扫频光相干断层扫描指导特发性黄斑裂孔手术后低头位的裂孔闭合率观察

The hole closure rate of swept-source optical coherence tomography-guided facedown positioning for macular hole surgery

目的 观察扫频光相干断层扫描（SS-OCT）指导特发性黄斑裂孔（IMH）手术后低头位的裂孔闭合率。 方法 回顾性系列病例研究。临床检查确诊为IMH的64例患者64只眼纳入研究。所有患者均于就诊后1周内行25G微创玻璃体切割联合内界膜剥除及玻璃体腔填充C3F8治疗。根据手术后所采取的体位将患者分为SS-OCT组及对照组，分别为35例35只眼、29例29只眼。SS-OCT组患者于手术后6 h及1、2、3、4、5、6 d在气体填充状态下行SS-OCT检查，根据检查结果调整体位。若裂孔已闭合，则终止低头位。对照组患者待手术后气体吸收过半黄斑暴露时再根据SS-OCT检查结果调整体位。若裂孔闭合，则终止低头位。所有患眼手术后随访6~11个月，平均随访时间8.4个月。对比观察两组患者低头位持续时间以及手术后6个月的裂孔闭合率。同时观察患者的眼部及全身并发症发生情况。两组患者手术后低头位持续时间采用两独立样本Wilcoxon秩和检验；手术后裂孔闭合率及并发症发生情况比较采用Cochran-Mantel-Haenszel χ^2检验。 结果 SS-OCT组、对照组患者手术后平均低头位持续时间分别为（1.67±1.28）、（7.65±1.42）d；两者比较，差异有统计学意义（Z=？6.784，P〈0.05）。手术后6个月，SS-OCT组35只眼中，裂孔闭合30只眼，裂孔闭合率为85.71%；裂孔未闭合5只眼，占14.29%。对照组29只眼中，裂孔闭合27只眼，裂孔闭合率为93.10%；裂孔未闭合2只眼，占6.90%。两组裂孔闭合率比较，差异无统计学意义（χ^2=0.889，P〉0.05）。所有患者均未出现巩膜切口渗漏、视网膜或脉络膜出血、眼内炎等眼部并发症。对照组有2例患者出现轻度头晕，予以对症治疗后缓解。SS-OCT组所有患者均未出现全身并发症。 结论 SS-OCT指导手术后低头位能明显缩短IMH患者低头位的持续时间，且能获得85.71%的裂孔闭合率。其裂孔闭合率与传统低头位相比并无明显差异。

Objective To observe the hole closure rate of swept-source optical coherence tomography （SS-OCT）-guided facedown positioning for idiopathic macular hole （IMH） surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy （PPV） with internal limiting membrane （ILM） peeling and intraocular perfluoropropane （C3F8） tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery （the SS-OCT group）. In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas （the control group）. The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was （1.67±1.28） and （7.65±1.42） days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant （Z=？6.784, P〈0.05）. At 6 months after surgery, the hole closure was detected in 30 eyes （85.71%） in the SS-OCT group and in 27 eyes （93.10%） in the control group. There was no difference of hole closure rate between the two groups （χ^2=0.889, P〉0.05）. There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate.