Objective To compare the changes of foveal microstructure and function after the two different retinal operations as scleral buckling and vitrectomy. Methods It was an retrospective non-randomized study. 81 eyes of 81 patients with rhegmatogenous retinal detachment( RRD ) involving in macula were recruited from April 2009 to April 2010.Proliferative vitreoretinopathy( PVR ) grade was A or B. Patients were divided into two groups. The first group 37 patients underwent scleral buckling, and the second gourp 44 patients underwent vitrectomy with endotamponade of C3 F8. Outcome measures included best corrected vision accuracy ( BCVA ), Amsler chart, indirect ophthalmoscopy, type-B ultrasonic and optical coherence tomography ( OCT ). Patients were measured at the 1st month, 3rd month and 6th month postoperatively.Data of foveal retinal herve fiber layer ( RNFL ) thicknesses and BCVA were Analysized using SPSS statistical software ( version 17.0 ) by a two-tailed paired t-test. Results All of the patients were followed up. The mean follow-up time is 6 ±3.4 months. All the patients achieved retinal re-attachment at the 1st postoperative month. The mean vision in the first group was 0.12 ± 0.07 at the 1st m, and 0.34 ± 0.16 at 6th m. The mean vision in the second group wa 0.39 ± 0.14 at the 1st m, and 0.36 ± 0.12 at 6th m ( t = 10.543, P ＜0.05 ). In the first group, the numbers of patients with positive in Amsler chart were 26 ( 70.3％ ) at the 1st m, 23 ( 62.2％ )at 3rd m and 21 ( 56.8％ )at 6th m. But there was only one patient in the second group. The outcomes of OCT were the subretinal fluid pooling and the pigment epithelium detachment ( PED ). Subretinal fluid pooling was observed in Compared with 28 patients occurred subretinal fluid pooling in the first group, there was only one patient in the second group. The mean foveal RNFL thicknesses of the two groups were 290 ± 78 μm and 172 ± 23 μm respectively ( t = 8.81, P ＜ 0.05 ). Conclusion Vitrectomy has been shown to be more effective compared to scleral buckling in retinal reattachment and visual recovery of patients with RRD involving in macula.But longer-term ( ＞ 6 months ) data of vision recovery had no difference.%目的 比较两种视网膜复位手术对累及黄斑的视网膜脱离患者术后黄斑形态与功能的差异.方法 回顾性、非随机对照研究.2009年4月至2010年4月收治的81例(81只眼)伴黄斑脱离的孔源性视网膜脱离患者.分为A、B两组,其中A组37例(37只眼)行巩膜扣带术;B组44例(44只眼)行玻璃体切除联合C3F8气体填充术.手术前和术后1、3、6个月给予最佳矫正视力、Amsler表、眼底以及B超和OCT等检查;OCT主要观察术后的黄斑形态和记录中心凹厚度.采用SPSS17.0进行统计学分析,术后两组视网膜神经纤维层(RNFL)测量值以及最佳矫正视力采用t检验.结果 所有患者参加随访,平均随访时间(6±3.4)个月.术后1个月时,所有患眼视网膜均复位.术后最佳矫正视力:A组1个月时为0.12±0.07,6个月时0.34±0.16;B组分别是 0.39±0.14和0.36±0.12(t=10.543,P<0.05).Amsler表检查:A组患者1个月时26例异常(70.3%),3个月和6个月时,分别是23例( 62.2%),21例(56.8%).B组仅有1例在1个月时呈现异常.OCT主要表现为神经上皮下积液和色素上皮局限脱离,除B组有1例显示异常外,其余28例均是A组患者.两组术后的中心凹厚度,分别是(290±78) μm和(172±23) μm (t=8.81,P<0.05).结论 在伴有黄斑脱离的单纯性视网膜脱离患者,玻璃体切除手术对于术后黄斑的解剖复位和视力恢复在早期明显优于巩膜扣带手术,但半年以后两组患者视力恢复无差别.
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