巩膜扣带术后黄斑解剖复位的临床观察  

Clinical investigation of macular reattachment after scleral buckling surgery

作　　者：田农[1] 黄振平[1] 吴勇[1] 葛轶睿[1] 王毅[1] 

机构地区：[1]南京军区南京总医院眼科,江苏南京210002

出　　处：《东南国防医药》2011年第2期122-125,共4页Military Medical Journal of Southeast China

摘　　要：目的应用光学相干断层扫描（OCT）与眼底照相技术观察孔源性视网膜脱离术后黄斑脱离的复位并与视力恢复进行初步相关研究。方法 2007年1月至2010年4月在我科诊断为孔源性视网膜脱离患者,手术方法采用巩膜扣带术联合巩膜外冷凝＋放液术,术后随访6-24个月有眼底照相与OCT检查记录患者47例（47眼）,所有患眼的玻璃体病变均≤B级,视网膜脱离范围在1-3象限之间,术前视力≤0.1占74.47%（35眼）,≥0.12占25.53%（12眼）,OCT记录术后1、3、6个月黄斑解剖学复位状况,部分1年以上。结果术后临床眼底检查和眼底照相记录视网膜复位的46眼,1眼手术后视网膜脱离未复位。通过OCT随访检查显示：术后1个月及以内黄斑区视网膜色素上皮与神经上皮复位的有19眼（41.30%）,3个月时复位达29眼（63.04%）,6个月复位眼数达35眼（76.09%）,在术后1年的复位眼数为42眼（91.30%）,至随访截止时有4眼（8.70%）黄斑未完全复位。视网膜中心凹神经上皮的厚度在术后1个月与3个月和6个月明显不同,术前与术后视力的对比研究显示：在术后6个月视力才有明显提高。结论 OCT检查为视网膜脱离术后黄斑解剖学复位提供了便捷,详细,客观的观察方法,视网膜脱离术后黄斑区的解剖复位与视力恢复需要较长的时间。Objective To investigate the time course of foveal reattachment after scleral buckling surgery and its relation to visual recovery using optical coherence tomography and fundus photography.Methods Forty-seven patients（47 eyes） who were diagnosed rhegmatogenous retinal detachment were recruited into the study in our hospital.All of them had undergone a combination method of sclera buckling,cryotherapy,drainage and then followed up to 6-24 months.The preoperative visual acuity was less than or equal to 0.1 in 35 eyes（74.47%）,equal to or greater than 0.12 in 12 eyes（25.53%）.The extent of retinal detachment with macula-off was between 1 and 3 quadrants.Proliferative vitreoretinopathy was classified as staged B or less.Preoperative and postoperative fundus photographs were taken for all patients and optical coherence tomography（OCT） of the macula after the surgery in 1,3,6 months and over 12 months partially was scanned and reported.The neuroepithelial thickness in foveola was recorded by manual measurement.Results Postoperative follow-up with OCT scan showed 19 eyes of macular reattachment（41.30%） in a month,29 eyes（63.04%） of macular reattachment in 3 months,35 eyes（76.09%） in 6 months and 42 eyes（91.30%） over a year.There were 4 eyes（8.70%） remaining a little fluid of submacula which couldn＇t been seen with funduscope in deadline of follow-up.The thickness of postoperative foveola in one month differed significantly from those in 3 or 6 months.The comparison of visual acuity preoperatively and postoperatively revealed the better visual recovery was occurred in 6 months.Conclusion OCT examination supplies a convenient,objective and quick method for understanding macula reattachment after surgery of retinal detachment.The visual acuity and macula reattachment completely may be needed more time for recovering.

关 键 词：视网膜脱离 光学相干断层扫描 巩膜扣带术 

分 类 号：R774.12[医药卫生—眼科]