摘要目的 评价孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)巩膜扣带术后黄斑中心凹形态与最佳矫正视力(Best-corrected visual acuity, BCVA)的关系.方法 回顾性连续病例观察研究.对象为73例(73只眼)RRD患者,男39例(53.4％),女34例(46.6％),平均年龄(46.6±11.2)岁,均行巩膜冷凝扣带术成功视网膜复位.其中孔源性视网膜脱离累及黄斑者48只眼,未累及黄斑者25只眼.术后利用SD-OCT (spectral domain-optical coherence tomography)扫描患眼后极部视网膜评估黄斑中心凹的结构.评价患者成功术后中心凹形态与BCVA的关系.结果 SD-OCT扫描发现术后黄斑中心凹视网膜异常眼59只眼(80.8％).黄斑中心凹持续视网膜下液者47只眼(64.4％),黄斑前膜16只眼(21.9％),视网膜水肿11只眼(15.1％),感光细胞内外节(IS/OS)连接中断或消失33只眼(45.2％).31只眼视网膜下液全部吸收,平均吸收时间(5.8±2.6)个月.其中IS/OS连接中断或消失均出现在术前视网膜脱离累及黄斑眼中.伴有视网膜下液、黄斑前膜和视网膜水肿眼的术后最佳矫正视力与无上述视网膜异常眼之间差异无统计学意义.术后最佳矫正视力IS/OS连接完好眼显著优于IS/OS连接中断或消失眼(P ＜0.001).Logistic回归分析显示患者中心凹IS/OS连接形态显著影响术后最佳矫正视力(r=0.835,P＜0.001),其余中心凹异常未见显著影响.结论 孔源性视网膜脱离巩膜扣带术后,视网膜下液吸收缓慢,约需6个月.术后感光细胞层内外节形态与术后视力显著相关,其异常形态可能为术后视力不全恢复的决定性因素.

abstractsObjective To evaluate the correlation between macular microstructure and best-corrected visual acuity (BCVA) after successful repair of rhegmatogenous retinal detachment (RRD) underwent scleral buckling procedure. Methods Retrospective,consecutive,observational case series.Seventy-three eyes of 73 patients with RRD underwent successful sclera buckling procedure.The average age of the 39 male patients and 34 female patients was 46.6±11.2 year-old.Among them,48 eyes had a macula-off retinal detachment and the other eyes had a macula-on retinal detachment.A microstructure of the fundus was obtained by spectral domain-optical coherence tomography (SD-OCT) to assess the postoperative macular anatomy and the thickness of the retina.The correlation between the postoperative best-corrected visual acuity (BCVA) and lesions of the macula was evaluated..Results Foveal abnormalities were found in 59 eyes (80.8％) using the SD-OCT,of which subretinal fluid in 47 eyes,16 eyes had a epiretinal membrane,macular edema in 11 eyes,and 33 eyes had disruption or loss of IS/OS junction.Thirty-one eyes had complete reabsorption of subretinal fluid with a mean 5.8±2.6 months.Disruption of the photoreceptor IS/OS junction was observed only in macula-off eyes,whereas other microstuctureal abnormalities were observed in both macula-on and macula-off eyes.In preoperative macula-off eyes,the postoperative BCVA was significantly correlated with the integrity of the photoreceptor IS/OS junction detected by SD-OCT postoperatively (r =0.835; P ＜0.001). Conclusions After successful anatomically repair of rhegrnatogenous retinal detachment using sclera buckling procedure,the mean time of absorption of subretinal fluid is about 6 months.The status of photoreceptor IS/OS junction correlates significantly with the final visual acuity and may be the determining factor that influences of the visual acuity after surgery.