摘要
目的探讨影响特发性黄斑裂孔（IMH）微创玻璃体切割手术（TSV）后视力预后的相关因素。方法前瞻性临床研究。连续接受23GTSV治疗的IMH患者46例50只眼纳入研究。其中，男性8例9只眼，女性38例41只眼；平均年龄（60．7±9．6）岁。均采用Snellen视力表行矫正视力（CVA）检查，同时行验光、裂隙灯显微镜加前置镜、频域（SD）光相干断层扫描（OCT）检查。将小数视力换算成最小分辨角对数（logMAR）视力进行统计学处理。患者CVA0．02～0．6，平均logMARCVA0．95±0．29；平均病程（11．1±7．8）个月；平均光感受器内外节连接（IS／OS）断裂长度（1566．9±830．5）μm；平均黄斑裂孔底部最大直径（914．0±484．8）pm。IMH2、3、4期分别为10、19、21只眼。患者均行TSV。以手术后3个月为疗效评价时间点，分析手术后视力与患者年龄、病程、手术前视力、IMH分期、手术前IS／OS断裂长度、黄斑裂孔底部最大直径、手术后中心凹感光细胞层厚度、IS／OS断裂长度的相关性；观察TSV治疗IMH的安全性。结果手术后3个月，所有患眼黄斑裂孔均闭合，占100．0％。平均logMARCVA0．45±0．25；平均中心凹感光细胞层厚度、平均IS／OS断裂长度分别为（183．8±62．6）、（477．5±341．9）μm。手术后平均IogMARCVA与手术前比较，差异有统计学意义（Z=6．571，P〈0．001）。平均IS／OS断裂长度较手术前明显缩短，差异有统计学意义（t=12．679，P〈0．001）。相关性分析结果显示，手术后logMARCVA与手术前logMARCVA（r=0．569）、病程（r=0．465）、手术前后IS／OS断裂长度（r=0．574、0．564）均呈正相关关系（P〈0．001）；与患者年龄、黄斑裂孔底部最大直径、手术后中心凹感光细胞层厚度无相关关系（r=0．546、0．361、-0．441，P〉0．05）。IMH4期患眼较2、3期患眼手术后logMARCVA差，其差异有统计学意义�
Objective To investigate the risk factors associated with visual acuity after minimally invasive vitrectomy of idiopathic macular hole （IMH）. Methods Forty-six IMH patients （50 eyes） who underwent minimally invasive vitrectomy were enrolled in this prospective clinical study. The patients included eight males （nine eyes） and 38 females （41 eyes）, with a mean age of （60.7±9.6） years. All the patients were examined for Snellen corrected visual acuity （CVA）, optometry, slit lamp microscope and preset lens, as well as spectral domain optical coherence tomography （SD-OCT）. The CVA was converted into a logarithm of the minimal angle of resolution （logMAR） for statistical analysis. The mean IogMAR CVA was 0.95±0.29 （CVA ranged from 0.02 - 0. 6）. The mean duration was （11.1±7.8） months. The mean breaking length of inner segment/outer segment （IS/OS） junction was （1 566.9±830. 5） μm. The mean maximum diameter of the bottom of maeular hole was （914. 0±484. 8） μm. There were 10, 19, 21 eyes with stage two, three and four IMH, respectively. The therapeutic effects were evaluated at three months after surgery. The relationship between visual acuity after surgery and age, duration, visual acuity before surgery, stage of IMH, breaking length of IS/OS before and after surgery, the maximum diameter ofthe bottom of macular hole, thickness of photoreceptors after surgery were analyzed. The safety of minimally invasive vitrectomy for IMH was observed. Results Three months after surgery, the closure rate of macular hole was 100.0%. The mean IogMAR CVA was 0.45 ± 0.25. The mean thickness of photoreceptors and breaking length of IS/OS were （183.8±62.6）, （477.5±341.9） μm respectively. The mean breaking length of IS/OS after surgery was significantly shorter than before surgery （t= 12. 679, P〈 0. 001）. The difference of IogMAR CVA before and after surgery was statistically significant （Z= 6. 571, P〈0. 001）. The logMAR CVA before surgery （r=0. 569）, dur
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2013年第2期126-130,共5页
Chinese Journal of Ocular Fundus Diseases
基金
国家自然科学基金（81170866）
广东省自然科学基金（S2011010004979）
眼科学国家重点实验室创新基金（2011C04）
