脉络膜厚度及血液循环与特发性黄斑裂孔的相关关系研究现状

研究分析特发性黄斑裂孔的发生与发展对疾病的治疗和预防具有重要意义.最新研究提示,脉络膜厚度降低、血液循环减少可能是裂孔的致病因素.随着光学相干层析成像技术在临床上的应用,脉络膜厚度及血液循环在特发性黄斑裂孔发病及预后中的作用日益受到学者们的重视.本文就脉络膜厚度及血液循环变化与特发性黄斑裂孔发病关系的最新研究进行综述.     

特发性黄斑裂孔研究进展

特发性黄斑裂孔(IMH)是指黄斑中心凹区无明显诱因发生的全层视网膜裂孔,是从内界膜到感光细胞层的全层组织破裂。本文从IMH的发病机制、相关检查、鉴别诊断及治疗等方面的进展作一综述。     

黄斑裂孔手术前后黄斑中心凹下脉络膜厚度的变化

目的 观测黄斑中心凹下脉络膜厚度（SFCT）在两种不同类型黄斑裂孔手术前后的变化规律,以探讨SFCT与黄斑裂孔预后的关系。设计 回顾性队列研究。研究对象 2021年8月至2022年1月潍坊医学院附属医院确诊为黄斑裂孔并接受玻璃体视网膜手术治疗的患者50例。方法 将研究对象分为特发性黄斑裂孔（IMH）组、高度近视性黄斑裂孔（HMMH）组、正常对照组。IMH组和HMMH组均在术前、术后1周、1个月、3个月随访。观察SFCT的变化,比较IMH组和HMMH组SFCT值变化的特点。主要指标 SFCT、黄斑裂孔闭合状况。结果 正常人组、术前IMH组和HMMH组SFCT值依次降低（F=71.33,P＜0.001）。IMH组术后裂孔闭合良好率为91.4%,好于HMMH组的53.3%。两组中裂孔闭合良好组在各个随访时间点的SFCT值较裂孔闭合不良组的差异均有统计学意义（P=0.001、P＜0.001、P＜0.001、P＜0.001）。IMH组中术后1周、术后1个月、术后3个月、术前SFCT值依次减少,差异有统计学意义（F=37.89,P＜0.001）。HMMH组中术后1周、1个月、3个月SFCT值依次减少,术前较术后1周SFCT值小（F=7.828,P=0.002）。其中术后1周至1个月时间范围内,HMMH组的SFCT值变化大于IMH组（P=0.001）。IMH组中,裂孔基底径与术后1个月脉络膜厚度相关（r=-0.345,P=0.043）。在IMH和HMMH组中,裂孔基底径均与裂孔高度均相关（P≤0.001、0.004）。IMH组的裂孔基底径小于HMMH组（P=0.045）。结论 MH术后,SFCT值会短暂性增加,然后逐渐降低。术后2~4周内,HMMH眼较IMH眼的SFCT值降低更显著。SFCT可能是影响黄斑裂孔术后愈合的重要因素。（眼科,2023,32：148-153）     

特发性黄斑裂孔患者黄斑部脉络膜厚度分析

目的 评价特发性黄斑裂孔(IMH)患眼和对侧健眼的黄斑部脉络膜厚度,并与年龄性别相匹配的正常人群比较,分析其临床意义.方法 横断面分析研究.对2011年3～8月在中山眼科中心就诊的40例单眼IMH患者,分为患眼组(A组)40只眼,对侧健眼组(B组)38只眼;另设正常对照组(C组)40例40只眼为年龄、性别、屈光度匹配的正常成年人.采用海德馒Spcctralis频域OCT加强深度扫描(Enhanced Depth Imaging,EDI)测定中心凹下脉络膜厚度(Subfoveal choroidal thickness,SFCT)、距中心凹l mm和3 mm处上下鼻颞四方位脉络膜厚度(SCT1mm、SCT3mm、 ICT1mm、ICT3mm、NCT1mm、NCT3mm、TCT1mm、TCT3mm、).结果 单眼IMH患者,配对t检验显示患眼SFCT值较对侧健眼变薄,t =-3.906,P＜0.001.三组间比较,A组、B组和C组SFCT均值分别为(214.82±66.67)μm,(243.53±76.67) μm和(259.87±64.39) μm,A组较C组明显降低.B组较C组降低,但差异无统计学意义.结论 IMH患眼中脉络膜厚度变薄明显,可能与其发病机制有关.对侧健眼的脉络膜厚度较正常对照组亦有降低,提示脉络膜血管代谢功能下降,可能是IMH发病的因素之一.     

特发性黄斑裂孔手术前后黄斑区脉络膜厚度变化

目的：探讨玻璃体切除手术对特发性黄斑裂孔(IMH)黄斑区脉络膜血流的影响及脉络膜微结构变化在黄斑裂孔形成中的作用。

方法：选取2014-05/2015-12单眼IMH患者56例56眼纳入研究,所有患者均行三通道平坦部玻璃体切除+吲哚菁绿辅助内界膜剥除+12%C₃F₈气体填充术。晶状体混浊者联合超声乳化吸出+人工晶状体植入。术前及术后1、3、6mo行EDI SD-OCT检查,记录黄斑中心凹下及距中心凹上方、下方、鼻侧、颞侧各1、3mm处共9个位点的脉络膜厚度。

结果：术前黄斑中心凹下脉络膜厚度(SFCT)值为233.43±84.638μm,术后1、3、6mo SFCT分别为242.46±88.199,238.97±89.252,236.71±88.661μm,术后1mo与术前相比明显升高(P<0.05)。距中心凹下方3mm处的脉络膜厚度值(ICT_3mm)术前(170.89±57.040μm)与术后1、3、6mo(179.63±62.941、179.74±65.981、180.80±58.379μm)相比呈逐渐增高趋势,但各个测量时间点的ICT_3mm值两两比较无差异。 距中心凹下方1mm处的脉络膜厚度值(ICT_1mm)术前(207.37±67.502μm)与术后1、3、6mo(216.31±80.297、214.54±75.693、205.69±68.697μm)有差异(P<0.05),术后6mo与术后1mo相比有差异(P<0.05)。

结论：脉络膜厚度降低可能是黄斑裂孔形成的原因,IMH患者术后脉络膜厚度值变化与位置有关,可能与术中填塞气体的压迫作用有关。     

患单侧特发性全层黄斑裂孔的马来西亚患者脉络膜厚度研究

目的：比较患单侧特发性全层黄斑裂孔(FTMH)眼、对侧眼以及正常对照组黄斑脉络膜厚度。

方法：横断面研究。选取30例单侧特发性全层黄斑裂孔马来西亚患者,以及年龄、性别、种族相匹配的正常对照组。用激光干涉法测量研究对象眼轴长度。利用谱域光学相干层析成像技术获取增强深度成像光学相干断层成像。在黄斑中心凹处,距中心凹1 mm和 2 mm鼻侧、颞侧、上方、下方测量脉络膜厚度。采用独立统计分析法、配对样本t-tests、chi-square tests和Pearson相关性检验进行数据分析。

结果：全层黄斑裂孔组平均中心凹脉络膜厚度为201.0±44.0 μm,对侧眼平均为225.3±51.4 μm,对照组为262.3±70.3 μm。相较于对照组,全层黄斑裂孔各部位脉络膜较薄(P<0.05)。对侧眼组除了鼻侧1 mm 和2 mm处,其余地方脉络膜厚度较对照组薄(P<0.05)。全层黄斑裂孔组脉络膜厚度低于对侧眼组,但两组间差异无统计学意义(P>0.05)。脉络膜厚度通常在中心凹处最高,在鼻侧最低。黄斑中心凹脉络膜厚度与年龄(r=-0.278, P=0.032)和眼轴长度(r=-0.328, P=0.011)呈负相关。

结论：单侧全层黄斑裂孔患眼与对侧眼和健康对照组相比,脉络膜厚度较低。     

特发性黄斑裂孔研究进展

特发性黄斑裂孔(idiopathic macular hole,IMH)是指无明确原因发生于黄斑区域的视网膜全层缺损。随着玻璃体切割技术的进步和对联合内界膜剥除的研究,特发性黄斑裂孔的治疗技术进一步成熟。本文从IMH的发病机制、术前预后评估及手术治疗相关等方面的进展作一综述。     

特发性黄斑裂孔患眼黄斑中心凹脉络膜毛细血管层血流面积和椭圆体带缺损直径与视力恢复的相关性分析

目的:观察特发性黄斑裂孔（IMH）患者手术前后黄斑中心凹下脉络膜毛细血管层血流面积（CBFA）与椭圆体带缺损直径（DEZA）的变化,分析两者与视力恢复的相关性。方法:前瞻性研究。2019年5月至2020年1月在蚌埠医学院第一附属医院眼科确诊为IMH并接受玻璃体视网膜手术治疗的23例患者23只眼（IMH患眼组）及其健康对...     

脉络膜厚度与特发性黄斑裂孔和黄斑前膜关系的研究进展

近年来对脉络膜厚度与特发性黄斑裂孔和特发性黄斑前膜的关系研究是黄斑区疾病研究的焦点问题之一,相干光断层扫描深度增强成像技术是相关研究的有效技术手段。针对特发性黄斑裂孔的研究较多,但是研究结果并不一致,无法得出脉络膜厚度与其发病机制的确切关系。针对特发性黄斑前膜的研究数量有限,结果也不统一。总结此类研究的方法和结果可以发现,需要更加直接而精确的观察脉络膜血流情况的技术手段来获取科学、全面的结果。     

不同方法治疗特发性黄斑裂孔对黄斑区解剖结构和脉络膜厚度的影响

目的：探讨玻璃体切割分别联合内界膜移植、内界膜翻瓣、自体血填充治疗特发性黄斑裂孔(IMH)的效果及对黄斑区解剖结构和脉络膜厚度的影响。

方法：回顾性分析2017-01/2019-12我院收治的IMH患者79例82眼的临床资料,所有患者均行标准玻璃体切割+内界膜剥除术及气液交换术,其中联合内界膜移植28例29眼(内界膜移植组)、联合内界膜瓣翻转26例28眼(内界膜翻瓣组)、联合自体血填充25例25眼(自体血填充组)。观察三组患者裂孔闭合情况、裂孔闭合形态; 记录最佳矫正视力(BCVA)、椭圆体带(EZ)及外界膜层(ELM)缺损直径、黄斑中心凹无血管区周长(PERIM)、浅层毛细血管层(SCP)血流密度及黄斑中心凹下(SFCT)、颞侧(TCT)、鼻侧(NCT)脉络膜厚度。

结果：三组患者均成功完成手术,术后3mo时内界膜移植组、内界膜翻瓣组BCVA优于自体血填充组,EZ层缺损直径、ELM层缺损直径低于自体血填充组(P<0.05)。三组间黄斑裂孔闭合率、椭圆体区闭合率、PERIM、SCP血流密度、SFCT、TCT、NCT脉络膜厚度比较无差异(P>0.05); 但三组患者黄斑裂孔闭合形态分型有差异(P<0.05),其中内界膜翻瓣组患者U型比例最高。

结论：玻璃体切割联合手术中内界膜移植术、内界膜翻瓣术及自体血填充治疗IMH均可较好地恢复黄斑裂孔闭合,但内界膜移植术、内界膜翻瓣术在恢复黄斑区解剖结构、提高视力方面优于自体血填充。     

脉络膜厚度与黄斑裂孔的相关性

目的：探究脉络膜厚度与黄斑裂孔的相关性,为黄斑裂孔的诊断与治疗提供理论依据。

方法：本研究观察对象为2015-06/2016-06于我院眼科治疗的40例单眼特发性黄斑裂孔患者以及40例正常体检人员,将特发性黄斑裂孔患者患眼(40眼)设为A组、健侧眼(40眼)设为B组,40例正常体检人员40只正常眼设为C组,通过增强深部成像的相干光断层扫描(enhanced depth image optical coherence tomography,EDI-OCT)对黄斑中心凹,黄斑中心凹外1、3mm上下鼻颞四方位9个点的脉络膜厚度进行测定,分别记为SFCT、SCT_1mm、SCT_3mm、ICT_1mm、ICT_3mm、NCT_1mm、NCT_3mm、TCT_1mm、TCT_3mm,并对SFCT与年龄的关系进行相关性分析。

结果：A、B组平均SFCT无显著性差异,C组显著高于A、B组,差异有统计学意义(P<0.05); A、B组SCT_1mm、SCT_3mm、ICT_1mm、ICT_3mm、NCT_1mm、NCT_3mm、TCT_1mm、TCT_3mm比较,差异无统计学意义(P>0.05),且C组各测量点脉络膜厚度均显著高于A、B组,差异有统计学意义(P<0.05); 与年龄的相关性分析发现,A、B组SFCT与年龄无明显相关性(r=-0.065,P=0.148; r=-0.057,P=0.658),C组SFCT与年龄呈负相关(r=-0.343,P=0.041)。

结论：特发性黄斑裂孔的发病机制可能与其脉络膜厚度明显降低有关,对侧健眼较正常人群脉络膜厚度也明显降低,提示脉络膜血管代谢降低可能是特发性黄斑裂孔的致病因素。     

Correlation between optical coherence tomography data and biomicroscopic interpretation of idiopathic macular hole

PURPOSE: This study was designed to assess the new clinical information given by optical coherence tomography in patients with idiopathic macular hole. METHODS: Sixty-one consecutive eyes of 47 patients with idiopathic macular hole at different stages of development were studied clinically. Patients with myopia, epiretinal macular membrane, and any other ocular disease were excluded. Best-refracted visual acuity and biomicroscopic fundus examination with macular contact lens were performed. Optical coherence tomography was performed through a dilated pupil. The optical coherence tomography findings were correlated with the Gass biomicroscopic classification of idiopathic macular hole. RESULTS: Optical coherence tomography provided different or additional information in 22 of 24 eyes (91.7%) biomicroscopically classified in stages 1-A and stage 1-B, according to the Gass macular hole classification, and in seven of 37 eyes (18.9%) biomicroscopically classified in stages 2, 3, and 4. The main difference from Gass biomicroscopic classification was a macular pseudocyst instead of a foveolar detachment in the first stages. The main additional optical coherence tomography observation, not detected biomicroscopically, was the presence of retinal tissue on the bottom of the macular hole. Optical coherence tomography may be particularly useful in evaluation of early stages in development of idiopathic macular hole. CONCLUSIONS: Compared with classic biomicroscopical observation, optical coherence tomography frequently gives different or additional information on idiopathic macular hole, especially in its early stages. Correct diagnosis and surgical indication of idiopathic macular hole may benefit from optical coherence tomography imaging.     

Traction maculopathies--pathogenesis and diagnostics

Traction maculopathies are a group of age-related degenerative diseases characterized by pathology of vitreomacular interface including idiopathic epimacular membranes, vitreomacular traction syndrome and idiopathic macular hole. The disorders develop due to mechanical forces caused by focal condensation or incomplete detachement of vitreous and shrinkage of pathological membranes. The forces can be tangential to retinal surface in epiretinal membranes, anterior-posterior in vitreomacular traction syndrome and oblique (trampoline) in idiopathic macular hole. Authors discuss pathogenesis and diagnostics of traction maculopathies with use of optical coherence tomography and microperimetry, based on current literature. This work presents also idiopathic macular hole classification with use of optical coherence tomography images compared with biomicroscopic classification by Gass.     

Analysis of vitrectomy for idiopathic macular hole by optical coherence tomography

PURPOSE: To evaluate foveal structure after vitrectomy for idiopathic macular hole in relation to postoperative visual outcome. METHODS: Optical coherence tomography was performed postoperatively to assess retinal thickness at the foveal center in patients who underwent vitrectomy, posterior hyaloid membrane removal, and perfluoropropane gas tamponade for idiopathic macular hole. Thirty-seven eyes of 36 patients documented to have achieved anatomic hole closure by optical coherence tomography were included in the study. RESULTS: Increased visual acuity significantly correlated with greater foveal thickness assessed at a median of 5 months postoperatively (Spearman analysis; R = .453, P = .005). CONCLUSION: Visual outcome after anatomic closure of macular holes by vitrectomy is closely related to the structure of the center of the fovea postoperatively.     

Macular hole formation associated with idiopathic parafoveal telangiectasia

Background To report the occurrence of a full thickness macular hole in association with idiopathic parafoveal telangiectasia. Methods Observational case report. Results A 60-year-old female with a history of bilateral idiopathic parafoveal telangiectasia presented with acute complaints of decreased vision and metamorphopsia in her right eye. The patient's retinal examination was significant for idiopathic parafoveal telangiectasia bilaterally, and a new, full-thickness macular hole in the right eye which was confirmed by optical coherence tomography. Conclusions Full-thickness macular hole formation may occur in conjunction with idiopathic parafoveal telangiectasia, which has not been reported to date.     

Preoperative factors for postoperative resolution of metamorphopsia in idiopathic macular hole surgery

PURPOSE: To elucidate factors for resolution of metamorphopsia after successful surgery for idiopathic macular hole. PATIENTS AND METHODS: A series of 15 cases of 15 patients with successful surgery for idiopathic macular hole were evaluated for signs of metamorphopsia before and one year after surgery. Preoperative and postoperative assessments included testing of metamorphopsia using M-CHART and optical coherence tomography. The postoperative state of the metamorphopsia was judged to have resolved when the test score was 0.2 or less and to be residual when it was more than 0.2. Classification of preoperative factors in two groups of patients included evaluation of metamorphopsia score, visual acuity, optical coherence tomography findings, and clinical stage of macular hole. RESULTS: Six of 15 eyes (40%) showed postoperative resolution of metamorphopsia. There was no significant correlation of postoperative metamorphopsia score with preoperative score or preoperative visual acuity. Eyes with postoperative resolution of metamorphopsia had a macular hole with a significantly smaller diameter and a significantly thinner retina surrounding the hole. Two eyes with clinical stage 4 macular hole had residual metamorphopsia after surgery. CONCLUSIONS: The diameter of a macular hole and the thickness of the retina surrounding a macular hole are significant preoperative factors for postoperative resolution of metamorphopsia after idiopathic macular hole surgery.     

OCT形态学参数在预测特发性黄斑裂孔手术预后中的价值

随着技术水平不断提高,光学相干断层扫描(optical coherence tomography,OCT)对特发性黄斑裂孔(idiopathic macular hole,IMH)术后效果的评估有着越来越重要的价值.术前测量的黄斑裂孔最小直径、裂孔基底最大直径、裂孔最大高度、黄斑裂孔指数、裂孔形成因子、裂孔牵拉指数、黄斑裂孔愈合指数、光感受器内外节连接、中心凹视锥细胞外节尖端线、中心子区视网膜厚度以及黄斑裂孔内口直径等形态学参数与术后视力和裂孔解剖复位情况存在一定相关性.认识各种预测指标、熟悉其价值有助于手术者直观地对术后情况进行判断,也有助于加深对黄斑裂孔形态、功能学改变的了解.     

Macular hole formation,progression, and surgical repair: case series of serial optical coherence tomography and time lapse morphing video study

Background  

To use a new medium to dynamically visualize serial optical coherence tomography (OCT) scans in order to illustrate and elucidate the pathogenesis of idiopathic macular hole formation, progression, and surgical closure.     

Treatment of Co-existent occult choroidal neovascular membrane and macular hole

The co-existence of a macular hole and a choroidal neovascular membrane can represent a diagnostic and therapeutic dilemma. In this noncomparative case report, we report on a patient with co-existent macular hole and choroidal neovascular membrane. The patient initially was found to have an occult choroidal neovascular membrane. The patient was not treated and the vision remained stable for almost 1 year until the patient noted further visual decline. The patient was treated with intravitreal pegaptanib and the patient's vision remained stable for 6 months. However, on follow-up the patient presented with visual decline and a full thickness macular hole was confirmed by optical coherence tomography (OCT). The patient underwent repair and vision improved with closure of the macular hole. The occult choroidal neovascular membrane remained stable with no evidence of disease progression. Fundus photos, intravenous fluorescein angiograms, and OCT were obtained before and after therapy and confirmed the diagnosis. This report highlights how the detection of co-existent macular hole and choroidal neovascular membrane may require OCT scanning. When treatment is entertained, therapy should be directed first toward the neovascular complex and then to repair the macular hole.