累及黄斑的孔源性视网膜脱离手术后黄斑下积液眼黄斑形态变化与视力预后的关系及其影响因素分析  

Relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid after surgery for macula-off rhegmatogenous retinal detachment and relevant factors of persistent submacular fluid

作　　者：禹海[1] 高明宏[1] 李颖[1] 王颖[1] 

机构地区：[1]沈阳军区总医院眼科,110015

出　　处：《中华眼底病杂志》2013年第2期136-141,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察累及黄斑的孔源性视网膜脱离手术后黄斑下积液眼黄斑形态变化与视力预后的关系，探讨长期黄斑下积液的影响因素。方法回顾性研究。分析63例一次性手术成功的累积黄斑的视网膜脱离患者的资料，共63只眼。根据手术后黄斑下积液时间分为无积液组，小于3个月的短期积液组，大于等于3个月的长期积液组。随访6～12个月。应用频域光相干断层扫描（SD-OCT）观察黄斑形态变化，测量手术后1个月中心凹黄斑下积液高度及中心凹外核层（ONL）厚度，评估黄斑形态变化与手术后最小分辨角对数（logMAR）视力的关系，探讨手术后长期黄斑下积液的影响因素。结果手术后存在黄斑形态异常45只眼，占71．42％。黄斑下积液32只眼，占50．79％。其中，长期积液21只眼。光感受器外节（OS）不规则23只跟。内外节连接（IS／OS）缺损21只眼，其中，IS／OS和外界膜（ELM）同时缺损14只服。OS不规则在长期积液组明显高于短期积液组（χ2=5．788，P=0．035），IS／OS缺损及IS／OS和ELM同时缺损发生的比例在长期积液组也高于短期积液组，但差异无统计学意义（χ2=0．744、0．375，P=0．472、0．403）。单因素相关统计结果显示，手术前视力、视网膜脱离时间与手术后视力显著相关（r=0．611、-0．374，P=0．007、0．037）。长期积液组、短期积液组和无黄斑下积液组患眼的手术后logMAR视力分别为0．53±0．41、0．42±0．31、0．27±0．26，3组间比较，差异有统计学意义（U=28．640，P=0．049）。OS不规则，IS／OS缺损均与手术后视力不相关（r=0．331、0．320，P=0．073、0．102），但OS不规则与IS／OS 缺损之间关系密切（r=0．388，P=0．027）。IS／OS缺损合并ELM缺损眼手术后视力明显低于其他患眼（U=29．920，P=0．036）。手术方式与是否有手术后黄斑下积液残留显著相关（r=0．477，P�Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid （SMF） after surgery for macuia-off rhegmatogenous retinal detachment （RRD） and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients （63 eyes） who underwent successful surgery for maeula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF： no SMF group, short-term group （duration of SMF less than three months） and long-term group （duration of SMF more than three months）. The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer （ONL） one month after surgery were assessed by spectral-domain optical coherence tomography （SD-OCT）. The relationship between morphologic macular changes and logarithm of the minimum angle of resolution （logMAR） visual acuity and the relevant factorsof persistent SMF were evaluated. Results Forty five of 63 eyes （71. 42%） presented morphologic changes after surgery. SMF was detected in 32 eyes （50.79%）, which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments （OS） was observed in 23 eyes; disrupted inner segment/outer segment （IS/OS） junction was noted in 21 eyes, and disrupted external limiting membrane （ELM） was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group （χ2= 5. 788, P=0. 035）. The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference （χ2=0.744, 0. 375; P=0. 472, 0. 403）. The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment （r= 0. 611, -0. 374; P=0. 007, 0. 037）. There was a signific

关 键 词：视网膜脱离 外科学 治疗结果 体层摄影术 光学相干 黄斑 

分 类 号：R77[医药卫生—眼科]