發(fā)布時間：2018-07-04 09:08

  本文選題：OCT + 視網(wǎng)膜脫離復(fù)位術(shù)后　； 參考：《南昌大學(xué)》2011年碩士論文

【摘要】：目的：應(yīng)用光學(xué)相干斷層掃描儀(optical coherence tomography, OCT)探討分析視網(wǎng)膜脫離復(fù)位術(shù)后1年以上的視力恢復(fù)不滿意及其與黃斑區(qū)光學(xué)相干斷層掃描圖像特征的關(guān)系。通過OCT檢測視網(wǎng)膜解剖復(fù)位術(shù)后,分析最佳矯正視力(best-corrected visual acuity, BCVA)不太滿意的原因。 方法：回顧臨床2008年10月至2011年3月在南昌大學(xué)第二附屬醫(yī)院眼科因視網(wǎng)膜脫離行視網(wǎng)膜復(fù)位術(shù)包括行玻璃體切割及氣體填充術(shù)25例,硅油充填49例,行鞏膜外環(huán)扎、外加壓及冷凝42例。所有患者術(shù)后1年以上行OCT檢查。綜合比較患者年齡、視網(wǎng)膜脫離時間、復(fù)位術(shù)后1年以上OCT黃斑部檢查對RRD患者術(shù)后最佳矯正視力的影響；健康人對照組：46例行OCT檢查。首先建立以上各因素的量化表,用SPSS17.0統(tǒng)計(jì)軟件對各種分組的術(shù)后視力變化情況進(jìn)行X2檢驗(yàn)(檢驗(yàn)水準(zhǔn)a=0.05)。檢查最佳矯正視力均≤0.1并行光學(xué)相干斷層掃描檢查,觀察黃斑區(qū)的形態(tài)變化,且分析其最佳矯正視力提高欠佳的原因。將研究組的黃斑中心凹厚度與健康人眼黃斑中心凹厚度進(jìn)行比較,運(yùn)用單因素方差分析。分析是否有統(tǒng)計(jì)學(xué)意義。 結(jié)果：術(shù)前視力：光感13眼,手動24眼,指數(shù)32眼,0.01-0.1者47眼。術(shù)后視力提高66眼(56.9%),視力不變27眼(23.3%),視力下降23眼(19.8%)。本組116例(116眼)根據(jù)年齡分為4組,18歲以下2例術(shù)后BCVA均提高；18-30歲28眼,術(shù)后BCVA下降3眼,不變1眼,提高24眼；30-50歲45眼,術(shù)后BCVA下降13眼,不變12眼,提高26眼；50歲以上41眼,術(shù)后BCVA下降13眼,不變14眼,提高14眼。患者術(shù)前、術(shù)后BCVA比較(X2=4.003,P=0.2610.05,無統(tǒng)計(jì)學(xué)意義)；術(shù)后BCVA變化情況在不同年齡組中的差別具有統(tǒng)計(jì)學(xué)意義(X2=20.818,P=0.0020.05),低年齡組患者中術(shù)后BCVA提高者居多；不同視網(wǎng)膜脫離時間的術(shù)后BCVA改善有明顯差異(X2=30.603,P=0.0000.05),視網(wǎng)膜脫離時間越長BCVA提高率越低。視網(wǎng)膜復(fù)位術(shù)后1年以上黃斑部OCT的圖像特征：1)黃斑區(qū)結(jié)構(gòu)正常5眼,2)視網(wǎng)膜海綿樣增厚19眼,3)黃斑視網(wǎng)膜變薄8眼,4)黃斑囊樣水腫13眼,5)視網(wǎng)膜神經(jīng)上皮層漿液性脫離11眼,6)黃斑裂孔6眼,7)視網(wǎng)膜色素上皮層損害16眼,8)黃斑水腫伴黃斑前膜11眼,9)黃斑變性12眼,10)視網(wǎng)膜前膜9眼,11)其他如脈絡(luò)膜新生血管、視網(wǎng)膜出血、視網(wǎng)膜下瘢痕形成、視網(wǎng)膜色素上皮層增厚、脈絡(luò)膜視網(wǎng)膜萎縮等6眼；所有患者BCVA均小于0.1。將研究組的黃斑中心凹厚度與健康人眼黃斑中心凹厚度進(jìn)行比較：除黃斑區(qū)結(jié)構(gòu)正常與健康人對照組P=0.4950.05,無顯著性意義外；其它種類與健康人對照組兩兩比較P=0.0000.05,在統(tǒng)計(jì)學(xué)上有顯著性意義。 結(jié)論：OCT對視網(wǎng)膜脫離復(fù)位術(shù)后1年以上黃斑區(qū)結(jié)構(gòu)形態(tài)的觀察,影響視網(wǎng)膜解剖復(fù)位術(shù)后BCVA恢復(fù)的原因可能與患者的年齡、視網(wǎng)膜脫離的時間有關(guān)；黃斑水腫、視網(wǎng)膜神經(jīng)上皮層脫離、黃斑裂孔、視網(wǎng)膜色素上皮層脫離、黃斑區(qū)結(jié)構(gòu)及厚度正常、黃斑區(qū)厚度變薄、視網(wǎng)膜前膜形成、黃斑水腫伴黃斑前膜、黃斑變性、視網(wǎng)膜神經(jīng)上皮層水腫及色素上皮損害等亦是其重要的影響因素。黃斑中心凹厚度對視功能恢復(fù)可能有一定的關(guān)系。OCT為臨床早期發(fā)現(xiàn)、診治疾病提供了極其重要的信息。OCT圖像可較好地詮釋視網(wǎng)膜脫離復(fù)位術(shù)后視力恢復(fù)過程。
[Abstract]:Objective: to analyze the dissatisfaction of visual recovery more than 1 years after retinal detachment reduction and the relationship with the characteristics of optical coherence tomography in macular region by optical coherence tomography (OCT). The best corrected visual acuity (best-corrected VI) was analyzed by OCT detection of retinal anatomic repositioning (best-corrected VI). Sual acuity, BCVA) not very satisfied.
Methods: 25 cases of retinal detachment underwent retinal detachment in the Second Affiliated Hospital of Nanchang University from October 2008 to March 2011, including 25 cases of vitrectomy and gas filling, 49 cases of silicone oil filling, 42 cases of external scleral encircling, external pressure and condensation. All patients were examined for more than 1 years after 1 years. The age of the patients was compared with the patient's age. The effect of retinal detachment time, more than 1 years after reduction of OCT macula examination on the best corrected visual acuity after operation of RRD patients; healthy control group: 46 cases of OCT examination. First set up the quantitative table of the above factors, using the SPSS17.0 statistical software to carry out X2 test (test level a=0.05) for various groups of postoperative visual changes. Check the most The good corrected visual acuity was less than 0.1 parallel optical coherence tomography, and the morphological changes in the macular region were observed and the reasons for the best corrected visual acuity were not improved. The thickness of the macular fovea of the study group was compared with the macular fovea thickness of the healthy human eyes, and the statistical significance was analyzed by the single factor difference analysis.
Results: preoperative vision: 13 eyes of light sensation, manual 24 eyes, 32 eyes of 32 eyes, 47 eyes of 0.01-0.1, 66 eyes (23.3%), 27 eyes (23.3%), and 23 eyes (19.8%). The group 116 (116 eyes) were divided into 4 groups according to age. 0-50 years of age and 45 eyes, BCVA decreased 13 eyes, 12 eyes, 26 eyes, 41 eyes, 41 eyes above 50 years old, and 13 eyes, 14 eyes and 14 eyes after operation. Before operation, the postoperative BCVA was compared (X2=4.003, P=0.2610.05, no statistical significance); the difference of BCVA in the different years of age group after operation was statistically significant (X2=20.818, P=0.0020.05), low (X2=20.818, P=0.0020.05). The increase of BCVA in the age group was most; the improvement of BCVA after different retinal detachment time was significantly different (X2=30.603, P=0.0000.05), the longer the retinal detachment time, the lower the BCVA enhancement rate. The image characteristics of OCT in the macular region above 1 years after retinal reposition operation: 1) the normal 5 eyes of the macular region, 2) 19 eyes of retinal sponge like thickening, 3) macular retina thinner, 8 eyes, 4) macular edema, 13 eyes, 5) retinal neuroepithelial serous detachment 11 eyes, 6 macular hole 6 eyes, 7 retinal pigment epithelial layer of 16 eyes, 8 macular edema with 11 eyes of macular membrane, 9) macular degeneration, retinal hemorrhage, retina, retina, retinal hemorrhage, and subretina Cicatricial formation, retinal pigment epithelial layer thickening and choroidal retinal atrophy were 6 eyes. All patients with BCVA were less than 0.1. and compared the macular fovea thickness of the study group with the healthy human eye macular fovea thickness. There was no significant difference between the normal and healthy control group P=0.4950.05, other types and healthy people. Control group 22 compared P=0.0000.05, statistically significant.
Conclusion: OCT observation of the macular structure over 1 years after retinal detachment reduction affects the cause of BCVA recovery after anatomic reduction of retina, which may be related to the age of the patients and the time of retinal detachment; macular edema, retinal detachment, Huang Banlie hole, retinal pigment epithelial detachment, macular structure and the structure of macular region. The thickness of the macular region, the formation of the anterior retinal membrane, macular edema with macular membrane, macular degeneration, retinal neuroepithelia edema and pigment epithelium damage are also important factors. The macular fovea thickness may have a certain relationship between the visual function recovery and.OCT for early clinical discovery and the diagnosis and treatment of disease. Important information.OCT images can better explain the process of visual recovery after retinal detachment surgery.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6

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本文編號：2095562