特发性黄斑裂孔手术后视力和光感受器内外节连接的变化

目的 观察微创玻璃体切割手术治疗特发性黄斑裂孔（IMH）手术后视力和光感受器内外节连接（IS/OS）的改变。方法 行玻璃体切割手术治疗的连续IMH患者40例40只眼纳入研究。其中，男性12例，女例28例；平均年龄（62.43±5.68）岁；平均病程2.78个月。均行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜联合前置镜检查，眼底彩色照相和频域光相干断层扫描检查。BCVA检查采用标准对数视力表，统计分析时换算为最小分辨角对数（logMAR）视力。患眼BCVA 0.05～0.5，平均logMAR BCVA 0.71±0.19。黄斑裂孔Ⅱ、Ⅲ、Ⅳ期分别为4、16、20只眼。平均黄斑裂孔颈部最小直径（410.13±175.72） μm；平均底部最大直径（775.00±264.77） μm。IS/OS破坏直径618.00～2 589.00 μm，平均破坏直径（1 682.08±484.11） μm。均行23G联合25G微创玻璃体切割手术。手术后平均随访时间33.75个月。观察手术后1、3个月和末次随访时的BCVA、黄斑中心凹结构；分析末次随访logMAR BCVA和IS/OS破坏直径的影响因素及其与随访时间的关系。结果 手术后1、3个月和末次随访平均logMAR BCVA分别为0.49±0.31、0.37±0.26、0.30±0.26。与手术前平均logMAR BCVA比较，差异均有统计学意义（Z=-4.598、-5.215、-5.218， P＜0.05）。手术前logMAR BCVA、黄斑裂孔最小直径与末次随访logMAR BCVA相关（r=0.401、0.392,P＜0.05）；手术前、末次随访IS/OS的破坏直径大小和末次随访logMAR BCVA相关（r=0.339、0.353,P＜0.05）；末次随访时间的长短与末次随访logMAR BCVA、IS/OS破坏直径的大小无相关(r=0.000、0.018，P＞0.05)。末次随访时，黄斑裂孔完全闭合39只眼，占97.5%。IS/OS完全连接32只眼；仍有破坏8只眼。结论 IMH手术后患者视力稳定，IS/OS完全连接率高。

Visual acuity and photoreceptor inner segment/outer segment structure changes of idiopathic macular hole patients after micro-invasive vitrectomy

Objective To observe outcome of visual acuity and photoreceptor inner segment (IS)/outer segment (OS) changes in idiopathic macular hole (IMH) patients after micro-invasive vitrectomy. Methods Forty patients (40 eyes) with idiopathic macular hole underwent micro-invasive vitrectomy were enrolled in this study. The patients included 12 males and 28 females, with an average age of (62.43±5.68) years, with an average course of 2.78 months. All the patients were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp ophthalmoscopy combine with preset lens, fundus color photography and optical coherence tomography (OCT) examination.The BCVA was converted to logarithm of the minimal angle of resolution (logMAR).The BCVA was 0.05-0.5, with an average log MAR BCVA of 0.71±0.19. The average diameter of minimum macular hole was (410.13±175.72) μm. The average base diameter of maximum macular hole was (775.00±264.77) μm. The diameter of IS/OS defect was 618-2589 μm, with an average of (1682.08±484.11) μm. There were 4, 16, 20 eyes with stage Ⅱ, Ⅲ, Ⅳ macular hole, respectively. The follow-up period was 33.75 months. BCVA and macular structure at month 1, 3 and the final follow-up after surgery were analyzed. The correlation among logMAR BCVA,diameter of IS/OS defect at final follow-up and the follow-up time was analyzed. Results The mean logMAR BCVA at month 1, 3 and the final follow-up after surgery were 0.49±0.31, 0.37±0.26, 0.30±0.26 respectively. Compared with the mean preoperative logMAR BCVA, the differences were significant (Z=-4.598, -5.215, -5.218;P＜0.05). The preoperative logMAR BCVA and the diameter of minimum macular hole were significantly correlated with the postoperative logMAR BCVA at final follow-up (r=0.401, 0.392,P＜0.05). The preoperative diameter of IS/OS defect and the postoperative diameter of IS/OS defect at final follow-up were significantly correlated with the postoperative logMAR BCVA at final follow-up (r=0.339, 0.353;P＜0.05). The time of final follow-up was not correlated with the postoperative logMAR BCVA and the diameter of IS/OS defect at final follow-up (r=0.000, 0.018;P＞0.05). At the final follow-up, the macular holes were totally closed in 39 eyes (97.5%). Thirty-two eyes exhibited a complete recovery of IS/OS junction, 8 eyes continued to exhibit an IS/OS junction defect. Conclusion Micro-invasive vitrectomy can stabilize vision of IMH patients, and promote complete recovery of IS/OS.