黄斑裂孔内界膜撕除术后视网膜内层远期形态改变的影像学观察

Long-term observation of morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery

目的探讨黄斑裂孔内界膜撕除术后视网膜内层远期的形态学改变特点。方法回顾性病例研究。收集2015至2018年间诊断为特发性黄斑裂孔、于北京中日友好医院行25G玻璃体切除+内界膜撕除(或反折)+长效气体填充术的患者。共纳入特发性黄斑裂孔术后患者17例(19只眼),其中男性4例(4只眼),女性13例(15只眼);年龄(62.7±5.2)岁。通过相干光层析成像术(OCT)获得患者黄斑区视网膜厚度地形图、黄斑区神经节细胞复合体(mGCC)地形图及病损概率图、黄斑区视网膜血管扫描及en-face扫描结果。综合分析术后视网膜内层形态学改变的影像学特点。结果19只眼中,内界膜撕除者9只眼,内界膜荷包样反折8只眼,上方180°内界膜反折2只眼。黄斑裂孔最小径为(543.06±220.17)μm,最大径为(947.18±319.12)μm;患者随访时间为(21.05±9.66)个月,末次随访视力0.45±0.35。19只特发性黄斑裂孔患眼中,所有患眼的黄斑裂孔均于术后闭合,且所有患眼均出现了神经纤维层松解样外观(DONFL)、同轴黄斑区暗斑(CMDS)及mGCC变薄改变。其中行内界膜上方180°反折的2只眼CMDS与mGCC改变主要见于视网膜上方,余17只眼为黄斑周围弥漫性病变,大致与内界膜撕除范围对应。2只眼在视网膜血管扫描结果上可清晰见到视网膜毛细血管密度降低。结论黄斑裂孔内界膜撕除术后视网膜内层远期形态改变显著,可见DONFL和CMDS样改变,改变累及mGCC。

Objective To investigate the characteristics of morphological changes of inner retinal layer after internal limiting membrane peeling in macular hole surgery.Methods Retrospective case study.Patients with idiopathic macular hole from 2015 to 2018 underwent vitrectomy+internal limiting membrane peeling(inverting)+gas tamponade in China-Japan Friendship Hospital were investigated.A total of 19 eyes(17 patients)were enrolled,including 4 males(4 eyes)and 13 females(15 eyes).The average age was 62.74±5.25 years.Optical coherence tomography(OCT)was used to obtain the topographic maps of retinal thickness,the thickness of retinal ganglion cell complex and probability maps,and the Angio/en-face maps of macular retina.The characteristics of the morphological changes of the inner retinal were comprehensively analyzed.Results Among 19 eyes,9 eyes had internal limiting membrane peeling,8 eyes had lotus-like internal limiting membrane inverting,and 2 eyes had the uper180 degrees internal limiting membrane inverting.The minimum diameter of macular hole was(543.06+220.17)μm and the maximum diameter was(947.18+319.12)μm.The follow-up time was(21.05+9.66)months,and the visual acuity was 0.45+0.35 at the last follow-up.In the 19 eyes,all the macular holes were closed postoperatively and dissociated optic nerve fiber layer appearance(DONFL)and concentric macular dark spots(CMDS)all showed,as well as mGCC thinning.The changes of CMDS and mGCC in 2 eyes in the uper180 degrees internal limiting membrane inverting group were mainly seen in the upper retina and in the remaining 17 eyes were seen diffused around the macula,which roughly corresponded to the extent of internal limiting membrane peeling.Two eyes showed clear decrease of retinal capillary density on Angio/map.Conclusions Long-term morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery are obvious.In addition to the appearance changes like DONFL and CMDS,the macular ganglion cell complex(mGCC)is also involved.(Chin J Ophthalmol,2019,55:747-756)