中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
5期
477-481
,共5页
王昞%刘小强%徐鼎%汪浩%高新蕊%王方
王昞%劉小彊%徐鼎%汪浩%高新蕊%王方
왕병%류소강%서정%왕호%고신예%왕방
高度近视%黄斑裂孔%硅油填充%预后%体层摄影术/光学相干断层扫描
高度近視%黃斑裂孔%硅油填充%預後%體層攝影術/光學相榦斷層掃描
고도근시%황반렬공%규유전충%예후%체층섭영술/광학상간단층소묘
High myopia%Macular hole%Silicone tamponade%Prognosis%Tomography/optical coherence tomography image
背景 伴有严重脉络膜萎缩的高度近视黄斑裂孔因预后的不确定性和高复发率一直是眼科临床的关注热点,频域光学相干断层扫描(SD-OCT)技术可以对黄斑裂孔进行测量和评估,但由于高度近视黄斑裂孔患者多伴有视网膜脱离,术前很难进行OCT检查.SD-OCT检查对高度近视眼视网膜复位术后黄斑裂孔复发风险的评估价值值得探讨. 目的 探讨SD-OCT对高度近视黄斑裂孔硅油填充眼硅油取出后裂孔复发风险的评估. 方法 采用描述性病例观察研究设计.收集2009年10月至2011年1月在同济大学附属第十人民医院眼科确诊的高度近视黄斑裂孔合并视网膜脱离的患者25例25眼,均为玻璃体切割联合内界膜剥离及硅油填充手术后6个月,所有患者均未进行晶状体联合手术,利用SD-OCT技术检查表现为视网膜色素上皮(RPE)裸露型愈合的黄斑裂孔.纳入的患者中男4例,女21例；平均年龄(61.4±9.0)岁；平均屈光度为(-14.14±6.86)D.均于硅油取出前1d进行SD-OCT检查,检测指标为黄斑区视网膜厚度、黄斑裂孔指数(MHI)和裂孔中心点下脉络膜厚度.其他检查项目包括裂隙灯显微镜检查、眼底照相、眼轴长度测定等,记录黄斑裂孔的愈合状态.硅油取出后随访6个月. 结果 25例患者均完成6个月的随访.术眼眼轴长度平均为(29.9±1.5) mm,25眼中有19眼黄斑裂孔愈合(裂孔愈合组),6眼黄斑裂孔复发(裂孔未愈合组),复发时间为术后1～5个月,平均(3.3±1.4)个月.裂孔愈合组术眼黄斑中心凹＜1 mm区视网膜厚度、MHI和裂孔中心凹下脉络膜厚度分别为(216.5±95.6) μm、0.30±0.09、(122.9±20.5)μm,裂孔未愈合组分别为(113.5±28.7) μm、0.58±0.27、(96.8±22.9)μm,两组比较差异均有统计学意义(t=2.577、-4.143、2.669,P＜0.05).以MHI=0.5作为界限,MHI＜0.5的黄斑裂孔愈合率为85.7％,MHI≥0.5的愈合率为25.0％,差异有统计学意义(P=0.031).裂孔愈合组黄斑裂孔基底直径为(533.3±277.7) μm,裂孔未愈合组为(1070.2±393.6) μm,裂孔未愈合组黄斑裂孔基底直径明显大于裂孔愈合组,差异有统计学意义(t=-3.700,P=0.001). 结论 高度近视黄斑裂孔硅油填充眼硅油取出术前应用SD-OCT进行黄斑区视网膜厚度、MHI和脉络膜厚度检查可预测硅油取出术后黄斑裂孔复发的风险.MHI＞0.5时裂孔复发风险提高.
揹景 伴有嚴重脈絡膜萎縮的高度近視黃斑裂孔因預後的不確定性和高複髮率一直是眼科臨床的關註熱點,頻域光學相榦斷層掃描(SD-OCT)技術可以對黃斑裂孔進行測量和評估,但由于高度近視黃斑裂孔患者多伴有視網膜脫離,術前很難進行OCT檢查.SD-OCT檢查對高度近視眼視網膜複位術後黃斑裂孔複髮風險的評估價值值得探討. 目的 探討SD-OCT對高度近視黃斑裂孔硅油填充眼硅油取齣後裂孔複髮風險的評估. 方法 採用描述性病例觀察研究設計.收集2009年10月至2011年1月在同濟大學附屬第十人民醫院眼科確診的高度近視黃斑裂孔閤併視網膜脫離的患者25例25眼,均為玻璃體切割聯閤內界膜剝離及硅油填充手術後6箇月,所有患者均未進行晶狀體聯閤手術,利用SD-OCT技術檢查錶現為視網膜色素上皮(RPE)裸露型愈閤的黃斑裂孔.納入的患者中男4例,女21例；平均年齡(61.4±9.0)歲；平均屈光度為(-14.14±6.86)D.均于硅油取齣前1d進行SD-OCT檢查,檢測指標為黃斑區視網膜厚度、黃斑裂孔指數(MHI)和裂孔中心點下脈絡膜厚度.其他檢查項目包括裂隙燈顯微鏡檢查、眼底照相、眼軸長度測定等,記錄黃斑裂孔的愈閤狀態.硅油取齣後隨訪6箇月. 結果 25例患者均完成6箇月的隨訪.術眼眼軸長度平均為(29.9±1.5) mm,25眼中有19眼黃斑裂孔愈閤(裂孔愈閤組),6眼黃斑裂孔複髮(裂孔未愈閤組),複髮時間為術後1～5箇月,平均(3.3±1.4)箇月.裂孔愈閤組術眼黃斑中心凹＜1 mm區視網膜厚度、MHI和裂孔中心凹下脈絡膜厚度分彆為(216.5±95.6) μm、0.30±0.09、(122.9±20.5)μm,裂孔未愈閤組分彆為(113.5±28.7) μm、0.58±0.27、(96.8±22.9)μm,兩組比較差異均有統計學意義(t=2.577、-4.143、2.669,P＜0.05).以MHI=0.5作為界限,MHI＜0.5的黃斑裂孔愈閤率為85.7％,MHI≥0.5的愈閤率為25.0％,差異有統計學意義(P=0.031).裂孔愈閤組黃斑裂孔基底直徑為(533.3±277.7) μm,裂孔未愈閤組為(1070.2±393.6) μm,裂孔未愈閤組黃斑裂孔基底直徑明顯大于裂孔愈閤組,差異有統計學意義(t=-3.700,P=0.001). 結論 高度近視黃斑裂孔硅油填充眼硅油取齣術前應用SD-OCT進行黃斑區視網膜厚度、MHI和脈絡膜厚度檢查可預測硅油取齣術後黃斑裂孔複髮的風險.MHI＞0.5時裂孔複髮風險提高.
배경 반유엄중맥락막위축적고도근시황반렬공인예후적불학정성화고복발솔일직시안과림상적관주열점,빈역광학상간단층소묘(SD-OCT)기술가이대황반렬공진행측량화평고,단유우고도근시황반렬공환자다반유시망막탈리,술전흔난진행OCT검사.SD-OCT검사대고도근시안시망막복위술후황반렬공복발풍험적평고개치치득탐토. 목적 탐토SD-OCT대고도근시황반렬공규유전충안규유취출후렬공복발풍험적평고. 방법 채용묘술성병례관찰연구설계.수집2009년10월지2011년1월재동제대학부속제십인민의원안과학진적고도근시황반렬공합병시망막탈리적환자25례25안,균위파리체절할연합내계막박리급규유전충수술후6개월,소유환자균미진행정상체연합수술,이용SD-OCT기술검사표현위시망막색소상피(RPE)라로형유합적황반렬공.납입적환자중남4례,녀21례；평균년령(61.4±9.0)세；평균굴광도위(-14.14±6.86)D.균우규유취출전1d진행SD-OCT검사,검측지표위황반구시망막후도、황반렬공지수(MHI)화렬공중심점하맥락막후도.기타검사항목포괄렬극등현미경검사、안저조상、안축장도측정등,기록황반렬공적유합상태.규유취출후수방6개월. 결과 25례환자균완성6개월적수방.술안안축장도평균위(29.9±1.5) mm,25안중유19안황반렬공유합(렬공유합조),6안황반렬공복발(렬공미유합조),복발시간위술후1～5개월,평균(3.3±1.4)개월.렬공유합조술안황반중심요＜1 mm구시망막후도、MHI화렬공중심요하맥락막후도분별위(216.5±95.6) μm、0.30±0.09、(122.9±20.5)μm,렬공미유합조분별위(113.5±28.7) μm、0.58±0.27、(96.8±22.9)μm,량조비교차이균유통계학의의(t=2.577、-4.143、2.669,P＜0.05).이MHI=0.5작위계한,MHI＜0.5적황반렬공유합솔위85.7％,MHI≥0.5적유합솔위25.0％,차이유통계학의의(P=0.031).렬공유합조황반렬공기저직경위(533.3±277.7) μm,렬공미유합조위(1070.2±393.6) μm,렬공미유합조황반렬공기저직경명현대우렬공유합조,차이유통계학의의(t=-3.700,P=0.001). 결론 고도근시황반렬공규유전충안규유취출술전응용SD-OCT진행황반구시망막후도、MHI화맥락막후도검사가예측규유취출술후황반렬공복발적풍험.MHI＞0.5시렬공복발풍험제고.
Background Macular hole in high myopia has been paid tremendous attention in clinical research due to its high recurrence rate and unpredictable prognosis.Spectral domain optical coherence tomography (SD-OCT) is considered to be of a good evaluating value for macular hole,yet its application is compromised in patient with high myopia.High myopia might lead to retinal detachment which consequently prevents an accurate OCT.Therefore,it is important to assess the effectiveness of OCT on prognosis in these patients after surgical restoration of the detached retina.Objective The aim of this study was to evaluate the risk of reopening of a macular hole in highly myopic patient after removing silicone oil by SD-OCT.Methods A case-observational study was designed.Twenty-five highly myopic patients with monocular macular holes who underwent vitrectomy combined with internal limiting membrane peeling and silicone oil tamponade were included in this study.Four patients were male and 21 patients were female,with the average age (61.4±9.0) years old and diopter (-14.14 ±6.86)D.Regular ocular examination,axial length measurement,fundus photography and OCT were performed at the day before removing silicone oil and every month till the 6 months after operation.Retinal thickness,macular height index (MHI) and choroidal thickness were measured by OCT.Written informed consent was obtained from each patient.Results All 25 patients finished the follow-up of 6 months.Macular holes remained closure 6 months after operation in 19 patients (76％) and reopened in 6 patients macular holes were in 1-5 months (24％),with a mean time at (3.3± 1.4) months.The average foveal retinal thickness,MHI and the choroidal thickness at the middle of the macular hole were (216.5±95.6) μm,0.30 ± 0.09 and (122.9 ± 20.5) μm in the closed group,respectively,and those in the unclosed group were (113.5±28.7) μm,0.58±0.27 and (96.8±22.9) μm,with significant differences between the two groups (t=2.577,-4.143,2.669,P ＜ 0.05).The percentage of macular hole closure was 85.7％ in the MHI＜0.5 group and 25.0％ in the MHI ≥ 0.5 group,showing a significant difference (P =0.031).The base diameter in the unclosed hole group was significantly larger than that in the closed hole group (1070.2±393.6 μm versus 533.3±277.7 μm) (t =-3.700,P =0.001).Conclusions The measurements of the retinal thickness,MHI and the choroidal thickness at the central area of the macular hole are helpful for the evaluation of reopening risk of macular hole after removing silicone oil.
