Kawashima Yu, Uji Akihito, Ooto Sotaro, Hangai Masanori, Hosoda Yoshikatsu, Yoshimura Nagahisa
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Ophthalmol. 2015 Nov;160(5):982-989.e1. doi: 10.1016/j.ajo.2015.08.015. Epub 2015 Aug 20.
To investigate whether the photoreceptor layer status of the detached retina, which has the potential to plug the macular hole (MH), can predict postoperative visual acuity (VA).
Retrospective, consecutive, observational case series.
A consecutive series of 48 eyes in 48 patients with surgically closed MHs were recruited into the study. Spectral-domain optical coherence tomography (SD OCT) images were obtained preoperatively and postoperatively. Length gaps between photoreceptor layers and the preoperative diameter of the basal MH in the detached part of the retina was calculated for the photoreceptor outer segment (OS) and the external limiting membrane (ELM). The postoperative photoreceptor layer status at the fovea, including continuity of the ELM line, inner segment ellipsoid line (ISe), and cone outer segment tip (COST) line, was categorized by graders.
The preoperative OS gap length and ELM gap length correlated significantly with postoperative VA. A larger OS or ELM gap length was associated with a more severe postoperative photoreceptor layer status. Eyes with a moderately reflective lesion had a significantly longer OS gap length and ELM gap length, significantly worse postoperative VA, and more severe photoreceptor layer status than did eyes without such a moderately reflective lesion. Eyes with a better postoperative COST status had significantly better postoperative VA (P = .0465).
OS and ELM gap length, which represent the degree of insufficiency of MH plugging, was strongly correlated with postoperative VA; moreover, these preoperative parameters were associated with the postoperative photoreceptor layer status, including glial cell proliferation.
研究具有封堵黄斑裂孔（MH）潜力的视网膜脱离的光感受器层状态能否预测术后视力（VA）。
回顾性、连续性、观察性病例系列研究。
本研究纳入了48例手术封闭MH的患者的48只眼。术前和术后均获取了频域光学相干断层扫描（SD OCT）图像。计算视网膜脱离部分光感受器外层（OS）和外界膜（ELM）的光感受器层之间的长度间隙以及基底MH的术前直径。由分级人员对术后黄斑中心凹处的光感受器层状态进行分类，包括ELM线、内节椭圆体线（ISe）和锥体外段尖端（COST）线的连续性。
术前OS间隙长度和ELM间隙长度与术后VA显著相关。OS或ELM间隙长度越大，术后光感受器层状态越严重。与无中度反射性病变的眼相比，有中度反射性病变的眼的OS间隙长度和ELM间隙长度显著更长，术后VA显著更差，光感受器层状态更严重。术后COST状态较好的眼术后VA显著更好（P = 0.0465）。
代表MH封堵不足程度OS和ELM间隙长度与术后VA密切相关；此外，这些术前参数与术后光感受器层状态有关，包括胶质细胞增殖。
