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)

The recovery of the visual function and morphological closure of the idiopathic macular hole after vitrectomy

OBJECTIVE: To investigate the relation of the visual function recovery and the postoperative form of the idiopathic macular holes. METHODS: 38 eyes with macular holes which were closed after one surgery were selected and were grouped into type of complete healed, partial healed and no healed by Optical Coherent Tomography (OCT). Scanning Laser Ophthalmoscope (SLO) examination were performed preoperatively and 1 month, 3 months and 6 months postoperatively to detect the sensitivity, areas of absolute scotoma, relative scotoma and central visual acuity. RESULTS: Among type of complete healed group and type of partial healed group 6 months after vitrectomy the central vision, sensitivity, areas of absolute scotoma and relative scotoma had statistical significant improvement. The central vision and sensitivity improved postoperatively and areas of absolute scotoma and relative scotoma had no significant changes in type of no healed group. The extent of improvement of vision, sensitivity, absolute scotoma in type of complete healed group was more greater than type of partial healed group and no healed group. The fovea configuration of stage II macular holes was easier to recover completely. CONCLUSIONS: The recovery of the normal curvature of macular fovea is positive to the improvement of the visual function. The better the fovea contour recover, the more significantly the visual function improve. The early stage of macular holes (stage II) could get better improvement of visual function.