特发性黄斑裂孔手术前后注视性质和视敏度变化  

Changes of Fixation Pattern and Visual Acuity Before and After Idiopathic Macular Hole Surgery

作　　者：牛梦迪 王海林[2] 牛彤彤[2] 曹珍珎 Niu Mengdi;Wang Hailin;Niu Tongtong;Cao Zhenzhen(Postgraduate Training Base of Jinzhou Medical University,the Fourth People's Hospital of Shenyang;The Fourth People's Hospital of Shenyang,Shenyang 110000 China)

机构地区：[1]锦州医科大学沈阳市第四人民医院研究生培养基地 [2]沈阳市第四人民医院,辽宁沈阳110000

出　　处：《锦州医科大学学报》2021年第3期44-48,共5页Journal of Jinzhou Medical University

基　　金：辽宁省科学技术计划项目,项目编号:2020JH2/10300052。

摘　　要：目的观察特发性黄斑裂孔手术前后注视性质和视敏度的变化,并探讨其与手术前后黄斑视功能变化的关系,为特发性黄斑裂孔手术提供更为有效的视功能观察指标。方法本实验采用回顾性分析,选取2018年12月至2019年12月于我院就诊,行玻璃体切除术(pars plana vitrectorny,PPV)联合内界膜撕除术的特发性黄斑裂孔(idiopathic macular hole,IMH)患者28例30只眼纳入研究。于术前、术后1个月、术后3个月、术后6个月分别行最佳矫正视力(best corrected visual acuity,BCVA)、光学相干断层成像(optical coherence tomography,OCT)、微视野查。采用OCT记录术前IMH的孔径及术后的愈合情况。采用微视野计行微视野检查,记录内容包括:(1)黄斑区视网膜平均敏感度(average threshold,AT);(2)2°固视率(P1)、4°固视率(P2);(3)优选的视网膜注视位点(preferred retinal location,PRL)移动距离。比较AT,BCVA术前术后的变化特点,并研究PRL的移动距离与视力变化及注视性质之间的关系。结果OCT显示术后黄斑裂孔全部闭合。术前与术后6个月的注视性质存在差异(两独立样本秩和检验,Z=-4.273,P<0.01)。术前至术后1个月(r=0.5276,P<0.01)、术前至术后3个月(r=0.802,P<0.01)、术前至术后6个月(r=0.5995,P<0.01)的PRL的移动距离均与相应阶段的BCVA改变量呈正相关。BCVA从基线时的(1.09±0.23)明显改善至术后6个月的(0.48±0.15)(P<0.01),但术后1个月与术前相比无显著改善(P=0.177),术后3个月(P<0.01)、术后6个月(P<0.01)均有显著改善。AT也有显著的提高,从基线时的(20.55±2.47)dB提高至术后6个月的(23.07±2.18)dB(P<0.01)。结论特发性黄斑裂孔术后裂孔闭合,注视性质向稳定中心注视转变。特发性黄斑裂孔术后黄斑区视网膜平均敏感度显著增加,在第1个月时尤为明显。可作为比最佳矫正视力更为敏感的视功能观测指标。Objective To observe the changes of fixation pattern and visual acuity before and after the surgery for idiopathic macular hole,and to explore the relationship between the two indexes and the changes of macular visual function before and after surgery,so as to provide a more effective indicator of visual function for idiopathic macular hole surgery.Methods A retrospective analysis was performed in this study.30 eyes in 28 patients with idiopathic macular hole(IMH)who were treated with pars plana vitrectorny(PPV)combined with internal limiting membrane peeling in our hospital from December 2018 to December 2019 were selected.The best corrected visual acuity(BCVA),optical coherence tomography(OCT)and microperimete were respectively performed before surgery,1 month after surgery,3 months after surgery,and 6 months after surgery.OCT was used to record the preoperative diameter of IMH and postoperative healing.Microperimeter was performed by using microperimetry.The recording contents included:(1)average threshold(AT)of retina in macular area;(2)2°fixation rate(P1)and 4°fixation rate(P2);(3)displacement distance of preferred retinal location(PRL).The changes of AT and BCVA before and after surgery were compared,and the relationship between the displacement distance of PRL and the changes of visual acuity and fixation patterns was studied.Results OCT showed that the macular hole was completely closed after surgery.After 6 months,the fixation pattern before surgery was different from that after surgery(rank sum test of two independent sample,Z=-4.273,P<0.01).The displacement distance of PRL from before surgery to 1 month after surgery(r=0.5276,P<0.01),from before surgery to 3 months after surgery(r=0.802,P<0.01),and from before surgery to 6 months after surgery(r=0.5995,P<0.01)were all positively correlated with the changes of BCVA at corresponding period.BCVA significantly improved from(1.09±0.23)at baseline to(0.48±0.15)6 months after surgery(P<0.01).It was not remarkably improved 1 month after surgery(P=0.177),bu

关 键 词：特发性黄斑裂孔 注视性质 视网膜平均敏感度 PRL 

分 类 号：R774.5[医药卫生—眼科]