玻璃体黄斑牵引综合征手术前后光学相干断层扫描的对比研究

A comparative study on OCT before and after the operation for vitreomacular traction syndrome

摘要:

目的：对比分析玻璃体黄斑牵引综合征(vitreomacular traction syndrome，VTS)手术前后光学相干断层扫描(optical coherence tomography，OCT)的差异。

方法：回顾性分析2013-01/2014-01经OCT检查确诊并接受25G玻璃体切除手术治疗的玻璃体黄斑牵引综合征患者11例11眼的临床资料。患者术后平均随访6mo，观察患者手术前后的视力及OCT检查情况，比较手术前后黄斑区视网膜厚度和局部形态的变化。

结果：单纯玻璃体牵引8眼，术后6眼视力提高，2眼视力不提高； 黄斑前膜牵引1眼(术中给予黄斑前膜剥除、视网膜内界膜剥除、曲安奈德玻璃体腔注射)术后视力不提高； 玻璃体合并视网膜黄斑前膜牵引2眼(术中给予黄斑前膜剥除)术后视力提高。其中视力达0.1以上者所占比例由术前的46%提高至术后的73%。术前黄斑中心凹视网膜平均厚度为619.27±195.13μm，术后平均厚度为239.12±143.84μm，术后黄斑中心凹视网膜平均厚度较术前明显减少，差异有统计学意义(P<0.05)。

结论：玻璃体切除术能有效解除玻璃体对黄斑部的牵引，阻止患者视力进一步下降，减轻黄斑水肿，并提高部分患者视力，OCT对本组病的诊断及预后有重要的指导意义。

Abstract:

AIM: To make a contrast and then analyze the difference of optical coherence tomography(OCT)before and after vitreomacular traction syndrome(VTS)was performed.

METHODS: The clinical date of 11 evaluable eyes of 11 patients with VTS who were diagnosed by OCT and underwent 25G vitreous surgery from January 2013 to January 2014 were retrospectively analyzed. Patients were followed up for an average of 6mo, to observe the visual acuity and OCT examination of the patient before and after operation. We compared the changes of retinal thickness and local morphology before and after operation.

RESULTS: After vitreous retraction, 6 eyes improved, 2 eyes do not improve. One eye received macular membrane traction, in the operation the macular epiretinal membrane peeling, retrial membrane stripping and the triamcinolone acetonide intravitreal injection were given, but after the operation, the vision does not improve. Two eyes received vitreous combined with retinal macular membrane traction. In the operation, macular epiretinal membrane stripping was given, after the operation, visual acuity improved. The proportion of those with visual acuity of 0.1 or more increased from 46% before to 73% after the operation. Before operations, the mean central macular thickness was 619.27±195.13μm, 239.12±143.84μm after, which decreased significantly(P<0.05).

CONCLUSION: Vitrectomy can effectively relieve the vitreous traction of the macula, and can prevent further decline in visual acuity and reduce macular edema as well as improve the visual acuity of some patients. So, OCT has important guiding significance on the diagnosis and prognosis of this group.