特发性黄斑裂孔患眼裂孔周围囊腔对手术前后黄斑区视功能影响的初步观察

Preliminary observation of the effect of cystic cavity on visual function of macular area before and after operation in idiopathic macular hole

目的观察并分析特发性黄斑裂孔(IMH)患眼裂孔周围(孔周)囊腔大小对手术前后黄斑区视功能的影响。方法回顾性临床研究。2020年7月至2021年2月于河北医科大学第四医院眼科检查确诊的单眼IMH患者25例25只眼(手术组)纳入研究。将患者的对侧健康眼作为对照组。所有患眼均行最佳矫正视力(BCVA)、微视野、频域光相干断层扫描(SD-OCT)、OCT血管成像(OCTA)检查。采用SD-OCT测量黄斑裂孔直径;采用OCTA横断面(en-face)模式检测视网膜深层毛细血管丛(DCP)囊腔形态,Image J软件测量其囊腔面积。采用MP-3微视野计测量中心凹视网膜光敏感度(MS)、平均黄斑敏感度(MMS)。手术组患眼分别测量黄斑中心MS(CMS)、MMS以及囊腔范围内MS;对照组受检眼测量MMS。将微视野图像叠加于OCTA的DCP层,识别和计算囊腔范围内平均MS并与对照组比较。患眼均行标准三切口经睫状体平坦部玻璃体切割+内界膜剥除+眼内无菌空气填充手术。手术后3个月,采用手术前相同设备和方法行相关检查。手术组、对照组MS比较采用配对样本t检验。囊腔面积与手术前黄斑裂孔直径、手术前后MS的相关性采用Pearson相关性分析;手术前后BCVA与囊腔面积的相关性采用Spearman相关性分析。结果手术组患眼囊腔范围内MS为(4.24±3.07)dB;对照组MMS为(19.08±6.11)dB。手术组患眼囊腔范围内MS较对照组明显降低,差异有统计学意义(t=-10.832,P<0.01)。手术前,手术组患眼囊腔面积、黄斑裂孔直径分别为(1.04±0.55)mm^(2)、(564.80±166.59)μm;CMS、MMS分别为(2.27±2.29)、(9.08±3.65)dB。黄斑裂孔直径(r=0.50,P=0.010)、手术前BCVA(r=0.57,P<0.001)与囊腔面积呈正相关;手术前CMS、MMS与囊腔面积呈负相关(r=-0.53、-0.47,P=0.010、0.020)。手术后3个月,囊腔面积与CMS、MMS均呈负相关(r=-0.65、-0.76,P=0.020、0.030);与BCVA无相关性(r=0.23,P=0.470)。结论IMH孔周囊腔范围内MS降低。囊腔面积、手术前BCVA与黄斑裂孔直径呈正相关。囊腔面积与手术前CMS、MMS呈负相关。

Objective To observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole(IMH).Methods A retrospective clinical study.From July 2020 to February 2021,a total of 25 patients with 25 eyes with monocular IMH(operation group)diagnosed by ophthalmology examination in Department of ophthalmology,Fourth Hospital of Hebei Medical University were included in the study.The control group was contralateral healthy eyes.All subjects were examined by best corrected visual acuity(BCVA),microfield of vision,frequency domain optical coherence tomography(SD-OCT),and OCT angiography(OCTA).The diameter of macular hole was measured by SD-OCT.The cystic morphology of deep capillary plexus(DCP)was detected by en face OCT,and the cystic area was measured by Image J software.MP-3 microperimeter was used to measure central macular retinal light sensitivity(MS)and mean macular retinal light sensitivity(MMS).Central macular retinal light sensitivity(CMS),MMS and cystic cavity MS were measured in the operation group.MMS was measured in the control group.The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group.Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body+stripping of the inner boundary membrane+intraocular sterile air filling.Three months after the operation,the same equipment and methods were used to perform relevant examinations.Paired sample t test was used to compare MS between operation group and control group.Pearson correlation analysis was used to analyze the correlation between capsular area,macular hole diameter before and after operation and MS before and after operation.The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis.Results In the surgical group,the retinal MS was(4.24±3.07)dB.The MMS of control group was(19.08±6.11)dB.The MS in the surgical group was significantly lower than that in the control group,and the difference was statistically significant(t=10.832,P<0.01).Before operation,the area of cyst was(1.04±0.55)mm2,and the diameter of macular hole was(564.80±166.59)μm.CMS and MMS were(2.27±2.29)dB and(9.08±3.65)dB,respectively.The diameter of macular hole(r=0.50,P=0.010)and BCVA before operation(r=0.57,P<0.001)were positively correlated with peripore cavity area.Before operation,CMS and MMS were negatively correlated with peripore cavity area(r=-0.53,-0.47;P=0.010,0.020).At 3 months after surgery,the capsular area was negatively correlated with CMS and MMS(r=-0.65,-0.76;P=0.020,0.030).There was no correlation with BCVA(r=0.23,P=0.470).Conclusions Retinal MS is decreased in the peri-capsular area of IMH pore.There is a positive correlation between capsule area,BCVA and macular hole diameter before operation.The capsular area is negatively correlated with CMS and MMS before operation.