Department of Ophthalmology, Afyonkarahisar Health Sciences University Medical School, Afyonkarahisar, Turkey,
formerly at Department of Ophthalmology, Afyon Kocatepe University Medical School, Afyonkarahisar, Turkey,
Ophthalmic Res. 2020;63(6):524-532. doi: 10.1159/000506382. Epub 2020 Feb 10.
To identify long-term changes in individual retinal layer thickness using automated retinal layer segmentation analysis on high-resolution spectral-domain optical coherence tomography (SD-OCT) scans of eyes with macula-off rhegmatogenous retinal detachment (RRD) treated with vitreoretinal surgery (VRS) and gas or silicone oil tamponade and having single-operation success.
A total of 58 patients operated on by VRS for RRD and followed up for 12 months were imaged by SD-OCT. The patients with retinal diseases such as an epiretinal membrane or cystic macular edema in the operated and fellow eyes were excluded. The thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer, and retinal pigment epithelium were compared to those of the fellow eyes after the 12-month follow-up. Thickness changes in individual layers were quantitatively analyzed in the operated and fellow eyes and correlated with the type of tamponade used in the surgery.
Spectralis OCT automated segmentation software was used for the retinal layer analysis. There were 22 females and 36 males. Their mean age was 60.7 ± 11.2 years. The mean central macular thickness was 214.3 ± 29.5 µm in the operated and 229.7 ± 21.7 µm in the fellow eyes (p = 0.008). There was a statistically significant difference between the operated and the healthy fellow eyes in the following layers: the RNFL (p = 0.017), GCL (p = 0.02), INL (p = 0.005), and ONL (p = 0.008) in the central foveal area; the RNFL (p < 0.001), INL (p = 0.017), and ONL (p = 0.022) in the perifoveal ring; and the RNFL (p < 0.001), IPL (p = 0.042), INL (p = 0.001), and OPL (p = 0.001) in the peripheral ring. The logMAR best corrected visual acuities were 2.51 ± 0.68 and 2.69 ± 0.62 at baseline and 0.60 ± 0.38 and 0.50 ± 0.38 at month 12 in the silicone oil tamponade (n = 28) and the gas tamponade (n = 30) group (p = 0.52 and p = 0.21, respectively). The foveal GCL, OPL, and ONL and the perifoveal GCL and IPL were statistically significantly thinner in the silicone oil tamponade group (p = 0.01, p = 0.046, p = 0.024, p = 0.006, and p = 0.011, respectively).
Significant changes were observed in the retinal layers after VRS for RRD. Individual retinal layers seem to be affected 1 year after VRS for RRD. The type of tamponade can influence the thickness of the retinal layers. The thickness of the retinal layers was significantly preserved in eyes treated with gas tamponade when compared to those treated with silicone oil tamponade in the long term. Further studies are needed to validate our results.
利用高分辨率频域光学相干断层扫描（SD-OCT）对接受玻璃体视网膜手术（VRS）联合气体或硅油填充治疗的黄斑裂孔性孔源性视网膜脱离（RRD）患者进行自动视网膜分层分析，以识别视网膜各层厚度的长期变化，并达到单眼手术成功。
对 58 例接受 VRS 治疗的 RRD 患者进行 SD-OCT 成像，并进行为期 12 个月的随访。排除手术眼和对侧眼存在视网膜内膜皱褶或囊样黄斑水肿等视网膜疾病的患者。比较手术眼和对侧眼在术后 12 个月时视网膜神经纤维层（RNFL）、神经节细胞层（GCL）、内丛状层（IPL）、内核层（INL）、外丛状层（OPL）、外核层（ONL）、光感受器层和视网膜色素上皮层的厚度。定量分析手术眼和对侧眼中各层的厚度变化，并与手术中使用的填充类型相关联。
使用 Spectralis OCT 自动分层软件进行视网膜分层分析。其中，女性 22 例，男性 36 例，平均年龄 60.7 ± 11.2 岁。手术眼中央黄斑厚度为 214.3 ± 29.5 µm，对侧眼为 229.7 ± 21.7 µm（p = 0.008）。手术眼与健康对侧眼在以下各层存在显著差异：中央凹区的 RNFL（p = 0.017）、GCL（p = 0.02）、INL（p = 0.005）和 ONL（p = 0.008）；周边凹区的 RNFL（p < 0.001）、INL（p = 0.017）和 ONL（p = 0.022）；以及周边环的 RNFL（p < 0.001）、IPL（p = 0.042）、INL（p = 0.001）和 OPL（p = 0.001）。硅油填充组（n = 28）和气体填充组（n = 30）的最佳矫正视力 logMAR 基线时分别为 2.51 ± 0.68 和 2.69 ± 0.62，术后 12 个月时分别为 0.60 ± 0.38 和 0.50 ± 0.38（p = 0.52 和 p = 0.21）。硅油填充组的中央 GCL、OPL 和 ONL 以及周边 GCL 和 IPL 明显变薄（p = 0.01，p = 0.046，p = 0.024，p = 0.006 和 p = 0.011）。
RRD 患者接受 VRS 治疗后，视网膜各层出现明显变化。RRD 患者接受 VRS 治疗 1 年后，各层视网膜可能受到影响。填充类型可能影响视网膜各层的厚度。与硅油填充相比，气体填充可长期更有效地保持视网膜各层的厚度。需要进一步的研究来验证我们的结果。
