Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ophthalmologica. 2021;244(4):339-346. doi: 10.1159/000510149. Epub 2020 Jul 15.
To investigate the reconstructive changes in foveal microstructures postoperatively and analyze the visual predictors in eyes with surgically closed traumatic macular holes (TMHs).
Seventy-one eyes with TMHs that underwent vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade were reviewed. Clinical data, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) images were recorded. The length of the ellipsoid zone (EZ) defect and the integrity of postoperative external limiting membrane (ELM) were measured. Preoperative and 1-month postoperative features were analyzed, respectively, as potential predictors of visual acuity at 6 months postoperatively.
The primary hole closure rate was 90.14% (64/71). In 43 cases of initially closed TMHs with SD-OCT scans preoperatively and at 1 and 6 months postoperatively, the number of eyes with intact ELM increased from 18 (41.86%) at 1 month to 26 (60.47%) at 6 months (p = 0.08), while the number of eyes with a restored EZ band remained the same in 2 eyes (4.65%). The mean length of the EZ defect progressively decreased postoperatively (p < 0.001). Poorer preoperative visual acuity (p = 0.002), lower mean macular hole (MH) height (p = 0.012), and greater preoperative mean length of EZ defect (p < 0.001) were associated with worse visual acuity 6 months postoperatively, but only the preoperative length of the EZ defect was proved to be a predictor, with the cutoff value of 1,800 μm provided by the receiver-operating characteristics (ROC) curve. Worse visual acuity and greater mean length of the EZ defect at 1 month were also associated with worse final visual acuity.
The mean length of the EZ defect both preoperatively and 1 month postoperatively were predictors of visual outcomes at 6 months postoperatively.
研究外伤性黄斑裂孔（TMH）手术后黄斑中心凹微结构的重建变化，并分析手术闭合性 TMH 眼的视力预测因素。
回顾性分析 71 例接受玻璃体切割术、内界膜（ILM）剥除术和气体填充治疗的 TMH 患者。记录临床资料、最佳矫正视力和频域光学相干断层扫描（SD-OCT）图像。测量椭圆体带（EZ）缺损的长度和术后外节膜（ELM）的完整性。分别分析术前和术后 1 个月的特征，作为术后 6 个月视力的潜在预测因素。
初次裂孔闭合率为 90.14%（64/71）。在 43 例最初闭合的 TMH 患者中，术前和术后 1 个月及 6 个月行 SD-OCT 扫描，术后 1 个月时完整 ELM 的眼数从 18 只（41.86%）增加到 26 只（60.47%）（p=0.08），而恢复 EZ 带的眼数则保持不变，仍为 2 只（4.65%）。术后 EZ 缺损的平均长度逐渐减小（p<0.001）。术前视力较差（p=0.002）、平均黄斑裂孔（MH）高度较低（p=0.012）和术前 EZ 缺损平均长度较长（p<0.001）与术后 6 个月视力较差相关，但只有术前 EZ 缺损长度被证明是预测因素，ROC 曲线提供的截断值为 1800μm。术后 1 个月视力较差和 EZ 缺损平均长度较大也与最终视力较差相关。
术前和术后 1 个月 EZ 缺损的平均长度是术后 6 个月视力结果的预测因素。
