度均與手術後視力恢複緩慢有關.
목적 관찰루급황반적공원성시망막탈리(RRD)환안공막구대수술전후황반미결구개변급기여시력예후적상관성.방법 회고성림상연구.루급황반적RRD병행공막구대수술치료적환자43례43지안납입연구.수술전급수술후3d,1、3、6개월,환안균행최가교정시력(BCVA)검사;환안급대측건강안동시행빈역광상간단층소묘(SD-OCT)검사.측량시망막하액(SRF)고도、중심요신경상피층급외핵층(ONL)후도,관찰황반구시망막외계막(ELM)、광감수기내외절련접(IS/OS)교계선급중간선등미결구개변,분석기여수술후6개월BCVA적관계.결과 수술전환안평균BCVA위1.18±0.93.탈리적시망막표현위중심요형태존재차신경상피층무명현수종、신경상피층미만성수종반ONL위주적층간낭양액강、신경상피층미만성수종반층간낭양액강합병외층시망막파랑양개변등3충형태.SRF고도위(885.05±493.28) μm.환안여대측건강안중심요신경상피층、ONL후도비교,차이균유통계학의의(t=2.642、1.895,P＜0.05).수술후3d,소유환안신경상피층적액명현흡수,낭양액강소실,시망막복위.수술후3d,1、3、6개월,SRF검출솔분별위100.0％、93.0％、77.8％、46.5％;SRF고도분별위(219.00±117.02)、(163.51±72.83)、(101.27±64.47)、(55.69±21.15) μm.SRF잔류정미만성、중심요하다량수포양、중심요하단일수포양등3충형태.수술후3d,1、3、6개월,환안여대측건강안중심요신경상피층、ONL후도비교,제수술후6개월환안여대측건강안중심요신경상피층후도지간적차이무통계학의의외(t=-2.186,P=0.570),기여시간점환안여대측건강안중심요신경상피층(t=-10.658、-8.550、-6.955)、ONL후도(t=-6.240、-5.424、-3.326、-3.323)지간적차이균유통계학의의(P＜0.05).광감수기손상표현위E1LM、IS/OS교계선급중간선균불련속;ELM련속,IS/OS교계선급중간선단렬;ELM、IS/OS교계선련속,중간선불련속;ELM、IS/OS교계선급중간선균련속등4충형태.수술후3d,1、3、6개월,환안BCVA균교수술전명현제고,차이균유통계학의의(t=-3.12、-4.89、-5.03、-4.53,P＜0.05).IS/OS련속여IS/OS단렬환안수술후6개월BCVA비교,차이유통계학의의(t=2.609,P＜0.05).수술전SRF고도、황반중심요신경상피층후도급ONL후도균여수술후6개월BCVA유상관성(r=0.817、0.028、0.521,P＜0.05).결론 루급황반적RRD환안공막구대수술전존재SRF,중심요신경상피층급ONL후도균명현변박;수술후SRF지속존재,중심요신경상피층급ONL후도잉교박,ELM、IS/OS교계선급중간선가단렬.수술전존재적SRF급이강저적중심요신경상피층、ONL후도균여수술후시력회복완만유관.
Objective To evaluate the correlation between macular microstructure changes and visual outcome before and after scleral buckling for macular-off primary rhegmatogenous retinal detachment (RRD).Methods A total of 43 eyes in 43 patients with RRD were enrolled in this retrospective study.All patients underwent scleral buckling and the retina was successfully reattached.Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were measured for all patients before and at 3 days,1,3 and 6 months after surgery.The height of subretinal fluids (SRF),the thickness of retinal neurosensory layer in foveal,and the thickness of outer nuclear layer (ONL) were measured.The microstructure changes of external limiting membrane (ELM),junction line and intermediate line of photoreceptor inner segment/outer segment (IS/OS) were observed.The correlation between morphologic changes in the macular foveal and BCVA on 6 months after surgery were also analyzed.Results The mean preoperative BCVA was 1.18±0.93.The detached retinas had 3 types of SD-OCT images,including normal foveal contour without edema,diffuse edema with ONL cystoids cavities,diffuse edema with ONL cystoids cavities and wave-like ONL.The mean preoperative SRF height was (885.05 ± 493.28) μm.The preoperative mean thickness of retinal neurosensory layer in foveal and ONL in the RRD eyes were thinner than the healthy fellow eyes (t=2.642,1.895;P＜0.05).The fluids and cystoids cavities were absorbed,retina reattached in all the RRD eyes at 3 days after surgery.SRF had been detected in 100.0％,93.0％,77.8％,46.5％ RRD eyes on 3 days,1 month,3 months and 6 months after surgery,with heights of (219.00±117.02),(163.51±72.83),(101.27±64.47),(55.69±21.15) μmrespectively.There were3 patterns of residual SRF:diffuse,subfoveal multi-bleb,subfoveal single bleb.Compared with the healthy fellow eyes,there were significant differences in the mean thickness of foveal neurosensory layer (t=-10.658,-8.550,-6.955) and ONL thickness (t=-6.240,-5.424,-3.326,-3.323) at 3 days,1 month,3 months and 6 months after surgery(P＜0.05),except for the thickness of foveal neurosensory layer at 6 months after surgery (t=-2.186,P=0.570).The reattached retinas had 4 types of SD-OCT images,including:(1) disrupted ELM,IS/OS line and intermediate line; (2) intact ELM with disrupted IS/OS line and intermediate line; (3) intact ELM and IS/OS line with disrupted intermediate line; (4) intact ELM,IS/OS line and intermediate line.The mean postoperative BCVA at different time points were better than preoperativeBCVA (t=-3.12,-4.89,-5.03,-4.53; P＜0.05).The postoperative BCVA of eyes with intact IS/OS was different from that of eyes with disrupted IS/OS at 6 months after surgery (t=2.609,P＜0.05).The preoperative SRF height,thickness of foveal neurosensory layer and ONL were correlated with the BCVA at 6 months after surgery (r=0.817,0.028,0.521; P＜0.05).Conclusions Macular-off RRD eyes had SRF,thinner foveal neurosensory layer and ONL before and after scleral buckling.The disruption of ELM,IS/OS junction line and intermediate line can be seen in most of RRD patients.The thinner foveal neurosensory layer and ONL were correlated with the slow recovery of postoperative BCVA.
