| Objective: To compare the changes of the best corrected visual acuity and the retinal microstructure in macular on OCT images after pars plana vitrectomy with silicone oil implantation surgery or scleral buckling surgery for rhegmatogenous retinal detachment.Methods: This study was a retrospective study.The subjects were first diagnosed with rhegmatogenous retinal detachment involving macula in the Second Affiliated Hospital of Guangzhou Medical University from May 2018 to February2021,and their treatment were pars plana vitrectomy(PPV)combined with silicone oil implantation surgery or scleral buckling(SB)surgery.They were 45 to 70 years old,had a course of disease less than 2 months and their PVR were grade A or B.On the second day after surgery,the retinal detachment of all the affected eyes was anatomically restored and no recurrence occurred during their follow-up.In the PPV group,18 people(18 eyes)underwent silicone oil extraction surgery 2 months after PPV,when the retinal restoration was good and stable,and some of them with severe cataracts underwent phacoemulsification combined with intraocular lens implantation surgery 1 month after the silicone oil extraction surgery.There are 20 people(20 eyes)in SB group.Preoperative general information of patients was recorded: Gender,age,eye type,disease course,intraocular pressure,refractive status,Best corrected visual acuity(BCVA),Roliferative vitreoretinopathy(PVR)grade,etc.Optical coherence tomography(OCT)and other examination data in 1 week,1 months and 2 months after surgery also need: BCVA,Central macular thickness(CMT)and submacular fluid,SMF height,the average of ganglion cell layer-inner plexiform layer(GCL-IPL)thickness and the integrity of the ellippsoid zone(EZ)in the macular region.In addition,the PPV group also counted these data six months after surgery.This study mainly observed the recovery of BCVA,CMT,SMF height,average GCL-IPL thickness in macular area,and EZ integrity in macular in different periods after PPV or SB surgery.Results: Results: There were no significant differences in preoperative basic information between the two groups,such as gender,eye type,age,course of disease,number of hiatal holes,preoperative BCVA,PVR grade and the proportion of high myopia.1.The visual acuity of SB group was significantly better than PPV group at1 W,1Mo and 2Mo after surgery(P<0.05);The visual acuity at 6Mo in PPV group was similar to that in SB group at 2Mo(P>0.05);2.There was no statistically significant difference in the mean GCL-IPL thickness of macular between two groups at 1W postoperatively(P>0.05).In PPV group,the mean GCL-IPL thickness in macular before silicone oil removal surgery decreased with time,but the GCL-IPL thickness at 4 months after silicone oil removal surgery was significantly greater than that at 1W,1Mo and 2Mo after PPV(P<0.05).The mean GCL-IPL thickness in macular of SB group at 1W,1Mo and 2Mo after surgery increased with time.3.The incidence of SMF 1W after PPV was small(27.8%),and the incidence of SMF in SB group was as high as 90.0% at 1W after PPV,and the height of SMF decreased gradually with the extension of time.4.The CMT of SB group at 1W,1Mo and 2Mo was higher than that of PPV group(P<0.05),but there were no significant changes within groups(P>0.05);5.The residual length of the ellipsoid zone in the macular(with a diameter of 1500um)was divided into four grades.The postoperative EZ integrity level of macular in SB group was concentrated in grade 3 and grade 4,while in PPV group concentrated in the vicinity of grade 2,indicating that the postoperative EZ integrity level of macular in SB group was relatively good.The integrity of EZ in macular after PPV was poor.6.The mean GCL-IPL thickness and EZ integrity of macular were significantly correlated with visual acuity.Conclusion: 1.Both PPV and SB surgery were effective surgery for the treatment of RRD.2.Visual acuity recovery after SB surgery was faster,while visual acuity recovery after PPV surgery took longer time;3.The improvement of visual acuity in patients with RRD was significantly correlated with the recovery of GCL-IPL and EZ in macular;4.The recovery of GCL-IPL and EZ in macular of patients with RRD after SB surgery was faster than that of patients with PPV combined with silicone oil implantation surgery.5.The incidence of postoperative SMF was high in SB group,and it had an influence on CMT. |
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