摘要目的:分析特发性黄斑孔(IMH)患者手术后黄斑区视网膜和脉络膜血流变化情况及其与视力的相关性。方法:前瞻性非随机对照研究。纳入山西省眼科医院2020年1月至2021年12月经OCT确诊的IMH者30例(30只眼)为IMH组，其对侧眼30例(30只眼)为对照组。以光学相干断层扫描血管成像(OCTA)测量浅层毛细血管(SCP)和深层毛细血管(DCP)的视网膜血管密度、黄斑中心凹无血管区面积(FAZ)、脉络膜血流参数及视网膜厚度。术前及术后1、3、6个月检查最佳矫正视力(BCVA)，对黄斑区域的所有参数进行评估。结果:本研究IMH组患者术后黄斑孔均已闭合，FAZ面积术后1个月(0.22±0.09)mm 2较术前明显缩小，术后6个月(0.26±0.17)mm 2与术后3个月(0.25±0.18)mm 2相比稍扩大，但是总体明显小于术前( P＝0.031)。IMH组术后1个月SCP和DCP的FAZ面积为(0.29±0.11)mm 2和(0.39±0.14)mm 2，明显小于对照组的(0.45±0.14)mm 2和(0.63±0.22)mm 2 (均 P<0.001)。FAZ面积与术后BCVA无相关性( r＝0.23, P＝0.461)，但与术后视网膜敏感度(RS)呈负相关(SCP： r＝－0.66, P＝0.011; DCP： r＝－0.63, P＝0.023)。在黄斑中心区，IMH组和对照组的黄斑中央区脉络膜血流面积、中心凹下脉络膜厚度、SCP和视网膜厚度差异均有统计学意义(均 P<0.05)。 结论:IMH患者黄斑孔的发生与FAZ面积及SCP血管密度相关，FAZ与术后RS呈负相关。OCTA可以定量评估IMH手术后血管和形态的变化。

abstractsObjective:To analyze the changes of retinal and choroidal blood flow in the macular region after surgery in patients with idiopathic macular hole (IMH) and its correlation with visual acuity.Methods:This was a prospective non-randomized control study. A total of 30 eyes of 30 cases diagnosed with macular holes by OCT from Jan. 2020 to Dec. 2021 in Shanxi Provincial Eye Hospital as the IMH group and contralateral healthy eyes were selected as the control group. With optical coherence tomography angiography (OCTA), retinal vascular density in shallow capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), choroidal blood flow parameters, and retinal thickness were measured. The best corrected visual acuity (BCVA) was examined before surgery and at 1, 3 and 6 months after surgery, and all parameters of the macular area were evaluated.Results:All macular holes were closed in the IMH group after surgery, and the FAZ surface volume decreased significantly at 1 month after surgery [(0.22±0.09) mm 2], and slightly expanded at 6 months after surgery [(0.26±0.17) mm 2] compared with that at 3 months after surgery [(0.25±0.18) mm 2], but the overall volume was significantly smaller than that before surgery ( P=0.031). The FAZ area of SCP and DCP in the IMH group was (0.29±0.11) mm 2 and (0.39±0.14) mm 2, which were significantly lower than those in the control group [(0.45±0.14) mm 2 and (0.63±0.22) mm 2 (all P<0.001)]. FAZ area was not correlated with postoperative BCVA ( r=0.23, P=0.461), but was negatively correlated with postoperative RS ( r=-0.66, P=0.011; r=-0.63, P=0.023). In the macular fovea area, there were significant differences in FBFA, SFCT, SCP and RT between the IMH group and the control group (all P<0.05). Conclusion:The occurrence of hives in IMH patients is correlated with FAZ area and vascular density in SCP layer, and FAZ area is negatively correlated with postoperative retinal sensitivity. OCTA is a useful indicator for evaluating macular hole before and after IMH surgery by quantitative evaluation of vascular and morphological changes.