玻璃体切除术后特发性黄斑裂孔闭合患者视力预后的相关因素：一项单中心研究4年的结果
Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study.
作者信息
Lachance Alexandre, Hébert Mélanie, You Eunice, Rozon Jean-Philippe, Bourgault Serge, Caissie Mathieu, Tourville Éric, Dirani Ali
机构信息
Faculté de Médecine, Université Laval, Québec, QC, Canada.
Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec, QC, Canada.
出版信息
J Ophthalmol. 2022 Apr 23;2022:1553719. doi: 10.1155/2022/1553719. eCollection 2022.
PURPOSE
To identify predictive factors of visual outcomes in the eyes after successful macular hole (MH) surgery.
METHODS
It is a retrospective monocentric study of the eyes that underwent successful vitrectomy for full-thickness MH in an academic, tertiary care center (CHU de Québec-Université Laval, Québec, Canada) between 2014 and 2018. We included a single eye per patient and excluded the eyes with ocular comorbidities. Clinical and anatomical features of patients were collected, including demographics, MH duration, baseline MH size, baseline visual acuity (VA), and final VA. Multiple logistic regressions were performed to determine predictive factors of VA ≥70 ETDRS letters (Snellen equivalent: 20/40) and VA gain ≥15 ETDRS letters at final follow-up. Areas under the receiver operating characteristic curve (AUC) were used to determine the performance of each model and identify the Youden index maximizing performance at a given threshold.
RESULTS
A total of 460 eyes were included in this study; 274/460 eyes (60%) achieved final VA ≥70 ETDRS letters and 304/460 eyes (66%) had a VA gain ≥15 ETDRS letters at 24 months follow-up. Multiple logistic regression analyses showed that the main predictive factors for final VA ≥70 ETDRS letters (model AUC = 0.716) were baseline VA (OR = 1.064; < 0.001), MH duration (OR = 0.950; =0.005), and age (OR = 0.954; =0.004). Predictors of VA gain ≥15 ETDRS letters at final follow-up (model AUC = 0.615) were baseline VA (OR = 0.878; < 0.001), MH duration (OR = 0.940; < 0.001), and MH size (OR = 0.998; =0.036). Thresholds for the final VA ≥70 ETDRS letters model and the VA gain ≥15 ETDRS letters model were VA ≥55.5 ETDRS letters (Snellen equivalent: 6/30) and MH size of 237 m, respectively.
CONCLUSION
The eyes with shorter MH duration, smaller MH size, and higher preoperative VA achieved better visual outcomes after successful MH surgery.
目的
确定黄斑裂孔（MH）手术成功后眼部视觉预后的预测因素。
方法
这是一项回顾性单中心研究，研究对象为2014年至2018年期间在加拿大魁北克大学拉瓦尔大学附属魁北克大学中心医院（CHU de Québec-Université Laval）这家学术性三级医疗中心接受全层MH成功玻璃体切除术的患者眼部。我们纳入每位患者的一只眼，并排除有眼部合并症的眼睛。收集患者的临床和解剖学特征，包括人口统计学资料、MH持续时间、基线MH大小、基线视力（VA）和最终VA。进行多因素逻辑回归分析以确定最终随访时VA≥70 ETDRS字母（Snellen等效值：20/40）和VA提高≥15 ETDRS字母的预测因素。采用受试者工作特征曲线（AUC）下的面积来确定每个模型的性能，并确定在给定阈值下使性能最大化的约登指数。
结果
本研究共纳入460只眼；274/460只眼（60%）最终VA≥70 ETDRS字母，304/460只眼（66%）在24个月随访时VA提高≥15 ETDRS字母。多因素逻辑回归分析显示，最终VA≥70 ETDRS字母的主要预测因素（模型AUC = 0.716）为基线VA（OR = 1.064；<0.001）、MH持续时间（OR = 0.950；=0.005）和年龄（OR = 0.954；=0.004）。最终随访时VA提高≥15 ETDRS字母的预测因素（模型AUC = 0.615）为基线VA（OR = 0.878；<0.001）、MH持续时间（OR = 0.940；<0.001）和MH大小（OR = 0.998；=0.036）。最终VA≥70 ETDRS字母模型和VA提高≥15 ETDRS字母模型的阈值分别为VA≥55.5 ETDRS字母（Snellen等效值：6/30）和MH大小为237μm。
结论
MH持续时间较短、MH大小较小且术前VA较高的眼睛在MH手术成功后视觉预后较好。
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