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目的应用光学相干断层扫描(OCT)与眼底照相技术观察孔源性视网膜脱离术后黄斑脱离的复位并与视力恢复进行初步相关研究。方法 2007年1月至2010年4月在我科诊断为孔源性视网膜脱离患者,手术方法采用巩膜扣带术联合巩膜外冷凝+放液术,术后随访6~24个月有眼底照相与OCT检查记录患者47例(47眼),所有患眼的玻璃体病变均≤B级,视网膜脱离范围在1-3象限之间,术前视力≤0.1占74.47%(35眼),≥0.12占25.53%(12眼),OCT记录术后1、3、6个月黄斑解剖学复位状况,部分1年以上。结果术后临床眼底检查和眼底照相记录视网膜复位的46眼,1眼手术后视网膜脱离未复位。通过OCT随访检查显示:术后1个月及以内黄斑区视网膜色素上皮与神经上皮复位的有19眼(41.30%),3个月时复位达29眼(63.04%),6个月复位眼数达35眼(76.09%),在术后1年的复位眼数为42眼(91.30%),至随访截止时有4眼(8.70%)黄斑未完全复位。视网膜中心凹神经上皮的厚度在术后1个月与3个月和6个月明显不同,术前与术后视力的对比研究显示:在术后6个月视力才有明显提高。结论 OCT检查为视网膜脱离术后黄斑解剖学复位提供了便捷,详细,客观的观察方法,视网膜脱离术后黄斑区的解剖复位与视力恢复需要较长的时间。
Objective To observe the reduction of macular detachment after rhegmatogenous retinal detachment with optical coherence tomography (OCT) and fundus photography, and to make a preliminary correlation study with visual acuity recovery. Methods From January 2007 to April 2010, patients diagnosed as rhegmatogenous retinal detachment in our department were treated with scleral buckling combined with scleral condensation and draining. The patients were followed up for 6-24 months with fundus photography and 47 cases (47 eyes) were recorded by OCT. All eyes had vitreous lesions≤B, retinal detachment ranged from 1 to 3 quadrants. Preoperative visual acuity ≤0.1 accounted for 74.47% (35 eyes), ≥0.12 accounted for 25.53 % (12 eyes). OCT recorded the status of macular anatomy at 1, 3, and 6 months after operation, some of them were over one year. Results Postoperative clinical fundus examination and retinal retinal reattachment in 46 eyes, retinal detachment after an operation did not reset. According to the OCT follow-up examination, 19 eyes (41.30%) had macular retinal pigment epithelium and neuroretinal reattachment within 1 month and within one month after operation, 29 eyes (63.04%) were restored after 3 months and 6 months Up to 35 eyes (76.09%), 42 eyes (91.30%) at 1 year after operation, and 4 eyes (8.70%) at the end of follow-up. The thickness of the retina central concave neuroepithelial tissue was significantly different from that at 3 months and 6 months after surgery. The comparative study of preoperative and postoperative visual acuity showed that visual acuity improved significantly at 6 months after surgery. Conclusions OCT examination provides a convenient, detailed and objective observation for the restoration of macular anatomy after retinal detachment. The anatomic reduction and visual acuity restoration of macular area after retinal detachment require a longer time.