Oquendo Paola L, Wright Thomas, Naidu Sumana C, Cruz Pimentel Miguel, Hamli Hesham, Issa Mariam, Faleel Afira, Nagel Flavia, Yan Peng, Muni Rajeev H
From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., T.W., S.C.N., M.C.P., H.H., M.I., F.N., P.Y., R.H.M.), Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto (P.L.O., M.C.P., H.H., F.N., P.Y., R.H.M.), Toronto, Ontario, Canada.
From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., T.W., S.C.N., M.C.P., H.H., M.I., F.N., P.Y., R.H.M.), Toronto, Ontario, Canada; Kensington Vision and Research Institute (T.W., P.Y., R.H.M.), Toronto, Ontario, Canada.
Am J Ophthalmol. 2025 Feb;270:261-272. doi: 10.1016/j.ajo.2024.10.018. Epub 2024 Oct 23.
To assess the photoreceptor mosaic in patients with idiopathic full-thickness macular hole (MH) before and after pars plana vitrectomy (PPV) with adaptive optics enhanced retinal imaging (AO).
Prospective case series.
Prospective cohort study of patients who presented at the Kensington Eye Institute, Toronto, Canada with a diagnosis of MH treated with PPV.
secondary MH, high myopia (axial length >26.5 mm), media opacity precluding optical coherence tomography or AO imaging, previous intraocular surgery except for cataract extraction. Imaging using an AO fundus camera (Imagine Eyes, RTX1) was performed preoperatively and 3 months following successful MH repair in both eyes. Cone density (CD), regularity, dispersion, and spacing were measured at 2° and/or 4° of eccentricity in 4 quadrants (superior, inferior, nasal, and temporal) with pre- and postoperative values compared.
We included 18 eyes of 9 patients. At 2° there was significant reduction in CD and increase in spacing and dispersion and a nonsignificant change in regularity postoperatively. Comparison between preoperative and postoperative measurements at 2° mean (standard error) were: CD: 14,612 ± 3003 and 12,280 ± 4632 photoreceptors/mm (95% CIs = -2413 to -702) P = .0004, regularity: 88% ± 7% and 84% ± 12% (95% CIs = -4.67 to 0.04) P = .054, dispersion: 19% ± 6% and 23% ± 10% (95% CIs = 0.5-4.24) P = .013, spacing: 9 ± 1 microns and 10 ± 2 microns (95% CIs = 0.40-1.27) P = .0002; at 4° was: CD: 13,377 ± 4339 and 12,770 ± 4391 photoreceptors/mm (95% CIs = -1368 to 252) P = .176, regularity:87% ± 9% and 86% ± 12% (95% CIs = -4.65 to 0.08) P = .74, dispersion: 20% ± 8% and 20% ±9% (95% CIs = -2.11 to 1.5) P = .74, spacing:10 ± 2 microns and 10 ± 3 microns (95% CIs = -0.23 to 0.58) P = .39.
AO imaging allows quantitative assessment of the photoreceptor mosaic pre- and post-PPV in patients with MH. There was a significant change to the photoreceptor mosaic related to the MH at 2° pre- and postoperatively. AO imaging enables high-resolution investigation of the photoreceptor remodeling process following surgery, which may allow for a more thorough assessment of surgical outcomes.
采用自适应光学增强视网膜成像（AO）评估特发性全层黄斑裂孔（MH）患者在玻璃体切割术（PPV）前后的光感受器镶嵌情况。
前瞻性病例系列研究。
对加拿大多伦多肯辛顿眼科研究所诊断为MH并接受PPV治疗的患者进行前瞻性队列研究。
继发性MH、高度近视（眼轴长度>26.5mm）、妨碍光学相干断层扫描或AO成像的介质混浊、除白内障摘除术外的既往眼内手术。使用AO眼底相机（Imagine Eyes，RTX1）在术前和双眼MH成功修复后3个月进行成像。在4个象限（上、下、鼻、颞）的2°和/或4°偏心度处测量视锥细胞密度（CD）、规则性、离散度和间距，并比较术前和术后的值。
我们纳入了9例患者的18只眼。在2°处，术后CD显著降低，间距和离散度增加，规则性无显著变化。2°处术前和术后测量值的比较（均值±标准误）为：CD：14,612±3003和12,280±4632个光感受器/mm（95%置信区间=-2413至-702），P=.0004；规则性：88%±7%和84%±12%（95%置信区间=-4.67至0.04），P=.054；离散度：19%±6%和23%±10%（95%置信区间=0.5-4.24），P=.013；间距：9±1微米和10±2微米（95%置信区间=0.40-1.27），P=.0002；在4°处为：CD：13,377±4339和12,770±4391个光感受器/mm（95%置信区间=-1368至252），P=.176；规则性：87%±9%和86%±12%（95%置信区间=-4.65至0.08），P=.74；离散度：20%±8%和20%±9%（95%置信区间=-2.11至1.5），P=.74；间距：10±2微米和10±3微米（95%置信区间=-0.23至0.58），P=.39。
AO成像可对MH患者PPV前后的光感受器镶嵌情况进行定量评估。术前和术后2°处与MH相关的光感受器镶嵌有显著变化。AO成像能够对手术后的光感受器重塑过程进行高分辨率研究，这可能有助于更全面地评估手术效果。
