应用频域光学相干断层扫描联合微视野计对黄斑裂孔手术后形态和功能的评估。

Morphologic and functional evaluation before and after successful macular hole surgery using spectral-domain optical coherence tomography combined with microperimetry.

机构信息

Department of Ophthalmology, Peking University People's Hospital, Beijing, PR China.

出版信息

Retina. 2012 Oct;32(9):1733-42. doi: 10.1097/IAE.0b013e318242b81a.

DOI:10.1097/IAE.0b013e318242b81a

PMID:22466479

Abstract

PURPOSE

To evaluate photoreceptor inner/outer segment (IS/OS) defects, best-corrected visual acuity (BCVA), macular sensitivity, and fixation stability to correlate morphologic changes with visual functional outcomes at different stages after macular hole surgery using spectral-domain optical coherence tomography combined with microperimetry.

METHODS

This study was an interventional, retrospective case series. Sixteen eyes of 16 patients with successfully operated idiopathic full-thickness macular holes were included in this study. The IS/OS defect maximal diameter and area, BCVA, central macular sensitivity, mean macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry, preoperatively, and with a follow-up of 3 months postoperatively.

RESULTS

Both the IS/OS defect diameter and area improved after successful macular hole surgery (P < 0.001; P < 0.001). The BCVA, central macular sensitivity, mean macular sensitivity, and fixation stability of the central 2° also improved (P = 0.001; P = 0.004; P = 0.036; P = 0.031). Stable BCVA improvement was achieved as early as 1-month postoperation despite continuous repair of the IS/OS junction defect diameter and area and improvement in fixation and macular sensitivity within the first 3 months after surgery. The postoperative central macular sensitivity and mean macular sensitivity negatively correlated with preoperative linear IS/OS junction defect diameter (P = 0.033; P = 0.006) and the defect area (P < 0.001; P = 0.002). However, the postoperative BCVA and the improvement in BCVA, macular sensitivity, and fixation stability were not correlated with preoperative IS/OS defect diameter or area.

CONCLUSION

Continuous anatomical and functional improvements can be observed after successful microinvasive macular hole surgery. The preoperative extent of the IS/OS junction defect is of good predictive value for postoperative macular sensitivity. However, the factors that influence BCVA are multiple. Prediction of BCVA based on a single anatomical parameter or assessment of macular function only based on BCVA should be avoided.

摘要

目的

利用频域光相干断层扫描联合微视野计，评估孔源性全层黄斑裂孔手术后不同阶段光感受器内外节（IS/OS）缺损、最佳矫正视力（BCVA）、黄斑敏感性和固视稳定性，将形态变化与视觉功能结果相关联。

方法

本研究为一项干预性、回顾性病例系列研究。纳入 16 例（16 只眼）成功手术治疗的特发性全层黄斑裂孔患者。应用频域光相干断层扫描联合微视野计测量 IS/OS 缺损最大直径和面积、BCVA、中心黄斑敏感性、平均黄斑敏感性和固视稳定性，分别于术前和术后 3 个月进行测量。

结果

成功的黄斑裂孔手术后，IS/OS 缺损直径和面积均得到改善（P < 0.001；P < 0.001）。BCVA、中心黄斑敏感性、平均黄斑敏感性和中心 2°固视稳定性也得到改善（P = 0.001；P = 0.004；P = 0.036；P = 0.031）。尽管 IS/OS 交界处缺陷直径和面积持续修复，术后前 3 个月固视和黄斑敏感性改善，但术后 1 个月即可实现稳定的 BCVA 改善。术后中心黄斑敏感性和平均黄斑敏感性与术前线性 IS/OS 交界处缺损直径（P = 0.033；P = 0.006）和缺损面积（P < 0.001；P = 0.002）呈负相关。然而，术后 BCVA 及 BCVA、黄斑敏感性和固视稳定性的改善与术前 IS/OS 缺损直径或面积无关。