摘要
背景 伴有严重脉络膜萎缩的高度近视黄斑裂孔因预后的不确定性和高复发率一直是眼科临床的关注热点,频域光学相干断层扫描（SD-OCT）技术可以对黄斑裂孔进行测量和评估,但由于高度近视黄斑裂孔患者多伴有视网膜脱离,术前很难进行OCT检查.SD-OCT检查对高度近视眼视网膜复位术后黄斑裂孔复发风险的评估价值值得探讨. 目的 探讨SD-OCT对高度近视黄斑裂孔硅油填充眼硅油取出后裂孔复发风险的评估. 方法 采用描述性病例观察研究设计.收集2009年10月至2011年1月在同济大学附属第十人民医院眼科确诊的高度近视黄斑裂孔合并视网膜脱离的患者25例25眼,均为玻璃体切割联合内界膜剥离及硅油填充手术后6个月,所有患者均未进行晶状体联合手术,利用SD-OCT技术检查表现为视网膜色素上皮（RPE）裸露型愈合的黄斑裂孔.纳入的患者中男4例,女21例；平均年龄（61.4±9.0）岁；平均屈光度为（-14.14±6.86）D.均于硅油取出前1d进行SD-OCT检查,检测指标为黄斑区视网膜厚度、黄斑裂孔指数（MHI）和裂孔中心点下脉络膜厚度.其他检查项目包括裂隙灯显微镜检查、眼底照相、眼轴长度测定等,记录黄斑裂孔的愈合状态.硅油取出后随访6个月. 结果 25例患者均完成6个月的随访.术眼眼轴长度平均为（29.9±1.5） mm,25眼中有19眼黄斑裂孔愈合（裂孔愈合组）,6眼黄斑裂孔复发（裂孔未愈合组）,复发时间为术后1～5个月,平均（3.3±1.4）个月.裂孔愈合组术眼黄斑中心凹＜1 mm区视网膜厚度、MHI和裂孔中心凹下脉络膜厚度分别为（216.5±95.6） μm、0.30±0.09、（122.9±20.5）μm,裂孔未愈合组分别为（113.5±28.7） μm、0.58±0.27、（96.8±22.9）μm,两组比较差异均有统计学意义（t=2.577、-4.143、2.669,P＜0.05）.以MHI=0.5作为界限,MHI＜0.5的黄斑裂孔愈合率为85.7％,MHI≥0.5的愈合率为25.0％,差异有统�
Background Macular hole in high myopia has been paid tremendous attention in clinical research due to its high recurrence rate and unpredictable prognosis.Spectral domain optical coherence tomography （SD-OCT） is considered to be of a good evaluating value for macular hole,yet its application is compromised in patient with high myopia.High myopia might lead to retinal detachment which consequently prevents an accurate OCT.Therefore,it is important to assess the effectiveness of OCT on prognosis in these patients after surgical restoration of the detached retina.Objective The aim of this study was to evaluate the risk of reopening of a macular hole in highly myopic patient after removing silicone oil by SD-OCT.Methods A case-observational study was designed.Twenty-five highly myopic patients with monocular macular holes who underwent vitrectomy combined with internal limiting membrane peeling and silicone oil tamponade were included in this study.Four patients were male and 21 patients were female,with the average age （61.4±9.0） years old and diopter （-14.14 ±6.86）D.Regular ocular examination,axial length measurement,fundus photography and OCT were performed at the day before removing silicone oil and every month till the 6 months after operation.Retinal thickness,macular height index （MHI） and choroidal thickness were measured by OCT.Written informed consent was obtained from each patient.Results All 25 patients finished the follow-up of 6 months.Macular holes remained closure 6 months after operation in 19 patients （76%） and reopened in 6 patients macular holes were in 1-5 months （24%）,with a mean time at （3.3± 1.4） months.The average foveal retinal thickness,MHI and the choroidal thickness at the middle of the macular hole were （216.5±95.6） μm,0.30 ± 0.09 and （122.9 ± 20.5） μm in the closed group,respectively,and those in the unclosed group were （113.5±28.7） μm,0.58±0.27 and （96.8±22.9） μm,with significant differences between the two groups （t=2.577,-4.1
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2013年第5期477-481,共5页
Chinese Journal Of Experimental Ophthalmology
关键词
高度近视
黄斑裂孔
硅油填充
预后
体层摄影术
光学相干断层扫描
High myopia
Macular hole
Silicone tamponade
Prognosis
Tomography/optical coherencetomography image
