Forsaa Vegard A, Lindtjørn Birger, Dahlø Kristian, Ushakova Anastasia, Krohn Jørgen
Department of Ophthalmology, Stavanger University Hospital, PO box 8100, Stavanger, N-4068, Norway.
Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.
Graefes Arch Clin Exp Ophthalmol. 2025 Feb 4. doi: 10.1007/s00417-025-06757-1.
To investigate changes in macular hole-related oedema depending on positioning.
Prospective interventional study of 40 patients with primary macular hole (MH). Optical coherence tomography scanning was done at 9 a.m., 1 p.m., and 3 p.m. Between the first and second scanning, the patients were instructed to stay upright, whereas they were positioned recumbent thereafter. Automated mean retinal thickness measurements were derived from the ETDRS grid for the central, parafoveal, and perifoveal subfields. Mean ocular perfusion pressure (MOPP) was calculated for all time points. Primary endpoints were changes in MH-related oedema from 9 a.m.-1 p.m., and from 1 p.m.-3 p.m.
In upright position from 9 a.m.-1 p.m., the mean parafoveal retinal thickness decreased from 362 μm (SD = 56) to 350 μm (SD = 51) (P < 0.001). The reduction of MH-related oedema when upright was positively correlated with a reduction in MOPP. Eyes with vitreomacular traction (VMT) exhibited significantly less reduction in MH-related oedema compared to eyes without VMT. In recumbent position from 1 p.m.-3 p.m., the mean parafoveal retinal thickness increased to 356 μm (SD = 52) (P = 0.002).
MH-related oedema belongs to the non-vasogenic cystoid maculopathies. The decrease in MH-related oedema when upright and its positive correlation to a reduction in MOPP is therefore unexpected. In recumbent position, the situation is reversed, and the oedema increases. This may be related to subtle leakage from the retinal capillaries. The presence of VMT seems to counteract the resolution of the oedema. In a clinical setting, upright positioning after MH surgery facilitates absorption of the oedema which is beneficial for MH closure.
What is known: Macular hole formation is associated with cystoid macular oedema, possibly due to hydration of the outer retinal layers exposed to the hypotonic vitreous fluid. This oedema promotes the elevation of the hole edges from the retinal pigment epithelium.
Macular hole-related oedema decreases when the patients are upright and increases, in parallel with an increase in mean minimum macular hole diameter, when they are recumbent. The reduction of macular oedema is correlated with a reduction in mean ocular perfusion pressure, indicating that the oedema is influenced by subtle leakage from retinal capillaries. The results suggest that upright positioning might be beneficial in the early postoperative period of macular hole surgery.
研究黄斑裂孔相关水肿随体位变化的情况。
对40例原发性黄斑裂孔（MH）患者进行前瞻性干预研究。分别于上午9点、下午1点和下午3点进行光学相干断层扫描。在第一次和第二次扫描之间，指导患者保持直立姿势，此后改为卧位。通过ETDRS网格自动测量中央、旁黄斑和黄斑周围子区域的平均视网膜厚度。计算所有时间点的平均眼灌注压（MOPP）。主要终点是上午9点至下午1点以及下午1点至下午3点期间MH相关水肿的变化。
上午9点至下午1点处于直立位时，旁黄斑平均视网膜厚度从362μm（标准差=56）降至350μm（标准差=51）（P<0.001）。直立时MH相关水肿的减轻与MOPP的降低呈正相关。与无玻璃体黄斑牵引（VMT）的眼相比，有VMT的眼MH相关水肿的减轻明显较少。下午1点至下午3点处于卧位时，旁黄斑平均视网膜厚度增至356μm（标准差=52）（P=0.002）。
MH相关水肿属于非血管源性黄斑囊样病变。因此，直立时MH相关水肿的减轻及其与MOPP降低的正相关是出乎意料的。在卧位时，情况相反，水肿增加。这可能与视网膜毛细血管的细微渗漏有关。VMT的存在似乎会抵消水肿的消退。在临床环境中，MH手术后采取直立位有利于水肿的吸收，这对MH的闭合有益。
已知内容：黄斑裂孔的形成与黄斑囊样水肿有关，可能是由于暴露于低渗玻璃体液中的视网膜外层发生水化。这种水肿促进裂孔边缘从视网膜色素上皮抬起。
患者直立时MH相关水肿减轻，卧位时水肿增加，同时黄斑裂孔平均最小直径增大。黄斑水肿的减轻与平均眼灌注压的降低相关，表明水肿受视网膜毛细血管细微渗漏的影响。结果表明，直立位可能在黄斑裂孔手术的术后早期有益。
