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目的 观察板层黄斑裂孔(LMH)患眼玻璃体切割手术(PPV)后视网膜微结构变化.方法 回顾性临床观察性研究.2014年1月至201 8年9月在北京大学人民医院眼科检查确诊并接受PPV治疗的LMH患者40例41只眼纳入研究.其中,男性14例15只眼,女性26例26只眼;平均年龄(67.8±8.6)岁.有晶状体眼37只眼,IOL眼4只眼.牵拉型、退行型、混合型分别为29、7、5只眼.患者均行BCVA、OCT检查.BCVA检查采用国际标准视力表,统计时换算为logMAR视力.患眼平均logMAR BCVA为0.57±0.27;平均黄斑区视网膜厚度(CRT)、黄斑厚度(MRT)分别为(192.3±108.9)、(427.5±110.2) μ.m.牵拉型29只眼中,伴视网膜囊腔17只眼,黄斑劈裂8只眼,椭圆体带(EZ)不完整3只眼.退行型7只眼中,伴LMH相关视网膜前增生膜(LHEP)5只眼,视网膜囊腔5只眼,EZ不完整5只眼.混合型5只眼中,伴LHEP 2只眼,黄斑前膜1只眼,EZ不完整4只眼.手术后平均随访时间(12.8±5.2)个月.其中,随访时间≥24个月者10只眼.手术后采用手术前相同设备和方法行相关检查.观察BCVA、CRT、MRT变化.连续变量比较行t检验.结果 末次随访时,患眼平均logMAR BCVA为0.37±0.26;与治疗前比较,差异有统计学意义(t=5.98,P＜0.01).平均CRT、MRT分别为(245.2±90.8)、(347.0±46.7) μm;与手术前比较,差异均有统计学意义(t=-2.49、-5.24,P＜0.05、＜0.01).CRT、MRT在手术后6个月内变化幅度较大,此后趋于平缓.牵拉型患眼,手术前存在EZ不完整的3只眼中,EZ恢复完整性2只眼,部分恢复1只眼.手术前伴视网膜囊腔的17只眼、黄斑劈裂的8只眼中,仍有囊腔4只眼,劈裂孔均消失.退行型患眼,手术前伴视网膜囊腔的5只眼中,仍有囊腔2只眼;EZ均未恢复完整性.随访时间≥24个月的10只眼中,出现黄斑区RGC复合体部分萎缩6只眼,神经纤维层分离样改变2只眼.所有患者手术后均未发生全层黄斑裂孔.结论 PPV可有效提高多数LMH患眼视力以及促进黄斑区视网膜微结构的恢复.

Objective To observe the changes of retinal microstructure in lamellar macular hole (LMH)after vitrectomy.Methods A retrospective clinical observational study.Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People's Hospital from January 2014 to September 2018 were included in this study.Among them,14 patients (15 eyes) were males and 26 patients (26 eyes) were females,with an average age of 67.8±8.6 years.There were 37 eyes with a lens and 4 eyes with an IOL.There were 29 eyes with LMH of tractional type,7 eyes of degenerative type,and 5 eyes of mixed type.All patients underwent BCVA and OCT examinations.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The average logMAR BCVA was 0.57±0.27;the mean macular retinal thickness (CRT) was 192.3 ± 108.9 μtm,the mean macular thickness (MRT) was 427.5± 110.2 μm.Among the 29 eyes of tractional type,there were 17 eyes with retinal cavity,8 eyes with macular retinoschisis,and 3 eyes with incomplete ellipsoid zone.Among the 7 eyes of degenerative type,there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP),5 eyes with retinal cavity,and 5 eyes with incomplete ellipsoid zone.Among the 5 eyes of mixed type,2 eyes with LHEP,1 eye with macular epiretinal membrane,and 4 eyes with incomplete ellipsoid zone.The average follow-up time after surgery was 12.8±5.2 months.Among them,10 eyes were followed up for equal or greater than 24 months.After the surgery,the same equipment and method before the surgery were used for relevant examination.The changes of BCVA,CRT,and MRT before and after surgery were observed.Continuous variables were compared by t test.Results At the last follow-up,the mean logMAR BCVA was 0.37± 0.26.Compared with before surgery,the difference was statistically significant (t=5.98,P＜0.01).The mean CRT and MRT were (245.2 ± 90.8) and (347.0 ±46.7) μtm,respectively.Compared with before surgery,the differences were statistically significant (t=-2.49,-5.24;P＜ 0.05,＜ 0.01).CRT and MRT changed greatly within 6 months after surgery,and then tended to be gentle.Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery,ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye.Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery,there were still 4 eyes with retinal cavity,but all the retinoschisis were disappeared.Among the 5 eyes with retinal cavity of degenerative type before surgery,there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone.Among 10 eyes with a follow-up time of equal or greater than 24 months,the macular ganglion cell complex partially atrophied in 6 eyes,and the nerve fiber layer separated in 2 eyes.There was no full-thickness macular hole after surgery.Conclusion For most LMH patients,vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.