特发性黄斑裂孔病人玻璃体切割术后黄斑区结构与功能变化

发布时间：2018-11-09 10:33

【摘要】：目的观察特发性黄斑裂孔(idiopathic macular hole,IMH)病人玻璃体切割手术前后视力、光学相干断层扫描(optical coherence tomography,OCT)及多焦视网膜电图(multifocal electroretinogram,mfERG)的变化,探讨评价黄斑裂孔病人结构与功能改变的敏感指标。方法收集34例(34眼)行玻璃体切割术治疗的单眼特发性黄斑裂孔病人,术后随访6个月,记录病人健眼及患眼术前、术后3个月、术后6个月的最佳矫正视力(best corrected visual acuity,BCVA)、mfERG及OCT。结果特发性黄斑裂孔病人术前患眼BCVA 0.01~0.8,平均0.10。病人术前OCT裂孔最大直径(maximum diameter,dmax)431~1 770μm,平均(998.7±302.6)μm,裂孔最小直径(minimum diameter,dmin)403~536μm,平均(470±189.2)μm。特发性黄斑裂孔病人患眼BCVA、中心凹及旁中心凹区mfERG P波及N1波振幅降低(P0.05)。术后黄斑裂孔全部解剖学闭合,其mfERG P波及N1波振幅亦在术后逐渐恢复,但仍不能恢复至健眼水平。术后3个月患眼P波潜伏期一过性延长,至术后6个月恢复。术前患眼BCVA与dmin、dmax相关(ρ=0.549,ρ=0.610,P0.01),与mfERG各项参数无相关性;术后BCVA与黄斑中央视网膜厚度(central retinal thickness,CRT)相关(P0.05),与mfERG各项参数无相关性。结论特发性黄斑裂孔病人患眼术后视力及视觉功能均较术前提高,其黄斑区结构及功能得到一定程度的恢复。术前及术后OCT的主要指标与病人最佳矫正视力相关,术前dmin、dmax对病人术后BCVA有预测意义,但本研究并未显示术前mfERG各项参数对病人术后最佳矫正视力有预测意义。
[Abstract]:Objective to observe the changes of visual acuity, optical coherence tomography (optical coherence tomography,OCT) and multifocal electroretinogram (multifocal electroretinogram,mfERG) in patients with idiopathic macular hole (idiopathic macular hole,IMH) before and after vitrectomy. Objective: to evaluate the sensitive indexes of structural and functional changes in macular hole patients. Methods 34 cases (34 eyes) of monocular idiopathic macular hole treated by vitrectomy were collected and followed up for 6 months. The best corrected visual acuity (best corrected visual acuity,) was recorded before operation, 3 months after operation and 6 months after operation. BCVA), mfERG and OCT. Results the preoperative BCVA of patients with idiopathic macular hole was 0. 01 and 0. 8, with an average of 0. 10. The maximum diameter (maximum diameter,dmax) of the OCT hole (maximum diameter,dmax) was 1 770 渭 m (mean (998.7 卤302.6) 渭 m), and the minimum diameter (minimum diameter,dmin) of the hole was (403 卤189.2) 渭 m (mean (470 卤189.2) 渭 m). The amplitudes of mfERG P and N1 wave in BCVA, fovea and paracentric fovea were decreased in patients with idiopathic macular hole (P0.05). All the macular holes were anatomically closed, and the amplitudes of mfERG P and N1 wave recovered gradually after operation, but still could not recover to the level of normal eyes. P wave latency was temporarily prolonged 3 months after operation and recovered 6 months after operation. Preoperative BCVA was correlated with dmin,dmax (蟻 = 0.549, 蟻 = 0.610 P0.01), but not with mfERG parameters; postoperative BCVA was correlated with macular central retinal thickness (central retinal thickness,CRT) (P0.05), but not with mfERG parameters. Conclusion the postoperative visual acuity and visual function of the patients with idiopathic macular hole were improved, and the structure and function of macular area were recovered to some extent. The main indexes of OCT before and after operation were related to the best corrected visual acuity (BCVA). Preoperative dmin,dmax had predictive significance for postoperative BCVA, but this study did not show that the parameters of preoperative mfERG could predict the best corrected visual acuity (BCVA) after operation.
【作者单位】：首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室;青岛大学医学院附属烟台毓璜顶医院眼科;河北联合大学附属开滦总医院眼科;
【分类号】：R774.5

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