硅油填充后视力下降的原因分析

Analysis of the Causes of Vision Loss after Silicone Oil Tamponade

摘要: 目的：分析孔源性视网膜脱离玻璃体切除硅油填充术后不明原因视力下降(SORVL)的临床特征，探讨其发生机制。方法：回顾性分析在2019年1月~2023年6月在青岛大学附属医院眼科首诊为孔源性视网膜脱离(RRD)并且行玻璃体切除联合硅油填充术患眼293例，进行最佳矫正视力(BCVA)、OCT、静态视野、VEP、ERG等检查，并分析相关数据。结果：孔源性视网膜脱离玻璃体切除硅油填充293眼，发生视力下降(SORVL) 20眼(6.83%)。术前黄斑附着眼的SORVL发生率约为13.33%，黄斑脱离眼的SORVL发生率约为4.59%；发现SORVL患者术后黄斑区神经节细胞层(GCL)平均厚度较术前明显变薄(P < 0.001)，P-VEP 15 min示P100波峰时明显延迟，振幅明显降低；FVEP示P2波振幅显著降低。结论：黄斑附着的患眼比黄斑脱离的患眼有更大的风险发生硅油相关性视力丧失，SORVL患者黄斑中心凹神经节细胞可能受损。一旦发生SORVL，应在视网膜复位良好的情况下及早取出硅油。

Abstract: Objective: To analyze the clinical features of unexplained vision loss following vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment and explore the underlying mechanisms. Methods: A retrospective analysis was conducted on 293 patients initially diagnosed at the Department of Ophthalmology of the Affiliated Hospital of Qingdao University from January 2019 to September 2023, who suffered from rhegmatogenous retinal detachment (RRD) and underwent vitrectomy combined with silicone oil tamponade. A comprehensive range of ophthalmic examinations was conducted, encompassing best-corrected visual acuity (BCVA), optical coherence tomography (OCT), static visual field, visual evoked potential (VEP), and electroretinography (ERG). Results: In 293 eyes that underwent vitrectomy with silicone oil tamponade for RRD, 20 eyes (6.83%) demonstrated a decline in vision (SORVL). The incidence of silicone oil-related vision loss (SORVL) was approximately 13.33% in eyes with macular attachment before surgery and 4.59% in eyes with macular detachment. The mean thickness of the ganglion cell layer (GCL) in the macular region of patients who developed SORVL was significantly thinner after surgery than before surgery (P < 0.001), and P-VEP 15 min showed a significant delay in the peak of the P100 wave and a significant decrease in its amplitude; FVEP showed a significant decrease in the amplitude of the P2 wave. Conclusion: Eyes with macular attachment are at a higher risk of experiencing silicone oil-related vision loss than those with macular detachment, and patients with SORVL may have damage to the ganglion cells of the macular central sulcus. In the event of SORVL, silicone oil should be removed as soon as the retina is well restored.