特发性黄斑裂孔脉络膜厚度及血流灌注观察

Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye

目的观察并分析特发性黄斑裂孔(IMH)患眼黄斑区脉络膜厚度和脉络膜血流灌注(CBP)情况及其相关性。方法横断面观察性临床研究。2019年3月至2021年10月于郑州大学第一附属医院眼科连续就诊的IMH患者60例60只眼(IMH组)以及健康志愿者60名60只眼(对照组)纳入研究。IMH组60只眼中,裂孔Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为8、8、15、29只眼。两组受检者年龄、等效球镜度、眼轴长度比较,差异无统计学意义(t=1.327、0.157、0.542,P>0.05)。采用扫频源光相干断层扫描仪测量受检眼黄斑区不同区域平均脉络膜厚度(AMCT)和CBP。根据糖尿病视网膜病变治疗研究的分区方法将中心凹6 mm范围内脉络膜划分为以黄斑中心凹为中心的3个同心圆,分别是直径为1 mm的中心区,1~3 mm的内环区,3~6 mm的外环区;在内环区和外环区分别有2条放射线将其各自分为4个区,包括内环上方(IS)、内环下方(II)、内环鼻侧(IN)、内环颞侧(IT)、外环上方(OS)、外环下方(OI)、外环鼻侧(ON)、外环颞侧(OT);共计9个区域。观察不同区域AMCT、CBP分布特点。AMCT与CBP的相关性采用Pearson相关性分析;AMCT、CBP与IMH分期的相关关系采用Spearman相关性分析。结果与对照组受检眼比较,IMH组患眼黄斑各区域AMCT均明显变薄,差异有统计学意义(t=2.378、4.641、2.888、3.390、3.575、4.870、4.077、4.946、4.578,P<0.05)。IMH组患眼OS、OT区域CBP较对照组显著降低,差异有统计学意义(t=3.424、4.516,P<0.05)。Pearson相关性分析结果显示,OT区域AMCT与CBP呈显著正相关(r=0.314,P<0.001)。Spearman相关性分析结果显示,各区域AMCT与IMH分期均呈显著正相关(r=0.375、0.374、0.289、0.379、0.441、0.392、0.303、0.341、0.292,P<0.05)。IN、OI、OT区域CBP与IMH分期无明显相关性(r=-0.138、-0.016、-0.221,P>0.05);其余区域CBP与IMH分期均呈显著负相关(r=-0.560、-0.390、-0.819、-0.692、-0.329、-0.587,P<0.05)。结论与正常者比较,IMH患眼黄斑区各区域脉络膜厚度显著变薄;局部区域存在脉络膜低灌注。其局部区域AMCT与CBP呈显著正相关;IMH分期越高,各区域AMCT有增厚趋势,多数区域CBP有减少现象。

Objective To observe and analyze the macular choroidal thickness and choroidal blood perfusion(CBP)in eyes with idiopathic macular hole(IMH)and their correlation.Methods A cross-sectional observational clinical study.From March 2019 to October 2021,60 IMH patients with 60 eyes(IMH group)and 60 healthy volunteers with 60 eyes(control group)who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study.Among the 60 eyes in the IMH group,8,8,15,and 29 eyes were at stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ,respectively.There was no significant difference in age,spherical equivalent power and axial length between the two groups(t=1.327,0.157,0.542;P>0.05).The average macular choriodal thickness(AMCT)and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner.According to the zoning method for the treatment of diabetic retinopathy,the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center.They are the central area with a diameter of 1 mm,the inner ring area of 1-3 mm,and the outer ring area of 3-6 mm;the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively,including the upper part of the inner superior(IS),the lower part of the inner inferior(Ⅱ),and the nasal side of the inner nasal(IN),inner temporal(IT),outer superior(OS),outer inferior(OI),outer nasal(ON),outer temporal(OT),a total of 9 regions.The distribution characteristics of AMCT and CBP in different regions were observed.The correlation between AMCT and CBP was analyzed by Pearson correlation;the correlation between AMCT,CBP and IMH stage was analyzed by Spearman correlation.Results Compared with the eyes of the control group,the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula,and the difference was statistically significant(t=2.378,4.641,2.888,3.390,3.575,4.870,4.077,4.946,4.578;P<0.05).Compared with the control group,the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower,the difference was statistically significant(t=3.424,4.516;P<0.05).The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region(r=0.314,P<0.001).Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region(r=0.375,0.374,0.289,0.379,0.441,0.392,0.303,0.341,0.292;P<0.05).There was no significant correlation between CBP and IMH staging in IN,OI and OT regions(r=-0.138,-0.016,-0.221;P>0.05);CBP and IMH staging in other regions were significantly negatively correlated(r=-0.560,-0.390,-0.819,-0.692,-0.329,-0.587;P<0.05).Conclusions The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects;there is choroidal hypoperfusion in local areas.There is a significant positive correlation between local regional AMCT and CBP;IMH stage is higher,the trend of AMCT in each region is thickening,and the CBP in most regions decrease.