特发性黄斑裂孔的黄斑裂孔直径、被破坏的光感受器细胞内外节直径及其与视力的相关性研究

摘要

目的 观察特发性黄斑裂孔(IMH)的频域光相干断层扫描(OCT)特征以及与视力的相互关系.方法 回顾性分析IMH患者37例39只眼的临床资料;其中11只眼接受了玻璃体切割手术治疗.所有患者均接受Snellen视力表检查、眼压、裂隙灯、间接检眼镜及OCT检查,OCT扫描速度为27 000A扫描/s,扫描区域6.0 mm× 6.0 mm,扫描模式为512×128;测量黄斑裂孔直径及被破坏的光感受器细胞内外节(IS/OS)直径.采用SPSS 14.0统计软件进行统计学处理,分析黄班裂孔直径、IS/OS直径与视力的相关性.结果 最小可分辨视角的对数值(10gMAR)为0.15～2.00,平均对数值0.99±0.44;黄斑裂孔直径171～1491 μm,平均直径(942.0±348.4)μm;被破坏的IS/OS直径463～3176 μm,平均直径(1870.3±673.2)μm.IogMAR、裂孔直径、被破坏的IS/OS直径三者间均具有相关性(P=0.038,0.002,P=0.000).接受手术治疗前后裂孔闭合的9只眼中,IogMAR和被破坏的IS/OS直径差异均有统计学意义(P=0.022,0.020).结论 IMH光感受器层的破坏大于裂孔直径,视力情况与裂孔直径、被破坏的IS/OS直径相关.经手术治疗后,视力提高且裂孔闭合,被破坏的IS/OS直径也相应缩小,但在裂孔闭合的情况下仍持续存在.%Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000 A scan/s, area was 6.0 mm×6.0 mm, and the mode was 512×128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean IogMAR was 0.99±0. 44 (ranged from 0. 15 to 2.00), the mean diameter of macular holes was (942.0± 348. 4)μm(ranged from 171 to 1491 μm), and the mean diameter of IS/OS disruption was (1870. 35±673.2) μm(range from 463 to 3176 μm). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and IogMAR in IMH (P= 0. 038, 0. 002, 0. 000). In eyes with closed macular hole after surgery, the IogMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the IS-OS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the maeular hole closure surgery.