玻璃体切除术后黄斑裂孔视网膜显微结构的变化

Q4 Medicine

中华眼底病杂志 Pub Date : 2019-11-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2019.06.003

Mengyang Li, J. Qu, Xin-Jia Han, Yuou Yao, Hui Zhang, Enzhong Jin, Jie Hu, Zongyi Wang

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The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. 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引用次数: 0

摘要

目的观察玻璃体切除术后黄斑裂孔视网膜显微结构的变化。方法回顾性临床观察研究。本研究纳入2014年1月至2018年9月北京大学人民医院眼科行玻璃体切除术的40例(41只眼)LMH患者。其中男性14例(15眼)，女性26例(26眼)，平均年龄67.8±8.6岁。37眼植入人工晶状体，4眼植入人工晶体。牵引型LMH 29眼，退行性7眼，混合型5眼。所有患者均行BCVA和OCT检查。BCVA检查采用国际标准视力表，视力表转换为logMAR视力。平均logMAR BCVA为0.57±0.27;平均黄斑视网膜厚度(CRT)为192.3±108.9 μm，平均黄斑厚度(MRT)为427.5±110.2 μm。牵拉型29只眼中，视网膜空洞17只眼，黄斑视网膜裂8只眼，不完全椭球带3只眼。7只退行性眼中，5只眼有板层孔相关性视网膜前增殖(LHEP)， 5只眼有视网膜空洞，5只眼有不完全椭球带。混合型5眼中2眼为LHEP, 1眼为黄斑视网膜前膜，4眼为不完全椭球带。术后平均随访时间12.8±5.2个月。其中10只眼随访24个月以上。术后使用与术前相同的设备和方法进行相关检查。观察术前、术后BCVA、CRT、MRT的变化。连续变量比较采用t检验。结果末次随访时，平均logMAR BCVA为0.37±0.26。与术前比较，差异有统计学意义(t=5.98, P<0.01)。平均CRT和MRT分别为(245.2±90.8)μm和(347.0±46.7)μm。与术前比较，差异有统计学意义(t=-2.49， -5.24;P < 0.05, < 0.01)。CRT和MRT在术后6个月内变化较大，之后趋于平缓。术前牵拉型椭球带不全的3眼中，椭球带恢复2眼，部分恢复1眼。术前出现视网膜空洞的17只眼和出现黄斑视网膜裂的8只眼中，仍有4只眼存在视网膜空洞，但视网膜裂全部消失。术前有退行性视网膜空洞的5只眼中，仍有2只眼有视网膜空洞，所有眼均有不完整的椭球带。随访时间等于或大于24个月的10只眼中，6只眼黄斑神经节细胞复合体部分萎缩，2只眼神经纤维层分离。术后未见全层黄斑孔。结论玻璃体切除术对大多数低分子视网膜病变患者能有效提高视力，促进视网膜显微结构的恢复。关键词:视网膜穿孔/手术;玻璃体切除术;层析光学相干

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Changes of retinal microstructure in lamellar macular hole after vitrectomy

Objective To observe the changes of retinal microstructure in lamellar macular hole (LMH) after vitrectomy. Methods A retrospective clinical observational study. Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People’s Hospital from January 2014 to September 2018 were included in this study. Among them, 14 patients (15 eyes) were males and 26 patients (26 eyes) were females, with an average age of 67.8±8.6 years. There were 37 eyes with a lens and 4 eyes with an IOL. There were 29 eyes with LMH of tractional type, 7 eyes of degenerative type, and 5 eyes of mixed type. All patients underwent BCVA and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. After the surgery, the same equipment and method before the surgery were used for relevant examination. The changes of BCVA, CRT, and MRT before and after surgery were observed. Continuous variables were compared by t test. Results At the last follow-up, the mean logMAR BCVA was 0.37±0.26. Compared with before surgery, the difference was statistically significant (t=5.98, P<0.01). The mean CRT and MRT were (245.2±90.8) and (347.0±46.7) μm, respectively. Compared with before surgery, the differences were statistically significant (t=-2.49, -5.24; P<0.05, <0.01). CRT and MRT changed greatly within 6 months after surgery, and then tended to be gentle. Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery, ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye. Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery, there were still 4 eyes with retinal cavity, but all the retinoschisis were disappeared. Among the 5 eyes with retinal cavity of degenerative type before surgery, there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone. Among 10 eyes with a follow-up time of equal or greater than 24 months, the macular ganglion cell complex partially atrophied in 6 eyes, and the nerve fiber layer separated in 2 eyes. There was no full-thickness macular hole after surgery. Conclusion For most LMH patients, vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure. Key words: Retinal perforations/surgery; Vitrectomy; Tomography optical coherence

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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).