特发性黄斑裂孔手术治疗后裂孔愈合和视力恢复的相关因素

Associated factors analysis for predicting anatomical outcomes and postoperative visual acuity after vitrectomy for idiopathic macular hole

目的探讨特发性黄斑裂孔手术治疗后影响裂孔愈合和视力恢复的相关因素。方法收集我院行玻璃体切割+内界膜撕除+气体充填手术的特发性黄斑裂孔患者35例(35眼)为研究对象,分别进行术前、术后常规检查,包括裂隙灯显微镜、间接检眼镜、最佳矫正视力(best correct visual acuity,BCVA)、频域光学相干断层扫描(spectral domain optical coherence tomography,SD-OCT),并测量裂孔底径(base diameter,BASE)、裂孔最小径(minimum diameter,MIN)、裂孔高度(height,H)、裂孔两侧外界膜的断端与光感受器脱离起点之间的距离(M、N)、水平方向光感受器内外节缺失区直径(diameter of IS/OS absence,DIOA)。采用最小分辨角对数(logMAR)记录矫正视力。根据患眼术后的SD-OCT图像结果,将黄斑裂孔愈合级别分为A、B、C3组。根据患眼术前术后BCVA情况,将术后视力分为:视力提高组、视力不变组、视力下降组。观察黄斑裂孔愈合和视力变化情况,并结合患者年龄、性别、术前黄斑裂孔各测量参数进行相关性分析。结果 35例中黄斑裂孔愈合A组23眼,B组6眼,C组6眼。视力提高组27眼,视力不变组、视力下降组均为4眼。结果显示:(1)黄斑裂孔愈合情况与BASE、H、MIN、黄斑裂孔指数(macular hole index,MHI)、裂孔牵拉指数(tractional hole index,THI)、孔径指数(DHI)、手术前BCVA(logMAR)弱相关(均为P<0.05);与黄斑裂孔指数(macular hole healing index,MHCI)显著相关(r=-0.588,P=0.000);与年龄、性别均无相关性(均为P>0.05)。(2)术后BCVA(logMAR)与BASE、MIN弱相关(均为P<0.05);与THI、DIOA、术前BCVA(logMAR)显著相关(均为P<0.05);与年龄、性别、H、MHCI、MHI、DHI均无相关性(均为P>0.05)。(3)术前DIOA与术前BCVA(logMAR)显著正相关(r=0.658,P=0.000);术后DIOA与术后BCVA(logMAR)显著正相关(r=0.565,P=0.000);术后BCVA(logMAR)和术后DIOA较术前均有所改善,且差异均有统计学意义(均为P<0.05)。结论 (1)MHCI与裂孔愈合等级的相关性最高,可作为手术前预测术后裂孔愈合情况的一个指标;(2)术前DIOA、术前BCVA(logMAR)、THI与术后视力恢复的相关性最高,可作为预测术后视力恢复情况的指标;(3)BCVA与DIOA具有显著相关性,因此视力改善与否的关键取决于DIOA的大小。

Objective To evaluate the associated factors for predicting anatomical outcomes and postoperative visual acuity of idiopathic macuiar hole （IMH） after vitrectomy. Methods A total of 35 eyes of 35 IMH patients underwent vitrectomy, ILM peeling and gas filling surgery were included in this study. The slit lamp, indirect ophthalmoscope ,best corrected visual acuity examination and spectral domain optical coherence tomography （SD-OCT） were performed for all the patients. The base diameter （ BASE ）, height （ H）, minimum diameter （ MIN ）, diameter of IS/OS absence （ DIOA ） were measured. Anatomical outcomes were divided into 3 levels based on the results of their OCT pictures： A： Good healing; B： Bridge-shaped healing; C： Poor healing. Postoperative visual acuity were divided into 3 groups：Visual improved group, visual unchanged group and visual decreased group. The multiple factors related with predicting anatomical outcome and visual acuity including age, sex, preoperative corrected visual acuity, BASE, H, MHCI, MIN, THI, DHI were analyzed. Results In the 35 eyes, the hole was closed in 23 eyes of group A, 5 eyes of group B, 5 eyes of group C and 27 eyes of visual improved group,4 eyes of.visual unchanged group,4 eyes of visual decreased group. （1） BASE, H, MIN, macuiar hole index （ MHI）, tractional hole index （ THI）, DHI, preoperative BCVA（logMAR） were weakly correlated with anatomical prognosis （all P 〈 0.05 ） ; Macular hole healing index （MHCI） was correlated significantly with anatomical out- comes （r = -0.588,P = 0.000） ;Age and sex were not correlated significantly with anatomical outcomes （ all P 〉 0.05 ）. （ 2 ） Postoperative BCVA （logMAR） was correlated weakly with BASE, MIN （ all P 〈 0.05 ）, correlated significantly with THI, DIOA, preoperative BCVA （logMAR） （ all P 〈 0.05 ）, not correlated with age, sex, H, MHCI, MHI, DHI （ all P 〉 0.05 ）. （ 3 ） Preoperative DIOA was significantly positive correlated with preoperative BCVA（logMAR） （ r = 0. 558, P = 0. 000 ） ; Postoperative DIOA was significantly positive correlated with postoperative BCVA （logMAR） （ r = 0. 565 ,P = 0. 000 ） ; Postop- erative DIOA and postoperative BCVA（logMAR） were all improved, there were statistical differences compared with pre-operation （ all P 〈 0.05 ）. Conclusion （ 1 ） MHCI has the best correlation with anatomical outcomes, It can be considered a key factor for predicting anatomical outcomes of IMH after vitrectomy. （2） Preoperative DIOA, BCVA（ logMAR）, THI can be considered as key factors for predicting postoperative BCVA（logMAR）. （3） BCVA has a significantly correlation with DIOA directly, no matter preoperative or postoperative. The length of DIOA is the key fact for predicting BCVA.