特发性黄斑裂孔手术成功愈合后的光相干断层扫描图像分析

Analysis of the results of optical coherence tomography in eyes with repaired idiopathic macular hole after operation

目的 研究玻璃体切除治疗特发性黄斑裂孔 (IMH)手术成功愈合后的光相干断层扫描(OCT)图像特征及其与视功能恢复的关系。 方法 IMH患者 2 4例 2 5只眼 ,通过玻璃体切除、内界膜剥除、自体血清注入等手术 ,黄斑裂孔均已成功闭合。回顾分析 IMH患者 OCT图像特征 ,IMH 级 9只眼 , 级 13只眼 ,IV级 3只眼。手术后 3～ 2 4个月进行视力、最佳矫正视力、裂隙灯、视网膜镜、间接检眼镜、荧光素眼底血管造影 (FFA)及 OCT检查。 结果 IMH手术使黄斑裂孔成功闭合后 ,其 OCT图像大致可分成3组。U型 5只眼 :相对正常的中心凹形状 ;V型 7只眼 :黄斑中心凹较陡 ;W型 13只眼 :黄斑中心凹处神经上皮缺损 ,但裂孔缘未翘起 ,无囊腔形成。手术后患者视力均有提高 ,以 U型视力预后最好。 结论 IMH的 OCT图像特征与手术后视力相关。

Objective To investigate the characteristics of optical coherence tomography (OCT) in eyes with repaired idiopathic macular hole (IMH) after operation and the relation with recovery of visual acuity. Methods The characteristics of OCT images of 24 patients (25 eyes) with repaired IMH after vitrectomy,internal limiting membrane(ILM)peeling and auto-serum healing were analyzed retrospectively. In the patients with IMH, the macular hole was found in 9 eyes at stage Ⅱ, 13 eyes at stage Ⅲ, and 3 eyes at stage Ⅳ. Examinations of best-corrected visual acuity, slit-lamp biomicroscopy with fundus contact lens, fundus photography, fundus fluorescein angiography(FFA) and OCT were performed on the patients 3 to 24 months after surgery. Results OCT images of the repaired IMH were categorized into 3 patterns: U-type (5 eyes) with relative normal foveal contour; V-type (7 eyes) with steep foveal contour;W-type (13 eyes) with foveal defect of neurosensory retina, but without warped hem of retinal hole or cystic formation. Postoperative visual acuities were improved in all of the patients and the best ones were in group U-type. Conclusion Characteristics of OCT images of repaired IMH may be related to the postoperative visual acuity.