孔源性视网膜脱离患者术后视网膜微结构改变及其与视功能的相关关系

摘要

目的 观察孔源性视网膜脱离患者玻璃体切割术后视网膜微结构改变及其与视功能的关系.方法 选取行玻璃体切割术的孔源性视网膜脱离患者作为研究对象,于术后1周、1个月、3个月、6个月行最佳矫正视力和光学相干断层扫描检查,记录视网膜神经上皮层、外核层厚度,观察椭圆体带、外界膜断裂情况,黄斑水肿、黄斑前膜等的发生情况.结果 入选患者共31例32眼,术后随着随访时间延长视力逐渐好转.黄斑中心凹下神经上皮层厚度、外核层厚度在术后1周[(122.75±111.84) μm,(79.06±76.67) μm]至3个月[(163.28±133.10)μm,(108.66±120.40) μm]的随访过程中逐渐增厚,术后6个月时稍有下降[(159.50±99.26) μm,(99.22±74.89) μm].随着随访时间的延长,椭圆体带及外界膜断裂的发生率明显下降(椭圆体带:1周68.8％,1个月65.6％,3个月56.3％,6个月50.O％;外界膜:1周53.1％,1个月46.9％,3个月40.6％,6个月37.5％),椭圆体带及外界膜断裂情况与患者视力恢复呈显著相关性.结论 孔源性视网膜脱离患者行玻璃体切割术后视网膜神经上皮层厚度与外核层厚度在一定时间内随着随访时间延长逐渐增加,视力逐渐好转;椭圆体带、外界膜的完整性是影响患者术后视力恢复的关键因素.%Objective To observe the retinal microstructure changes in patients with rhegmatogenous retinal detachment following vitrectomy procedures and its correlation with the best corrected visual acuity (BCVA).Methods Patients who were diagnosed with rhegmatogenous retinal detachment and underwent vitrectomy were recruited in this study.BCVA and optical coherence tomography (OCT) examination were performed at 1 week,1 month,3 months and 6 months after operation for recording the neurosensory retinal thickness and outer nuclear layer thickness as well as observing the occurrence of ellipsoid zone,external limiting membrane rupture,macuiar edema,macular epiretinal membrane.Results A total of 32 eyes from 31 patients were followed up,and the BCVA became better as the follow-up prolonged.Both neurosensory retinal thickness and outer nuclear layer thickness thickened from 1 week [(122.75 ± 111.84) μm and (79.06 ±76.67) μm] to 3 months [(163.28 ± 133.10) μm and (108.66 ± 120.40)μm],and slightly thinned at 6 months [(159.50 ± 99.26) μm and (99.22 ± 74.89) μm].AS follow-up went by,the occurrence rate of ellipsoid zone and external limiting membrane rupture were 68.8％ and 53.1％,65.6％ and 46.9％,56.3％ and 40.6％,50.0％ and 37.5％ at 1 week,1 month,3 months,6 months,respectively,and both variables were significantly correlation with the patients' BCVA.Conclusion The neurosensory retinal thickness and outer nuclear layer thickness in patients with rhegmatogenous retinal detachment became gradually thicker and the vision became better during follow-up.Meanwhile,the ellipsoid zone and external limiting membrane rupture are the key factors for patients' BCVA.