[1]朱欣悦,朱小敏,刘亚军,等.特发性黄斑裂孔手术治疗后裂孔愈合和视力恢复的相关因素[J].眼科新进展,2017,37(1):065-68.[doi:10.13389/j.cnki.rao.2017.0018]
　ZHU Xin-Yue,ZHU Xiao-Min,LIU Ya-Jun,et al.Associated factors analysis for predicting anatomical outcomes and postoperative visual acuity after vitrectomy for idiopathic macular hole[J].Recent Advances in Ophthalmology,2017,37(1):065-68.[doi:10.13389/j.cnki.rao.2017.0018]
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特发性黄斑裂孔手术治疗后裂孔愈合和视力恢复的相关因素/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
37卷
期数:
2017年1期
页码:
065-68
栏目:
应用研究
出版日期:
2017-01-05

文章信息/Info

Title:
Associated factors analysis for predicting anatomical outcomes and postoperative visual acuity after vitrectomy for idiopathic macular hole
作者:
朱欣悦; 朱小敏; 刘亚军; 黄振平
210093　江苏省南京市，南京大学医学院临床学院眼科（朱欣悦，刘亚军）；210002　江苏省南京市，南京军区南京总医院眼科(朱小敏，黄振平)
Author(s):
ZHU Xin-Yue; ZHU Xiao-Min; LIU Ya-Jun; HUANG Zhen-Ping
Department of Ophthalmology，School of Medicine，Nanjing University（ZHU Xin-Yue，LIU Ya-Jun），Nanjing 210093，Jiangsu Province，China;Department of Ophthalmology，Nanjing General Hospital of Nanjing Military Command(ZHU Xiao-Min，HUANG Zhen-Ping)，Nanjing 210002，Jiangsu Province，China
关键词:
特发性黄斑裂孔; 光学相干断层扫描; 预后分析
Keywords:
idiopathic macular hole; optical coherence tomography; prognosis analysis
分类号:
R774.5
DOI:
10.13389/j.cnki.rao.2017.0018
文献标志码:
A
摘要:
目的　探讨特发性黄斑裂孔手术治疗后影响裂孔愈合和视力恢复的相关因素。方法　收集我院行玻璃体切割+内界膜撕除+气体充填手术的特发性黄斑裂孔患者35例(35眼)为研究对象，分别进行术前、术后常规检查，包括裂隙灯显微镜、间接检眼镜、最佳矫正视力（best correct visual acuity，BCVA）、频域光学相干断层扫描（spectral domain optical coherence tomography，SD-OCT），并测量裂孔底径（base diameter，BASE）、裂孔最小径（minimum diameter，MIN）、裂孔高度（height，H）、裂孔两侧外界膜的断端与光感受器脱离起点之间的距离（M、N）、水平方向光感受器内外节缺失区直径（diameter of IS/OS absence，DIOA）。采用最小分辨角对数（logMAR）记录矫正视力。根据患眼术后的SD-OCT图像结果，将黄斑裂孔愈合级别分为A、B、C 3组。根据患眼术前术后BCVA情况，将术后视力分为：视力提高组、视力不变组、视力下降组。观察黄斑裂孔愈合和视力变化情况，并结合患者年龄、性别、术前黄斑裂孔各测量参数进行相关性分析。结果　35例中黄斑裂孔愈合A组23眼，B组6眼，C组6眼。视力提高组27眼，视力不变组、视力下降组均为4眼。结果显示：（1）黄斑裂孔愈合情况与BASE、H、MIN、黄斑裂孔指数（macular hole index，MHI)、裂孔牵拉指数（tractional hole index，THI)、孔径指数（DHI）、手术前BCVA（logMAR）弱相关(均为P<0.05)；与黄斑裂孔指数（macular hole healing index，MHCI)显著相关（r=-0.588，P=0.000）;与年龄、性别均无相关性(均为P>0.05)。（2）术后BCVA（logMAR）与BASE、MIN弱相关(均为P<0.05);与THI、DIOA、术前BCVA（logMAR）显著相关(均为P<0.05)；与年龄、性别、H、MHCI、MHI、DHI均无相关性(均为P>0.05)。（3）术前DIOA与术前BCVA（logMAR）显著正相关（r=0.658，P=0.000）；术后DIOA与术后BCVA（logMAR）显著正相关（r=0.565，P=0.000）；术后BCVA（logMAR）和术后DIOA较术前均有所改善，且差异均有统计学意义(均为P<0.05)。结论　（1）MHCI与裂孔愈合等级的相关性最高，可作为手术前预测术后裂孔愈合情况的一个指标；（2）术前DIOA、术前BCVA(logMAR)、THI与术后视力恢复的相关性最高，可作为预测术后视力恢复情况的指标；（3）BCVA与DIOA具有显著相关性，因此视力改善与否的关键取决于DIOA的大小。
Abstract:
Objective　To evaluate the associated factors for predicting anatomical outcomes and postoperative visual acuity of idiopathic macular hole (IMH) after vitrectomy.Methods　A total of 35 eyes of 35 IMH patients underwent vitrectomy,ILM peeling and gas filling surgery were included in this study.The slit lamp,indirect ophthalmoscope,best corrected visual acuity examination and spectral domain optical coherence tomography (SD-OCT) were performed for all the patients.The base diameter（BASE）,height（H）,minimum diameter（MIN）,diameter of IS/OS absence（DIOA）were measured.Anatomical outcomes were divided into 3 levels based on the results of their OCT pictures:A:Good healing;B:Bridge-shaped healing;C:Poor healing.Postoperative visual acuity were divided into 3 groups:Visual improved group,visual unchanged group and visual decreased group.The multiple factors related with predicting anatomical outcome and visual acuity including age,sex,preoperative corrected visual acuity,BASE,H,MHCI,MIN,THI,DHI were analyzed.Results　In the 35 eyes,the hole was closed in 23 eyes of group A,6 eyes of group B,6 eyes of group C and 27 eyes of visual improved group,4 eyes of visual unchanged group,4 eyes of visual decreased group.（1）BASE,H,MIN,macular hole index (MHI),tractional hole index (THI),DHI,preoperative BCVA(logMAR) were weakly correlated with anatomical prognosis (all P<0.05);Macular hole healing index (MHCI) was correlated significantly with anatomical outcomes (r=-0.588,P=0.000);Age and sex were not correlated significantly with anatomical outcomes (all P>0.05).(2) Postoperative BCVA (logMAR) was correlated weakly with BASE,MIN (all P<0.05),correlated significantly with THI,DIOA,preoperative BCVA (logMAR) (all P<0.05),not correlated with age,sex,H,MHCI,MHI,DHI(all P>0.05).(3) Preoperative DIOA was significantly positive correlated with preoperative BCVA(logMAR) (r=0.658,P=0.000);Postoperative DIOA was significantly positive correlated with postoperative BCVA (logMAR) (r=0.565,P=0.000);Postoperative DIOA and postoperative BCVA(logMAR) were all improved,there were statistical differences compared with pre-operation (all P<0.05).Conclusion　(1) MHCI has the best correlation with anatomical outcomes,It can be considered a key factor for predicting anatomical outcomes of IMH after vitrectomy.(2) Preoperative DIOA,BCVA(logMAR),THI can be considered as key factors for predicting postoperative BCVA(logMAR).(3) BCVA has a significantly correlation with DIOA directly,no matter preoperative or postoperative.The length of DIOA is the key fact for predicting BCVA.

参考文献/References:

［1］　KELLYN E，WENDEL RT.Vitreous surgery for idiopathic macular holes.Results of a pilot study［J］.Arch Ophthalmol，1991，109(5):654-659.
［2］　MESTER V，KUHN F.Internal limiting membrane removal in the management of full-thickness macular holes［J］.Am Ophthalmol，2000，32(4):308-315.
［3］　YOREH BARAK，MARK A，IHNEN，SCHAAL S.Spectral domain optical coherence tomography in the diagnosis and management of vitreoretinal interface pathologies［J］.J Ophthalmol，2012，2012(6):876472.
［4］　KIERNAN DF，MIELER WF，HARIPRASAD SM.Spectral-domain optical coherence tomography:a comparison of modern high-resolution retinal imaging systems［J］.Am J Ophthalmol，2010，149(1):18-31.
［5］　刘佩佩，赵明威，董冲亚，孙摇遥，黎晓新，姜燕荣，等.特发性黄斑裂孔玻璃体切割手术治疗裂孔解剖愈合的相关因素分析［J］.中华眼底病杂志，2014，30(4):339-342.
LIU PP，ZHAO MW，DONG CY，SUN YY,LI XX,JIANG YR,et al.Associated factors analysis for predicting anatomical outcomes of idiopathic macular hole after vitrectomy［J］.Chin J Ocul Fundus Dis，2014,30(4):339-342.
［6］　VILLATE N，JI E L，VENKATRAMAN A，SMIDDY WE.Photoreceptor layer features in eyes with closed macular holes:Optical coherence tomography findings and correlation with visual outcomes［J］.Am J Ophthalmol，2005，139(2):280-289.
［7］　WAKELY L，RAHMAN R，STEPHENSON J.A comparison of several methods of macular hole measurement using optical coherence tomography，and their value in predicting anatomical and visual outcomes［J］.Br J Ophthalmol，2012，96(7):1003-1007.
［8］　IP MS，BAKER BJ，DUKER JS，REICHEL E，BAUMAL CR，GANGNON R，et al.Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography［J］.Arch Ophthalmol，2002，120(1):29-35.
［9］　STERAOKA K.Prediction of postoperative visual outcome based on hole configuration by optica l coherence tomography in eyes with idiopathic macular holes［J］.Am J Ophthalmol，2005，138(5):709-716.
［10］　RUIZMORENO JM，STAICU C，PIERO DP，MONTERO J，LUGO F，AMAT P.Optical coherence tomography predictive factors for macular hole surgery outcome［J］.Br J Ophthalmol，2008，92(5):640-644.
［11］　CHANG LK，KOIZUMI H，SPAIDE RF.Disruption of the photoreceptor inner segment-outer segment junction in eyes with macular holes［J］.Retina，2008，28(7):969-975.
［12］　LANDA G，SU E，GARCIA PM，SEIPLE WH，ROSEN RB.Inner segment-outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of age-related macular degeneration［J］.Retina，2011，31(2):364-70.
［13］　INOUE M，WATANABE Y，ARAKAWA A，SATO S，KOBAYASHI S，KADONOSONO K.Spectral-domain optical coherence tomography images of inner/outer segment junctions and macular hole surgery outcomes［J］.Graefes Arch Clin Exp Ophthalmol，2009，247(3):325-330.

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更新日期/Last Update: 2017-02-15