设计：回顾性，连续性的系列病例研究。

对象：共有163例患者的167只眼入选本研究，所有患者均被诊断为特发性黄斑裂孔，并接受黄斑裂孔手术。

方法：所有患者均接受了经睫状体平坦部玻璃体切割手术，联合内界膜剥除，气液交换自体血小板应用及气体填充。通过频域OCT记录术前术后患者黄斑裂孔状态。

主要结果测量：分别测量黄斑裂孔两侧脱离的视网膜光感受器长度之和，以及无光感受器覆盖的视网膜色素上皮层长度，并以二者之比定义为黄斑裂孔愈合指数（MHCI）。本实验中共有五种黄斑裂孔愈合类型，每例患者的愈合类型均同时被记录。

结果：五种愈合种类所分别对应的眼数为125(74.85%),21(12.57%),18(10.78%),2 (1.20%)及1(0.60%)。将前两种愈合定义为“良好解剖结果”，将后三种愈合定义为“不良愈合结果”。当MHCI≥1时，术后获得“良好解剖结果”的患者比例要高于MHCI<1的情况(P=0.000)。所有“不良解剖结果”的患者的平均MHCI值为0.83±0.11, 95%单侧置信区间上限为0.87±0.38。而当MHCI与0.87相比时，MHCI≥0.87的患者术后获得“良好解剖结果”的患者比例要高于MHCI<0.87的情况(P=0.006)。桥状愈合患者的平均MHCI值为1.27,95%置信区间上限为1.13。当MHCI≥1.13时，桥状愈合的患者比例要高于MHCI<1.13时。同时，对MHCI<1的患者的MHCI值以0.2为区间进行分析，结果发现MHCI<0.6，0.8，1.0的患者获得良好愈合比率依次为70%，72.13%，77.11%，MHCI≥1的比率则为97.62%。

结论：MHCI可以作为预测黄斑裂孔术后解剖结果的参数。未来可以将绘图软件整合到OCT仪器中以便于测量和计算MHCI。在不具备条件的情况下，利用圆规直尺可以方便的比较MHCI值与1的大小。对于MHCI值小于0.87的患者，术中扩大内界膜剥除范围可能是有意义的，但仍需进一步实验证实。

Objective: To determine whether an improved preoperative macular hole (MH) closure index could serve as a predictive factor for anatomic outcome after MH surgery.

Methods: A total of 167 eyes from 163 patients diagnosed with idiopathic macular hole (IMH) who had undergone MH surgery were studied.All patients received pars plana vitrectomy surgery, with inner limit membrane peeling, air-fluid exchange and intravitreal gas tamponade. The preoperative and postoperative anatomic status of the MH was defined using spectral-domain OCT.

Main Outcome Measures: The MH closure index (MHCI) was calculated as (A+B)/C based on the preoperative OCT status. A and B were the curve lengths of the detached photoreceptor arms, and C was the length of the retinal pigment epithelial layer (RPE layer) that was not in contact with the photoreceptors. The patients in our study experienced five types of anatomic outcomes: type I, complete closure; type II, bridge-like closure, type III, poor closure with the absence of foveal neuroretina; type IV, no closure, with the hole edge attached; and type V, not closed, with the hole edge detached. The closure type of each patient was recorded.

Results: The number of patients with each closure type (types I-V) was as follows: 125 (74.85%), 21(12.57%), 18 (10.78%), 2 (1.20%) and 1 (0.60%), respectively. The overall closure rate was 98.20%. When the patients were divided into 2 groups based on whether MHCI ≥1, there was a significant difference in the closure status (F=16.36, P=0.000). Then, the average MHCI of patients with a “poor or no closure” was 0.83±0.11, and the average MHCI of patients with a bridge-like closure was 1.27±0.38. In addition, we calculated the rate of “good closures” using an MHCI value interval of 0.2 (<0.6, <0.8, <1.0, and >1) and found that the rate was higher for higher MHCI values".

Conclusions: Whether the bilateral detached photoreceptor layer was sufficiently long to cover the exposed RPE layer was the most important factor for determining postoperative MH anatomic outcomes. A total release of the tangential traction could not partially compensate for the insufficient length of the photoreceptors in covering the RPE layer. MHCI could be a predictive index for anatomic outcomes after IMH surgery. These conclusions are important for patient consultations to aid in evaluating patient expectations when selecting a surgical option.