术中OCT导航下的视网膜手术  

Intraoperative navigating with optical coherence tomography in retinal surgery

作　　者：王文战[1] 宋德弓 邓先明[1] 石径 Wang Wenzhan;Song Degong;Deng Xianming;Shi Jing(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hosptial,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2022年第5期392-395,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨术中OCT导航下视网膜手术的方法和效果。方法利用术中OCT的导航作用,对因屈光间质浑浊术前无法明确诊断的眼底病进行术中OCT扫描,即时诊断。本研究纳入郑州大学第一附属医院1名玻璃体浑浊伴视网膜脱离患者,玻璃体切除后应用术中OCT扫描后极部病变区,发现视网膜表面的增生膜和视网膜下增生组织,并在术中OCT导航下进行视网膜前膜的剥离和激光光凝封闭视网膜裂孔,评价其治疗效果。结果术前眼科B超显示玻璃体浑浊伴可疑局限性视网膜浅脱离,眼底检查视网膜无法视及。切除浑浊的玻璃体后,术中OCT扫描显示:后极部黄斑区视网膜水肿,结构紊乱,中心凹上方1/3 PD处可见视网膜下指状突起,其周围有视网膜下积液,黄斑颞下方见视网膜前膜。于术中OCT导航下剥除前膜,填充硅油及激光光凝封闭裂孔并对指状突起进行激光光凝。术后诊断:右眼息肉样脉络膜血管病变(PCV)、玻璃体浑浊、继发性视网膜脱离及黄斑前膜。术后1个月随访发现黄斑区出血和水肿减轻,视力提高。结论术中OCT导航有助于发现潜在的病理改变,并可针对病灶进行精确的处理从而提高疗效。Objective To investigate the method and efficacy of retinal surgery under the navigation of intraoperative OCT.Methods Using the intraoperative navigating function of OCT,intraoperative OCT scanning was performed for the undiagnosed ocular fundus diseases,and the diagnosis was made immediately,thus overcoming the shortage of conventional OCT that cannot be detected due to the preoperative opacity of the refractive medium.In this study,a case of vitreous opacity and retinal detachment in the right eye in the First Affiliated Hospital of Zhengzhou University was included.After vitrectomy,intraoperative OCT was used to scan the lesion area in the posterior pole,to find the proliferative membrane on the retinal surface and the subretinal proliferative tissue lesions,thus,under the guidance of intraoperative OCT,epiretinal membrane peeling and laser photocoagulation were performed to seal retinal tear.The efficacy was evaluated.Results Preoperative ophthalmic B-mode ultrasonography showed vitreous opacity with suspected limited superficial retinal detachment,and the retina could not be seen by fundus examination.After excision of the opaque vitreous,intraoperative OCT scan showed edema and structural disorder of the subretinal tissue in the macular area,subretinal finger-like protrusions were seen in the upper 1/3 PD of the fovea,surrounding subretinal fluid,and the epiretinal membrane near macular area was seen below the temporal region,and removed under intraoperative OCT navigation.After the operation,silicone oil was tamponaded for laser photocoagulation to seal the hole,and the finger-like protrusions(polypoid choroidal vasculopathy,PCV)were subjected to intraoperative laser photocoagulation under OCT navigation.Postoperative diagnosis:PCV,vitreous opacity,secondary retinal detachment and macular membrane in the right eye.Conclusion Intraoperative OCT is helpful to detect potential pathological changes and carry out precise and high-precision treatment for the lesions,leading to improve treatment efficacy.

关 键 词：导航 术中 OCT 光凝 激光 手术 玻璃体视网膜 血管病变 息肉状 脉络膜 治疗 精准 

分 类 号：R779.6[医药卫生—眼科]