中华眼底病杂志

中华眼底病杂志

手术中光相干断层扫描在黄斑疾病玻璃体切割联合内界膜剥除手术中的应用

查看全文

目的观察评估手术中OCT(iOCT)在黄斑疾病玻璃体切割联合内界膜剥除手术中的应用价值。方法回顾性系列病例研究。2015年6月至2016年9月在温州医科大学附属眼视光医院杭州院区因黄斑疾病行玻璃体切割联合内界膜剥除的71例患者71只眼纳入研究。其中,男性24例24只眼,女性47例47只眼;年龄25~78岁,平均年龄(63.35±10.01)岁。所有患者均为单眼发病,包括特发性黄斑裂孔26只眼、特发性黄斑前膜42只眼、玻璃体黄斑牵拉综合征3只眼。由同一眼科医生于23G微创玻璃体切割联合吲哚青绿染色辅助剥除黄斑区内界膜手术中行iOCT检查,记录内界膜剥除前后患眼黄斑区发生的形态变化。对比分析iOCT与手术者显微镜下观察结果。同时记录因iOCT结果而改变原定手术治疗策略的病例。结果71只眼中,iOCT与手术者显微镜下判断一致者63只眼(90.14%),非一致者8只眼(11.27%)。iOCT与手术者显微镜下判断非一致者中,特发性黄斑裂孔5只眼(62.50%)、特发性黄斑前膜2只眼(25.00%)、玻璃体黄斑牵拉综合征1只眼(12.50%)。71只眼中,因iOCT结果而发生手术治疗策略改变8只眼(11.27%)。其中,特发性黄斑裂孔5只眼(62.50%)、特发性黄斑前膜2只眼(25.00%)、玻璃体黄斑牵拉综合征1只眼(12.50%)。治疗策略的改变主要为更改眼内填充物及再次剥膜。结论iOCT在黄斑疾病玻璃体切割联合内界膜剥除手术中可以及时发现手术显微镜下难以察觉的细微形态变化,指导手术者及时调整修正手术方式。

ObjectiveTo evaluate the assistant effect of intraoperative OCT (iOCT) in vitreous retinal surgery for macular disease.MethodsA retrospective case study. A total of 71 patients (71 eyes) with macular disease who underwent vitrectomy in Eye Hospital of Wenzhou Medical University at Hangzhou from June 2015 to September 2016 were collected. There were 24 males (24 eyes) and 47 females (47 eyes), aged from 25 to 78 years, with the mean age of 63.35±10.01 years. Among 71 eyes, there were 26 eyes with idiopathic macular hole, 42 eyes with idiopathic epiretinal membrane, 3 eyes with vitreomacular traction syndrome. The examination of iOCT was performed on the patients during 23G minimally invasive vitreoretinal surgery combined with internal limiting membrane peeling. Use observational method to compare the difference between result of iOCT and observation under the microscope, record the change of treatment strategy.ResultsEight eyes (11.27%) iOCT results were different from the surgeon’s observation, which including 5 eyes (62.50%) with idiopathic macular hole, 2 eyes (25.00%) with idiopathic epiretinal membrane, 1 eye (12.50%) with vitreomacular traction syndrome. The treatment strategy was changed in 8 eyes (11.27%) based on iOCT result, which including 5 eyes (62.50%) with idiopathic macular hole, 2 eyes (25.00%) with idiopathic epiretinal membrane, 1 eye (12.50%) with vitreomacular traction syndrome.ConclusionsiOCT can help the surgeon find some subtle morphological changes which can hardly be seen by eyes. The surgeon can change and optimize the treatment strategy based on the result of iOCT.

关键词: 玻璃体视网膜手术/仪器和设备; 体层摄影术,光学相干; 黄斑疾病

Key words: Vitreoretinal surgery/instrumentation; Tomography, optical coherence; Macular disease

引用本文: 王奇骅, 陶继伟, 林晶晶, 沈丽君. 手术中光相干断层扫描在黄斑疾病玻璃体切割联合内界膜剥除手术中的应用. 中华眼底病杂志, 2019, 35(1): 54-57. doi: 10.3760/cma.j.issn.1005-1015.2019.01.012 复制

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 王奇骅, 陶继伟, 沈丽君. 手术中光相干断层扫描在玻璃体视网膜手术中的应用[J]. 中华眼底病杂志, 2015, 31(5): 498-500. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.027.Wang QH, Tao JW, Shen LJ. The application of intraoperative optical coherence tomography in vitreous retinal surgery[J]. Chin J Ocul Fundus Dis, 2015, 31(5): 498-500. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.027.
2. 陶继伟, 王奇骅, 褚梦琪, 等. 手术中光相干断层扫描在玻璃体视网膜手术中应用的初步观察报告[J]. 中华眼底病杂志, 2016, 32(5): 491-494. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.008.Tao JW, Wang QH, Chu MQ, et al. The preliminary application of intraoperative optical coherence tomography in vitreous retinal surgery[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 491-494. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.008.
3. Wykoff CC, Berrocal AM, Schefler AC, et al. Intraoperative OCT of a full-thickness macular hole before and after internal limiting membrane peeling[J]. Ophthalmic Surg Lasers Imaging, 2010, 41(1): 7-11. DOI: 10.3928/15428877-20091230-01.
4. Ehlers JP, Griffith JF, Srivastava SK, et al. Intraoperative optical coherence tomography during vitreoretinal surgery for dense vitreous hemorrhage in the pioneer study[J]. Retina, 2015, 35(12): 2537-2542. DOI: 10.1097/IAE.0000000000000660.
5. Pichi F, Alkabes M, Nucci P, et al. Intraoperative SD-OCT in macular surgery[J]. Ophthalmic Surg Lasers Imaging, 2012, 43(6 Suppl): S54-60. DOI: 10.3928/15428877-20121001-08.
6. Falkner-Radler CI, Glittenberg C, Gabriel M, et al. Intrasurgical microscope-integrated spectral domain optical coherence tomography-assisted membrane peeling[J]. Retina, 2015, 35(10): 2100-2106. DOI: 10.1097/IAE.0000000000000596.
7. Ehlers JP, Tam T, Kaiser PK, et al. Utility of intraoperative optical coherence tomography during vitrectomy surgery for vitreomacular traction syndrome[J]. Retina, 2014, 34(7): 1341-1346. DOI: 10.1097/IAE.0000000000000123.
8. Hayashi A, Yagou T, Nakamura T, et al. Intraoperative changes in idiopathic macular holes by spectral-domain optical coherence tomography[J]. Case Rep Ophthalmol, 2011, 2(2): 149-154. DOI: 10.1159/000328752.
9. Ehlers JP, Tao YK, Srivastava SK. The value of intraoperative optical coherence tomography imaging in vitreoretinal surgery[J]. Curr Opin Ophthalmol, 2014, 25(3): 221-227. DOI: 10.1097/ICU.000000000000044.
10. Ehlers JP, Xu D, Kaiser PK, et al. Intrasurgical dynamics of macular hole surgery: an assessment of surgery-induced ultrastructural alterations with intraoperative optical coherence tomography[J]. Retina, 2014, 34(2): 213-221. DOI: 10.1097/IAE.0b013e318297daf3.
11. Nam DH, Desouza PJ, Hahn P, et al. Intraoperative spectral-domain optical coherence tomography imaging after internal limiting membrane peeling in idiopathic epiretinal membrane with connecting strands[J]. Retina, 2015, 35(8): 1622-1630. DOI: 10.1097/IAE.000000000000534.
12. Ray R, Barañano DE, Fortun JA, et al. Intraoperative microscope-mounted spectral domain optical coherence tomography for evaluation of retinal anatomy during macular surgery[J]. Ophthalmology, 2011, 118(11): 2212-2217. DOI: 10.1016/j.ophtha.2011.04.012.
13. Ehlers JP, Yuan A, Kaiser PK. Trans-tamponade optical coherence tomography: postoperative imaging in gas-filled eyes[J]. Retina, 2013, 33(6): 1172-1178. DOI: 10.1097/IAE.0b013e31827b6565.
14. Ehlers JP, Han J, Petkovesk D, et al. Membrane peeling-induced retinal alterations on intraoperative OCT in vitreomacular interface disorders from the PIONEER study[J]. Invest Ophthalmol Vis Sci, 2015, 56(12): 7324-7330. DOI: 10.1167/iovs.15-17526.
15. Almeida DR, Wong J, Belliveau M, et al. Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning[J]. Retina, 2012, 32(3): 506-510. DOI: 10.1097/iae.0b013e3182219abd.
16. Gupta D. Face-down posturing after macular hole surgery: a review[J]. Retina, 2009, 29(4): 430-443. DOI: 10.1097/IAE.0b013e3181a0bd01.
17. Krohn J. Duration of face‐down positioning after macular hole surgery: a comparison between 1 week and 3 days[J]. Acta Ophthalmol Scand, 2005, 83(3): 289-292. DOI: 10.1111/j.1600-0420.2005.00462.x.
18. Malik A, Dooley I, Mahmood U. Single night postoperative prone posturing in idiopathic macular hole surgery[J]. Eur J Ophthalmol, 2012, 22(3): 456-460. DOI: 10.5301/ejo.5000039.
19. Dhawahir-Scala FE, Maino A, Saha K, et al. To posture or not to posture after macular hole surgery[J]. Retina, 2008, 28(1): 60-65. DOI: 10.1097/iae.0b013e31813c68a2.
20. Yagi F, Sato Y, Takagi S, et al. Idiopathic macular hole vitrectomy without postoperative face-down positioning[J]. Jpn J Ophthalmol, 2009, 53(3): 215-218. DOI: 10.1007/s10384-008-0642-7.
21. Tornambe PE, Poliner LS, Grote K. Macular hole surgery without face-down positioning: a pilot study[J]. Retina, 1997, 17(3): 179-185. DOI: 10.1097/00006982-199717030-00001.