| Purpose:To observe the changes of macular microstructure and retinal function after vitrectomy（PPV）combined with filtered air filling in the treatment of rhegmatogenous retinal detachment（RRD）,and to analyze the correlation between postoperative visual acuity and macular microstructure and retinal function.Methods:From January 2019 to September 2021,40 patients with rhegmatogenous retinal detachment were diagnosed in our department and met the inclusion criteria,including 25males（25 eyes）and 15 females（15 eyes）,with an average age of（55.93±9.19）years and an average disease course of（24±23.38）days,all patients underwent vitrectomy combined with filtered air filling.The surgery was performed by the same experienced fundus surgeon.According to whether the macular area was detached,the patients were divided into two groups:macular-on group and macular-off group,the postoperative follow-up time was≥6months,preoperative best corrected visual acuity（BCVA）（log MAR）was recorded.Spectal-domain optical coherence tomography（SD-OCT）and multifocal electroretinogram（mfERG）were performed on the patients at 1 week and 1,3,6 months after surgery.The central foveal thickness（CFT）and grade of external limiting membrane and ellipsoid zone in macular fovea were recorded,whether there was macular premembrane macular edema of subretinal fluid,and the amplitude density and latency of P1 wave N1 wave of mfEGR R1 ringwas recorded.The changes of BCVA CFT and mfERG measurements at different postoperative time points were compared between the two groups.The defect degree of ELM and EZ in macular-off group was analyzed.The correlation between BCVA and OCT measurements at different postoperative time points in the two groups was analyzed.The correlation between BCVA,OCT and mfERG measurements at 6 months after operation was analyzed.Result:1.Success rate of surgery:a total of 45 eyes met the inclusion criteria,of which 42 had good postoperative retinal reduction,and 3 had retinal detachment again,of which 2underwent secondary surgery with vitreous injection of oil to achieve retinal reduction;One patient refused the second operation.In this study,the success rate of one operation was93.33%.Among the 42 patients with retinal reattachment in one operation,2 patients were not followed up on time,and the follow-up data were not complete.Finally,40 eyes of 40patients were included in this study.2.General data:There were 29 patients in macular-on group,including 12 males（12eyes）and 17 females（17 eyes）,with an average age of（54.03±8.67）years and preoperative BCVA（log MAR）of（1.12±0.64）.Macular off group included 11 patients,5 males（5 eyes）and 6 females（6 eyes）,with an average age of（60.91±9.0）years and preoperative BCVA（log MAR）of（1.81±0.91）.The preoperative BCVA of macular-on group was better than that of macular-off group,and the difference was statistically significant（p<0.05）.There were no statistically significant differences in age,sex,eye size,course of disease,crystal state,number of involved quadrants,PVR grade,number of hiatus,size of hiatus and surrounding degenerative lesions between the two groups（p>0.05）.3.Postoperative BCVA changes:BCVA（log MAR）at 1 week,1 month,3 months and6 months were（1.14±0.52）,（0.68±0.29）,（0.54±0.29）and（0.41±0.22）respectively in macular off group,and postoperative visual acuity improved gradually,the difference was significant（p<0.001）.In macular-on group,BCVA（log MAR）was（0.78±0.31）,（0.55±0.21）,（0.35±0.22）and（0.28±0.15）at 1 week,1 month,3 month and 6 month after surgery respectively.Postoperative visual acuity improved gradually,and the difference was significant（p<0.001）.BCVA in the macular-on group was better than that in the macular-off group at different postoperative time points,the difference was statistically significant（p<0.05）,but there was no statistical significance in BCVA between the two groups 1 month after surgery（p>0.05）.4.Postoperative microstructural changes in macular area:postoperative microstructural abnormalities in macular area were as follows:epiretinal membranes,macular edema,subretinal fluid,ELM fracture and EZ fracture.In the macular-off group,macular edema and subretinal fluid were gradually absorbed with the extension of follow-up time,and the number of ELM fracture and EZ fracture gradually decreased,that is,ELM/EZ defect gradually improved,and the microstructural abnormalities in macular area were mostly several abnormalities simultaneously.The macular-on group only had a structural abnormality of the macular edema.5.Integrity change of ELMand EZ:The ELM defect degree in macular-off group was（0.82±0.87）,（0.73±0.79）,（0.55±0.69）,（0.18±0.41）at 1 week,1 month,3 month and 6 month after surgery in macular-off group,and the ELM defect degree decreased gradually and the difference was significant（p<0.01）.The average degree of EZ defect was（1.27±0.91）,（1.09±0.83）,（0.64±0.67）,（0.27±0.47）at 1 week,1 month,3 months and 6 months after operation.The degree of EZ defect gradually decreased and the difference was significant（p>0.001）.6.Changes in macular fovea retinal thickness（CFT）:The CFT values of macular-off group were（242.39±34.16）,（230.59±31.22）,（220.32±18.34）,（218.06±14.71）μm at 1 week,3 months and 6 months,respectively.The CFT values decreased gradually and the difference was significant（p<0.001）.The CFT values of macular group at 1 week,1 month,3 months and 6 months were（187.38±7.12）,（187.89±7.66）,（187.36±6.48）and（185.46±3.87）μm,respectively,and there was no significant difference（p>0.05）.The CFT value of macular off group was significantly higher than that of Macular on group at different postoperative time points（p<0.001）.7.Changes in amplitude density and latency of P1 wave in R1 ring:the mean amplitude density of P1 wave in macular-off group was（64.21±8.74）,（98.31±15.13）,（106.71±8.60）nv/dge~2 at 1,3 and 6 months after surgery,respectively.The average amplitude density of P1 wave at each time point in macular-on group was（99.76±6.85）,（108.22±4.32）,（112.41±3.96）nv/deg~2,respectively.The average amplitude density of P1 wave increased gradually in both groups,and the difference was significant（p<0.001）.The average amplitude density of P1 wave in macular-on group was significantly higher than that in macular-off group（p<0.001）.The mean latency of P1 wave in macular off group was（47.84±1.52）,（44.26±1.76）and（43.86±1.28）ms at 1,3 and 6 months after operation,respectively.The mean latency of P1 wave in macular-on group was（46.17±1.20）,（44.01±1.65）and（42.83±0.81）ms,respectively.The mean latency of P1 wave in both groups decreased gradually,and the difference was significant（p<0.001）.The mean latency of P1 wave in macular-on group was significantly lower than that in macular-off group（p<0.001）.8.Changes in amplitude density and latency of N1 wave in R1 ring:the average amplitude density of N1 wave in macular-off group was（37.69±7.69）,（49.16±3.78）,（53.94±3.25）nv/deg~2 at 1,3 and 6 months after surgery,respectively.The average amplitude density of N1 wave at each time point in macular-on group was（45.18±3.20）,（51.32±2.91）and（55.69±3.16）nv/deg~2,respectively.The average amplitude density of N1 wave in both groups increased gradually and the difference was significant（p<0.001）.The average amplitude density of N1 wave in macular-on group was significantly higher than that in macular-off group（p<0.001）.The mean latency of N1 wave in macular-off group was（28.70±2.30）,（28.12±2.20）,（27.45±0.54）ms at 1,3 and 6 months after operation,respectively.The average latency of N1 wave in macular-on group was（26.85±2.14）,（26.32±1.23）and（26.09±1.28）ms,respectively.The average latency of N1 wave in both groups decreased gradually,and there was no statistical significance（p>0.05）.The mean latency of N1 wave in macular-on group was significantly lower than that in macular-off group（p<0.001）.9.Correlation analysis:（1）Correlation analysis between BCVA and OCT measurements:There was no correlation between CFT and BCVA in macular-off group and macular-on group（p>0.05）.There was a positive correlation between ELM/EZ defect and BCVA in macular-off group（p<0.05）.（2）Correlation analysis between BCVA and ELM/EZ defects and mfERG parameters6 months after surgery:The defect degree of BCVA and ELM/EZ at 6 months after macular-off was negatively correlated with the amplitude density of P1 wave and N1 wave in R1 ring（p<0.05）,positively correlated with the latency of P1 wave（p<0.05）,but not with the latency of N1 wave（p>0.05）.In macular-on group,BCVA was negatively correlated with the amplitude density of P1 wave in R1 ring 6 months after surgery（p<0.05）,but had no correlation with the amplitude density and latency of P1 wave and N1 wave（p>0.05）.Correlation analysis between CFT values and mfERG parameters 6 months after surgery:there was no correlation between CFT values and amplitude density and latency of R1 ring P1 wave and N1 wave in both groups（p>0.05）.Conclusion:1.Vitrectomy combined with filtered air filling can effectively treat RRD with upper hiatus;2.With the passage of time,BCVA gradually increased after RRD postoperative,and the postoperative BCVA of patients in macular area was better than that of patients with macular area detachment at all postoperative time points;3.As time went by,the postoperative macular microstructure gradually improved,ELM/EZ defect degree was positively correlated with postoperative BCVA.4.With the passage of time,the amplitude density of P1 wave and N1 wave of mfERG R1 ring in RRD patients increased continuously,and the latency of P1 wave shortened continuously,and the amplitude density of P1 wave and N1 wave in macular-on group was higher than that in macular-off group.There was a positive correlation between BCVA and amplitude density of P1 wave 6 months after operation in macular-on group,and a positive correlation between BCVA and amplitude density of P1 wave and N1 wave 6 months after operation,and a negative correlation between BCVA and latency of P1 wave.5.The defect status of ELM/EZ was closely related to the electrophysiological function of retina.The ELM/EZ defect degree of the macular area detachment group 6 months after surgery was positively correlated with the amplitude density of P1 and N1 waves,and negatively correlated with the latency of P1. |
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