Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan.
Retina. 2012 Feb;32(2):281-8. doi: 10.1097/IAE.0b013e31821e208f.
To study the significance of the increased fundus autofluorescence (FAF) signals at closed macula with spectral-domain optical coherence tomography and visual prognosis after successful surgery in eyes with idiopathic full-thickness macular holes (MHs).
Seventy-eight eyes of 78 consecutive patients with full-thickness MHs underwent successful standard vitrectomy, with internal limiting membrane peeling and followed by 10% sulfur hexafluoride gas injection. Simultaneous FAF and optical coherence tomography images were recorded at 10 days, and 1, 3, and 6 months postoperatively, using a combined spectral-domain optical coherence tomography-fluorescein angiography device (Spectralis™/HRA Heidelberg Retina Angiograph 2). The appearance of increased FAF in the macula postoperatively and the relationship of FAF and optical coherence tomography findings to best-corrected visual acuity were examined.
Stage 2, 3, and 4 MHs were present in 31, 29, and 18 eyes, respectively. The median patient age was 66 years, with a range of 54 to 79 years. In all patients, the MHs were successfully closed, and the preoperative increased FAF corresponding to MH disappeared 10 days after surgery. In 36 eyes (46.2%), however, hyperautofluorescence again appeared in the macular area 1 month postoperatively. This hyperautofluorescence was significantly associated with the recovery of the external limiting membrane lines at the fovea 1 month after surgery (P = 0.001, multiple logistic regression analysis). Also, this recovery of the external limiting membrane lines 1 month postoperatively was significantly associated with the recovery of photoreceptor inner and outer segment junction line 3 months postoperatively at the fovea (P < 0.001, Fisher exact test). Moreover, a good best-corrected visual acuity of 20/28 or better at 6 months after surgery was significantly associated with hyperautofluorescence in the macula 1 month postoperatively, the recovery of the photoreceptor inner and outer segment lines at the fovea 3 months postoperatively, and preoperative good visual acuity (P < 0.05, multiple logistic regression analysis).
In full-thickness MHs, 46.2% of our patients showed increased FAF in the macula 1 month after successful MH surgery. This hyperautofluorescence could be a sign of good visual prognosis postoperatively.
研究特发性全层黄斑裂孔（MH）成功手术后，眼底自发荧光（FAF）信号在黄斑区闭合时增加的意义，以及与视觉预后的关系。
78 例（78 只眼）特发性全层 MH 患者接受了标准玻璃体切除术，包括内界膜剥除和随后的 10%六氟化硫气体注入。使用联合频域光学相干断层扫描-荧光素血管造影设备（Spectralis ™ / HRA Heidelberg Retina Angiograph 2），在术后 10 天、1 个月、3 个月和 6 个月记录 FAF 和光学相干断层扫描图像。观察术后黄斑区 FAF 增加的表现，以及 FAF 和光学相干断层扫描结果与最佳矫正视力的关系。
31 只眼为 2 期 MH，29 只眼为 3 期 MH，18 只眼为 4 期 MH。中位患者年龄为 66 岁，范围为 54 岁至 79 岁。所有患者的 MH 均成功闭合，术前对应 MH 的 FAF 增加在术后 10 天消失。然而，在 36 只眼（46.2%）中，术后 1 个月黄斑区再次出现高荧光。这种高荧光与术后 1 个月黄斑区外节细胞内外段连接线的恢复显著相关（P=0.001，多因素逻辑回归分析）。此外，术后 1 个月外节细胞内外段连接线的恢复与术后 3 个月黄斑区光感受器内外节连接线的恢复显著相关（P<0.001，Fisher 精确检验）。而且，术后 6 个月最佳矫正视力达到 20/28 或更好与术后 1 个月黄斑区高荧光、术后 3 个月黄斑区光感受器内外节连接线的恢复以及术前良好视力显著相关（P<0.05，多因素逻辑回归分析）。
在全层 MH 中，46.2%的患者在 MH 手术后 1 个月出现黄斑区 FAF 增加。这种高荧光可能是术后良好视觉预后的标志。
