摘要目的 应用高清频域光学相干断层扫描(SD-OCT)~察累及黄斑的视网膜脱离扣带术前后黄斑中心凹的显微结构变化,评估其对术后最佳矫正视力(BCVA)的影响.方法 回顾性研究分析22例一次性手术成功的累积黄斑的视网膜脱离患者的资料,术前及术后1月,3月应用SD-OCT观察中心凹显微结构变化,测量黄斑脱离高度及外核层(ONL)厚度.结果 22例患者术后1月13例(59%)有黄斑下积液.发病年龄、术前ONL厚度与术后BCVA不相关,而病程、术前视力、黄斑脱离高度、脱离范围、术后ONL厚度及术后有无黄斑积液均与术后BCVA显著相关(P=0.046,0.0001.0.0007,0.036.0.01 1.0.002).术后有黄斑积液眼与无黄斑积液眼术后视力差异有统计学意义(u=25,P<O.05),有积液眼术前黄斑脱离高度明显高于术后无黄斑积液眼(u=5,P<0.01).黄斑脱离后出现以下几种形态改变:视网膜水肿、神经上皮层间分离、内外核层囊肿、光感受器内外节层连接(IS/OS)缺失、神经上皮外层波浪状改变及色素上皮层颗粒状改变.结论 持续的黄斑脱离是影响视网膜脱离扣带术后视力恢复的关键因素,SD-OCT是手术前后观察中心凹的显微结构变化及评估视力预后的可靠手段.

abstractsObjective To evaluate foveal microstructure changes in eyes with successful scleral buckling procedure of rhegmatogenous retinal detachments. Methods This retrospective study included 22 eyes of 22 patients with macula-off rhegmatogenous retinal detachment. The fundus examination was conducted followed by spectral-domain optical coherence tomography (SD-OCT) to assess the preoperative and postopera tive foveal microstructure included height of macular detachment and thickness of the outer nuclear layer. Preoperative and postoperative factors analyzed for their association with postoperative best-corrected visual acuity (BCVA) and foveal microstructure changes. Results Residual macular detachment was found in 13 eyes with SD-OCT 1 month postoperatively. Age, preoperative thickness of the outer nuclear layer did not influence postoperative BCVA. The duration of macular detachment, worse preoperative visual acuity, height of macular detachment, postoperative thickness of the outer nuclear layer and postoperative foveal fluid were important negative prognostic factors for postoperative BCVA. The macular anatomic abnormalities were detected by SD-OCT included macular edema, intraretinal separation, intraretinal cyst, undulation of the outer retina, dropout of the photoreceptor inner and outer segment layers in the fovea and graininess of pigment epithelial layer. Conclusions Persistent macular detachment is the most important factor for postoperative BCVA. SD-OCT is a valuable tool for evaluating foveal micro-structural changes and predicting visual recovery.