摘要
目的观察特发性黄斑裂孔(IMH)内界膜(ILM)翻瓣手术后黄斑裂孔愈合形态以及黄斑微结构和视功能恢复情况。方法回顾性病例研究。2016年至2018年于天津市眼科医院检查确诊的IMH患者39例39只眼纳入研究。其中,男性4例4只眼,女性35例35只眼;平均年龄(64.56±7.20)岁。均行BCVA、OCT、OCT血管成像、微视野检查。采用国际标准视力表行BCVA检查,统计时换算为logMAR视力。均行玻璃体切割手术(PPV)联合ILM翻瓣覆盖、空气填充手术。根据手术后OCT图像特征,将患眼分为U形闭合组、V形闭合组、不规则闭合组、平坦状闭合组,分别为26、5、7、1只眼。四组患眼间最小裂孔直径、黄斑裂孔分级比较,差异有统计学意义(F=5.118、3.608,P=0.005、0.024)。U形闭合组患眼浅层毛细血管层(SCP)血流密度与V形闭合组、不规则闭合组+平坦状闭合组比较,差异均有统计学意义(t=2.079、2.368,P=0.047、0.025)。手术后1、3、6个月,采用手术前相同设备和方法行相关检查。比较各组患眼手术前后BCVA、黄斑区SCP血流密度以及黄斑中心凹无血管区周长(PERIM)和黄斑10°总体平均光敏感度(MS)。不同组间定量数据比较行独立样本t检验;计数资数比较行χ2检验。结果手术后6个月,U形闭合组患眼logMAR视力较手术前提高-0.75±0.29;较V形闭合组、不规则闭合组+平坦状闭合组更好,差异有统计学意义(t=-2.974、-2.518,P=0.006、0.018)。U形闭合组患眼外界膜(ELM)、椭圆体带完整性明显高于V形闭合组、不规则形闭合组+平坦状闭合组,差异有统计学意义(χ2=15.229、10.809,P=0.020、0.013);U形闭合组患眼中黄斑中心凹下强反射团块百分率明显低于V形闭合组、不规则闭合组+平坦状闭合组,差异有统计学意义(χ2=20.107,P=0.000)。U形闭合组PERIM较V形闭合组、不规则闭合组+平坦状闭合组更小,差异均有统计学意义(t=-3.391、-2.427,P=0.002、0.022)。U形闭合组患眼黄斑区10°总体MS明显高于V形闭合组、不规则闭合组+平坦状闭合组,差异有统计学意义(t=2.939、2.811,P=0.001、0.001)。结论IMH内界膜翻瓣手术后U形闭合表现出更好BCVA及黄斑区MS;ELM及椭圆体带重新恢复结构完整性比例更高,PERIM更小,出现黄斑中心凹下强反射团块更少。
Objective To observe the healing morphology,macular microstructure and visual function of idiopathic macular hole(IMH)after pars plana vitrectomy(PPV)combined with internal limiting membrane(ILM)flap.Methods Retrospective case study.From 2016 to 2018,39 eyes of 39 patients with IMH diagnosed in Tianjin Eye Hospital were included in the study.Among them,there were 4 eyes in 4 males and 35 eyes in 35 females,with an average age of 64.56±7.2 years.BCVA,OCT,OCT angiography(OCTA)and MAIA microperimetry examination were performed in all patients.BCVA examination was performed with the international standard visual acuity chart,which was converted to logMAR visual acuity when recording.All patients underwent PPV combined with ILM flap covering and air tamponade.According to the characteristics of OCT images postoperatively,the eyes were divided into U-shaped closed group,V-shaped closed group,irregular closed group and flat closed group,with 26,5,7 and 1 eyes respectively.There was a significant difference in the minimum hole diameter(F=5.118,P=0.005)and macular hole classification(F=3.608,P=0.024).The shallow capillary layer(SCP)blood flow density in the U-shaped closure group was significantly higher than that in the V-shaped closure group,the irregular closure group and the flat closure group(t=2.079,2.368;P=0.047,0.025).At 1,3,6 months after the operation,the same equipment and methods were used for relevant examination.The blood flow density of BCVA,SCP,perimeter of foveal avascular zone(PERIM)and mean sensitivity(MS)were compared before and after operation.Independent sample t-test was used for quantitative data comparison between different groups,andχ2 test was used for counting data comparison.Results Six months after operation,the logMAR of the eyes in the U-shaped closure group was-0.75±0.29 higher than that before operation,and was better than that in the V-shaped closure group,the irregular closure group and the flat closure group(t=-2.974,-2.518;P=0.006,0.018).The integrity of external limiting membrane(ELM)and ellipsoid in U-shaped closed group was significantly higher than that in V-shaped closed group,irregular closed group and flat closed group(χ2=15.229,10.809;P=0.020,0.013).The percentage of macular central fovea reflex mass in the U-shaped closed group was significantly lower than that in the V-shaped closed group,irregular closed group and flat closed group(χ2=20.107,P=0.000).PERIM in U-shaped closure group was smaller than that in V-shaped closure group,irregular closure group and flat closure group,and the difference was statistically significant(t=-3.391,-2.427;P=0.002,0.022).The total MS of macular area 10°in the U-shaped closure group was significantly higher than that in the other V-shaped closure group,irregular closure group and flat closure group(t=2.939,2.811;P=0.001,0.001).Conclusion After IMH operation,the U-shaped closure showed better BCVA and macular light sensitivity,the proportion of ELM and ellipsoid to restore structural integrity are higher,PERIM is smaller,and there are fewer macular fovea strong reflex masses.
作者
王莹
姚旭阳
梁冬青
刘玉燕
韩泉洪
Wang Ying;Yao Xuyang;Liang Dongqing;Liu Yuyan;Han Quanhong(Tianjin Eye Hospital,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin Eye Institute,Clinical College of Ophthalmology Tianjin Medical University,Tianjin 300020,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2020年第5期374-378,共5页
Chinese Journal of Ocular Fundus Diseases
