特发性黄斑裂孔患者术后黄斑区视网膜微结构修复与视功能恢复关系研究  

Relationship between postoperative macular microstructure repair and visual function recovery in patients with idiopathic macular fissure

作　　者：王一博 孟旭霞[1] 余川 杨静[1] 刘鹏辉[1] 耿文慧 WANG Yibo;MENG Xuxia;YU Chuan;YANG Jing;LIU Penghui;GENG Wenhui(Department of Ophthalmology,Affiliated Hospital of Qingdao University,Qingdao 266500,Shandong Province,China;Wuhan Aiger Eye Hospital,Wuhan 430000,Hubei Province,China;Shandong Lunan Eye Hospital,Linyi 276002,Shandong Province,China)

机构地区：[1]青岛大学附属医院眼科,山东省青岛市266500 [2]武汉艾格眼科医院,湖北省武汉市430000 [3]山东省鲁南眼科医院,山东省临沂市276002

出　　处：《眼科新进展》2021年第3期244-249,共6页Recent Advances in Ophthalmology

摘　　要：目的观察特发性黄斑裂孔(IMH)患者术后黄斑区视网膜各层微结构解剖修复过程与视功能恢复的关系。方法回顾性研究。选取手术治疗的IMH患者40例40眼,根据患眼术后1周~1个月光学相干断层扫描(OCT)图像微结构连续变化的愈合特征分为3组,其中,A组裂孔缺损组织及黄斑中心凹曲线完全或部分修复,且已修复部分为椭圆体带先愈合者;B组裂孔缺损组织及黄斑中心凹曲线完全或部分修复,且已修复部分为除椭圆体带外的其他视网膜层先愈合者;C组裂孔缺损组织及黄斑中心凹曲线未修复者。对比并观察3组患眼最佳矫正视力(BCVA)、微视野光敏度(MS)及OCT和多焦视网膜电图(mfERG)检查结果。结果40例(40眼)患者中术后黄斑裂孔愈合的34例(34眼)裂孔愈合时间为术后1~10(5.42±3.16)d,椭圆体带完全对接时间为术后2~12(5.57±3.69)d。术后1周,A组较B组有更高的全层愈合率(P=0.038)。3组患眼术后1周BCVA均较术前提高(均为P<0.05)。术后1周,A组BCVA优于B组、C组,差异均有统计学意义(均为P<0.05);术后1个月、3个月、6个月时,A组、B组BCVA均较C组提高,差异均有统计学意义(均为P<0.05),但A组与B组BCVA间差异均无统计学意义(均为P>0.05)。术后1个月,A组、B组MS与术前相比差异均无统计学意义(均为P>0.05),但A组MS优于B组、B组优于C组(均为P<0.05);术后3个月、6个月,A组、B组MS均较C组提高(均为P<0.05),但A组与B组MS相比差异均无统计学意义(均为P>0.05)。术后6个月,A组、B组黄斑中心1环、2环N1、P1波振幅密度及潜伏期均较术前明显改善(均为P<0.05),C组与术前相比差异均无统计学意义(均为P>0.05);A组、B组黄斑中心1环、2环N1、P1波振幅密度及潜伏期与C组相比差异均有统计学意义(均为P<0.05),但A组与B组间相比差异均无统计学意义(均为P>0.05)。结论IMH患眼术后初期椭圆体带先愈合者黄斑区视网膜微结构具有更高的全层愈合Objective To observe the relationship between the anatomical repair process of the retinal layers of the macula and the recovery of visual function after idiopathic macular fissure(IMH)surgery.Methods Retrospective study.Forty eyes of 40 patients with surgically treated IMH were divided into three groups according to the healing characteristics of the successive changes of microstructure on optical coherence tomography(OCT)images from 1 week to 1 month after surgery,group A was patients with complete or partial repair of the lacunar defect and macular notch curve,and healing of the ellipsoid band,group B was patients with complete or partial repair of the lacunar defect and macular notch curve,and healing of the repaired portion of the retinal layer other than the ellipsoid band,and group C was patients who had no repair of the lacunar defect and macular notch curve.The best-corrected visual acuity(BCVA),microfield sensitivity(MS),optical coherence tomography(OCT)and multifocal electroretinography(mfERG)were compared in the three groups.Results The healing time of the macular fissure in 34 eyes of 40 eyes ranged from 1 to 10(5.42±3.16)days,and the complete docking time of the ellipsoidal band ranged from 2 to 12(5.57±3.69)days.One week after operation,group A had a higher full-thickness healing rate than group B(P=0.038).At 1 week after surgery,the BCVA in group A was better than that in groups B and C,and the difference was statistically significant(both P<0.05).At 1 month,3 months,and 6 months after surgery,the BCVA of group A and group B were both higher than that of group C,and the difference was statistically significant(both P<0.05),but there were no statistically significant differences between group A and group B(P>0.05).At 1 month after surgery,there was no statistically significant difference in MS of group A and group B compared with that before surgery(both P>0.05),but MS in group A was better than that in group B and group B was better than that in group C(both P<0.05);at 3 and 6 months after surge

关 键 词：特发性黄斑裂孔 黄斑 视网膜微结构 微视野 光学相干断层扫描 多焦视网膜电图 

分 类 号：R774.5[医药卫生—眼科]