累及黄斑的孔源性视网膜脱离手术前后黄斑区光学相干断层扫描与多焦视网膜电图的变化

摘要

目的:观察累及黄斑区的孔源性视网膜脱离(RRD)患眼手术前后黄斑区光学相干断层扫描(OCT)与多焦视网膜电图(mfERG)表现的变化.方法:回顾性研究.选择2013年9月至2014年7月在河南省眼科研究所确诊为累及黄斑的RRD并行巩膜扣带术的患者52例(52眼),以对侧正常眼作对照.RRD患眼均行巩膜扣带手术治疗.手术前及手术后1周,术后1、3、6个月,进行OCT及mfERG检查,观察RRD患眼黄斑区微结构,以及黄斑区反应振幅密度及潜伏期的变化.采用t检验对术前患眼与正常眼进行比较,采用重复测量方差分析对患眼手术前后黄斑中心凹厚度变化与中央1环的N1、P1波反应密度和潜伏期比较分析;采用Pearson积矩相关分析法分析术后各时间点最佳矫正视力(BCVA)与黄斑中心凹厚度、中央1环的N1、P1波反应密度和潜伏期的相关性.结果:所有患眼术后均成功复位.术前患眼黄斑中心凹厚度较正常眼明显增厚,为(534±44)μm,差异有统计学意义(t=17.127,P<0.05),术后1周、1个月、3个月、6个月患者黄斑中心凹厚度,较术前明显降低,差异有统计学意义(P<0.01).与正常眼相比较,术前患者中央1环N1波和P1波振幅密度降低(tN1=17.372、tP1=23.943,P<0.05),潜伏期延长(tN1=5.291、tP1=7.306,P<0.05),差异均有统计学意义,术后1周、术后1、3、6个月中央1环N1波及P1波振幅密度较术前均提高(P<0.01),潜伏期与术前差异无统计学意义.患者BCVA在术后1、3、6个月与黄斑中心凹厚度呈负相关(r=-0.801、-0.695、-0.643,P<0.05),与中央1环N1波及P1波振幅密度呈正相关(r N1=0.702、0.695、0.632,rp1=0.811、0.713、0.648;P<0.05),与潜伏期无相关性.结论:OCT与mfERG可以客观综合观察RRD患者术后黄斑区的形态和功能,评估视网膜脱离后的手术疗效.%Objective: To evaluate changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) before and after surgery in patients with rhegmatogenous retinal detachment (RRD) involving the macular area. Methods: This was a retrospective study in which 52 eyes (52 patients) with RRD involving the macular area (RRD group) were compared with the fellow healthy eyes (normal control group). All patients in the RRD group underwent scleral buckling surgery. Before each surgery, the eyes were examined by mfERG and OCT. At one week and at 1, 3, and 6 months after surgery, the eyes were examined again. Using Pearson product moment correlation analysis and repeated measurement methods were used to analyze the datas. Results: All RRD eyes successfully underwent the surgery successfully. The thickness of the macular fovea of the RRD group before surgery, 534±44 μm, was significantly greater than for the normal control group (t=17.127, P<0.05). At one week and at 1, 3, and 6 months after surgery, the foveal retinal thickness decreased significantly (P<0.01). The N1 and P1 wave amplitude densities at ring 1 of the RRD eyes were significantly less than in the control eyes (tN1=17.372, tP1=23.943, P<0.05) as was the delay in the peak latency (tN1=5.291, tP1=7.306, P<0.05). At one week and at 1, 3, and 6 months after surgery, the N1 and P1wave amplitude densities at ring 1 were higher than before the surgery (P<0.01). The delay in the peak latency was not significantly changed compared to the preoperative values. At 1, 3, and 6 months after the surgery, the best corrected visual acuity was negatively correlated with macular center thickness (r=-0.801, -0.695, -0.643, P<0.05, at each follow up). The ring 1 N1 and P1 wave amplitude densities were positively correlated with the macular center thickness (rN1=0.702, 0.695, 0.632, rP1=0.811, 0.713, 0.648, P<0.05, at each follow up), but the peak latency was not correlated with the macular center thickness. Conclusions: The morphology and function in the macular area of patients with RRD can be objectively and comprehensively measured by OCT and mfERG applications. With mfERG and OCT, the success after retinal detachment surgery can be assessed.