黑色素相关近红外眼底自发荧光联合OCT评估孔源性视网膜脱离巩膜扣带术后早期黄斑功能的改变

发布时间：2019-04-03 20:42

【摘要】：目的伴黄斑脱离的孔源性视网膜脱离（RRD）行巩膜扣带术，观察术后初期黄斑区的黑色素相关近红外眼底自发荧光表现（NIA）和光学相干断层扫描（OCT）表现，通过将NIA与OCT相结合，对RRD巩膜扣带术后早期黄斑的结构进行评估。方法前瞻性系列病例研究。将行巩膜扣带术的21例（21眼）伴黄斑脱离的孔源性视网膜脱离患者纳入本研究，全部患眼均经双目间接检眼镜和（或）裂隙灯显微镜结合前置镜进行确诊。所有患眼术后经检眼镜检查眼底视网膜均复位，每次随访时视网膜均在位。应用共聚焦激光眼底血管造影仪HRA2(海德堡视网膜脉络膜眼底造影系统),对所有患眼术后3个月行NIA检查和OCT检查。通过与同一图像的背景灰度进行对比分析后，将异常荧光按荧光等级分为强荧光、弱荧光、无荧光。我们对患眼术后3个月的NIA及OCT结果进行评估。观察检查图像的异常和手术后视力的恢复情况。对视力的变化进行配对t检验，NIA与术后BCVA的相关性采用双向无序分类变量资料的关联性进行分析。结果黄斑NIA结果：16眼表现为弱荧光周围围绕着强荧光，5眼表现为不均匀的强荧光。黄斑OCT结果：20眼存在黄斑下液，，其中6眼中心凹区视网膜神经感觉层变薄，14眼正常；1眼无黄斑下液，中心凹区视网膜神经感觉层变厚；21眼IS/OS反射异常。视力恢复情况：术后3个月视力与术后1天比较，NIA表现为弱荧光周围围绕着强荧光者，视力差异有统计学意义（t=9.922,P0.05），表明术后3个月较术后1天视力提高；NIA表现为不均匀强荧光者，视力差异无统计学意义（t=2.409,P0.05），尚不能表明术后3个月视力较术后1天视力有提高。黄斑NIA表现与术后BCVA变化高度相关（C=0.5020，p0.05）。结论伴黄斑脱离的孔源性视网膜脱离行巩膜扣带术后早期，黄斑区的结构与功能均尚未完全恢复，需要我们加以重视。
[Abstract]:Objective to observe the (NIA) and optical coherence tomography (OCT) findings of melanin-related near infrared fundus spontaneous fluorescence (NIA) and optical coherence tomography (OCT) in macular region of (RRD) with macular detachment after scleral buckling. The early macular structure of RRD after scleral cingulate surgery was evaluated by combining NIA with OCT. Methods A prospective series of case studies was carried out. Twenty-one cases (21 eyes) of rhegmatogenous retinal detachment with macular detachment who underwent scleral buckling were included in this study. All eyes were diagnosed by binocular indirect ophthalmoscope and / or slit lamp microscope combined with anterior lens. All eyes were reattached after ophthalmoscope, and the retina was in place at each follow-up. Using confocal laser fundus angiography instrument HRA2 (Heidelberg retinal choroidal fundus angiography system), all eyes were examined by NIA and OCT 3 months after operation. After comparing and analyzing the background gray scale of the same image, the abnormal fluorescence was classified into strong fluorescence, weak fluorescence and no fluorescence according to the fluorescence grade. We evaluated the results of NIA and OCT at 3 months after eye surgery. The abnormal images and the recovery of visual acuity after operation were observed. Paired t-test was performed for visual acuity changes. The correlation between NIA and postoperative BCVA was analyzed by using two-way disordered classification variable data. Results the results of macular NIA showed that 16 eyes showed strong fluorescence around weak fluorescence, and 5 eyes showed non-uniform strong fluorescence. The results of macular OCT showed that submacular fluid was present in 20 eyes, of which 6 eyes were thinned and 14 eyes were normal in the central concave area, 1 eyes had no submacular fluid, the retinal nerve sensory layer thickened in the central concave area, and 21 eyes had abnormal IS/OS reflex. Visual acuity recovery: 3 months after operation compared with postoperative 1 day, NIA showed weak fluorescence around the strong fluorescence, the visual acuity difference was statistically significant (t = 9.922, P0.05), indicating that the postoperative 3 months compared with the postoperative 1 day visual acuity improved; There was no significant difference in visual acuity between the two groups (t = 2.409, P0.05). There was no significant difference in visual acuity between the two groups (t = 2.409, P0.05). It could not be seen that the visual acuity at 3 months after operation was better than that at 1 day postoperatively. The macular NIA findings were highly correlated with the changes of BCVA after operation (C = 0.502, p 0.05). Conclusion in the early stage of scleral cingulate surgery for rhegmatogenous retinal detachment with macular detachment, the structure and function of macular region have not been completely recovered, so we should pay more attention to it.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R774.1

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