Heng Jacob S, Arevalo J Fernando, Handa James T
Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, USA.
Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
Int J Retina Vitreous. 2022 Jun 11;8(1):38. doi: 10.1186/s40942-022-00386-0.
The purpose of this study was to evaluate visual acuity after cataract surgery in eyes with Macular Telangiectasia (MacTel) Type 2.
Single-center retrospective cohort study of patients with MacTel Type 2 who underwent cataract surgery and were managed at the same institution. Patients underwent pre-operative assessment by a retinal specialist with examination and optical coherence tomography (OCT) at the same institution. The main outcome measure was the post-operative change in best corrected visual acuity (BCVA). Secondary study outcomes were achieving post-operative BCVA better than Snellen acuity of 20/40 and time to BCVA loss by two lines or more (10 or more ETDRS letters).
A total of 20 eyes (11 patients) underwent cataract surgery and were followed for a median of 25.5 months (IQR 17.5-44.2 months). The median post-operative BCVA improvement was 10.5 letters (IQR 3.50-20.25). Nuclear sclerosis severity [β = 8.99 (95% CI 3.35, 14.6), p = 0.00177] was associated with post-operative change in BCVA and central foveal ellipsoid zone (EZ) breaks [OR 1.33 × 10 (95% CI 5.12 × 10-3.43 × 10), p < 0.001] on OCT was inversely correlated with post-operative BCVA > 20/40 using a multivariate generalized linear model. Central foveal EZ breaks [HR 1.77 × 10 (95% CI 3.86 × 10, 8.11 × 10), p < 0.001] and MacTel Type 2 disease stage [HR 2.83, (95% CI 1.12, 7.12), p = 0.027] were independently associated with shorter time to vision loss of two lines or more in a multivariate Cox regression model.
Visual acuity significant improved after cataract surgery in eyes with MacTel Type 2 regardless of disease severity. The presence of central foveal EZ breaks may predict poorer post-operative visual acuity and subsequent vision loss from disease progression.
本研究的目的是评估2型黄斑毛细血管扩张症（MacTel）患者白内障手术后的视力。
对在同一机构接受白内障手术并接受治疗的2型MacTel患者进行单中心回顾性队列研究。患者在同一机构由视网膜专科医生进行术前评估，包括检查和光学相干断层扫描（OCT）。主要结局指标是最佳矫正视力（BCVA）的术后变化。次要研究结局是术后BCVA优于Snellen视力20/40，以及BCVA下降两行或更多（10个或更多ETDRS字母）的时间。
共有20只眼（11例患者）接受了白内障手术，中位随访时间为25.5个月（四分位间距17.5 - 44.2个月）。术后BCVA改善的中位数为10.5个字母（四分位间距3.50 - 20.25）。核硬化严重程度[β = 8.99（95%可信区间3.35, 14.6），p = 0.00177]与BCVA的术后变化相关，并且在多变量广义线性模型中，OCT上的中央凹椭圆体带（EZ）断裂[比值比1.33×10（95%可信区间5.12×10 - 3.43×10），p < 0.001]与术后BCVA > 20/40呈负相关。在多变量Cox回归模型中，中央凹EZ断裂[风险比1.77×10（95%可信区间3.86×10, 8.11×10），p < 0.001]和2型MacTel疾病分期[风险比2.83，（95%可信区间1.12, 7.12），p = 0.027]与视力下降两行或更多的时间缩短独立相关。
无论疾病严重程度如何，2型MacTel患者白内障手术后视力均有显著改善。中央凹EZ断裂的存在可能预示术后视力较差以及疾病进展导致的后续视力丧失。
