原发性黄斑裂孔眼的视功能和脉络膜形态分析  

Choroidal blood flow and visual function in idiopathic macular hole

作　　者：陈敏锋 郑晨琛 刘昱 陈峰 徐丹 Chen Minfeng;Zheng Chenchen;Liu Yu;Chen Feng;Xu Dan(Eye Hospital of Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院,国家眼部疾病临床医学研究中心,温州325027

出　　处：《中华眼科杂志》2022年第6期412-419,共8页Chinese Journal of Ophthalmology

基　　金：温州市科技局资助项目(Y20180171)。

摘　　要：目的探讨原发性黄斑裂孔眼的脉络膜形态和血流灌注特征及其与视功能的相关性。方法横断面研究。选取2018年6月至2019年7月在温州医科大学附属眼视光医院诊断为单眼原发性全层黄斑裂孔的患者22例纳入研究,其中男性8例,女性14例,年龄(64.05±7.31)岁。将22只患眼作为裂孔眼组,对侧眼排除眼底病和眼底图像质量不佳的3只眼,其余19只眼作为对侧眼组;另选取年龄匹配的健康者16人(16只眼)作为健康眼组,其中男性2名,女性14名,年龄(63.25±5.14)岁。检查项目包括最佳矫正视力、微视野计检查视网膜敏感度、相干光层析血管成像术测量脉络膜血流灌注的情况、相干光层析成像术测量黄斑裂孔直径和脉络膜的厚度。通过独立样本t检验分析不同裂孔基底径下视功能及眼底情况的差异,通过广义线性模型分析3个组视功能及眼底情况的差异,采用Pearson相关性分析对视网膜、脉络膜的形态学参数与视功能参数之间的相关性进行分析。结果裂孔眼组最佳矫正视力和视网膜敏感度分别为1.02±0.22和(13.03±2.91)dB,显著低于对侧眼组的0.15±0.11和(17.25±2.03)dB(t=17.019,-4.085;P<0.001)及健康眼组的0.04±0.05和(16.63±2.89)dB(t=21.736,-3.134;P=0.004)。裂孔眼组、对侧眼组和健康眼组的脉络膜浅层毛细血管血流面积分别为(1.33±0.29)、(1.98±0.13)和(1.93±0.12)mm2,差异有统计学意义(t=-9.424,-8.707;P<0.001)。裂孔眼组旁中心血流密度为48.91%±10.12%,低于对侧眼组和健康眼组的58.27%±6.18%、55.20%±2.12%,差异有统计学意义(t=-3.502,-2.830;P=0.001,0.020)。中心凹处脉络膜较厚,然后向周边逐渐变薄,最薄的区域在鼻侧;裂孔眼组的中心凹下脉络膜厚度为(188±21)μm,显著低于对侧眼组的(217±36)μm(t=-3.672,P=0.002)和健康眼组的(229±25)μm(t=-3.304,P<0.001),而对侧眼组和健康眼组的差异无统计学意义(t=-0.916,P=0.368)。裂孔眼组裂孔基底径分别Objective To investigate the choroidal blood flow and visual function in idiopathic macular hole.Methods In this prospective study,fundus structure and visual function in 22 eyes with macular hole and their fellow eyes and 16 normal eyes were assessed.The best corrected visual acuity and retinal sensitivity were detected by the EDTRS visual chart and MP1.The choroidal blood flow was observed by optical coherence tomography angiography.The choriocapillary blood flow density was measured using MatLab.The thickness of the choroid and the aperture size of macular hole were measured using enhanced depth imaging mode of Heidelberg optical coherence tomography.Results The best corrected visual acuity and retinal sensitivity of macular hole eyes[1.02±0.20 and(13.03±2.91)dB]were significantly lower than fellow eyes[0.15±0.11,t=17.019,P<0.001 and(17.25±2.03)dB,t=-4.085,P<0.001]and normal eyes[0.04±0.05,t=21.736,P=0.001 and(16.63±2.89)dB,t=-3.134,P=0.004].The blood flow area of choroidal capillaries in macular hole eyes[(1.33±0.29)mm2]was significantly lower than fellow eyes[(1.98±0.13)mm2;t=-9.424,P<0.001]and normal eyes[(1.93±0.12)mm2;t=-8.707,P<0.001].The paracentral blood vessel density of the choroid capillary layer in macular hole eyes(48.91%±10.12%)was significantly lower than fellow eyes(58.27%±6.18%;t=-3.502,P=0.001)and normal eyes(55.20%±2.12%;t=-2.830,P=0.020).The subfoveal choroidal thickness of macular hole eyes[(188±21)μm]was significantly lower than fellow eyes[(217±36)μm;t=-3.672,P=0.002]and normal eyes[(229±25)μm;t=-3.304,P<0.001].The basic diameter of macular hole eyes was correlated with the blood vessel density(r=-0.584,P=0.004),the subfoveal choroidal thickness(r=-0.511,P=0.015)and the retinal sensitivity(r=-0.432,P=0.044).The retinal sensitivity was correlated with the blood vessel density(r=0.450,P=0.035)and the subfoveal choroidal thickness(r=0.429,P=0.046).Conclusions The retinal sensitivity and fundus blood perfusion of idiopathic macular hole was decreased,and the thickness of pa

关 键 词：视网膜穿孔 脉络膜 局部血流 视敏度 体层摄影术 光学相干 血管造影术 

分 类 号：R774.5[医药卫生—眼科]