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目的 应用光相干断层扫描 (OCT)对临床诊断为 ～ 期特发性黄斑裂孔患眼进行随诊观察 ,了解其裂孔进展过程及与玻璃体后分离的相互关系。 方法 按 Gass的临床分期标准 ,结合 OCT图像特征 ,诊断特发性黄斑裂孔 ～ 期未行手术治疗的 72只眼 ,进行 OCT随诊检查。 结果 ～ 期裂孔分别为 2 3、19、11、19只眼 ,随诊时间最长 4 3个月 (平均 13.4个月 ) ,每只眼 OCT检查次数 2～ 10次(平均 4 .7次 ) ,在随诊期间 , 期裂孔 2 3只眼 ,9只眼 (39.1% )进展为 ～ 期裂孔 ,2只眼玻璃体后脱离(PVD)后中心凹曲线恢复正常 ; 期裂孔 19只眼 ,13只眼 (6 8.4 % )进展为 ～ 期裂孔 ,有 1只眼 PVD后裂孔自行愈合 ; 期裂孔 11只眼 ,5只眼 (45 .5 % )进展为 期裂孔 ,1只眼 12个月后裂孔部分自行愈合。OCT图像显示 ,玻璃体从黄斑中心凹周围开始与视网膜分离 ,直至完全后脱离的过程与黄斑裂孔进展过程一致。在随诊期间 ,15只眼因病程进展接受手术治疗。 结论 黄斑裂孔形成和发展与玻璃体后脱离的发生密切相关。OCT可直观显示黄斑裂孔的进展变化 ,对提供 IMH的分期诊断和手术指征有较大帮助。
Objective To observe the progress of the process of hilar fracture and the relationship with posterior vitreous detachment by using optical coherence tomography (OCT) to observe the clinical stage of idiopathic macular hole. Methods According to Gass’s clinical staging criteria and OCT image features, 72 eyes with idiopathic macular hole who had not undergone surgical treatment were examined with OCT. RESULTS: There were 23, 19, 11, and 19 eyes with a maximum of 43 months follow-up (average 13.4 months). The number of OCT examinations in each eye ranged from 2 to 10 (average, 4.7) During the follow-up period, 23 eyes (39.1%) had stage debridement and 23 cases (19 eyes) had postoperative vitreous detachment (PVD) The eye (6 8.4%) progressed to ~ stage hiatus, and one eye underwent self-healing after PVD. There were 11 eyes with stage hiatus and 5 eyes (45.5% Heal themselves. OCT images showed vitreous detachment from the retina from around the foveal until the detachment process completely coincided with macular hole progression. During the follow-up period, 15 eyes underwent surgical treatment due to the course of the disease. Conclusion The formation and development of macular hole are closely related to the occurrence of posterior vitreous detachment. OCT can directly show the progress of macular hole changes, to provide the staging of IMH and surgical indications a great help.