玻璃体积血患者玻璃体切割术中黄斑区微结构形态与术后早期视力的关系  

Relationship between morphology of macular microstructure and early visual acuity after vitrectomy for vitreous hemorrhage

作　　者：宋德弓 王文战[1] 万光明[1] 邓先明[1] 李龙[1] 石径 SONG Degong;WANG Wenzhan;WAN Guangming;DENG Xianming;LI Long;SHI Jing(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2023年第8期638-641,共4页Recent Advances in Ophthalmology

摘　　要：目的探究玻璃体积血患者玻璃体切割术中黄斑区微结构形态与术后早期(1个月内)视力的关系。方法回顾性病例系列研究。纳入郑州大学第一附属医院眼科2021年12月至2022年8月因玻璃体积血行玻璃体切割术的患者40例42眼。术中均获得患者清晰的黄斑区OCT图像,用于分析黄斑中心凹厚度(CFT)、感光细胞层中椭圆体带(EZ)连续性与术后早期最佳矫正视力(BCVA)的关系。按照EZ连续性结构划分为EZ连续组18例19眼(A组)、EZ断裂组11例12眼(B组)和EZ消失组11例11眼(C组),对三组患者间的性别、年龄、术中CFT、术前及术后早期BCVA进行比较。亚组分析:排除包含黄斑囊样水肿、黄斑前膜、神经纤维层萎缩、板层及全层黄斑孔的黄斑病变患者12例13眼,将剩余的28例29眼患者按照术后早期BCVA的恢复程度进行分组,即术后早期BCVA(logMAR)≤0.3为预后较好组(9例10眼),术后早期BCVA(logMAR)>0.3为预后较差组(19例19眼),对两组患者间的性别、年龄、术中CFT、术前BCVA及术中EZ连续性异常的发生率进行比较。结果A组、B组、C组患者间性别、年龄、术前BCVA、术中CFT差异均无统计学意义(均为P>0.05)。A组、B组、C组患者术后早期BCVA差异有统计学意义(P<0.05),两两比较结果显示,A组患者术后早期BCVA优于B组和C组(均为P<0.05),B组患者术后早期BCVA优于C组(P<0.05)。亚组分析中,预后较好组与预后较差组患者性别、术前BCVA、术中CFT差异均无统计学意义(均为P>0.05)。两组患者年龄差异有统计学意义(P<0.05);两组患者术中EZ连续性异常的发生率差异有统计学意义(P<0.05),即术后早期视力恢复较好组患者术中EZ连续性异常的发生率明显低于术后早期视力恢复较差组。结论术中以感光细胞层EZ的连续性为依据,预测玻璃体积血患者术后早期视力是可行的。Objective To explore the relationship between the intraoperative macular microstructure and the early postoperative visual acuity in patients with vitreous hemorrhage.Methods This was a retrospective case-series study.A total of 40 patients(42 eyes)who underwent vitrectomy for vitreous hemorrhage from December 2021 to August 2022 in the First Affiliated Hospital of Zhengzhou University were included in the study.Clear macular images were obtained during the operation with the aid of optical coherence tomography to analyze the relationship between the central foveal thickness(CFT),the continuity of the ellipsoid zone(EZ)in the photoreceptor cell layer,and the early postoperative best-corrected visual acuity(BCVA).These patients were divided into three groups based on their EZ continuity:group A with continuous EZ(18 patients,19 eyes),group B with broken EZ(11 patients,12 eyes),and group C with vanishing EZ(11 patients,11 eyes).Gender,age,intraoperative CFT,preoperative and early postoperative BCVA were analyzed and compared among the three groups.Subgroup analysis:13 eyes of 12 patients with macular lesions such as macular cystoid edema,macular anterior membrane,nerve fiber layer atrophy,lamellar and full-thickness macular hole were excluded.The remaining 29 eyes of 28 patients were grouped according to the recovery of BCVA in the early postoperative period,with BCVA(logMAR)≤0.3 in the good prognosis group(10 eyes of 9 patients)and BCVA(logMAR)>0.3 in the poor prognosis group(19 eyes of 19 patients).Comparative analysis of gender,age,intraoperative CFT,preoperative BCVA,and intraoperative EZ continuity anomaly was performed between the two subgroups.Results There were no significant differences in gender,age,preoperative BCVA,and intraoperative CFT among groups A,B,and C(all P>0.05),but there was a significant difference in the early postoperative BCVA(P<0.05).The early postoperative BCVA was better in group A than in groups B and C(both P<0.05).The early postoperative BCVA was better in group B than in group C(

关 键 词：黄斑区微结构 椭圆体带 术中OCT 黄斑中心凹厚度 视力 

分 类 号：R774[医药卫生—眼科]