特发性黄斑裂孔对侧眼的观察分析

Idiopathic macular hole development in fellow eyes of patients with unilateral macular hole

目的 应用光学相干断层扫描（optical coherence tomography,OCT）对特发性黄斑裂孔患者对侧眼的后极部视网膜与玻璃体的扫描,观察其早期变化及演变过程分析.方法 对45例临床已确诊的特发性黄斑裂孔患者的对侧眼进行OCT扫描.结果 45例患者对侧45只眼中,23只眼有异常,OCT扫描后显示其中8只眼为1～2期单纯玻璃体后脱离（posterior vitreous detachment,PVD）,3只眼为3期PVD,4只眼为1期黄斑裂孔,5只眼为2期黄斑裂孔,3只眼为3期黄斑裂孔,未发现4期黄斑裂孔,其余22只眼未见明显异常表现.随访一年半后发现1期黄斑裂孔的2只眼、2期黄斑裂孔的4只眼,1～2期PVD的2只眼进展为3～4期黄斑裂孔（共8只眼进展为3～4期黄斑裂孔）,1期黄斑裂孔1只眼进展为2期黄斑裂孔,22只正常眼中有4例发现1～2期PVD,其余未见异常改变.结论 特发性黄斑裂孔有双眼发病的可能,对侧眼发生黄斑裂孔的可能性应引起重视,利用OCT可以对其黄斑区玻璃体视网膜关系进行观察、随访,并且评估其发生黄斑裂孔的可能性及危险性,可以适时采取干预措施.

Objective Using OCT （optical coherence tomography, OCT） to scan the posterior retina and vitreous, investigate the initial changes and developing process. Methods The fellow eyes of 45 patients with unilateral full-thickness macular holes were examined by OCT. Results In the 45 eyes, 23 eyes were abnormity observed by OCT. OCT images showed that among the 23 initially diseased eyes the number of posterior vitreous detachment of 1-2 and 3stages was respectively 8 and 3 eyes, macular hole of 1, 2, 3 stages was respectively 4, 5, and 3 eyes, there was not stage 4 macular hole. After one year and a half fellow-up, among the 23 abnormity eyes, 8 eyes developed a full-thickness macular hole, and 4 eyes of the other 22 normal eyes developed a posterior vitreous detachment. Conclusions It is possible that idiopathic macular hole development in fellow eyes of patients with unilateral macular hole should attract our attention. Posterior vitreoretinal relationship can be observed and follow-up by OCT, and to assess the likelihood of occurrence of macular holes and risk, guide our interventions.