ANATOMICAL RECOVERY FOLLOWING RETINAL DETACHMENT

The histological findings in experimental retinal detachment and reattachment of the cat retina are described. Loss of photoreceptor outer segments, mounding of the apical surface of the retinal pigment epithelium, and loss of the apical villi of the retinal pigment epithelium are prominent features of the detached cat retina. Reattachment within the first week of retinal detachment is followed by good photoreceptor regeneration and orientation. Longer term detachment of 2 to 6 weeks results in poorer photoreceptor outer segment regeneration and orientation 4 weeks following reattachment surgery. These experimental results are consistent with clinical data concerning visual recovery following retinal reattachment surgery.     

Morphological recovery in the reattached retina

After experimental retinal detachment in the cat, a number of morphological changes take place in retinal and RPE cells. Following reattachment, the ultrastructural relationship between the photoreceptors and the RPE is re-established, but it does not return to the predetachment state even after short detachment episodes coupled with prolonged recovery periods. All of the reattached retinae show some degree of abnormality, ranging from subtle changes in photoreceptor ultrastructure to dramatic degenerative effects in the outer retina. Abrupt transitions in morphology from one reattached area to an adjacent area are not unusual. Photoreceptor recovery varies widely between animals, and between adjacent regions within the same retina. Ensheathment of outer segments by RPE apical processes is abnormal. In some reattached areas rod outer segment dimensions and disc structure are near normal as is the displacement rate of rod outer segment discs. In others, especially in areas of RPE or Müller cell proliferation and hypertrophy, the outer segments are shortened or absent completely, and there is a reduction of cell bodies in the outer nuclear layer. In some retinae, recovery in cones is inferior to that in rods. At short detachment durations (less than 1 wk) morphological recovery in the reattached retina is optimal while at long intervals (greater than 1 month) recovery is poor. The changes at the photoreceptor-RPE interface identified in the reattached cat retina probably have adverse effects on visual recovery when they occur within the human macula.     

关注视网膜脱离手术后的视功能恢复

原发性视网膜脱离手术治疗的历史已有90多年.虽然视网膜解剖复位的成功率可以达到90％以上,但视力恢复仍不够令人满意.视网膜脱离复位后究竟发生了什么变化?通过动物疾病模型的研究,已知主要在视网膜色素上皮细胞、光感受器细胞及其界面出现一系列的细胞学反应,其结构和功能重建需要较长时间.近年光学相干断层扫描(OCT)发现,光感受器内节与外节连接(IS/OS连接)断裂、外界膜(ELM)断裂,以及黄斑的微小病变,是视力后果不良的影响因素.关于手术方式等治疗因素对视力恢复的影响,仍有争议.因此,应更多地关注视网膜复位后的视力恢复,进行相关的基础和临床研究.     

Increased levels of soluble syndecan-1 in the subretinal fluid and the vitreous of eyes with rhegmatogenous retinal detachment

PURPOSE: To investigate whether rhegmatogenous retinal detachment (RRD) alters intraocular soluble syndecan-1 levels. METHODS: In all, 39 samples of subretinal fluid (SRF) and 10 samples of vitreous fluid from RRD patients were collected. Using ELISA, soluble syndecan-1 levels were detected, and potential correlations between syndecan-1 levels with clinical parameters were analyzed. RESULTS: Soluble syndecan-1 in the vitreous fluid (2.577+/-0.578 ng/ml) and in the SRF (1.499+/-0.184 ng/ml) from eyes with RRD enhanced significantly compared to that of the controls (0.224+/-0.095 ng/ml) (p<0.0001 and p=0.006). An increase in the syndecan-1 concentrations in SRF samples correlated with a longer duration of retinal detachment (r=0.716, p<0.0001) and a younger age (r= -0.341, p=0.017). CONCLUSIONS: RRD was found to be associated with a significant increase of soluble syndecan-1 in the vitreous fluid and SRF. In SRF, an enhanced soluble syndecan-1 concentration correlated positively with the duration of retinal detachment and inversely with the age of patients.     

Fibrinolytic activity of subretinal fluid after cryopexy

PURPOSE: To measure the tissue plasminogen activator antigen (t-PA Ag) content and plasminogen activator inhibitor type 1 (PAI-1) activity of SRF and blood. METHODS: 22 patients aged from 20 to 77 years (median: 57.3 years), were studied, undergoing retinal detachment surgery. Excluded were patients with vein or arterial disease and any other factors that could change the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery, after cryopexy. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. T-PA Ag concentration and PAI-1 activity in subretinal fluid and citrated plasma and their relation to patients' age and sex, the duration and extent of retinal detachment, and degenerative changes of the retina were assessed. RESULTS: The median t-PA Ag concentration in 22 samples of SRF was 6.7 ng/ml (interquartile range 3.6 ng/ml) and PAI-1 activity 14.0 IU/ml (interquartile range 7.5 IU/ml). The median levels of t-PA Ag and PAI in plasma were respectively 10.7 ng/ml (interquartile range 8.6 ng/ml) and 15.7 IU/ml (interquartile range 12.2 IU/ml). There were no differences between the t-PA Ag concentration and PAI-1 activity in SRF and blood. We found no correlation between the levels of t-PA Ag and PAI-1 activity in SRF and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes. CONCLUSIONS: The parameters of the fibrinolytic cascade studied here indicated the presence of high levels of t-PA Ag and PAI-1 activity in SRF.     

The ability of rapid retinal reattachment to stop or reverse the cellular and molecular events initiated by detachment

PURPOSE: To determine the effects of reattachment on the molecular and cellular events initiated by a retinal detachment lasting 1 hour or 1 day. METHODS: Experimental retinal detachments were created in the right eyes of nine cats. Reattachments were performed 1 hour (n = 3) or 1 day (n = 3) after the detachment, and the animals were killed 3 days after detachment. Three-day detached (n = 3) and normal (n = 3) retinas were used for comparisons. Agarose-embedded sections were double labeled with a panel of antibodies. Some sections were also probed with the TUNEL technique to detect apoptotic cells. Wax-embedded sections were labeled with the MIB-1 antibody to the Ki67 protein to detect proliferating cells. RESULTS: The 1-hour and 1-day detachments followed by reattachment showed a very similar and consistent reduction in photoreceptor deconstruction and the Müller cell gliotic response when compared with 3-day retinal detachments without reattachment. Light microscopy and immunolabeling with opsin antibodies showed a significant reduction in both rod and cone outer segment (OS) degeneration, even though OS length was shorter than normal. The reattachments also showed a reduction in opsin redistribution, retraction of rod terminals, TUNEL-labeled photoreceptors, loss of cytochrome oxidase staining in photoreceptors, neurite outgrowth from second-order neurons, the number of proliferating cells, and the increase in intermediate filaments and loss of soluble proteins from Müller cells. The apparent re-ensheathing of the OS by the apical processes of the retinal pigment epithelium had begun but was not completely normal. CONCLUSIONS: These data indicate that, even though the length of the OS is less than normal, retinal reattachment within 1 day of detachment can either greatly retard or reverse many of the molecular and cellular changes initiated by detachment.     

视网膜脱离复位后的视网膜电图研究

目的 研究视网膜脱离（ＲＤ）复位后视网膜电图改变,探讨视功能损害的程度和部位。方法 １０只健康灰兔分为实验组４组８只,正常对照组２只。通过在视网膜下注射０．１％透明质酸钠方法建立ＲＤ模型。在术前和术后１,２,３,４周时分别记录视网膜电图。结果 暗视视杆细胞反应,最大反应ａ,ｂ波,单闪光明视锥细胞反应和闪烁光反应振幅,在视网膜复位后逐渐升高,复位１周时恢复到正常时的６０％～６５％,复位３周时视网膜ＥＲＧ恢复到７０％～９０％。暗视最大反应ａ波潜伏期在视网膜复位后２天,延长１０．９％,复位１周后逐渐恢复。ＯＰｓ和其它各波的潜伏期未见有显著改变（Ｐ〉０．０５）。结论 复位后的视网膜电图虽然逐渐恢复,但ａ,ｂ波的不完全恢复提示了光感受器和Ｍｕｌｌｅｒ细胞功能的改变。     

Retinal detachment in the cat: the outer nuclear and outer plexiform layers

The retinae of cats were surgically detached for 1/2 hr to 14 months, and the outer nuclear (ONL) and outer plexiform layers (OPL) were studied by light and electron microscopy. The longer the duration or the greater the height of detachment the more likely was the occurrence of cell death. Histologic signs of degeneration were present 1 hr after detachment. The number of photoreceptor nuclei in the ONL decreased significantly by 1 month. Loss of cells in the ONL occurred by necrosis and by the migration of photoreceptor cell bodies into the subretinal space. The OPL degenerated by the necrosis of cell processes and synaptic terminals and by the retraction of the synaptic terminals. By 2 weeks most synaptic terminals were necrotic or in the process of retracting. Photoreceptor synaptic contact with second order neurons was diminished by 30 days and was essentially absent by 50 days. Müller cells proliferated and hypertrophied; their nuclei and cell processes filled the intraretinal spaces left by the degenerating photoreceptors. In addition, Müller cells protruded into the subretinal space and formed multiple layers of cell bodies and processes between the retina and retinal pigment epithelium. By 14 months these subretinal Müller cell processes covered the entire detached retina, and appeared morphologically like an astroglial scar. Similar changes in human retinal detachments may significantly influence the degree of visual recovery after retinal reattachment, especially in retinae detached for more than a few days.     

Cell adhesion molecules in subretinal fluid: Soluble forms of VCAM-1 (vascular cell adhesion molecule-1) and L-selectin

Purpose: In this study we investigated the presence of soluble VCAM-1 and soluble L-selectin-1 in subretinal fluids (SRF) of patients suffering from rhegmatogenous retinal detachment . Method: Subretinal fluids were collected from drainage sclerotomies during surgery from 27 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR) or uncomplicated retinal detachment. Levels of sVCAM-1 and sL-selectin-1 were quantified with ELISA. Results: The mean ± SEM values of sVCAM-1 and sL-selectin-1 were 222.2 ± 81 ng/ml and 171.7 ± 42.1 ng/ml, respectively. The concentrations of sVCAM-1 in patients with Grade C PVR (498.2 ± 170 3 ng/ml) were significantly different from those with Grade B PVR (45.6 ± 16.5 ng/ml) and uncomplicated retinal detachments (19.4 ± 12.3 ng/ml). SVCAM-1 concentration in detachments which had been present for more than 8 weeks was 738.8 ± 431 ng/ml, significantly higher than the levels in detachments of shorter duration (132.4 ± 47.7 ng/ml). sL-selectin-1 level in Grade C PVR (291.6 ± 92.8 ng/ml) was higher than in uncomplicated retinal detachments (72.8 ±13.5 ng/ml). Significantly elevated levels of sL-selectin-l were observed in detachments lasting more than 8 weeks (605 ± 151.1 ng/ml) compared to those of shorter duration (96.3 ± 13.1 ng/ml). Conclusion: The present study supports growing evidence that these cell adhesion molecules are involved in the inflammatory process during the development and progression of PVR. This revised version was published online in July 2006 with corrections to the Cover Date.     

Apoprotein A and A-I profiles in subretinal fluid

Previous reports have described the presence of apoproteins A in subretinal fluid (SRF). We studied the presence of total apoprotein A (apo A) and apoprotein A-I (apo A-I), using the method described by Laurel in SRF and its levels in serum in 20 patients with retinal detachment. By this method we can quantify the concentrations of apoproteins in SRF. All cases showed the presence of these apoproteins in SRF. The mean ±standard deviation obtained was 78.7±26.94 mg/dl and 173.35±30.08 mg/dl for total apo A in SRF and serum respectively. For apo A-I these values were 32.62 ± 14.36 mg/dl in SRF and 123.4 ± 24.11 mg/dl in serum. We found no correlation between levels of total apo A and apo A-I in SRF and its levels in serum. Statistical differences were found between apo A-I content in SRF from detachments with the size of 3 quadrants and that of 1 and 2 quadrants but not between 3 and 4 quadrants. When the detachment affected 1 and 2 quadrants the concentrations of apo A-I were statistically lower. No statistical differences were found between concentrations of total apo A and apo A-I in SRF and the duration or presence of PVR in the detachments. These findings suggest that the outer blood retinal barrier is preserved during rhegmatogenous retinal detachment.     

Apoprotein B in subretinal fluid

We studied the presence of apolipoprotein B (apo B) by immunoelectrophoresis in subretinal fluid (SRF) and serum from 15 rhegmatogenous retinal detachments and 5 retinal detachments with proliferative vitreoretinopathy (PVR). Apo B concentration ± standard deviation was 1.49 ± 1.06 mg/dl in SRF and 108.41 ± 40.22 mg/dl in serum. Only in four cases was apo B not detected in SRF. We found no significant correlation between apo B concentrations in SRF and apo B levels in serum. We did not find a positive correlation between apo B concentrations in SRF and the duration and size of the detachments. There was no statistical relationship between the presence of PVR and apo B levels. This phenomenon suggests the preservation of the outer blood retinal barrier during rhegmatogenous retinal detachment.     

不放液巩膜外加压治疗视网膜脱离手术的适应证探讨

目的 探讨不放液巩膜外加压治疗视网膜脱离手术的适应证.方法 回顾分析83例(85只眼)增生性玻璃体视网膜病变﹙proliferative vitreoretinopathy,PVR)C2级以下孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)行不放液的巩膜外加压术临床资料,分析视网膜解剖复位率、术后视力和手术并发症.83例患者术后随访时间3～48个月,平均9.2个月.结果视网膜复位79只眼,手术成功率为92.9%.PVRA级、B级、 C1级及 C2级视网膜复位率比较其差异无统计学意义(P>0.05).手术并发症为3.5%,术后视力进步73只眼,占85.9%.结论 只要掌握好手术的适应证,不放液的巩膜外加压手术成功率高,手术并发症少,术后视力恢复快,适合于非复杂性视网膜脱离.     

Opsin distribution and protein incorporation in photoreceptors after experimental retinal detachment.

The distribution of opsin was examined immunocytochemically after experimental retinal detachment in adult cats. Retinal detachments were produced by injecting fluid between the retinal pigment epithelium and neural retina. One to 60 days later the animals were killed. Tissue areas from detached and attached retinal regions from the eye with the detached retina, as well as normal (control) retinas, were processed for post-embedding light and electron microscopic immunocytochemistry. In normal and attached retinal regions, anti-opsin labeled the outer segments and Golgi apparatus most heavily, although the entire photoreceptor plasma membrane was labeled at a low level. Beginning at 2 days after retinal detachment, immunolabeling increased in the photoreceptor inner segment, cell body and synaptic terminal plasma membranes. This pattern of anti-opsin labeling continued at all intervals up through the 60-day detachment time-point. Injection of radiolabeled amino acid in detachments from 1 to 30 days show that radiolabeled protein is still transported to the truncated outer segments of the photoreceptor cells. In addition, these outer segment disks label with anti-opsin. These data imply that opsin continues to be transported and incorporated into the outer segments of photoreceptors showing severe degeneration as a result of long-term detachment from the RPE.     

Retinal detachment in the cat: the pigment epithelial-photoreceptor interface

Twenty-six cat retinae were surgically detached by injecting fluid into the subretinal space (SRS). The retinae were then studied by light and electron microscopy at detachment intervals ranging from 1/2 hr to 14 months. Degenerative and proliferative changes occur at the retinal pigment epithelial (RPE)-photoreceptor interface very soon after detachment, and the severity of these changes depends upon both the duration and height of the detachment. The specialized apical RPE processes that ensheath the outer segments are replaced by a uniform fringe of short, undifferentiated processes. The apical RPE surface becomes mounded, and this mounding becomes more pronounced at longer detachment durations. Labeling experiments with 3H-thymidine showed that some cat RPE cells enter a phase of stimulated DNA synthesis 12-24 hrs after detachment; RPE mitotic figures are first apparent 48 hrs after detachment. In the cat, discrete regions of proliferated RPE cells usually appear in one of several configurations. A number of different cell types, including polymorphonuclear neutrophils, monocytes at various maturational stages, photoreceptor cells, Müller cells, and RPE cells, appear in the expanded SRS of detached retinae. Rod and cone outer segments degenerate rapidly and become membrane bound sacs by 3 days postdetachment; the assembly of new outer segment membrane apparently does not stop completely even at moderately long detachment intervals (ie, 2 months). Degenerative changes in the inner segments do not take place with the same rapidity as those in the outer segments. The changes that occur at the RPE-photoreceptor interface are rapid, progressive, and sometimes irreversible events that have significant implications for photoreceptor recovery following retinal reattachment surgery.     

巩膜外垫压术治疗孔源性视网膜脱离215例的临床观察

目的:观察巩膜外垫压术对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效.方法:选取2008-05/2014-05在我院接受巩膜外垫压术治疗RRD的215例215眼患者的临床资料进行回顾性研究和分析.所有纳入研究的患眼必须达到确诊RRD的标准且增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)评级均在B级及以下.所有患眼术中均在双目检眼镜直视下行裂孔定位及巩膜外冷凝.随访至少2mo,术后观察视网膜的解剖复位、术后视力、术后并发症.结果:术中行视网膜下液(subretinal fluid,SRF)引流者107眼(49.8%),82眼(38.1%)在手术结束时向其玻璃体腔注入无菌空气.接受单次巩膜外垫压术达到视网膜解剖复位并随访2 mo以上无复发者196眼(91.2%),视网膜未能Ⅰ期复位者19眼(8.8%).与术前相比较,术后视力提高192眼(89.3%),视力不变14眼(6.5%),视力下降9眼(4.2%).没有因SRF引流和玻璃体腔注入无菌空气而产生相关并发症.发生手术相关并发症的患眼共有11眼(5.1%).结论:巩膜外垫压术治疗RRD安全有效,准确的裂孔定位及裂孔与垫压嵴的关系是手术成功最重要的因素.     

Retardation of photoreceptor degeneration in the detached retina of rd1 mouse

PURPOSE: To study the neuroprotective effect of experimental retinal detachment (RD) on photoreceptor degeneration in rd1 mice. METHODS: RD was produced in the eyes of rd1 mice at postnatal day (P) 9. These eyes were collected and compared to controls without RD. The effects of RD on retinal degeneration were evaluated by histochemical staining of nuclei in the outer nuclear layer (ONL), rod and cone photoreceptors, and retinal vessels at P30 in retinal sections and flatmounts. Apoptotic photoreceptors were detected by TdT-mediated dUTP nick-end labeling (TUNEL) at P15. Mice with or without RD were also reared in darkness and evaluated immunohistochemically at P30. RESULTS: The numbers of rhodopsin-positive (rod), peanut agglutinin-positive (cone), and diamino-2-phenyl-indol-stained (rod-plus-cone) cells in the ONL were increased by 2.0-fold, 1.3-fold, and 1.2-fold, respectively, in the rd1 eyes with RD compared to those without RD at P30. In the detached retina, the cone photoreceptor inner/outer segment structures and the deep retinal vessels surrounding the inner nuclear layer and the ONL, but not the ganglion cell layer, were preserved. At P15, TUNEL-positive cell numbers in the ONL were significantly reduced in the eyes with RD. Light exposure had no effect on photoreceptor degeneration in the eyes with or without RD. CONCLUSIONS: RD mediates the preservation of cone and rod photoreceptors in the ONL and surrounding vascular structures by reducing the rate of apoptosis of photoreceptors in rd1 mice. Light deprivation does not appear to be one of the mechanisms of photoreceptor protection in the detached retinas in these mice.     

Macular function of successfully repaired macula-off retinal detachments

PURPOSE: To assess the macular function of successfully repaired macula-off retinal detachments in the long term and to evaluate the relationship between duration of macular detachment and functional recovery. METHODS: Of 214 consecutive patients, 29 who were operated on because of unilateral retinal detachment with at least 6 months of follow-up and whose best-corrected visual acuity was better than 0.05 Snellen chart value in both eyes were examined. Operated eyes were included in group I, and the fellow eyes were included in group II. Macular functions were evaluated in terms of visual acuity, contrast sensitivity, color vision, visual field, and visual evoked potentials after reattachment. RESULTS: All macular functions except P100 amplitudes in the operated eyes were significantly less than those in the fellow eyes (P = 0.28) following reattachment after nearly 5 years. It was found that the longer the duration of macular detachment (except detachment duration of < or = 7 days), the smaller the increase in visual acuity, contrast sensitivity, and color vision defect scores (P = 0.000, P = 0.034, and P = 0.0003, respectively). CONCLUSIONS: Macular functions except P100 amplitude cannot be recovered completely 5 years after retinal reattachment. There was no relation between the duration of macular detachment and the mean deviation in visual field and the P100 latency and P100 amplitude difference between both eyes.     

Cone photoreceptor recovery after experimental detachment and reattachment: an immunocytochemical,morphological, and electrophysiological study

PURPOSE: To compare the morphologic and functional recovery of the retina after detachment and reattachment in an animal with a cone-dominant retina, the ground squirrel. METHODS: Ground squirrel (Spermophilus beecheyi) retinas were detached for 1 day and reattached for 7, 35, or 96 days (n = 2, each time point). Flicker ERGs were recorded 1 day after the detachment and at various times after reattachment. Contrast-response functions were measured for isochromatic modulation and for selective modulation of short-wavelength-sensitive (S) and middle-wavelength-sensitive (M) cones. At the end of the experiment, retinas were prepared for light microscopy or immunocytochemical staining with antibodies to rod opsin, S and M cone opsins, cytochrome oxidase, synaptophysin, glial fibrillary acidic protein (GFAP), cellular retinaldehyde-binding protein (CRALBP), interphotoreceptor-binding protein (IRBP), and peanut agglutinin lectin (PNA). Photoreceptor density maps were created from wholemount preparations labeled with biotinylated PNA and anti-S cone opsin. Cell counts of photoreceptor nuclei and cone outer segments (OS) were compared with flicker ERG data. Cell death was examined by the TUNEL method. RESULTS: Reattachment stopped photoreceptor cell death and reversed the disruption of interphotoreceptor matrix as well as the redistribution of Müller cell proteins. It also activated some astrocytes based on anti-GFAP staining. S- and M-cone OS showed a gradual recovery in length after reattachment, and this recovery continued to the longest time points examined. ERG contrast gains also recovered after reattachment, but these reached asymptotic levels by approximately a week after reattachment. There were significant correlations between outer nuclear layer (ONL) cell counts and ERG contrast gains. No differences were noted in the indices of recovery of M and S cones. CONCLUSIONS: The ERG can be used to follow specifically the changes in the retina that occur after retinal detachment and reattachment.     

累及黄斑的视网膜脱离巩膜扣带术后中心凹显微结构及视力变化

目的 应用高清频域光学相干断层扫描(SD-OCT)~察累及黄斑的视网膜脱离扣带术前后黄斑中心凹的显微结构变化,评估其对术后最佳矫正视力(BCVA)的影响.方法 回顾性研究分析22例一次性手术成功的累积黄斑的视网膜脱离患者的资料,术前及术后1月,3月应用SD-OCT观察中心凹显微结构变化,测量黄斑脱离高度及外核层(ONL)厚度.结果 22例患者术后1月13例(59%)有黄斑下积液.发病年龄、术前ONL厚度与术后BCVA不相关,而病程、术前视力、黄斑脱离高度、脱离范围、术后ONL厚度及术后有无黄斑积液均与术后BCVA显著相关(P=0.046,0.0001.0.0007,0.036.0.01 1.0.002).术后有黄斑积液眼与无黄斑积液眼术后视力差异有统计学意义(u=25,P相似文献   

累及黄斑的视网膜脱离巩膜扣带术后中心凹显微结构及视力变化

目的 应用高清频域光学相干断层扫描(SD-OCT)~察累及黄斑的视网膜脱离扣带术前后黄斑中心凹的显微结构变化,评估其对术后最佳矫正视力(BCVA)的影响.方法 回顾性研究分析22例一次性手术成功的累积黄斑的视网膜脱离患者的资料,术前及术后1月,3月应用SD-OCT观察中心凹显微结构变化,测量黄斑脱离高度及外核层(ONL)厚度.结果 22例患者术后1月13例(59%)有黄斑下积液.发病年龄、术前ONL厚度与术后BCVA不相关,而病程、术前视力、黄斑脱离高度、脱离范围、术后ONL厚度及术后有无黄斑积液均与术后BCVA显著相关(P=0.046,0.0001.0.0007,0.036.0.01 1.0.002).术后有黄斑积液眼与无黄斑积液眼术后视力差异有统计学意义(u=25,P相似文献