累及黄斑的孔源性视网膜脱离巩膜扣带手术后视网膜形态与视功能恢复的观察  

The retinal morphology and function after scleral bulking on macular-off rhegmatogenous retinal detachment

作　　者：孟旭霞[1] 周贤慧[1] 刘鹏辉[1] 

机构地区：[1]青岛大学医学院附属医院黄岛院区眼科,266500

出　　处：《中华眼底病杂志》2014年第4期348-351,共4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巩膜扣带手术后视网膜形态及视功能的变化情况.方法 前瞻性临床研究.行巩膜扣带手术治疗的累及黄斑的孔源性视网膜脱离的连续性病例41例42只眼纳入研究.其中,男性26例27只眼,女性15例15只眼;平均年龄（33.78±11.21）岁.均行最佳矫正视力（BCVA）、眼压、间接检眼镜、电脑视野、光相干断层扫描（OCT）、B型超声检查.患眼平均BCVA 0.29±0.18.平均视网膜脱离时间（21.12±3.71）d.平均视野平均缺损（MD）值（13.54±6.44） dB;平均丢失方差（LV）值（8.43±2.11） dB.所有患者均行巩膜扣带手术治疗.手术中联合巩膜外冷冻及脉络膜上腔放液.手术后平均随访时间（12.41±5.22）个月.手术后1、2周,1、3、6、12个月采用与手术前相同的设备和方法行相关检查.观察BCVA、视野和视网膜形态变化情况.双目间接检镜联合B型超声、OCT检查观察视网膜下液吸收时间.结果 双目间接检眼镜联合B型超声检查发现,手术后平均视网膜复位时间（7.32±2.53）d.OCT检查发现,平均视网膜下液吸收时间（7.82±3.52）个月.手术后12个月,视网膜下液吸收37只眼,占88.1％.其中,视网膜微结构正常15只眼;神经上皮层黄斑囊样水肿5只眼;光感受器内外节连接（IS/OS）断裂12只眼;IS/OS和外界膜（ELM）断裂5只眼.视网膜下液残留5只眼,占11.9％.手术后6、12个月平均BCVA比较,差异无统计学意义（t=-0.636,P=0.529）.手术后12个月,视网膜微结构正常者、黄斑囊样水肿者、IS/OS断裂者、IS/OS和ELM断裂者之间平均BCVA比较,差异有统计学意义（F=52.42,P＜0.05）.视网膜下液残留者平均BCVA与视网膜下液吸收者之间比较,差异有统计学意义（t=-5.747,P=0.000）.手术后1、2周,1、3、6、12个月平均MD值分别为（11.38±2.53）、（10.14±2.19）、（9.17±2.13）、（6.63±1.70）、（5.71±1.89）、（5.14±1.69） dB.各观察�Objective To observe the changes of retinal morphology and function of macular-off rhegmatogenous retinal detachment （RRD） after scleral bulking.Methods In this prospective study,42 eyes of 41 patients who underwent scleral bulking were enrolled.There were 26 males （27 eyes） and 15 females （15 eyes）,with an average age of （33.78± 11.21） years.Best corrected visual acuity （BCVA）,intraocular pressure,indirect ophthalmoscope,visual fields,optical coherence tomography （OCT） and B scan of ocular ultrasound were measured for all patients.The average BCVA was 0.29±0.18.The retinal detachment time was （21.12±3.71） days.The mean visual field defect （MD） was （13.54±6.44） dB.The mean loss variance （LV） was （8.43±2.11） dB.All the patients were performed cryotherapy and sub-choroidal fluid drain out.The mean follow up was 12.4 months （from 6 to 24 months）.At two weeks,1,3,6,12 months after surgery,the changes of BCVA,visual fields,retinal morphology and subretinal fluid were observed.Results Indirect ophthalmoscope combined with B scan showed the time of retinal reattachment was （7.32±2.53） days.Subretinal fluid was found completely absorbed by OCT with a mean of （7.82±3.52） months.At 12 months after surgery,subretinal fluid was completely absorbed in 37 eyes （88.10％）.In these 37 eyes,15 eyes had normal retinal microstructure,5 eyes had neuroepithelial cystoid edema; 12 eyes had disrupted inner segment/outer segment （IS/OS） junction,and 5 eyes had disrupted IS/ OS and external limiting membrane （ELM）.BCVA at 6 months after surgery was no significant difference with that at 12 months after surgery （t=-0.636,P=0.529）.At 12 months after surgery,there were4 retinal patterns on OCT examination,including normal retinal microstructure,neuroepithelial cystoid edema,IS/OS line disruption,and IS/OS and ELM disruption.The BCVA difference among these 4 groups was significant （F =52.42,P ＜ 0.05）.The BCVA difference between eyes with or without residual

关 键 词：视网膜脱离 外科学 体层摄影术 光学相干 视野 巩膜扣带术 

分 类 号：R774.12[医药卫生—眼科]