孔源性视网膜脱离中玻璃体后脱离的诊断评价  

Research on the diagnosis of posterior vitreous detachment in rhegmatogenous retinal detachment patients

作　　者：汪枫桦[1] 王雯秋[1] 俞素勤[1] 莫亚南[1] 张磊[1] 姜媛[1] 刘海芸[1] 王泓[1] 张皙[1] 许迅[1] 孙晓东[1] 

机构地区：[1]上海交通大学附属第一人民医院眼科,200080

出　　处：《中华眼视光学与视觉科学杂志》2013年第1期52-55,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家973课题资助项目（2011CB707506）;国家十二五“重大新药创制”科技重大专项（2011ZX09302-007-02）;国家自然科学基金资助项目（30973259）;上海市自然科学基金资助项目（10ZR1424000）;上海市浦江人才计划项目（2010-00049）

摘　　要：目的对孔源性视网膜脱离（RRD）患者完全性玻璃体后脱离（PVD）的情况进行分析，研究RRD中PVD发生率以及不同诊断方法的准确性。方法前瞻性病例系列研究。采用前置镜、超声、光学相干断层扫描（OCT）诊断PVD，与术中采用曲安奈德（TA）染色观察PVD进行比较。我院住院治疗RRD患者30例（30眼），所有患者术前行裂隙灯下前置镜眼底、超声和OCT检查玻璃体情况。玻璃体切除手术中采用TA辅助玻璃体染色作观察PVD的金标准，比较各种术前玻璃体检查方法对于诊断PVD的准确性和特异性。数据采用Kappa检验进行分析。结果通过对不同检查方法对于诊断完全性PVD发生率进行比较，我们发现各种诊断方法间存在明显的差异．术中TA染色中发现完全性PVD发生率为10．0％；B超诊断完全性PVD发生率为76．7％，眼底检查诊断完全性PVD发生率为36．7％，OCT检查诊断完全性PVD发生率为13-3％，其中B超检查与术中发现的差异性最大。结论在RRD中完全性PVD发生率较低。现有各种术前检查方法有其局限性，而术中TA染色，能够更好的显示玻璃体应质残留．Objective To investigate the prevalence of complete posterior vitreous detachment in rhegmatogenous retinal detachment （RRD） patients and to evaluate the following diagnostic tests： fundus examination, B-scan ultrasound and optical coherence tomography （OCT）. Methods Thirty patients （30 eyes） with RRD who underwent vitrectomy in Shanghai First People＇s Hospital were included in this prospective case-series study. Patients received comprehensive ocular examinations that included fundus examination, B-scan ultrasound and OCT. TA stain （triamcinolone acetonide） was used to assist during the vitrectomy surgery as well as being the gold standard for PVD diagnosis. Data were analyzed using a Kappa test. Results The rate of detection for the prevalence of complete PVD was as follows： 10.0% by TA stain, 76.7% by B-scan, 36.7% by fundus examination and 13.3% by OCT. Different rates of PVD detection were found by the above examinations and, of these, the difference was most significant between B-scan and observation during surgery. Conclusion Observation during surgery with the help of TA is comparatively the most persuasive diagnostic method for PVD. Different examination methods can be selected for individual cases.

关 键 词：玻璃体后脱离 孔源性视网膜脱离 光学相干断层扫描 B型超声 曲安奈德 

分 类 号：R77[医药卫生—眼科]