Wang Yi, Liang Xida, Gao Meng, Liu Ju, Liu Limei, Liu Wu
Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China.
Ophthalmology Department, Beijing Electric Power Hospitals, Beijing, China.
Int Ophthalmol. 2019 Dec;39(12):2775-2783. doi: 10.1007/s10792-019-01124-6. Epub 2019 May 29.
To evaluate the influence of vision-related quality of life (VR-QOL) after pars plana vitrectomy (PPV) with or without combined cataract surgery for idiopathic macular hole (IMH) patients.
This prospective consecutive case series study included 53 eyes of 53 consecutive IMH patients who were divided into two groups: 34 eyes underwent PPV combined with cataract surgery (combined group), 19 eyes only underwent PPV (vitrectomy group). Clinical data were collected at baseline and 3 and 6 months after surgery, respectively, including VR-QOL evaluated by The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25), logarithm of minimal angle of resolution best-corrected visual acuity (logMAR BCVA) using ETDRS chart, severity of metamorphopsia evaluated by M-Charts, contrast sensitivity evaluated by functional acuity contrast test, MH diameter detected by SD-OCT and lens opacity assessment evaluated by Lens Opacity Classification System III (LOCS III). ANOVA and LSD, Wilcoxon signed-rank test were used to compare the difference in logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores between three time points; Spearman's rank correlation test was used to test the correlations between logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores.
All eyes had achieved an anatomical success after surgery in both groups. BCVA (logMAR), metamorphopsia and contrast sensitivity were significantly improved at month 3 and month 6 (p = < 0.005). VFQ-25 composite and four subscale scores (general vision, near activities, distant activities, role difficulties) were significantly improved in combined group at month 6 compared with baseline (p = 0.011, 0.001, 0.003, < 0.001, 0.009). VFQ-25 composite and two subscale scores (general vision, role difficulties) were significantly and negatively correlated with logMAR BCVA (p = 0.046, 0.011, 0.012) and metamorphopsia (p = 0.009, 0.002, < 0.001) in combined group. VFQ-25 composite and four subscale scores (general vision, near activities, distance activities, mental health) were significantly improved in vitrectomy group at month 3 compared with baseline (p = 0.014, 0.047, 0.011, 0.018, 0.037). VFQ-25 composite score and mental health score were significantly decreased in vitrectomy group at month 6 compared with month 3 (p = 0.031, 0.029) and were significantly and negatively correlated with LOCS III score (p = 0.047, 0.017) at month 6.
Visual function and VR-QOL were significantly improved after successful macular hole surgery. The fluctuation of VR-QOL after surgery was attributed to the progression of the lens opacity. PPV combined with cataract surgery can help macular hole patients to maintain stable VR-QOL improvement by degrees.
评估接受或未接受白内障联合手术的特发性黄斑裂孔（IMH）患者行玻璃体切割术（PPV）后视觉相关生活质量（VR-QOL）的影响。
本前瞻性连续病例系列研究纳入53例连续的IMH患者的53只眼，分为两组：34只眼接受PPV联合白内障手术（联合组），19只眼仅接受PPV（玻璃体切割术组）。分别在基线、术后3个月和6个月收集临床数据，包括通过美国国立眼科研究所25项视觉功能问卷（VFQ-二十五）评估的VR-QOL、使用ETDRS视力表测量的最佳矫正视力最小分辨角对数（logMAR BCVA）、通过M图表评估的视物变形严重程度、通过功能视力对比测试评估的对比敏感度、通过SD-OCT检测的黄斑裂孔直径以及通过晶状体混浊分类系统III（LOCS III）评估的晶状体混浊情况。采用方差分析和LSD、Wilcoxon符号秩检验比较三个时间点之间logMAR BCVA、视物变形评分、对比敏感度、LOCS III评分和VFQ-二十五评分的差异；采用Spearman等级相关检验检验logMAR BCVA、视物变形评分、对比敏感度、LOCS III评分和VFQ-二十五评分之间的相关性。
两组所有患眼术后均获得解剖学成功。BCVA（logMAR）、视物变形和对比敏感度在术后3个月和6个月时显著改善（p < 0.005）。联合组在术后6个月时VFQ-二十五综合评分和四个子量表评分（总体视力、近距活动、远距活动、角色困难）与基线相比显著改善（p = 0.011、0.001、0.003、< 0.001、0.009）。联合组中VFQ-二十五综合评分和两个子量表评分（总体视力、角色困难）与logMAR BCVA（p = 0.046、0.011、0.012）和视物变形（p = 0.009、0.002、< 0.001）显著负相关。玻璃体切割术组在术后3个月时VFQ-二十五综合评分和四个子量表评分（总体视力、近距活动、远距活动、心理健康）与基线相比显著改善（p = 0.014、0.047、0.011、0.018、0.037）。玻璃体切割术组在术后6个月时VFQ-二十五综合评分和心理健康评分与术后3个月相比显著降低（p = 0.031、0.029），且在术后6个月时与LOCS III评分显著负相关（p = 0.047、0.017）。
黄斑裂孔手术成功后视觉功能和VR-QOL显著改善。术后VR-QOL的波动归因于晶状体混浊的进展。PPV联合白内障手术可帮助黄斑裂孔患者逐步维持稳定的VR-QOL改善。
