Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Acta Ophthalmol. 2022 Dec;100(8):919-926. doi: 10.1111/aos.15129. Epub 2022 Mar 25.
While the postoperative closure rate of idiopathic macular holes (IMH) is quite high, its success rate and visual prognosis differ depending on macular hole (MH) characteristics. This study investigated the IMH progression rate before vitrectomy.
This retrospective study compared optical coherence tomography (OCT) taken at baseline and on operation day for patients with stage 2, 3 and 4 IMH to determine the changes in minimum linear diameter (MLD), base diameter (BD), height and MH index (MHI). The IMH progression rate was calculated by dividing each difference in OCT parameters by the time interval.
A total of 224 eyes of 216 patients were included. The average time interval from baseline to operation was 35.59 ± 23.43 (7-137) days. Final visual acuity was related to preoperative MLD, BD, best-corrected visual acuity and time interval between baseline and operation (p = 0.005, p = 0.003, p <0.001 and p = 0.005 respectively). Between baseline and operation, the average MLD and BD increased significantly (all p <0.001). The average progression rates of MLD and BD assessed by simple regression analysis were 0.698 μm/day (R = 0.066, p <0.001) and 1.368 μm/day (R = 0.097, p <0.001) respectively. When patients were classified according to the MH stage, the progression rates of MLD and BD in those with stage 2 MH were significantly faster than those with stage 3 or 4 MH.
The relatively smaller MHs in stage 2 progress faster than those in stages 3 and 4. Therefore, it would ultimately be beneficial to perform vitrectomy without delay in patients with stage 2 MH.
特发性黄斑裂孔（IMH）术后闭合率相当高，但由于 MH 特征不同，其成功率和视力预后存在差异。本研究旨在探讨术前 IMH 的进展速度。
回顾性比较 2 期、3 期和 4 期 IMH 患者术前和手术当天的光学相干断层扫描（OCT），以确定最小线性直径（MLD）、基底直径（BD）、高度和 MH 指数（MHI）的变化。通过将 OCT 参数的每个差异除以时间间隔来计算 IMH 进展率。
共纳入 216 例 224 只眼。从基线到手术的平均时间间隔为 35.59±23.43（7-137）天。最终视力与术前 MLD、BD、最佳矫正视力和基线与手术时间间隔相关（p=0.005、p=0.003、p<0.001 和 p=0.005）。与基线相比，手术时 MLD 和 BD 均显著增加（均 p<0.001）。简单回归分析评估的 MLD 和 BD 平均进展率分别为 0.698μm/天（R=0.066，p<0.001）和 1.368μm/天（R=0.097，p<0.001）。根据 MH 分期对患者进行分类时，2 期 MH 患者的 MLD 和 BD 进展速度明显快于 3 期或 4 期 MH 患者。
分期 2 的较小 MH 进展更快，分期 3 和 4 则相对较慢。因此，对于分期 2 的 MH 患者，及时进行玻璃体切除术将最终获益。
