关键词: 视网膜脱离, 巩膜扣带术, 持续性黄斑下液

Abstract: Objective To investigate the different patterns of persistent submacular fluid (PSF) in rhegmatogenous retinal detachment (RRD) after scleral buckling and its relationship with visual prognosis. Design Retrospective case series. Participants From June 2020 to February 2023, 50 cases (50 eyes) of RRD patients who was undergone the scleral buckling and successful retinal reattachment at one time and were observed PSF after 1 month after the sugrey. Methods The surgery followed the rules of minimal scleral buckling design. PSF was defined as that submacular fluid was not absorbed for more than one month. All patients were followed up at 1 day, 3 days, 7 days, one month, and every month after operation until the PSF was absorbed completely. Visual acuity, intraocular pressure and OCT were checked at every visit. Based on the PSF pattern in OCT at 1 month after the surgery, patients were divided into 3 groups:  single discrete bleb of fluid group, multiple blebs of fluid group, and confluent fluid group. Main Outcome Measures PSF patterns, PSF absorption time, best corrected visual acuity (BCVA, LogMAR). Results Among 50 cases (50 eyes), 6 eyes(12%) were in single discrete bleb of fluid pattern group, 12 eyes (24%) were in multiple blebs of fluid pattern group and 32 eyes (64%) were in confluent fluid pattern group. During follow-up, 9 eyes changed from multiple blebs pattern to single discrete bleb pattern, 25 eyes changed from confluent fluid pattern to multiple blebs pattern and single discrete bleb pattern. There were no significant differences among the 3 groups in preoperative BCVA ≥0.05 (χ2=2.13, P=0.345), high myopia(χ2=1.64，P=0.441), duration of disease within 1 month (χ2=2.10，P=0.350), drainage (χ2=0.44，P=0.803) and surgical method segmental combined encircling episcleral buckles (χ2=2.47，P=0.291). The PSF absorption time was 4.50 (2.75, 5.25) months, 6.00 (3.00, 8.75) months, and 7.50 (4.25, 9.75) months in single discrete bleb of fluid pattern, multiple blebs of fluid pattern and confluent fluid pattern, respectively, without significant difference (H=5.26，P=0.072). The BCVA (LogMAR) at final visit was 0.20 (0.10, 0.33), 0.10 (0.00, 0.45), 0.15 (0.10, 0.50) in single discrete bleb of fluid pattern, multiple blebs of fluid pattern, and confluent fluid pattern group, respectively, without significant difference (H=1.16，P=0.560). At final visit, there was no significant difference in the continuity of the outer retinal ellipsoid zone among 3 groups (χ2=0.87, P=0.648). Conclusion Different patterns of PSF after scleral buckling can change during follow-up, and the multiple blebs pattern is an intermediate process between confluent fluid pattern and single discrete bleb pattern. There is no difference among different patterns of PSF in the absorption time, visual prognosis and the continuity of the outer retinal ellipsoid zone. (Ophthalmol CHN, 2024, 33: 29-34)

Key words: retinal detachment, scleral buckling, persistent submacular fluid