微视野联合OCTA对于大直径特发性黄斑裂孔行内界膜覆盖术后的疗效分析  

Therapeutic effect of microperimetry combined with optical coherence tomography angiography on large-diameter idiopathic macular hole after internal limiting membrane covering surgery

作　　者：吴泠瑶 游志鹏[1] 谈赟玉 苏晓涵 WU Lingyao;YOU Zhipeng;TAN Yunyu;SU Xiaohan(the Affiliated Eye Hospital of Nanchang University,Jiangxi Eye Hospital,Jiangxi Clinical Medical Research Center for Ophthalmic Diseases,Jiangxi Provincial Institute of Ophthalmology and Visual Science,Jiangxi Provincial Key Laboratory of Ophthalmology,Jiangxi Provincial Branch of National Clinical Medical Research Center for Otolaryngological Diseases,Jiangxi Key Laboratory of Vitreoretinal Science,Nanchang 330006,Jiangxi Province,China)

机构地区：[1]南昌大学附属眼科医院,江西省眼科医院,江西省眼科疾病临床医学研究中心,江西省眼科学与视觉科学研究所,江西省眼科学重点实验室,国家耳鼻喉疾病临床医学研究中心江西省分中心,江西省卫生健康玻璃体视网膜疾病重点实验室,江西省南昌市330006

出　　处：《眼科新进展》2024年第9期707-713,共7页Recent Advances in Ophthalmology

基　　金：中央引导地方科技发展资金项目(提前批)科技创新基地建设(编号:2022ZDG02012);江西省卫健委科技创新重点项目(编号:2023ZD004)。

摘　　要：目的 采用光学相干断层扫描血管成像(OCTA)和微视野计观察玻璃体切割(PPV)联合内界膜(ILM)覆盖术对大直径特发性黄斑裂孔(IMH)患者的有效性和安全性。方法 选取2023年2月至2023年7月在南昌大学附属眼科医院治疗的23例23眼大直径IMH患者。分别在术前及手术后1周、1个月、3个月、6个月观察患者最佳矫正视力(BCVA)、裂孔闭合率、黄斑区(分为中心子区、内层区及外层区)浅层微循环[浅层毛细血管灌注密度(PSCP)与视网膜浅层毛细血管密度(VSCP)]及黄斑区视网膜光敏感度(MS)、固视稳定性及中心凹无血管区(FAZ)面积的变化,对比患者术前及术后的患眼参数改变并研究参数之间的相关性。结果 随访6个月,所有患眼黄斑裂孔均闭合,闭合率100%。与术前BCVA相比,患者术后1周、术后1个月、术后3个月及术后6个月BCVA逐渐改善,两两相比差异均有统计学意义(均为P<0.05)。与术前FAZ面积相比,患者术后1周、术后1个月、术后3个月及术后6个月FAZ面积均减小,差异均有统计学意义(均为P<0.05)。患者3个区域的VSCP在术后1周时与术前相比均有下降,在术后6个月时与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者3个区域的PSCP在术后3个月、术后6个月时与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者术后1个月、3个月及6个月黄斑区12°MS与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者术后1个月、术后3个月及术后6个月固视点在2°及4°内的占比与术前相比均有所提高,差异均有统计学意义(均为P<0.05),在术后1周时,患者固视点在4°内的占比与术前相比有所提高,差异有统计学意义(P<0.05)。相关性结果显示,术前MS与固视点在2°内占比与术后6个月BCVA(logMAR)均呈负相关(r=-0.819、-0.790,均为P<0.05),术前FAZ面积及术前最小孔径与术后6个月BCVA(logMAR)均呈正相关(r=0.5Objective To explore the efficacy and safety of pars plan vitrectomy(PPV)combined with internal limiting membrane(ILM)covering surgery in patients with large-diameter idiopathic macular holes(IMH)using optical coherence tomography angiography(OCTA)and microperimetry.Methods Twenty-three eyes of 23 patients with large-diameter IMH treated at the Eye Hospital Affiliated with Nanchang University from February 2023 to July 2023 were selected.The patients’best-corrected visual acuity(BCVA),hole closure rate,microcirculation[perfusion density at the superficial capillary plexus(PSCP)and vascular density at the retinal superficial capillary plexus(VSCP)]in the macular area(divided into central,inner and outer regions),macular sensitivity(MS),fixation stability,and foveal avascular zone(FAZ)area were observed before surgery and at 1 week,1 month,3 months,and 6 months after surgery.Changes in eye parameters before and after surgery were compared,and the correlation between parameters was analyzed.Results After a 6-month follow-up,all macular holes in the affected eyes were closed,with a closure rate of 100%.Compared to before surgery,the BCVA of the patients improved gradually at 1 week,1 month,3 months,and 6 months after surgery,and the differences between any two time points were statistically significant(all P<0.05).The FAZ area decreased at 1 week,1 month,3 months,and 6 months after surgery compared to before surgery,and the differences were statistically significant(all P<0.05).The VSCP in the three regions showed a decrease at 1 week postoperatively and an increase at 6 months postoperatively compared to before surgery,and the differences were statistically significant(both P<0.05).The PSCP increased at 3 months and 6 months postoperatively compared to before surgery,with statistically significant differences(both P<0.05).The 12°MS increased at 1 month,3 months,and 6 months after surgery compared to before surgery,with statistically significant differences(all P<0.05).The proportions of fixation points within 2°

关 键 词：内界膜覆盖术 光学相干断层扫描血管成像 微视野 

分 类 号：R774.5[医药卫生—眼科]