Hansen Sean, Batson Sean, Weinlander Kenneth M, Cooper Robert F, Scoles Drew H, Karth Peter A, Weinberg David V, Dubra Alfredo, Kim Judy E, Carroll Joseph, Wirostko William J
*Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin; †Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; ‡Department of Biomedical Engineering, University of Rochester, Rochester, New York; §Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin; and ¶Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.
Retin Cases Brief Rep. 2015 Winter;9(1):15-20. doi: 10.1097/ICB.0000000000000117.
To describe photoreceptor structure and recovery after macular hole (MH) closure with pars plana vitrectomy (PPV) using adaptive optics scanning light ophthalmoscopy and spectral domain optical coherence tomography.
A pilot imaging study of four eyes from four subjects undergoing PPV for MH was conducted. Imaging with spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy was performed at varying time points after PPV.
Despite successful MH closure, disruption of the foveal inner segment ellipsoid zone was seen in all patients when imaged at a mean of 117 days after PPV. Disruption of the photoreceptor mosaic was seen using adaptive optics scanning light ophthalmoscopy at locations corresponding to regions of ellipsoid zone disruption on spectral domain optical coherence tomography. Cone density immediately surrounding these disruptions was normal, except for one patient. In 2 patients who were imaged serially up to 516 days after PPV, recovery of cone cells within regions of mosaic disruption could be detected over time.
Photoreceptor disruption exists even after apparent MH closure. Remodeling of the foveal cone mosaic continues for many months after surgery, perhaps accounting for the delayed postoperative improvements of visual acuity in some patients. Spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy are useful tools for monitoring photoreceptor recovery after surgical closure of MH.
使用自适应光学扫描激光检眼镜和光谱域光学相干断层扫描技术，描述黄斑裂孔（MH）经玻璃体切除术（PPV）封闭后光感受器的结构及恢复情况。
对4例接受PPV治疗MH的患者的4只眼进行了一项初步成像研究。在PPV后的不同时间点，使用光谱域光学相干断层扫描和自适应光学扫描激光检眼镜进行成像。
尽管MH成功封闭，但在PPV后平均117天成像时，所有患者均可见黄斑中心凹内节椭圆体带破坏。在光谱域光学相干断层扫描上与椭圆体带破坏区域相对应的位置，使用自适应光学扫描激光检眼镜观察到光感受器镶嵌破坏。除1例患者外，这些破坏区域周围的视锥细胞密度正常。在2例PPV后长达516天进行连续成像的患者中，随着时间推移可检测到镶嵌破坏区域内视锥细胞的恢复。
即使在MH明显封闭后，仍存在光感受器破坏。手术后黄斑视锥细胞镶嵌的重塑会持续数月，这可能是部分患者术后视力改善延迟的原因。光谱域光学相干断层扫描和自适应光学扫描激光检眼镜是监测MH手术封闭后光感受器恢复的有用工具。
