Akkoyun I, Yilmaz G
Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey.
Klin Monbl Augenheilkd. 2013 Aug;230(8):814-9. doi: 10.1055/s-0032-1328422. Epub 2013 May 13.
The aim of this study was to evaluate results of optical coherence tomography (OCT) with regard to anatomic and functional outcome after scleral buckling surgery (SBS) in macula-off rhegmatogenous retinal detachment (RRD).
Medical charts of 87 patients (87 eyes), who underwent SBS for macula off RRD were analysed retrospectively. Patients with follow-up ≥ 6 months were included. Exclusion criteria were giant retinal tears, retinal dialysis, chorioretinal dystrophies, proliferative vitreoretinopathy ≥ grade-C1, schisis detachment and vitreous opacities. Reattachment success rate, pre- and postoperative visual acuity (VA) were examined. Postoperative spectral-domain (SD) OCT images were evaluated. The status of photoreceptor inner segment/outer segment (IS/OS) and external limiting memrane (ELM) junction were analysed. Potential risk factors influencing postoperative VA were evaluated by using linear multivariate logistic regression.
The primary anatomic success rate was 93.8 % (81 eyes), final success rate was 98.7 % (86 eyes). Preserved ELM (OR 0.58, p = 0.004) and IS/OS integrity (OR 0.84, p = 0.031), drainage of subretinal fluid (OR 0.42, p < 0.0001) were detected as significant independent factors for influencing postoperative VA favourably. Duration of detachment > 6 days (OR 1.46, p = 0.04), two/three retinal breaks (OR 1.30, OR 1.36, p < 0.0001) were significant independent risk factors for a poor postoperative VA. Severe IS/OS disruption was the most important risk factor for poor postoperative VA (β 0.724, OR 2.06, p < 0.0001).
Severe IS/OS disruption may be the most important predictor of postoperative VA after successful surgery in macula-off rhegmatogenous retinal detachment.
本研究旨在评估黄斑脱离的孔源性视网膜脱离（RRD）患者巩膜扣带术（SBS）后光学相干断层扫描（OCT）在解剖和功能预后方面的结果。
回顾性分析87例（87眼）因黄斑脱离的RRD接受SBS治疗患者的病历。纳入随访时间≥6个月的患者。排除标准包括巨大视网膜裂孔、视网膜脱离、脉络膜视网膜营养不良、增殖性玻璃体视网膜病变≥C1级、劈裂性视网膜脱离和玻璃体混浊。检查视网膜复位成功率、术前和术后视力（VA）。评估术后光谱域（SD）OCT图像。分析光感受器内节/外节（IS/OS）和外界膜（ELM）连接的状态。采用线性多因素逻辑回归评估影响术后VA的潜在危险因素。
主要解剖成功率为93.8%（81眼），最终成功率为98.7%（86眼）。保留ELM（比值比[OR]0.58，p = 0.004）和IS/OS完整性（OR 0.84，p = 0.031）、视网膜下液引流（OR 0.42，p < 0.0001）被检测为对术后VA有有利影响的显著独立因素。脱离时间>6天（OR 1.46，p = 0.04）、两个/三个视网膜裂孔（OR 1.30，OR 1.36，p < 0.0001）是术后VA差的显著独立危险因素。严重的IS/OS破坏是术后VA差的最重要危险因素（β 0.724，OR 2.06，p < 0.0001）。
严重的IS/OS破坏可能是黄斑脱离的孔源性视网膜脱离成功手术后VA的最重要预测因素。
