3期和4期黄斑裂孔的形态学分析：对治疗的启示

Wender Jon, Iida Tomohiro, Del Priore Lucian V

Albert Einstein College of Medicine, Bronx, New York, USA.

Am J Ophthalmol. 2005 Jan;139(1):1-10. doi: 10.1016/j.ajo.2004.07.038.

PURPOSE

To determine whether the observed anatomy of macular holes can be explained by a hydrodynamic model in which fluid flow through the hole is balanced by fluid pumping across the retinal pigment epithelium. We use this model to draw conclusions about the possible role of vitreomacular traction in determining the anatomy of macular holes and their resolution after vitreous surgery.

DESIGN

Cross sectional.

METHODS

Retrospective study in a clinical practice. The study included 42 eyes of 42 patients with a stage 3 or 4 macular hole (Gass classification). We measured the radius of the macular hole and the radius of the surrounding cuff of subretinal fluid from color or red-free fundus photographs and determined the relationship between these two variables.

RESULTS

The mean age of the patients was 68.0 +/- 7 years (range, 51 to 80). Twenty-five patients had stage 3 macular holes and 17 patients had stage 4 macular holes. The neurosensory detachment radius was related to the square of the macular hole radius for stage 3 and stage 4 holes, with no significant difference between the stage 3 and stage 4 linear trend lines (P = .999). There was no correlation between patient age and the area of the macular hole (r = 0.0645) or neurosensory detachment plus hole (r = 0.156) over the range of age in this study. However, the area of the doughnut-shaped cuff of subretinal fluid increased with increasing patient age (P = .0493), thus suggesting an age-dependent decline in the pumping ability of the retinal pigment epithelium.

CONCLUSIONS

Our data are consistent with a hydrodynamic model in which macular hole anatomy is determined by a balance between fluid flow through the hole and fluid outflow across the retinal pigment epithelium. Because stage 3 and stage 4 macular holes exhibit a similar relationship between the size of the macular hole and the size of the cuff of subretinal fluid around the hole, simple relief of vitreomacular traction would not lead to resolution of the subretinal fluid cuff unless it is accompanied by a reduction in hole diameter due to approximation of wound edges.

目的

确定观察到的黄斑裂孔解剖结构是否能用一种流体动力学模型来解释，在该模型中，通过裂孔的流体流动由跨视网膜色素上皮的流体泵入来平衡。我们使用该模型来推断玻璃体黄斑牵引在确定黄斑裂孔解剖结构及其玻璃体切除术后转归中可能发挥的作用。

设计

横断面研究。

方法

在临床实践中进行回顾性研究。该研究纳入了42例患有3期或4期黄斑裂孔（Gass分类）患者的42只眼。我们从彩色或无赤眼底照片中测量黄斑裂孔的半径以及视网膜下液周围套环的半径，并确定这两个变量之间的关系。

结果

患者的平均年龄为68.0±7岁（范围51至80岁）。25例患者为3期黄斑裂孔，17例患者为4期黄斑裂孔。3期和4期裂孔的神经感觉脱离半径与黄斑裂孔半径的平方相关，3期和4期线性趋势线之间无显著差异（P = 0.999）。在本研究的年龄范围内，患者年龄与黄斑裂孔面积（r = 0.0645）或神经感觉脱离加裂孔面积（r = 0.156）之间无相关性。然而，视网膜下液甜甜圈形套环的面积随患者年龄增加而增大（P = 0.0493），因此提示视网膜色素上皮泵功能随年龄下降。

结论

我们的数据与一种流体动力学模型一致，在该模型中，黄斑裂孔的解剖结构由通过裂孔的流体流动与跨视网膜色素上皮的流体流出之间的平衡所决定。由于3期和4期黄斑裂孔在裂孔大小与裂孔周围视网膜下液套环大小之间呈现相似关系，单纯解除玻璃体黄斑牵引不会导致视网膜下液套环消退，除非同时因伤口边缘靠近导致裂孔直径减小。