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  

The relationship between the sizes of idiopathic macular hole and the healing types of fovea photoreceptor layer after vitrectomy

作　　者：谢艾芮 文峰[1] 刘文[1] 

机构地区：[1]中山大学中山眼科中心 眼科学国家重点实验室,广州510060

出　　处：《中华眼底病杂志》2018年第2期144-148,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：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�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.

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 

分 类 号：R774.12[医药卫生—眼科]