Department of Ophthalmology, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 09116, Chemnitz, Germany.
Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
Sci Rep. 2020 Nov 16;10(1):19932. doi: 10.1038/s41598-020-77078-y.
To investigate the prevalence and predictive value of the foveal crack sign (FCS) in fellow eyes of patients with full-thickness macular holes (FTMH) regarding future macular hole (MH) formation. In a retrospective observational case series, 113 fellow eyes of 113 patients with FTMH have been observed during a mean follow-up time of 21 months. According to baseline SD-OCT images, patients were divided into 4 separate groups: patients with FCS and vitreous adhesion, patients with FCS and vitreous detachment, patients without FCS with vitreous adhesion, patients without FCS with vitreous detachment. Progression rate to MH formation, predictive value of FCS and of vitreous interface status were calculated and compared across the four groups. FCS was observed in 19 of 113 fellow eyes (17%) of patients with FTMH, 10 of them with progression to MH during the mean follow up time of 21 months. 2 other eyes with progression to MH showed no FCS at baseline. Progression rate was shown to be 77% (10 of 13 eyes) in patients with FCS and vitreous adhesion, 0% (none of 6 eyes) in patients with FCS and vitreous detachment, 4% (2 of 48 eyes) in patients without FCS with vitreous adhesion, 0% (none of 46 eyes) in patients without FCS with vitreous detachment. FCS had sensitivity of 83.3% (95% CI 50.9-97.1%) and specificity of 91.1% (95% CI 83.3-95.6%) in predicting MH formation, positive predictive value of FCS was 52.6% (95% CI 29.5-74.8%) and negative predictive value 97.9% (95% CI 91.8-99.6%). Having simultaneously FCS and vitreous adhesion showed 83.3% (95% CI 50.9-97.1%) sensitivity and 97.1% (95% CI 91.1-99.2%) specificity in predicting macular hole formation; positive predictive value was 76.9% (95% CI 46.0-93.8%) and negative predictive value was 98.0% (95% CI 92.4-99.7%). Fellow eyes of patients with FTMH with foveal crack sign are at a very high risk (77%) of FTMH development, as long as posterior vitreous adhesion is present.
为了研究全层黄斑裂孔（FTMH）患者对侧眼的中心凹裂（FCS）的患病率及其对未来黄斑裂孔（MH）形成的预测价值。在一项回顾性观察性病例系列研究中，观察了 113 例 FTMH 患者的 113 只对侧眼，平均随访时间为 21 个月。根据基线 SD-OCT 图像，患者被分为 4 个单独的组：FCS 伴玻璃体粘连组、FCS 伴玻璃体脱离组、无 FCS 伴玻璃体粘连组、无 FCS 伴玻璃体脱离组。计算各组 MH 形成的进展率、FCS 和玻璃体界面状态的预测价值，并进行比较。在 113 例 FTMH 患者的 113 只对侧眼中，有 19 只（17%）出现 FCS，其中 10 只在平均 21 个月的随访时间内进展为 MH。另外 2 只进展为 MH 的眼在基线时没有 FCS。FCS 伴玻璃体粘连组的进展率为 77%（13 眼中有 10 眼），FCS 伴玻璃体脱离组为 0%（6 眼均无），无 FCS 伴玻璃体粘连组为 4%（48 眼中有 2 眼），无 FCS 伴玻璃体脱离组为 0%（46 眼均无）。FCS 预测 MH 形成的敏感性为 83.3%（95%CI 50.9-97.1%），特异性为 91.1%（95%CI 83.3-95.6%），阳性预测值为 52.6%（95%CI 29.5-74.8%），阴性预测值为 97.9%（95%CI 91.8-99.6%）。同时存在 FCS 和玻璃体粘连时，预测 MH 形成的敏感性为 83.3%（95%CI 50.9-97.1%），特异性为 97.1%（95%CI 91.1-99.2%）；阳性预测值为 76.9%（95%CI 46.0-93.8%），阴性预测值为 98.0%（95%CI 92.4-99.7%）。只要存在后玻璃体粘连，FTMH 患者对侧眼的中心凹裂存在很高的（77%）FTMH 发展风险。
