中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
9期
807-811
,共5页
戴元敏%沈洁%李九可%金晓红%李毓敏
戴元敏%瀋潔%李九可%金曉紅%李毓敏
대원민%침길%리구가%금효홍%리육민
视网膜穿孔%眼外科手术%体层摄影术,光学相干%视敏度%预测
視網膜穿孔%眼外科手術%體層攝影術,光學相榦%視敏度%預測
시망막천공%안외과수술%체층섭영술,광학상간%시민도%예측
Retinal perforations%Ophthalmologic surgical procedures%Tomography,optical coherence%Visual acuity%Forecasting
目的 探索相干光断层扫描(OCT)量化参数与特发性黄斑裂孔(IMH)患者术后视力预后的相关性.方法 系列病例研究.收集2009年1月至201 1年11月在浙江大学医学院附属邵逸夫医院眼科中心经玻璃体切除联合视网膜内界膜剥离手术治疗后经OCT证实黄斑裂孔闭合且规律随访时间≥6个月的23例(25只眼)IMH患者的临床资料.其中男性6例(7只眼),女性17例(18只眼)；年龄为63 ～71岁,平均67岁；病程3.5 ～12.0个月,平均6.0个月；根据Gass分期:Ⅱ期9只眼,Ⅲ期11只眼,Ⅳ期5只眼.手术前后均进行最佳矫正视力(BCVA)检查,通过OCT测量黄斑裂孔最小直径、裂孔高度、裂孔底径,并计算裂孔高度/裂孔底径(MHI)、裂孔高度/裂孔最小直径(THI)、裂孔最小直径/裂孔底径(DHI).利用Spearman相关分析探索相关参数与术后视力预后间的相关性,ROC曲线分析MHI及THI预测术后视力预后的准确度,并取得MHI及THI界值.结果 术前IMH患者BCVA为0.100(0.050～0.180),MHI为0.476(0.416 ～0.684),THI为1.048(0.761～1.346),DHI为0.536(0.431 ～0.645)；术后3个月BCVA为0.150(0.120 ～0.275),较术前明显提高(Mann-Whitney U检验:P =0.002)；术后最终随访BCVA为0.250(0.135 ～0.350),较术前得到显著提高(Mann-Whitney U检验:P=0.000)；最终随访BCVA与术前BCVA、MHI、THI之间有相关性(r术前BCVA=0.560,P=0.004;rMHI=0.481,P =0.015；rTHI =0.516,p=0.008)；ROC曲线分析取得MHI 及THI界值分别为0.475和0.973,且MHI≥0.475组术后BCVA明显好于MHI＜0.475组,THI≥ 0.973组术后BCVA明显好于THI＜0.973组(Mann-Whitney U检验:P =0.013,P=0.008).结论 MHI≥0.475或THI≥0.973的患者具有较好的视力预后,可作为潜在预测IMH患者术后视力预后的指标之一.
目的 探索相榦光斷層掃描(OCT)量化參數與特髮性黃斑裂孔(IMH)患者術後視力預後的相關性.方法 繫列病例研究.收集2009年1月至201 1年11月在浙江大學醫學院附屬邵逸伕醫院眼科中心經玻璃體切除聯閤視網膜內界膜剝離手術治療後經OCT證實黃斑裂孔閉閤且規律隨訪時間≥6箇月的23例(25隻眼)IMH患者的臨床資料.其中男性6例(7隻眼),女性17例(18隻眼)；年齡為63 ～71歲,平均67歲；病程3.5 ～12.0箇月,平均6.0箇月；根據Gass分期:Ⅱ期9隻眼,Ⅲ期11隻眼,Ⅳ期5隻眼.手術前後均進行最佳矯正視力(BCVA)檢查,通過OCT測量黃斑裂孔最小直徑、裂孔高度、裂孔底徑,併計算裂孔高度/裂孔底徑(MHI)、裂孔高度/裂孔最小直徑(THI)、裂孔最小直徑/裂孔底徑(DHI).利用Spearman相關分析探索相關參數與術後視力預後間的相關性,ROC麯線分析MHI及THI預測術後視力預後的準確度,併取得MHI及THI界值.結果 術前IMH患者BCVA為0.100(0.050～0.180),MHI為0.476(0.416 ～0.684),THI為1.048(0.761～1.346),DHI為0.536(0.431 ～0.645)；術後3箇月BCVA為0.150(0.120 ～0.275),較術前明顯提高(Mann-Whitney U檢驗:P =0.002)；術後最終隨訪BCVA為0.250(0.135 ～0.350),較術前得到顯著提高(Mann-Whitney U檢驗:P=0.000)；最終隨訪BCVA與術前BCVA、MHI、THI之間有相關性(r術前BCVA=0.560,P=0.004;rMHI=0.481,P =0.015；rTHI =0.516,p=0.008)；ROC麯線分析取得MHI 及THI界值分彆為0.475和0.973,且MHI≥0.475組術後BCVA明顯好于MHI＜0.475組,THI≥ 0.973組術後BCVA明顯好于THI＜0.973組(Mann-Whitney U檢驗:P =0.013,P=0.008).結論 MHI≥0.475或THI≥0.973的患者具有較好的視力預後,可作為潛在預測IMH患者術後視力預後的指標之一.
목적 탐색상간광단층소묘(OCT)양화삼수여특발성황반렬공(IMH)환자술후시력예후적상관성.방법 계렬병례연구.수집2009년1월지201 1년11월재절강대학의학원부속소일부의원안과중심경파리체절제연합시망막내계막박리수술치료후경OCT증실황반렬공폐합차규률수방시간≥6개월적23례(25지안)IMH환자적림상자료.기중남성6례(7지안),녀성17례(18지안)；년령위63 ～71세,평균67세；병정3.5 ～12.0개월,평균6.0개월；근거Gass분기:Ⅱ기9지안,Ⅲ기11지안,Ⅳ기5지안.수술전후균진행최가교정시력(BCVA)검사,통과OCT측량황반렬공최소직경、렬공고도、렬공저경,병계산렬공고도/렬공저경(MHI)、렬공고도/렬공최소직경(THI)、렬공최소직경/렬공저경(DHI).이용Spearman상관분석탐색상관삼수여술후시력예후간적상관성,ROC곡선분석MHI급THI예측술후시력예후적준학도,병취득MHI급THI계치.결과 술전IMH환자BCVA위0.100(0.050～0.180),MHI위0.476(0.416 ～0.684),THI위1.048(0.761～1.346),DHI위0.536(0.431 ～0.645)；술후3개월BCVA위0.150(0.120 ～0.275),교술전명현제고(Mann-Whitney U검험:P =0.002)；술후최종수방BCVA위0.250(0.135 ～0.350),교술전득도현저제고(Mann-Whitney U검험:P=0.000)；최종수방BCVA여술전BCVA、MHI、THI지간유상관성(r술전BCVA=0.560,P=0.004;rMHI=0.481,P =0.015；rTHI =0.516,p=0.008)；ROC곡선분석취득MHI 급THI계치분별위0.475화0.973,차MHI≥0.475조술후BCVA명현호우MHI＜0.475조,THI≥ 0.973조술후BCVA명현호우THI＜0.973조(Mann-Whitney U검험:P =0.013,P=0.008).결론 MHI≥0.475혹THI≥0.973적환자구유교호적시력예후,가작위잠재예측IMH환자술후시력예후적지표지일.
Objective To evaluate the use of preoperative optical coherence tomography (OCT) image and some related indexes as predictive factors for the visual outcomes of the idiopathic macular hole (IMH) after pars plana vitrectomy and the internal limiting membrane(ILM) peeling surgery.Methods This was a case-series study.Twenty-five eyes of 23 IMH patients undergoing a successful vitrectomy and ILM peeling surgery and following up more than 6 months were included in this retrospective study.Of the 23 patients,6 were male and 17 were female.The median patient age was 67-year old (range 63 to 71 years).The median duration of IMH was 6 months (range 3.5 to 12.0 months).In the patients,the macular hole was found in 9 eyes at stage]Ⅱ,11 eyes at stage Ⅲ,and 5 eyes at stage Ⅳ.Best corrected visual acuity(BCVA) were examined before and after the surgery.The minimum diameter(a),the height (b) and the base diameter(c) of macular holes were measured by OCT.According to the indexes,macular hole index (MHI,b/c),tractional hole index (THI,b/a),diameter hole index (DHI,a/c) were calculated,respectively.Spearman rank correlation analysis was performed to understand the correlations between postoperative BCVA and the related indexes.Cut-off values were obtained for MHI and THI,respectively,from receiver operating characteristic(ROC) curve analysis.Results The median preoperative BCVA was 0.100(range 0.050 to 0.180).The median MHI,THI and DHI was 0.476(range 0.416 to 0.684),1.048(range 0.761 to 1.346) and 0.536 (range 0.431 to 0.645),respectively.The median 3-month postoperative BCVA was 0.150 (range 0.120 to 0.275),markedly improved after surgery(Mann-Whitney U test:P =0.002).The median latest postoperative BCVA was 0.250 (range 0.135 to 0.350),also markedly improved(Mann-Whitney U test,P =0.002).M HI,THI and preoperative BCVA correlated significantly with postoperative BCVA by Spearman rank correlation analysis (rMuI =0.481,P =0.015 ; rTHI =0.516,P =0.008 ; rpreoperative BCVA =0.560,P =0.004,respectively).Areas under the curve of 0.740 and 0.760 for MHI and THIwere obtained respectively.Cut-off values of 0.475 and 0.973 were obtained for MHI and THI,respectively,from ROC curve analysis.Postoperative BCVAs in the MHI ≥0.475 group and in the THI ≥ 0.973 group was better than that in the MHI ＜ 0.475 and in the THI ＜ 0.973 group,respectively (MannWhitney U test:PMHI =0.013,PTHI =0.008).Conclusion An MHI≥0.475 or a THI≥0.973 may be predictive factors for a good visual prognosis after IMH surgery.
