| Objective: Optical coherence tomography angiography(OCTA)was used to study the changes of Optic nerve head and macular blood flow after scleral buckling for macula-off rhegmatogenous retinal detachment(RRD)and the factors that may affect the changes of blood flow,and to investigate its correlation with visual prognosis.Methods: This study is a clinical follow-up study.Patients with unilateral RRD who visited the Department of Ophthalmology of the Second Hospital of Lanzhou University from September 2019 to November 2020 were collected,with the affected eye as the observation group and the fellow eye as the control group.A total of 35patients(35 eyes)with RRD were included in this study,and all included patients underwent one minimal scleral buckling(MSB).The follow-up study was performed at 1 week,1 month,3 months,6 months and 1 year after operation.The best corrected visual acuity(BCVA),intraocular pressure(IOP),optical coherence tomography(OCT)and OCTA of the affected eye were measured at each follow-up.The fellow eye served as the control.According to the duration of follow-up,the observation group was divided into those with follow-up of 1 month,6 months and 1 year,respectively,for analysis,including 35 cases with postoperative follow-up of 1 month,24 cases with follow-up of 6 months and 9 cases with follow-up of 1 year.The changes of vascular density(VD),perfusion density(PD)and foveal avascular area(FAZ)area and perimeter of superficial retinal capillary plexus in optic nerve head and macular after operation in the follow-up period were observed.The changes of BCVA,IOP,foveal sensory retinal thickness and submacular fluid(SMF)were also observed.The correlation between IOP,SMF,foveal sensory retinal thickness and various vascular parameters was analyzed.The main factors that may be related to the final visual acuity were explored.Result: There was no significant statistical difference in macular vascular parameters between the observation group and the control group at 1 week,1 month and 1 year after operation(P>0.05),but the macular VD and PD in the observation group were significantly lower than those in the control group at 3 months and 6months after operation(P<0.05).In the observation group,the VD and PD of the macula gradually decreased from 1 week to 6 months after surgery and tended to be stable from 6 months to 1 year,with no significant change in FAZ area and perimeter.There was no correlation between IOP,SMF and the vascular parameters of the macula at 1 week,1 month,3 months,and 6 months after surgery(P>0.05).The foveal sensory retinal thickness was positively correlated with macular VD and PD(P<0.05)and negatively correlated with FAZ area(P<0.05)at 1 week after operation.There was no correlation between foveal sensory retinal thickness and macular vascular parameters at 1 month,3 months and 6 months after operation(P>0.05).There was no significant statistical difference in optic nerve head vascular parameters between the observation group and the control group at each follow-up time point(P>0.05).There was no correlation between IOP,SMF,foveal sensory retinal thickness and optic nerve head vascular parameters at 1 week,1 month,3 months and6 months after operation(P>0.05).The BCVA at each follow-up time point was higher than that before operation,and the difference was statistically significant(P<0.05).The BCVA gradually improved from 1 week to 6 months after operation,and there was no statistical difference between 6 months after operation and 1 year after operation(P>0.05).Therefore,the visual acuity at 6 months was used as the endpoint for regression analysis.Univariate analysis identified several factors significantly associated with postoperative BCVA at 6 months after surgery.Preoperative BCVA(P<0.05),VD and PD in the central area of 1 × 1 mm of the macula(P<0.05),FAZ area and perimeter(P<0.05),and foveal sensory retinal thickness(P<0.05)were associated with postoperative BCVA at 6 months.However,in the multivariate analysis,only FAZ perimeter and preoperative BCVA were significantly associated with final BCVA(P<0.05).The IOP at each time point after surgery was not statistically different from the IOP before surgery(P>0.05).The foveal sensory retinal thickness in the observation group was lower than that in the control group at 1 week and 1 month after operation(P<0.05),and there was no significant difference between the observation group and the control group at 3months,6 months and 1 year after operation(P>0.05).SMF decreased significantly from 1 week to 1 month,1 month to 3 months,and 3 months to 6 months after operation,with statistical significance(P<0.05),and there was no statistical difference between 6 months and 1 year after operation(P>0.05).Conclusion: 1.After reattachment of the retina by MSB in patients with RRD,macular vascular parameters gradually decreased from 1 week to 6 months after surgery and tended to stabilize from 6 months to 1 year.Optic nerve head vascular parameters did not change within 1 year after surgery.2.Visual acuity gradually improved in eyes with RRD after retinal reattachment by MSB,and final visual acuity was significantly correlated with FAZ perimeter and preoperative visual acuity.3.After long-term observation,it was found that MSB surgery had no significant effect on IOP in the affected eye with RRD.4.After MSB for macula-off RRD,some patients had retained SMF,which was gradually absorbed during the 1-year postoperative period. |
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