OCT在视网膜脱离复位术后视功能评价中的应用研究

发布时间：2018-07-04 09:08

本文选题：OCT + 视网膜脱离复位术后　；参考：《南昌大学》2011年硕士论文

【摘要】：目的：应用光学相干断层扫描仪(optical coherence tomography, OCT)探讨分析视网膜脱离复位术后1年以上的视力恢复不满意及其与黄斑区光学相干断层扫描图像特征的关系。通过OCT检测视网膜解剖复位术后,分析最佳矫正视力(best-corrected visual acuity, BCVA)不太满意的原因。方法：回顾临床2008年10月至2011年3月在南昌大学第二附属医院眼科因视网膜脱离行视网膜复位术包括行玻璃体切割及气体填充术25例,硅油充填49例,行巩膜外环扎、外加压及冷凝42例。所有患者术后1年以上行OCT检查。综合比较患者年龄、视网膜脱离时间、复位术后1年以上OCT黄斑部检查对RRD患者术后最佳矫正视力的影响；健康人对照组：46例行OCT检查。首先建立以上各因素的量化表,用SPSS17.0统计软件对各种分组的术后视力变化情况进行X2检验(检验水准a=0.05)。检查最佳矫正视力均≤0.1并行光学相干断层扫描检查,观察黄斑区的形态变化,且分析其最佳矫正视力提高欠佳的原因。将研究组的黄斑中心凹厚度与健康人眼黄斑中心凹厚度进行比较,运用单因素方差分析。分析是否有统计学意义。结果：术前视力：光感13眼,手动24眼,指数32眼,0.01-0.1者47眼。术后视力提高66眼(56.9%),视力不变27眼(23.3%),视力下降23眼(19.8%)。本组116例(116眼)根据年龄分为4组,18岁以下2例术后BCVA均提高；18-30岁28眼,术后BCVA下降3眼,不变1眼,提高24眼；30-50岁45眼,术后BCVA下降13眼,不变12眼,提高26眼；50岁以上41眼,术后BCVA下降13眼,不变14眼,提高14眼。患者术前、术后BCVA比较(X2=4.003,P=0.2610.05,无统计学意义)；术后BCVA变化情况在不同年龄组中的差别具有统计学意义(X2=20.818,P=0.0020.05),低年龄组患者中术后BCVA提高者居多；不同视网膜脱离时间的术后BCVA改善有明显差异(X2=30.603,P=0.0000.05),视网膜脱离时间越长BCVA提高率越低。视网膜复位术后1年以上黄斑部OCT的图像特征：1)黄斑区结构正常5眼,2)视网膜海绵样增厚19眼,3)黄斑视网膜变薄8眼,4)黄斑囊样水肿13眼,5)视网膜神经上皮层浆液性脱离11眼,6)黄斑裂孔6眼,7)视网膜色素上皮层损害16眼,8)黄斑水肿伴黄斑前膜11眼,9)黄斑变性12眼,10)视网膜前膜9眼,11)其他如脉络膜新生血管、视网膜出血、视网膜下瘢痕形成、视网膜色素上皮层增厚、脉络膜视网膜萎缩等6眼；所有患者BCVA均小于0.1。将研究组的黄斑中心凹厚度与健康人眼黄斑中心凹厚度进行比较：除黄斑区结构正常与健康人对照组P=0.4950.05,无显著性意义外；其它种类与健康人对照组两两比较P=0.0000.05,在统计学上有显著性意义。结论：OCT对视网膜脱离复位术后1年以上黄斑区结构形态的观察,影响视网膜解剖复位术后BCVA恢复的原因可能与患者的年龄、视网膜脱离的时间有关；黄斑水肿、视网膜神经上皮层脱离、黄斑裂孔、视网膜色素上皮层脱离、黄斑区结构及厚度正常、黄斑区厚度变薄、视网膜前膜形成、黄斑水肿伴黄斑前膜、黄斑变性、视网膜神经上皮层水肿及色素上皮损害等亦是其重要的影响因素。黄斑中心凹厚度对视功能恢复可能有一定的关系。OCT为临床早期发现、诊治疾病提供了极其重要的信息。OCT图像可较好地诠释视网膜脱离复位术后视力恢复过程。
[Abstract]:Objective: to analyze the dissatisfaction of visual recovery more than 1 years after retinal detachment reduction and the relationship with the characteristics of optical coherence tomography in macular region by optical coherence tomography (OCT). The best corrected visual acuity (best-corrected VI) was analyzed by OCT detection of retinal anatomic repositioning (best-corrected VI). Sual acuity, BCVA) not very satisfied.
Methods: 25 cases of retinal detachment underwent retinal detachment in the Second Affiliated Hospital of Nanchang University from October 2008 to March 2011, including 25 cases of vitrectomy and gas filling, 49 cases of silicone oil filling, 42 cases of external scleral encircling, external pressure and condensation. All patients were examined for more than 1 years after 1 years. The age of the patients was compared with the patient's age. The effect of retinal detachment time, more than 1 years after reduction of OCT macula examination on the best corrected visual acuity after operation of RRD patients; healthy control group: 46 cases of OCT examination. First set up the quantitative table of the above factors, using the SPSS17.0 statistical software to carry out X2 test (test level a=0.05) for various groups of postoperative visual changes. Check the most The good corrected visual acuity was less than 0.1 parallel optical coherence tomography, and the morphological changes in the macular region were observed and the reasons for the best corrected visual acuity were not improved. The thickness of the macular fovea of the study group was compared with the macular fovea thickness of the healthy human eyes, and the statistical significance was analyzed by the single factor difference analysis.
Results: preoperative vision: 13 eyes of light sensation, manual 24 eyes, 32 eyes of 32 eyes, 47 eyes of 0.01-0.1, 66 eyes (23.3%), 27 eyes (23.3%), and 23 eyes (19.8%). The group 116 (116 eyes) were divided into 4 groups according to age. 0-50 years of age and 45 eyes, BCVA decreased 13 eyes, 12 eyes, 26 eyes, 41 eyes, 41 eyes above 50 years old, and 13 eyes, 14 eyes and 14 eyes after operation. Before operation, the postoperative BCVA was compared (X2=4.003, P=0.2610.05, no statistical significance); the difference of BCVA in the different years of age group after operation was statistically significant (X2=20.818, P=0.0020.05), low (X2=20.818, P=0.0020.05). The increase of BCVA in the age group was most; the improvement of BCVA after different retinal detachment time was significantly different (X2=30.603, P=0.0000.05), the longer the retinal detachment time, the lower the BCVA enhancement rate. The image characteristics of OCT in the macular region above 1 years after retinal reposition operation: 1) the normal 5 eyes of the macular region, 2) 19 eyes of retinal sponge like thickening, 3) macular retina thinner, 8 eyes, 4) macular edema, 13 eyes, 5) retinal neuroepithelial serous detachment 11 eyes, 6 macular hole 6 eyes, 7 retinal pigment epithelial layer of 16 eyes, 8 macular edema with 11 eyes of macular membrane, 9) macular degeneration, retinal hemorrhage, retina, retina, retinal hemorrhage, and subretina Cicatricial formation, retinal pigment epithelial layer thickening and choroidal retinal atrophy were 6 eyes. All patients with BCVA were less than 0.1. and compared the macular fovea thickness of the study group with the healthy human eye macular fovea thickness. There was no significant difference between the normal and healthy control group P=0.4950.05, other types and healthy people. Control group 22 compared P=0.0000.05, statistically significant.
Conclusion: OCT observation of the macular structure over 1 years after retinal detachment reduction affects the cause of BCVA recovery after anatomic reduction of retina, which may be related to the age of the patients and the time of retinal detachment; macular edema, retinal detachment, Huang Banlie hole, retinal pigment epithelial detachment, macular structure and the structure of macular region. The thickness of the macular region, the formation of the anterior retinal membrane, macular edema with macular membrane, macular degeneration, retinal neuroepithelia edema and pigment epithelium damage are also important factors. The macular fovea thickness may have a certain relationship between the visual function recovery and.OCT for early clinical discovery and the diagnosis and treatment of disease. Important information.OCT images can better explain the process of visual recovery after retinal detachment surgery.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

【参考文献】