特发性黄斑裂孔患眼玻璃体切割手术后视力恢复情况及其影响因素纵向分析

目的纵向观察分析特发性黄斑裂孔患眼玻璃体切割手术后视力恢复情况及其影响因素。方法回顾性研究。2016年8月至2018年6月在天津市眼科医院行25G玻璃体切割联合内界膜剥除手术的单眼特发性黄斑裂孔患者302例302只眼纳入研究。患者中,男性130例,女性172例;平均年龄(63.36±6.91)岁。左眼158只,右眼144只。平均logMAR BCVA为1.13±0.45。OCT测得其最小水平直径、裂孔基底直径及中心凹下脉络膜厚度分别为(422.92±211.73)、(835.47±366.42)、(244.84±60.68)μm。以黄斑裂孔最小水平直径≤250μm为小裂孔,>250μm和≤400μm为中裂孔,>400μm为大裂孔;并以此分为3组。观察手术后1、3、6个月3组患眼logMAR BCVA情况。采用两因素重复测量方差分析比较3组患眼视力变化规律。采用广义估计方程(GEE)分析手术后视力恢复的影响因素。结果手术后1个月,所有患眼黄斑裂孔均已闭合。手术后1、3、6个月,小裂孔组患眼平均logMAR BCVA分别为0.33±0.25、0.23±0.18、0.16±0.17;中裂孔组患眼平均logMAR BCVA分别为0.46±0.25、0.35±0.26、0.27±0.28;大裂孔组患眼平均logMAR BCVA分别为0.81±0.51、0.61±0.48、0.53±0.37。两因素重复测量方差分析结果显示,不同组和不同时间节点之间存在交互作用(F=23.133,P<0.01)。将所有数据分割并进行单因素重复测量方差分析,结果显示小裂孔组和中裂孔组组内,手术前与手术后1个月的视力差异有统计学意义(P<0.05),而手术后1、3、6个月之间的视力差异无统计学意义(P>0.05);大裂孔组组内,手术前及手术后1、3个月之间的视力差异有统计学意义(P<0.05),而手术后3个月和手术后6个月之间的视力差异无统计学意义(P>0.05)。GEE分析结果显示,黄斑裂孔大小(χ^2=4.17,P=0.04)、裂孔基底直径(χ^2=7.25,P=0.01)、病程(χ^2=19.26,P=0.00)、脉络膜厚度(χ^2=4.19,P=0.04)对黄斑裂孔患眼手术后视力恢复有影响;而年龄(χ^2=2.50,P=0.10)、性别(χ^2=0.28,P=0.59)对其视力恢复无影响。结论不同大小黄斑裂孔玻璃体切割手术后视力恢复趋势不同,小裂孔和中裂孔会较快恢复视力,在1个月时视力基本恢复;而大裂孔需要一个缓慢的恢复过程,在3个月时视力趋于稳定。裂孔大小、裂孔基底直径、脉络膜厚度是视力恢复的影响因素。

Visual acuity recovery after vitrectomy of idiopathic macular hole and its influencing factors:a longitudinal study

Objective To observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole,and analyze the influencing factors.Methods A retrospective study.From August 2016 to June 2018,302 patients(302 eyes)with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study.There were 130 males and 172 females,with the mean age of 63.36±6.91 years.There were 158 left eyes and 144 right eyes.The logMAR BCVA was 1.13±0.45.The minimum diameter(422.92±211.73μm)and basal diameter(835.47±366.42μm)of macular hole and choroid thickness under fovea(244.84±60.68μm)were measured by OCT.According to the minimum diameter,the holes were divided into small hole group(≤250μm),middle hole group(>250μm and≤400μm)and large hole group(>400μm).The logMAR BCVA at 1, 3 and 6 months after surgery in 3 groups were observed. Two-factor repeated measure ANOVA was used tocompare the visual acuity of the 3 groups. The generalized estimation equation (GEE) was used to analyze theinfluencing factors of postoperative visual recovery. Results One month after surgery, all the holes wereclosed. One, 3 and 6 months after surgery, the logMAR BCVA were 0.33±0.25, 0.23±0.18, 0.16±0.17 in thesmall hole group; the logMAR BCVA were 0.46±0.25, 0.35±0.26, 0.27±0.28 in the middle hole group; thelogMAR BCVA were 0.81±0.51, 0.61±0.48, 0.53±0.37 in the large hole group. Through repeatedmeasurement variance analysis of two factors, it was found that there was an interaction between different groupsand different time nodes (F=23.133, P<0.01). All data were segmented and one-way repeated measure ANOVAwas performed. The results showed that there was a statistically significant difference in visual acuity betweenthe small hole group and the middle hole group among preoperative and 1 month after surgery (P<0.05), whilethere was no statistically significant difference in visual acuity between 1, 3 and 6 months after surgery(P>0.05). In the large hole group, among preoperative, 1 months after surgery, 3 months after surgery, thevisual acuity difference was statistically significant (P<0.05), while the visual acuity difference between 3months after surgery and 6 months after surgery was not statistically significant (P>0.05). The results of GEEanalysis showed that hole size (χ^2=4.17, P=0.04), basal diameter (χ^2=7.25, P=0.01), disease course (χ^2=19.26,P=0.00), and choroid thickness (χ^2=4.19, P=0.04) were the influencing factors of postoperative visual acuity.Conclusions After vitrectomy of macular holes of different sizes, the visual recovery trend is different. Thevisual recovery of small holes and middle holes is faster and basically restored at 1 month. The large holesrequires a slow recovery process and stabilizes vision at 3 months. Hole size, basal diameter, course of diseaseand choroid thickness are the influencing factors of visual acuity recovery.