特发性黄斑裂孔视网膜内囊腔截面积与视网膜血流密度的关系及对视网膜功能的影响

Relationship between macular hole cavity cross-sectional area and retinal blood flow density and its impact on retinal function in idiopathic macular holes

目的探讨特发性黄斑裂孔(IMH)视网膜内囊腔截面积与视网膜各层血流密度的相关性,以及囊腔截面积对术前和术后视网膜功能的影响。方法回顾性队列研究。收集2019年8月至2021年12月于山西医科大学附属眼科医院诊断为IMH并行玻璃体切除联合内界膜剥除术的18例(18只眼)患者的临床资料。所有患者术前及术后1、3、6个月均行视力及最佳矫正视力(BCVA)、谱域相干光层析成像术(SD-OCT)、相干光层析血管成像术(OCTA)及多焦视网膜电图(mfERG)检查。收集视网膜各层的整体、黄斑中心凹及黄斑旁中心凹的血流密度数据,并使用ImageJ软件测量囊腔截面积。收集同时期于山西医科大学附属眼科医院行mfERG的10名无眼底病变的受试者作为对照组,将其mfERG检查结果与IMH患者(IMH组)对比,每名受试者选取一只眼纳入研究,随机选取5只左眼和5只右眼。采用Pearson相关分析、独立样本t检验和重复测量方差分析进行统计学处理。结果18例(18只眼)IMH患者均为单眼患病;男性3例,女性15例;年龄为(64.22±4.33)岁,病程为75(38,120)d。对照组10名受试者中,男性4名,女性6名;年龄(63.67±6.96)岁。术前18只患眼均可见视网膜内囊腔,术后1个月时黄斑裂孔均闭合且囊腔消失。囊腔总截面积为(4.84±2.28)mm2,平均截面积为(0.27±0.13)mm2。囊腔截面积与裂孔高度(r=0.82,P<0.001)、椭圆体带缺失直径(r=0.74,P<0.001)和术前BCVA(r=0.62,P=0.006)相关。囊腔截面积与视网膜浅层黄斑中心凹的血流密度呈正相关(r=0.47,P=0.049),与视网膜深层血流密度(r=-0.50,P=0.033)及深层黄斑旁中心凹血流密度(r=-0.65,P=0.003)呈负相关。与对照组健眼相比,IMH患眼mfERG的P1波和N1波振幅均降低,P1波潜伏期除1环(黄斑中心凹向外2.18°)外均延长,N1波潜伏期除2环(黄斑中心凹向外7.46°)与5环(黄斑中心凹向外29.75°)外均延长(均P<0.05)。囊腔截面积仅与术前2环N1波的潜伏期有关(r=0.64,P=0.004),且对术前和术后1环P1和5环N1潜伏期的变化有影响(F=4.94,5.96;P=0.042,0.027)。时间变化对术前和术后mfERG P1、N1波振幅和潜伏期均无影响(均P>0.05),而囊腔截面积与时间的交互作用在1环P1与2环N1振幅有统计学意义(F=6.89,3.76;P=0.003,0.035)。结论IMH患者视网膜内囊腔截面积越大,术前视网膜深层尤其黄斑旁中心凹血流密度越小,视力越差,视网膜功能在黄斑中心凹向外7.46°处越低。

Objective To investigate the correlation between the cross-sectional area of the macular hole(MH)cavity and the blood flow density in different retinal layers,as well as the impact of cavity size on preoperative and postoperative retinal function in patients with idiopathic macular holes(IMH).Methods A retrospective cohort study was conducted.Clinical data were collected from 18 patients(18 eyes)diagnosed with IMH who underwent vitrectomy combined with internal limiting membrane peeling at Shanxi Eye Hospital affiliated to Shanxi Medical University from August 2019 to December 2021.Visual acuity,best-corrected visual acuity(BCVA),spectral-domain optical coherence tomography(SD-OCT),optical coherence tomography angiography(OCTA),and multifocal electroretinography(mfERG)were performed preoperatively and at 1,3,and 6 months postoperatively.Blood flow density data were collected for the overall retina,macular center fovea,and parafoveal regions,and the cavity cross-sectional area was measured using ImageJ software.Ten healthy subjects without retinal abnormalities who underwent mfERG at Shanxi Eye Hospital affiliated to Shanxi Medical University during the same period were included as a control group.One eye was randomly selected for each subject,with 5 left eyes and 5 right eyes.Statistical analysis was performed using Pearson correlation analysis,independent samples t-test,and repeated measures analysis of variance.Results All 18 IMH patients had unilateral disease,including 3 males and 15 females,with an average age of(64.22±4.33)years and a duration of illness of 75(38,120)days.In the control group,consisting of 10 subjects,4 were male and 6 were female,with an average age of(63.67±6.96)years.Preoperatively,all 18 affected eyes exhibited a macular hole cavity,which closed and disappeared one month postoperatively.The total cavity cross-sectional area was(4.84±2.28)mm2,with an average area of(0.27±0.13)mm2.The cavity cross-sectional area was positively correlated with the MH height(r=0.82,P<0.001),ellipsoid zone disruption diameter(r=0.74,P<0.001),and preoperative BCVA(r=0.62,P=0.006).The cavity cross-sectional area was positively correlated with the blood flow density of the superficial macular center fovea(r=0.47,P=0.049)and negatively correlated with the blood flow density of the deep retina(r=-0.50,P=0.033)and deep parafoveal blood flow density(r=-0.65,P=0.003).Compared to healthy eyes in the control group,IMH eyes showed decreased amplitudes of P1 and N1 waves in mfERG,prolonged P1 wave latency except at ring 1(2.18°outward from the foveal center),and prolonged N1 wave latency except at ring 2(7.46°outward from the foveal center)and 5(29.75°outward from the foveal center)(all P<0.05).The cavity cross-sectional area was only related to the preoperative latency of the N1 wave at ring 2(r=0.64,P=0.004)and had an effect on the changes in the preoperative and postoperative latency of P1 and N1 waves at ring 1 and 5(F=4.94,5.96;P=0.042,0.027).Time changes had no effect on the preoperative and postoperative amplitudes and latencies of mfERG P1 and N1 waves(all P>0.05),but the interaction between cavity cross-sectional area and time had statistical significance for the amplitudes of P1 at ring 1 and N1 at ring 2(F=6.89,3.76;P=0.003,0.035).Conclusions In patients with IMH,a larger macular hole cavity cross-sectional area is associated with lower blood flow density,particularly in the deep parafoveal region,poorer visual acuity,and decreased retinal function at 7.46°outward from the foveal center.