特发性黄斑裂孔手术治疗后裂孔愈合和视力恢复的相关因素

发布时间：2018-01-22 03:14

本文关键词： 特发性黄斑裂孔光学相干断层扫描预后分析　出处：《眼科新进展》2017年01期 　论文类型：期刊论文

【摘要】：目的探讨特发性黄斑裂孔手术治疗后影响裂孔愈合和视力恢复的相关因素。方法收集我院行玻璃体切割+内界膜撕除+气体充填手术的特发性黄斑裂孔患者35例(35眼)为研究对象,分别进行术前、术后常规检查,包括裂隙灯显微镜、间接检眼镜、最佳矫正视力(best correct visual acuity,BCVA)、频域光学相干断层扫描(spectral domain optical coherence tomography,SD-OCT),并测量裂孔底径(base diameter,BASE)、裂孔最小径(minimum diameter,MIN)、裂孔高度(height,H)、裂孔两侧外界膜的断端与光感受器脱离起点之间的距离(M、N)、水平方向光感受器内外节缺失区直径(diameter of IS/OS absence,DIOA)。采用最小分辨角对数(logMAR)记录矫正视力。根据患眼术后的SD-OCT图像结果,将黄斑裂孔愈合级别分为A、B、C3组。根据患眼术前术后BCVA情况,将术后视力分为:视力提高组、视力不变组、视力下降组。观察黄斑裂孔愈合和视力变化情况,并结合患者年龄、性别、术前黄斑裂孔各测量参数进行相关性分析。结果 35例中黄斑裂孔愈合A组23眼,B组6眼,C组6眼。视力提高组27眼,视力不变组、视力下降组均为4眼。结果显示:(1)黄斑裂孔愈合情况与BASE、H、MIN、黄斑裂孔指数(macular hole index,MHI)、裂孔牵拉指数(tractional hole index,THI)、孔径指数(DHI)、手术前BCVA(logMAR)弱相关(均为P0.05);与黄斑裂孔指数(macular hole healing index,MHCI)显著相关(r=-0.588,P=0.000);与年龄、性别均无相关性(均为P0.05)。(2)术后BCVA(logMAR)与BASE、MIN弱相关(均为P0.05);与THI、DIOA、术前BCVA(logMAR)显著相关(均为P0.05);与年龄、性别、H、MHCI、MHI、DHI均无相关性(均为P0.05)。(3)术前DIOA与术前BCVA(logMAR)显著正相关(r=0.658,P=0.000);术后DIOA与术后BCVA(logMAR)显著正相关(r=0.565,P=0.000);术后BCVA(logMAR)和术后DIOA较术前均有所改善,且差异均有统计学意义(均为P0.05)。结论 (1)MHCI与裂孔愈合等级的相关性最高,可作为手术前预测术后裂孔愈合情况的一个指标;(2)术前DIOA、术前BCVA(logMAR)、THI与术后视力恢复的相关性最高,可作为预测术后视力恢复情况的指标;(3)BCVA与DIOA具有显著相关性,因此视力改善与否的关键取决于DIOA的大小。
[Abstract]:Objective to investigate the related factors affecting the healing and visual recovery of idiopathic macular hole after surgical treatment. Methods the internal boundary membrane avulsion of vitrectomy was performed in our hospital. 35 cases of idiopathic macular hole with gas filling. 35 eyes were studied. Routine examinations were performed before and after operation, including slit lamp microscope, indirect ophthalmoscope and best correct visual acuity. Frequency-domain optical coherence tomography (domain optical coherence tomographyn SD-OCTs). The bottom diameter of the hole is measured, the minimum diameter of the hole is minimum and the height of the hole is high. The distance between the broken end of the outer membrane and the photoreceptor from the starting point of the outer membrane on both sides of the hole. Diameter of IS/OS absence in horizontal direction photoreceptor. The corrected visual acuity was recorded by lognormal least resolution angle. According to the SD-OCT images of the affected eyes, the healing grade of macular hole was classified as Aneb. Group C3: according to the preoperative and postoperative BCVA of the affected eyes, the postoperative visual acuity was divided into three groups: visual acuity improvement group, visual acuity invariant group, visual acuity decreased group, macular hole healing and visual acuity changes were observed, and combined with the age of the patients. Results in 35 cases, macular hole healing in group A (23 eyes), group B (6 eyes), group C (6 eyes), visual acuity improvement group (27 eyes), visual acuity unchanged group (27 eyes). There were 4 eyes in the group of visual acuity loss. The results showed that the healing of macular hole and macular hole index (macular hole index). The pore drag index (hole) and pore diameter index (DHI). There was a weak correlation between BCVA and log Mar before operation (P 0.05). There was a significant correlation between macular hole healing index and macular hole healing. There was no correlation between age and sex (both P0.05, P < 0.05) and BCVA logMAR (P 0.05) and the weak correlation between BCVA logMAR and BASE min (all P 0.05). There was a significant correlation with DIOAA, BCVA log Mar (all P 0.05). With age, sex, MHCI and MHI. There was no significant correlation between preoperative DIOA and preoperative BCVA logMAR (P 0.05). There was a significant positive correlation between preoperative DIOA and preoperative BCVA logMAR (P < 0. 658; P < 0. 000). There was a significant positive correlation between postoperative DIOA and postoperative BCVA log Mar. Both postoperative BCVA log Mar and postoperative DIOA were better than those before operation. The difference was statistically significant (P 0.05). Conclusion the correlation between MHCI and the healing grade of the hiatus is the highest, which can be used as an index to predict the healing of the hiatus before and after operation. (2) preoperative DIOAA, preoperative BCVAlogMARHI-Thi has the highest correlation with postoperative visual acuity recovery, which can be used as a predictor of postoperative visual acuity recovery. There is a significant correlation between BCVA and DIOA, so the key of vision improvement depends on the size of DIOA.
【作者单位】：南京大学医学院临床学院眼科;南京军区南京总医院眼科;
【分类号】：R779.6
【正文快照】： 特发性黄斑裂孔(idiopathic macular hole,IMH)是黄斑区中心凹结构的视网膜神经纤维层的断裂,不伴有其他眼底相关疾病,多发于中老年女性,严重损害视力。目前,玻璃体切割联合内界膜剥除及气体充填手术是治疗黄斑裂孔的主要方法,但术后患者裂孔愈合情况和视力恢复情况不尽相同[1

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