Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
Invest Ophthalmol Vis Sci. 2014 Dec 18;56(2):1141-6. doi: 10.1167/iovs.14-15765.
To investigate preoperative and intraoperative factors associated with persistent subfoveal fluid in surgically closed macular holes (MHs).
This was a prospective consecutive case series of eyes undergoing surgical repair for full-thickness MH in the PIONEER study, a prospective intraoperative optical coherence tomography (OCT) multisurgeon single-center study. Thirty-seven eyes (36 patients) with surgically closed MH were studied. Quantitative OCT analysis was performed including intraoperative MH area, volume, ellipsoid zone to retinal pigment epithelium (EZ-RPE) height, extent of subretinal hyporeflectivity (SRHR), and the amount of postoperative subfoveal fluid.
Persistent subfoveal fluid was identified in 58% of eyes at 2 weeks following surgery. The mean time to two-line improvement in visual acuity was greater in eyes with persistent subfoveal fluid (P = 0.03). Final visual acuity did not correlate with the initial presence of fluid. Two intraoperative factors following internal limiting membrane (ILM) peeling were associated with the formation of persistent subfoveal fluid: EZ-RPE height and SRHR width (P < 0.01). These were both negatively correlated with amount of postoperative subfoveal fluid (P = 0.028 and 0.04, respectively).
Persistent subfoveal fluid following MH surgery is a common finding that appears to delay visual recovery but not effect final visual outcome. The incidence of persistent subfoveal fluid appears to be related to intraoperative alterations after ILM peeling in the outer retinal architecture (e.g., increased EZ-RPE height and SRHR width). This finding suggests a novel mechanism for facilitating MH closure through ILM peeling (e.g., altering photoreceptor/RPE adherence and increasing retinal mobility that allows for complete hole closure).
研究与手术封闭黄斑裂孔（MH）后持续性中心凹下积液相关的术前和术中因素。
这是一项在 PIONEER 研究中进行的手术修复全层 MH 的前瞻性连续病例系列研究，这是一项前瞻性术中光相干断层扫描（OCT）多外科医生单中心研究。研究了 37 只（36 例）手术封闭 MH 的眼睛。进行了定量 OCT 分析，包括术中 MH 面积、体积、椭圆体带至视网膜色素上皮（EZ-RPE）高度、视网膜下低反射区（SRHR）的范围以及术后中心凹下积液量。
术后 2 周，58%的眼存在持续性中心凹下积液。在存在持续性中心凹下积液的眼中，视力提高两行的平均时间更长（P = 0.03）。最终视力与初始积液的存在无关。内界膜（ILM）剥离后两个术中因素与持续性中心凹下积液的形成相关：EZ-RPE 高度和 SRHR 宽度（P < 0.01）。这两个因素均与术后中心凹下积液量呈负相关（P = 0.028 和 0.04）。
MH 手术后出现持续性中心凹下积液是一种常见发现，似乎会延迟视力恢复，但不影响最终视力结果。持续性中心凹下积液的发生率似乎与 ILM 剥离后外视网膜结构中的术中改变有关（例如，EZ-RPE 高度增加和 SRHR 宽度增加）。这一发现提示了一种通过 ILM 剥离促进 MH 闭合的新机制（例如，改变光感受器/RPE 的附着并增加视网膜的可动性，从而实现完全孔闭合）。
