黄斑裂孔形态学分析及其与视力关系的研究

目的 研究黄斑裂孔3D频域光学相干断层扫描(optical coherence tomography,OCT)形态学图像和视力关系及其临床意义.方法 回顾性分析38例39眼患者(其中黄斑全层裂孔17眼、板层裂孔10眼、假性黄斑孔12眼)3D频域OCT图像,分析黄斑裂孔大小、深度、位置及其周围视网膜厚度变化与视力的关系.结果 全层黄斑裂孔、板层黄斑裂孔患者矫正视力比较,差异无统计学意义(t=-1.66,P=0.109);全层黄斑裂孔表面积<0.25 μm2组视力好于0.25～0.78 μm2组,差异有统计学意义(t=4.34,P=0.001);全层黄斑裂孔视力与裂孔面积、裂孔基底宽度成负相关(r=-0.604,P=0.01;r=-0.518,P=0.03),与裂孔位置无相关性(r=0.157.P=0.54);板层黄斑裂孔视力与裂孔面积、基底宽度、位置无相关性(P=0.28、0.18、0.36,均>0.05).2组裂孔表面宽度、基底宽度、表面积比较,差异无统计学意义(均为P>0.05);裂孔深度、裂孔底至RPE外界厚度比较,差异均有统计学意义(均为P<0.05).全层黄斑裂孔、板层黄斑裂孔1 mm中心环、1～3环内4个象限视网膜厚度比较,差异无统计学意义(均为P>0.05),2组与假性黄斑孔比较差异均有统计学意义(均为P<0.05);3～6 mm环内4个象限视网膜厚度3组比较,差异无统计学意义(均为P>0.05).结论 全层黄斑裂孔表面积大小明显影响视力,视力与裂孔大小、基底宽度相关;板层黄斑裂孔视力与裂孔形态无相关性.全层和板层裂孔除裂孔深度、裂孔底至视网膜色素上皮外界厚度外,其他形态学比较无差异性,两者3 mm内区域视网膜厚度变化不同,3 mm外区域视网膜厚度变化相同.     

Macular hole size as a prognostic factor in macular hole surgery

BACKGROUND/AIM: In 1991 there was a series of successful closures of a macular hole after vitrectomy and membrane peeling. Today this technique has become a standard procedure. The aim of this study was to evaluate the role of optical coherence tomography in diagnosing and staging, as well as in predicting, the functional and anatomical outcome after macular hole surgery. METHOD: In a prospective study 94 consecutive patients (20 male, 74 female) with a mean age of 67.6 (SD 6.0) years and a macular hole stage II (n = 8), III (n = 72), and IV (n = 14) according to the classification by Gass were examined with optical coherence tomography (OCT) before pars plana vitrectomy. Macular hole diameters were determined at the level of the retinal pigment epithelium (base diameter) and at the minimal extent of the hole (minimum diameter). Calculated hole form factor (HFF) was correlated with the postoperative anatomical success rate and best corrected visual acuity. The duration of symptoms was correlated with base and minimum diameter of the macular hole. RESULTS: In eyes without anatomical closure of the macular hole after one surgical approach (13/94) the base diameter (p1) and the minimum diameter (p2) were significantly larger than in cases with immediate postsurgical closure (p1 = 0.003; p2 = 0.028). There was a significant negative correlation between both the base and the minimum diameter of the hole and the postoperative visual function (p1 = 0.016; p2 = 0.002). In all patients with HFF >0.9 the macular hole was closed following one surgical procedure, whereas in eyes with HFF <0.5 anatomical success rate was 67%. Better postoperative visual outcome correlated with higher HFF (p = 0.050). There was no significant correlation between the duration of symptoms and base or minimum diameters (p1 = 0.053; p2 = 0.164), respectively. CONCLUSION: Preoperative measurement of macular hole size with OCT can provide a prognostic factor for postoperative visual outcome and anatomical success rate of macular hole surgery. The duration of symptoms did not correlate with the diameters measured. Base and minimum diameters especially seem to be of predictive value in macular hole surgery.     

Familial exudative vitreoretinopathy and macular hole exhibited in same individual

This observational case report is designed to report the first known occurrence of Familial Exudative Vitreoretinopathy (FEVR) and macular hole in the same individual. Clinical exams and fluorescein angiography were used to evaluate patient. Indirect laser panretinal photocoagulation was used to treat the right eye. A nine-year old male was diagnosed with familial exudative vitreoretinopathy in both eyes, as well as a full-thickness macular hole in his right eye. Medical histories indicated that the macular hole was not caused by trauma. Indirect laser panretinal photocoagulation was performed to treat an exudative process caused by FEVR in the right eye, and the exudative retinal detachment regressed. A vitrectomy was later also performed to treat traction retinal detachment as well as macular hole in the right eye. Our conclusion is that macular hole can be associated with familial exudative vitreoretinopathy.     

Early postoperative macular morphology and functional outcomes after successful macular hole surgery

PURPOSE: To investigate the relationship between early postoperative macular morphology and postoperative visual acuity in eyes that had undergone successful macular hole (MH) surgery. METHODS: Pars plana vitrectomy and internal limiting membrane peeling were performed during surgery for idiopathic MHs on 25 eyes. The macular configuration was determined by optical coherence tomography, and best-corrected VA (BCVA) was measured postoperatively. RESULTS: Eleven eyes had nearly normal foveal morphology (normal group) and 14 eyes had subretinal fluid or intraretinal cysts (abnormal group) at 1 month. Among the 14 eyes in the abnormal morphology group, normal foveal morphology was confirmed in 9 eyes 3 months and in the remaining 5 eyes 6 months after surgery. Mean BCVA improved significantly from the preoperative values in both groups 6 months after surgery. CONCLUSIONS: The morphology of the macular area was abnormal in more than one half of eyes that had successful MH surgery 1 month after surgery. However, by 6 months, all eyes had normal macular configuration, and BCVA was not significantly different in the two groups. We conclude that an abnormal morphologic appearance of the macular area in the early postoperative period does not predict the final visual outcome.     

Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography

Background  

To report on changes in retinal morphology during the 12 months after macular hole surgery.     

Predictive value of pattern VEP, pattern ERG and hole size in macular hole surgery

· Objective: To describe pattern-reversal visual evoked response (PRVEP) and pattern electroretinogram (PERG) parameters in eyes with macular hole and their value for predicting postoperative visual outcome. · Methods: Prospectively we studied 27 eyes (27 patients) with a full-thickness macular hole. Preoperatively the hole and rim were measured and the PRVEP and PERG were recorded. The preoperative parameters were correlated with postoperative visual outcome. · Results: The macular hole was closed in 26 of 27 eyes. Sixteen eyes (59%) had an increase in visual acuity (VA) of two lines or more, 10 eyes (37%) remained within one line of preoperative VA and 1 eye (4%) had a decrease in VA of two lines. Duration of symptoms was negatively correlated with preoperative VA (R=–0.547, P=0.0038) and postoperative VA (R=–0.519, P=0.0065) and positively correlated with hole area (R=0.533, P=0.0061) and rim area R=0.633, P=0.0009). Only the PRVEP P100 latency of the 10′ check size and the PERG N35 latency were significantly associated with visual outcome (P=0.022 and P=0.042 respectively). · Conclusions: There was no association of either hole or rim size with postoperative visual outcome. Preoperative electrophysiology, however, is useful as a prognostic tool. Utilization is limited to the use of latency parameters of the response and is dependent on the check size of the stimulus. Received: 3 November 1998 Revised version received: 8 January 1999 Accepted: 19 January 1999     

Visual acuity related to retinal distance from the fovea in macular disease

The visual potential of patients with macular diseases involving the fovea has not been adequately documented. We evaluated 55 eyes of patients having discrete macular lesions and related best visual acuity to retinal distance from the fovea. Best visual acuity in the parafoveal area extending from the center of the fovea to a distance of 0.25 disk diameters (DD) away was 20/25 to 20/50; from 0.25 to 0.5 DD, 20/50 to 20/100; from 0.5 to 0.75 DD, 20/100 to 20/200; from 0.75 to 1.0 DD, 20/200 to 20/400; and greater than 1.0 DD, counting fingers. The clinical importance of the findings as they relate to the rationale of laser treatment of macular lesions and to the evaluation of the low-vision is discussed.     

Tomographic features of a lamellar macular hole formation and a lamellar hole that progressed to a full-thickness macular hole

PURPOSE: To report optical coherence tomography of a lamellar macular hole and a lamellar macular hole that progressed to a full-thickness macular hole. METHODS: Case Reports. RESULTS: Case 1. In the right eye of a 66-year old man, a lenticular-shaped split was present in the inner neurosensory retina corresponding to the fovea. Three months later, an operculum formed anterior to the fovea where the retina was attenuated. Case 2. In the left eye of a 58-year old woman, a foveal cyst was seen in the inner neurosensory retina and the inner wall of the cyst was elevated, where a slightly detached posterior vitreous cortex was attached. One month later, the inner wall was operculated, leaving a thin foveal bottom. Four months later, the hole progressed to a full-thickness macular hole. CONCLUSION: Lamellar macular hole appears to form when the inner wall of a split or cyst in the neurosensory retina at the fovea is avulsed by vitreous traction.     

特发性黄斑裂孔对侧眼的观察分析

目的 应用光学相干断层扫描(optical coherence tomography,OCT)对特发性黄斑裂孔患者对侧眼的后极部视网膜与玻璃体的扫描,观察其早期变化及演变过程分析.方法 对45例临床已确诊的特发性黄斑裂孔患者的对侧眼进行OCT扫描.结果 45例患者对侧45只眼中,23只眼有异常,OCT扫描后显示其中8只眼为1～2期单纯玻璃体后脱离(posterior vitreous detachment,PVD),3只眼为3期PVD,4只眼为1期黄斑裂孔,5只眼为2期黄斑裂孔,3只眼为3期黄斑裂孔,未发现4期黄斑裂孔,其余22只眼未见明显异常表现.随访一年半后发现1期黄斑裂孔的2只眼、2期黄斑裂孔的4只眼,1～2期PVD的2只眼进展为3～4期黄斑裂孔(共8只眼进展为3～4期黄斑裂孔),1期黄斑裂孔1只眼进展为2期黄斑裂孔,22只正常眼中有4例发现1～2期PVD,其余未见异常改变.结论 特发性黄斑裂孔有双眼发病的可能,对侧眼发生黄斑裂孔的可能性应引起重视,利用OCT可以对其黄斑区玻璃体视网膜关系进行观察、随访,并且评估其发生黄斑裂孔的可能性及危险性,可以适时采取干预措施.

Abstract：

Objective Using OCT (optical coherence tomography, OCT) to scan the posterior retina and vitreous, investigate the initial changes and developing process. Methods The fellow eyes of 45 patients with unilateral full-thickness macular holes were examined by OCT. Results In the 45 eyes, 23 eyes were abnormity observed by OCT. OCT images showed that among the 23 initially diseased eyes the number of posterior vitreous detachment of 1-2 and 3stages was respectively 8 and 3 eyes, macular hole of 1, 2, 3 stages was respectively 4, 5, and 3 eyes, there was not stage 4 macular hole. After one year and a half fellow-up, among the 23 abnormity eyes, 8 eyes developed a full-thickness macular hole, and 4 eyes of the other 22 normal eyes developed a posterior vitreous detachment. Conclusions It is possible that idiopathic macular hole development in fellow eyes of patients with unilateral macular hole should attract our attention. Posterior vitreoretinal relationship can be observed and follow-up by OCT, and to assess the likelihood of occurrence of macular holes and risk, guide our interventions.     

玻璃体手术联合黄斑裂孔光凝治疗高度近视黄斑裂孔性视网膜脱离

目的 探讨高度近视黄斑裂孔性视网膜脱离玻璃体手术中行黄斑裂孔光凝的适应证及手术技巧并评价治疗效果.方法 选择21例高度近视黄斑裂孔性视网膜脱离患者,行常规经平坦部玻璃体切除、重水下行黄斑裂孔激光光凝、气-液交换、C3F8填充玻璃体腔,术后保持头低位,随访1～6个月.结果 18例术后视网膜全部复位,3例气体吸收后视网膜脱离复发;术后视力提高者16例,不变者2例,下降者3例.结论 对于某些高度近视黄斑裂孔性视网膜脱离,行玻璃体手术,并在手术中行激光封闭黄斑裂孔能够到达复位视网膜、防止视网膜脱离复发的目的.     

Spontaneous macular hole closure in bilateral macular holes

The natural course of full thickness macular hole is progression in size and stage. There have been reports of spontaneous closure of unilateral idiopathic full thickness macular holes, but we report the first case of spontaneous closure of a full thickness macular hole in one eye in a patient with bilateral idiopathic full thickness macular holes. After macular hole surgery in the left eye of the patient, spontaneous closure of the macular hole in the right eye was observed during the follow-up period.     

黄斑裂孔手术

目的：评价转移生长因子（ＴＧＦｂ）、自体血清、或无眼内填充物治疗黄斑裂孔的手术成功率。 方法对４４例５０只眼行玻璃体切割手术联合后部玻璃体脱离治疗黄斑裂孔。１５只眼术中用ＴＧＦｂ，其中包括 ３ 只眼初次手术失败，２０只眼用自体血清，１５只眼术中无任何填充物。 结果５０只眼中３５只眼（７０％）黄斑裂孔手术成功，其中 ＴＧＦｂ组 １５只眼（１００％），自体血清组１１只眼（５５％），无填充物组 ９只眼（６０％）手术成功（Ｐ＜０．０５）。 ＴＧＦｂ组术后视力均提高（Ｐ＜０． ０５）。术后并发症包括晶体核硬化 （１１只眼， ２２％），视网膜脱离（２ 只眼，４％），眼压高于 ４． ００ｋＰａ并持续１ｗｋ以上（７ 只眼， １４％），自体血清组有 １例术后１ｗｋ发生感染性眼内支。 结论ＴＧＦｂ对治疗黄斑裂孔有显著作用。     

Stereo acuity in patients with unilateral macular hole and after unilateral macular hole surgery

PURPOSE: To investigate stereo acuity levels in patients with unilateral idiopathic macular hole and after surgical intervention. METHODS: In 31 consecutive patients with a unilateral macular hole and 46 consecutive patients who underwent successful unilateral macular hole surgery, complete ocular examinations, including orthoptic examinations and microperimetry using the scanning laser ophthalmoscope, were performed. RESULTS: A significantly positive correlation was found between VA and stereo acuity (r = 0.87, P < 0.01). After successful surgery, stereo acuity also correlated with the presence or absence of absolute and/or relative scotoma, and was best in eyes without scotomata. Patients with unilateral idiopathic macular hole, suppression, and symptom duration of 24 months or longer had no stereoscopic vision. CONCLUSIONS: The results indicated that in patients with unilateral idiopathic macular hole and after surgery, stereo acuity correlated with VA. Patients with unilateral macular hole should be operated upon as early as possible, resulting in better VA and better stereo acuity.     

黄斑裂孔视网膜脱离再手术分析

１９９０年１月至１９９５年１２月，我院黄斑裂孔视网膜脱离再手术的病例１２１眼，占同期黄斑裂孔视网膜脱离病人数的１８．０％。再手术原因以ＰＶＲ发展、黄斑孔周玻璃体视网膜牵引、后巩膜葡萄肿、黄斑区脉络膜萎缩斑为主；再次手术以玻璃体手术为主，总治愈率达８０．２％。手术后视力有明显提高。术后激光的使用对视力无明显影响。     

Factors related to initial success in macular hole surgery

PURPOSE: To evaluate the factors of initial success in macular hole surgery. METHODS: This study included 526 eyes of 480 patients who underwent idiopathic macular hole surgery by one and the same surgeon. Surgical methods included conventional method (392 eyes), retinal pigment epithelium (RPE) scalping (61 eyes), internal limiting membrane (ILM) removal (62 eyes), and RPE scalping combined with ILM removal (11 eyes). To evaluate the factors of initial success multiple regression was performed using the variables of (gender, age, stage, duration of symptoms, hole size, axial length, and preoperative visual acuity). RESULTS: The rate of initial success was 81.4% in all eyes, 80.9% in the conventional method, 78.7% in RPE scalping, 83.9% in ILM removal, and 100% in RPE scalping combined with ILM removal. Significant factors of initial success were as follows: gender (r = -0.091, p = 0.053), age (r = -0.14, p = 0.0062), duration of symptoms (r = -0.23, p < 0.0001), hole size (r = -0.23, p < 0.0001), and axial length (r = -0.21, p < 0.0001) in the conventional method, hole size (r = -0.56, p = 0.0006) in ILM removal and stage (r = -0.43, p = 0.0011) and preoperative visual acuity (r = 0.30, p = 0.018) in RPE scalping. CONCLUSIONS: Significant factors of initial success were being male being young, shorter duration of symptoms, smaller hole size, and shorter axial length in the conventional method, smaller hole size in ILM removal and stage 4 and better preoperative visual acuity in RPE scalping method.