频域OCT观察两种类型视网膜脱离术后黄斑中心凹结构变化  

Changes in foveal microstructure after surgery for two types of retinal detachment with spectral-domain OCT

作　　者：黄定国[1] 黄惠春[1] 张安琳[1] 陈伟奇[1] 

机构地区：[1]汕头大学.香港中文大学联合汕头国际眼科中心,广东省汕头市515041

出　　处：《眼科新进展》2016年第12期1176-1179,共4页Recent Advances in Ophthalmology

摘　　要：目的利用频域光学相干断层扫描(optical coherence tomography,OCT)观察单纯视网膜脱离(rhegmatogenous retinal detachment,RRD)和视网膜脱离合并脉络膜脱离(rhegmatogenous retinal detachment associated with choroidal detachment,RRDCD)术后黄斑中心凹结构的变化,并分析中心凹结构与术后最佳矫正视力的相关性。方法 77例(77眼)视网膜脱离患者纳入研究,其中RRD组44例(44眼),RRDCD组33例(33眼),所有患者均接受玻璃体切割联合硅油填充复位视网膜,利用频域OCT观察术后黄斑区光感受器内/外节(photoreceptor inner and outer segment,IS/OS)连接带及外界膜(external limiting membrane,ELM)的形态、视网膜中心凹厚度,分析两组间中心凹形态变化差异,并分析IS/OS连接带与ELM形态以及视网膜中心凹厚度与术后最佳矫正视力的相关性。结果两组间的IS/OS连接带形态差异有统计学意义(χ2=6.888,P=0.032),RRDCD组IS/OS连接带的形态消失率明显高于RRD组;两组间ELM形态差异无统计学意义(χ2=3.597,P=0.166),两组的IS/OS连接带及ELM形态的完整性均与术后最佳矫正视力有相关性(RRD组:r=0.649、P<0.05,r=0.466、P<0.05;RRDCD组r=0.480、P<0.05,r=0.442、P=0.010)。结论频域OCT是一种评价视网膜脱离复位术后黄斑微结构改变的有效手段。RRDCD的IS/OS连接带消失率明显高于RRD,这也是提示术后视力较差的原因之一,IS/OS连接带及ELM形态的完整性可能是预测视网膜脱离复位术后视力恢复的重要因素。Objective To study the foveal microstructural changes of rhegmatog- enous retinal detachment （RRD） and rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD）after surgery by spectral-domain optical coherence tomography （SD-OCT）,and determine its association with visual outcomes. Methods Forty-four patients with RRD and 33 patients with RRDCD were included in this study. All the patients underwent vitrectomy combined silicone oil tamponade. The following postoperative foveal microstructures were evaluated by SD-OCT： photoreceptor inner/ outer segment （IS/OS） junction, external limiting membrane （ELM） and foveal thick- ness. The correlation between the postoperative best-corrected visual acuity （BCVA） and microstructural findings at the fovea was evaluated, and the differences of foveal micro- structure between the two groups were assessed at the santo time. Results There was significant difference in IS/OS junction stage between the two groups （X^2 = 6. 888, P = 0. 032）. The absent rate of the photoreceptor IS/OS junction in RRDCD group was higher than that in RRD group, however, there was no difference in ELM stage between the two groups （X^2 =3. 597 ,P=0. 155）, and the postoperative BCVA was significantly correlated with the integrity of the photoreceptor IS/OS junction and ELM signals detected by SD- OCT postoperatively in two groups （ RRD group： r = 0. 649, P 〈 0.05 ; r = 0. 466, P 〈 0.05. RRDCD group：r =0.480,P 〈0.05 ;r =0.442,P = 0. 010,respectively）. Conclusion SD- OCT is a valuable tool for evaluating foveal microstructural changes after retinal detach- ment repair. The absent rate of the photoreceptor IS/OS junction in RRDCD group was significantly higher than that in RRD group, which may account for poor prognosis for pa- tients with RRDCD. IS/OS junction and ELM integrity may be important predictors of postoperative visual outcome after anatomically successful RRD surgery.

关 键 词：频域光学相干断层扫描 视网膜脱离 脉络膜脱离 视网膜中心凹厚度 

分 类 号：R774.1[医药卫生—眼科]