特发性黄斑裂孔病人玻璃体切割术后黄斑区结构与功能变化

doi:10.3969/j.issn.1006-7795.2017.01.006

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (1): 29-34.doi: 10.3969/j.issn.1006-7795.2017.01.006

特发性黄斑裂孔病人玻璃体切割术后黄斑区结构与功能变化

胡艳华¹, 王怡¹, 刘武¹, 刘丽梅², 高萌¹, 闫玮玉¹, 刘克高¹, 刘欣欣³

1. 首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室, 北京 100730;
2. 青岛大学医学院附属烟台毓璜顶医院眼科, 山东烟台 264000;
3. 河北联合大学附属开滦总医院眼科, 河北唐山 063003

收稿日期:2016-09-10 出版日期:2017-01-21 发布日期:2017-01-20
通讯作者: 刘武 E-mail:wuliubj@sina.com

Observation of the changes of structure and function of the macular area after vitrectomy in patients with idiopathic macular hole

Hu Yanhua¹, Wang Yi¹, Liu Wu¹, Liu Limei², Gao Meng¹, Yan Weiyu¹, Liu Kegao¹, Liu Xinxin³

1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China;
2. Department of Ophthalmology, Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, China;
3. Department of Ophthalmology, Kailuan Hospital of Hebei United University, Tangshan 063003, Hebei Province, China

Received:2016-09-10 Online:2017-01-21 Published:2017-01-20

摘要/Abstract

摘要： 目的观察特发性黄斑裂孔（idiopathic macular hole，IMH）病人玻璃体切割手术前后视力、光学相干断层扫描（optical coherence tomography，OCT）及多焦视网膜电图（multifocal electroretinogram，mfERG）的变化，探讨评价黄斑裂孔病人结构与功能改变的敏感指标。方法收集34例（34眼）行玻璃体切割术治疗的单眼特发性黄斑裂孔病人，术后随访6个月，记录病人健眼及患眼术前、术后3个月、术后6个月的最佳矫正视力（best corrected visual acuity，BCVA）、mfERG及OCT。结果特发性黄斑裂孔病人术前患眼BCVA 0.01~0.8，平均0.10。病人术前OCT裂孔最大直径（maximum diameter，dmax）431~1 770 μm，平均（998.7±302.6）μm，裂孔最小直径（minimum diameter，dmin）403~536μm，平均（470±189.2）μm。特发性黄斑裂孔病人患眼BCVA、中心凹及旁中心凹区mfERG P波及N₁波振幅降低（P<0.05）。术后黄斑裂孔全部解剖学闭合，其mfERG P波及N₁波振幅亦在术后逐渐恢复，但仍不能恢复至健眼水平。术后3个月患眼P波潜伏期一过性延长，至术后6个月恢复。术前患眼BCVA与dmin、dmax相关（ρ=0.549，ρ=0.610，P<0.01），与mfERG各项参数无相关性；术后BCVA与黄斑中央视网膜厚度（central retinal thickness，CRT）相关（P<0.05），与mfERG各项参数无相关性。结论特发性黄斑裂孔病人患眼术后视力及视觉功能均较术前提高，其黄斑区结构及功能得到一定程度的恢复。术前及术后OCT的主要指标与病人最佳矫正视力相关，术前dmin、dmax对病人术后BCVA有预测意义，但本研究并未显示术前mfERG各项参数对病人术后最佳矫正视力有预测意义。

关键词: 特发性黄斑裂孔(IMH), 玻璃体切割术, 多焦视网膜电图(mfERG), 光学相干断层扫描(OCT)

Abstract: Objective To observe the changes of visual acuity, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) before and after vitrectomy in patients with idiopathic macular hole (IMH), and explore the sensitive indexes of structural and functional changes in these patients. Methods Data of 34 eyes of 34 patients who underwent vitrectomy from December 2013 to April 2014 in Beijing Tongren Hospital for idiopathic macular hole for IMH were collected. All patients were followed up for 6 months. Best corrected visual acuity(BCVA), mfERG and OCT were examined at baseline, 3 months and 6 months, respectively. The results were analyzed statistically compared with the other eye of patients.Results The patients with idiopathic macular hole suffered a significant reduction in BCVA, as well as mfERG P wave and N₁ amplitude in foveal and perifoveal area (P<0.05). Though the mfERG parameters gradually recovered after operation, can not reach healthy level. This study also observed that the mfERG P wave latency delayed at 3 months postoperatively and recovered at 6 months after surgery. Preoperative BCVA and dmin, dmax were significantly related (ρ=0.549, ρ=0.610, P<0.01),but had no correlation with the parameters of mfERG; postoperative BCVA and central retinal thickness(CRT) were related (P<0.05), and no relationship was found between postoperative BCVA and mfERG parameters.Conclusion The postoperative visual acuity and visual function of eyes with idiopathic macular hole improved. The macular structure and function had a certain degree of recovery. Preoperative and postoperative OCT of main indexes in patients with best corrected vision, preoperative dmin, dmax of patients visual acuity after predictive significance. This study did not find preoperative mfERG parameters on postoperative best corrected visual acuity has prognostic significance.

Key words: idiopathic macular hole, vitrectomy, multifocal electroretinogram(mfERG), optical coherence tomography(OCT)

中图分类号:

R774.5

胡艳华, 王怡, 刘武, 刘丽梅, 高萌, 闫玮玉, 刘克高, 刘欣欣. 特发性黄斑裂孔病人玻璃体切割术后黄斑区结构与功能变化[J]. 首都医科大学学报, 2017, 38(1): 29-34.

Hu Yanhua, Wang Yi, Liu Wu, Liu Limei, Gao Meng, Yan Weiyu, Liu Kegao, Liu Xinxin. Observation of the changes of structure and function of the macular area after vitrectomy in patients with idiopathic macular hole[J]. Journal of Capital Medical University, 2017, 38(1): 29-34.

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特发性黄斑裂孔病人玻璃体切割术后黄斑区结构与功能变化

Observation of the changes of structure and function of the macular area after vitrectomy in patients with idiopathic macular hole

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