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Macular Morphological Changes of Persistent Subclinical Subretinal Fluid after Scleral Buckle Surgery:An Optical Coherence Tomography Study
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摘要:
目的 探讨孔源性视网膜脱离术后亚临床性视网膜下液的黄斑区光学相干断层扫描(optical coherence tomo-graphy, OCT)表现。 方法 对孔源性视网膜脱离巩膜扣带术后临床视网膜复位但视力恢复不佳或有视物变形症状患者19例21眼, 应用3D OCT在其黄斑部行范围为6 mm×6 mm×1.7 mm、分辨率为512×128的三维扫描检查。分析患者黄斑部的OCT表现, 包括中心凹神经上皮厚度、神经上皮脱离情况、感光细胞内外节(inner segment/outer segment, IS/OS)结合部情况等。 结果 3D OCT检查显示15眼存在黄斑区亚临床性视网膜下液, 均为术前黄斑脱离的患者。其中14眼神经上皮的IS/OS结合部反光信号完整且增厚增强, 2眼可见中心凹外色素上皮层的高反射隆起, 2眼可见视网膜前膜反射信号。15眼中, 7眼神经上皮断续脱离。7例患者进行了多次OCT随访, 时间为术后3~12个月, 神经上皮脱离最终全部消失, 最佳矫正视力恢复到0.7~1.2。 结论 3D OCT能发现临床视网膜复位患者的亚临床性视网膜下液并确定脱离范围, 大多数患者表现为神经上皮浅脱离, IS/OS结合部反光信号完整且增厚增强。 -
关键词:
- 孔源性视网膜脱离 /
- 谱域光学相干断层扫描 /
- 巩膜扣带术 /
- 亚临床性视网膜下液
Abstract:Objective To evaluate macular morphological changes by spectral domain optical coherence tomography (3D OCT) in patients with persistent subclinical subretinal fluid after successful scleral buckle surgeries. Methods Totally 19 cases (21 eyes) with incomplete visual acuity recovery or metamorphosis were reviewed. 3D OCT was performed in the macula (size:6 mm×6 mm×1.7 mm; resolution:512×128). The morphological changes of macula including thickness of foveal neuroepithelium, neuroepithelial detachment, inner segment/outer segment (IS/OS) junction were recorded. Results 3D OCT showed persistent subclinical subretinal fluid in 15 eyes, and all of them occurred in patients with preoperative macular detachment. Also, 14 of 15 eyes showed disruption of the photoreceptor IS/OS junction, 2 showed irregularity of retinal pigment epithelium reflection signal, and 2 showed thin epiretinal membrane. Seven of these 15 eyes showed discontinuous retinal detachment. During the 3to 12month continuous follow-up for 7 eyes, the neuroepithelial detachment finally disappeared, and the best corrected visual acuity returned to 0.7-1.2. Conclusions 3D OCT can demonstrate areas of persistent subclinical subretinal fluid after successful scleral buckle surgeries. Most patients have neural epithelium shallow detachment as well as complete and enhanced IS/OS junction signal. -
图 1 孔源性视网膜脱离术后亚临床性视网膜下液患者眼底图像示神经上皮断续脱离A.3DOCT显示黄斑上方近血管弓处神经上皮断续浅脱离, IS/OS结合部反射信号明显增厚增强; B.彩色眼底照相未见明显的视网膜脱离, 上方较粗绿线表示OCT扫描部位, 此部位可见两处暗红色的圆形区域对应于OCT上视网膜在位处
OCT:光学相干断层扫描; IS/OS:内外节
图 3 术后不同时间孔源性视网膜脱离术后亚临床性视网膜下液患者眼底图像变化A.术后5周, 3DOCT显示中心凹下神经上皮浅脱离, IS/OS结合部反射信号明显增厚增强, 外界膜反射信号完整; B.彩色眼底照相未见明显的视网膜脱离, 中央绿线代表扫描部位; C.术后12个月, OCT显示中心凹信号恢复正常; D.彩色眼底照相未见明显异常
OCT、IS/OS:同图 1
表 1 多次光学相干断层扫描随访患者的亚临床性视网膜下液及随诊情况
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