Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair
Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair
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DOI：
10.1016/j.ophtha.2006.01.003
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发表时间：
2006-04-01
期刊：
影响因子：
13.7
通讯作者：
Duker, JS
中科院分区：
文献类型：
--
作者：
Schocket, LS;Witkin, AJ;Duker, JS
目的：应用超高分辨率光学相干断层扫描(UHR OCT)评价孔源性视网膜脱离(RD)解剖修复术后视力不完全恢复的视网膜微结构改变。设计：回顾性观察病例系列。研究对象：17例RD修复术后视力下降患者。12例有黄斑受累，5例无黄斑视网膜病变。方法：研制出轴向分辨率接近3微米的UHR OCT样机，用于临床应用。对17例RD术后视力有主诉的患者进行了中心凹中心的UHR OCT扫描。患者要么是新英格兰眼科中心的术后患者，要么是第三方转诊的患者。主要观察指标：RD修复后UHR OCT图像。结果：术后1~84个月(中位数5个月)获得UHR OCT图像。术前最小分辨角度(LogMAR)视力的平均对数为1.37(相当于Snellen，20/390)。术后平均LogMAR视力为0.48(相当于Snellen，20/60)。检出的解剖异常包括17例患者中14例(82%)光感受器内/外节段(IS/OS)连接变形，10例(59%)视网膜前膜，3例(18%)视网膜下积液，2例(12%)黄斑囊样水肿。5例术前黄斑脱离的患者中，4例RD修复后视网膜外变形。结论：超高分辨率OCT有利于IS/OS结合部的成像。因此，UHR OCT能够证实先前的组织病理学结果，即视网膜脱离可能会对光感受器外节造成损害。这可能解释了解剖修复成功的眼睛术后视力较差的原因。
Objective: To assess microstructural changes in the retina that may explain incomplete visual recovery after anatomically successful repair of rhegmatogenous retinal detachments (RD) using ultrahigh-resolution optical coherence tomography (UHR OCT).Design: Retrospective observational case series.Participants: Seventeen patients with decreased visual acuity after RD repair. Twelve patients had macula-involving and 5 had macula-sparing RDs.Methods: The UHR OCT prototype capable of similar to 3 mu m axial resolution was developed for clinical use. The UHR OCT images through the center of the fovea in 17 patients with visual complaints after RD surgery were obtained. Patients were either postoperative patients from the New England Eye Center or tertiary referrals. Baseline visual acuity, preoperative lens status, location of retinal detachment, macular involvement, and postoperative visual acuity were recorded.Main Outcome Measures: The UHR OCT images after RD repair.Results: The UHR OCT images were obtained 1 to 84 months (median, 5 months) postoperatively. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.37 (Snellen equivalent, 20/390). The mean postoperative logMAR visual acuity was 0.48 (Snellen equivalent, 20/60). Anatomical abnormalities that were detected included distortion of the photoreceptor inner/outer segments (IS/OS) junction in 14 of 17 patients (82%), epiretinal membranes in 10 of 17 patients (59%), residual subretinal fluid in 3 of 17 patients (18%), and cystoid macular edema in 2 of 17 patients (12%). Of the 5 patients with preoperative macula-on detachments, 4 had distortion of the outer retina after RD repair.Conclusions: The higher resolution of UHR OCT facilitates imaging of the IS/OS junction. Therefore, UHR OCT is able to confirm prior histopathologic findings that damage to photoreceptor outer segments may occur as a consequence of retinal detachment. This may explain poor postoperative visual acuity in eyes with anatomically successful repair.