目的:观察累及黄斑区视网膜脱离巩膜扣带术后的黄斑光学相干断层扫描(OCT)图像及术前和术后最佳矫正视力(BCVA)之间的关系的研究。方法:回顾分析5a随访的47例47眼累及黄斑区视网膜脱离患者,并将其分成两组:黄斑脱离≤7d组和>7d组。间接眼底镜行眼底检查,并行TOPCON光学相干断层扫描。结果:患者47例术后5a较术后3mo平均术后BCVA增加1.60±0.02行。≤7d组术后5a的BCVA为0.53,>7d组为0.25,两组之间有显著差异(P=0.008)。≤7d组术后BCVA≥0.4者28例,而>7d组术后BCVA≥0.4者7例(P<0.01)。5a术后随访间接检眼镜检查表明,视网膜脱离均复位。而OCT显示视网膜下液1眼(2%),黄斑区神经上皮层组织堆积1眼(2%),这2例患者术后5a的平均视力只有0.13,明显低于其他45例,术后5a平均BCVA视力为0.54(P=0.025)。术后视网膜较厚组BCVA明显高于视网膜较薄的组,并有统计学差异(P=0.008)。结论:累及黄斑的视网膜脱离时间对术后视力的恢复有很大影响,呈负相关,同时术后视力在较长时间里仍会不同程度的提高,术后视网膜的厚度与术后视力呈正相关性。我们建议对于某些术后复位良好而视力不佳者进行OCT扫描,以便发现视力不佳的原因。本研究对临床预测评估累及黄斑的视网膜脱离复位术后,潜在视功能恢复的情况提供依据。

AIM:To observe the long-term results of the macula-off rhegmatogenous retinal detachment(RRD)with optical coherence tomography(OCT)after scleral buckling and to analyze the relation between duration of macular detachment and postoperative best-corrected visual acuity(BCVA)with OCT image.METHODS:Retrospective 5 years follow-up of 47 eyes of 47 patients with macula-off RRD was involved.A microscopic fundus examination was conducted followed by Topcon OCT to assess the postoperative foveal microstructure.The correlation between the postoperative BCVA and microstructural findings at the fovea were evaluated.Images of the foveal microstructure were obtained by OCT and the BCVA was measured on the same day.Patients were divided into duration of macula detachment(DMD)less than 7 days and more than 7 days.RESULTS:Indirect ophthalmoscope indicated that all retinal detachments were reattached 5 years after operation.OCT showed that accumulation of subretinal fluid and macular neurosensory tissue accumulation at the fovea was in 1 eye(2%)respectively.And the mean visual acuity of these 2 patients was 0.13 after 5 years,which was significantly lower than that in the other 45 patients(without subretinal fluid)(0.54)(Student’s t test,P=0.025).CONCLUSION:The time of macula-off RRD has great influence on the recovery of visual acuity,which is a negative correlation,while visual acuity in the long period of time will increase to varying degrees,postoperative retinal thickness and visual acuity was positively correlated.We suggest that patients with good reattachment poor vision after reset should be performed OCT scans in order to discover the reasons for poor vision.This study assessed clinical prediction of macular retinal detachment surgery and potential restoration of visual function to provide the basis for the situation.

R779.6