特发性黄斑裂孔手术后黄斑结构变化及其与视功能的关系  

Macular structure changes after surgery and its relationship with visual function in patients with idiopathic macular hole

作　　者：邵清[1] 邹悦[1] 徐吉[1] 冯竞仰 陈凤娥[1] 樊莹[1] 

机构地区：[1]上海交通大学附属第一人民医院眼科,200080

出　　处：《中华眼底病杂志》2012年第2期126-129,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：上海市眼底病重点实验室开放课题基金（07222911）

摘　　要：目的观察分析特发性黄斑裂孔（IMH）患者手术前后黄斑结构变化及其与视功能预后的关系。方法接受玻璃体切割手术治疗的47例IMH患者47只眼纳入研究。所有患者均经最小分辨角对数视力表（10gMAR）最佳矫正视力（BCVA）、裂隙灯显微镜、间接检眼镜、光相干断层扫描（OCT）、B型超声及微视野检查确诊，并接受标准三切口经睫状体平坦部玻璃体切割手术治疗。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，观察患者手术前后BCVA、黄斑区光敏感度、黄斑裂孔直径、光感受器内外节连接（IS／OS）缺损直径及外界膜（ELM）缺损直径变化，分析手术前后IS／OS缺损直径、ELM缺损直径、黄斑区敏感度与BCVA的相关性。结果手术后1、3、6个月，患者平均IogMARBCVA均较治疗前提高，差异均有统计学意义（t=16．4，35．7，20．7；P〈0．05）；平均黄斑裂孔直径较手术前明显减小，差异均有统计学意义（t=7．7，7．7，7．7；P〈O．05）；平均IS／OS缺损直径均较治疗前减小，差异均有统计学意义（t=24．1，19．3，27．4；P〈O．05）；平均ELM缺损直径均较治疗前减小，差异均有统计学意义（t=20．5，6．7，15．8；P〈0．05）；黄斑区平均光敏感度均较治疗前提高，差异均有统计学意义（t=-13．8，-17．9，-2．5；P〈0．05）。相关性分析发现，手术前IS／OS、ELM缺损直径均与手术前黄斑区敏感度相关（r=0．55，-0．53；P〈0．05），而与手术前BCVA关系不明显（r=0．13，0．13；P〉0．05）。手术后1、3、6个月IS／OS、ELM缺损直径与BCVA及黄斑区敏感度均有明显相关性（P〈0．05）。结论手术后IMH患者平均logMARBCVA及黄斑区平均光敏感度提高，平均IS／OS缺损直径及平均ELM缺损直径减小。手术后IS／OS缺损直径、ELM缺损直径与BCVA、黄斑区敏感度相关。Objective To observe the macular structure changes and its relationship with visual function in patients with idiopathic macular hole （IMH）. Methods Forty-seven patients （47 eyes） with IMH who underwent pars plana vitrectomy were enrolled in this study. All patients were examined including best corrected visual acuity （ BCVA ）, slit-lamp microscopy, indirect ophthalmoscopy, B-scan ultrasonography, optical coherence tomography （OCT） and MP-1. All the patients underwent a standard three-port pars plana vitrectomy. The BCVA, mean light sensitivity （MS） in macular area, macular hole diameter, the photoreceptor inner and outer segment （IS/OS） junction defect, external limiting membrane （ELM） defect were observed on the 1st, 3rd and 6th months after surgery, and then the relationship of IS/OS junction defect, ELM defect, sensitive and BCVA were analyzed. Results The 1st, 3rd and 6th months after surgery, the logarithm of minimal angle of resolution （logMAR） BCVA （t= 16.4, 35.7, 20.7; P〈0.05） and MS （t=13.8, -17.9, -2.5; P〈0.05） were improved significantly; the macular hole diameter （t=7.7, 7.7, 7.7; P〈0.05）, IS/OS junction defect （t=24.1, 19.3, 27.4; P〈0.05） and ELM （t= 20.5, 6.7, 15.8; P〈0.05） defect were decreased significantly. Preoperative IS/OS junction defect and ELM defect were both related to sensitive （r= -0.55, -0.53; P%0.05）, but uncorrelated with BCVA （r=0.13, 0.13; P〈0.05）. IS/OS junction defect and ELM defect 1st, 3rd and 6th months after surgery were both related to MS and BCVA （P ~ 0.05）. Conclusions The logMAR BCVA and MS increase, while IS/OS junction and defect ELM defect decrease after surgery in IMH patients. IS/OS junction defect and ELM defect after surgery were both related to sensitive and BCVA.

关 键 词：视网膜穿孔/外科学 玻璃体切除术 治疗结果 

分 类 号：R779.6[医药卫生—眼科]