背景 视网膜脱离患者在成功完成视网膜复位手术后并不能很快恢复视力,其原因目前尚不十分清楚. 目的 比较累及黄斑的孔源性视网膜脱离患者巩膜扣带术和玻璃体切割术后黄斑椭圆体区完整性、黄斑区视网膜神经上皮层下积液的发生率及留存时间,探讨黄斑区视网膜神经上皮层下积液存留对视力预后的影响.方法 回顾性分析2010年1月至2013年1月于北京大学人民医院眼科确诊的孔源性视网膜脱离患者66例66眼的病例资料,按手术方式分为巩膜扣带术组和玻璃体切割术组,记录2个组患者病程、屈光状态、最佳矫正视力LogMAR、有无合并症等,观察黄斑区神经上皮下积液存留时间及黄斑椭圆体区完整性,计算2个组在术后1个月时黄斑区神经上皮下积液的发生率. 结果 术前巩膜扣带术组及玻璃体切割术组间年龄、性别、病程、屈光度及LogMAR视力差异均无统计学意义(均P＞0.05).巩膜扣带术组视网膜下积液平均存留(96±60)d,玻璃体切割术组为(21±6)d,差异有统计学意义(t=7.966,P=0.000).术后1个月时,巩膜扣带术组黄斑区神经上皮下积液发生率为78.6％,大于玻璃体切割术组的12.5％,差异有统计学意义(x2=26.891,P=0.000),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异有统计学意义(t=3.185,P=0.003);术后6个月时,巩膜扣带术组与玻璃体切割术组LogMAR视力比较,差异无统计学意义(t=1.876,P--0.065),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异无统计学意义(t=1.755,P=0.087).视网膜神经上皮下积液吸收后,2个组内黄斑椭圆体区连续患者与椭圆体区缺失患者LogMAR视力比较,差异均有统计学意义(巩膜扣带术组:t=2.555,P=0.015;玻璃体切割术组:t=4.005,P=0.001). 结论 椭圆体区受损程度与视网膜脱离时间有关,而椭圆体区的完整性明显影响患者的视力预后.对于累及黄斑的孔源性视网膜脱离患者,玻璃体切割术后视网膜神经上皮下积液吸收较巩膜扣带术快;视网膜神经上皮下积液的存留延缓视力的恢复,手术方式对最终的视力恢复影响不大.%Background The patients who have undergone successful surgery for retinal detachment (RD) cannot recover their vision quickly,and the reason is not very clearly now.Objective This study was to compare the ellipsoid zone integrity in macula and frequency and duration of subretinal fluid after scleral buckling and pars plana vitrectomy (PPV) in primary macula-off rhegmatogenous RD,and to discuss the sequent influence of subretinal fluid on postoperative visual acuity.Methods A retrospective analysis was carried out on 66 cases of rhegmatogenous RD in Peking University People's Hospital from January 2010 to January 2013.All the cases were divided into 2 groups:scleral buckling group and PPV group.The courses of disease,refractive status,best corrected visual acuity (BCVA) and complications were recorded.The duration of subretinal fluid and ellipsoid zone integrity in macula were observed and the occurrence rates of subretinal fluid were calculated 1 month after surgery.Results There were no statistic differences on age,gender,courses of disease,refractive status and LogMAR visual acuity (all at P＞0.05).The average duration of subretinal fluid was (96 ±60) days in scleral buckling group,and (21 ±6) days in PPV group,with a statistically significant difference between the two groups (t =7.966,P =0.000).The occurrence rate of subretinal fluid at 1 month after surgery was 78.6％ in the scleral buckling group and 12.5％ in the PPV group,with a statistically significant difference between the two groups (x2=26.891,P =0.000).The LogMAR visual acuity was significantly different between the patients with and without subretinal fluid at 1 month after scleral buckling surgery (t=3.185,P=0.003).The LogMAR visual acuity was not significantly different between the scleral buckling group and PPV group 6 months after scleral surgery (t =1.876,P =0.065).The LogMAR visual acuity was not significantly different between the patients with and without subretinal fluid at 6 month after scleral buckling surgery (t =1.755,P=0.087).After the subretinal fluid was reabsorbed,the LogMARs visual acuity were significantly different between the patients with intact ellipsoid zone and with disrupt ellipsoid zone in both groups (scleral buckling group:t=2.555,P=0.015;PPV group:t=4.005,P=0.001).Conclusions The disruption extent of the ellipsoid zone is related to the duration of RD,and the integrity affects the postoperative visual acuity distinctly.The subretinal fluid is removed more rapidly after PPV when compared with scleral buckling in macula-off rhegmatogenous RD.The subretinal fluid delays visual recovery postoperatively but the operation method does not influence final visual acuity seriously.
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