| Objective: The healing of the macular structure in patients with idiopathic macular hole(IMH)was observed by optical coherence tomography(OCT),and its correlation with the recovery of visual acuity was analyzed.Methods: Patients with IMH diagnosed in our ophthalmology department between May 2019 and December 2020,39 eyes of 39 cases,were collected,and all hiatus were successfully closed after surgical treatment.All IMH patients underwent slit lamp,indirect fundoscopy,best corrected visual acuity(BCVA),and OCT before the procedure and at 1 month,6 months,12 months,and 24 months after the procedure.The data of minimum diameter(MIN),base diameter(BASE),height(H),diameter of right and left arm of hole(RA,LA)before operation were determined by OCT.And the macular hole index(MHI),diameter hole index(DHI),tractional hole index(THI),hole form factor(HFF)were calculated.At the same time,the defect diameter,continuity and postoperative hole closure morphology of external limiting membrane(ELM),ellipsoid zone(EZ)and interdigitation zone(IZ)were observed.According to the closure pattern of fissure hole 1 month after surgery,patients with IMH were divided into two groups:Group A was U-shaped closed(level 1);Group B was V-shaped closed(level 2).According to the recovery of the retinal microstructure in the outer layer of macular central fovea 24 months after surgery,the patients with IMH were divided into 3 groups:Group a showed the continuity of ELM was complete,the continuity of EZ and IZ was interrupted;In group b,the continuity of ELM and EZ was complete,and IZ connection was interrupted.Group c showed that the continuity of ELM,EZ and IZ was complete.BCVA of all IMH patients at postoperative follow-up were recorded to analyze the correlation between hiatus structure healing and visual recovery after IMH.Results:1.No recurrent hole was found in 39 eyes with hiatus closure during postoperative follow-up,and no such postoperative complications as macular edema,secondary glaucoma,or retinal detachment occurred.2.Hole closure after IMH surgery: 39 eyes,U-shaped closure in 21 eyes,V-shaped closure in 18 eyes,correlation analysis results showed: The closure of postoperative hole was positively correlated with MIN and BASE.The smaller MIN and BASE were,the more U-shaped the closure shape was,and the stronger the correlation was with BASE(P<0.05).It was negatively correlated with H,MHI,THI and HFF(P<0.05).The larger H,MHI,THI and HFF were,the more U-shaped the closure shape of the hole was.There was no correlation with age,sex,eye type,duration of symptoms,preoperative BCVA(log MAR)and DHI(all P>0.05).3.Recovery of retinal microstructure in the outer layer of the macular central fovea after surgery in eyes with IMH: a,b,and c groups of patients with IMH continued to reconstruct the retinal microstructure in the outer layer of the macular central fovea after surgery,in the order of ELM,EZ,and IZ.The BCVA(log MAR)continued to improve in all three groups of affected eyes after surgery,and the difference was statistically significant(P<0.05),and the difference between BCVA(log MAR)was statistically significant at 24 months after surgery(F=17.087,P<0.01),with the best recovery of visual acuity in group c.The BCVA(log MAR)in group c improved from 0.80±0.12 to0.08±0.09(P<0.05).4.The BCVA(log MAR)of all IMH patients before surgery was 0.87±0.15,and the visual acuity continued to improve during postoperative follow-up,the difference was statistically significant(P<0.01).At 24 months after surgery,BCVA(log MAR)was positively correlated with symptom duration,MIN,BASE,preoperative BCVA(log MAR),postoperative closure type,and preoperative defect diameter of ELM,EZ and IZ(all P<0.01).It was negatively correlated with the continuity of MHI,THI,HFF,ELM,EZ and IZ(P<0.01).Conclusions:First,U-shaped closure is better than V-shaped vision after surgery for IMH,and fissure-related parameters can be used as an important indicator to predict the closure pattern after surgery.Second,the microscopic structure of retina in the outer layer of macular central fovea in IMH affected eyes was gradually repaired,and the healing sequence was ELM,EZ,IZ.Third,the eyes with IMH have good postoperative visual acuity,and the eyes with IMH with U-shaped closure and ELM,EZ,and IZ continuity have the best visual acuity recovery.Fourth,the visual acuity 24 months after the surgery for IMH was correlated with preoperative factors.The shorter the duration of symptoms,the better preoperative visual acuity,the smaller the hole MIN and BASE,the shorter preoperative defect diameter of ELM,EZ and IZ,and the larger the MHI,THI and HFF,and the better visual acuity recovery 24 months after the surgery for IMH. |
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