Shin J Y, Chu Y K, Hong Y T, Kwon O W, Byeon S H
Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Eye (Lond). 2015 Aug;29(8):1051-9. doi: 10.1038/eye.2015.81. Epub 2015 May 22.
To determine the preoperative anatomic factors in macular holes and their correlation to hole closure.
Forty-six eyes with consecutive unilateral macular hole who had undergone surgery and followed up for at least 6 months were enrolled. Optical coherence tomography images and best-corrected visual acuity (BCVA) within 2 weeks prior to operation and 6 months after surgery were analyzed. The maximal hole dimension, foveal degeneration factors (inner nuclear layer cysts, outer segment (OS) shortening) and the widest foveolar floor size of the fellow eyes were measured. For overcoming preoperative individual variability of foveal morphology, an 'adjusted' hole size parameter (the ratio between the hole size and the fellow eye foveolar floor size) was used based on the fact that both eyes were morphologically symmetrical.
Mean preoperative BCVA (logMAR) was 1.03±0.43 and the mean postoperative BCVA was 0.50±0.38 at 6 months. Preoperative BCVA is significantly associated with postoperative BCVA (P=0.0002). The average hole diameter was 448.9±196.8 μm and the average fellow eye foveolar floor size was 461.3±128.4 μm. There was a correlation between hole diameter and the size of the fellow eye foveolar floor (Pearson's coefficient=0.608, P<0.0001). The adjusted hole size parameter was 0.979±0.358 (0.761-2.336), which was a strong predictor for both anatomic (P=0.0281) and visual (P=0.0016) outcome.
When determining the extent of preoperative hole size, we have to take into consideration the foveal morphologic variations among individuals. Hole size may be related to the original foveal shape, especially in relation to the centrifugal retraction of the foveal tissues.
确定黄斑裂孔的术前解剖学因素及其与裂孔闭合的相关性。
纳入46例连续的单侧黄斑裂孔患者，这些患者均接受了手术并随访至少6个月。分析术前2周内及术后6个月的光学相干断层扫描图像和最佳矫正视力（BCVA）。测量裂孔的最大尺寸、黄斑变性因素（内核层囊肿、外节缩短）以及对侧眼最宽的黄斑中心凹底部尺寸。为克服术前黄斑形态的个体差异，基于双眼形态对称这一事实，使用了一个“调整后”的裂孔大小参数（裂孔大小与对侧眼黄斑中心凹底部大小的比值）。
术前平均BCVA（logMAR）为1.03±0.43，术后6个月平均BCVA为0.50±0.38。术前BCVA与术后BCVA显著相关（P = 0.0002）。平均裂孔直径为448.9±196.8μm，对侧眼黄斑中心凹底部平均大小为461.3±128.4μm。裂孔直径与对侧眼黄斑中心凹底部大小之间存在相关性（Pearson系数 = 0.608，P < 0.0001）。调整后的裂孔大小参数为0.979±0.358（0.761 - 2.336），这是解剖学（P = 0.0281）和视觉（P = 0.0016）结果的有力预测指标。
在确定术前裂孔大小范围时，必须考虑个体间黄斑形态的差异。裂孔大小可能与原始黄斑形状有关，特别是与黄斑组织的离心性回缩有关。
