CAJ | 학술논문

目的探讨影响特发性黄斑裂孔(IMH)微创玻璃体切割手术(TSV)后视力预后的相关因素.方法前瞻性临床研究.连续接受23G TSV治疗的IMH患者46例50只眼纳入研究.其中,男性8例9只眼,女性38例41只眼；平均年龄(60.7±9.6)岁.均采用Snellen视力表行矫正视力(CVA)检查,同时行验光、裂隙灯显微镜加前置镜、频域(SD)光相干断层扫描(OCT)检查.将小数视力换算成最小分辨角对数(logMAR)视力进行统计学处理.患者CVA 0.02～0.6,平均logMAR CVA 0.95±0.29；平均病程(11.1±7.8)个月；平均光感受器内外节连接(IS/OS)断裂长度(1 566.9±830.5) μm;平均黄斑裂孔底部最大直径(914.0±484.8) μm. IMH 2、3、4期分别为10、19、21只眼.患者均行TSV.以手术后3个月为疗效评价时间点,分析手术后视力与患者年龄、病程、手术前视力、IMH分期、手术前IS/OS断裂长度、黄斑裂孔底部最大直径、手术后中心凹感光细胞层厚度、IS/OS断裂长度的相关性；观察TSV治疗IMH的安全性.结果手术后3个月,所有患眼黄斑裂孔均闭合,占100.0％.平均logMAR CVA 0.45±0.25;平均中心凹感光细胞层厚度、平均IS/OS断裂长度分别为(183.8±62.6)、(477.5±341.9) μm.手术后平均logMAR CVA与手术前比较,差异有统计学意义(Z=6.571,P＜0.001).平均IS/OS断裂长度较手术前明显缩短,差异有统计学意义(t=12.679,P＜0.001).相关性分析结果显示,手术后logMAR CVA与手术前logMAR CVA(r=0.569)、病程(r=0.465)、手术前后IS/OS断裂长度(r=0.574、0.564)均呈正相关关系(P＜0.001)；与患者年龄、黄斑裂孔底部最大直径、手术后中心凹感光细胞层厚度无相关关系(r=0.546、0.361、-0.441,P＞0.05).IMH 4期患眼较2、3期患眼手术后logMAR CVA差,其差异有统计学意义(Z=0.455、2.556,P＜0.05).手术后出现并发性白内障17只眼；黄斑前膜8只眼.行白内障摘除手术后视力再次明显提高.未出现眼内感染等与手术相关的并发症.结论影响IMH患眼TSV后视力预后的主要因素为手术前视力、病程、IS/OS断裂长度. 目的探討影響特髮性黃斑裂孔(IMH)微創玻璃體切割手術(TSV)後視力預後的相關因素.方法前瞻性臨床研究.連續接受23G TSV治療的IMH患者46例50隻眼納入研究.其中,男性8例9隻眼,女性38例41隻眼；平均年齡(60.7±9.6)歲.均採用Snellen視力錶行矯正視力(CVA)檢查,同時行驗光、裂隙燈顯微鏡加前置鏡、頻域(SD)光相榦斷層掃描(OCT)檢查.將小數視力換算成最小分辨角對數(logMAR)視力進行統計學處理.患者CVA 0.02～0.6,平均logMAR CVA 0.95±0.29；平均病程(11.1±7.8)箇月；平均光感受器內外節連接(IS/OS)斷裂長度(1 566.9±830.5) μm;平均黃斑裂孔底部最大直徑(914.0±484.8) μm. IMH 2、3、4期分彆為10、19、21隻眼.患者均行TSV.以手術後3箇月為療效評價時間點,分析手術後視力與患者年齡、病程、手術前視力、IMH分期、手術前IS/OS斷裂長度、黃斑裂孔底部最大直徑、手術後中心凹感光細胞層厚度、IS/OS斷裂長度的相關性；觀察TSV治療IMH的安全性.結果手術後3箇月,所有患眼黃斑裂孔均閉閤,佔100.0％.平均logMAR CVA 0.45±0.25;平均中心凹感光細胞層厚度、平均IS/OS斷裂長度分彆為(183.8±62.6)、(477.5±341.9) μm.手術後平均logMAR CVA與手術前比較,差異有統計學意義(Z=6.571,P＜0.001).平均IS/OS斷裂長度較手術前明顯縮短,差異有統計學意義(t=12.679,P＜0.001).相關性分析結果顯示,手術後logMAR CVA與手術前logMAR CVA(r=0.569)、病程(r=0.465)、手術前後IS/OS斷裂長度(r=0.574、0.564)均呈正相關關繫(P＜0.001)；與患者年齡、黃斑裂孔底部最大直徑、手術後中心凹感光細胞層厚度無相關關繫(r=0.546、0.361、-0.441,P＞0.05).IMH 4期患眼較2、3期患眼手術後logMAR CVA差,其差異有統計學意義(Z=0.455、2.556,P＜0.05).手術後齣現併髮性白內障17隻眼；黃斑前膜8隻眼.行白內障摘除手術後視力再次明顯提高.未齣現眼內感染等與手術相關的併髮癥.結論影響IMH患眼TSV後視力預後的主要因素為手術前視力、病程、IS/OS斷裂長度.
목적 탐토영향특발성황반렬공(IMH)미창파리체절할수술(TSV)후시력예후적상관인소.방법 전첨성림상연구.련속접수23G TSV치료적IMH환자46례50지안납입연구.기중,남성8례9지안,녀성38례41지안；평균년령(60.7±9.6)세.균채용Snellen시력표행교정시력(CVA)검사,동시행험광、렬극등현미경가전치경、빈역(SD)광상간단층소묘(OCT)검사.장소수시력환산성최소분변각대수(logMAR)시력진행통계학처리.환자CVA 0.02～0.6,평균logMAR CVA 0.95±0.29；평균병정(11.1±7.8)개월；평균광감수기내외절련접(IS/OS)단렬장도(1 566.9±830.5) μm;평균황반렬공저부최대직경(914.0±484.8) μm. IMH 2、3、4기분별위10、19、21지안.환자균행TSV.이수술후3개월위료효평개시간점,분석수술후시력여환자년령、병정、수술전시력、IMH분기、수술전IS/OS단렬장도、황반렬공저부최대직경、수술후중심요감광세포층후도、IS/OS단렬장도적상관성；관찰TSV치료IMH적안전성.결과 수술후3개월,소유환안황반렬공균폐합,점100.0％.평균logMAR CVA 0.45±0.25;평균중심요감광세포층후도、평균IS/OS단렬장도분별위(183.8±62.6)、(477.5±341.9) μm.수술후평균logMAR CVA여수술전비교,차이유통계학의의(Z=6.571,P＜0.001).평균IS/OS단렬장도교수술전명현축단,차이유통계학의의(t=12.679,P＜0.001).상관성분석결과현시,수술후logMAR CVA여수술전logMAR CVA(r=0.569)、병정(r=0.465)、수술전후IS/OS단렬장도(r=0.574、0.564)균정정상관관계(P＜0.001)；여환자년령、황반렬공 저부최대직경、수술후중심요감광세포층후도무상관관계(r=0.546、0.361、-0.441,P＞0.05).IMH 4기환안교2、3기환안수술후logMAR CVA차,기차이유통계학의의(Z=0.455、2.556,P＜0.05).수술후출현병발성백내장17지안；황반전막8지안.행백내장적제수술후시력재차명현제고.미출현안내감염등여수술상관적병발증.결론 영향IMH환안TSV후시력예후적주요인소위수술전시력、병정、IS/OS단렬장도.
Objective To investigate the risk factors associated with visual acuity after minimally invasive vitrectomy of idiopathic macular hole (IMH).Methods Forty-six IMH patients (50 eyes) who underwent minimally invasive vitrectomy were enrolled in this prospective clinical study.The patients included eight males (nine eyes) and 38 females (41 eyes),with a mean age of (60.7±9.6) years.All the patients were examined for Snellen corrected visual acuity (CVA),optometry,slit lamp microscope and preset lens,as well as spectral domain optical coherence tomography (SD-OCT).The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis.The mean logMAR CVA was 0.95±0.29 (CVA ranged from 0.02-0.6).The mean duration was (11.1±7.8) months.The mean breaking length of inner segment/outer segment (IS/OS) junction was (1 566.9 ± 830.5) μm.The mean maximum diameter of the bottom of macular hole was (914.0±484.8) μm.There were 10,19,21eyes with stage two,three and four IMH,respectively.The therapeutic effects were evaluated at three months after surgery.The relationship between visual acuity after surgery and age,duration,visual acuity before surgery,stage of IMH,breaking length of IS/OS before and after surgery,the maximum diameter of the bottom of macular hole,thickness of photoreceptors after surgery were analyzed.The safety of minimally invasive vitrectomy for IMH was observed.Results Three months after surgery,the closure rate of macular hole was 100.0％.The mean logMAR CVA was 0.45 ± 0.25.The mean thickness of photoreceptors and breaking length of IS/OS were (183.8±62.6),(477.5±341.9) μm respectively.The mean breaking length of IS/OS after surgery was significantly shorter than before surgery (t=12.679,P＜0.001).The difference of logMAR CVA before and after surgery was statistically significant (Z=6.571,P＜0.001).ThelogMARCVA before surgery (r=0.569),duration (r=0.465),breaking length of IS/OS before (r=0.574) and after surgery (r=0.564) had a positive correlation with logMAR CVA after surgery (P＜0.001).The logMAR CVA after surgery was independent of age,the maximum diameter of the bottom of macular hole and thickness of photoreceptors after surgery (r=0.546,0.361,-0.441; P＞0.05).The logMAR CVA after surgery in eyes with stage four IMH was significant decreased than that in eyes with stage two and three IMH (Z =0.455,2.556 ; P ＜ 0.05).Except 17 eyes with complicated cataract and eight eyes with macular epiretinal membrane,there were no other surgery-related serious complications.The cataract eyes had improved visual acuity after phacoemulsification.Conclusion The visual acuity before surgery,duration and breaking length of IS/OS are main influence factors of visual acuity after surgery.