累及黄斑视网膜脱离术后解剖学改变和功能恢复情况

摘要

AIM:To observe the macula structure of the macula-off rhegmatogenous retinal detachment ( RRD ) with optical coherence tomography ( OCT ) 5 years after successful scleral buckling ( SB ) surgery and to analyze the correlation between the duration of macular detachment ( DMD) and postoperative visual acuity with OCT image. METHODS:Forty-seven eyes of 47 patients with macula-off RRD were retro spectively studied and follow-up was carir ed out for a period of 5 years.The correlation among the postoperative best-corrected visual acuity (VA), the DMD and the microstructural findings with OCT at the fovea were evaluated. RESULTS: The sub-acute RRD ( DMD7 days ) ( 209.76μm ) with no statistical difference (P=0.791).Meanwhile, the sub-acute RRD had better mean final VA 0.53, compared with the prolonged one of 0.25, with significant difference ( Student's t-test, P=0.008).Among 47 eyes, foveal anatomic abnormalities were detected in 5 eyes (10%);disruption of the junction between the photoreceptor inner and outer segments ( IS/OS) in 4 eyes, and with a disrupted external limiting membrane (ELM) also (8.5%);and the mean VA of these 5 patients was 0.15 lower after 5 years. CONCLUSION:Sub-acute macula-off RRD has a better impact on the final visual recovery than the prolonged one.Furthermore, the retinal thickness in the fovea was positively correlated to the postoperative VA. The disrupted inner segment/outer segment ( IS/OS) junction could be restored in the patients without disrupted ELM signa ls at the initial examination.The duration of macula-off RRD within 7d had fewer disrupted inner segment/outer segment ( IS/OS ) junction with disrupted ELM signals than those for more than 7d.It is recommended to perform OCT in cases where VA was not improved as expected.%目的：OCT观察累及黄斑视网膜脱离行巩膜外加压术后5 a黄斑情况。分析脱离时间及术后5 a黄斑OCT及视功能的相关性。　　方法：回顾性分析47例47眼，累及黄斑视网膜脱离行巩膜外加压术后5a OCT，视功能及脱离时间，并行统计学分析。结果：视网膜脱离时间＜7 d的黄斑厚度（226北88μm ）较脱离时间＞7d黄斑厚度（209北76μm）厚，但无统计学意义。而术后复位的黄斑厚度和视力呈正相关（ Pearson correlation test， R＝1，P＝0．01）。脱离时间＜7d组视力（0．53）明显好于脱离时间＞7d组视力（0．25），明显统计学差异（t-test， P＝0．008）。5例（10％）患者发现黄斑区结构异常，包括4例IS/OS层断裂，同时伴有外界膜的断裂（8．5％），且术后5a平均视力（0．15）低于两组的平均视力。　　结论：脱离时间的长短严重影响视功能的恢复、术后黄斑的厚度及黄斑结构的改变。累计黄斑视网膜脱离手术尽可能在脱离时间＜7d内完成。对于视力恢复较差者，建议行OCT检查。