I NGHIEN c i r u KHOA HOC
U'NG DUNG OCT NGHIEN CLtU HINH ANH VONG MAC TRUNG TAM SAU PHAU THUAT BOC MANG TRl/ffC VONG MAC
Nguyin Kiem Hiip*. Dd Nhu Han*, Cung Ifong San *
TOM TAT
Muc lieu: ,\/<> td hinh anh vdng mgc irung tdm .souphau thudt Iwc mdng trudc vdng mac (MTVM) tren ind\ OCT. phdn tich .su phii hgp giua ldm .sang vd OCT
Doi tuong va phirong phap nghien cuu: Nghien ciru md ideal ngang tien ciru. durrc tiin hdnh tren 45 mdi cua 45 binh nhdn \ IT\ '\ I nguy en phdt da duac phau thudt tgi khoa Ddy mdt - Mdng bd ddo, Binh vien
Wil TW lir thdng 1/2009 din 6/2010
Kk qua: Sau phau thudt, do ddy vong mac trung lain: 262,1 ± 52.2fim. dg ddy trung binh vong mac 241,5 ± 46.4. ihi lich hodng diem. 8,2 ± 0.63 mm' gidm nhimg khong Ira ve hinh thircmg. Cdc ton thuang irin ldm sdng vd OCT khd luang xung. thi luc vd do ddy vong mgc, the tich hodng dtim cd mdi luang qiim khdng chai che.
Ket luan: Sau phau thudt, vong mac phuc hdi nhung khdng trd vi binh thirong, OCTcd khd ndng phai hiin cdc tdn thirong sam han khdm ldm sdng.
Tir khda: OCT. mdng trudc vong mgc, vong mgc Irung tdm. do ddy vong mac
I. DAT VAN DE
Miing trude vdng mac la mdt mang tan tao mdng, ed ban chat la td ehuc \ o lien ket nam trudc vdng mae tai dien tiep xiic djch kinh - vdng mac. OCT la kham nghigm cd gia trj danh gia tdn thuong vdng mae trung tam, tinh trang MTVM ca dinh tinh va dinh lugng. Hien Viet Nam, chua cd nghien cuu nao vg hinh anh OCT vdng mac trung tam sau phau thuiit cat dich kinh bde mang trudc vong mac Vi vay, cbung tdi thue hien de tai nay vdi hai mue lieu sau:
1 Mo td hinh dnh vong mgc trung tdm sau phdu thugt bdc mdng truac vong mgc bang chup cat lap vong mac OCT.
2. Phdn lich suphirhgp giira lain sdng vd OCT.
n. DOI T l O V ; \ .\ P H U O M ; PH VPNGHIENCil' 1. Doi tmmg nghien ciru
Nghign euu duge tien hanh tren nhirng benh nhan MT\'M nguyen phat da phau thuat tai khoa Day mat - Miing bd dao Benh vien Mat Trung uong tir thang 1 /2009 dgn 6/2010.
Tieu chudn chgn henh nhdn
- Benh nhiin MTVM nguygn phat da duge phau thuat.
- Nhirng benh nhan sau phau thuat tren ba thang, dugc kham va chup OCT it nhat mgt lan.
- Benh nhan chap nhan tham gia nghien eiiu.
Tiin chudn logi trir - Benh nhan MTVM thu phat.
* Binh viin Mdt Trung ucmg
36 I Nhan khoa Viet Nam (Sd25 - 2012)
- Cd benh mat khac gay due eac mdi tnrdng trong sudt,
- Mat cd kem theo cac tdn Ihuong phirc tap: ton thuang thj than kmh.
2. Phuong phiip nghien eim Thiet ke nghien eiru: md ta lidn ciru.
Thu thap sd lidu qua mau benh an va xir ly bing phanmdm SPSS 16 0.
3. Cac budc tien hanh
- Xay dyng mau benh an nghign cuu - Chpn benh nhan dii lieu chuan, - Mdi benh nhan den kham lai.
- Thu thap sd lieu theo mau benh an nghien eim.
4. Tieu chuan danh gia kel qua
• Ldm sdng - vi thi hrc
Theo bang phan loai eua td chirc Y tg the gidi (1997), thj lue sau khi chinh kinh toi da dugc danh gia theo mirc do sau:
+ Thi luc < 0.3 la muc do kem.
+ Thi lyc tir 0,3 den 0,7 la muc do trung binh + Thj lye > 0,7 la muc do tdt
• Wnh dnh ton thuang vdng mgc trung tdm tren OCT
- Mang trudc vong mae.
- Phil vdng mac, phu hoang diem.
- Bong bieu md than kinh, - Gia Id boimgdiem.
- Phil hoang diem dang nang.
- Xuat tiet ciing.
• Suphu hap giira ldm sdng vd hinh dnh OCT - Sy phii hgp ve cac tdn thuong tren vdng mac.
- Mang trudc vdng mac.
- Vdng mac: bg mat vdng mac, cd phii hay khdng, mirc dd, vi tri phii, cac ngp gap, tinh trang CO keo, xuat tiet, bong bieu md than kmh.
- Hoang diem: phii ne, eo keo, bign dang, thay ddi vi iri, phil hoang digm dang nang, giii lo. Id hoang diem,
• Suphu hgp giua thi lire vd cdc chi sd tren OCT.
+ Phan tieh mdi luong quan giua Ihi lue vii ehieu day vdng mac,
+ Phiin lich mdi tirang quan giira thi lue va the tich hoimgdigm,
III. KKTQUA 1. Dac dicm benh nhiin
Tudi nhd nhit la 14 va tuoi ldn nhat la 74, tuoi trung binh la 51,I±I6,4. Benh nhan nim trong nhdm tudi tren 50 la cao nhat vdi 30 benh nhan chiem 67%; gidi: 13 nam (28,9%). nu 32(71,1%).
Sd mat phai gdm 24 benh nhan (53,3%), mit trai 21 benh nhan (46,7%) va khdng cd benh nhan nao phau thuat bde MTVM ea 2 mit. Thj lue trung binh 34 mit (77,56%), thj lyc kem 10 mit (22,22%), thj lue tdt 1 mit (0,22%).
2. Hinh anh OCT vdng mac trung tam sau phau thuat
• Tinh trgng mdng trudc vong mgc sau phdn thudt
Tren OCT. 42 mat khdng edn mang trudc vdng mac chigm 93,3%, 3 mat khdng cdn MTVM viing trung tam, hoang diem duge giai phdng hoan toan chfgm 6,7%, 45/45 mit (100%) benh nhan bdc dugc MTVM.
• Cdc chi sd tren OCT
Do day vdng mac trung tam Idn nhat 456)im, nhd nhit 203 nm va trung binh la 262,1 ± 52,2(im.
Dp day trung binh vong mae ldn nhit 392fim, nhd nhat 189|im va trung binh la 241,5 ± 46,4nm.
Thg tich hoang digm Idn nhat 10,6mm^ nhd nhit 7,3mm' va trung binh 8,2 ± 0,63mm\
I NGHIEN CUtJ KHOA HOC
I Cdc tdn thuang phoi hap khde tren OCT
Bdng I. Cdc tdn thuang phoi hop Dim liiOii
Plui vfing ni.n; kliu Irii Plu] vOng mqc lan loa Phil hoang diem d.iiiLi nang Gia iS hoang dicm Lo hoi)ng dicm 1 lo lioiing diem binh tlurirng Xual licl eijng Bong bi^u mo than kinh
n 10 12 8 5 2
( i
4
«
T l 1$ % 22,2 26.7 17,8 II.1 4,4 13.3 8.8 17.8
3. Sir phil hop him .siing \ :i OCT
• Phdt hien (rieu chung trin ldm sdng vd OCT Miing trudc vdng mac: lam sang 0 mat, OCT 3 mat MTVM ngoai \ung trung tam. Phii vdng mac khu trii: lam sang 2 mit (4,4%) OCT 10 mat (22,2%.), Phil VM lan Ida lam simg 1 mat (2,2%), OCT phat hien 12 mil (26.7%) Phii hoang diem dang nang: lam sang 1 mat (2,2%i), OCT 8 mat (17.6%o). Ld, gia Id hoang diem' lam sang I mit (2,2%), OCT 7 mit (15,6%).
Hd hoang diem binh thudng. lam simg 4 mat (8.8%), OCT 6 mit (13.3%). Bong bidu md thin kinh: iam sang I mit (2.2%.). OCT 8 mil (17,6%). Xuat tiet cung: lam sang 1 mil (2,2%), OCT 4 mil (8,8%).
• Tirang quan thi luc, do day VMTT, do ddy TBVM, the tich hodng diem
Thi lire trung binh 0,41 ±0,18. do day vong mac trung tam 261,l±49,2nm, do day trung binh vdng mac 241,5 ± 46,4, the tich hoang didm 8,2±0,57mm', Khdng cd su luang quan thj lue va cac chi sd trgn.
IV. BAN LUAN I. Bac diem benh nhan
Nhdm tudi > 50 gap nhigu nhat, vi d dp tuoi nay thudng gap bong dich kfnh sau la nguyen nhan benh sinh cua benh, nu gap nhidu han nam. Ti le
MTVM mat phai va mat trai tuong duang nhau.
Thi lye trung binh gap nhieu nhat \i benh nhan
> 50 luoi ngoai MTVM cdn cd due the thiiy tinh.
Ket qua nay tuong tu cac nghien ciiu cua cac tac gia khac tren the gidi, eao hon nghien eiru eiia N.CThing (2005), PT B.Man (2007) vi cac tac gia nay nghign ciru ca benh nhan M TVM thir phat.
2. Hinh anh OCT vdng mac Irung tam sau phau thuat
Sau phau thuat ed 3 mat cdn mdt phan MTVM ngoai vimg irung tam. Cac chi sd dp day trung binh vdng mac trung tam: 261.l±49,2pm, dp day tnmg binh vdng mac: 241.5 ± 46.4. the tieh hoang digm: 8.2±0,57mni' giam nhumg khdng ird ve binh thirdng, Ket qua na\ luong ty nghign ciiu Clia Massin P (2000), Hiloshi. A (2004). Cac ton thirong khae tren vdng mae nhu phii vdng mac, hoang dicm gap nhieu hon ca.
3. Sir phil hop lam sang va OCT
• Phdt hien trieu chung trin ldm sdng vd OCT Sau phau thuat. bde MTVM ti le cae tdn thuang vdng mac trung tam khd hoac khdng dugc phat hien tren lam sang nhung lai phat hien chinh xac ca djnh tinh tren OCT. Ket qua nay tuong ty nhu eac nghien ciiu ciia cac tac gia N.CThing (2005), T.VHa (2010). OTC cd kha nang phat hien cae tdn thuong VMTT sdm hon, ehinh xac han tren lam sang.
38 I Nhan khoa Viet Nam (So 25 - 2012)
• Bdn ludn luong quan thi luc. do ddy vong mgc trung tdm, do ddy trung hinh vdng mgc, thi tich hodng diem
DDVMTT
Biiu dd 1: Tuang quan thi luc vd do ddy vdng mgc tnmg tdm - Sau phau thuat, thi luc tang cac chi sd do day
vdng mac va thg tich hoang diem giam. Nhung mdi tuong quan nay khdng chat ehe vdi r = -0,126, p = 0.4; r = 0.03.P = 0,9; r = -0,258, p = 0,8. Kdl qua nay tuong tu eac nghien cuu cua Massin P. (2000), Hitoshi,A(2004).
- Ngay sau phau thuat, eac dp day vdng mac va the tich hoang diem giam rat nhanh nhung sau dd giam rat cham, thi lyc lai phue hdi dan dan.
Thdi gian phuc hdi thi luc ngan hon so vdi cac tdn thuong tren vdng mac. Vi vay, mdi tuang quan giiia thj luc va cac chi sd trgn khdng chat che V. KET LUAN
L Hinh anh vong mac trung tam sau phau thuat bdc mang triro'c vdng mac tren OCT
Sau phiu thuat, 45 mit MTVM ed 3 mat edn mdt phan mang tnrdc vong mae d ngoai viing trung tam.
- Do day vong mac trung tam, do day vong mae trung binh, the tich hoang diem da gan ve
vdi chi sd binh thudng. Phii vdng mac khu tni gap d 10 mat (22,2%i). Phii vdng mae lan tda xuat hien d 12 mat (26,7%). Phii hoang digm dang nang ed 8 mat (17,8%) Ld, gia Id hoang diem gap tren 7 mat (15,5%)), Hd hoang diem binh thudng d 6 mat (13,3%.), Cd 8 mat ed dau hieu bong bigu md than kinh (17,8%). Xuat tiet ciing phat hien d 4 mit (8,9%).
2. Su phil hop giira hinh anh OCT va lam sang - Ket qua chan doan lam sang kha phii hgp vdi hinh anh tdn thucmg tren OCT. Tuy nhien, hinh anh OCT giiip chan doan mgt sd tdn thuang ma lam simg khd hoac khdng thg phat hien dugc. Nhu vay, OCT la kham nghigm can lam simg ed tinh khach quan va do chinh xac cao cd bieu qua rat tdt trong hd trg cho tham kham lam sang.
- Sau phau thuat bde MTVM cae ehi sd tren OCT nhu do day vdng mae trung tam, do day trung binh vdng mac, thg tieh hoang diem giam nhung khdng trd ve gia tri binh thudng, thi lue tang nhung khdng ed su tuang quan cd y nghTa thdng ke.
I NGHIEN ClitJ KHOA HOC
TAI Lll-U TIIAM KHAO
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3, DONHL IlONCOOl).-Mdlviiilicnbdgan day licn the gidi \ c k\ lliual chan doan vii dieu Irj benh ly vdng mae dieb kinh". Ndi .san Midn khoa so 4. tr 68-69.
4 DO NHU I ION CDO I/. Chuven di djch kinh vdng mac. Ha Ndi 2001,
5. PHAM TIM BICH MAN (2007), "Danh gia ket qua digu tri phau thuat benh ly mang trudc vdng mac". Ludn vdn tdi nghiip bdc s7 chuyin khoa cdp 11- Ha Ndi
6. NGUYEN CANH THANG (2005), "Nghien cdu hinh anh tdn thuang ciia mang trudc vdng mac
hiing ch\ip cal Idp vdng mae", Ludn vdn tot nghiep Thac si Yhgc- 1 Iii Ngi.
7. ARIiVALO ,11' (2009), "Retinal and optical coherence tomography". Springer .science and business iiicilni. New York. USA.
8. IIAOUC'IIINI. B. MASSIN P. TADAVONI R. 1:KGINAY A . G A U D K I C A (2004), -Diagnosis 111 macular pscudoholes and lamellar macular holes by optical coherence tomography". Am J Ophthalmol Nov; 138(5). p 732.
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SUMMARY
OPTICAL COHERENCE TOMOGRAPHY OF CENTRAL RETINAL AFTER REMOVAL IDIOPATHIC EPIRETINAI, MEMBRANES
Purpose: To describe characteristics of central retina and compare these clinical figures with optical coherence tomography (OCT) images of idiopathic epiretinal membranes.
Purpose and methods A cross-sectional study. Clinical charts and OCT images of 45 consecutive patients (45 eyes) ajler removal idiopathic epiretinal membranes al Viet Nam National Institute of Ophthlalmotogy from 1/2009 lo 6/2010
Results Meanage5l.l±16 4. 13 male (29%). 32 female ("1%.) Mcim V.i 0 41 ± 0.1S Macular volume' 8.2 ±0.63mm\ mean central stihfield thickness 262 1 i 52 2 pm. mean retinal thickness 241.5 ±46.4 ^m.
Thefovealpil reappeared in 6 eyes Postoperatively, visual acuilv nol correlated with macular thickness (r =-0.126. p = 0.4)
Conclusions: Macular thickness, macular volume decreases after epiretinal membrane surgery, bul ihe macular profile rarely returns to normal However, this does nol preclude satisfactory improvement of visual acuity.
Keywords: OCT^ epiretinal membranes, central retinal, retinal thickness
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