【摘要】 目的 探讨黄斑脱离型孔源性视网膜脱离(RRD)患者经玻璃体切割联合空气或硅油填充术后黄斑区结构和功能的改变以及扫频源光学相干断层扫描血管成像(SS-OCTA)测量参数与最佳矫正视力(BCVA)的相关性。方法 回顾性分析郑州大学第一附属医院眼二科于2021年1月至2022年3月收治的黄斑脱离型RRD患者77例(77眼),根据玻璃体切割术中眼内填充物的不同，分为空气组(37眼)和硅油组(40眼)。分别于术后1周、1个月、2个月通过SS-OCTA观察比较两组患者术眼BCVA和黄斑区微血管结构变化及其相关性。结果 空气组和硅油组患者的BCVA术后均较术前显著改善，差异均有统计学意义(均为P<0.01),两组间对比，术后1周、1个月、2个月空气组较硅油组患眼BCVA改善更明显，差异均有统计学意义(均为P<0.01)。术后2个月与术后1周比较，空气组患眼视网膜浅层血管复合体(SVC)和视网膜深层血管复合体(DVC)的整体血流密度(VD)、黄斑区中心凹血流密度(FVD)、黄斑区旁中心凹血流密度(PFVD)均增加，差异均有统计学意义(均为P<0.01);硅油组患眼SVC的整体VD、PFVD均降低，差异均有统计学意义(均为P<0.01),SVC的FVD及DVC的整体VD、FVD、PFVD差异均无统计学意义(均为P>0.05)。与空气组相比，硅油组患眼术后2个月SVC和DVC的整体VD、FVD、PFVD更低，差异均有统计学意义(均为P<0.01)。偏相关分析结果显示，术后2个月，FAZ 300μm内VD(FD-300)、SVC的FVD及DVC整体VD、FVD、PFVD均与BCVA(logMAR)呈负相关(均为P<0.05);FD-300的变化与BCVA(logMAR)的变化呈负相关(r=-0.274,P=0.017)。结论 黄斑脱离型RRD患者行玻璃体切割联合空气填充较硅油填充患眼术后黄斑区微血管结构更佳，BCVA更好。更多还原

【Abstract】 Objective To investigate the changes in macular structure and function of patients with macular-off rhegmatogenous retinal detachment(RRD) after receiving the vitrectomy combined with air or silicone oil tamponade and analyze the correlation between swept source optical coherence tomography angiography(SS-OCTA) measurement parameters and best corrected visual acuity(BCVA). Methods A retrospective analysis was made on 77 patients(77 eyes) with macular-off RRD who visited the Ophthalmology Clinic II of the First Affiliated Hospital of Zhengzhou University from January 2021 to March 2022. According to the different tamponades, patients were divided into the air group(37 eyes) and the silicone oil group(40 eyes). The changes in BCVA and microvascular structure of the macular region of patients in the two groups were observed and compared via SS-OCTA at 1 week, 1 month and 2 months after surgery. Results The BCVA of patients in the air group and silicone oil group significantly improved after surgery(both P<0.01). The BCVA improvement in the air group was better than that in the silicone oil group at 1 week, 1 month and 2 months after surgery, and the differences were statistically significant(all P<0.01). Compared with 1 week after surgery, the overall vascular density(VD), foveal vascular density(FVD) and parafoveal vascular density(PFVD) of the superficial vascular complex(SVC) and deep vascular complex(DVC) in the air group increased at 2 months after surgery, with significant differences(all P<0.01); the overall VD and PFVD of SVC in the silicone oil group were lower at 2 months after surgery, with significant differences(both P<0.01), while the differences in the FVD of SVC, overall VD, FVD and PFVD of DVC were not significant(all P>0.05). Compared with the air group, the overall VD, FVD and PFVD of SVC and DVC in the silicone oil group were lower at 2 months after surgery(all P<0.01). Partial correlation analysis showed that, at 2 months after surgery, VD of a 300-μm width annulus surrounding foveal avascular zone(FD-300), FVD of SVC, overall VD, FVD and PFVD of DVC were negatively correlated with BCVA(logMAR)(all P<0.05); the change of FD-300 was negatively correlated with the change of BCVA(logMAR)(r=-0.274, P=0.017). Conclusion The microvascular structure of the macular region and BCVA in the patients with macular-off RRD who undergo vitrectomy combined with air tamponade are better than those in patients who undergo vitrectomy combined with silicone oil tamponade.更多还原