本文關(guān)鍵詞：頻域OCT觀察視網(wǎng)膜脫離復位術(shù)后黃斑微結(jié)構(gòu)改變與視功能恢復關(guān)系的研究，由筆耕文化傳播整理發(fā)布。

        目的：應(yīng)用頻域光學相干斷層掃描（spectral-domain optical coherencetomography，SD-OCT）觀察孔源性視網(wǎng)膜脫離（rhegmatogenous retinaldetachment, RRD）行鞏膜扣帶聯(lián)合鞏膜外冷凍手術(shù)前后黃斑區(qū)光學相干斷層掃描圖像特征，探索黃斑區(qū)微結(jié)構(gòu)的改變與視力的關(guān)系。方法：觀察2011年10月至2013年1月在河北醫(yī)科大學第二醫(yī)院眼科就診的孔源性視網(wǎng)膜脫離患者43例43只眼，全部行鞏膜外墊壓聯(lián)合鞏膜外冷凍術(shù)，術(shù)后均視網(wǎng)膜復位。術(shù)前眼部檢查包括最佳矯正視力（best-corrected visual acuity，BCVA）、裂隙燈顯微鏡、雙目間接眼底鏡、SD-OCT和視野，并在術(shù)后3天、1、3、6月行BCVA和SD-OCT，術(shù)后1、3、6月行視野檢查�；颊邔�(cè)健康眼對照組:39例行SD-OCT和視野檢查。應(yīng)用SD-OCT測量RRD患者中心凹處視網(wǎng)膜下液（subretinal fluid，SRF）高度、神經(jīng)上皮層厚度、外核層（outer nuclear layer，ONL）厚度，并觀察黃斑區(qū)微結(jié)構(gòu)的改變，分析其與術(shù)后視力的關(guān)系。以患者年齡和裂孔位置作為分組標準，比較不同年齡和裂孔位置對術(shù)后SRF吸收是否有影響。結(jié)果：1術(shù)前視網(wǎng)膜下液（SRF）平均高度為885.05±493.28μm，術(shù)后第3天行OCT檢查示所有患者視網(wǎng)膜神經(jīng)上皮層下均殘留不同程度的SRF，其后隨著時間的延長，SRF逐漸吸收。術(shù)后1月93%（39眼）患者檢出SRF，在術(shù)后3、6月SRF的檢出率分別為77.8%（33眼）、46.5%（20眼）。術(shù)前視網(wǎng)膜脫離高度與術(shù)后視力存在相關(guān)關(guān)系（r=0.817，P=0.001），視網(wǎng)膜脫離越高，術(shù)后視力恢復越差。術(shù)后SRF吸收情況在不同年齡組（≤30歲，＞30歲）之間差別存在統(tǒng)計學意義（P=0.12），低年齡組SRF較高年齡組吸收快。裂孔位置不同術(shù)前SRF高度有明顯差異（P＜0.01），裂孔位于上方者術(shù)前視網(wǎng)膜脫離較下方高；同時術(shù)后不同時間點SRF高度存在顯著差別（F=42.28，P＜0.01），下方裂孔的RRD患者SRF吸收較快。術(shù)后OCT圖像示3種形態(tài)的SRF殘留：（1）彌漫SRF；(2)中心凹下多量水泡樣SRF；（3）中心凹下單一水泡樣SRF；2術(shù)前行OCT檢測可見脫離的黃斑區(qū)視網(wǎng)膜有三種結(jié)構(gòu)的改變：（1）中心凹形態(tài)存在；(2)神經(jīng)上皮層彌漫性水腫伴層間囊樣液腔，以外核層為主；（3）神經(jīng)上皮層彌漫性水腫伴層間囊樣液腔，外層視網(wǎng)膜波浪樣改變。3術(shù)前中心凹處神經(jīng)上皮層平均厚度（128.88±41.63μm）較正常對側(cè)眼（181.17±10.36μm）顯著降低（P＜0.01）。術(shù)后6月中心凹處神經(jīng)上皮層平均厚度（149.55±45.75μm）較術(shù)前明顯增加(P＜0.05)，但與對側(cè)眼相比無明顯差異（P＞0.05）。術(shù)前中心凹處神經(jīng)上皮層厚度與術(shù)后BCVA明顯相關(guān)(r=0.028；P＜0.05)。4術(shù)前外核層（ONL）平均厚度（74.95±25.21μm）較正常對側(cè)眼（102.28±11.63μm）降低（P＜0.05）。術(shù)后6月ONL平均厚度(86.28±19.26μm)較術(shù)前有所增加，無統(tǒng)計學差異(P＞0.05），但仍較對側(cè)眼降低(P＜0.05）。術(shù)前外核層厚度與術(shù)后BCVA相關(guān)(r=0.521；P=0.035)。5在黃斑中心凹已復位的眼中，可見黃斑區(qū)光感受器損傷有如下4種：（1）外界膜（ELM）、光感受器內(nèi)、外節(jié)（IS/OS）交界線、中間線（intermediateline，IL）均不連續(xù)；（2）ELM連續(xù)，IS/OS交界線、IL斷裂；（3） ELM、IS/OS交界線連續(xù)，IL不連續(xù)；（4）ELM、IS/OS交界線和IL連續(xù)。6術(shù)前黃斑10°平均視敏度（11.74±10.04dB）較正常對側(cè)眼組（29.23±3.45dB）降低（P＜0.05），術(shù)后6月黃斑區(qū)平均視敏度與正常對側(cè)眼組比較無統(tǒng)計學差異（P＞0.05）。術(shù)后6月與術(shù)前比較平均視敏度提高（P＜0.05），說明隨著視網(wǎng)膜復位，視功能逐漸恢復。結(jié)論：1鞏膜扣帶術(shù)后持續(xù)存在的SRF及術(shù)前中心凹神經(jīng)上皮層和外核層厚度與術(shù)后視力預(yù)后有關(guān)。2SD-OCT能檢測出孔源性視網(wǎng)膜脫離后ELM、IS/OS和IL等黃斑區(qū)微結(jié)構(gòu)的改變，這些可能是預(yù)測術(shù)后視力的重要指標。

    Objective: To evaluate the correlation between morphologic changes inthe macular foveal and visual function after scleral buckling procedure ofrhegmatogenous retinal detachment（RRD） by using the spectral-domainoptical coherence tomography（SD-OCT）.Methods: Forty-three eyes of43patients who were diagnosed as RRD inour hospital (the Department of Ophthalmology of the Second Hospital ofHebei Medical University) met the selection. All eyes received scleralbuckling combined with cryoretinopexy procedure and the retina wassuccessfully reattached. A thorough ophthalmologic examination includingbest correct visual acuity(BCVA)，slit-lamp biomicroscopy, binocular indirectophthalmology, SD-OCT scanning and perimetry were performedpreoperatively, and SD-OCT scanning was performed during all subsequentfollow-up visits at3d,1mon,3mon,6mon postoperatively. Perimetry wasperformed at1mon,3mon,6mon postoperatively. Healthy fellow eye controlgroup:39eyes SD-OCT and perimetry routine inspection. The height of thesubretinal fluid, foveal central retina thickness, and outer nuclear layer（ONL）thickness were measured using SD-OCT. The morphologic changes in themacular foveal and visual function were also evaluated. We compared whetherthe age or hole location has effect on the postoperative SRF absorption.Results:1Preoperative SRF height was885.05±493.28μm,and100%patientsshowed residual SRF in different degree on SD-OCT.As time goes by, SRFwas absorbed slowly.93%(39eyes) had SRF at postoperative1month,and77.8%(33eyes) at3months，46.5%(20eyes) at6months. The height of SRFwas correlated with preoperative visual acuities（r=0.817，P=0.001）.Postoperative SRF absorption in different age groups(≤30years，＞ 30years) has statistically significant（P=0.12），SRF absorption in low agegroup was fast. Preoperative the height of the detached retina in differentlocation of hole groups has statistically significan（tP＜0.01）,the height of thedetached retina with superior hole was high than the ones with inferior hole.Meanwhile, the height of the detached retina at different time points hasstatistically significant （F=42.28，P＜0.01），SRF absorption in patients withinferior hole was quickly than the ones with superior hole.There were three patterns of SRF on postoperative SD-OCT sans(1)aconfluent bleb，(2)multiple blebs，（3）a single bleb.2There are three changes of detached retina on preoperative SD-OCTscans:(1)a normal foveal contour was preserved,(2)diffuse edema in the outernuclear layer with cystoids cavities, and (3) diffuse edema in the outer nuclearlayer with cystoids cavities, undulations of outer retinal layer.3Preoperative the mean central retinal thickness（128.88±41.63μm） inthe RRD eyes resulted significantly lower（P＜0.01）compared with thehealthy fellow eye（181.17±10.36μm）.The mean thickness at six months（149.55±45.75μm） was significantly increased compared withpreoperative(P＜0.05)，but compared with healthy follow eye it still remainedthinner（P＞0.05）. The central retinal thickness was strongly correlated withpostoperative BCVA(r=0.028；P＜0.05).4Preoperative the mean ONL thickness（74.95±25.21μm） in the RRDeyes resulted statistically lower（P＜0.05）compared with the healthy felloweye（102.28±11.63μm）.The mean thickness at six months(86.28±19.26μm)was increased compared with preoperative, and has no statisticallydifference(P＞0.05），，and compared with healthy follow eye it has statisticallydifference(P＜0.05）. The ONL thickness was correlated with postoperativeBCVA (r=0.521；P=0.035).5There are four types of microstructure abnormalities in the foveal aftersuccessful reattachment：（1） disruption of ELM， IS/OS junction andIL,(2)ELM was preserved, IS/OS junction and IL were disrupted,(3)ELM andIS/OS junction were intact, IL was disrupted, and(4)All of the three were intact.6Preoperative mean perimetry sensitivity（11.74±10.04dB）in the RRDeyes resulted lower （P＜0.05） compared with the healthy fellow eye（29.23±3.45dB），at six months after surgery it has no difference with thehealthy fellow eye.The mean perimetry sensitivity at six months wasincreased compared with preoperative(P＜0.05)，illustrated that with retinalreattached，visual function gradually restored.Conclusions:1Postoperative persistent SRF, preoperative central foveal thickness andONL thickness were correlated with a delayed visual outcome in macula-offRRD patients.2The integrity of ELM, IS/OS and IL maybe important predictors ofpostoperative visual outcome after RRD repair.

頻域OCT觀察視網(wǎng)膜脫離復位術(shù)后黃斑微結(jié)構(gòu)改變與視功能恢復關(guān)系的研究

摘要4-7ABSTRACT7-9前言10-11材料與方法11-14結(jié)果14-19附圖19-26附表26-28討論28-32結(jié)論32-33參考文獻33-37綜述 視網(wǎng)膜脫離復位術(shù)后黃斑區(qū) OCT 圖像的特點及其與術(shù)后視功能恢復的關(guān)系37-47    參考文獻43-47致謝47-48個人簡歷48

  本文關(guān)鍵詞：頻域OCT觀察視網(wǎng)膜脫離復位術(shù)后黃斑微結(jié)構(gòu)改變與視功能恢復關(guān)系的研究，由筆耕文化傳播整理發(fā)布。