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黄斑裂孔性视网膜脱离手术后视力预后相关因素

Park, D.H., Choi, K.S., Sun, H.J., Lee, S.J.

期刊名称:Retina

卷期:2018年第38卷第1期

摘要

摘要:目的:旨在评价视网膜脱离术治疗黄斑裂孔性视网膜脱离复位手术后影响视力预后的术前因素和术后视力改变的相关因素。方法:对180例接受再次手术治疗黄斑裂孔性视网膜脱离,治疗随访12个月以上的患者的180只眼进行回顾性分析。应用单变量和多变量模型综合分析术前和术后特征,包括光学相干断层扫描结果,以评估影响黄斑裂孔性视网膜脱离术后12个月最佳矫正视力的术前影响因素,以及与术后最佳矫正视力改变有关的术后因素。结果:术前脱离程度(P = 0.037),黄斑脱落持续时间(P <0.001),外界膜完整性(β= 0.163; P = 0.002)与术后视力预后显着相关。 6个因素与术后视力改变相关:RD眼和对侧眼椭圆区完整性(β= 0.167; P <0.001),Henle纤维层和外核层(HFL + ONL/感光层比值(β= 0.199;感光体外节长度(β= -0.020; P <0.001),感光体内节长度/感光体外节长度比(β= 0.047; P = 0.005),感光体层厚度(β= -0.126; P = 0.018)和感光细胞外段长度比(β= -0.425; P <0.001)。结论:黄斑裂孔性视网膜脱离手术后视力预后相关术前因素有脱落程度,黄斑脱离持续时间,外界膜完整性。术后预测因素为视网膜外层微结构,特别是感光细胞外层。

PURPOSE:To evaluate preoperative factors influencing the visual outcome and postoperative factors associated with the changes in visual acuity, after reattachment surgery to treat macula-off rhegmatogenous retinal detachment.METHODS:A total of 180 eyes of 180 patients who underwent reattachment surgery to treat macula-off rhegmatogenous retinal detachment, and who were followed up for more than 12 months, were reviewed retrospectively. Preoperative and postoperative characteristics, including optical coherence tomography findings, were comprehensively analyzed using univariate and multivariate models to evaluate preoperative factors influencing best-corrected visual acuity 12 months after macula-off rhegmatogenous retinal detachment surgery and postoperative factors associated with changes in best-corrected visual acuity after surgery.RESULTS:Preoperatively, the extent of detachment (P = 0.037), macula-off duration (P < 0.001), and integrity of the external limiting membrane (β = 0.163; P = 0.002) were significantly associated with postoperative visual prognosis. Six factors were associated with changes in visual acuity after surgery: disruption of ellipsoid zone integrity (β = 0.167; P < 0.001), the Henle's fiber layer and the outer nuclear layer (HFL + ONL)/photoreceptor layer ratio (β = 0.199; P < 0.001), the photoreceptor outer segment length (β = -0.020; P < 0.001), the photoreceptor inner segment length/photoreceptor outer segment length ratio (β = 0.047; P = 0.005), the ratio of photoreceptor layer thickness between the RD eye and fellow eye (β = -0.126; P = 0.018), and the photoreceptor outer segment length ratio between the RD eye and fellow eye (β = -0.425; P < 0.001).CONCLUSION:Preoperative factors associated with the visual outcome after macula-off rhegmatogenous retinal detachment surgery were the extent of detachment, macula-off duration, and external limiting membrane integrity. Postoperatively, predictive factors were the outer retinal microstructures, particularly the photoreceptor outer segment layer.


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