Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
Br J Ophthalmol. 2019 Feb;103(2):238-244. doi: 10.1136/bjophthalmol-2017-311689. Epub 2018 Apr 9.
To evaluate long-term reconstructive changes in foveal microstructures and their associations with visual improvement in eyes with surgically closed macular holes (MHs).
Twenty-eight eyes of 28 patients who underwent successful idiopathic MH repair were retrospectively studied. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography images were examined preoperatively and 1, 3, 6, 12, 24 and 36 months postoperatively. Correlations between postoperative BCVA and parameters relating to the reconstruction of the foveal photoreceptor layer including the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) as well as changes in glial cells were evaluated.
Logarithm of the minimum angle of resolution BCVA improved continuously during 3-year follow-up (baseline 0.70±0.27, 1 month 0.36±0.34, 3 months 0.29±0.30, 6 months 0.22±0.24, 12 months 0.18±0.25, 24 months 0.14±0.22, 36 months 0.10±0.19) (p=0.015). Continuous reconstruction of the foveal microstructure was apparent throughout the 3-year follow-up. The reconstruction process was initiated by glial proliferation, followed by ELM bridging, glial elimination with EZ reconstruction and CIZ reconstruction. Better BCVA at the 3-year time-point was significantly associated with early ELM bridging, early glial disappearance and photoreceptor integrity defined as complete reconstruction of the ELM, EZ and CIZ.
Integrity of the photoreceptor layer was correlated with better long-term visual outcomes after MH repair. Reconstruction of the foveal ELM and disappearance of glial proliferation in the early postoperative period predicted better visual recovery.
评估手术闭合性黄斑裂孔（MH）后黄斑中心凹微观结构的长期重建变化及其与视力改善的关系。
回顾性研究了 28 例 28 只眼接受特发性 MH 修复术的患者。术前及术后 1、3、6、12、24 和 36 个月检查最佳矫正视力（BCVA）和频域光学相干断层扫描图像。评估术后 BCVA 与重建黄斑中心凹光感受器层的参数（包括外节限膜（ELM）、椭圆体带（EZ）和锥间融合带（CIZ））以及神经胶质细胞变化之间的相关性。
在 3 年的随访中，最小角分辨率 BCVA 的对数持续提高（基线 0.70±0.27，1 个月 0.36±0.34，3 个月 0.29±0.30，6 个月 0.22±0.24，12 个月 0.18±0.25，24 个月 0.14±0.22，36 个月 0.10±0.19）（p=0.015）。在 3 年的随访中，黄斑中心凹微观结构的连续重建是明显的。重建过程是由神经胶质细胞增生开始，随后是 ELM 桥接，神经胶质细胞消失，EZ 重建和 CIZ 重建。3 年时更好的 BCVA 与早期 ELM 桥接、早期神经胶质细胞消失以及光感受器完整性显著相关，后者定义为 ELM、EZ 和 CIZ 的完全重建。
MH 修复后，光感受器层的完整性与长期视力预后相关。术后早期 ELM 重建和神经胶质细胞增生消失预测更好的视力恢复。
