特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

Correlation between Postoperative Visual Outcome and the Restoration of Foveal Microstructures after Idiopathic Full-Thickness Macular Hole Surgery

摘要: 目的：通过OCT观察特发性全层黄斑裂孔(IFTMH)患眼术后的视网膜黄斑中心凹外层显微结构变化，并分析其与视力之间的相关性。方法：选取2019年5月至2020年10月在蚌埠医学院第一附属医院眼科就诊诊断为IFTMH的患者，共37例，37眼，均成功行手术修复。比较患眼在术前和术后1个月、3个月、6个月、12个月和24个月检查中的最佳矫正视力(BCVA)及OCT中黄斑中心凹外层显微结构变化。根据24个月末次随访的外界膜(ELM)、椭圆体带(EZ)、嵌合体带(IZ)愈合情况，将其分为3组：A组为ELM完整，EZ和IZ连接中断，共有11眼；B组为ELM、EZ完整，IZ连接中断，共有15眼；C组为ELM、EZ、IZ完全恢复，共有11眼。分析视力与黄斑中心凹ELM、EZ、IZ的连续性之间的相关性。结果：在37例37眼中，三组患者年龄、性别、眼别、症状持续时间、术前BCVA、术前裂孔最小径、基底径等差异无统计学意义(P > 0.05)，最后一次随访时，三组患眼BCVA之间差异有统计学意义(F = 24.257, P < 0.01)，其中C组视力恢复最佳，C组LogMAR BCVA从0.80 ± 0.12改善至0.08 ± 0.09。在术后1个月、3个月、6个月、12个月和24个月的随访中黄斑中心凹显微结构持续重建，ELM、EZ和IZ的缺损直径持续减少，BCVA持续好转，较术前具有统计学差异(P < 0.05)。重建过程由ELM先开始，依次为EZ、IZ。术后24个月BCVA与术前裂孔最小径、基底径、症状持续时间、术前BCVA、术前ELM缺损直径、术前EZ缺损直径、术前IZ缺损直径均呈正相关(r = 0.798, 0.601, 0.683, 0.732, 0.682, 0.695, 0.702, P < 0.01)。结论：IFTMH患眼术后黄斑中心凹光感受器持续重建，重建顺序依次为ELM、EZ、IZ，视力持续提高。同时，外层显微结构的重建程度与术后视力呈正相关。

Abstract: Objective: To observe the microstructural changes of the outer layer of the macular central recess of the retina after surgery in eyes with idiopathic total macular fissure (IFTMH) by OCT and analyze the correlation between them and visual acuity. Methods: A total of 37 patients, 37 eyes, who attended the ophthalmology department of the First Affiliated Hospital of Bengbu Medical College with the diagnosis of IFTMH from May 2019 to October 2020 were selected and all of them were successfully repaired surgically. The best-corrected visual acuity (BCVA) and changes in the outer microstructure of the macular central recess on OCT were compared between the affected eyes at preoperative and postoperative examinations at 1 month, 3 months, 6 months, 12 months, and 24 months. According to the healing of the external limitinag membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ) at the end follow-up at 24 months, they were divided into three groups: Group A had intact ELM, and the connection between EZ and IZ was interrupted, with a total of 11 eyes; in group B, the ELM and EZ were intact, and the IZ connection was interrupted, with 15 eyes in total. In group C, ELM, EZ and IZ recovered completely, with a total of 11 eyes. The correlation between visual acuity and the continuity of ELM, EZ, and IZ in the central macular recess was analyzed. Results: In 37 eyes of 37 cases, there were no statistically significant differences (P > 0.05) in age, gender, eye type, duration of symptoms, preoperative BCVA, minimal hole diameter, and base diameter between the three groups of patients. At the last follow-up, there was a statistically significant difference in BCVA between the three groups of affected eyes (F = 24.257, P < 0.01), with the best recovery of visual acuity in group C. Group C LogMAR BCVA improved from 0.80 ± 0.12 to 0.08 ± 0.09. At 1 month, 3 months, 6 months, 12 months, and 24 months postoperative follow-up, the macular sulcus microstructure continued to reconstruct, the defect diameters of ELM, EZ, and IZ continued to be reduced, and the BCVA continued to improve, which was statistically different from that before surgery (P < 0.05). The reconstruction process started with ELM first, followed by EZ and IZ. 24 months after surgery, BCVA was positively correlated with preoperative minimal hole diameter, and base diameter, duration of symptoms, preoperative BCVA, preoperative ELM defect diameter, preoperative EZ defect diameter, and preoperative IZ defect diameter (r = 0.798, 0.601, 0.683, 0.732, 0.682, 0.695, 0.702, P < 0.01). Conclusion: The reconstruction of the photoreceptor layer of the central macular fovea continued after surgery in IFTMH eyes, and the sequence of reconstruction was ELM, EZ, and IZ, and the visual acuity continued to improve. Meanwhile, and the degree of reconstruction of the outer microstructure was positively correlated with the postoperative visual acuity.