[光学相干断层扫描对特发性黄斑裂孔手术结果的预测因素]

[Optical coherence tomography predictive factors for idiopathic macular hole surgery outcome].

作者信息

Dai Yuan-min, Shen Jie, Li Jiu-ke, Jin Xiao-hong, Li Yu-min

机构信息

Department of Ophthalmology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou 310016, China.

Department of Ophthalmology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou 310016, China. Email:

出版信息

Zhonghua Yan Ke Za Zhi. 2013 Sep;49(9):807-11.

PMID:24330930

Abstract

OBJECTIVE

To evaluate the use of preoperative optical coherence tomography (OCT) image and some related indexes as predictive factors for the visual outcomes of the idiopathic macular hole (IMH) after pars plana vitrectomy and the internal limiting membrane (ILM) peeling surgery.

METHODS

This was a case-series study. Twenty-five eyes of 23 IMH patients undergoing a successful vitrectomy and ILM peeling surgery and following up more than 6 months were included in this retrospective study. Of the 23 patients, 6 were male and 17 were female. The median patient age was 67-year old (range 63 to 71 years). The median duration of IMH was 6 months (range 3.5 to 12.0 months).In the patients, the macular hole was found in 9 eyes at stage II, 11 eyes at stage III, and 5 eyes at stage IV. Best corrected visual acuity (BCVA) were examined before and after the surgery. The minimum diameter (a) , the height (b) and the base diameter (c) of macular holes were measured by OCT. According to the indexes, macular hole index (MHI, b/c) , tractional hole index (THI, b/a) , diameter hole index (DHI, a/c) were calculated, respectively. Spearman rank correlation analysis was performed to understand the correlations between postoperative BCVA and the related indexes. Cut-off values were obtained for MHI and THI, respectively, from receiver operating characteristic (ROC) curve analysis.

RESULTS

The median preoperative BCVA was 0.100(range 0.050 to 0.180). The median MHI, THI and DHI was 0.476(range 0.416 to 0.684), 1.048(range 0.761 to 1.346) and 0.536(range 0.431 to 0.645), respectively. The median 3-month postoperative BCVA was 0.150 (range 0.120 to 0.275), markedly improved after surgery (Mann-Whitney U test:P = 0.002) . The median latest postoperative BCVA was 0.250 (range 0.135 to 0.350), also markedly improved (Mann-Whitney U test, P = 0.002) . MHI, THI and preoperative BCVA correlated significantly with postoperative BCVA by Spearman rank correlation analysis (rMHI = 0.481, P = 0.015; rTHI= 0.516, P = 0.008; preoperative BCVA = 0.560, P = 0.004, respectively). Areas under the curve of 0.740 and 0.760 for MHI and THI were obtained respectively. Cut-off values of 0.475 and 0.973 were obtained for MHI and THI, respectively, from ROC curve analysis. Postoperative BCVAs in the MHI ≥ 0.475 group and in the THI ≥ 0.973 group was better than that in the MHI < 0.475 and in the THI < 0.973 group, respectively (Mann-Whitney U test:P MHI = 0.013, P THI = 0.008) .

CONCLUSION

An MHI ≥ 0.475 or a THI ≥ 0.973 may be predictive factors for a good visual prognosis after IMH surgery.

摘要

目的

评估术前光学相干断层扫描（OCT）图像及一些相关指标作为特发性黄斑裂孔（IMH）行玻璃体切割术联合内界膜（ILM）剥除术后视力预后预测因素的价值。

方法

这是一项病例系列研究。本回顾性研究纳入了23例成功接受玻璃体切割术联合ILM剥除术且随访时间超过6个月的IMH患者的25只眼。23例患者中，男性6例，女性17例。患者年龄中位数为67岁（范围63至71岁）。IMH持续时间中位数为6个月（范围3.5至12.0个月）。患者中，II期黄斑裂孔9只眼，III期11只眼，IV期5只眼。手术前后检查最佳矫正视力（BCVA）。通过OCT测量黄斑裂孔的最小直径（a）、高度（b）和基底直径（c）。根据这些指标分别计算黄斑裂孔指数（MHI，b/c）、牵拉性裂孔指数（THI，b/a）、直径裂孔指数（DHI，a/c）。采用Spearman等级相关分析来了解术后BCVA与相关指标之间的相关性。通过受试者工作特征（ROC）曲线分析分别获得MHI和THI的截断值。

结果

术前BCVA中位数为0.100（范围0.050至0.180）。MHI、THI和DHI中位数分别为0.476（范围0.416至0.684）、1.048（范围0.761至1.346）和0.536（范围0.431至0.645）。术后3个月BCVA中位数为0.150（范围0.120至0.275），术后明显改善（Mann-Whitney U检验：P = 0.002）。术后最新BCVA中位数为0.250（范围0.135至0.350），同样明显改善（Mann-Whitney U检验，P = 0.002）。通过Spearman等级相关分析，MHI、THI和术前BCVA与术后BCVA均显著相关（rMHI = 0.481，P = 0.015；rTHI = 0.516，P = 0.008；术前BCVA = 0.560，P = 0.004）。MHI和THI的曲线下面积分别为0.74和0.76。通过ROC曲线分析，MHI和THI的截断值分别为0.475和0.973。MHI≥0.475组和THI≥0.973组的术后BCVA分别优于MHI<0.475组和THI<0.973组（Mann-Whitney U检验：P MHI = 0.013，P THI = 0.008）。