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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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

Received: 05 August 2019

Corresponding Authors: Qi Chen, Department of Ophthalmology, the Second Hospital of Zhengzhou University, Zhengzhou 450003, China (Email: 2631059578@qq.com)

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

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