| Idiopathic macular holes(IMH) are self-occuringmacular lesionsbetween the inner limiting membrane and photoreceptor without any primary eye conditions such as refractive error, ocular trauma and inflammation, or vascular diseases. The disease seriouslycompromises the central vision andusually occurs in people over the age of 50. It usually has a hidden onset, slow progression and few early symptoms. Patients often first notice it when the other eye is covered. When it progresses, the central vision is seriously compromised, affecting quality of life. As the world population is aging and the elderly population in China grows, IMH research has received increasing attention. With the improvement in ophthalmic technology and equipment, especially the emergence of the Enhanced Depth Imaging Spectral-domain Optical Coherence Tomography(EDI SD-OCT), people are enabled to have a clear view of the structure of the choroid layer structure and obtainits cross-sectional images. Currently this technology has been used to study a variety of retinal diseases, particularly macular diseases, such as high myopia retinopathy, central serous retinopathy, PCV, age-related macular degeneration, Koyanagi- Harada disease, etc.In these studies, some scholars believe that the change in choroidal thickness is related to choroidal blood supply and inflammation. As the fovea is avascular and its blood supply comes from the choroid layer, variation in choroidal thickness in macular diseaseshas drawn people's attention, followed by studies on the correlation between choroidal thickness variation and pathogenesis of IMH. Studies have suggested a possible link between the change in choroidal thickness and the occurrence of macular holes. However, no causal correlation has been established. Further clinical research and demonstration on this question is needed?Objective:1 Investigate the relationship between changes in choroidal thickness and occurrences of IMH?2 Investigate factors affecting the choroidal thickness of IMH?Method:1 From the visits to the Department of Ophthalmology of the Second Hospital of Hebei Medical University between May 2014 to December 2015, 112 eyes of 56 patientswere diagnosed of monocular IMH via EDI SD-OCT examination according to the Gass staging and excluded of high myopia and other eye diseases. The 56 eyes with IMH were grouped as A and the 56 contralateralhealthy eyesas B. Both groups received phacoemulsification and intraocular lens implantation, pars planar vitrectomy, indocyanine green assisted inner limiting membrane peeling combined with intraocular gas tamponade and the patients remained in facedown position for a few days after the surgery. EDI SD-OCT was used to follow up and OCT images showed anatomical closure of the macular holes. Among the 56 cases, 35 cases complied with all the conditions in the follow-ups. Their 35 eyes were grouped as D. Related medical records including age, sex, and medical history were collected. Eye examinations included intraocular pressure(IOP), best corrected visual acuity(BCVA), slit-lamp microscopy, binocular indirect ophthalmoscope, binocular optical biometry(IOL-Master) and EDI SD-OCT.Both the affected eye and the contralateral healthy eye were examined and the affected eye was also examined by EDI SD-OCT at 1, 3 and 6 months after the surgery. Choroidal thickness at 9 points: the fovea, and 1 mm, 3 mm above, below, nasal to and temporal to the fovea were measure by EDI SD-OCT for both eyes.The axial length of the affected eye, the minimum diameter and basal diameter of the macular hole were also measured. Patients' gender, age, eye differentiation, duration of the disease and macular hole staging were recorded. These data were used to compare choroidal thicknesses of the affected eye with the healthy eye, the affected eye before the surgery and after the surgery at various locations at the macular, and investigate relationships between choroidal thickness and axial length, minimum diameter, basal diameter of the macular hole, sex, age, eye differentiation, duration of the condition and macular hole staging,and brought the smallest diameter of group A which greater than 500 um into the giant hole group,the remaining subjects were divided into the control group.2 From January 2014 to December 2015, 56 eyes of 56 age and sex-matched healthy people were used for the control group C. Choroidal thickness at the fovea were measured by EDI SD-OCT to investigate if there is difference betweenhealthy human eyes and IMH eyes.The vertical distance between the outer boundary of the retinal pigment layer and the inner boundary of the sclera boundary was used to represent the thickness of choroid. The statistical analysis aimed at comparing the mean choroidal thickness.If the measurement data satisfied normality distribution thenthe parametric test was used; if not, the nonparametric test was used.Result:1 SFCT and the choroidal thickness atother measurement points before the surgery:SFCT for IMH Group A was 236.09 ± 79.254 ?m; Group B 249.71 ± 86.103?m and Group C 283.29 ± 64.165?m(Table2). The differences between Group A and B(t =-2.024, P = 0.043 < 0.05), Group B and Group C(t =-2.340, P = 0.021 <0.05); Group A and Group C(t = 3.464, P = 0.001 <0.05) were statistically significant. Group C, B and Ashowed a gradual decrease in SFCT value.However, before the surgery, no significant difference was found at each measurement points for group A and group B.2 The affected eye of IMH patients SFCT and choroidal thickness at other measurement points:Before the surgery, group D SFCT value was 233.43 ± 84.638?m. 1, 3, 6 months after the surgery, the SFCT values were 242.46 ± 88.199?m, 238.97 ± 89.252?m, and 236.71 ± 88.661?m, respectively. The SFCT of 1 month after surgery was significantly increased compared to that of before the surgery(P = 0.002). However, it gradually decreased to the base line 6 months after the surgery(P> 0.05).Choroidal thickness values at other measurement points:we observed that 1,3,and 6 months after the surgery the choroidal thickness at 3mm below the fovea(ICI3mm)gradually increased compared with before the surgery:(170.89±57.040?179.63±62.941?179.74±65.981,180.88±58.379?t1????=-2.448,P1????=0.014;t3????=-2.654,P3????=0.008;t6????=-2.630,P6????=0.009).However,this increase was not observed at other measurement points.3 SFCT values of the affected eye of IMH patients showed no obvious correlation to the axial length, the minimum diameter and basal diameter of the macular hole, age, gender, eye differentiation, disease duration, and the macular hole stage(P >0.05).And compared with the control group,the SFCTvalue of the giant split hole group was lower than that of the control group,but the difference was not statistically significant(245.49±82.341 um,220.43±73.043 um,t=-1.149,P=0.256)?Conclusion:1 SFCT values of the normal eyes, the contralateral healthy eyesof IMH patients and the affected eyes gradually decreased, suggesting a possiblecorrelation between the occurrence of IMH and choroidal thickness.2 The SFCT value of the affected eyes showed a transient increase one month after the surgery, then gradually returned to the base line. As the macular hole was sealed and healed, the choroidal thickness didn't increase, indicating that the decreasing in choroidal thickness is possibly the cause to the formation of the macular hole, not the results.3 The choroidal thickness of the affected eyes in IMH patients showed no correlation to the axial length, the minimum diameter and basal diameter of the macular hole, age, gender, eye differentiation, disease duration, and macular hole stage.4 IMH postoperative choroidal thickness values change by location, which may be due to the oppression by the injected gas in the macular hole surgery. |
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