光学相干断层扫描发现的裂孔盖及其他预测黄斑裂孔手术预后因素的研究

Purpose:To evaluate the prognostic influence of the presence of an operculum in macular hole and to correlate the prognosis for postoperative visual acuity(VA)with the size of the macular hole,its duration and preoperative VA.Methods:We carried out a prospective study of 61 eyes of 59 patients with full thickness macular hole.All patients were examined with optical coherence tomography(OCT)in order to ascertain the presence of an operculum.The VA was measured with the ETDRS chart.A standard pars plana vitrectomy with inner limiting membrane peeling was performed in all cases and 20% C2F6 was used as tamponade.Results:Anatomical closure was obtained after one surgical procedure in 59/61(97%)patients.Linear regression analysis showed only baseline VA to be predictive of visual outcome(p < 0.001).The presence of an operculum preoperatively did not correlate with VA either pre-or postoperatively,nor with the anatomical closure rate.Conclusion:The finding that postoperative VA in macular hole correlates with preoperative VA seems to allow for good prediction of postoperative VA in macular hole surgery.However,the presence of an operculum is of no prognostic significance.

玻璃体腔内注射曲安西龙治疗糖尿病性黄斑水肿黄斑厚度减少与视力间的关系

PURPOSE: To evaluate the correlation between improvement in visual acuity and the reduction of foveal thickness after a single intravitreal injection of 4 mg of triamcinolone in diabetic macular edema. DESIGN: Prospective, interventional, nonrandomized clinical trial. METHOD: PATIENTS: In a prospective study 24 eyes with diabetic macular edema were treated with an intravitreal injection of 4 mg of triamcinolone acetonide. MAIN OUTCOME MEASURES: Best-corrected logMAR visual acuity and optical coherence tomography were performed at baseline and 3 months after the treatment. RESULTS: At baseline the average foveal thickness was 462±154 μm(95%confidence interval, 397-527μm) and at 3 months 257 ±114 μm (95%confidence interval, 209-305 μm) (P< .0001). The best-corrected logMAR average visual acuity was 60.5±10.5 (95%confidence interval, 56.0-65.0) ETDRS letters at baseline compared with 65.5±11.1 (95%confidence interval, 60.8-70.1) 3 months after the injection (P=.0001). There was no correlation between the improvement in visual acuity and the reduction of foveal thickness (r=0.054, P=.8), but there was a correlation between reduction in foveal thickness and the age of the patients (r=0.53, P=.008). CONCLUSION: A single injection of 4 mg of intravitreal triamcinolone acetonide effectively reduces the foveal thickness in diabetic macular edema and improves visual acuity, but there does not appear to be a strong correlation between the reduction of foveal thickness and the improvement in visual acuity.

用光学相干断层扫描视网膜地形图评价玻璃体切除术治疗玻璃体黄斑牵拉综合征

Purpose: To evaluate vitreomacular traction syndrome with ocular coherence tom ography (OCT) retinal mapping before and after vitrectomy. Methods: A prospectiv e study of 11 eyes with vitreomacular traction syndrome was carried out. Ocular coherence tomography retinal mapping was performed before vitrectomy and 6 month s postoperatively. Visual acuity (VA) was measured with the ETDRS chart. Results : All patients showed a reduction in the thickness of the macular area postopera tively. The mean thickness in the central macular area was 609 μm preoperativel y and 243 μm 6 months postoperatively (P < 0.001). Ten patients had an increase in VA of at least two lines on the ETDRS chart and in one patient VA was unchan ged. The mean improvement in VA was 3.1 lines. Conclusion: Retinal mapping with OCT is a good method of evaluating the thickness of the macula before and after surgery in vitreomacular traction syndrome and vitrectomy improves VA in most cases.