摘要目的 观察巩膜扣带手术后持续性黄斑下积液(SMF)的发生及转归,探讨SMF发生的相关因素及其对视力的影响.方法 行巩膜扣带手术且符合纳入标准的连续病例89例90只眼纳入研究.患者均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、三面镜、间接检眼镜、B型超声检查.90只眼中,伴萎缩性裂孔者21只眼,伴马蹄形裂孔者42只眼;陈旧性视网膜脱离者22只眼,非陈旧性视网膜脱离者68只眼.行巩膜环扎手术(SE组)32只眼,行巩膜外垫压手术(SSB组)58只眼.手术后1个月行光相干断层扫描(OCT)检查,根据有无SMF将患眼分为SMF组、NSMF组.手术后1、3、6、12个月及末次随访时,除常规眼科检查外,均行OCT检查.手术后随访时间1年及以上,且SMF完全消失6个月以上.结果 OCT检查,手术后1个月,SE组、SSB组患眼中存在SMF为20、23只眼,分别占各组患眼的62.5％、39.7％.两组SMF发生率比较,差异有统计学意义(x2=5.024,P＜0.05).伴萎缩性裂孔 21只眼中,发生SMF 14只眼,占66.7％;伴马蹄形裂孔 42只眼中,发生SMF 16只眼,占38.1％.两者SMF发生率比较,差异有统计学意义(x2 =4.582,P＜0.05).陈旧性视网膜脱离者22只眼中,发生SMF 16只眼,占72.7％;非陈旧性者68只眼中,发生SMF 27只眼,占39.7％,两者SMF发生率比较,差异有统计学意义(x2=7.264,P＜0.01).手术后各随访时间点,SE组、SSB组患眼平均logMAR BCVA比较,差异均无统计学意义(t=0.659、0.699、1.108、1.037、1.902,P＞0.05).手术后1、3个月,NSMF组、SMF组平均logMAR BCVA比较,差异无统计学意义(t=1.812、1.957,P＞0.05);6、12个月和末次随访时,两组平均logMAR BCVA比较,差异均有统计学意义(t=2.324、2.147、2.184,P＜0.05).结论 巩膜环扎手术后SMF发生率较外垫压手术后高;裂孔类型和陈旧性视网膜脱离是可能的潜在影响因素;SMF持续不能吸收可能影响手术后最终视力.

abstractsObjective To observe the occurrence and evolution of persistent submacular fluid (SMF) after scleral buckling surgery (SB) in rhegmatogenous retinal detachment,and then to study the related factors of persistent SMF and the effect of persistent SMF on visual outcome.Methods Ninety eyes of 89 patients with rhegmatogenous retinal detachment which had been performed SB were included in this study.Best corrected visual acuity (BCVA),intraocular pressure,slit-lamp microscopy,three mirror contact lens,indirect ophthalmoscopy and B-scan ultrasonography were measured for all patients.There were 21 eyes with atrophic holes while 42 eyes with horse-shoe tears,22 eyes with old retinal detachment while 68 new suffered eyes.Thirty-two eyes underwent scleral encircling surgery (SE) and 58 eyes underwent segmental scleral buckling surgery (SSB).The patients were divided into SMF group and non-SMF (NSMF) group according to the results of optical coherence tomography (OCT) at 1 month postoperatively.Thorough ophthalmologic examinations were performd at 1,3,6 and 12 months after surgery to the patients,further observations were continued to carry out unless the abnormality had resolved for at least 6 months.Results Patients who underwent SE (20 eyes,62.5 ％) had a higher incidence of persistent SMF at 1 month after surgery than those who underwent SSB (23 eyes,39.7 ％),the difference was significant (x2 =5.024,P＜ 0.05).Persistent SMF was more frequent in eyes with atrophic holes (66.7％) than that with horseshoe tears (38.1％),the difference was significant (x2 =4.582,P＜0.05).Persistent SMF was found in 72.7％ old retinal detachment eyes and in 39.7％ new suffered eyes,showed a striking differences (x2=7.264,P＜0.01).There was no significant difference in BCVA among SE and SSB groups at every time point (t=0.659,0.699,1.108,1.037,1.902; P＞0.05).The SMF group have a similar BCVA with NSMF group 1 and 3 months after surgery (t=1.812,1.957; P＞0.05),whereas the SMF group showed worse BCVA than NSMF group from since 6 months after surgery (t=2.324,2.147,2.184; P＜0.05).Conclusions Persistent SMF is more frequent after SE than SSB,the type of retinal breaks and old retinal detachment may be the potential influencing factors.Persistent SMF after SB may affect the final visual outcome.