玻璃体切割术和巩膜扣带术治疗累及黄斑的孔源性视网膜脱离黄斑区微结构及脉络膜厚度的对比研究

发布时间：2018-05-02 12:25

本文选题：频域相干光断层深度增强成像技术 + 黄斑中心凹下脉络膜厚度　；参考：《河北医科大学》2017年硕士论文

【摘要】：第一部分巩膜扣带术和玻璃体切割术治疗累及黄斑的孔源性视网膜脱离黄斑微结构改变目的:应用频域光学相干断层扫描(spectral domain-optical coherencetomography,SD-OCT)观察比较巩膜扣带术(scleral buckling,SB)或经睫状体平坦部玻璃体切割手术(pars plana vitrectomy,PPV)两种术式后黄斑区超微结构的术后恢复情况。方法:收集2015年12月至2016年12月在河北医科大学第二医院眼科住院的累及黄斑的孔源性视网膜脱离患者37例37只眼,根据行巩膜扣带术及玻璃体切割术共分为两组。在术前、术后7天、1个月及3个月行BCVA和SD-OCT。应用SD-OCT观察黄斑中心凹处视网膜的形态学改变,并测量:黄斑中心凹下视网膜下液(subfoveal fluid,SF)高度。结果:1 PPV组中一次性手术成功率为100%;SB组中有2只眼第一次手术未成功,第二次行玻璃体切割术并复位成功,复位率为87.5%。2 PPV组中术前、术后7天、1个月、3个月视网膜下液高度分别为957.10±507.35μm、20.32±39.31μm、15.10±34.26μm、12.38±28.48μm,SB组术前、术后7天、1个月、3个月视网膜下液高度分别为454.63±408.28μm、135.60±94.31μm、104.63±67.67μm、86.75±53.23μm,两组在术前、术后7天、1个月、3个月分别进行非参数(Mann-Whitney U检验)统计学检验,差异有统计学意义。两组均在术后7天下降最快,其后趋势变缓慢。3两组的IS/OS断裂及外界膜不完整性的发生率差异无统计学意义。4术后3个月PPV组中有1只眼黄斑萎缩,1只眼黄斑水肿,1只眼视网膜前膜。SB组中无以上黄斑部变化。5 PPV组视力平均提高1.06±0.52 log MAR;SB组视力平均提高0.79±0.53 log MAR;术后3月PPV组与SB组相比,平均视力有显著提高。小结:1 PPV手术有助于黄斑解剖复位,而且没有明显的视网膜下液,从而实现更好的术后视力。2 PPV手术后会有黄斑区异常变化如黄斑萎缩、黄斑水肿及视网膜前膜等变化,但是由于本研究样本量小,其异常病变的发生率较低,结果有较大偏差。3两组中早期视网膜下液吸收较快,术后7天后速度逐渐减慢。第二部分巩膜扣带术和玻璃体切割术治疗累及黄斑的孔源性视网膜脱离黄斑区视网膜下液与黄斑中心凹下脉络膜厚度的的相关性研究目的:利用频域相干光断层深度增强成像技术(Enhanced depth imaging spectral-domainoptical coherence tomography EDI SD-OCT)测量巩膜扣带术(scleral buckling,SB)或经睫状体平坦部玻璃体切割手术(pars plana vitrectomy,PPV)后患者的黄斑中心凹下视网膜下液高度、脉络膜厚度等,并研究脉络膜厚度与视网膜下液的关系,寻找持续性视网膜下液存在原因方法:收集2015年12月至2016年12月在河北医科大学第二医院眼科住院的累及黄斑的孔源性视网膜脱离患者37例37只眼,根据行巩膜扣带术及玻璃体切割术共分为两组。在术前、术后7天、1个月及3个月应用EDI SD-OCT测量黄斑中心凹下脉络膜厚度(subfoveal choroid thickness,SFCT)、距黄斑中心凹3mm的鼻侧、颞侧、上方及下方的脉络膜厚度。结果:1 PPV组中术前、术后7天、术后1个月及术后3个月的黄斑中心凹下脉络膜厚度(SFCT)、距黄斑中心凹3mm的上方(SCT3.0)、距黄斑中心凹3mm的下方(ICT3.0)、距黄斑中心凹3mm的鼻侧(NCT3.0)、距黄斑中心凹3mm的颞侧(TCT3.0)平均值走行趋势为逐渐升高,在术后7天达到最高值并逐渐下降,在术后3个月时基本达到术前水平。2 SB组中术前、术后7天、术后1个月及术后3个月的SFCT、SCT3.0、ICT3.0、NCT3.0、TCT3.0平均值的走行趋势为逐渐升高,在术后7天达到最高值,之后逐渐下降,在最后一次随访即术后3个月依旧低于术前水平。术前SFCT(194.25±56.87 um)与各时间点进行配对t检验,术后1个月(176.13±51.84 um)及术后3个月(176.69±53.03 um)SFCT与术前相比差异有统计学意义,术后7天(205.19±56.25 um)与术前相比差异无统计学意义。术前、术后7天、术后1个月及术后3个月外垫压侧与非外垫压侧距黄斑中心凹处3mm的脉络膜厚度差异无统计学意义。3 SB组中术后7天、术后1个月及术后3个月的黄斑中心凹下视网膜下液的高度分别与相应时间的距黄斑中心凹3mm的扣带侧的脉络膜厚度均无线性关系。术后7天、术后1个月及术后3个月的黄斑中心凹下视网膜下液的高度分别与相应时间的黄斑中心凹下脉络膜厚度均无线性关系。小结:1 PPV组和SB组各个位点的脉络膜厚度在术后均有短暂的升高,均在术后7天达到最高值,随后降低,PPV组可以达到术前水平,SB组低于术前水平。2视网膜下液与在任何位置下的脉络膜厚度均无线性关系。从中我们可以认为,脉络膜血流量对持续性视网膜下液的吸收影响不明显。
[Abstract]:Part 1 scleral buckling and vitrectomy for macular retinal detachment with macular microstructures: the use of spectral domain-optical coherencetomography (SD-OCT) to compare the scleral buckling (scleral buckling, SB) or pars plana vitreous cutting hand After operation (pars plana vitrectomy, PPV), the postoperative recovery of the ultrastructure of the macular region of two kinds of surgical procedures. Methods: 37 eyes of 37 patients with macular rhegmatogenous retinal detachment in the ophthalmology of the second hospital of Hebei Medical University from December 2015 to December 2016 were collected and divided into two groups according to scleral buckling and vitrectomy. Before operation, 7 days, 1 months and 3 months after operation, BCVA and SD-OCT. applied SD-OCT to observe the morphological changes of retina in the macular fovea, and measured the height of subretinal subretinal fluid (subfoveal fluid, SF) under the macular fovea. Results: the success rate of one time operation was 100% in group 1 PPV; 2 eyes in group SB were unsuccessful for the first time and second times of glass were performed. Volume cutting and reduction were successful. The reduction rate was in group 87.5%.2 PPV, 7 days, 1 months, 3 months, 3 months, 957.10 + 507.35 mu, 20.32 + 39.31, m, 15.10 + 34.26, m, 12.38 + 28.48, m, SB group before operation, 7, 1 months, and 3 months, respectively. .67 mu m, 86.75 + 53.23 m, two groups before the operation, 7 days, 1 months, 3 months, respectively, non parameter (Mann-Whitney U test) statistical test, the difference was statistically significant. The two groups were the fastest after the 7 after the operation, then the trend of.3 two group IS/OS fracture and the incidence of external membrane incompleteness was not statistically significant 3 after.4 operation. In group PPV, there were 1 eyes with atrophy of macula, 1 eyes with macular edema, 1 eyes in group.SB of anterior retinal membrane, and no macular change in group.5 PPV. The average vision of.5 PPV in group SB increased by 0.79 + 0.53 log MAR in SB group. The average visual acuity in the PPV and SB group in March was significantly higher than that in the SB group. Summary: 1 PPV surgery was helpful to the macular anatomy. And there is no obvious subretinal fluid, so as to achieve better postoperative visual acuity.2 PPV operation, there will be abnormal changes in macular region such as macular atrophy, macular edema and the anterior retinal membrane. However, because of the small sample size of this study, the incidence of abnormal lesions is low, and the fruit has a greater deviation from the early subretinal fluid absorption in the.3 two groups. Faster and slower 7 days after operation. Second parts of scleral buckling and vitrectomy for the treatment of macular retinal detachment in the macular region of the macular subretinal fluid and the subfoveal choroid thickness under the macula Objective: Enhanced depth imaging spec (Enhanced spec) Tral-domainoptical coherence tomography EDI SD-OCT) measurement of scleral buckling (scleral buckling, SB) or the subfoveal subfoveal subretinal fluid height, choroidal thickness, and the relationship between the choroidal thickness and the subretinal fluid after the scleral buckling (scleral buckling, SB) or the pars plana vitrectomy (pars plana vitrectomy, PPV) and to investigate the relationship between the choroidal thickness and the subretinal fluid. The reason for the existence of subretinal fluid: collecting 37 patients with macular retinal detachment from December 2015 to December 2016 at the second hospital of Hebei Medical University, 37 eyes with macular retinal detachment, was divided into two groups according to scleral buckling and vitrectomy. EDI SD-OCT was used before the operation for 7 days, 1 months and 3 months after the operation. Subfoveal choroid thickness (SFCT), the nasal side, temporal, upper and lower choroidal thickness of the macular fovea 3mm. Results: in group 1 PPV, 7 days after operation, 1 months after operation, and 3 months after operation, the choroidal thickness (SFCT), above the macular fovea 3mm (SCT3.0), from macula. The lower (ICT3.0) of the central concave 3mm, the nasal side (NCT3.0) from the macular fovea 3mm (NCT3.0), the average value of the temporal lateral (TCT3.0) from the macular fovea 3mm, increased gradually, reached the highest value at the 7 day after the operation and gradually decreased, and basically reached the preoperative level of the.2 SB group before the operation, 7 days after the operation, 1 months after the operation and 3 months postoperative SFCT, SC. The average value of T3.0, ICT3.0, NCT3.0, and TCT3.0 increased gradually, reached the highest value at 7 days after the operation, and then decreased gradually. At the last follow-up, 3 months after the operation, it was still lower than the preoperative level. SFCT (194.25 + 56.87 UM) before operation paired t test with each time point, 1 months (176.13 + 51.84 UM) after operation and 3 months after operation (176.69 + 53.03). UM) SFCT was statistically significant compared with preoperative, and there was no statistically significant difference between 7 days (205.19 + 56.25 UM) after operation. Before operation, 7 days after operation, 1 months after operation, 1 months after operation and 3 months after operation, there was no statistically significant difference in the thickness of the choroid thickness of 3mm in the macular center of the macular fovea, and 7 days after the operation in group.3 SB, and 1 months after the operation. The height of subretinal subfoveal subfoveal subfoveus at 3 months after the operation was respectively wirelessly related to the choroidal thickness of the cingulate region of the macular center 3mm, respectively. The height of the subfoveal subfoveal subfoveal fluid at the 7 day after the operation and the 1 months after the operation and the 3 months after the operation were respectively the thickness of the choroidal thickness under the corresponding macular subfoveal. No linear relationship. Summary: the choroidal thickness of each site in group 1 PPV and SB had a short increase after operation, all reached the highest value at the 7 day after operation, and then decreased, and the PPV group could reach the preoperative level. In group SB, there was no linear relationship between the preoperative level of.2 subretinal fluid and the thickness of the vascular collaterals under any position. The effect of choroidal blood flow on continuous subretinal fluid absorption is not obvious.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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