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目的 初步探寻先天性视盘小凹(ODP)合并浆液性黄斑脱离患眼激光光凝及其联合玻璃体切割手术(PPV)治疗的成功标志.方法 回顾性病例分析.2003年至2018年于中山眼科中心眼底病中心检查确诊的先天性ODP合并浆液性黄斑脱离患者12例12只眼纳入研究.其中,男性2例2只眼,女性8例8只眼.平均年龄30.17岁.患眼均行视网膜激光光凝和(或)PPV联合眼内光凝治疗.采用德国Heidelberg公司Spectralis OCT仪的跟踪模式对视盘、黄斑进行跟踪扫描.“堤坝样”改变为治疗后OCT图像上视盘小凹与黄斑之间通道上形成视网膜脉络膜瘢痕.根据视盘旁有无“堤坝样”改变,将患眼分为有“堤坝样”改变组(A组)、未见“堤坝样”改变组(B组),分别为10例10只眼和2例2只眼.A组10只眼,BCVA 0.03～0.6.单纯光凝治疗1只眼,PPV联合眼内光凝治疗9只眼.B组2只眼BCVA均为0.1.均行PPV联合眼内光凝治疗.治疗后随访6～174个月;治疗后1、3、6、12、18、24个月采用治疗前相同设备和方法行相关检查.观察患眼BCVA变化以及视网膜下液(SRF)吸收、视网膜脉络膜“堤坝样”形成情况.结果 末次随访时,A组10只眼BCVA0.4～1.0,其中0.4、0.5、0.6、0.8、1.0分别为1、3、2、3、1只眼.PPV联合眼内光凝治疗的9只眼,SRF完全吸收;单纯光凝治疗的1只眼,SRF少量存留.B组2只眼BCVA分别为0.03、0.3;SRF均未吸收.结论 视网膜激光光凝治疗后视盘旁形成的“堤坝样”改变,能促进SRF吸收、提高BCVA;可作为治疗后成功标志.

Objective To investigate the successful signs of laser photocoagulation or endolaser combined vitrectomy for congenital optic disc pit (ODP) with serous macular detachment.Methods A retrospective case analysis.Twelve eyes of 12 patients with congenital ODP complicated with serous macular detachment diagnosed in Zhongshan Ophthalmic Center from 2003 to 2018 were included in this study.There were 2 males (2 eyes) and 8 females (8 eyes).The average age was 30.17 years old.Retinal laser photocoagulation and/or vitrectomy were performed in all the eyes.The optic disc and macular area were scanned using the tracking mode of the Germany Heidelberg Spectralis OCT instrument.The "dam-sign" change was a retinal choroidal scar on the channel between the ODP and the macula on the OCT image after treatment.The eyes were divided into a "dam-sign" change group (group A,10 eyes) and no "dam-sign" change group (group B,2 eyes).The BCVA of eyes in group A was 0.03-0.6.In group A,1 eye was treated with laser photocoagulation alone,9 eyes were treated with vitrectomy combined with laser photocoagulation.The BCVA of eyes in group B was 0.1.All the eyes in group B underwent vitrectomy combined with laser photocoagulation.The follow-up was ranged from 6 to 174 months.The same equipment and method before treatment were used for 1,3,6,12,18,and 24 months after treatment.The BCVA,absorption of subretinal fluid (SRF) and the formation of"dam-sign" change were observed.Results At the last follow-up,the BCVA of eyes in group A was 0.4-1.0 (0.4 in 1 eye,0.5 in 3 eyes,0.6 in 2 eyes,0.8 in 3 eyes,1.0 in 1 eye).In 9 eyes treated with vitrectomy combined with laser photocoagulation,SRF was completely absorbed.In 1 eye treated with laser photocoagulation alone,SRF remained in small amount.The BCVA of the two eyes in group B was 0.03 and 0.3,respectively;and SRF was not absorbed in both of them.Conclusions The "dam-sign" change near optic disc after laser photocoagulation can promote SRF absorption and improve BCVA.It can be used as a success indicator after treatment.