巩膜扣带手术后视物变形的原因分析

目的 探讨巩膜扣带手术后视网膜复位患者视物变形的原因。 方法 对巩膜扣带手术后视网膜成功复位的79例79只眼行临床观察，手术后2周、2、6个月及1年时行Amsler表检查，分为视物变形组和无视物变形组；同时行检眼镜、荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）检查。并对手术后2周视物变形10只眼和正常人10只眼行视盘-中心凹角测量。 结果 79只眼手术后2周51只眼（64.56%）视物变形，视物变形眼和正常眼的视盘-中心凹角无明显差异(P=0.880)。79只眼中44只眼(视物变形组35只眼，无视物变形组9只眼) 手术后2周时检查OCT和FFA ，视物变形组OCT发现黄斑结构异常31只眼(88.57%)，有7种类型，主要为神经上皮层脱离（74.29%）；FFA发现黄斑结构异常6只眼(17.14%)，也主要为神经上皮层脱离(66.67%)。无视物变形组OCT发现神经上皮层脱离和色素上皮层脱离各1只眼，FFA未见异常。手术后2、6个月、1年时随访，各有18只眼（18/28）、5只眼(5/9)和3只眼(3/7)异常黄斑结构好转，视物变形减轻或消失；而黄斑前膜形成后未见明显变化，视物变形严重而持续。 结论 巩膜扣带手术后视物变形的主要原因是黄斑结构异常，手术后早期和晚期视物变形的主要原因分别是神经上皮层脱离和黄斑前膜。（中华眼底病杂志，2004，20：94-97）

Clinical observation of the causes of metamorphopsia after scleral buckling surgery

Objective To evaluate the causes of the metamorphopsia in patients with reattached retina after scleral buckling surgery. Methods Amsler grid test, ophthalmoscopic examination, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed on 79 patients (79 eyes) with reattached retina at the 2nd week, 2nd, 6th month and 1st year after scleral buckling operation. Results Two weeks after the operation, 51 patients (51 eyes, 64.56%) complained of metamorphopsia, and 44 patients (44 eyes, including 35 with and 9 without metamorphopsia) were examined by OCT and FFA. In patients with metamorphopsia, the results of OCT in 31 (88.57%) revealed abnormal macula with seven kinds consisting mostly of stratum neuroepithelium detachment (74.29%), while of FFA in 6 patients showed abnormal macular (17.14%) including 4 with neuroepithelium detachment (66.67%). In patients without metamorphopsia, abnormal macula could be found in 2 by OCT while nothing special was seen in FFA. Most abnormal macula in patients followed-up 2 months, 6 months and 1 year postoperatively meliorated as time went by, with alleviative or disappeared metamorphopsia; while the patients with persistently existing macular membrane had aggravating metamorphopsia. Conclusions Abnormal macula is the main reason for metamorphopsia after scleral buckling surgery. Neuroepithelium detachment and macular membrane are the main causes of metamorphopsia at the early and terminal stage after operation.