| Objective:In this study,we intend to analyze the correlation between microcirculation and microstructural changes and changes in visual function in the macular area after retinal reduction of the subjects,and analyze the correlation between microcirculation and microstructural changes and changes in visual function in the macular area through microscopic visual field examination,so as to provide indicators for predicting postoperative visual function for RRD patients.Methods:In this study,30 patients with rhegmatogenous retinal detachment(RRD)involving the macular region were selected to have 30 eyes,and the opposite healthy eye was set as the control group and the affected eye was set as the experimental group.All patients underwent transciliary plana vitrectomy(PPV)with silicone oil filling.After six months after surgery,the best corrected visual acuity(BCVA)examination was performed using the international standard visual acuity chart before surgery,3 months after silicone oil injection and 3 months after silicone oil removal,and the examination results were converted into Log MAR visual acuity and recorded.Optical coherence tomography angiography(OCTA)was used to scan the retina in the macular area by 6mm×6mm,and the built-in software was used to measure the area and morphological index of the foveal avascular zone area(FAZ)of the superficial capillary macular macular area of the retina.microcirculation in the macular region such as retinal vessel densities of the superficial capillary plexus(VSCP)and retinal perfusion densities of the superficial capillary plexus(PSCP);Optical coherence tomography(OCT)was used to examine the macular fovea and record the presence of submacular fluid(SMF),Epiretinal Membranes(ERM),cystoid macular edema(CME),and macular hole,MH),retinal fold(RF),and microstructural changes in the macular region such as ellipsoid zone(EZ)and external limiting membrane(ELM)continuity disruption;The mean sensitivity(MS)and focal stability(FS)of the macular area were examined using the MP-3microscopic meter.Results:1.A total of 30 patients with 30 eyes involving macular RRD were included in this study,including 21 males(70.0%)and 9 females(30.0%).The average age of the patients was 53.60±9.78 years,the course of disease was 5.90±2.88 months,the best corrected visual acuity in Log MAR before surgery was 1.09 ± 0.46,and all patients were anatomically reduced to retinal after PPV surgery,and there were no complications such as secondary endophthalmitis,secondary glaucoma,and severe proliferative vitreoretinopathy;2.Changes in visual function: 3 months after silicone oil removal,the final BCVA(Log MAR)increased from 1.301(1.000-1.699)before surgery to 0.301(0.222-0.602),and the difference was statistically significant(P<0.01).MS decreased significantly in the contralateral eye(P<0.01)3 months after silicone oil injection,and gradually increased after silicone oil removal(P<0.01),but still lower than that in contralateral eye(P<0.01).There was no significant change in the stability of fixed vision in 3 months after silicone oil injection and 3 months after silicone oil removal compared with the contralateral eye,and there was no significant difference between3 months after silicone oil removal and 3 months after silicone oil injection;3.Microcirculation changes in macular area: the area of the superficial macular fovea(FAZ)of the retina was enlarged compared with the contralateral eye in patients with RRD 3 months after silicone oil injection,and the difference was statistically significant(P<0.01),which gradually decreased after silicone oil removal,but was still larger than that of the contralateral eye(P<0.01).The FAZ morphological index was significantly smaller than that of the contralateral eye in 3 months after silicone oil injection,and the difference was statistically significant(P<0.01),which gradually increased after the silicone oil was removed,but finally it was still smaller than that of the contralateral eye(P<0.01).The difference between Macular PSCP and VSCP was significantly smaller than that of the contralateral eye in 3 months after silicone oil injection(P<0.01),and increased significantly after silicone oil removal(P<0.01),and finally there was no significant difference from the contralateral eye(P>0.05);4.Microstructural changes in the macular area: at the time of silicone oil injection at 3 months,5 patients developed SMF,1 patient developed ERM,1 patient developed CME,21 patients developed EZ fracture,and 14 patients developed ELM fracture;At 3 months of silicone oil removal,3 patients developed SMF,1 patient developed ERM,1 patient developed CME,11 patients developed EZ rupture,and 5patients developed ELM rupture.Three months after silicone oil was removed,the incidence of SMF decreased compared with that in 3 months after silicone oil injection,the incidence of ERM and CME remained unchanged,and the incidence of continuous fracture of EZ and ELM decreased significantly;5.Correlation analysis between microcirculation changes,microstructure changes and visual function in macular area of patients with RRD after PPV surgery:BCVA(Log MAR)was correlated with the continuity of FAZ area,PSCP,VSCP,ellipsoidal and outer membrane at 3 months after silicone oil removal(r=0.368,-0.489,-0.493,-0.705,-0.656,P<0.05),but there was no obvious correlation with FAZ morphology index and whether SMF,ERM and CME occurred(r=-0.192,0.311,0.043,0.043,P>0.05);MS was correlated with the continuity of FAZ area,PSCP,VSCP,ellipsoidal and outer membrane(r=-0.426,0.625,0.577,0.676,0.627,P<0.05),but there was no significant correlation with FAZ morphology index and whether SMF,ERM and CME occurred(r=0.234,-0.096,-0.236,-0.236,P>0.05),and fixed visual stability was correlated with the continuity of VSCP,ellipsoid and outer membrane(r=0.419,0.402,0.280,P< 0.05),but not significantly correlated with FAZ area,FAZ morphology index,PSCP,and whether SMF,ERM,or CME occur(r=-0.250,0.024,0.352,0.108,0.168,0.168,P>0.05).There was a negative correlation between blood flow density PSCP and VSCP and FAZ area in macular area(r=-0.557,-0.583,P<0.01).Conclusion:1.FAZ area and continuity of EZ and ELM can predict changes in postoperative visual function in patients with RRD;2.The negative effect of silicone oil on the blood flow density of superficial capillaries of the retina completely disappeared 3 months after silicone oil removal. |
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