| BackgroundIdiopathic Macular Hole(IMH)is a common and blinding phthalmology disease in the elderly women.Which usually cause significant central vision loss,and severe cases can lead to retinal detachment.At present,the 23 G or 25 G,or even 27 G vitrectomy combined with internal limiting membrane peeling for idiopathic macular hole to treat idiopathic Macular Hole have achieved good surgical results.The majority of patients,Macular hole achieve closure after surgery,but the degree of postoperative visual acuity is inconsistent.The visual acuity of some patients with postoperative decreased compared with preoperative,therefore,which makes people looking for various factors and causes to influence visual prognosis of Idiopathic Macular Hole for patients.There are many effective indicators to predict the Idiopathic Macular Hole after surgery,such as Macular hole index(MHI);tractional hole index(THI);macular hole clousure(MCHI)and so on.ObjectivesThrough the measurement and collection of the OCT morphological data of preoperative and postoperative for Idiopathic Macular Hole to know the acquaintance macular morphology recovery and the degree of improvement of visual function before and after the operation.In order to discover a new methods to accurately predict the correlation between preoperative OCT imaging parameters and early postoperative visual recovery in patients with idiopathic macular holes.Methods1 We chose 29 patients(30 eyes)with idiopathic macular holes who were enrolled in the Third Affiliated Hospital of Xinxiang Medical College from January 2012 to June 2015.After a series of related influencing factors were excluded,24 patients(25 eyes)were finally included in the study.2 Test items: The Heidelberg Spectralis HRA-OCT device(Germany)was used toscan the macula horizontally,the software comes with a caliper tool to measure the highest retinal thickness at the edge of the hole.The Image-Pro Plus 6.0 software measures the following parameters,base diameter of macular hole(BD),minimum liner diameter(MLD),the maximum vertical height of the photoreceptor breaking point and the retinal pigment epithelium at the edge of the hole.3 Surgical methods: Standard three-channel 23 G vitrectomy through the ciliary body flat,the vitreous cortex was stained with triamcinolone acetonide and excised,combined with macular around the upper and lower vascular arch within the 1-2PD internal limiting membrane annular stripping.Gas-liquid exchange,0.6 mL of C3F8 was injected into the vitreous.After measuring normal intraocular pressure,tobramycin dexamethasone eye ointment was used inconjunctival and anpatients were bandaged.At last,all patients in the prone position after at least 2 weeks,not less than 8h per day.4 All the data were processed by SPSS 22.0 statistical package.General information are expressed using the mean ± standard deviation.The area under the curve of the subject operating characteristic was analyzed and take the maximum value of the sum of sensitivity and specificity as the cut-off value.Results1 General conditions: Operations were successfully completed,and there was no iatrogenic retinal tears and retinal hemorrhage or other complications.Postoperative intraocular pressure in 2 cases,after using conventional intraocular pressure lowering drugs,the intraocular pressure can be controlled,the intraocular pressure return to normal after1 month.Macular hole was not closed within 12 weeks for 2 cases.The remaining patients were normal during follow-up.2 vision: Preoperative IMH patients BCVA for the 0.03 ~ 0.200,and the average for0.104.The BCVA of the patients at the 12 th week was 0.020-0.700,with an average of0.240,postoperative significantly increased compared with preoperative(U test: P = 0.000).The BCVA in postoperative was improved in 19 eyes(76.0%),BCVA remained unchanged in 4 eyes(16.0%)and decreased in 2 eyes(8.0%).3 Parameter measurement results: The BCVA of IMH patients at the 12 th week after operation was significantly higher than that before operation and the difference wasstatistically significant(P <0.001).The correlation analysis showed that there was correlation between BCVA and MHI(H / BD),THI(H / MLD),MHI '(H' / BD),THI '(H' /MLD).The cutoff values of MHI,THI,MHI 'and THI' were analyzed by area under ROC curve,the result showed that the area under the curve of MHI,THI,MHI 'and THI were0.855,0.860,0.816 and 0.825,respectively.the standard errors were 0.100,0.083,0.111,0.093.The BCVA at 12 weeks after MHI cut-off ? 0.705 was higher than that at MHI <0.705(P = 0.023);the BCVA at 12 weeks after THI ? 1.425 was significantly higher than that of THI <1.425(P = 0.001).ConclusionTHI cut-off value ? 1.425 or MHI cut-off value ? 0.705 at 12 weeks after surgery to get better vision,so they can be used as predictors of early postoperative vision recovery in IMH patients. |
PDF Full Text Request