Boden Karl Thomas, Januschowski Kai, Szurman Peter, Seuthe Anna-Maria, Rickmann Annekatrin, Seitz Berthold, Alsharairi Mohammad, Leers Stephan, Wakili Philip
Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany.
Centre for Ophthalmology, University Eye Hospital Tuebingen, Tubingen, Baden-Württemberg, Germany.
BMJ Open Ophthalmol. 2021 Mar 8;6(1):e000419. doi: 10.1136/bmjophth-2019-000419. eCollection 2021.
BACKGROUND/AIMS: The classification of retinal detachment is currently still based on many objective criteria such as duration of symptoms and funduscopic macular status, which leaves some important questions unanswered. The most important factor is the macular status, which is determined using direct or indirect ophthalmoscopy. Optical coherence tomography (OCT) has become a standard tool in clinical practice and enables detecting the exact extent of subretinal fluid in macula-off/on retinal detachment. We introduce a new and simple OCT-based grading system for macular detachment to provide a basis for further investigations to determine the optimal timing for surgery.
We retrospectively included 155 patients who were treated for retinal detachment. We defined the extent of the macular detachment in six stages based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid of the OCT scan.The outermost ring of the ETDRS grid was defined as zone 1, the middle ring as zone 2 and the inner ring as zone 3. Only zone 3 differed in the retinal detachment height grades (grade a <250 µm vs grade b >250 µm). Retinal detachment heights that could not be measured were considered grade 4 (ungradable) detachments.
Forty-seven patients had no macular involvement (grade 0). Regarding macular detachment, 14 patients had grade 1, 20 had grade 2, 9 had grade 3a, 29 had grade 3b and 36 had grade 4.
The newly developed OCT grading system for macular involvement following retinal detachment is a crucial tool to objectively classify a retinal detachment in order to be able to make better statements in the future, like for defining the optimal time for surgical intervention. A secondary benefit of this grading system would be that it improves predicting postoperative visual acuity.
背景/目的：视网膜脱离的分类目前仍基于许多客观标准，如症状持续时间和眼底黄斑状态等，这使得一些重要问题悬而未决。其中最重要的因素是黄斑状态，它通过直接或间接检眼镜检查来确定。光学相干断层扫描（OCT）已成为临床实践中的标准工具，能够检测黄斑脱离/未脱离视网膜脱离时视网膜下液的确切范围。我们引入一种新的、基于OCT的黄斑脱离分级系统，为进一步研究确定手术的最佳时机提供依据。
我们回顾性纳入了155例接受视网膜脱离治疗的患者。我们根据OCT扫描的早期糖尿病视网膜病变研究（ETDRS）网格将黄斑脱离程度分为六个阶段。ETDRS网格的最外环定义为1区，中环定义为2区，内环定义为3区。仅3区在视网膜脱离高度分级上有所不同（a级<250µm与b级>250µm）。无法测量的视网膜脱离高度被视为4级（不可分级）脱离。
47例患者黄斑未受累（0级）。关于黄斑脱离，14例为1级，20例为2级，9例为3a级，29例为3b级，36例为4级。
新开发的视网膜脱离后黄斑受累的OCT分级系统是客观分类视网膜脱离的关键工具，以便未来能够做出更好的判断，比如确定手术干预的最佳时机。该分级系统的另一个好处是它能改善对术后视力的预测。
