相干光断层扫描量化参数与特发性黄斑裂孔患者术后视力预后的相关性分析

Optical coherence tomography predictive factors for idiopathic macular hole surgery outcome

目的探索相干光断层扫描（OCT）量化参数与特发性黄斑裂孔（IMH）患者术后视力预后的相关性。方法系列病例研究。收集2009年1月至2011年11月在浙江大学医学院附属邵逸夫医院眼科中心经玻璃体切除联合视网膜内界膜剥离手术治疗后经OCT证实黄斑裂孔闭合且规律随访时间／〉6个月的23例（25只眼）IMH患者的临床资料。其中男性6例（7只眼），女性17例（18只眼）；年龄为63—71岁，平均67岁；病程3．5—12．0个月，平均6．0个月；根据Gass分期：Ⅱ期9只眼，Ⅲ期11只眼，Ⅳ期5只眼。手术前后均进行最佳矫正视力（BCVA）检查，通过OCT测量黄斑裂孔最小直径、裂孔高度、裂孔底径，并计算裂孔高度／裂孔底径（MHI）、裂孔高度／裂孔最小直径（THI）、裂孔最小直径／裂孔底径（DHI）。利用Spearman相关分析探索相关参数与术后视力预后间的相关性，ROC曲线分析MHI及THI预测术后视力预后的准确度，并取得MHI及THI界值。结果术前IMH患者BCVA为0．100（0．050～0．180），MHI为0．476（0．416～0．684），THI为1．048（0．761～1．346），DHI为0．536（0．431—0．645）；术后3个月BCVA为0．150（0．120～0．275），较术前明显提高（Mann—WhitneyU检验：P=0．002）；术后最终随访BCVA为0．250（0．135～0．350），较术前得到显著提高（Mann—Whitney U检验：P=0．000）；最终随访BCVA与术前BCVA、MHI、THI之间有相关性（r术前BcvA=0．560，P=0．004；rMHI=0．481，P=0．015；rTHI=0．516，P=0．008）；ROC曲线分析取得MHI及THI界值分别为0．475和0．973，且MHI≥0．475组术后BCVA明显好于MHI〈0．475组，THI≥0．973组术后BCVA明显好于THI〈0．973组（Mann—WhitneyU检验：P=0．013，P=0．008）。结论MHII〉0．475或THI〉／0．973的患者具有较好的视力预后，可作为潜在预测IMH患者术后视力预后的指标之一。

Objective To evaluate the use of preoperative optical coherence tomography （OCT） image and some related indexes as predictive factors for the visual outcomes of the idiopathic macular hole （[MH） after pars plana vitrectomy and the internal limiting membrane （ILM） peeling surgery. Methods This was a case-series study. Twenty-five eyes of 23 IMH patients undergoing a successful vitrectomy and ILM peeling surgery and following up more than 6 months were included in this retrospective study. Of the 23 patients ,6 were male and 17 were female. The median patient age was 67-year old （range 63 to 71 years）. The median duration of IMH was 6 months （ range 3.5 to 12. 0 months）. In the patients, the macular hole was found in 9 eyes at stage I][ , 11 eyes at stage m, and 5 eyes at stage IV. Best corrected visual acuity（BCVA） were examined before and after the surgery. The minimum diameter（a）,the height （b） and the base diameter（c） of macular holes were measured by OCT. According to the indexes, macular hole index （ MHI, b/c）, tractional hole index （ THI, b/a）, diameter hole index （ DHI, a/c ） were calculated, respectively. Spearman rank correlation analysis was performed to understand the correlations between postoperative BCVA and the related indexes. Cut-off values were obtained for MHI and THI, respectively, from receiver operating characteristic（ROC） curve analysis. Results The median preoperative BCVA was 0. 100（ range 0. 050 to 0. 180）. The median MHI,THI and I）HI was 0. 476（ range 0. 416 to 0. 684） , 1. 048 （range 0. 761 Io 1. 346 ） and 0.536 （ range 0.431 to 0. 645 ） , respe（＇iively. The median 3-1nonth posioperaliw, BCVA was 0. 150 （range 0. 120 to 0. 275 ） , markedly improved after surgery （ Mann-Whitney Utest ： 17 = 0. 002 ）. The median latest postoperative BCVA was 0. 250 （ range 0. 1 35 to 0. 350 ） , also markedly imIwoved （ Mann-Whither Ulesl. P = 0. 002 ）. MHI, THI and preoperative BCV A correlated significantly with postoperative BCW by Spearman rank correlation analysis （ rMHI = 0, 481 , P = 0. 015; rTHI = 0. 516, P = 0. 008 ; r preoperative BCVA = 0. 560, P = 0. 004, respeetively ）. Areas under the curve of 0. 740 and 0. 760 for MHI and Tlllwere obtained respectively. Cul-off values of 0. 475 and 0. 973 were obtained for MHI and Till, respectively,from ROC curve analysis. Posloperative BCVAs in the MHI≥0. 475 group and in lhe Tttl 1〉 0. 973 grolq~ wag better Ihan that in the Mill 〈 0. 475 and in the TH1 〈 0. 973 group, respeelively （ Mann- Whitney U lest：Pure = 0. 013, PTHI = 0. 008 ）. Conclusion An Mill t〉 0. 475 or a TMI ≥ 0. 973 may be predictive factors for a good visual prognosis after IMH surgery.