特发性黄斑裂孔临床及光学相干断层扫描图像分析

目的分析特发性黄斑裂孔的临床特征及光学相干断层扫描图像的特点。方法回顾性分析2000年3月至2005年12月在我科就诊的152例162眼特发性黄斑裂孔患者的临床资料及光学相干断层扫描图像，观察指标包括发病年龄、性别、眼别、视力、裂孔分期、裂孔孔径及底径大小、裂孔缘视网膜神经上皮层厚度以及对侧眼黄斑部病变情况。结果152例162眼特发性黄斑裂孔患者中，男36例40眼，女116例122眼；年龄28～72岁，其中51~70岁者占76.6％；发病无左、右眼别差异；视力眼前指数~0.5，平均0.15±0.09；特发性黄斑裂孔分期：I期Ⅱ眼，Ⅱ期23眼，Ⅲ期78眼，Ⅳ期50眼；裂孔孔径大小为（552．57±237．39）μm，裂孔底径大小为（980．55±365．64）μm；裂孔缘两侧视网膜神经上皮层厚度分别为（343．68±86．08）μm及（363．45±90．25）μm；23眼伴有黄斑前膜，56眼伴有玻璃体后脱离。非黄斑裂孔眼中黄斑板层孔8眼，黄斑前膜10眼，Ⅲ期裂孔5眼，Ⅳ期裂孔2眼，玻璃体黄斑牵引17眼，玻璃体后脱离16眼。结论特发性黄斑裂孔在临床上多见于5l~70岁的女性患者，发病无眼别差异。光学相干断层扫描可用于特发性黄斑裂孔的分期，观察裂孔大小、裂孔缘视网膜神经上皮层厚度，监测对侧眼黄斑区病情变化，还有助于探索特发性黄斑裂孔的形成机制从而指导临床治疗。     

54例黄斑裂孔临床分析

本文对５４例５６眼黄斑裂孔进行临床分析，提出了不同类型黄斑裂孔的诊断要点和处理原则。认为黄斑裂孔视网膜脱离的手术方式应根据黄斑裂孔大小，有无周边裂孔、视网膜脱离范围等因素决定。对于特发性黄斑裂孔和大部分外伤性黄斑裂孔，即使形成全层裂孔，通常病情稳定，很少发生视网膜脱离，不需要用光凝或其他手术来预防孔源性视网膜脱离。     

全层黄斑裂孔的鉴别诊断

目的：探讨全层黄斑裂孔与板层黄斑裂孔以及囊样黄斑变性的诊断和鉴别诊断方法。 方法：用Amsler方格表、Watzke征检查和激光瞄准光检查对30例全层黄斑裂孔、12例板层黄斑裂孔和8例囊样黄斑变性患者进行检查,其结果用四格表确切概率法进行统计分析。 结果：Amsler方格表检查,Watzke征检查及50μm激光瞄准光试验在全层黄斑裂孔组中阳性率均为100%;板层黄斑裂孔和囊样黄斑变性组中分别为85%、65%及0。 结论：对全层黄斑裂孔的诊断,Amsler表检查具有敏感性,但不具特异性;Watzke征敏感而且较特异;激光瞄准光检查非常敏感而且特异．这些检查有助于对全层黄斑裂孔的准确诊断。 （中华眼底病杂志,1996,12：211-213）     

特发性黄斑裂孔与外伤性黄斑裂孔玻璃体切割手术治疗预后差异比较

目的 观察玻璃体切割手术治疗特发性黄斑裂孔和外伤性黄斑裂孔的预后差异及其影响因素.方法 对特发性黄斑裂孔72例72只眼,外伤性黄斑裂孔55例55只眼的临床资料进行回顾性分析.所有患眼均接受相同方式的玻璃体切割手术治疗.观察两组患者手术后视力改变和黄斑裂孔闭合形式;对比分析黄斑裂孔直径、手术前视力＜0.1和≥0.1、病程＜4个月和≥4个月与手术后视力改变和黄斑裂孔闭合形式之间的相关性.结果 特发性黄斑裂孔72只眼中,闭合72只眼,占100.0%;外伤性黄斑裂孔 55只眼中,闭合47只眼,占85.5%;黄斑裂孔贴附8只眼,占14.5%.特发性黄斑裂孔的裂孔闭合高于外伤性黄斑裂孔的裂孔闭合,二者比较,差异有统计学意义(χ2=11.177,P=0.001).特发性黄斑裂孔和外伤性黄斑裂孔手术后视力与手术前视力比较,差异均有统计学意义(t=-6.841,-4.093;P值均=0.000).特发性黄斑裂孔和外伤性黄斑裂孔手术后视力提高者组间比较,差异无统计学意义(χ2=3.651,P=0.07).特发性黄斑裂孔手术前视力＜0.1和≥0.1的患眼手术后视力提高者之间比较,差异有统计学意义(x=12.04,P=0.001).外伤性黄斑裂孔手术前视力＜0.1和≥0.1的患眼手术后视力提高者之间比较,差异无统计学意义(χ2=0.371,P=0.486).特发性黄斑裂孔手术后视力提高者手术前黄斑裂孔直径小于手术后视力不提高者,差异有统计学意义(t=2.476,P=0.016).外伤性黄斑裂孔的裂孔闭合者手术前黄斑裂孔直径小于裂孔贴附者手术前黄斑裂孔直径,差异有统计学意义(t=-4.042,P＜0.001).外伤性黄斑裂孔病程＜4个月和≥4个月的患眼,手术后视力改变之间(χ2=0.704)、黄斑裂孔闭合形式之间(χ2=0.166)比较,差异无统计学意义(P=0.401,0.684).结论 特发性黄斑裂孔的裂孔闭合率优于外伤性黄斑裂孔的裂孔闭合率.黄斑裂孔直径和手术前视力是影响特发性黄斑裂孔视力预后的主要因素;而手术前视力和病程对外伤性黄斑裂孔的视力预后无显著影响.     

全层黄斑裂孔的鉴别诊断

目的：探讨全层黄斑裂孔与板层黄斑裂孔以及囊样黄斑变性的诊断和鉴别诊断方法。方法：用Ａｍｓｌｅｒ方格表、Ｗａｔｚｋｅ征检查和激光瞄准光检查对３０例全层黄斑裂孔、１２例板层黄斑裂孔和８例囊样黄斑变性患者进行检查，其结果用四格表确切概率法进行统计分析。结果：Ａｍｓｌｅｒ方格表检查、Ｗａｔｚｋｅ征检查及５０μｍ激光瞄准光试验在全层黄斑裂孔组中阳性率均为１００％；板层黄斑裂孔和囊样黄斑变性组中分别为８５％、６５％及０。结论：对全层黄斑裂孔的诊断，Ａｍｓｌｅｒ表检查具有敏感性，但不具特异性；Ｗａｔｚｋｅ征敏感而且较特异；激光瞄准光检查非常敏感而且特异。这些检查有助于对全层黄斑裂孔的准确诊断。     

黄斑裂孔诊断的新方法:自体荧光检测

目的 评价自体荧光检测诊断黄斑裂孔的效果。方法 应用自体荧光检测黄斑裂孔。对黄斑裂孔、手术修补术的患者(组1)和作为对照的黄斑假洞或黄斑皱褶的患者(组2)，分别行眼底荧光血管造影、自体荧光检测、眼底彩照、无赤光和红外摄像检查，进行回顾性研究。其中自体荧光采用132型Heidelberg眼球探针，对所得到的9个图象进行平均处理。而所有患者手术前后都进行OCT Ⅲ检测。结果 10个术前被自体荧光检测发现的黄斑裂孔均由OCT确诊，而且所有病例的自体荧光信号均与黄斑裂孔相对应。自体荧光也可应用于术后，以评价裂孔的闭合程度。在OCT确诊裂孔闭合的所有患者以及对照组10例黄斑皱褶或假洞患者，均没有发现自体荧光。对照组均由OCT证实，没有黄斑裂孔的发生。结论 自体荧光检测是诊断黄斑裂孔的一个新方法，它同时能够检测术后黄斑裂孔的封闭效果，没有自体荧光则表明裂孔已封闭。     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

目的 观察外伤性黄斑裂孔的光相干断层扫描（OCT）形态特征及其临床意义。方法 对采用国际标准视力表、裂隙灯显微镜、直接或间接检眼镜、三面镜检查确诊的74例闭合性眼外伤致黄斑裂孔患者74只眼进行光相干断层扫描（OCT）检查。利用OCT分析软件对外伤性黄斑裂孔进行定量测量,并根据OCT图像特征对外伤性黄斑裂孔进行分型。OCT检查完毕用Topcon眼底照相机进行眼底50°彩色照相。回顾分析患者黄斑裂孔与平均视力、病程、孔缘神经上皮层厚度、裂孔底径、孔径之间的相互关系。结果 74只眼的OCT图像特征可分为5种类型。其中,黄斑裂孔伴神经上皮层对称性水肿27只眼,占36.5%;黄斑裂孔伴神经上皮层不对称性水肿12只眼,占16.2%;单纯性黄斑裂孔14只眼占18.9%;黄斑裂孔伴神经上皮层局限性脱离17只眼,占23.0%;黄斑裂孔伴神经上皮层变薄4只眼,占5.4%。不同类型的黄斑裂孔之间视力比较,差异无统计学意义（F=1.574, P=0.191）;其视力与孔缘平均神经上皮层厚度呈正相关 （r＝0.342,P＝0.003）,与致伤时间、年龄、裂孔直径无明显相关关系（r＝-0.022～-0.134,P＝0.863～0.261）。黄 斑裂孔伴神经上皮层局限脱离者,病程较其它各型黄斑裂孔者病程短;病程90 d及以上的患者中,黄斑裂孔伴神经上皮层对称性水肿最多。各型黄斑裂孔的孔缘神经上皮层厚度之间比较,差异有统计学意义（F=13.921, P=0.000）。结论 外伤性黄斑裂孔可根据OCT形态特征分为5种类型,不同类型的外伤性黄斑裂孔临床特征存在差异。     

应用OCT观察黄斑裂孔的自发闭合

特发性黄斑裂孔多发生于60～70岁，无屈光不正的老年女性，人群中约有千分之三的患者因黄斑裂孔而致视力损害，是比较常见的致盲眼病。外伤性黄斑裂孔多发生于年轻人，一般是由于受伤后黄斑部视网膜撕裂或外伤性黄斑囊样水肿破裂所致的黄斑中心凹处的神经上皮缺失。近年来由于对黄斑裂孔进行玻璃体切割手术，大部分病人视力都有所改善，所以越来越多的人开始对黄斑裂孔进行早期手术干预。     

黄斑裂孔手术治疗现状

近年来，随着黄斑裂孔手术治疗技术的不断完善和提高，黄斑裂孔手术治疗后的闭合率约达90%以上，视功能亦有相应的改善。黄斑裂孔手术中，生物辅助剂和内界膜剥离等技术不断被采用。但这些技术本身对于黄斑裂孔的闭合率及对术后视功能的影响，不同献报道中尚有争议，本对黄斑裂孔手术治疗的现状、视功能预后、采用的主要技术及其存在的分歧进行了综述和分析。     

白体浓缩白血小板在黄斑裂孔手术中的应用

为探寻增视的黄斑裂孔封闭方法，对黄斑裂孔４３眼，玻璃体切除术后采用自体浓缩血小板封孔２０－３０％ＳＦ６注入。结果术后视力〉０．１者：者发性黄斑裂孔为１００％，外伤性黄斑裂孔为８３．３％，黄斑裂孔视网膜脱郭为４１．２％。     

Macular hole hypotheses

PURPOSE: To report the development of a macular hole as a complication of cat scratch disease. DESIGN: Case report. METHODS: A 10-year-old girl was seen with unilateral neuroretinitis from serologically confirmed cat scratch disease. Twelve days later, she developed a macular hole in the involved eye. Fundus photography and optical coherence tomography (OCT) were obtained at presentation and after the development of a macular hole. RESULTS: Fundus photography and OCT on presentation revealed a nasal neurosensory detachment and multiple inflammatory foci throughout the macula, including a subfoveal lesion. Fundus photography and OCT 12 days later revealed the development of a partial posterior vitreous detachment and a full thickness macular hole. CONCLUSIONS: Macular hole should be included among posterior segment complications of cat scratch disease. In this case, the macular hole was associated with partial vitreous detachment and a preexisting subfoveal lesion, likely representing an inflammatory focus.     

Clinical Observation on Juvenile Macular Hole without Trauma and Hypermyopia

Purpose: To investigate the clinical characteristics of juvenile macular hole without trauma and hypermyopia, and research the mechanism of macular hole. Methods: Sixty-seven patients less than 40 years of age were studied retrospectively from June 1998 to March 2003. Five cases (7 eyes) aged from 22 to 38 years were reported and the clinical characteristics that had macular hole without trauma or hypermyopia were summed up. Results: There was 1 male and 4 females with visual acuity from 0.08 to 0.8. The images of optical coherence tomography (OCT) showed full thickness macular hole in 5 patients (7 eyes), and the diameters were from 87 to 1043μm. Among them, 2 cases were combined with retina pigmentosa; 1 case with binocular Coat's disease; 1 case had bilateral macular hole combined with Eagles' disease; 1 case was combined with 2-2.5PD old retinochoroidal lesion under middle-peripheral fundus, and 1.5 PD retinal pigment epithelium (RPE) defect on the optical disk. Conclusion: The juvenile macular hole     

玻璃体手术治疗外伤性黄斑裂孔的预后及影响因素

目的 评价玻璃体手术治疗外伤性黄斑裂孔的预后及其影响因素分析。方法 回顾性病例研究。行玻璃体切割术的外伤性黄斑裂孔患者54例（54眼）,分析这些裂孔愈合情况、视力预后及术前视力、病程,黄斑孔径、有无术前眼前段或眼后段合并症与视力预后的关系。采用配对t检验和卡方检验。结果 外伤性黄斑裂孔手术后裂孔闭合48眼（89%）,裂孔贴附6眼。闭合时间为（20.6±10.1）d。视力提高28眼（52%）,术后视力明显提高（t=4.496,P＜0.01）。术前视力、病程、术前眼前段合并症三因素在不同视力预后组之间差异无统计学意义。术前黄斑裂孔直径、术前眼后段合并症两因素在不同视力预后组之间差异有统计学意义（χ2=6.006、10.650,P＜0.05）。结论 玻璃体手术治疗外伤性黄斑裂孔有很好的解剖预后和较好的功能预后,但合并眼后段病变的患者视力预后差。     

光学相干断层成像对黄斑部视网膜手术疗效的评价

目的：探讨光学相干断层成像(optical coherence tomography，OCT)在黄斑部视网膜手术疗效评价中的作用。方法：应用OCT检查35例35只眼行黄斑部视网膜手术的患者，其中特发性黄斑裂孔23例23只眼，黄斑前膜12例12只眼。于术前和术后2～4周，分别对黄斑裂孔和黄斑前膜形态进行观察，测量裂孔直径、晕轮直径、孔缘厚度。结果：OCT显示黄斑裂孔术后裂孔直径、晕轮直径和孔缘厚度均明显缩小。黄斑前膜术后视网膜厚度在术后2周与术前对比，无显著性差异；术后4周与术前有显著性差异。结论：OCT可定量客观地提供黄斑病变形态学特征，在黄斑部视网膜手术疗效的评价上具有不可替代的作用。     

Bilateral full-thickness macular hole

Bilateral full-thickness macular hole is a rare retinal disease. A 63-year-old man complained of metamorphopsy on his left eye. Pars plana vitrectomy was performed for stage 2 macular hole with anatomical and functional success. Postoperatively, the right eye showed the same symptoms, and stage 2 macular hole, detected by ocular coherency tomography, developed within 4 months, but closed after pars plana vitrectomy.     

Management of traumatic macular holes: case report

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.     

外伤性黄斑裂孔的频域光相干断层扫描观察

目的:探讨外伤性黄斑裂孔的频域光相干断层扫描的形态特征及临床价值.方法:我院2008-01/2011-01经采用国际标准视力表、裂隙灯显微镜、直接及间接检眼镜、三面镜确诊的外伤性黄斑裂孔患者29例29眼,进行频域光相干视网膜断层扫描(FD-OCT)检查,分析其图像特征.结果:患者29例29眼中黄斑板层裂孔3例3眼(10%),OCT表现为黄斑区神经上皮层部分缺失;黄斑全层裂孔26例26眼(90%),OCT图像均可见黄斑区神经上皮层全层缺失.其中黄斑全层裂孔中单纯性黄斑裂孔3例3眼;黄斑全层裂孔伴孔周神经上皮层水肿6例6眼;伴神经上皮层局限性脱离5例5眼;伴黄斑区脉络膜裂伤7例7眼;伴孔周神经上皮层局部萎缩变薄3例3眼;伴视网膜前膜2例2眼.结论:频域OCT能清晰的观察到外伤性黄斑裂孔的形态及其周围组织损害,有利于外伤性黄斑裂孔的诊断及病情评估.     

Macular holes: classification,epidemiology, natural history and treatment

BACKGROUND: Macular hole is a retinal disease primarily affecting elderly women. Its overall prevalence in the Danish population is estimated to be 0.14%. The majority of cases are unilateral. The fully developed macular hole evolves through a series of stages starting with an impending hole. About half of impending macular holes regress spontaneously. The remaining half progress to full thickness macular holes. In a patient with a macular hole in one eye, the risk of development of a macular hole in the fellow eye is less than 2% if posterior vitreous detachment is present. If the posterior vitreous is attached, the risk is approximately 15%. If an impending hole is found in the other eye, the risk rises to 50%. TREATMENT AND OUTCOMES: Macular hole surgery is able to close full thickness macular holes in approximately 90% of cases. Visual acuity of 20/50 or better can be obtained in approximately half of patients with recent onset of symptoms. Complications include retinal detachment, endophthalmitis, late reopening of an initially successfully closed hole and retinal pigment epithelial abnormalities. Retinal detachment should be expected in less than 5% of cases.     

Management of eyes with both idiopathic macular hole and choroidal neovascularization.

PURPOSE: To describe the characteristics, treatment, and outcome of five eyes with both choroidal neovascularization (CNV) and macular hole. METHODS: Medical records of five patients with both macular hole and CNV were reviewed. RESULTS: All eyes had full-thickness macular holes. Most eyes had atypical-appearing macular holes (subretinal hemorrhage, prominent subretinal fluid, or discoloration at the hole margin) at presentation or subsequently when CNV developed. Fluorescein angiography (FA) confirmed the presence of CNV in each eye. Three eyes underwent combined macular hole repair and CNV removal, and sustained closure of these macular holes was achieved. A fourth eye underwent successful argon laser photocoagulation of extrafoveal CNV, and macular hole surgery was declined. The final eye underwent two macular hole repairs before sustained closure was achieved. Final visual acuity, ranging from 20/100 to hand motions, was limited by macular pathology and/or cataract. CONCLUSIONS: Choroidal neovascularization can occur in association with a macular hole. In eyes with an atypical-appearing macular hole, FA should be obtained to detect CNV. Excision of the CNV can be done safely in conjunction with macular hole surgery. Final visual acuity may be limited by cumulative retinal and retinal pigment epithelium damage, especially in eyes with underlying macular disease.