CAJ | 학술논문

目的探讨特发性黄斑裂孔玻璃体切割手术后影响裂孔解剖愈合的相关因素.方法回顾性临床研究.行玻璃体切割联合内界膜剥除手术的特发性黄斑裂孔患者164例165只眼纳入研究.其中,男性43例,女性121例;平均年龄(64.0±6.7)岁.采用最小分辨角对数(logMAR)视力表行矫正视力检查,以及间接检眼镜、频域光相干断层扫描(SD-OCT)检查.患眼平均logMAR矫正视力1.0;平均病程(8.7±14.9)个月;平均裂孔最小径(MIN)、裂孔底径(BASE)、裂孔高度(H)分别为521、1010、406 μm;平均黄斑裂孔指数(MHI)、裂孔牵拉指数(THI)、孔径指数(DHI)、黄斑裂孔愈合指数(MHCI)分别为0.43、0.82、0.57、0.92.根据患眼手术后SD-OCT图像特征,将黄斑裂孔愈合分为A、B、C级.A级:黄斑裂孔桥状愈合;B级:黄斑裂孔良好愈合;C级:黄斑裂孔不良愈合.手术后平均随访时间(3.6±3.2)个月.观察黄斑裂孔愈合形态,并与患者年龄、性别、手术前病程、logMAR矫正视力、黄斑裂孔各测量参数、指数行相关性分析.结果 165只眼中,黄斑裂孔愈合A、B、C级分别为30、120、15只眼.相关性分析结果显示,黄斑裂孔愈合等级与病程(r=0.141)、手术前logMAR矫正视力(r=0.082)、年龄(r=0.044)、性别(r=0.109)无关;与MIN(r=0.397)、BASE(r=0.276)、H(r=-0.240)、MHI(r=-0.363)、THI(r=-0.432)、DHI(r=0.272)呈弱相关或低度相关(P＜0.05).MHCI与手术后黄斑裂孔愈合等级呈显著相关(r=-0.543,P=0.000).A、B、C级MHCI中位数分别为1.07、0.91、0.56.A、B、C级MHCI比较,差异有统计学意义(H=52.857,P＜0.05).结论 MHCI与裂孔愈合等级的相关性最好,可视为影响手术后裂孔愈合的主要因素并作为预测解剖愈合的指标.
목적 탐토특발성황반렬공파리체절할수술후영향렬공해부유합적상관인소.방법 회고성림상연구.행파리체절할연합내계막박제수술적특발성황반렬공환자164례165지안납입연구.기중,남성43례,녀성121례;평균년령(64.0±6.7)세.채용최소분변각대수(logMAR)시력표행교정시력검사,이급간접검안경、빈역광상간단층소묘(SD-OCT)검사.환안평균logMAR교정시력1.0;평균병정(8.7±14.9)개월;평균렬공최소경(MIN)、렬공저경(BASE)、렬공고도(H)분별위521、1010、406 μm;평균황반렬공지수(MHI)、렬공견랍지수(THI)、공경지수(DHI)、황반렬공유합지수(MHCI)분별위0.43、0.82、0.57、0.92.근거환안수술후SD-OCT도상특정,장황반렬공유합분위A、B、C급.A급:황반렬공교상유합;B급:황반렬공량호유합;C급:황반렬공불량유합.수술후평균수방시간(3.6±3.2)개월.관찰황반렬공유합형태,병여환자년령、성별、수술전병정、logMAR교정시력、황반렬공각측량삼수、지수행상관성분석.결과 165지안중,황반렬공유합A、B、C급분별위30、120、15지안.상관성분석결과현시,황반렬공유합등급여병정(r=0.141)、수술전logMAR교정시력(r=0.082)、년령(r=0.044)、성별(r=0.109)무관;여MIN(r=0.397)、BASE(r=0.276)、H(r=-0.240)、MHI(r=-0.363)、THI(r=-0.432)、DHI(r=0.272)정약상관혹저도상관(P＜0.05).MHCI여수술후황반렬공유합등급정현저상관(r=-0.543,P=0.000).A、B、C급MHCI중위수분별위1.07、0.91、0.56.A、B、C급MHCI비교,차이유통계학의의(H=52.857,P＜0.05).결론 MHCI여렬공유합등급적상관성최호,가시위영향수술후렬공유합적주요인소병작위예측해부유합적지표.
Objective To evaluate the associated factors for predicting anatomical outcomes of idiopathic macular hole (IMH) after vitrectomy.Methods This is a retrospective study.A total of 165 eyes in 164 IMH patients underwent a successful vitrectomy and ILM peeling surgery were included in this study.The patients included 43 males and 121 females,with the mean age of (64.0±6.7) years.The corrected vision acuity of logarithm of the minimum angle of resolution (logMAR),indirect ophthalmoscope and spectral domain optical coherence tomography (SD-OCT) were measured for all patients.The mean logMAR corrected vision acuity was 1.0.The duration of disease was (8.7±14.9) months.The minimum diameter (MIN),base diameter (BASE) and height (H) were 521,1010,406 μm respectively.The macular hole index (MHI),tractional hole index (THI),diameter hole index (DHI) and macular hole closure index (MHCI) were 0.43,0.82,0.57,0.92 respectively.Anatomical outcomes were divided into 3 levels.A:bridge-shaped healing; B:good healing; C:poor healing.The mean follow-up was (3.6±3.2) months.The multiple factors related with prognosis including age,sex,duration of disease,preoperative logMAR corrected vision acuity,MIN,BASE and H,MHI,THI,DHI,MHCI were analyzed.Results Duration of disease (r=0.141),preoperative logMAR corrected vision acuity (r=0.082),age (r=0.044),sex (r=0.109) was independent of anatomical prognosis (P＞0.05).MIN (r=0.397),BASE (r=0.276),H (r=-0.240),MHI (r=-0.363),THI (r=-0.432),DHI (r=0.272) was weak correlation to anatomical prognosis (P＜0.05).MHCI correlated significantly with anatomical outcomes (r=-0.543,P=0.000).The median MHCI of A,B and C were 1.07,0.91,0.56 respectively.There were significant difference of MHCI among the three levels (H =52.857,P＜0.05).Conclusions MHCI has the best correlation with anatomical outcomes.It can be considered a key factor for predicting anatomical outcomes of IMH after vitrectomy.