25G玻璃体切除治疗特发性黄斑裂孔术后1年视力影响因素分析

Analysis of impact factors of visual acuity 1 year after vitrectomy for idiopathic macular hole

目的研究25G玻璃体切除治疗特发性黄斑裂孔(IMH)术后1年的视力情况及影响因素。设计回顾性病例系列。研究对象 2015年12月至2017年2月于天津市眼科医院行25G玻璃体切除联合内界膜剥离或者翻瓣手术治疗的IMH患者,随访1年,失访患者除外,累计100例(103眼)。方法手术前记录患者年龄、性别和病程,均行最佳矫正视力(BCVA)、IOLMaster和相干光断层扫描(OCT)检查。手术后1年随访,检查BCVA和OCT。根据手术后视力分为A组(≤0.3)和B组(>0.3);根据术后与术前视力之差分为C组(≤0.6)和D组(>0.6)。对比A组与B组、C组与D组术前资料的差异,分析影响术后视力及视力增长的因素。主要指标 BCVA、病程、屈光度、眼轴、裂孔最小直径、裂孔分期、术后视力增加值。结果 A组术前视力(0.86±0.39)低于B组(1.30±0.46)(P<0.001);A组术前黄斑裂孔最小直径(376.97±140.16 μm)小于B组(603.67±193.56 μm)(P<0.001);术前A组和B组年龄、性别、眼轴、屈光度、病程和裂孔分期之间差异均无统计学意义(P均>0.05)。C组术前视力(0.78±0.35)低于D组(1.35±0.42)(P<0.001);C组和D组年龄、性别、眼轴、屈光度、病程、裂孔最小直径和裂孔分期之间差异均无统计学意义(P均>0.05)。结论 IMH手术后1年视力与术前视力和裂孔最小直径有关,而手术后视力增加值只与术前视力有关。

Objective To study the 1-year postoperative visual acuity of idiopathic macular hole treated with 25G vitrectomy and its associated factors. Design Retrospective case series. Participants One hundred and three eyes of 100 idiopathic macular hole patients treated in Tianjin Eye Hospital from December 2015 to February 2017 were included. All the patients were treated with 25G vitrectomy combined with internal limiting membrane peeling or flap and followed for 1+ years. Patients who failed follow-up were excluded. Method Age, gender and course duration and axial length measured with IOL master were recorded preoperatively. The best-corrected visual acuity(BCVA) and coherent optical tomography(OCT) were performed before operation and at one-year follow-up. The patients were divided into group A and group B according to the postoperative visual acuity ≤ 0.3 or > 0.3 respectively, or group C and group D according to the vision increase after operation ≤ 0.6 or >0.6 respectively. The factors affecting postoperative visual acuity and visual acuity increase were analyzed. Main Outcome Measures Age, course of duration, AL, BCVA and macular hole diameter. Results There was statistically significant difference in preoperative visual acuity and minimum linear diameter of hole between group A and group B (both P<0.001), while there was no significant difference between the two groups in age, gender, axial length, refraction, duration of disease, and the stage (all P>0.05). There was statistically significant difference in preoperative visual acuity between group C and group D (P<0.001), but no significant difference in age, sex, axial length, refraction, duration of disease, minimum linear diameter of hole and the stage (all P>0.05). Conclusion The worse the visual acuity before surgery, the more the visual acuity increase after surgery. With the increase of the minimum linear diameter of macular hole, the postoperative visual acuity gets worse. But the postoperative visual acuity increasement was not related to minimum linear diameter of hole.