特发性黄斑裂孔的视功能

随着玻璃体手术的飞速发展,特发性黄斑裂孔日益受到重视。另外,以往临床上一直作为评价术后疗效主要指标的裸眼及最佳矫正视力,已很难涵盖视觉质量的全部内容。本文介绍对比敏感度、视野、多焦点视网膜电图、立体视功能等现代视功能检查及其在特发性黄斑裂孔中的应用和临床意义,以及手术对其视功能的影响。这些检查不仅对特发性黄斑裂孔的早期诊断、手术适应证把握及术后视觉质量的评价有重要指导意义,而且有助于客观分析术后患者主观视觉质量差的原因并加以处理。熟悉视功能评价的内容和意义,有助于提高此类黄斑裂孔的手术水平,使患者获得更好的术后视觉质量。     

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。     

特发性黄斑裂孔手术治疗前后的视功能

目的 探讨特发性黄斑裂孔手术治疗前后患者的视功能。方法 19例(19只眼)特发性黄斑裂孔患者,其中2期3只眼,3期10只眼,4期6只眼。采用玻璃体视网膜手术治疗黄斑裂孔。术前和术后均进行国际标准视力、激光视网膜视力、明视强度反应ERG和Humphrey　30-2程序视野测定。 结果 (1)国际标准视力：术前视力0.01至0.1,术后视力0.04至0.4,术前术后视力改变差异无显著性的意义(p＞0.05)。(2)激光视网膜视力：术前激光视网膜视力0.12至0.4,术后激光视网膜视力 从0.2至0.63。术前和术后激光视网膜视力改变差异有显著性的意义(P＜0.05)。(3)ERG明视强度反应曲线：术前和术后b波最大振幅Rmax(μV)和代表曲线斜率的n值的改变差异均无显著性的意义(P＞0.05)。术后半饱合光刺激强度K(cd·sec/m2)的对数单位Log值,较术前降低,差异有显著性的意义(P＜0.05)。(4)Humphrey视野：术后 0～10° 较术前光阈值提高,差异 有显著性的意义(P＜0.05)。术前和术后15～30°光阈值差异无显著性的意义(P＞0.05)。 结论 手术治疗IMH能提高视网膜黄斑部视锥细胞功能。（中华眼底病杂志,2000,16：213-284）     

特发性黄斑裂孔手术前后的视功能改变

玻璃体手术自1991年以来已成为治疗黄斑裂孔的主要手段,而手术后的视功能改善情况成为评价手术成功与否的关键,其指标主要表现在手术后远、近视力有所提高,视物变形有所减轻,中心暗点有所减轻,色觉敏感度有所提高,多焦ERG、立体视觉以及对比敏感度有所改善。     

特发性黄斑裂孔患者术后裂孔愈合形态与视功能恢复的研究

目的探讨特发性黄斑裂孔患者术后裂孔愈合形态与视功能恢复的关系。方法选择特发性黄斑裂孔1次性术后裂孔愈合患者36例(38只眼)的连续临床资料,进行回顾性分析。应用相干光断层扫描(OCT)观察裂孔愈合形态,采用激光扫描检眼镜(SLO)测定患者术前,术后1、3、6个月黄斑区光敏度、绝对暗点、相对暗点平均面积及中心视力,并对检测结果进行分析。结果根据OCT图像,裂孔形态分为完全愈合型(22只眼)、部分愈合型(10只眼)及未愈合型(6只眼)。术后6个月,完全愈合型和部分愈合型眼的中心视力、光敏度、绝对暗点和相对暗点的平均面积均较术前有明显改善(均P<0.05);未愈合型眼的中心视力、光敏度虽较术前改善,但绝对暗点、相对暗点差异则无显著意义(P>0.05);完全愈合型眼的视力、光敏度、绝对暗点改善程度与部分愈合型和未愈合型眼比较,差异有显著意义(P<0.05)。Ⅱ期裂孔眼术后黄斑中心凹形态可完全恢复。结论术后黄斑区中心凹部视网膜正常形态的恢复与视功能改善程度呈正相关(P<0.05)。术后中心凹的形态恢复越好,视功能改善程度越高。裂孔早期阶段(Ⅱ期裂孔)行手术,更有机会获取良好的视功能。(中华眼科杂志,2004,40:443-447)     

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.     

特发性黄斑裂孔不同浓度吲哚青绿辅助剥除内界膜后视功能对比研究

目的 观察对比不同浓度吲哚青绿(ICG)辅助剥除内界膜后视功能的恢复.方法 取44例(44只眼)特发性黄斑裂孔患者随机分为四组:第1组9例(9只眼),第2组20例(20只眼),第3组10例(10只眼),第4组5例(5只眼).手术方式采用标准三切口玻璃体切割、内界膜剥除联合C3F8填充术.手术中使用ICG辅助剥除内界膜,1、2、3、4组ICG溶液的浓度分别为5.0、2.5、1.25、0.5mg/ml.手术中第1组用少量黏弹剂暂时封闭黄斑裂孔,而第2、3、4组未用任何物质封闭黄斑裂孔.术后定期随访,记录患者的黄斑裂孔闭合率,视力,视野,多焦视网膜电图(MERG).结果 第4组术后黄斑裂孔闭合率偏低.第3组的术后最佳矫正视力优于其它3组.第1,2组术后周边视野缺损的发生率明显高于第3、4组.第1、2组术后MERG周边视网膜二级反应的振幅明显低于手术前,而第3、4组手术前后周边视网膜二级反应的振幅无明显差异.结论 高浓度ICG辅助剥除内界膜对视网膜存在毒性,不利于黄斑裂孔患者术后视功能的恢复;而低浓度ICG辅助剥除内界膜可明显降低ICG对视网膜的毒性,不影响黄斑裂孔患者术后视功能的恢复.     

特发性黄斑裂孔OCT形态特点对视力预后的影响

目的:应用光学相干断层扫描(OCT)进行对玻璃体切割联合内界膜剥除术治疗的特发性黄斑裂孔(IMH)患者术前术后的裂孔形态观察,分析影响视力预后的因素,为有效预测术后视力提供潜在指标。方法:选取患者32例(男7例,女25例)行玻璃体切割联合内界膜剥除,膨胀气体充填手术的IMH患者,对其均进行术前术后的OCT检查和眼科常规检查。取随访期间最佳矫正视力(BCVA),利用OCT的分析模式,分别测量手术前黄斑裂孔的最小直径、基底直径、裂孔高度、黄斑区视网膜厚度。用SPSS13.0软件包,比较术前黄斑裂孔自身形态测量值与术后BCVA的相关性。结果:术后BCVA与术前黄斑裂孔的最小直径和基底直径(r=-0.524,-0.610,P<0.01)呈负相关;与裂孔高度,黄斑区视网膜厚度(r=-0.064,0.003,P>0.05)无明显相关性;与术前黄斑裂孔(maculer hole index,MHI),临床观察,取MHI=0.5为分界值,MHI≥0.5组的患者术后视力明显优于MHI<0.5组(Mann-Whitney Test,P<0.01);手术治疗后的IMH患者BCVA较术前明显提高。结论:黄斑裂孔的最小直径,基底直径越小,术后视力恢复越好。MHI计算简便,MHI≥0.5的患者手术后视力恢复较好,可作为手术选择的指标。玻璃体切割联合内界膜剥除手术治疗特发性黄斑裂孔有良好效果。     

Evaluation of the retinal nerve fiber layer thickness in eyes with idiopathic macular holes

PURPOSE: To compare the retinal nerve fiber layer thickness in eyes with idiopathic macular holes and age-matched normal controls using scanning laser polarimeter. METHODS: The retinal nerve fiber layer thickness was measured in 40 eyes of 40 consecutive patients with idiopathic macular hole (stage 1, 10 eyes; stage 2, eight eyes; stage 3, 15 eyes; stage 4, seven eyes) and 40 eyes of 40 age-matched normal controls with a scanning laser polarimeter. The retinal nerve fiber layer thickness within a 10-pixel-wide ellipse located concentrically with the disk and located 1.5-disk diameters from the center of the disk was measured. The mean overall retinal nerve fiber layer thickness of the peripapillary retina, four 90-degree quadrants, and 16 equal sectors of every 22.5 degrees was calculated for both groups. The retinal nerve fiber layer thickness in the two groups was statistically compared. RESULTS: The mean retinal nerve fiber layer thickness measurement for the overall peripapillary retina and for three of the four 90-degree quadrants was not significantly different between the two groups. However, the temporal 90-degree quadrant was significantly thinner in the macular hole group (47.2 versus 54.6 microm, P =.026). For the 16 sectors of 22.5 degrees, the lower three sectors of the four sectors in the temporal quadrant were thinner in the macular hole group (P <.05). CONCLUSIONS: The retinal nerve fiber layer thickness of the papillomacular area is thinner in eyes with idiopathic macular hole than that in normal eyes. The progressive thinning of the retinal nerve fiber layer thickness as the stage of the macular hole advances may suggest that surgery should be done at the earliest stage.     

Senile idiopathic macular holes

We studied idiopathic macular holes in 11 consecutive patients (all women). We tried to discover the cause of these senile macular holes, so far called idiopathic. The role of vitreoretinal traction is probably unimportant. We found indications of a vascular etiology, which is more suggestive of a cause situated in the choroid or pigment layer. Other possible factors are chronic solar damage and former high oestrogen levels. Therapy is not necessary in this type of macular hole.     

Operculum in idiopathic macular holes

PURPOSE: To detect the factors related to the operculum in idiopathic macular holes and present a pathogenesis of idiopathic macular holes. METHODS: This study included 583 eyes of idiopathic macular hole that underwent macular hole surgery. To detect the factor related to the operculum, the variables of age, duration of symptoms, hole size, preoperative visual acuity, refraction, axial length, refraction axial length ratio were used for the comparison between two groups and multiple regression. The success rate of surgery and postoperative visual acuity were examined whether the operculum was present or not. RESULTS: The variables that were significantly related to the operculum were as follows: refraction axial length ratio (r = 0.18, p = 0.0092) in women of stage 3, duration of symptoms (r = -0.44, p < 0.001), preoperative visual acuity (r = -0.33, p = 0.0025), and refraction axial length ratio (r = -0.22, p = 0.020) in women of stage 4, and age (r = 0.19, p = 0.047) in men of stage 3. There were no significant differences in the success rate of surgery and postoperative visual acuity whether the operculum was present or not. CONCLUSIONS: Generally, operculum tends to occur in aged and round eyes and possibly does not occur in younger and back projected eyes because of retinal fissure. In women of stage 4, the operculum is possibly a torn retina and does not occur in atrophic holes.     

Spectral sensitivity in eyes with macular holes and their fellow eyes

Background: This prospective study was undertaken to investigate whether spectral sensitivity can be useful in determining the prognosis of fellow eyes of eyes with macular holes. Methods: Spectral sensitivity measurements using a one degree test spot presented at a rate of 1 Hz and 25 Hz on a bright (1000 td) white background were carried out on 10 patients aged between 67 and 74 years (mean age 70.3 ± 2.6 years). Each patient had a full thickness macular hole in one eye and a normal contralateral fellow eye. The spectral sensitivity measurements were made with eccentric fixation in the eyes with macular holes and with central fixation in the normal fellow eye. A year later, the patient files were reviewed to look at the patient's ocular condition. Another 10 subjects between the ages of 50 and 80 years (mean age 69.5 ± 4.2 years) were also seen. These control group subjects had visual acuities of 6/9 or better with minimal ocular media changes and no ocular or systemic pathology that could affect colour vision. Results: The 1 Hz and 25 Hz spectral sensitivities of all patients were reduced for both eyes. Despite the good eye without a macular hole having a VA of 6/6, the spectral sensitivity was similar to that of the eye with the macular hole and markedly reduced visual acuity. Conclusion: The present investigation enabled us to examine the chromatic and achromatic mechanisms by testing spectral sensitivity at 1 Hz and 25 Hz, respectively. The data revealed that both chromatic and achromatic processing could be damaged in the eye with a macular hole. Surprisingly, the spectral sensitivities of both 1 Hz and 25 Hz are equally reduced in the good fellow eye with no macular hole. A one‐year follow‐up showed that two of the 10 patients (20 per cent) did eventually develop a macular hole in the normal fellow eye. This indicates that there is some subclinical foveal dysfunction in the normal fellow eye, the nature of which is unclear.     

Bilaterality of idiopathic macular holes

Background: There has been wide variation in estimates of the incidence of bilateral idiopathic macular holes in the literature. This report of a large series of patients with macular holes provides further information regarding incidence of bilaterality, interval between onset in the first and the second eye, and visual outcome. Methods: A retrospective chart review was done of 550 patients with idiopathic macular holes examined at the Bascom Palmer Eye Institute between 1968 and 1994. The incidence of bilaterality was estimated from 365 patients in whom the fellow eye was normal at the initial examination. The rate of onset in the fellow eye was evaluated by survival analysis. Mean follow-up was 31 months (median 17 months). Results: Patients with incomplete macular holes (stage 1, aborted stage 1, lamellar) or full-thickness holes had a 19% incidence of bilaterality at 48 months follow-up. In the subset of 32 patients with full-thickness macular holes in the first eye, 13% developed full-thickness holes in the fellow eye within 48 months. The median interval between the onset in the first and in the second eye was 17.5 months. Visual acuity was excellent and stable in eyes with aborted stage 1 and lamellar holes. The visual acuity in the first eye with full-thickness macular hole decreased to 20/200 or worse in 79% of cases within 36 months' follow-up. Conclusions: The incidence of bilaterality and poor visual function in the majority of full-thickness idiopathic macular holes by 3 years' duration should be considered when advising patients and planning management.     

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。     

Early macular holes with retinoschisis in highly myopic eyes

PURPOSE: We present two cases with early macular holes (MH) complicated by retinoschisis and foveal detachment (RSFD). DESIGN: Case reports. CASE REPORT: A 46-year-old woman and a 70-year-old woman, both with high myopia, presented visual loss and a small MH associated with RSFD. Vitrectomy and gas tamponade were performed. However, both MHs enlarged postoperatively, resulting in progressive retinal detachment. Additional gas tamponade led to retinal reattachment. At the final visit, the MH was open in case 1 but closed in case 2. CONCLUSIONS: Although the benefit of vitrectomy is uncertain, RSFD and MHs can be associated in highly myopic eyes.     

Pathogenesis of idiopathic macular holes

An improvement in our understanding of the pathogenesis and natural history of idiopathic macular holes over the last 10 years has led to a more optimistic and interventionist approach to the surgical management of this vitreoretinal disorder. This article reviews the theories postulated for the pathogenesis of this condition and looks at recent work that has investigated the role of the vitreous, internal limiting membrane, and posterior vitreous detachment in the natural history of macular holes.