特发性黄斑裂孔术后的黄斑区视网膜厚度变化的远期观察

Long- term changes of macular retinal thickness after idiopathic macular hole surgery

目的：对特发性黄斑裂孔患者进行玻璃体切割手术（ pars plana vitrectomy, PPV）及内界膜（ inner limiting membrane, ILM）剥除、气体眼内填充后,应用频域光学相干断层扫描仪（ spectral domain optical coherence tomography,SD-OCT）观察黄斑裂孔术后的闭合黄斑孔的黄斑区视网膜厚度（ retinal thickness,RT）变化。 方法：非随机、回顾性临床病例研究。筛选我院2011-03-01/2013-06-30入院诊断为“特发性黄斑裂孔”的患者17例17眼,均为同一术者行25 G-PPV和ILM剥除、短效气体填充、黄斑孔闭合良好、随访观察超过6 mo以上者。所有患者术后均使用Topcon公司SD-OCT进行术眼及对侧正常眼的黄斑区线性扫描检测黄斑区视网膜厚度变化。黄斑区视网膜厚度根据ETDRS分成9个区域。术后观察随访时间分别为术后3～5wk（A 期）、术后2～3mo（B期）、术后〉6mo（C期）。 结果：在A期中,OCT检查的黄斑区视网膜厚度：术眼C, IS,II,IN,OS,OI和ON较对侧眼相应区域的厚度增加（ P〈0.01）,而IT和OT（291.58±18.97μm,250.83±21.21μm）较对侧眼（280.33±20.82μm,242.08±24.02μm）的差异无统计学意义（P〉0.01）。在B期中,术眼II,IN,OS和ON区域较对侧眼相应区域视网膜厚度增加（P〈0.01）,而术眼C,IS,IT,OI和OT区域较对侧正常眼相应区域的视网膜厚度值差异无统计学意义（P〉0.01）。 C期中,除术眼IN区较对侧眼厚度增加外（P〈0.01）,余C,IS,II,IT,OS, OI,ON和OT较对侧眼相应区域厚度均无明显变化（ P〉0.01）。另外,C期的术眼ON和IT视网膜厚度较A期有明显下降（P〈0.01）。 结论：特发性黄斑裂孔术后出现黄斑区视网膜厚度的持续变化,可能与ILM的剥除导致黄斑区显微组织结构的变化有关。 SD-OCT为黄斑裂孔术后随访观察提供了客观便捷的观察工具,为进一步研究ILM 剥除对黄斑区视网膜的远期结构及对视功能的影响提供了依据。

AlM：To determine the changes of regional macular retinal thickness （ RT ） with spectral domain optical coherence tomography （ SD-OCT ） after successful pars plana vitrectomy （ PPV ） surgery with inner limiting membrane （ lLM ） peeling in patients with idiopathic macular hole. METHODS：A non-randomized retrospective case study on 17 patients （ 17 eyes ） who were hospitalized between March 1, 2011 and June 30, 2013. All 17 eyes had been diagnosed with idiopathic macular hole and thereafter underwent 25G-PPV surgeries performed by the same surgeon with lLM peeling and short - term gas tamponade. ln the 6mo-plus follow-up after surgery, these eyes were found to have successful closure in the macular hole. The macular RT of the nine areas in the Early Treatment Diabetic Retinopathy Study was measured by SD-OCT. All patients were applied by SD-OCT with linear scan of the macular. At least four examinations on the operated eye were conducted in contrast to the other normal eye： before the surgery, 3～5wk after the surgery （stage A）, 2～3mo after the surgery （stage B）, and 〉6mo after the surgery （stage C）. RESULTS：ln stage A, the macular RT of operated eyes in the areas of C, lS, ll, lN, OS, Ol, ON （263. 00±39. 48, 313. 92±18. 35, 311. 00±18. 02, 335. 67±19. 91, 280. 83±33. 74, 269. 92 ± 23. 32, 307. 00 ± 28. 40 ） were significantly thicker than the corresponding areas of the normal fellow eyes （220. 51 ± 23. 94, 292. 08 ± 21. 93, 282. 50 ± 20. 30, 288. 33 ± 20. 76, 251. 25±17. 60, 247. 75±21. 48, 265. 17±24. 76＆#252; m） （P〈0. 01） with the exception of the lT （291. 58±18. 97, 280. 33± 20.82＆#252;m） and OT （250.83±21.21, 242.08±24.02＆#252;m） （P〉0. 01）. ln Stage B, the macular RT in the areas of ll, lN, OS （335.67±19.20,319.75±19.20, 273.50±16.89＆#252;m） were significantly thicker than the corresponding areas of the normal fellow eyes （286. 33±20. 46, 293. 42±17. 64, 252. 50± 16.32＆#252;m） （P〈0. 01）. However, the macular RT of the operated eyes in the areas of C, lS, lT, Ol and OT had no statistically significant difference compared with the corresponding areas of the normal fellow eyes （P〉 0. 01）. ln Stage C, the macular RT of operated eyes with the areas of lN （321. 17 ± 19. 71＆#252; m） were significantly thicker than the corresponding areas of the normal fellow eyes （296.25±19.57＆#252;m） （P〈0.01）. Meanwhile the other areas of the operated eyes were not significantly different from the normal fellow eyes （P〉0. 01）. Moreover, the macular RT of operated eyes in the areas of ON, lT （307. 00±28. 40, 291. 58 ± 18. 97＆#252; m ） in stage A significantly decreased compared to that of the corresponding areas in stage C （276. 08±32. 39, 278. 75±10. 19＆#252; m） （P〈0. 01）. CONCLUSlON： SD-OCT is a convenient tool for the observation of macular regional changes after macular hole surgery. Macular RT had persistent changes after vitrectomy on eyes with macular hole by SD-OCT. lLM peeling may have caused microstructural changes in wide areas of the macular region after PPV surgery. More support and evidence were provided to the further study of the long - term observation for the structural and function of macular after macular hole surgery.