| 摘要
[目的]
对玻璃体切割联合内界膜剥除术治疗的特发性黄斑裂孔(IMH)患者，应用光学相干断层扫描（OCT）进行术前术后的裂孔形态观察，分析术前裂孔本身形态特征，包括黄斑裂孔的最小直径（裂孔边缘直径）、基底直径（色素上皮层水平测得的直径）、黄斑裂孔的孔高、黄斑区视网膜厚度与术后最佳校正视力（BCVA）的相关性，并试提供有效的视力预后指标。评价本院内界膜剥除手术治疗特发性黄斑裂孔的效果。
[方法]
前瞻性分析32例（7例男性，25例女性）于湘雅二医院行玻璃体切割联合内界膜剥除，膨胀气体充填手术的IMH患者，对其均进行术前术后的OCT检查和裂隙灯，眼压，眼底，验光检查。取随访期间最佳校正视力，利用OCT的分析模式，分别测量手术前黄斑裂孔的最小直径，基底直径，裂孔高度，黄斑区视网膜厚度。用SPSS13.0软件包，比较黄斑裂孔自身形态测量值与术后BCVA的相关性。
[结果]
⑴术后BCVA与术前黄斑裂孔的最小直径（r1=-0.524, P=0.000＜0.01）和基底直径(r2=-0.610, P=0.000＜0.01）呈负相关；
⑵术后BCVA与术前裂孔高度（r1=-0.064, P=0.726＞0.05），黄斑区视网膜厚度(r2=0.003, P=0.986＞0.05）无明显相关性；
⑶ MHI与术后BCVA呈正相关（r=0.457, P=0.006＜0.05）。
⑷据临床观察，取MHI＝0.5为分界值，MHI≥0.5组的患者术后视力明显优于MHI＜0.5组(Mann-Whitney Test)（U=30.0,W=135, p=0.000＜0.01）
⑸本院手术的解剖愈合率为84.38％，81.25％的患者视力提高一行以上。
术后BCVA较术前明显提高（Wilcoxon Signed Ranks Test） (Z=-4.203, p=0.000＜0.01)
[结论]
利用OCT定量测量黄斑裂孔的自身形态特征，可以对术后的视力预后提供评价指标，在这些特征中，黄斑裂孔的最小直径与基底直径对术后视力有预测价值。MHI反应了在与视网膜垂直方向和水平方向上黄斑裂孔的特征对比，计算简便，与术后BCVA相关性高，可作为临床预后评估指标。本院玻璃体切割联合内界膜剥除手术治疗特发性黄斑裂孔的取得良好效果。
[关键词]
特发性黄斑裂孔，直径，裂孔高度，视网膜厚度， 黄斑裂孔指数，视力预后
Abstract
[objectives]
Got the optical coherence tomagraphy(OCT) images of the idiopathic macular hole (IMH, ratio of hole height to base diameter of hole) patients post the operation of vitrectomy and internal limiting membrane peeling (ILMP) surgery, analyzed the macular hole configuration, including the minimum diameters which is measured at the mimimal extent of the hole, the base diameters which is measured at the level of the retinal pigment epithelium, the hole highs, the macular retinal thinkness in the central(<1000 microm)，etc，were correlated with the postoperative best corrected visual acuity (BCVA). And tried to give an effect index to evaluate the predict visual outcome in eyes with idiopathic macular holes. Evaluate the therapeutic efficacy to the IMH of IMP surgery in our hospital.
[Methods]
In a prospective study 32 consecutive patients of IMH (7 male,25 female), which were done the operation of PPV and ILMP in the XiangYa the Second Hospital, were examined with OCT before and after the operation. The minimum diameter, the base diameter, the hole high before the operation, and the macular retinal thickness before and after the operation all being measured by OCT was correlated visual acuity. Macular hole index (MHI) was correlated BCVA post operation. All statistics was analyzed by the SPSS13.0.
[Results]
⑴The negative correlation was observed between the post operative BCVA and the minimum diameter（r1=-0.524, P=0.000＜0.01）and the base diameter(r2=-0.610,P=0.000＜0.01)
⑵There are no significant correlation was observed between the post operative BCVA and the hole height（r1=-0.064, P=0.726＞0.05） and the macular retinal thickness(r2=0.003,P=0.986＞0.05）
⑶The positive correlation was observed between the post operative BCVA and the MHI（r=0.457, P=0.006＜0.01）
⑷The cut-off value of MHI was defined as 0.5 by clinical observation. Postop BCVA in the MHI≥0.5 group was much better than that in the MHI＜0.5（Mann-Whitney Test）（U=30.0,W=135, p=0.000＜0.01）
⑸Anatomic success was achieved in 27 (84.38%) of 32 patients. BCVA was improved in 26 (81.25%) in 32 patients more than one line.
The postop BCVA was much better than that before the operation.( Wilcoxon Signed Ranks Test) (Z=-4.203,p=0.000＜0.01)
[Conclusions]
Measuring the macular hole configuration parameter by OCT can get the parameter for the post operative BCVA, in that parameter, the minimum diameter and the base diameter was the most valuable.
The MHI,which is criteria reflecting the retinal character in horizontal and vertical directions.It was easily caculated, and was correlated well with postop BCVA, we can used it as clinical evaluated index.
The PPV combined with IMLP can effectively treated the IMH in our hospital.
[Key words]
idiopathic macular hole, diameter, hole height, retinal thinkness, macular hole index ,visual acuity
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