特发性黄斑裂孔患者手术前后中心视野的改变

目的 分析特发性黄斑裂孔患者手术前后的中心视野改变情况.方法 对2005～2006年在中山大学中山眼科中心接受玻璃体手术联合0.25%ICG辅助内界膜剥离治疗的特发性黄斑裂孔患者共19例(19只眼),用Octopns101全自动视野计M2程序观察手术前及手术后2个月、6个月、1年时患者中心10度视野平均缺损(MD)及中心4度平均敏感度(MS)的改变情况.结果 特发性黄斑裂孔手术后共有16例裂孔闭合(84.21%).经多元方差分析16例裂孔闭合的病人手术前及术后2月、6月、1年10度中心视野MD及4度中心视野MS四次测量结果之间的改变情况,趋势图显示术后2个月视野较术前差,随时间延长逐渐有所恢复.结论 特发性黄斑裂孔患者术后2个月时中心视野较术前变差,随时间延长逐渐接近术前水平.     

Incomplete fluid-air exchange technique for idiopathic macular hole surgery

AIM: To explore an improved procedure involving incomplete fluid-air exchange for idiopathic macular hole (IMH), and the closure rate, visual function, and the visual field of macular holes (MHs) were evaluated. METHODS: This prospective randomized controlled study, included 40 eyes of 40 patients with IMH who were treated with pars plana vitrectomy and peeling of the internal limiting membrane. They were grouped by random digital table. Twenty-one eyes underwent incomplete fluid-air exchange (IFA) and 19 eyes underwent traditional complete fluid-air exchange (CFA) as the control group. Outcomes included best-corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography, light adaptive electroretinography, and visual field evaluations. RESULTS: All MHs <400 μm were successfully closed. BCVAs before and 6mo after surgery were 0.82±0.41 logMAR and 0.28±0.17 logMAR in IFA group and 0.86±0.34 logMAR and 0.34±0.23 logMAR in CFA group, respectively. The electroretinogram analysis of patients in IFA group revealed increases in b-wave amplitudes at 1, 3, and 6mo after surgery. Additionally, patients in IFA group showed an amplitude increase of 28.6% from baseline at 6mo (P<0.05), while no obvious improvements were noted in CFA group. Although there were no statistically significant improvements in either group, the IFA group showed a slight increase in mean sensitivity (P>0.05). CONCLUSION: IFA is a reliable method that offers comparable closure rate to CFA and facilitates improvements in visual function.     

Characteristics of macular microvasculature before and after idiopathic macular hole surgery

AIM:To evaluate the macular microvasculature before and after surgery for idiopathic macular hole(MH)and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration.METHODS:Twenty eyes from 20 patients with idiopathic MH were enrolled.Optical coherence tomography angiography(OCTA)images were obtained before,2 wk,1,and 3 mo after vitrectomy with internal limiting membrane peeling.Preoperative foveal avascular zone(FAZ)area and perimeter and regional vessel density(VD)in both layers were compared according to the 3-month best-corrected visual acuity(BCVA).RESULTS:The BCVA improved from 0.98±0.59(log MAR,Snellen 20/200)preoperatively to 0.30±0.25(Snellen 20/40)at 3 mo postoperatively.The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group(all P<0.05).A significant reduction was observed in FAZ parameters and all VDs 2 wk postoperatively.Except for deep perifoveal VD,all VDs recovered only to their preoperative values.The postoperative FAZ parameters were lower during follow-up.Decreases in preoperative deep VDs were correlated with worse postoperative BCVA(Pearson’s r=-0.667 and-0.619,respectively).A larger FAZ perimeter(Spearman’s r=-0.524)and a lower deep perifoveal VD preoperatively(Pearson’s r=0.486)were associated with lower healing stage.CONCLUSION:The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH.Except for the deep perifoveal region,VD recovers only to preoperative levels.     

黄斑孔患者手术后生活质量变化

目的评价黄斑孔手术对患者生活质量的影响。方法黄斑孔患者25例（25眼）行常规玻璃体切除术并注入C3F8。手术前和手术后5月完成中文版低视力者生活质量量表。结果1次手术黄斑孔解剖闭合率为84．00％（21／25）。手术眼视力及双眼并用视力在手术前和手术后5月差异无统计学意义（分别是P=0.206，P=0.283）。远视力、移动和光感以及读和精细工作2个指标和生活质量总分在手术前后差异有统计学意义（分别为P=0．043，P=0．034，P=0．035）。结论 黄斑孔手术能改善患者的生活质量。生活质量量表的应用结合传统的临床检查能较全面地反映手术干预后患者健康状况的变化。     

特发性黄斑前膜手术前后嵌合体带改变与视功能的相关性

目的:探讨特发性黄斑前膜(IMEM)患者手术前后黄斑区微结构与术后视功能恢复的相关性。方法:选取2017-01/2019-12就诊于我院的IMEM患者43例43眼,术前、术后3、6、9mo均检测最佳矫正视力(BCVA),进行视物变形(M-chart评分表)评分,并采用频域光学相干断层扫描(SD-OCT)测量中心凹视网膜厚度(CFT)、中心凹下脉络膜厚度(SFCT)、神经节细胞-内丛状层(GC-IPL)厚度及嵌合体(IZ)带缺损长度。结果:术后3、6、9mo,纳入患者BCVA和视物变形程度均较术前逐渐改善(均P<0.05),且BCVA与CFT、IZ带缺损长度均呈正相关(P<0.05),与SFCT、GC-IPL厚度均无相关性(P>0.05);视物变形评分与CFT均呈正相关(P<0.05),与SFCT、GC-IPL厚度、IZ带缺损长度均无相关性(P>0.05)。结论:CFT和IZ带缺损长度与IMEM术后BCVA具有显著相关性,这两项指标可作为预测IMEM术后视功能恢复的指标。     

Multifocal ERG changes before and after macular hole surgery

To evaluate the visual function of 15 eyes suffering from macular hole the multifocal ERG was used pre and postoperatively. In all the cases a successful vitrectomy has been done with macular hole closure in all the eyes. The Multifocal ERG shows an improvement of retinal response density in regions 1 and 2, even in the 2 eyes with unchanged visual acuity postoperatively. Although a relationship exist between the postoperative retinal response density and the visual acuity, the retinal response density varies between eyes with the same visual acuity.     

SD-OCT参数评估黄斑裂孔内界膜撕除术后视力改善的应用价值

目的：分析频域光学相干断层扫描(SD-OCT)参数评估黄斑裂孔内界膜撕除术后视力改善情况的应用价值。方法：回顾性分析2019-05/2021-02于我院行玻璃体切除+内界膜撕除+长效气体填充术治疗的特发性黄斑裂孔(IMH)患者82例82眼的临床资料,分析术后3mo IMH闭合情况与SD-OCT参数的相关性,并评估影响术后视力改善不良的危险因素。结果：Spearman秩相关分析显示,术后3mo IMH闭合情况与术前外界膜(ELM)缺损直径呈正相关(rs=0.308,P&#x003C;0.05),与术前黄斑裂孔指数(MHI)呈负相关(rs=-0.266,P&#x003C;0.05)。Logistic回归分析显示,术前MHI≥0.5是影响术后视力改善不良的保护因素(OR=0.691,P&#x003C;0.05)。结论：SD-OCT可通过检测术前MHI及ELM缺损直径等参数预测手术疗效,对判断视功能改善情况有利。     

恰当开展特发性黄斑裂孔的手术治疗

特发性黄斑裂孔是近二十年来眼科手术治疗领域里较为引人注目的疾病,特别是近十年来,随着视网膜检查设备的更新和手术技术的发展,有关该病的发病机制、治疗对策和手术效果等方面均发生了很多变化,同时仍然存在一些有争议的技术问题。国内对该病的认识和治疗效果已部分接近或达到国际水平,但各地水平差异较大。本文目的旨在帮助国内同行提高对特发性黄斑裂孔发病本质及其手术技术的认识,恰当开展有关的手术治疗,避免盲目追求手术治疗或一味保守观察而错失手术时机。     

Hyperbaric oxygen therapy reduces visual field defect after macular hole surgery

BACKGROUND AND OBJECTIVE: One of the serious complications that may arise after macular hole (MH) surgery is a temporal visual fields (TVF) defect. We hypothesized that hyperbaric oxygen (HBO) therapy improves the visual field (VF) in these patients. MATERIALS AND METHODS: Vitrectomy for MH was performed on 73 eyes from 1994 to 1997. TVF defect was detected in 19 eyes and, of that 19, 12 patients were followed. Seven patients were treated with HBO therapy and 5 were controls. HBO was performed for approximately 110 minutes a day with 100% oxygen inhalation and a maximum of 2.8 atmospheric pressure. This continued for 20 days. The preoperative VF determined by kinetic perimetry was considered to be 100%, and the VF following HBO therapy was compared with that standard. RESULTS: We detected VF defect (postoperative VF area average 71.9+/-12.8% of the preoperative VF). In all 5 patients who had no HBO therapy, TVF defects remained, while the TVF recovered remarkably in all patients treated with HBO therapy. The VF recovered to 81.7+/-16.7% of the preoperative VF after 3 days of HBO, and to 91.6+/-15.8% months after HBO therapy. CONCLUSION: We speculated that the cause of TVF defect is likely to be chorioretinal circulation disturbance during surgery, and that HBO activates the retinal cells and improves VF. We conclude that HBO is useful in the treatment of TVF defect after macular hole surgery.     

特发性黄斑裂孔玻璃体切割手术后的视功能

目的：探讨特发性黄斑裂孔（IMH）玻璃体切割手术后的视功能状况，方法：复习并总结国内外相关文献资料，综合评述IMH玻璃体切割手术后视功能状况。结果：多数患者术后视力较术前提高2行或2行以上，并且主观感觉的视物变形和暗点，辨色力，双眼融合功能和立体视功能也有所改善，术后视野光敏度较术前有所提高；注视性质由术前的偏心注视多数恢复为主后的中心注视，然后部分患者视力的改善提高不显著甚至出现视力下降，部分患者黄斑裂孔虽然获得解剖愈合，但仍遗留某些视觉缺陷。影响术后视力和其他视功能恢复的因素是复杂的，通常与术前视力和视功能状况的好坏，病程长程，裂孔分期早期、手术方式，裂孔愈合状态以及手术合并症等诸多因素相关。结论：黄斑裂孔一旦发生，其裂孔愈合和视功能稳定的机会极少，因此多数学者主张若诊断明确应早手术封闭裂孔，评价玻璃体切割手术治疗IMH的疗效。应在解决形态愈合的基础上综合患者的视力，主观感觉及临床多项视功能进行全面评估。     

Visual function assessment and metamorphopsia after macular hole surgery.

The purpose of this study was to develop a new resolution acuity measure for patients after macular hole surgery. Fifty eyes of 44 patients who had undergone successful treatment were tested. Visual acuity was measured with the Snellen, Early Treatment of Diabetic Retinopathy Study and Landolt-C charts. A Line Resolution Test was performed as part of their follow-up exam where a vertical line was presented. Participants were categorized by their perception of the line as solid, bent or broken. The line could be distorted into a sine-wave pattern in order to determine the participants' detection threshold for the distortion. Chart acuities did not differ among the three groups, as categorized by their line perception. Only the distortion measure was sensitive enough to differentiate the solid- from the broken-line group. The distortion measure assesses resolution power of the macula in smaller increments than acuity charts. This hyperacuity approach is more appropriate in the assessment of functional outcome after microsurgery.     

改良黄斑裂孔手术疗效分析

目的：比较改良黄斑裂孔手术与传统黄斑裂孔手术治疗特发性黄斑裂孔(idiopathic macular hole,IMH)的疗效。

方法：连续选取2014-04/2017-06就诊于我院的IMH患者28例28眼,接受我院同一医师独立完成的手术治疗,分为两组。A组13例为传统玻璃体切除内界膜剥除术联合C₃F₈填充治疗组(简称传统组),B组15例为改良吲哚菁绿染色内界膜剥除联合黄斑裂孔整复空气填充治疗组(简称改良组)。所有患者在术后1wk,1、3、6mo复查。比较两组患者术前和术后末次最佳矫正视力(best corrected visual acuity,BCVA)、手术时间、末次复查时裂孔的闭合率、俯卧时间。

结果：两组患者裂孔闭合率差异无统计学意义(P>0.05); 两组患者术后BCVA较术前均提高,差异有统计学意义(P<0.05),但两组间术前和术后BCVA比较差异均无统计学意义(P>0.05); B组手术时间较A组明显缩短,差异有统计学意义(P<0.05); B组俯卧时间较A组明显缩短,差异有统计学意义(P<0.05)。

结论：与传统组相比,改良吲哚菁绿染色内界膜剥除联合黄斑裂孔整复空气填充可以获得同样较高的裂孔闭合率,而且手术操作步骤简化,缩短了手术时间,减少器械进出切口的次数,从而减少并发症的发生。术后患者俯卧时间明显缩短,舒适度高、依从性好。     

Residual triamcinolone acetonide at macular hole after vitreous surgery

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.     

两种内界膜剥离方式治疗MHCI<0.7特发性黄斑裂孔的疗效

目的：观察玻璃体切割术中不同内界膜剥离方式治疗黄斑裂孔闭合指数(MHCI)<0.7特发性黄斑裂孔(IMH)的临床效果。

方法：将2014-05/2017-05收治的MHCI<0.7 IMH患者88例88眼随机分为A组(44眼,行扩大内界膜剥离术)和B组(44眼,行标准内界膜剥离术),观察两组患者黄斑裂孔闭合情况、最佳矫正视力(BCVA)、中心暗点及并发症发生情况。

结果：术后6mo,A组患者黄斑裂孔闭合率明显高于B组(91% vs 75%,P<0.05),BCVA优于B组(0.47±0.05 vs 0.74±0.14,P<0.05),中心暗点眼数占比低于B组(4% vs 23%,P<0.05),且两组患者并发症发生率无明显差异(11% vs 9%,P>0.05)。

结论：临床治疗MHCI<0.7的IMH采用扩大内界膜剥离术较标准内界膜剥离术疗效更突出,前者视网膜功能恢复效果更佳。     

Outcomes of chronic macular hole surgical repair

Purpose:

To report visual and anatomic outcomes of chronic macular hole surgery, with analysis of pre-operative OCT-based hole size and post-operative closure type.

Settings and Design:

An IRB-approved, retrospective case series of 26 eyes of 24 patients who underwent surgery for stage 3 or 4 idiopathic chronic macular holes at a tertiary care referral center.

Statistical Analysis:

Student''s t-test.

Results:

Nineteen of 26 eyes (73%) had visual improvement after surgery on most recent exam. Twenty-one of 26 eyes (81%) achieved anatomic closure; 16 of 26 eyes (62%) achieved type 1, and five of 26 eyes (19%) achieved type 2 closure. Post-operative LogMAR VA for type 1 closure holes (0.49) was significantly greater than for type 2 closure and open holes (1.26, P < 0.003 and 1.10, P < 0.005, respectively), despite similar pre-operative VA (P = 0.51 and 0.68, respectively). Mean pre-operative hole diameter for eyes with type 1 closure, type 2 closure, and holes that remained open were 554, 929, and 1205 microns, respectively. Mean pre-operative hole diameter was significantly larger in eyes that remained open as compared to eyes with type 1 closure (P = 0.015).

Conclusion:

Vitrectomy to repair chronic macular holes can improve vision and achieve long-term closure. Holes of greater than 3.4 years duration were associated with a greater incidence of remaining open and type 2 closure. Larger holes (mean diameter of 1205 microns) were more likely to remain open after repair.     

Additional gas injection after failed macular hole surgery with internal limiting membrane peeling

PURPOSE: To report the efficacy of additional intravitreal gas injection in eyes where primary failure occurred following apparently successful macular hole surgery. METHODS: Patients presenting with macular hole underwent a primary surgical procedure consisting of vitrectomy with phacoemulsification and intraocular lens implantation. The internal limiting membrane was stained with indocyanine green and peeled. At the end of this manoeuvre a fluid-gas exchange was performed and the macular hole tamponaded with 20% sulphur hexafluoride. The patients were instructed to assume a face-down position for 12 h per day until the macular hole closed. In those cases where primary closure was not achieved, an additional quantity of 20% sulphur hexafluoride was injected into the vitreous cavity via a 27-gauge needle connected to a 5-mL syringe. The patients were instructed to assume the same position. RESULTS: A total of 40 eyes from 40 consecutive patients underwent primary macular hole surgery. The macular hole was not successfully closed in seven eyes and a further gas injection was made in these eyes. This additional procedure led to macular hole closure in all cases within a mean of 4.1 days. Visual acuity improved in all seven eyes, and the final visual outcomes were no worse than those eyes that had successful primary closure. CONCLUSIONS: Additional gas injection is an effective treatment for eyes with open holes following unsuccessful primary surgery.     

Assessment of macular function by multifocal electroretinogram before and after macular hole surgery

AIM: To evaluate macular function before and after successful surgical closure of idiopathic macular holes using multifocal electroretinogram (ERG). METHODS: 40 patients (40 eyes) with idiopathic macular holes were examined using multifocal ERG both before and after vitreous surgery. The postoperative period was from 1 to 12 months. RESULTS: Preoperatively, the electrical retinal response densities in the foveal and the perifoveal area were apparently decreased. After a mean postoperative period of 3-6 months, the foveal and perifoveal area electrical retinal response densities improved to two to four times the preoperative level and the improvement continued to 1 year after surgery. CONCLUSION: In macular holes, the decrease in retinal electrophysiological response was not limited to the fovea but involved an area of the perifovea of 1.6 disc diameters. The electrical retinal response density of these areas gradually improved after macular hole closure.     

特发性黄斑裂孔玻璃体切割术后视力恢复及黄斑解剖愈合的相关因素分析

目的 探讨特发性黄斑裂孔玻璃体切割术后影响视力恢复及黄斑解剖愈合的相关因素.方法 49例49眼特发性黄斑裂孔行玻璃体切割联合内界膜剥离术的患者纳入本研究.行最佳矫正视力(best corrected visual acuity,BCVA) (logMAR)检查、裂隙灯显微镜及间接检眼镜等检查,同时采用光学相干断层扫描检测黄斑裂孔基底直径、裂孔边缘高度及裂孔最小径,计算黄斑裂孔指数(macular hole index,MHI)、黄斑裂孔牵拉指数(tractional hole index,THI),对黄斑裂孔愈合情况分类.观察术后6个月时视力恢复及黄斑裂孔愈合情况,并与年龄、病程、术前BCVA、裂孔基底直径、裂孔高度、裂孔最小径、MHI、THI等进行相关性分析.结果 术后BCVA为(0.45±0.29) logMAR,与术前BCVA(0.89±0.34) logMAR相比差异具有统计学意义(t=34.2,P=0.000).术后裂孔基底直径为(432.1±90.7) μm,裂孔边缘高度为(214.0±81.3) μm,裂孔最小径为(195.3 ±86.2)μm,均较术前明显减小,差异均有统计学意义(均为P=0.000);术后49眼中,裂孔完全愈合者31眼(63.3％),部分愈合者14眼(28.6％),未愈合者4眼(8.2％).相关性分析结果表明,术后BCVA (logMAR)与年龄、病程、术前BCVA (logMAR)均无相关性(均为P ＞0.05),而与MHI、THI显著相关(r=0.763,P=0.000;r =0.814,P=0.000);黄斑裂孔愈合类型与裂孔基底直径、裂孔边缘高度、裂孔最小径、MHI、THI均显著相关(均为P＜0.05),而与术前BCVA、病程、年龄无相关性(均为P＞0.05).结论 MHI、THI可作为预测术后视力恢复及黄斑裂孔愈合的指标.