光学相干断层扫描血管造影在评价老年特发性黄斑裂孔患者玻璃体切除术疗效中的应用

Application of Optical Coherence Tomography Angiography in Evaluating the Efficacy of Vitrectomy in Elderly Patients with Idiopathic Macular Hole

【目的】 探讨光学相干断层扫描血管造影(OCTA)在评价老年特发性黄斑裂孔患者玻璃体切除术疗效中的应用。【方法】 选取2015年1月至2017年3月于本院行玻璃体切除术的老年特发性黄斑裂孔患者46例(46只眼)作为观察对象,所有患者均于术前及术后1个月进行OCTA检测,观察手术前后裂孔直径、孔缘厚度、晕轮直径、视网膜厚度及视网膜神经纤维层厚度的变化情况;术后1个月随访黄斑裂孔愈合情况。【结果】 46例患者术后1个月裂孔完全愈合31例(31眼)占67.39%,部分愈合者11例(11眼)占23.91%,未愈合者4例(4眼)占8.70%。术前OCTA检测显示,患者裂孔平均直径、平均孔缘厚度、平均晕轮直径较术前均减小;患者术后1个月OCTA检测显示黄斑中心凹、黄斑内环视网膜厚度、黄斑内环上侧及鼻侧视网膜神经纤维层厚度较术前均明显减少,差异均具有统计学意义(均P<0.05)。【结论】 OCTA能更客观、精确、有效地判断特发性黄斑裂孔患者玻璃体切除术后组织结构的疗效,是术后随访检查的有效手段。

【Objective】 To investigate the value of optical coherence tomography angiography (OCTA) in evaluating the efficacy of vitrectomy in elderly patients with idiopathic macular hole. 【Methods】 Forty-six cases (46 eyes) of elderly patients with idiopathic macular hole who underwent vitrectomy in our hospital from January 2015 to March 2017 were selected as objects of observation. All patients were examined by OCTA before and one month after operation. The changes of hole diameter, hole edge thickness, halo diameter, retinal thickness and retinal nerve fiber layer thickness were observed before and after operation.The macular hole healing was followed up 1 month after operation. 【Results】 One month after operation, 31 cases (31 eyes) healed completely, 11 cases (11 eyes) healed partially and 4 cases (4 eyes) did not heal, accounting for 67.39%, 23.91% and 8.70% respectively. Preoperative OCTA showed that the average diameter of the hole, the average thickness of the edge of the hole and the average diameter of the halo were all smaller than those before operation. One month after operation, OCTA showed that the thickness of the fovea, the retina of the inner macular ring, the retinal nerve fiber layer of the upper and nasal sides of the inner macular ring were significantly reduced compared with those before operation, and the difference was statistically significant (all P<0.05). 【Conclusion】 OCTA can more objectively, accurately and effectively judge the effect of histological structure of patients with idiopathic macular hole after vitrectomy, and it is an effective means of follow-up examination after surgery.