| Objective:To investigate the correlation between the changes of retinal microstructure and visual function in the adolescent rhegmatogenous retinal detachment(RRD).Methods:Prospective clinical studies were used.The object of this study was a total of 75eyes,aged 15 to 30,of adolescent patients with porogenic retinal detachment involving macular degeneration.There were 39 males(39 eyes)and 36 females(36eyes).All patients have proliferative vitreoretinopathy(PVR)grades B-C1.The patients were divided into two groups according to the surgical method:the anterior equatorial fissure was treated with pars plana vitrectomy(PPV),with 35 eyes in 35cases.The posterior equatorial fissure was performed by scleral buckling(scleral buckling,SB),a total of 40 cases(40 eyes.LogMAR,optic coherence tomography(OCT),multifocal electroretinogram(mfEGR)were performed 1 day before surgery,1 month,3 months and 6 months after surgery.The thickness of the retinal epidermis,the outer nuclear layer and the multiple focal retinal currents were recorded in macular fovea.The changes of OCT retinal microstructure and mERG in two groups were analyzed.Results:1.Patients in SB group and PPV group were of age(22.25±5.61,23.77±5.05),gender(male/female 21/19,18/17)and refractive state(yes/no 21/19,18/17)),time of onset(13.15±8.60,12.23±7.78)day,preoperative visual acuity(0.69±0.22,0.77±0.26)(logMAR),thickness of the superior cortex(129.12±35.18,137.07±47.08)?m,and thickness of the outer nuclear layer(91.35±33.73,84.77±26.83)?m showed no significant difference(P>0.05).2.BCVA changes:the postoperative visual acuity of SB group was better than that of PPV group,with statistical difference(P=0.03).In the SB group,BCVA was gradually increased,and the BCVA(logMAR)at 1 month,3 months and 6 months after surgery were(0.64±0.24),(0.58±0.23)and(0.49±0.23),respectively,with statistical difference(P<0.05).BCVA(logMAR)of PPV group was(0.75±0.27),(0.71±0.26)and(0.67±0.28),respectively,with statistical difference(P<0.05).3.Changes in retinal thickness:Between the two groups:the thickness of the superior cortex of the fovea macula increased gradually to the normal value(154.53±8.45)?m,and the difference was statistically significant.The thickness of the outer nuclear layer gradually increased to the normal value(120.40±8.20)?m,the difference was not statistically significant.Within the group,the thickness of the superior cortex and outer nuclear layer of the fovea in SB group gradually increased:1 month after surgery(141.6±34.9),(88.7±26.4)?m,3 months(154.4±31.8),(94.93±25.6)?m,6 months(168.5±31.0),(102.63±24.7)?m,with statistical significance.In the PPV group,the thickness of the supraural cortex and outer nuclear layer of macular fovea was increased in the postoperative follow-up,with statistical significance at 1 month(127.6±29.4)?m,76.5±21.8)?m,3 months(137.2±31.3)?m,82.6±23.3)?m,6 months(144.9±32.1)?m,6 months(89.2±24.4)?m.4.IS/OS and ELM integrity changes:between groups:the integrity of IS/OS and ELM in the two groups recovered gradually after surgery,with statistically significant differences.Within the group:the number of postoperative IS/OS and ELM fractures in SB group decreased from 22 eyes in 22 cases 1 month after surgery,18 eyes in 18 cases 3 months after surgery,to 13 eyes in 13 cases 6 months after surgery.The number of postoperative IS/OS fractures in the PPV group decreased from 27 eyes in 27 cases 1 month after surgery,25 eyes in 25 cases 3 months after surgery,to 20 eyes in 20 cases 6 months after surgery.5.Subretinal effusion and interlaminar effusion:the incidence of postoperative subretinal effusion decreased in the two groups,SB group was more prone to subretinal effusion than PPV group,and the difference at 6 months after surgery was statistically significant.The incidence of interlaminar effusion decreased,and the difference was not statistically significant.The incidence of subretinal effusion and interlaminar effusion was 67.5%(27 cases)/17.5%(7 cases),50%(20 cases)/10%(4cases)and 25%(10 cases)/5%(2 cases)in SB group at 1,3 and 6 months after surgery,respectively.The incidence of subretinal effusion was 14.3%(5 cases)/14.2%(5 cases),20%(7 cases)/8.5%(3 cases)and 11.4%(4 cases)/2.8%(1 cases)in the PPV group at1,3 and 6 months after surgery,respectively.6.Changes in amplitude and incubation period of 1 cyclic P1 wave:the amplitude of 1 cyclic P1 wave in SB group was higher than that in PPV group after surgery,and the difference was statistically significant.The incubation period was longer than PPV group,and there was no statistical difference.7.Within the group:the amplitude of 1 ring P1 wave in SB group increased gradually after surgery,and reached the maximum value(82.52±21.49)nV/deg~2 6months after surgery,which was statistically significant compared with that at 3months and 1 month after surgery.The incubation period was prolonged without statistical significance.In the PPV group,the amplitude of P1 wave 6 months after surgery was(66.55±11.85)nV/deg~2,reaching the maximum value,which was statistically significant compared with the increase of amplitude 3 months and 1month after surgery.The incubation period was prolonged without statistical significance.Conclusions:1.The integrity of IS/OS and ELM,subretinal effusion,and the thickness of the superior cortex of macular fovea are the key factors affecting postoperative visual acuity.2.Within 6 months,scleral buckling had better visual recovery than vitrectomy;3.Optical correlation tomography and multifocal electroretinogram can objec-ively evaluate visual function recovery. |
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