黄斑裂孔手术前后黄斑中心凹下脉络膜厚度的变化

目的 观测黄斑中心凹下脉络膜厚度（SFCT）在两种不同类型黄斑裂孔手术前后的变化规律，以探讨SFCT与黄斑裂孔预后的关系。设计 回顾性队列研究。研究对象 2021年8月至2022年1月潍坊医学院附属医院确诊为黄斑裂孔并接受玻璃体视网膜手术治疗的患者50例。方法 将研究对象分为特发性黄斑裂孔（IMH）组、高度近视性黄斑裂孔（HMMH）组、正常对照组。IMH组和HMMH组均在术前、术后1周、1个月、3个月随访。观察SFCT的变化，比较IMH组和HMMH组SFCT值变化的特点。主要指标 SFCT、黄斑裂孔闭合状况。结果 正常人组、术前IMH组和HMMH组SFCT值依次降低（F=71.33，P＜0.001）。IMH组术后裂孔闭合良好率为91.4%，好于HMMH组的53.3%。两组中裂孔闭合良好组在各个随访时间点的SFCT值较裂孔闭合不良组的差异均有统计学意义（P=0.001、P＜0.001、P＜0.001、P＜0.001）。IMH组中术后1周、术后1个月、术后3个月、术前SFCT值依次减少，差异有统计学意义（F=37.89，P＜0.001）。HMMH组中术后1周、1个月、3个月SFCT值依次减少，术前较术后1周SFCT值小（F=7.828，P=0.002）。其中术后1周至1个月时间范围内，HMMH组的SFCT值变化大于IMH组（P=0.001）。IMH组中，裂孔基底径与术后1个月脉络膜厚度相关（r=-0.345，P=0.043）。在IMH和HMMH组中，裂孔基底径均与裂孔高度均相关（P≤0.001、0.004）。IMH组的裂孔基底径小于HMMH组（P=0.045）。结论 MH术后，SFCT值会短暂性增加，然后逐渐降低。术后2~4周内，HMMH眼较IMH眼的SFCT值降低更显著。SFCT可能是影响黄斑裂孔术后愈合的重要因素。（眼科，2023，32：148-153）

Changes in subfoveal choroidal thickness before and after surgery of macular hole

Objective To exploring the changes of subfoveal choroidal thickness (SFCT) of two different types of macular holes before and after surgery to investigate the correlation between SFCT and their postoperative recovery. Design Retrospective cohort study. Participants From August 2021 to January 2022, 50 patients diagnosed with macular hole and treated with vitreo retinal surgery in the Ophthalmology Center of Weifang Medical College Affiliated Hospital were included. Methods The study subjects were divided into three groups: idiopathic macular hole (IMH) group, highly myopic macular hole (HMMH) group, and normal control group. The follow-up time points for the IMH and HMMH groups were preoperative, postoperative of 1 week, 1 month, and 3 months. Changes in SFCT were observed and the differences and similarities in SFCT value changes between the IMH and HMMH groups were compared. Main Outcome Measures SFCT and the closure status of the macular hole. Results The SFCT values of the normal control group, preoperative IMH group, and HMMH group decreased sequentially (F=71.33, P<0.001). The closure rate of macular holes in the IMH group after surgery was 91.4%, which was better than the 53.3% in the HMMH group. There were significant differences in SFCT values between the macular hole closure group and the non-closure group at each follow-up time point in both groups (P=0.001, P<0.001, P<0.001, P<0.001). In the IMH group, the SFCT values decreased sequentially 1 week, 1 month, and 3 months after surgery compared to preoperative values, with significant differences (F=37.89, P<0.001). In the HMMH group, the SFCT values decreased sequentially 1 week, 1 month, and 3 months after surgery, and were smaller 1 week after surgery than preoperative values (F=7.828, P=0.002). During the 1-week to 1-month postoperative period, the change in SFCT values was greater in the HMMH group than in the IMH group (P=0.001). In the IMH group, the base diameter of the macular hole was correlated with choroidal thickness 1 month after surgery (r=-0.345, P=0.043). In both the IMH and HMMH groups, the base diameter of the macular hole was correlated with the height of the macular hole (P≤0.001, 0.004). The base diameter of the macular hole was smaller in the IMH group than in the HMMH group (P=0.045). Conclusion After MH surgery, SFCT values will temporarily increase and then gradually decrease. Within 2-4 weeks postoperatively, the SFCT value in the fellow eye with HMMH decreases more significantly than in the fellow eye with IMH. SFCT may be an important factor that affects postoperative healing of macular holes. (Ophthalmol CHN, 2023, 32: 148-153)