本文選題：頻域相干光斷層深度增強成像技術(shù) + 黃斑中心凹下脈絡(luò)膜厚度　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分鞏膜扣帶術(shù)和玻璃體切割術(shù)治療累及黃斑的孔源性視網(wǎng)膜脫離黃斑微結(jié)構(gòu)改變目的:應(yīng)用頻域光學(xué)相干斷層掃描(spectral domain-optical coherencetomography,SD-OCT)觀察比較鞏膜扣帶術(shù)(scleral buckling,SB)或經(jīng)睫狀體平坦部玻璃體切割手術(shù)(pars plana vitrectomy,PPV)兩種術(shù)式后黃斑區(qū)超微結(jié)構(gòu)的術(shù)后恢復(fù)情況。方法:收集2015年12月至2016年12月在河北醫(yī)科大學(xué)第二醫(yī)院眼科住院的累及黃斑的孔源性視網(wǎng)膜脫離患者37例37只眼,根據(jù)行鞏膜扣帶術(shù)及玻璃體切割術(shù)共分為兩組。在術(shù)前、術(shù)后7天、1個月及3個月行BCVA和SD-OCT。應(yīng)用SD-OCT觀察黃斑中心凹處視網(wǎng)膜的形態(tài)學(xué)改變,并測量:黃斑中心凹下視網(wǎng)膜下液(subfoveal fluid,SF)高度。結(jié)果:1 PPV組中一次性手術(shù)成功率為100%;SB組中有2只眼第一次手術(shù)未成功,第二次行玻璃體切割術(shù)并復(fù)位成功,復(fù)位率為87.5%。2 PPV組中術(shù)前、術(shù)后7天、1個月、3個月視網(wǎng)膜下液高度分別為957.10±507.35μm、20.32±39.31μm、15.10±34.26μm、12.38±28.48μm,SB組術(shù)前、術(shù)后7天、1個月、3個月視網(wǎng)膜下液高度分別為454.63±408.28μm、135.60±94.31μm、104.63±67.67μm、86.75±53.23μm,兩組在術(shù)前、術(shù)后7天、1個月、3個月分別進行非參數(shù)(Mann-Whitney U檢驗)統(tǒng)計學(xué)檢驗,差異有統(tǒng)計學(xué)意義。兩組均在術(shù)后7天下降最快,其后趨勢變緩慢。3兩組的IS/OS斷裂及外界膜不完整性的發(fā)生率差異無統(tǒng)計學(xué)意義。4術(shù)后3個月PPV組中有1只眼黃斑萎縮,1只眼黃斑水腫,1只眼視網(wǎng)膜前膜。SB組中無以上黃斑部變化。5 PPV組視力平均提高1.06±0.52 log MAR;SB組視力平均提高0.79±0.53 log MAR;術(shù)后3月PPV組與SB組相比,平均視力有顯著提高。小結(jié):1 PPV手術(shù)有助于黃斑解剖復(fù)位,而且沒有明顯的視網(wǎng)膜下液,從而實現(xiàn)更好的術(shù)后視力。2 PPV手術(shù)后會有黃斑區(qū)異常變化如黃斑萎縮、黃斑水腫及視網(wǎng)膜前膜等變化,但是由于本研究樣本量小,其異常病變的發(fā)生率較低,結(jié)果有較大偏差。3兩組中早期視網(wǎng)膜下液吸收較快,術(shù)后7天后速度逐漸減慢。第二部分鞏膜扣帶術(shù)和玻璃體切割術(shù)治療累及黃斑的孔源性視網(wǎng)膜脫離黃斑區(qū)視網(wǎng)膜下液與黃斑中心凹下脈絡(luò)膜厚度的的相關(guān)性研究目的:利用頻域相干光斷層深度增強成像技術(shù)(Enhanced depth imaging spectral-domainoptical coherence tomography EDI SD-OCT)測量鞏膜扣帶術(shù)(scleral buckling,SB)或經(jīng)睫狀體平坦部玻璃體切割手術(shù)(pars plana vitrectomy,PPV)后患者的黃斑中心凹下視網(wǎng)膜下液高度、脈絡(luò)膜厚度等,并研究脈絡(luò)膜厚度與視網(wǎng)膜下液的關(guān)系,尋找持續(xù)性視網(wǎng)膜下液存在原因方法:收集2015年12月至2016年12月在河北醫(yī)科大學(xué)第二醫(yī)院眼科住院的累及黃斑的孔源性視網(wǎng)膜脫離患者37例37只眼,根據(jù)行鞏膜扣帶術(shù)及玻璃體切割術(shù)共分為兩組。在術(shù)前、術(shù)后7天、1個月及3個月應(yīng)用EDI SD-OCT測量黃斑中心凹下脈絡(luò)膜厚度(subfoveal choroid thickness,SFCT)、距黃斑中心凹3mm的鼻側(cè)、顳側(cè)、上方及下方的脈絡(luò)膜厚度。結(jié)果:1 PPV組中術(shù)前、術(shù)后7天、術(shù)后1個月及術(shù)后3個月的黃斑中心凹下脈絡(luò)膜厚度(SFCT)、距黃斑中心凹3mm的上方(SCT3.0)、距黃斑中心凹3mm的下方(ICT3.0)、距黃斑中心凹3mm的鼻側(cè)(NCT3.0)、距黃斑中心凹3mm的顳側(cè)(TCT3.0)平均值走行趨勢為逐漸升高,在術(shù)后7天達到最高值并逐漸下降,在術(shù)后3個月時基本達到術(shù)前水平。2 SB組中術(shù)前、術(shù)后7天、術(shù)后1個月及術(shù)后3個月的SFCT、SCT3.0、ICT3.0、NCT3.0、TCT3.0平均值的走行趨勢為逐漸升高,在術(shù)后7天達到最高值,之后逐漸下降,在最后一次隨訪即術(shù)后3個月依舊低于術(shù)前水平。術(shù)前SFCT(194.25±56.87 um)與各時間點進行配對t檢驗,術(shù)后1個月(176.13±51.84 um)及術(shù)后3個月(176.69±53.03 um)SFCT與術(shù)前相比差異有統(tǒng)計學(xué)意義,術(shù)后7天(205.19±56.25 um)與術(shù)前相比差異無統(tǒng)計學(xué)意義。術(shù)前、術(shù)后7天、術(shù)后1個月及術(shù)后3個月外墊壓側(cè)與非外墊壓側(cè)距黃斑中心凹處3mm的脈絡(luò)膜厚度差異無統(tǒng)計學(xué)意義。3 SB組中術(shù)后7天、術(shù)后1個月及術(shù)后3個月的黃斑中心凹下視網(wǎng)膜下液的高度分別與相應(yīng)時間的距黃斑中心凹3mm的扣帶側(cè)的脈絡(luò)膜厚度均無線性關(guān)系。術(shù)后7天、術(shù)后1個月及術(shù)后3個月的黃斑中心凹下視網(wǎng)膜下液的高度分別與相應(yīng)時間的黃斑中心凹下脈絡(luò)膜厚度均無線性關(guān)系。小結(jié):1 PPV組和SB組各個位點的脈絡(luò)膜厚度在術(shù)后均有短暫的升高,均在術(shù)后7天達到最高值,隨后降低,PPV組可以達到術(shù)前水平,SB組低于術(shù)前水平。2視網(wǎng)膜下液與在任何位置下的脈絡(luò)膜厚度均無線性關(guān)系。從中我們可以認為,脈絡(luò)膜血流量對持續(xù)性視網(wǎng)膜下液的吸收影響不明顯。
[Abstract]:Part 1 scleral buckling and vitrectomy for macular retinal detachment with macular microstructures: the use of spectral domain-optical coherencetomography (SD-OCT) to compare the scleral buckling (scleral buckling, SB) or pars plana vitreous cutting hand After operation (pars plana vitrectomy, PPV), the postoperative recovery of the ultrastructure of the macular region of two kinds of surgical procedures. Methods: 37 eyes of 37 patients with macular rhegmatogenous retinal detachment in the ophthalmology of the second hospital of Hebei Medical University from December 2015 to December 2016 were collected and divided into two groups according to scleral buckling and vitrectomy. Before operation, 7 days, 1 months and 3 months after operation, BCVA and SD-OCT. applied SD-OCT to observe the morphological changes of retina in the macular fovea, and measured the height of subretinal subretinal fluid (subfoveal fluid, SF) under the macular fovea. Results: the success rate of one time operation was 100% in group 1 PPV; 2 eyes in group SB were unsuccessful for the first time and second times of glass were performed. Volume cutting and reduction were successful. The reduction rate was in group 87.5%.2 PPV, 7 days, 1 months, 3 months, 3 months, 957.10 + 507.35 mu, 20.32 + 39.31, m, 15.10 + 34.26, m, 12.38 + 28.48, m, SB group before operation, 7, 1 months, and 3 months, respectively. .67 mu m, 86.75 + 53.23 m, two groups before the operation, 7 days, 1 months, 3 months, respectively, non parameter (Mann-Whitney U test) statistical test, the difference was statistically significant. The two groups were the fastest after the 7 after the operation, then the trend of.3 two group IS/OS fracture and the incidence of external membrane incompleteness was not statistically significant 3 after.4 operation. In group PPV, there were 1 eyes with atrophy of macula, 1 eyes with macular edema, 1 eyes in group.SB of anterior retinal membrane, and no macular change in group.5 PPV. The average vision of.5 PPV in group SB increased by 0.79 + 0.53 log MAR in SB group. The average visual acuity in the PPV and SB group in March was significantly higher than that in the SB group. Summary: 1 PPV surgery was helpful to the macular anatomy. And there is no obvious subretinal fluid, so as to achieve better postoperative visual acuity.2 PPV operation, there will be abnormal changes in macular region such as macular atrophy, macular edema and the anterior retinal membrane. However, because of the small sample size of this study, the incidence of abnormal lesions is low, and the fruit has a greater deviation from the early subretinal fluid absorption in the.3 two groups. Faster and slower 7 days after operation. Second parts of scleral buckling and vitrectomy for the treatment of macular retinal detachment in the macular region of the macular subretinal fluid and the subfoveal choroid thickness under the macula Objective: Enhanced depth imaging spec (Enhanced spec) Tral-domainoptical coherence tomography EDI SD-OCT) measurement of scleral buckling (scleral buckling, SB) or the subfoveal subfoveal subretinal fluid height, choroidal thickness, and the relationship between the choroidal thickness and the subretinal fluid after the scleral buckling (scleral buckling, SB) or the pars plana vitrectomy (pars plana vitrectomy, PPV) and to investigate the relationship between the choroidal thickness and the subretinal fluid. The reason for the existence of subretinal fluid: collecting 37 patients with macular retinal detachment from December 2015 to December 2016 at the second hospital of Hebei Medical University, 37 eyes with macular retinal detachment, was divided into two groups according to scleral buckling and vitrectomy. EDI SD-OCT was used before the operation for 7 days, 1 months and 3 months after the operation. Subfoveal choroid thickness (SFCT), the nasal side, temporal, upper and lower choroidal thickness of the macular fovea 3mm. Results: in group 1 PPV, 7 days after operation, 1 months after operation, and 3 months after operation, the choroidal thickness (SFCT), above the macular fovea 3mm (SCT3.0), from macula. The lower (ICT3.0) of the central concave 3mm, the nasal side (NCT3.0) from the macular fovea 3mm (NCT3.0), the average value of the temporal lateral (TCT3.0) from the macular fovea 3mm, increased gradually, reached the highest value at the 7 day after the operation and gradually decreased, and basically reached the preoperative level of the.2 SB group before the operation, 7 days after the operation, 1 months after the operation and 3 months postoperative SFCT, SC. The average value of T3.0, ICT3.0, NCT3.0, and TCT3.0 increased gradually, reached the highest value at 7 days after the operation, and then decreased gradually. At the last follow-up, 3 months after the operation, it was still lower than the preoperative level. SFCT (194.25 + 56.87 UM) before operation paired t test with each time point, 1 months (176.13 + 51.84 UM) after operation and 3 months after operation (176.69 + 53.03). UM) SFCT was statistically significant compared with preoperative, and there was no statistically significant difference between 7 days (205.19 + 56.25 UM) after operation. Before operation, 7 days after operation, 1 months after operation, 1 months after operation and 3 months after operation, there was no statistically significant difference in the thickness of the choroid thickness of 3mm in the macular center of the macular fovea, and 7 days after the operation in group.3 SB, and 1 months after the operation. The height of subretinal subfoveal subfoveal subfoveus at 3 months after the operation was respectively wirelessly related to the choroidal thickness of the cingulate region of the macular center 3mm, respectively. The height of the subfoveal subfoveal subfoveal fluid at the 7 day after the operation and the 1 months after the operation and the 3 months after the operation were respectively the thickness of the choroidal thickness under the corresponding macular subfoveal. No linear relationship. Summary: the choroidal thickness of each site in group 1 PPV and SB had a short increase after operation, all reached the highest value at the 7 day after operation, and then decreased, and the PPV group could reach the preoperative level. In group SB, there was no linear relationship between the preoperative level of.2 subretinal fluid and the thickness of the vascular collaterals under any position. The effect of choroidal blood flow on continuous subretinal fluid absorption is not obvious.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

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