特发性黄斑裂孔患者手术前后视物变形的定量分析

doi:10.3760/cma.j.cn115909-20190805-00216

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摘要目的：观察特发性黄斑裂孔（IMH）患者术前视物变形类型及玻璃体切割术后视物变形改善程度，并对玻璃体切割术后视物变形与视力进行相关性分析。方法：前瞻性非随机对照研究。选取2017年12月至2018年9月于吉林大学第二医院确诊为IMH并行玻璃体切割联合内界膜撕除术或翻转内界膜瓣填塞眼内消毒空气或硅油填充治疗的患者共29例（29眼）。手术前后均进行最佳矫正视力（BCVA）检查。使用M-Charts对视物变形的严重程度进行量化，测量患眼垂直视物变形评分（MV）、水平视物变形评分（MH）及其平均值（M-Score）。采用重复测量资料方差分析来比较患眼手术前后视功能改善情况，采用独立样本t检验比较同一阶段MV和MH的变化，采用Pearson相关性分析来研究BCVA与视物变形之间的相关性。结果：术前检测IMH视物变形为枕形失真的患眼22眼，病程小于6个月有21眼；不规则形失真的IMH患眼7眼，病程小于6个月有2眼。术后任一时间点MV较术前都有显著改善，差异有统计学意义（F=52.265，P<0.001）；术后任一时间点MH较术前都有显著改善，差异有统计学意义（F=27.507，P=0.002）。手术前后各时间点MV与MH比，差异均无统计学意义。术后6个月M-Score与BCVA（logMAR）之间不存在相关性（r=0.360，P=0.055）。结论：病程小于6个月的IMH患者视物变形类型以枕形失真为主，病程大于6个月的IMH患者视物变形以不规则形失真为主；IMH的玻璃体切割手术显著改善了视物变形，恢复视功能；视物变形可以作为评估IMH治疗效果的一项指标。

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关键词 ：特发性黄斑裂孔, 视物变形, M-charts, 光感受细胞层

Abstract：Objective: To observe the type of preoperative metamorphopsia and the degree of improvement in metamorphopsia in patients after vitrectomy for an idiopathic macular hole (IMH), and to analyze the relationship between metamorphopsia and visual acuity after vitrectomy. Methods: This was a prospective, non-randomized controlled study. An analysis was conducted on 29 patients (29 eyes) who were diagnosed with idiopathic macular hole (IMH) in the Second Hospital of Jilin University from December 2017 to September 2018. Patients underwent vitrectomy combined with internal limiting membrane peeling or inversion of the internal limiting membrane flap, and intraocular disinfectant air or silicone oil were used as a filling after treatment. Best corrected visual acuity (BCVA) was assessed before and after surgery. The severity of the metamorphopsia was quantified using M-CHARTS, and vertical metamorphopsia (MV), horizontal metamorphopsia (MH), and mean metamorphopsia scores (M-Score) were measured. Repeated analysis of variance was used to compare the improvement in visual function before and after surgery. An independent samples t test was used to compare the changes in MV and MH at the same stage. Pearson correlation analysis was used to study the correlation between BCVA and metamorphopsia. Results: A total of 22 eyes with a pincushion distortion were measured before surgery, in which 21 eyes had a disease course of less than 6 months. A total of 7 eyes with an unpatterned distortion were measured before surgery. Of these, 2 eyes had a disease duration of less than 6 months. At any stage after surgery, MV was significantly improved compared with preoperative measurements and the difference was statistically significant (F=52.265, P<0.001). There was a significant improvement in MV between 3 months and 6 months postoperatively, and the difference was statistically significant (F=7.879, P=0.009). MH at any stage after surgery was also significantly improved compared with preoperative measurements (F=27.507, P=0.002). There was no significant improvement in MH between 3 months and 6 months postoperatively, and the difference was not statistically significant (F=0.114, P=0.078). There was no significant difference in the preoperative and postoperative stages between MV and MH (P all >0.05). The correlation between M-Score and BCVA (logMAR) did not reach significance 6 months postoperatively (r=0.360, P=0.055). Conclusions: The type of metamorphopsia in IMH patients with less than 6 months' duration is mainly pincushion distortion, and the type of metamorphopsia in IMH patients with more than 6 months' duration is mainly unpatterned distortion. The vitrectomy of IMH significantly reduces metamorphopsia and restores visual function. The improvement in postoperative visual quality in IMH patients cannot be evaluated by BCVA alone. Metamorphopsia can be used as an index to evaluate the outcome of IMH treatment.

Key words： idiopathic macular hole metamorphopsia M-charts photoreceptor layer

收稿日期: 2019-08-05

通讯作者: 陈琪（ORCID：0000-0003-2546-1869），Email：2631059578@qq.com

引用本文:

陈琪1 刘早霞2. 特发性黄斑裂孔患者手术前后视物变形的定量分析[J]. 中华眼视光学与视觉科学杂志, 2020, 22(4): 287-292. Qi Chen1,Zaoxia Liu2. Quantitative Analysis of Metamorphopsia in Patients with Idiopathic Macular Holes before and after Surgery. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(4): 287-292. DOI: 10.3760/cma.j.cn115909-20190805-00216

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190805-00216 或 https://www.cjoovs.com/CN/Y2020/V22/I4/287

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