预测特发性黄斑裂孔手术治疗的解剖学结果。
Predicting anatomical results of surgical treatment of idiopathic macular hole.
作者信息
Shpak Alexander A, Shkvorchenko Dmitry O, Sharafetdinov Ilias Kh, Yukhanova Olga A
机构信息
The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow 127486, Russia.
出版信息
Int J Ophthalmol. 2016 Feb 18;9(2):253-7. doi: 10.18240/ijo.2016.02.13. eCollection 2016.
AIM
To determine the parameters most informative in predicting the anatomical results of surgical treatment of idiopathic full-thickness macular hole (IMH).
METHODS
One hundred and sixty-two consecutive patients (170 eyes) after primary operation for IMH were enrolled. Outcomes were classified as anatomical success when both IMH closure and restoration of the outer retinal structure were achieved. "Prospective" group included 108 patients (115 eyes) followed with optical coherence tomography (OCT) and microperimetry for 1y after surgery. Potential prognostic criteria, except microperimetry data, were tested in "retrospective" group (54 patients, 55 eyes). Prognostic value of each parameter was determined using receiver operating characteristic (ROC) analysis. Combined predictive power of the best prognostic parameters was tested with the use of linear discriminant analysis.
RESULTS
IMH closure was achieved in 106 eyes (92%) in the prospective group and 49 eyes (89%) in the retrospective group. Despite anatomical closure, the outer retinal structure was not restored in two eyes in the first group and in one eye in the second group. Preoperative central subfield retinal thickness demonstrated the best discriminatory capability between eyes with anatomical success and failure: area under the ROC-curve (AUC) 0.938 (95% CI: 0.881-0.995), sensitivity 64% at fixed specificity 95% (cut-off value 300 µm) in the prospective group; sensitivity 57% and specificity 90% in the retrospective group. Other continuous parameters except tractional hole index (AUC: 0.796, 95% CI: 0.591-1.000) had significantly lower AUCs (P<0.05). The best combination of the parameters, established by discriminant analysis in the prospective group, could not confirm its predictive value in the retrospective group.
CONCLUSION
Preoperative central subfield retinal thickness is a strong and probably the best predictor of anatomical results of IMH surgical treatment.
目的
确定在预测特发性全层黄斑裂孔（IMH）手术治疗的解剖学结果方面最具信息量的参数。
方法
纳入162例（170只眼）接受IMH初次手术后的连续患者。当IMH闭合且视网膜外层结构恢复时，结果被分类为解剖学成功。“前瞻性”组包括108例患者（115只眼），术后随访1年，采用光学相干断层扫描（OCT）和微视野计检查。除微视野计数据外，在“回顾性”组（54例患者，55只眼）中测试潜在的预后标准。使用受试者工作特征（ROC）分析确定每个参数的预后价值。使用线性判别分析测试最佳预后参数的联合预测能力。
结果
前瞻性组106只眼（92%）实现了IMH闭合，回顾性组49只眼（89%）实现了IMH闭合。尽管实现了解剖学闭合，但第一组中有2只眼、第二组中有1只眼的视网膜外层结构未恢复。术前中心子区域视网膜厚度在解剖学成功和失败的眼之间显示出最佳的区分能力：前瞻性组ROC曲线下面积（AUC）为0.938（95%CI：0.881 - 0.995），在固定特异性为95%（截断值300 µm）时敏感性为64%；回顾性组敏感性为57%，特异性为90%。除牵拉性裂孔指数（AUC：0.796，95%CI：0.591 - 1.000）外，其他连续参数的AUC显著更低（P<0.05）。在前瞻性组中通过判别分析确定的参数最佳组合，在回顾性组中未能证实其预测价值。
结论
术前中心子区域视网膜厚度是IMH手术治疗解剖学结果的有力且可能是最佳的预测指标。
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