Mete Maurizio, Maggio Emilia, Ramanzini Francesca, Guerriero Massimo, Airaghi Giulia, Pertile Grazia
Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
Eye Clinic, Department of Neuroscience and Sensory Organs, Policlinico San Martino Hospital IRCCS Hospital-University San Martino, University of Genoa, Genoa, Italy.
Ophthalmologica. 2021;244(6):551-559. doi: 10.1159/000517880. Epub 2021 Jun 24.
This study aimed to describe foveal microstructural changes after pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD).
External limiting membrane (ELM) and ellipsoid zone (EZ) integrity, cystoid macular edema (CME), and subretinal fluid bleb (SB) development were analyzed using optical coherence tomography in 59 eyes over a 6-month follow-up period after PPV surgery for RRD. Eyes were grouped as macula-on (n = 30) or macula-off (n = 29), and the association between ELM and EZ recovery and best-corrected visual acuity (BCVA) was investigated. Predictive factors for ELM and EZ recovery were also identified.
The interval between symptom onset and surgery did not significantly differ between the macula-on and macula-off groups. Macula-on patients showed ELM and EZ integrity throughout, whereas macula-off patients had ELM and EZ integrity restored in 89.7% and 86.2% cases, respectively, with a resultant increase in final BCVA. Significant associations were found between preoperative macular involvement and ELM/EZ restoration. ELM/EZ recovery was also inversely associated with CME development. Significant associations were also found between final BCVA and preoperative BCVA and EZ recovery. CME and SB development were equally distributed between the 2 groups.
Prompt surgery for macula-off RRD allows the progressive recovery of outer retinal layers and significant visual gain.
本研究旨在描述采用空气填塞的玻璃体切除术（PPV）治疗孔源性视网膜脱离（RRD）后黄斑区的微观结构变化。
在RRD的PPV手术后6个月的随访期内，使用光学相干断层扫描分析了59只眼的外界膜（ELM）和椭圆体带（EZ）的完整性、黄斑囊样水肿（CME）和视网膜下液泡（SB）的形成情况。将眼睛分为黄斑在位组（n = 30）和黄斑不在位组（n = 29），并研究ELM和EZ恢复与最佳矫正视力（BCVA）之间的关联。还确定了ELM和EZ恢复的预测因素。
黄斑在位组和黄斑不在位组症状发作至手术的间隔时间无显著差异。黄斑在位患者全程保持ELM和EZ完整，而黄斑不在位患者中，分别有89.7%和86.2%的病例ELM和EZ完整性得以恢复，最终BCVA随之提高。术前黄斑受累与ELM/EZ恢复之间存在显著关联。ELM/EZ恢复也与CME的发生呈负相关。最终BCVA与术前BCVA和EZ恢复之间也存在显著关联。CME和SB的形成在两组中分布均匀。
对于黄斑不在位的RRD及时进行手术可使视网膜外层逐渐恢复并显著提高视力。
