微视野联合OCTA对于大直径特发性黄斑裂孔行内界膜覆盖术后的疗效分析

Therapeutic effect of microperimetry combined with optical coherence tomography angiography on large-diameter idiopathic macular hole after internal limiting membrane covering surgery

目的 采用光学相干断层扫描血管成像(OCTA)和微视野计观察玻璃体切割(PPV)联合内界膜(ILM)覆盖术对大直径特发性黄斑裂孔(IMH)患者的有效性和安全性。方法 选取2023年2月至2023年7月在南昌大学附属眼科医院治疗的23例23眼大直径IMH患者。分别在术前及手术后1周、1个月、3个月、6个月观察患者最佳矫正视力(BCVA)、裂孔闭合率、黄斑区(分为中心子区、内层区及外层区)浅层微循环[浅层毛细血管灌注密度(PSCP)与视网膜浅层毛细血管密度(VSCP)]及黄斑区视网膜光敏感度(MS)、固视稳定性及中心凹无血管区(FAZ)面积的变化,对比患者术前及术后的患眼参数改变并研究参数之间的相关性。结果 随访6个月,所有患眼黄斑裂孔均闭合,闭合率100%。与术前BCVA相比,患者术后1周、术后1个月、术后3个月及术后6个月BCVA逐渐改善,两两相比差异均有统计学意义(均为P<0.05)。与术前FAZ面积相比,患者术后1周、术后1个月、术后3个月及术后6个月FAZ面积均减小,差异均有统计学意义(均为P<0.05)。患者3个区域的VSCP在术后1周时与术前相比均有下降,在术后6个月时与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者3个区域的PSCP在术后3个月、术后6个月时与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者术后1个月、3个月及6个月黄斑区12°MS与术前相比均有所提高,差异均有统计学意义(均为P<0.05)。患者术后1个月、术后3个月及术后6个月固视点在2°及4°内的占比与术前相比均有所提高,差异均有统计学意义(均为P<0.05),在术后1周时,患者固视点在4°内的占比与术前相比有所提高,差异有统计学意义(P<0.05)。相关性结果显示,术前MS与固视点在2°内占比与术后6个月BCVA(logMAR)均呈负相关(r=-0.819、-0.790,均为P<0.05),术前FAZ面积及术前最小孔径与术后6个月BCVA(logMAR)均呈正相关(r=0.596、0.853,均为P<0.05)。术前内层区、外层区的VSCP与术后6个月BCVA(logMAR)均呈负相关(r=-0.521、-0.570,均为P<0.05)。结论 OCTA及微视野的结果显示大直径IMH经PPV联合ILM覆盖术治疗后裂孔闭合率良好,各项指标与术前相比均有所改善。

Objective To explore the efficacy and safety of pars plan vitrectomy(PPV)combined with internal limiting membrane(ILM)covering surgery in patients with large-diameter idiopathic macular holes(IMH)using optical coherence tomography angiography(OCTA)and microperimetry.Methods Twenty-three eyes of 23 patients with large-diameter IMH treated at the Eye Hospital Affiliated with Nanchang University from February 2023 to July 2023 were selected.The patients’best-corrected visual acuity(BCVA),hole closure rate,microcirculation[perfusion density at the superficial capillary plexus(PSCP)and vascular density at the retinal superficial capillary plexus(VSCP)]in the macular area(divided into central,inner and outer regions),macular sensitivity(MS),fixation stability,and foveal avascular zone(FAZ)area were observed before surgery and at 1 week,1 month,3 months,and 6 months after surgery.Changes in eye parameters before and after surgery were compared,and the correlation between parameters was analyzed.Results After a 6-month follow-up,all macular holes in the affected eyes were closed,with a closure rate of 100%.Compared to before surgery,the BCVA of the patients improved gradually at 1 week,1 month,3 months,and 6 months after surgery,and the differences between any two time points were statistically significant(all P<0.05).The FAZ area decreased at 1 week,1 month,3 months,and 6 months after surgery compared to before surgery,and the differences were statistically significant(all P<0.05).The VSCP in the three regions showed a decrease at 1 week postoperatively and an increase at 6 months postoperatively compared to before surgery,and the differences were statistically significant(both P<0.05).The PSCP increased at 3 months and 6 months postoperatively compared to before surgery,with statistically significant differences(both P<0.05).The 12°MS increased at 1 month,3 months,and 6 months after surgery compared to before surgery,with statistically significant differences(all P<0.05).The proportions of fixation points within 2°and 4°increased at 1 month,3 months,and 6 months postoperatively compared to before surgery,with statistically significant differences(all P<0.05).The proportion of fixation points within 4°increased at 1 week postoperatively compared to before surgery,with a statistically significant difference(P<0.05).Correlation analysis showed that preoperative MS and the proportion of fixation points within 2°were negatively correlated with BCVA(logMAR)at 6 months postoperatively(r=-0.819,-0.790,both P<0.05),while preoperative FAZ area and minimum hole diameter were positively correlated with BCVA(logMAR)at 6 months postoperatively(r=0.596,0.853,both P<0.05).The preoperative VSCP in the inner and outer regions were negatively correlated with BCVA(logMAR)at 6 months postoperatively(r=-0.521,-0.570,both P<0.05).Conclusion The results of OCTA and microperimetry show that after treatment with PPV and ILM covering surgery,the closure rate of large-diameter IMH is good,and all indicators have improved compared to before surgery.