特发性黄斑裂孔OCT影像与术后早期视力恢复的相关性研究

摘要

目的 研究特发性黄斑裂孔(idiopathic macular holes,IMH)患者术前光学相干断层扫描技术(optical coherence tomography,OCT)测量的相关参数与术后早期视力恢复的相关性.方法 收集24例(25眼)IMH患者,均行玻璃体切割+内界膜剥离+玻璃体内注气术,术前、术后12周均行最佳矫正视力(best corrected visual acuity,BCVA)检查,术前1周内OCT影像上直接测量裂孔最大高度,通过Image-Pro Plus 6.0软件测量黄斑裂孔最小径、基底径及外界膜光感受器断裂点与视网膜色素上皮层的最大垂直高度,并计算黄斑孔指数(macular hole index,MHI)、牵拉孔指数(tractional hole index,THI)、黄斑孔指数’(macular hole index’,MHI’)及牵拉孔指数’(tractional hole index’,THI’),应用SPSS 22.0软件包进行Spearman相关性分析,得出各参数与术后12周时BCVA的相关性,受试者工作特征曲线拟合分析得出MHI、THI、MHI’、THI’界值.结果 IMH患者术后12周BCVA较术前明显提高且差异有统计学意义(P=0.000).相关性分析结果表明:术后12周BCVA与术前MHI、THI、MHI’、THI’具有相关性(均为P＜0.05).MHI ≥0.705组术后12周时BCVA平均为0.297,好于MHI＜0.705组的0.103(P=0.023);THI≥1.425组术后12周时BCVA平均为0.288,好于THI＜1.425组的0.163(P =0.001).结论 THI≥1.425或MHI ≥0.705者术后12周时能获得较好的BCVA,可作为预测IMH患者术后早期视力恢复情况的指标.%Objective To study the correlation between the preoperative optical coherence tomography (OCT) images and postoperative visual outcome in patients with idiopathic macular hole (IMH).Methods This was a retrospective case.24 IMH patients (24 eyes) were chosen.The pars plana vitrectomy (PPV),internal limiting membrane peeling (ILMP) and pneumatic retinopexy were operated in all patients and consecutive follow-up time was more than 12 weeks.The best-corrected visual acuity (BCVA) before and after the surgery were recorded.The hole height (H) was measured by OCT at 1 week before the surgery.The soft of Image-Pro Plus 6.0 was used to measure the minimum diameter (MLD),the base diameter(BD),the max height(H')of broken end point of the external limiting membrane (ELM) to retinal pigment epithelial layer (RPE) before the operation.According to the data,the macular hole index (MHI,H/BD),tractional hole index (THI,H/MLD),macular hole index'(MHI',H'/BD),ractional hole index'(THI',H'/MLD) were calculated.SPSS 22.0 was used to analyze the spearman rank relationship between the MHI,THI,MHI',THI'and BCVA in post operation.The receiver operating characteristic(ROC) curve analysis was used to obtain the cut-off values of MHI,THI,MHI'and THI'.Results The BCVA of median postoperative 12-weeks was significantly higher than preoperative,and there was statistical difference (P =0.000).There was correlations among MHI,THI,MHI',THI'and preoperative BCVA (all P ＜ 0.05).Postoperative BCVA in MHI ≥ 0.705 and THI ≥ 1.425 group were better than those in MHI ＜ 0.705 and THI ＜ 1.425 group (P =0.023,P =0.001).Conclusion The patients with THI ≥ 1.425 or MHI ≥0.705 can achieve the better BCVA,which maybe an effective predictive factor after IMH surgery in IMH patients.