频域OCT观察视网膜脱离复位术后黄斑微结构改变与视功能恢复关系的研究

  本文关键词：频域OCT观察视网膜脱离复位术后黄斑微结构改变与视功能恢复关系的研究，由笔耕文化传播整理发布。

        目的：应用频域光学相干断层扫描（spectral-domain optical coherencetomography，SD-OCT）观察孔源性视网膜脱离（rhegmatogenous retinaldetachment, RRD）行巩膜扣带联合巩膜外冷冻手术前后黄斑区光学相干断层扫描图像特征，探索黄斑区微结构的改变与视力的关系。方法：观察2011年10月至2013年1月在河北医科大学第二医院眼科就诊的孔源性视网膜脱离患者43例43只眼，全部行巩膜外垫压联合巩膜外冷冻术，术后均视网膜复位。术前眼部检查包括最佳矫正视力（best-corrected visual acuity，BCVA）、裂隙灯显微镜、双目间接眼底镜、SD-OCT和视野，并在术后3天、1、3、6月行BCVA和SD-OCT，术后1、3、6月行视野检查。患者对侧健康眼对照组:39例行SD-OCT和视野检查。应用SD-OCT测量RRD患者中心凹处视网膜下液（subretinal fluid，SRF）高度、神经上皮层厚度、外核层（outer nuclear layer，ONL）厚度，并观察黄斑区微结构的改变，分析其与术后视力的关系。以患者年龄和裂孔位置作为分组标准，比较不同年龄和裂孔位置对术后SRF吸收是否有影响。结果：1术前视网膜下液（SRF）平均高度为885.05±493.28μm，术后第3天行OCT检查示所有患者视网膜神经上皮层下均残留不同程度的SRF，其后随着时间的延长，SRF逐渐吸收。术后1月93%（39眼）患者检出SRF，在术后3、6月SRF的检出率分别为77.8%（33眼）、46.5%（20眼）。术前视网膜脱离高度与术后视力存在相关关系（r=0.817，P=0.001），视网膜脱离越高，术后视力恢复越差。术后SRF吸收情况在不同年龄组（≤30岁，＞30岁）之间差别存在统计学意义（P=0.12），低年龄组SRF较高年龄组吸收快。裂孔位置不同术前SRF高度有明显差异（P＜0.01），裂孔位于上方者术前视网膜脱离较下方高；同时术后不同时间点SRF高度存在显著差别（F=42.28，P＜0.01），下方裂孔的RRD患者SRF吸收较快。术后OCT图像示3种形态的SRF残留：（1）弥漫SRF；(2)中心凹下多量水泡样SRF；（3）中心凹下单一水泡样SRF；2术前行OCT检测可见脱离的黄斑区视网膜有三种结构的改变：（1）中心凹形态存在；(2)神经上皮层弥漫性水肿伴层间囊样液腔，以外核层为主；（3）神经上皮层弥漫性水肿伴层间囊样液腔，外层视网膜波浪样改变。3术前中心凹处神经上皮层平均厚度（128.88±41.63μm）较正常对侧眼（181.17±10.36μm）显著降低（P＜0.01）。术后6月中心凹处神经上皮层平均厚度（149.55±45.75μm）较术前明显增加(P＜0.05)，但与对侧眼相比无明显差异（P＞0.05）。术前中心凹处神经上皮层厚度与术后BCVA明显相关(r=0.028；P＜0.05)。4术前外核层（ONL）平均厚度（74.95±25.21μm）较正常对侧眼（102.28±11.63μm）降低（P＜0.05）。术后6月ONL平均厚度(86.28±19.26μm)较术前有所增加，无统计学差异(P＞0.05），但仍较对侧眼降低(P＜0.05）。术前外核层厚度与术后BCVA相关(r=0.521；P=0.035)。5在黄斑中心凹已复位的眼中，可见黄斑区光感受器损伤有如下4种：（1）外界膜（ELM）、光感受器内、外节（IS/OS）交界线、中间线（intermediateline，IL）均不连续；（2）ELM连续，IS/OS交界线、IL断裂；（3） ELM、IS/OS交界线连续，IL不连续；（4）ELM、IS/OS交界线和IL连续。6术前黄斑10°平均视敏度（11.74±10.04dB）较正常对侧眼组（29.23±3.45dB）降低（P＜0.05），术后6月黄斑区平均视敏度与正常对侧眼组比较无统计学差异（P＞0.05）。术后6月与术前比较平均视敏度提高（P＜0.05），说明随着视网膜复位，视功能逐渐恢复。结论：1巩膜扣带术后持续存在的SRF及术前中心凹神经上皮层和外核层厚度与术后视力预后有关。2SD-OCT能检测出孔源性视网膜脱离后ELM、IS/OS和IL等黄斑区微结构的改变，这些可能是预测术后视力的重要指标。

    Objective: To evaluate the correlation between morphologic changes inthe macular foveal and visual function after scleral buckling procedure ofrhegmatogenous retinal detachment（RRD） by using the spectral-domainoptical coherence tomography（SD-OCT）.Methods: Forty-three eyes of43patients who were diagnosed as RRD inour hospital (the Department of Ophthalmology of the Second Hospital ofHebei Medical University) met the selection. All eyes received scleralbuckling combined with cryoretinopexy procedure and the retina wassuccessfully reattached. A thorough ophthalmologic examination includingbest correct visual acuity(BCVA)，slit-lamp biomicroscopy, binocular indirectophthalmology, SD-OCT scanning and perimetry were performedpreoperatively, and SD-OCT scanning was performed during all subsequentfollow-up visits at3d,1mon,3mon,6mon postoperatively. Perimetry wasperformed at1mon,3mon,6mon postoperatively. Healthy fellow eye controlgroup:39eyes SD-OCT and perimetry routine inspection. The height of thesubretinal fluid, foveal central retina thickness, and outer nuclear layer（ONL）thickness were measured using SD-OCT. The morphologic changes in themacular foveal and visual function were also evaluated. We compared whetherthe age or hole location has effect on the postoperative SRF absorption.Results:1Preoperative SRF height was885.05±493.28μm,and100%patientsshowed residual SRF in different degree on SD-OCT.As time goes by, SRFwas absorbed slowly.93%(39eyes) had SRF at postoperative1month,and77.8%(33eyes) at3months，46.5%(20eyes) at6months. The height of SRFwas correlated with preoperative visual acuities（r=0.817，P=0.001）.Postoperative SRF absorption in different age groups(≤30years，＞ 30years) has statistically significant（P=0.12），SRF absorption in low agegroup was fast. Preoperative the height of the detached retina in differentlocation of hole groups has statistically significan（tP＜0.01）,the height of thedetached retina with superior hole was high than the ones with inferior hole.Meanwhile, the height of the detached retina at different time points hasstatistically significant （F=42.28，P＜0.01），SRF absorption in patients withinferior hole was quickly than the ones with superior hole.There were three patterns of SRF on postoperative SD-OCT sans(1)aconfluent bleb，(2)multiple blebs，（3）a single bleb.2There are three changes of detached retina on preoperative SD-OCTscans:(1)a normal foveal contour was preserved,(2)diffuse edema in the outernuclear layer with cystoids cavities, and (3) diffuse edema in the outer nuclearlayer with cystoids cavities, undulations of outer retinal layer.3Preoperative the mean central retinal thickness（128.88±41.63μm） inthe RRD eyes resulted significantly lower（P＜0.01）compared with thehealthy fellow eye（181.17±10.36μm）.The mean thickness at six months（149.55±45.75μm） was significantly increased compared withpreoperative(P＜0.05)，but compared with healthy follow eye it still remainedthinner（P＞0.05）. The central retinal thickness was strongly correlated withpostoperative BCVA(r=0.028；P＜0.05).4Preoperative the mean ONL thickness（74.95±25.21μm） in the RRDeyes resulted statistically lower（P＜0.05）compared with the healthy felloweye（102.28±11.63μm）.The mean thickness at six months(86.28±19.26μm)was increased compared with preoperative, and has no statisticallydifference(P＞0.05），，and compared with healthy follow eye it has statisticallydifference(P＜0.05）. The ONL thickness was correlated with postoperativeBCVA (r=0.521；P=0.035).5There are four types of microstructure abnormalities in the foveal aftersuccessful reattachment：（1） disruption of ELM， IS/OS junction andIL,(2)ELM was preserved, IS/OS junction and IL were disrupted,(3)ELM andIS/OS junction were intact, IL was disrupted, and(4)All of the three were intact.6Preoperative mean perimetry sensitivity（11.74±10.04dB）in the RRDeyes resulted lower （P＜0.05） compared with the healthy fellow eye（29.23±3.45dB），at six months after surgery it has no difference with thehealthy fellow eye.The mean perimetry sensitivity at six months wasincreased compared with preoperative(P＜0.05)，illustrated that with retinalreattached，visual function gradually restored.Conclusions:1Postoperative persistent SRF, preoperative central foveal thickness andONL thickness were correlated with a delayed visual outcome in macula-offRRD patients.2The integrity of ELM, IS/OS and IL maybe important predictors ofpostoperative visual outcome after RRD repair.

频域OCT观察视网膜脱离复位术后黄斑微结构改变与视功能恢复关系的研究

摘要4-7ABSTRACT7-9前言10-11材料与方法11-14结果14-19附图19-26附表26-28讨论28-32结论32-33参考文献33-37综述 视网膜脱离复位术后黄斑区 OCT 图像的特点及其与术后视功能恢复的关系37-47    参考文献43-47致谢47-48个人简历48

  本文关键词：频域OCT观察视网膜脱离复位术后黄斑微结构改变与视功能恢复关系的研究，由笔耕文化传播整理发布。