iOCT在病理性近视黄斑病变手术中的应用

doi:10.3760/cma.j.cn115909-20190701-00190

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摘要目的：在病理性近视黄斑病变的手术治疗中评估术中光学相干断层扫描(iOCT)的可行性，并探讨其术中应用价值。方法：回顾性系列病例研究。收集2015年5月至2017年12月期间于温州医科大学附属眼视光医院杭州院区行玻璃体切除术的黄斑前膜、黄斑裂孔、黄斑劈裂及玻璃体黄斑牵拉综合征等病理性近视黄斑病变患者。所有患眼术中均行iOCT检查，定性评估术中视网膜变化，包括术中微损伤、手术技术准确性及裂孔边缘改变等，探讨其术中应用的价值。结果：本研究共纳入29例（29眼），男9例，女20例；年龄（58.8±10.3）岁；眼轴长度（28.9±2.0）mm。其中，黄斑前膜14眼，黄斑裂孔8眼，黄斑劈裂4眼及玻璃体黄斑牵拉综合征3眼。iOCT显示：7眼（7/29）确认术中存在微损伤或异常情况，其中神经纤维层异常6眼，内层视网膜抬高1眼；黄斑前膜患眼中4眼（4/14）确认剥膜后前膜残留；黄斑裂孔患眼中3眼（3/8）剥膜后观察到孔缘形态改变；黄斑劈裂患眼中均未观察到剥膜后全层黄斑裂孔的发生，其中1眼术前未明确的黄斑裂孔经iOCT确认；术中行保留中心凹内界膜或内界膜翻转覆盖术式的3眼在iOCT图像中均得到确认。结论：iOCT有助于术中实时评估剥膜的完整性、术中微损伤情况及手术技术的精确性，帮助主刀医师提高黄斑裂孔的诊出率，并可在术中观察到黄斑裂孔剥膜后孔缘形态的特殊改变，提示iOCT在病理性近视黄斑病变的手术治疗中有一定的应用价值。

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关键词 ：术中光学相干断层扫描, 病理性近视黄斑病变, 玻璃体视网膜手术

Abstract：Objective: To evaluate the feasibility of intraoperative optical coherence tomography (iOCT) for vitreous macular surgery in pathological myopic macular diseases and investigate the value of the intraoperative application. Methods: This was a retrospective case series study. Chosen patients underwent vitrectomy for epiretinal membrane (ERM), macular hole (MH), macular foveoschisis (MF), vitreomacular traction syndrome (VMT) and other pathological myopic macular diseases from May 2015 to December 2017 in Eye Hospital, Wenzhou Medical University. Vitreoretinal surgery was performed on all eyes and iOCT scans qualitatively assessed intraoperative retinal changes, included intraoperative micro injuries, accuracy of surgical techniques, changes at the margin of the holes, et al, and the application of iOCT was evaluated.Results: A total of 29 eyes were chosen. The patients included 9 males and 20 females with an average age of 58.8±10.3 years and an average axial length of 28.9±2.0 mm. Fourteen eyes were diagnosed with ERM, 7 eyes with MH, 4 eyes with MF, 3 eyes with VMT and 1 eye with PRM. iOCT confirmed intraoperative micro injuries or abnormalities in 7 eyes (7/29), including 6 eyes with abnormal layers of nerve fibers and 1 eye with an elevated inner retina. A residual membrane after peeling was identified in 4 eyes with ERM (4/14). After peeling, iOCT revealed the change at the margin of the hole in 3 eyes with MH (3/8). iOCT showed there was no macular hole after peeling in all 4 eyes with MF. An MF case combined with MH was undefined by OCT preoperatively but was confirmed by iOCT. Three eyes with intraoperative fovea reservation or ILM reversal coverage technique were all confirmed in iOCT images. Conclusions: iOCT can help to assess membrane peeling integrity, intraoperative micro injuries and the accuracy of surgical techniques while surgery is in progress. It can also help surgeons improve the diagnosis rate of macular hole, and observe the changes at the margin of the hole after peeling. iOCT has some application value for concurrently monitoring vitreoretinal surgery in pathological myopic macular disease.

Key words： intraoperative optical coherence tomography pathological myopic macular disease vitreoretinal surgery

收稿日期: 2019-07-01

基金资助:国家自然科学基金（81700884）

通讯作者: 沈丽君（ORCID：0000-0001-9106-5456），Email：slj@mail.eye.ac.cn

引用本文:

陶继伟王辰茜沈丽君陈焕陈亦棋毛剑波林丽. iOCT在病理性近视黄斑病变手术中的应用[J]. 中华眼视光学与视觉科学杂志, 2020, 22(6): 415-420. Jiwei Tao, Chenxi Wang, Lijun Shen, Huan Chen, Yiqi Chen, Jianbo Mao, Li Lin. The Application of Intraoperative Optical Coherence Tomography for Vitreomacular Surgery in Pathological Myopic Macular Diseases. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(6): 415-420. DOI: 10.3760/cma.j.cn115909-20190701-00190

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190701-00190 或 https://www.cjoovs.com/CN/Y2020/V22/I6/415

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