频域光学相干断层扫描评价视网膜脱离后黄斑区的显微结构

发布时间：2018-10-21 18:05

【摘要】：目的:利用频域光学相干断层扫描(Optical Coherence Tomography,OCT)评价孔源性视网膜脱离后黄斑区的显微结构改变,研究这些改变的相关因素和对功能影响。方法:回顾性收集2008年7月到2010年12月在汕头大学·香港中文大学联合汕头国际眼科中心(JSIEC)诊治的孔源性视网膜脱离患者的术前频域OCT结果和临床病历。分析频域OCT中黄斑区显微结构改变,比较发生结构改变与不发生结构改变两组之间术前因素和术前、术后视力之间是否具有统计学显著性差异。结果:共有177人177眼纳入研究。频域OCT显示孔源性视网膜脱离后黄斑部显微结构改变有:黄斑脱离(86.4%);黄斑裂孔(12.1%);视网膜前膜(25.4%);视网膜内增殖(1.7%);视网膜下增殖(10.2%);外层波浪样改变(74.6%);光感受器丢失(53.7%);光感受器脱离(20.1%);外核层囊样水肿(74.6%);内核层囊样水肿(22.6%);视网膜内表面皱褶(43.8%)。其中黄斑脱离、黄斑裂孔、视网膜前膜、外层波浪状改变、光感受器脱离及外核层/内核层囊样水肿均与手术前/后视力差相关:光感受器丢失与手术后视力差相关。中心凹视网膜厚度与视网膜脱离的高度(r=-0.487,p0.001)及手术前最佳矫正视力(r=-0.306,p=0.001)呈负相关。影响术后最佳矫正视力的独立因素为:光感受器丢失(B=0.225,p=0.038)、外核层波浪样改变(B=0.344, p=0.004),及视网膜前膜(B=0.356,p=0.013)。结论:频域OCT能显示孔源性视网膜脱离后的黄斑区显微结构改变。这些结构改变可能是视网膜脱离视力不良的原因之一。影响术后最佳矫正视力的独立因素为:光感受器丢失、外层波浪样改变及视网膜前膜,可作为孔源性视网膜脱离手术预后的预测因素。进一步研究这些病变的发病机制、在各种手术治疗后的转归,可以帮助探讨措施预防和治疗这些病变,最终有利于提高孔源性视网膜脱离手术的视力结果。
[Abstract]:Aim: to evaluate the microstructural changes of macular area after rhegmatogenous retinal detachment by frequency-domain optical coherence tomography (Optical Coherence Tomography,OCT). Methods: from July 2008 to December 2010, the frequency domain OCT results and clinical records of patients with rhegmatogenous retinal detachment diagnosed and treated in Shantou University of Hong Kong combined with Shantou International Ophthalmology Center (JSIEC) were collected retrospectively. The macular microstructural changes in frequency domain OCT were analyzed to compare the preoperative factors and preoperative visual acuity between the two groups. Results: a total of 177 people and 177 eyes were included in the study. Frequency domain OCT showed macular microstructural changes after rhegmatogenous retinal detachment (86.4%), macular hole (12.1%), preretinal membrane (25.4%), intraretinal proliferation (1.7%), subretinal proliferation (10.2%), wave-like change of outer layer (74.6%), loss of photoreceptor (53.7%). Photoreceptor detachment (20.1%), cystic edema of outer nuclear layer (74.6%), cystic edema of nuclear layer (22.6%), and inner retinal surface fold (43.8%). Among them, macular detachment, macular hole, anterior retinal membrane, wave-like changes in outer layer, photoreceptor detachment and cystic edema in outer nuclear / nuclear layer were all correlated with poor visual acuity before and after operation, and the loss of photoreceptor was related to poor visual acuity after operation. There was a negative correlation between the retinal thickness of fovea and the height of retinal detachment (r = -0.487p 0.001) and the best corrected visual acuity before operation (r = -0.306). The independent factors affecting the best corrected visual acuity after operation were: loss of photoreceptor (BV 0.225), wavy change of outer nuclear layer (BU 0.344, p0. 004), and preretinal membrane (BV 0.356U p0.013). Conclusion: frequency domain OCT can show the change of macular microstructure after rhegmatogenous retinal detachment. These structural changes may be one of the causes of poor vision in retinal detachment. The independent factors affecting the best corrected visual acuity after operation were the loss of photoreceptor, the wave-like changes in the outer layer and the membrane of the retina, which could be used as prognostic factors in the operation of rhegmatogenous retinal detachment. Further study of the pathogenesis of these lesions and the outcome after various surgical treatments can help to explore measures to prevent and treat these lesions and ultimately to improve the visual acuity of rhegmatogenous retinal detachment surgery.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.1

【相似文献】