硅油对视网膜神经纤维层厚度影响的观察以及对取出硅油时机的探讨
Observation of the Influence of Silicone Oil on the Thickness of Retinal Nerve Fiber Layer and Discussion on the Timing of Removing Silicone Oil
摘要: 目的：观察硅油对视网膜神经纤维层(RNFL)厚度的影响。方法：临床自身对照研究。2020年1~7月于济南明水眼科医院行玻璃体切除视网膜复位硅油填充术的孔源性视网膜脱离33例(33眼)纳入研究。术后观察视力及视网膜复位情况，分别测量硅油填充术后3天、1、2、3个月及硅油取出术后1、2、3个月的RNFL厚度。结果：术后所有患眼视网膜均复位；术后视力均较术前提高(P < 0.05)。硅油填充术后2个月，RNFL厚度与硅油填充术后3天及1个月比较明显变薄(P < 0.05)。硅油填充术后3个月，RNFL厚度与硅油填充术后2个月比较明显变薄(P < 0.05)。硅油取出术后1、2、3个月，RNFL厚度与硅油取出术前比较差异均无统计学意义(P > 0.05)。结论：在视网膜复位稳定的情况下，尽量在术后2个月左右取出硅油，以避免引起RNFL的损伤，且硅油取出后RNFL变薄不可逆转。
Abstract: Objective: To observe the effect of silicone oil on the thickness of retinal nerve fiber layer. Methods: This was a clinical self-controlled study. From Jan. to Jul. 2020, 33 cases (33 eyes) of rhegmatogenous retinal detachment that underwent vitrectomy, retinal reattachment and silicone oil tamponade in Jinan Mingshui Eye Hospital were included in the study. The visual acuity and retinal reattachment status were observed after operation. The thickness of RNFL was measured at 3 days, 1, 2, and 3 months after silicone oil tamponade and 1, 2, and 3 months after silicone oil removal. Results: The retinas of all affected eyes were reattached after operation; the visual acuity after operation was improved compared with that before operation (P < 0.05). At 2 months after silicone oil tamponade, the thickness of RNFL was significantly thinner than that at 3 days and 1 month after silicone oil tamponade (P < 0.05). At 3 months after silicone oil tamponade, the thickness of RNFL became significantly thinner than that 2 months after silicone oil tamponade (P < 0.05). There was no statistically significant difference in the thickness of RNFL at 1, 2, and 3 months after the removal of the silicone oil compared with that before the removal of the silicone oil (P > 0.05). Conclusion: In the case of stable retinal reattachment, the silicone oil should be removed within 2 months after surgery to avoid damage to the RNFL, and the thinning of the RNFL is irreversible after the silicone oil is removed.
文章引用：牛科, 于广委, 吕永斌, 王东林. 硅油对视网膜神经纤维层厚度影响的观察以及对取出硅油时机的探讨[J]. 临床医学进展, 2022, 12(3): 1503-1508. https://doi.org/10.12677/ACM.2022.123217

参考文献

[1] Vaziri, K., Schwartz, S.G., Kishor, K.S., et al. (2016) Tamponade in the Surgical Management of Retinal Detachment. Clinical Ophthalmology, 10, 471-476.
[2] Rabina, G., Azem, N., Barequet, D., et al. (2020) Silicone Oil Tamponade Effect on Macular Layer Thickness and Visual Acuity. Retina, 40, 998-1004. [Google Scholar] [CrossRef] 
[3] Miller, J.B., Papakostas, T.D. and Vavvas, D.G. (2014) Complications of Emulsified Silicone Oil after Retinal Detachment Repair. Seminars in Ophthalmology, 29, 312-318. [Google Scholar] [CrossRef] [PubMed]
[4] Lappas, A., Dietlein, T.S., Rosentreter, A., et al. (2018) Vision Loss after Silicone Oil Surgery. Klinische Monatsblätter für Augenheilkunde, 235, 725-729. [Google Scholar] [CrossRef] [PubMed]
[5] Tavares, R., Nóbrega, M.J., Nóbrega, F., et al. (2015) Timing and Outcomes after Silicone Oil Removal in Proliferative Vitreoretinopathy: A Retrospective Clinical Series. International Journal of Retina and Vitreous, 1, Article No. 2. [Google Scholar] [CrossRef] [PubMed]
[6] 李秋明, 李洋, 陈霞, 等. 视网膜脱离复位术后硅油取出时机及效果临床研究[J]. 中国实用眼科杂志, 2016, 34(8): 797-800. [Google Scholar] [CrossRef] 
[7] 赵全良, 张春香, 勾明宝. PDR患者硅油填充术后视网膜功能评价[J]. 国际眼科杂志, 2013, 13(4): 756-758. [Google Scholar] [CrossRef] 
[8] Shalchi, Z., Mahroo, O.A., Shunmugam, M., et al. (2015) Spectral Domain Optical Coherence Tomography Findings in Long-Term Silicone Oil-Related Visual Loss. Retina, 35, 555-563. [Google Scholar] [CrossRef] 
[9] 关禹博, 陈松, 赵秉水. 83例硅油取出时机及并发症的临床分析[J]. 中国实用眼科杂志, 2004, 22(2): 125-127. [Google Scholar] [CrossRef] 
[10] 张少冲, 李松峰, 刘恬, 等. 硅油长期充填眼部改变及取出原因和结果[J]. 中国实用眼科杂志, 2004, 22(4): 269-271. [Google Scholar] [CrossRef] 
[11] Lee, Y.H., Lee, J.E., Shin, Y.I., et al. (2012) Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Vitrectomy for Rhegmatogenous Retinal Detachment. Investigative Ophthalmology & Visual Science, 53, 5471-5474. [Google Scholar] [CrossRef] [PubMed]
[12] Takkar, B., Azad, R., Kamble, N., et al. (2018) Retinal Nerve Fiber Layer Changes Following Primary Retinal Detachment Repair with Silicone Oil Tamponade and Subsequent Oil Removal. Journal of Ophthalmic and Vision Research, 13, 124-129.
[13] Clark, A., Balducci, N., Pichi, F., et al. (2012) Swelling of the Arcuate Nerve Fiber Layer after Internal Limiting Membrane Peeling. Retina, 32, 1608-1613. [Google Scholar] [CrossRef] 
[14] Jurišić, D., Geber, M.Z., Ćavar, I., et al. (2018) Retinal Layers Measurements Following Silicone Oil Tamponade for Retinal Detachment Surgery. Seminars in Ophthalmology, 33,711-718. [Google Scholar] [CrossRef] [PubMed]
[15] Caramoy, A., Droege, K.M., Kirchhof, B., et al. (2014) Retinal Layers Measurements in Healthy Eyes and in Eyes Receiving Silicone Oil-Based Endotamponade. Acta Ophthalmologica, 92, e292-e297. [Google Scholar] [CrossRef] [PubMed]
[16] 刘素美, 田秀英, 黄淑萍. 玻璃体切除术后硅油对眼底损害的临床观察[J]. 眼外伤职业眼病杂志, 2010, 32(4): 271-272. [Google Scholar] [CrossRef] 
[17] 黄欣, 赵培泉, 徐格致, 等. 复杂性视网膜脱离硅油注入手术后视神经萎缩多因素回归分析[J]. 中华眼底病杂志, 2006, 22(5): 305-307. [Google Scholar] [CrossRef] 
[18] Knecht, P., Groscurth, P., Ziegler, U., et al. (2007) Is Silicone Oil Optic Neuropathy Caused by High Intraocular Pressure Alone? A Semi-Biological Model. British Journal of Ophthalmology, 91, 1293-1295. [Google Scholar] [CrossRef] [PubMed]

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