膜填塞术治疗内界膜剥除术后未闭合黄斑裂孔患者的视力预后相关因素分析

Factors associated with visual prognosis of membrane insertion for unclosed macular hole after internal limiting membrane peeling

目的分析玻璃体切除(PPV)联合膜填塞术治疗内界膜剥除术后未闭合黄斑裂孔(MH)患者的视力预后影响因素。设计回顾性病例系列。研究对象2018年1月至2020年11月北京同仁医院治疗的既往内界膜剥除术后未闭合MH患者27例27眼。方法回顾患者年龄、最佳矫正视力(BCVA)、眼压、眼轴、裂孔形态分类(贴附型、翘起型)、OCT测量参数、既往手术与本次手术间隔时间、填塞材料、末次随访BCVA。术后平均随访(12.07±8.65)个月(1~36个月)。采用单因素及多因素Logistic回归分析末次随访BCVA(LogMAR)>0.70者的危险因素。主要指标末次随访BCVA及可能的危险因素。结果单因素Logistic回归分析显示膜填塞术术前裂孔形态(OR=14.667,95%CI 1.970~109.204,P=0.009)、既往手术与本次手术间隔时间(OR=9.625,95%CI 1.378~67.246,P=0.022)与末次随访BCVA相关。多因素Logistic回归分析显示翘起型MH(OR=20.230,95%CI 1.640~249.561,P=0.019)、既往手术与本次手术间隔时间>2个月(OR=13.899,95%CI 1.072~180.278,P=0.044)增加膜填塞术后末次随访BCVA>0.70的可能性。结论翘起型MH、既往手术与本次手术间隔时间超过2个月是膜填塞术治疗内界膜剥除术后未闭合MH术后视力恢复差的危险因素。

Objective To analyze the factors associated with visual prognosis of pars plana vitrectomy(PPV)combined with membrane insertion for unclosed macular hole(MH)after internal limiting membrane peeling.Design Retrospective case series.Participants Twenty-seven eyes of 27 patients with unclosed MH after internal limiting membrane peeling who were treated in Beijing Tongren Hospital from January 2018 to November 2020.Methods The date about age,best corrected visual acuity(BCVA),intraocular pressure,axial length,morphological classification of MH,OCT measuring parameters,interval between two operations,material of insertion and BCVA at last follow-up were collected.The follow-up time was(12.07±8.65)months(1-36 months).Risk factors of BCVA(LogMAR)more than 0.70 at last follow-up was analyzed by univariate and multivariate Logistic regression analysis.Main Outcome Measures BCVA at last follow-up and its possible risk factors.Results Univariate Logistic regression analysis revealed that morphology of MH before operation(OR=14.667,95%CI 1.970-109.204,P=0.009)and interval between two operations(OR=9.625,95%CI 1.378-67.246,P=0.022)were associated with BCVA at last follow-up.Multivariate Logistic regression analysis showed that elevated MH(OR=20.230,95%CI 1.640-249.561,P=0.019)and interval between two operations longer than 2 months(OR=13.899,95%CI 1.072-180.278,P=0.044)increases the chances of BCVA more than 0.70 at last follow-up.Conclusion Elevated MH and interval between two operations longer than 2 months were the risk factors of poor postoperative BCVA after PPV combined with membrane insertion for unclosed MH after internal limiting membrane peeling.