Visual acuity recovery after vitrectomy of idiopathic macular hole and its influencing factors: a longitudinal study

Q4 Medicine

中华眼底病杂志 Pub Date : 2020-01-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2020.01.009

Ying Wang, Q. Han

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引用次数: 0

Abstract

Objective To observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole, and analyze the influencing factors. Methods A retrospective study. From August 2016 to June 2018, 302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study. There were 130 males and 172 females, with the mean age of 63.36±6.91 years. There were 158 left eyes and 144 right eyes. The logMAR BCVA was 1.13±0.45. The minimum diameter (422.92±211.73 μm) and basal diameter (835.47±366.42 μm) of macular hole and choroid thickness under fovea (244.84±60.68 μm) were measured by OCT. According to the minimum diameter, the holes were divided into small hole group (≤ 250 μm), middle hole group (>250 μm and ≤400 μm) and large hole group (>400 μm). The logMAR BCVA at 1, 3 and 6 months after surgery in 3 groups were observed. Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups. The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery. Results One month after surgery, all the holes were closed. One, 3 and 6 months after surgery, the logMAR BCVA were 0.33±0.25, 0.23±0.18, 0.16±0.17 in the small hole group; the logMAR BCVA were 0.46±0.25, 0.35±0.26, 0.27±0.28 in the middle hole group; the logMAR BCVA were 0.81±0.51, 0.61±0.48, 0.53±0.37 in the large hole group. Through repeated measurement variance analysis of two factors, it was found that there was an interaction between different groups and different time nodes (F=23.133, P 0.05). In the large hole group, among preoperative, 1 months after surgery, 3 months after surgery, the visual acuity difference was statistically significant (P 0.05). The results of GEE analysis showed that hole size (χ2=4.17, P=0.04), basal diameter (χ2=7.25, P=0.01), disease course (χ2=19.26, P=0.00), and choroid thickness (χ2=4.19, P=0.04) were the influencing factors of postoperative visual acuity. Conclusions After vitrectomy of macular holes of different sizes, the visual recovery trend is different. The visual recovery of small holes and middle holes is faster and basically restored at 1 month. The large holes requires a slow recovery process and stabilizes vision at 3 months. Hole size, basal diameter, course of disease and choroid thickness are the influencing factors of visual acuity recovery. Key words: Retinal perforations/surgery; Vitrectomy; Root cause analysis; Longitudinal study

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特发性黄斑裂孔玻璃体切除术后视力恢复及其影响因素的纵向研究

目的观察不同大小的特发性黄斑孔玻璃体切除术后的视力动态特征，并分析其影响因素。方法回顾性研究。本研究选取2016年8月至2018年6月在天津市眼科医院行25G玻璃体切除联合内限制膜剥离术的单眼特发性黄斑裂孔患者302例(302眼)。男性130例，女性172例，平均年龄63.36±6.91岁。左眼158只，右眼144只。logMAR BCVA为1.13±0.45。采用oct测量黄斑孔的最小直径(422.92±211.73 μm)、底直径(835.47±366.42 μm)和中央凹下脉络膜厚度(244.84±60.68 μm)，根据最小直径将孔分为小孔组(≤250 μm)、中孔组(>250 μm和≤400 μm)和大孔组(>400 μm)。观察3组患者术后1、3、6个月的logMAR BCVA。采用双因素重复测量方差分析比较三组患者的视力。应用广义估计方程(GEE)分析影响术后视力恢复的因素。结果术后1个月，所有孔均闭合。术后1、3、6个月，小孔组logMAR BCVA分别为0.33±0.25、0.23±0.18、0.16±0.17;中孔组的logMAR BCVA分别为0.46±0.25、0.35±0.26、0.27±0.28;大孔组的logMAR BCVA分别为0.81±0.51、0.61±0.48、0.53±0.37。通过对两因素的重复测量方差分析，发现不同组与不同时间节点之间存在交互作用(F=23.133, P 0.05)。大孔组术前、术后1个月、术后3个月视力差异有统计学意义(P < 0.05)。GEE分析结果显示，影响术后视力的因素有孔大小(χ2=4.17, P=0.04)、基底直径(χ2=7.25, P=0.01)、病程(χ2=19.26, P=0.00)、脉络膜厚度(χ2=4.19, P=0.04)。结论不同大小的黄斑孔洞玻璃体切除术后，视力恢复趋势不同。小孔和中孔视力恢复较快，1个月基本恢复。大的孔洞需要一个缓慢的恢复过程，并在3个月时稳定视力。孔大小、基底直径、病程、脉络膜厚度是影响视力恢复的主要因素。关键词:视网膜穿孔/手术;玻璃体切除术;根本原因分析;纵向研究

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).