Kong Eye Hospital, Seoul, South Korea.
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2021 Jan;259(1):69-79. doi: 10.1007/s00417-020-04822-5. Epub 2020 Jul 9.
To investigate foveal morphologic parameters related to visual acuity and the stages classified in this study reflect the severity of the macular pseudohole (MPH).
Seventy-eight eyes of 78 consecutive patients diagnosed with MPH were studied. Quantitative optical coherence tomography (OCT) parameters including central foveal thickness, parafoveal thickness, parafoveal inner and outer retinal thickness (PIRT and PORT), pseudohole depth, pseudohole diameter, and inner nuclear layer (INL) angulation were measured and the morphologic features of the inner retina (disorganization of retinal inner layers (DRIL)) and the photoreceptor layer (external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and cotton ball sign) were determined. Associations between OCT parameters and best-corrected visual acuity (BCVA) were analyzed. Based on the location of the inner margin of INL, all patients were divided into three stages and the mean comparison between the three stages was analyzed.
PIRT (r = 0.6489; p < 0.0001) and pseudohole depth (r = 0.5266; p < 0.0001) had a statistically significant correlation with BCVA. Statistically significant visual acuity differences were found in eyes with DRIL (p < 0.001) and IZ disruption (p = 0.018), but not in ELM disruption (p = 0.916), EZ disruption (p = 0.581), and cotton ball sign (p = 0.075). According to the univariate and multivariate regression analyses, PIRT was associated with BCVA in both univariate (p < 0.001) and multivariate (p = 0.002) regression analyses. Defect diameters of both ELM (p = 0.025) and IZ (p = 0.006) were associated with BCVA in univariate regression analysis, but not in multivariate regression analysis. INL angulation and the ratio of the IZ disruption was significantly different in the three groups. Stage 3 (95.8%) had significantly higher disrupted IZ ratio than stage 1 (40%) and stage 2 (65.5%). The BCVA of stages 1, 2, and 3 were identified as 0.06 ± 0.07 (20/23 Snellen equivalent), 0.23 ± 0.17 (20/34 Snellen equivalent), and 0.48 ± 0.23 (20/60 Snellen equivalent), respectively, and the differences in BCVA between the three groups were significant (p < 0.0001).
The parameters related to visual acuity were PIRT, pseudohole depth, DRIL, and IZ. The stage classification proposed in this study included morphologic changes of the inner retina and photoreceptor layer and is likely to be clinically useful for showing the severity of the MPH.
探讨与视力相关的黄斑假性裂孔（MPH）的中心凹形态学参数，本研究中分类的阶段反映了黄斑假性裂孔的严重程度。
研究了 78 例（78 只眼）被诊断为 MPH 的连续患者。测量了定量光学相干断层扫描（OCT）参数，包括中心凹厚度、旁中心凹厚度、旁中心凹内、外层视网膜厚度（PIRT 和 PORT）、假性裂孔深度、假性裂孔直径和内核层（INL）角度，并确定了内视网膜（视网膜内层紊乱（DRIL））和光感受器层（外节层（ELM）、椭圆体带（EZ）、内连接带（IZ）和棉球状标志）的形态特征。分析了 OCT 参数与最佳矫正视力（BCVA）之间的关系。根据 INL 内缘的位置，将所有患者分为三个阶段，并对三个阶段进行平均比较。
PIRT（r = 0.6489；p < 0.0001）和假性裂孔深度（r = 0.5266；p < 0.0001）与 BCVA 呈显著正相关。在存在 DRIL（p < 0.001）和 IZ 中断（p = 0.018）的眼中发现了统计学上显著的视力差异，但在存在 ELM 中断（p = 0.916）、EZ 中断（p = 0.581）和棉球状标志（p = 0.075）的眼中未发现统计学上显著的视力差异。根据单变量和多变量回归分析，PIRT 在单变量（p < 0.001）和多变量（p = 0.002）回归分析中均与 BCVA 相关。ELM（p = 0.025）和 IZ（p = 0.006）的缺陷直径在单变量回归分析中与 BCVA 相关，但在多变量回归分析中不相关。INL 角度和 IZ 破坏率在三组之间差异有统计学意义。第 3 期（95.8%）的 IZ 破坏率明显高于第 1 期（40%）和第 2 期（65.5%）。第 1、2 和 3 期的 BCVA 分别为 0.06 ± 0.07（20/23 斯涅伦等效视力）、0.23 ± 0.17（20/34 斯涅伦等效视力）和 0.48 ± 0.23（20/60 斯涅伦等效视力），三组之间的 BCVA 差异有统计学意义（p < 0.0001）。
与视力相关的参数是 PIRT、假性裂孔深度、DRIL 和 IZ。本研究提出的阶段分类包括内视网膜和光感受器层的形态变化，可能对显示 MPH 的严重程度具有临床意义。
