中华眼底病杂志

中华眼底病杂志

特发性黄斑裂孔玻璃体切割手术后黄斑中心凹光感受器层愈合分型与裂孔大小的关系

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目的 观察特发性黄斑裂孔(IMH)大小与玻璃体切割手术(PPV)后光感受器层愈合分型的关系。 方法 回顾性非对照病例分析。行PPV治疗的连续IMH患者31例33只眼纳入研究。其中,男性9例9只眼,女性22例24只眼。平均年龄(58.16±9.10)岁。视力下降平均时间为(4.97±5.97)个月。均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查。采用国际标准视力表行BCVA检查,记录时换算为最小分辨角对数(logMAR)视力。患眼平均logMAR BCVA为1.07±0.38。平均眼压为(14.05±0.54)mmHg(1 mmHg=0.133 kPa)。裂孔最小直径(MIN)、裂孔基底直径(BASE)、平均裂孔宽度、平均裂孔高度分别为(465.19±232.84)、(943.63±389.26)、(704.72±292.64)、(443.84±72.47)μm。根据MIN值将裂孔大小分为小、中、大裂孔;分别为9、15、9只眼。根据手术后OCT图像特征,将裂孔光感受器层愈合分为0~Ⅳ型。患眼均行25G或27G标准三切口经睫状体平坦部PPV。手术后平均随访时间为(326.42±157.17)d。将手术后第1次行OCT检查时间定义为手术后早期;以末次随访时间为疗效判定时间点。手术前后BCVA及眼压比较行配对t检验。手术前BCVA、裂孔平均宽度、裂孔平均高度以及随访时间、MIN与手术后BCVA行Pearson相关性分析。 结果 末次随访时,logMAR BCVA为1.52~1.40者3只眼;1.30~0.52者22只眼;0.40~−0.07者8只眼。与手术前logMAR BCVA比较,差异有统计学意义(t=−6.023,P<0.001)。手术后早期,33只眼中,裂孔光感受器层愈合为0型10只眼,占30.3%;Ⅰ型4只眼,占12.1%;Ⅱ型10只眼,占30.3%;Ⅲ型9只眼,占27.3%。末次随访时,0型5只眼,占15.2%;Ⅰ型5只眼,占15.2%;Ⅲ型12只眼,占36.4%;Ⅳ 型11只眼,占33.3%。手术后早期、末次随访时,不同裂孔大小与光感受器层愈合分型均呈负相关(r=−0.590、−0.768,P<0.01)。相关性分析结果显示,手术后BCVA与手术前BCVA、裂孔分期、手术前裂孔大小分级、MIN、BASE、手术前裂孔平均宽度和裂孔平均高度、手术后早期和末次随访时裂孔愈合分型相关(r=0.500、0.370、0.470、0.435、0.533、0.505、0.462、−0.442、−0.656,P<0.05);与年龄、视力下降时间、随访时间无相关(r=0.285、0.234、−0.310,P>0.05)。 结论 手术前IMH大小与手术后光感受器层愈合类型相关。

Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P<0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P<0.01) and the last follow-up (r=−0.768, P<0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P<0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P>0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.

关键词: 视网膜穿孔/外科学; 光感受器, 视网膜; 体层摄影术, 光学相干

Key words: Retinal perforations/surgery; Photoreceptors, retinal; Tomography, optical coherence

引用本文: 谢艾芮, 文峰, 刘文. 特发性黄斑裂孔玻璃体切割手术后黄斑中心凹光感受器层愈合分型与裂孔大小的关系. 中华眼底病杂志, 2018, 34(2): 144-148. doi: 10.3760/cma.j.issn.1005-1015.2018.02.009 复制

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