Ezra E, Wells J A, Gray R H, Kinsella F M, Orr G M, Grego J, Arden G B, Gregor Z J
Vitreoretinal Unit, Moorfields Eye Hospital, London, England.
Ophthalmology. 1998 Feb;105(2):353-9. doi: 10.1016/s0161-6420(98)93562-x.
This study aimed to determine the incidence of idiopathic full-thickness macular hole (FTMH) in normal fellow eyes and to evaluate the role of electrodiagnostic and psychophysical tests in identifying eyes at risk.
A prospective longitudinal natural history study of a cohort of patients with unilateral holes and normal, asymptomatic fellow eyes without posterior vitreous detachment was conducted. Subjects underwent baseline examination, pattern reversal electroretinography, electro-oculography (EOG), and color contrast sensitivity (CCS) testing for protan, deutan, and tritan thresholds and were recalled for clinical examination at 18 months and 5 years.
At baseline, 114 patients were examined. Eighty were available for review at 18 months, of whom 6 had full-thickness macular holes develop in the fellow eye. At 5 years, 67 of the remaining 74 patients who had not developed holes at 18 months were re-examined and a further 5 were found to have holes develop in the fellow eye. A posterior vitreous detachment without hole formation had developed in 20 fellow eyes at 5 years. Although mean pattern reversal electroretinography and EOG responses were within normal limits in affected and fellow eyes at baseline, mean CCS protan, deutan, and tritan thresholds were elevated significantly in affected eyes at baseline (P = 0.0001). Unaffected fellow eyes showed normal mean protan and deutan thresholds, but significantly elevated mean tritan thresholds (P = 0.01) at baseline. Mean tritan CCS loss was, however, similar in fellow eyes in which holes later developed and in fellow eyes in which holes did not.
The Kaplan-Meier estimated risk of fellow eye involvement is 15.6% (range, 8.4%-22.3%; P = 0.05) at 5 years. Although electrodiagnostic and psychophysical testing was not predictive of fellow eye involvement, tritan CCS loss at baseline, in apparently normal fellow eyes, may indicate subclinical foveal dysfunction, the nature of which is unclear.
本研究旨在确定正常对侧眼中特发性全层黄斑裂孔（FTMH）的发生率，并评估电诊断和心理物理学测试在识别有风险眼睛中的作用。
对一组单侧黄斑裂孔且对侧眼正常、无症状且无玻璃体后脱离的患者进行了前瞻性纵向自然史研究。受试者接受了基线检查、图形翻转视网膜电图、眼电图（EOG）以及针对红绿色盲、蓝黄色盲和全色盲阈值的颜色对比敏感度（CCS）测试，并在18个月和5年时被召回进行临床检查。
基线时检查了114例患者。18个月时80例可供复查，其中6例对侧眼出现了全层黄斑裂孔。5年时，对18个月时未出现裂孔的其余74例患者中的67例进行了复查，发现另有5例对侧眼出现了裂孔。5年时20例对侧眼出现了无裂孔形成的玻璃体后脱离。尽管基线时患眼和对侧眼的平均图形翻转视网膜电图和EOG反应均在正常范围内，但患眼基线时的平均CCS红绿色盲、蓝黄色盲和全色盲阈值显著升高（P = 0.0001）。未受影响的对侧眼基线时红绿色盲和蓝黄色盲平均阈值正常，但全色盲平均阈值显著升高（P = 0.01）。然而，在后来出现裂孔的对侧眼和未出现裂孔的对侧眼中，全色盲CCS平均损失相似。
5年时，采用Kaplan-Meier法估计对侧眼受累风险为15.6%（范围为8.4%-22.3%；P = 0.05）。尽管电诊断和心理物理学测试不能预测对侧眼受累，但在明显正常的对侧眼中，基线时全色盲CCS损失可能表明存在尚不清楚其性质的亚临床黄斑功能障碍。
