特发性黄斑裂孔患者术后视网膜光敏感度变化的临床观察

Changes of retinal sensitivity in idiopathic macular hole after vitrectomy

目的观察特发性黄斑裂孔(IMH)患者接受玻璃体手术后视网膜光敏感度的临床变化并探讨其与黄斑区视网膜血流密度之间的关系。方法回顾性病例对照研究。收集32例(32只眼)IMH患者纳入本组研究。所有患者依据手术方式的不同,被非随机分为两组:A组患者接受玻璃体切除联合内界膜填塞手术。B组患者接受玻璃体切除联合内界膜翻转覆盖手术。主要观察指标为中心视网膜光敏感度(0°~5°范围)、外周视网膜光敏感度(5°~10°范围),其他观察指标包括:最佳矫正视力(BCVA)(logMAR)、视网膜浅层血流密度、视网膜深层血流密度、黄斑中心凹下脉络膜厚度。比较各观察指标在两组间的差异,并分析视网膜光敏感度与视网膜血流密度、脉络膜厚度之间的相关性。结果所有患者术后BCVA均得到明显改善,中心视网膜光敏感度在出现明显改善,视网膜浅层、深层血流密度和黄斑中心凹下脉络膜厚度明显增加,两组患者术后中心视网膜光敏感度的变化均与视网膜浅层、深层血流密度的变化之间呈负相关。结论玻璃体手术治疗IMH后黄斑部中心视网膜光敏感度在术后早期就出现明显提高,而黄斑中心视网膜光敏感度的改善与视网膜血流密度的变化密切相关。

Objective To observe the clinical changes of retinal sensitivity in patients with idiopathic macular hole undergoing vitreous surgery and its correlation with macular microstructure.Methods A retrospective cases-control study.32 patients(32 eyes)with idiopathic macular hole were included in this study.All the patients were divided into two groups depending on the type of surgery.TheA group underwent vitrectomy combined with tamping inner limiting mem⁃brane.The Bgroup underwent vitrectomy combined with reversing to cover inner limiting membrane.The main observation items include central retinal sensitivity(0°~5°),peripheral retinal sensitivity(5°~10°),other observational indicators include:best corrected visual acuity(BCVA)(LogMAR),superficial retinal blood density,deep retinal blood density and subfoveal choroidal thickness.The difference of each observation index between the two groups was compared,and the correlation between retinal sensitivity and retinal blood flow density,choroid thickness was analyzed.Results The BCVA was significantly improved in all patients.Central retinal sensitivity improved significantly at 1 and 3 months after the surgery,the blood flow density of superficial,deep retina and the subfoveal choroid thickness increased significantly at 1 month after the surgery,there was a significant correlation between the changes in central retinal sensitivity and the changes of superficial,deep retinal blood flow density in both groups.Conclusions Central retinal sensitivity in macular has been improved significantly in the early postoperative period after vitreous surgery for idiopathic macular hole.There was a significant correlation between the change of central retinal sensitivity and the change of retinal blood flow density.