| Objective:The purpose of this study was to observe the changes of retinal and choroid structure and blood flow after the surgery of Rhegmatogenous retinal detachment(RRD),and to explore the correlation between various indexes and visual acuity recovery.Methods : This topic adopts the method of prospective research.The patients diagnosed with simple Rhegmatogenous retinal detachment in a hospital from March to November 2022 were selected,and the surgical methods were divided into vitrectomy(PPV)and scleral clasp(SB)according to the location and number of holes and the extent of mesh detachment.A total of 36 patients(n=36 eyes)were included in this study,which were divided into 20 patients(n=20 eyes)in PPV group and 16 patients(n=16 eyes)in SB group according to the surgical method.All patients in PPV or SB group were observed,and the contralateral healthy eye was used as control group.Collect the basic information of the patient,including name,gender,age,course of disease,number of hiatus,whether the detachment involved macular area,etc.All the selected patients underwent the Best corrected visual acuity(BCVA),Intraocular pressure(IOP),anterior and posterior segment examination under slit lamp,Ultra-wide Angle fundus photography,Optical coherence tomography(OCT),and Optical coherence tomography angiography(OCTA)during preoperative and postoperative follow-up.BCVA and IOP,the thickness of optic disc Retinal nerve fiber layer(RNFL),the thickness of Central macular thickness(CMT),the thickness of Subfoveal choroidal thickness(SFCT),the height of Submacular fluid(SMF),the Superficial retinal capillary plexus(SCP),the Intermediate retinal capillary plexus(ICP),and the Deep retinal capillary plexus(DCP)were recorded before and after surgery,the Vessel density(VD)of the Choroidal capillary plexus(CCP)and the area of Foveal avascular zone(FAZ).The RNFL thickness of the optic disc,the microstructure and microcirculation of the retinochoroid in the macular area were analyzed before and after surgery,and the correlation with visual acuity was discussed.In this study,SPSS26.0 statistical system was used for statistical analysis of the collected patient data.Results:1.BCVA: BCVA in the PPV and SB observation groups was gradually improved at each time point before and after operation,and the difference was statistically significant(P<0.05),there were significant differences in BCVA between the observation group and the control group at the same time point(P<0.05).2.Retinal choroid blood flow density in macular area :The blood flow density of SCP,ICP,DCP and CCP in the PPV and SB groups was gradually improved,and the variance analysis showed statistical difference(P<0.05);Compared with the control group,there were statistically significant differences in VD in the observation group at multiple follow-up time points(P<0.05).3.FAZ area:PPV group: The FAZ area of the observation group gradually improved in each postoperative period,and the variance analysis showed statistically significant differences(P<0.05);Compared with the control group,the area at each time point after FAZ operation was statistically different(P<0.05).SB group: There was no statistical significance in the variance analysis of FAZ area between the observation groups(P>0.05);Postoperative(1w,1m)and control group were statistically different(P<0.05).4.Integrity of ELM and EZ: PPV group: postoperative(1w,1m,3m,4m,6m)EZ and postoperative(1w,1m)ELM integrity in observation group were statistically significant compared with control group(P<0.05).SB group: The integrity of ELM and EZ in the observation group was significantly different from that in the control group at 1w after operation(P<0.05).5.CMT,SFCT,SMF in macular region: PPV group: there were statistically significant differences in variance analysis of CMT at multiple time points in the observation group(P<0.05),compared with the control group,there were statistical differences before and after surgery(1m,3m,4m,6m)(P<0.05);There was no significant difference in SFCT between the observation group and the control group at all time points(P>0.05).SB group: The variance analysis of CMT at multiple time points in the observation group was statistically significant(P<0.05),the CMT of the control group was significantly different before and at 1w after surgery(P<0.05).There was no significant difference in SFCT between the observation group and the control group at each time point(P>0.05),the postoperative 3m was significantly different from the control group(P<0.05).The variance analysis of SMF at multiple time points in the observation group obtained(P<0.05),the difference of 3m SMF height before and after surgery was statistically significant(P<0.05).6.Thickness of optic disc Retinal nerve fiber layer(RNFL): There was no significant difference in variance analysis of RNFL data between PPV and SB observation group at each time point(P>0.05),there was no statistical significance in RNFL at each time point compared with the control group(P>0.05).7.Correlation analysis: PPV group: choroid blood flow density,ELM、EZ were positively correlated with BCVA;Preoperative visual acuity,preoperative CMT and postoperative 6m BCVA were correlated(r=0.734、-0.517,P<0.05).SB group: retinal chorioid blood flow density,ELM、EZ were positively correlated with BCVA,and preoperative visual acuity was positively correlated with postoperative 6m BCVA(r=0.753,P=0.001).Conclusions:1.RRD can cause damage to retinal choroid blood flow in macular area,thickening of CMT,occurrence of SMF,destruction of ELM and EZ integrity.2.Both PPV and SB are effective treatments for RRD,and postoperative visual acuity,microstructure and microcirculation of retinal choroid in macular area are improved compared with those before surgery.3.Visual acuity recovery after RRD surgery was positively correlated with macular blood flow,ELM and EZ integrity,and was more significantly correlated with EZ. |
PDF Full Text Request