【摘要】：研究背景自上個(gè)世紀(jì)九十年代以來(lái),眼科各項(xiàng)檢查技術(shù)日新月異發(fā)展,光學(xué)相干斷層掃描技術(shù)就是在這個(gè)時(shí)候迅速發(fā)展起來(lái)的一種新的醫(yī)學(xué)斷層成像分析技術(shù),它融合了光學(xué)技術(shù)、半導(dǎo)體激光技術(shù)、數(shù)據(jù)模型計(jì)算和數(shù)字化圖像處理技術(shù)等,在對(duì)人體進(jìn)行非損傷性的活體形態(tài)學(xué)檢測(cè)同時(shí),獲得生物組織內(nèi)部微結(jié)構(gòu)的橫斷面圖像。特別是隨著OCT從時(shí)域模式轉(zhuǎn)變?yōu)轭l域模式,OCT發(fā)展也進(jìn)入了新的時(shí)代。從OCT技術(shù)引入眼科伊始,其在黃斑裂孔診斷中的研究最早也最深入。在黃斑裂孔中,以特發(fā)性黃斑裂孔最為多見(jiàn)。研究者們發(fā)現(xiàn)OCT能清晰的發(fā)現(xiàn)視網(wǎng)膜內(nèi)各層結(jié)構(gòu)的形態(tài)學(xué)變化,對(duì)于黃斑裂孔的形成過(guò)程和分期,OCT檢查能清晰的顯示類似于病理切片的“解剖學(xué)”改變,因此能精確的解釋患者與視網(wǎng)膜解剖結(jié)構(gòu)變化相對(duì)應(yīng)的視力改變和預(yù)后。在各種檢查手段中,臨床眼科醫(yī)生發(fā)現(xiàn)OCT是優(yōu)于各種傳統(tǒng)檢測(cè)手段的眼底影像學(xué)技術(shù)。隨著手術(shù)技術(shù)和設(shè)備的日益完善,術(shù)后患者黃斑裂孔的裂孔封閉率日益提高。但是,術(shù)后OCT檢查證實(shí)裂孔封閉的患者,視力改善的程度卻不一致,有的患者術(shù)后視力甚至較術(shù)前下降,使得人們尋找影響IMH患者視力預(yù)后的各種原因。以往的時(shí)域OCT在特發(fā)性黃斑裂孔的觀察上,多集中在黃斑裂孔直徑、基底裂孔直徑、裂孔面積、黃斑中央視網(wǎng)膜厚度、裂孔形態(tài)、裂孔鼻側(cè)和顥側(cè)邊緣水腫程度等指標(biāo)上。有的學(xué)者通過(guò)回顧性研究中發(fā)現(xiàn)裂孔大小、孔緣神經(jīng)上皮層厚度與患眼視力密切相關(guān)。但是同時(shí)也有學(xué)者發(fā)現(xiàn)板層黃斑裂孔矯正視力與裂孔面積、裂孔基底寬度、裂孔位置均無(wú)相關(guān)性,而且與以往研究得出的“裂孔越大、視力越低,裂孔越小、視力越好”的結(jié)論并不一致,在徑線選取的部位上也存在一定程度的主觀性。所以,通過(guò)SD-OCT能夠清晰分清視網(wǎng)膜各層組織結(jié)構(gòu)的功能,尋找一個(gè)可以較好評(píng)估IMH患者手術(shù)視力預(yù)后的觀察指標(biāo),成為學(xué)者們研究的熱點(diǎn)。 由于光感受器內(nèi)外節(jié)是將光信息轉(zhuǎn)化成生物電信號(hào)后向中樞神經(jīng)傳遞的重要一環(huán),IS/OS層的完整性,被認(rèn)為是光感受器完整性的重要標(biāo)志,是評(píng)估患者視功能預(yù)后的重要指標(biāo)。越來(lái)越多的研究,通過(guò)頻域OCT觀察發(fā)現(xiàn),IS/OS層連續(xù)性的變化與患者的視力預(yù)后相關(guān)。在SD-OCT對(duì)IS/OS層連續(xù)性的評(píng)估上,國(guó)內(nèi)外一些學(xué)者將IS/OS層分為連續(xù)、中斷和缺失的不同形態(tài),進(jìn)行了定性分析。有的研究者甚至分別測(cè)量IS/OS層水平、垂直兩方向上缺失區(qū)直徑后相乘得出缺失區(qū)面積后進(jìn)行分析。我們的研究目的即是觀察手術(shù)前后水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑的變化,分析其與患者視力預(yù)后的關(guān)系。 從“特發(fā)性黃斑裂孔”的命名上可見(jiàn)這一疾病的原因目前并不清楚,IMH的發(fā)病機(jī)制也一直是眼科領(lǐng)域一個(gè)探索了多年的課題。目前較為公認(rèn)的是Gass提出的玻璃體的切向牽拉理論,認(rèn)為玻璃體對(duì)黃斑中心凹切線方向上的牽拉是造成IMH的主要原因。有學(xué)者通過(guò)手術(shù)觀察和后來(lái)出現(xiàn)的OCT技術(shù)檢查發(fā)現(xiàn),黃斑牽拉綜合征的患者有半數(shù)病例最終會(huì)發(fā)展成為特發(fā)性黃斑裂孔,在完全后脫離的玻璃體后界膜上有時(shí)可見(jiàn)粘連的游離的孔蓋組織。另一些學(xué)者通過(guò)OCT和手術(shù)發(fā)現(xiàn)玻璃體后脫離時(shí)對(duì)中心凹施加的向前的牽拉聯(lián)合眼球轉(zhuǎn)動(dòng)時(shí)的反作用力是發(fā)生IMH的始動(dòng)因素,以上觀點(diǎn)均從玻璃體視網(wǎng)膜界面因素來(lái)考慮IMH的形成原因。但也有研究者為了了解在全層黃斑裂孔患者的手術(shù)前,其玻璃體是否仍粘連于后極部視網(wǎng)膜,對(duì)OCT檢測(cè)未能清晰顯示玻璃體后界膜的部分患者進(jìn)行人工玻璃體后脫離,結(jié)果發(fā)現(xiàn)在玻璃體后皮質(zhì)仍然與黃斑區(qū)視網(wǎng)膜貼合緊密的患者,依然發(fā)生了明顯的黃斑裂孔,可見(jiàn),除了玻璃體對(duì)黃斑切線方向牽拉力的作用之外,還有其他因素對(duì)特發(fā)性黃斑裂孔的形成產(chǎn)生作用。近來(lái),國(guó)內(nèi)外學(xué)者通過(guò)頻域OCT的深度增強(qiáng)成像技術(shù)發(fā)現(xiàn)正常人群隨著年齡的增加脈絡(luò)膜厚度逐漸降低,而且女性的中心凹下脈絡(luò)膜厚度值明顯低于同齡男性,,而IMH多發(fā)于老年女性的特點(diǎn)也使學(xué)者們把目光轉(zhuǎn)向脈絡(luò)膜厚度因素上來(lái)探討特發(fā)性黃斑裂孔的發(fā)生機(jī)制。 采用傳統(tǒng)的頻域OCT儀作脈絡(luò)膜的掃描獲取圖像是很困難的,因?yàn)樗玫募t外光很難穿透視網(wǎng)膜色素上皮層到達(dá)下面的脈絡(luò)膜層。最近,一項(xiàng)被稱為深度增強(qiáng)成像技術(shù)(EDI)的革新出現(xiàn)后,以上的難題迎刃而解,使脈絡(luò)膜掃描成像成為可能。傳統(tǒng)SD-OCT的眼底掃描主要顯示視網(wǎng)膜內(nèi)界膜到RPE層之間的組織結(jié)構(gòu)。而脈絡(luò)膜,負(fù)責(zé)眼內(nèi)循環(huán)主要的血液供應(yīng),是許多脈絡(luò)膜血管相關(guān)疾病的組織起源,如息肉樣脈絡(luò)膜血管病變、惡性脈絡(luò)膜黑色素等。同樣,另一類與年齡和微循環(huán)相關(guān)的疾病,如老年性黃斑變性和微小動(dòng)脈粥樣硬化,也同樣與脈絡(luò)膜有關(guān)。但是,用傳統(tǒng)的OCT完成對(duì)脈絡(luò)膜的非侵入性檢查很難成功。首先,傳統(tǒng)OCT采用的光波波長(zhǎng)不夠,難以穿透視網(wǎng)膜色素上皮層到達(dá)深層的脈絡(luò)膜組織。光波二相性原理告訴我們：光程增加,散射越發(fā)衰減,而離零延時(shí)越遠(yuǎn),反射光靈敏度則越低,而傳統(tǒng)SD-OCT所采用的傅里葉轉(zhuǎn)換又一定程度上制約了光波的穿透性�？偨Y(jié)來(lái)說(shuō),傳統(tǒng)OCT不能掃描脈絡(luò)膜成像的缺點(diǎn)是：(1)信號(hào)的清晰度和分辨率會(huì)隨著脈絡(luò)膜掃描零延遲距離的增加而降低；(2)傅里葉轉(zhuǎn)換造成傳統(tǒng)SD-OCT的最大探測(cè)范圍降低；(3)反射光波長(zhǎng)和信號(hào)會(huì)在光波散射的過(guò)程中逐漸衰減；(4)圖像雙側(cè)邊界產(chǎn)生對(duì)光柱的離焦現(xiàn)象。普通的SD-OCT采用的是800nm左右的紅外光,而波長(zhǎng)為1060nm的紅外光才能穿透達(dá)到脈絡(luò)膜。因此為了使更深層的組織成像清晰,人們采用深度增強(qiáng)掃描成像技術(shù),即采用1060nm左右的紅外光投射被檢查者,使光源聚焦于更深層的脈絡(luò)膜組織,當(dāng)組織反射的光信號(hào)延遲為零時(shí),成像最清晰：相反,前面的視網(wǎng)膜血管和神經(jīng)纖維層則時(shí)間延遲增加,成像相對(duì)模糊。而目前最新的光學(xué)相干斷層掃描EDI技術(shù)避免了以上缺點(diǎn),可以使傳統(tǒng)SD-OCT獲得清晰脈絡(luò)膜掃描圖像的同時(shí),視網(wǎng)膜組織的圖像也不受任何影響。 第一部分頻域OCT觀察特發(fā)性黃斑裂孔手術(shù)前后光感受器內(nèi)外節(jié)的變化 目的通過(guò)頻域光相干斷層掃描(SD-OCT)觀察光感受器內(nèi)外節(jié)在特發(fā)性黃斑裂孔手術(shù)前后的變化。 方法前瞻性對(duì)比分析23例(25只眼)確診并接受玻璃體手術(shù)治療的特發(fā)性黃斑裂孔患者的臨床資料,采用Topcon公司Version3.21型頻域OCT測(cè)量并對(duì)比分析手術(shù)前后水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑(diameter of IS/OS absence,DIOA)的差別(配對(duì)資料的T檢驗(yàn))和相關(guān)性(Bivariate過(guò)程中的Pearson相關(guān)分析)。 結(jié)果手術(shù)后有18只眼黃斑裂孔閉合,裂孔封閉率為72%。術(shù)前DIOA范圍為(551～2900)μm,平均(1933.16±650.80)μm；術(shù)后12月DIOA范圍為(412-2811)μm,平均(1329.20±780.13)μm,術(shù)后12月DIOA較術(shù)前減少了約604μm。經(jīng)配對(duì)樣本的t檢驗(yàn),手術(shù)前后差異有顯著性意義(t=3.73,P=0.001)。經(jīng)Pearson相關(guān)分析,術(shù)前DIOA與術(shù)后DIOA之間不存在有統(tǒng)計(jì)學(xué)意義的相關(guān)關(guān)系(r=0.37,P=0.069)。 結(jié)論頻域OCT能清晰觀察視網(wǎng)膜IS/OS層的結(jié)構(gòu),特發(fā)性黃斑裂孔患者術(shù)后水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑較術(shù)前明顯減少,但兩者無(wú)明顯相關(guān)性。 第二部分頻域OCT觀察特發(fā)性黃斑裂孔手術(shù)前后光感受器內(nèi)外節(jié)與視力的關(guān)系 目的通過(guò)頻域相干光斷層掃描觀察光感受器內(nèi)外節(jié)在特發(fā)性黃斑裂孔手術(shù)前后的變化并探討與視力預(yù)后的關(guān)系。 方法前瞻性對(duì)比分析28例(30只眼)確診并接受玻璃體手術(shù)治療的特發(fā)性黃斑裂孔患者的臨床資料,分別記錄手術(shù)前后的最佳矯正視力(轉(zhuǎn)換成logMAR視力)和水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑(diameter of IS/OS absence,DIOA),分析兩者手術(shù)前后的差別(配對(duì)資料的T檢驗(yàn))和相關(guān)性(Bivariate過(guò)程中的Pearson相關(guān)分析)。 結(jié)果手術(shù)后有22只眼黃斑裂孔閉合,裂孔封閉率為73.3%。術(shù)前l(fā)ogMAR視力為0.18-1.30,平均為0.99±0.37,術(shù)后12月logMAR視力為0.10-1.60,平均為0.75±0.46,術(shù)后12個(gè)月較術(shù)前平均下降了0.24。術(shù)前DIOA為551～2900μm,平均1945.57±609.33μm；術(shù)后12月DIOA為412～2811μm,平均1357.07±772.67μm,術(shù)后12個(gè)月較術(shù)前平均下降了589μm。經(jīng)配對(duì)樣本的T檢驗(yàn),術(shù)后12個(gè)月logMAR較術(shù)前l(fā)ogMAR明顯減少,兩者差異有顯著性意義(t=2.859,P=0.008)；術(shù)后12個(gè)月DIOA較術(shù)前DIOA明顯減少,兩者差異有顯著性意義(t=3.94,P0,001)。經(jīng)Pearson相關(guān)分析,術(shù)前l(fā)ogMAR與DIOA之間具有顯著正相關(guān)性(r=0.895,P0.01)；術(shù)后logMAR與DIOA之間同樣也具有顯著正相關(guān)性(r=0.921,P0.01)。 結(jié)論特發(fā)性黃斑裂孔患者手術(shù)后視力和光感受器內(nèi)外節(jié)缺失區(qū)直徑較術(shù)前明顯改善；手術(shù)前后水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑與logMAR視力具有明顯正相關(guān)性,是評(píng)估患者視力預(yù)后的重要因素。 第三部分頻域OCT觀察特發(fā)性黃斑裂孔手術(shù)前后光感受器內(nèi)外節(jié)與中心凹下脈絡(luò)膜厚度的關(guān)系 目的通過(guò)頻域相干光斷層掃描(SD-OCT)及其深度增強(qiáng)成像技術(shù)(EDI)觀察光感受器內(nèi)外節(jié)和中心凹下脈絡(luò)膜厚度在特發(fā)性黃斑裂孔手術(shù)前后的變化并探討兩者間的關(guān)系。 方法記錄35例單眼確診并接受玻璃體手術(shù)治療的特發(fā)性黃斑裂孔患者的臨床資料(年齡、性別),EDI模式掃描后測(cè)量手術(shù)前后水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑(diameter of IS/OS absence,DIOA)和中心凹下脈絡(luò)膜厚度(subfoveal chorodial thickness,SFCT),分析兩者的差別(配對(duì)資料的T檢驗(yàn))和相關(guān)性(Bivariate過(guò)程中的Pearson相關(guān)分析)。 結(jié)果手術(shù)后有29只眼黃斑裂孔閉合,裂孔封閉率為83%。術(shù)前DIOA為386～2900μm,平均1257.49±678.39μm；術(shù)后6個(gè)月DIOA為203～1410μm,平均660.80±298.59μm,經(jīng)配對(duì)資料的T檢驗(yàn),手術(shù)前后DIOA相比差異有顯著性意義(t=6.926,P0.001)。術(shù)前SFCT為85～268μm,平均130.80±37.09μm；術(shù)后6個(gè)月SFCT為93～201μm,平均137.17±32.64μm,經(jīng)配對(duì)資料的T檢驗(yàn),手術(shù)前后SFCT相比差異無(wú)顯著性意義(t=-1.780,P=0.084)。經(jīng)Pearson相關(guān)分析,術(shù)前DIOA與SFCT之間具有顯著負(fù)相關(guān)性(r=-0.797,P0.001)；術(shù)后6個(gè)月DIOA與SFCT之間同樣具有顯著負(fù)相關(guān)性(r=-0.647,P0.001)。 結(jié)論特發(fā)性黃斑裂孔患者手術(shù)后6個(gè)月時(shí)水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑較術(shù)前明顯減小,但黃斑中心凹下脈絡(luò)膜厚度無(wú)明顯變化。特發(fā)性黃斑裂孔患者手術(shù)前與術(shù)后6個(gè)月時(shí)水平方向上光感受器內(nèi)外節(jié)缺失區(qū)直徑與黃斑中心凹下脈絡(luò)膜厚度均具有顯著負(fù)相關(guān)性,提示IMH的發(fā)生和嚴(yán)重程度與脈絡(luò)膜的血流灌注狀態(tài)可能存在一定關(guān)系。
[Abstract]:The research background has developed rapidly since the 90s of last century. Optical coherence tomography (OCT) is a new technique of medical tomography, which has developed rapidly at this time. It combines optical technology, semiconductor laser technique, data model calculation and digital image processing technology. At the same time, a cross-sectional image of the internal microstructures of the biological tissue is obtained at the same time with the noninvasive living body morphological examination of the human body. In particular, with the transformation of OCT from time domain to frequency domain model, the development of OCT has also entered a new era. From the introduction of OCT technology to the beginning of the ophthalmology, the research of the yellow spot hole is the earliest and most in-depth. The researchers found that OCT can clearly discover the morphological changes in the structure of each layer in the retina. For the formation and stages of the macular hole, the OCT examination can clearly show the "anatomical" changes similar to the pathological sections, so that the anatomical structure of the patients and the retina can be accurately explained. In various methods of examination, clinical ophthalmologists have found that OCT is superior to all kinds of traditional methods of Ophthalmology. With the increasing improvement of surgical techniques and equipment, the closure rate of the macular hole in the postoperative patients is increasing. However, the postoperative OCT examination confirms the closure of the hole. The extent of improvement of visual acuity is not consistent, and the visual acuity of some patients is even lower than before operation, which makes people look for various reasons that affect the visual prognosis of IMH patients. In the past time domain OCT, the diameter of the macular hole, the diameter of the basal fissure, the area of the fissure, the retinal thickness of the macula, and the hole in the macular hole were mostly observed in the observation of the idiopathic macular hole. In some scholars, some scholars found that the size of the hiatus and the thickness of the epithelial layer of the rim of the orifice were closely related to the visual acuity. But at the same time, some scholars found that the corrected visual acuity of the lamellar macular hole has no correlation with the area of the cracked hole, the width of the fissure basement and the position of the fissure. The conclusion is that "the bigger the hole, the lower the eyesight, the smaller the hole, the better the vision" is not consistent, and there is a certain degree of subjectivity in the selected parts of the path. Therefore, the function of the tissue structure of the retina can be clearly identified by SD-OCT, and finding a better evaluation of the visual prognosis of the operation of the IMH patients can be found. The observation index has become the hot spot of the scholars' research.
The integrity of the IS/OS layer is considered to be an important marker of the integrity of photoreceptors, and is an important indicator of the prognosis of the visual function of the patient. More and more studies have revealed the changes in the continuity of the IS/OS layer through the frequency domain OCT observation. It is related to the prognosis of the patient's vision. In the evaluation of the continuity of the IS/OS layer by SD-OCT, some scholars at home and abroad classify the IS/OS layer into successive, interruption and missing forms, and carry out qualitative analysis. Some researchers even measure the level of the IS/OS layer, and then analyze the area of the missing area after the missing area in the vertical two direction. The purpose of our study was to observe the changes of the diameter of the photoreceptor missing area in the horizontal direction before and after surgery, and to analyze the relationship between the diameter of the photoreceptor missing area and the visual prognosis of the patients.
It is not clear from the name of "idiopathic macular hole" that the pathogenesis of the disease is not clear. The pathogenesis of IMH has been a research subject in the field of ophthalmology for many years. At present, it is generally accepted that the vitreous tangential traction theory proposed by Gass is that the pulling of the vitreous body in the direction of the concave tangent is caused by IMH The main reasons. Some scholars have found that half of the patients with macular traction syndrome eventually develop into idiopathic macular holes through surgical observation and subsequent OCT technical examination. The free Kong Gai tissue is sometimes seen on the posterior vitreous membrane that is completely disconnected. Other scholars have found glassy through OCT and surgery. The reacting force of the forward pull combined with the eyeball during the posterior disengagement of the vitreous body is a starting factor for the occurrence of IMH. All these views consider the cause of the formation of IMH from the vitreoretinal interface factor, but the researchers also have to know whether the vitreous body still adheres to the posterior vitreous surgery before the operation of the whole layer of the macular hole. In the polar retina, a part of the patient who failed to clearly display the posterior vitreous membrane was detected by artificial vitreous detachment by OCT. It was found that a significant macular hole still occurred in the posterior vitreous cortex still closely associated with the retina of the macular region. It was visible, in addition to the effect of the glass body on the traction of the macular line. Other factors have been involved in the formation of idiopathic macular holes. Recently, domestic and foreign scholars have found that the normal population gradually decreases with the increase of age and the thickness of the choroid in the female is significantly lower than those of the same age, and the IMH is more frequent in the older women by the depth enhanced imaging of the frequency domain OCT. In addition, scholars have turned their attention to the mechanism of choroidal thickness in the pathogenesis of idiopathic macular hole.
It is difficult to use the traditional frequency domain OCT for choroidal scan to obtain images, because the infrared light is difficult to wear with the fluoroscopy epithelia layer to reach the following choroidal layer. Recently, after a innovation called EDI (depth enhanced imaging), the above problems are solved to make it possible. The fundus scanning of the traditional SD-OCT mainly shows the tissue structure between the inner boundary of the retina and the RPE layer, and the choroid, which is responsible for the main blood supply of the intraocular circulation, is the tissue origin of many choroidal vascular related diseases, such as polypoid choroidal vasculopathy, malignant choroidal melanin, etc., the other is associated with age and microcirculation. Diseases, such as age-related macular degeneration and micro atherosclerosis, are also related to the choroid membrane. However, the non-invasive examination of the choroid membrane by traditional OCT is difficult to succeed. First, the wavelength of the light wave used by the traditional OCT is not enough to penetrate the choroidal tissue that penetrated into the deep layer of the epiretinal layer of the omentum. The principle of light wave duality is reported. If the light path is increased, the scattering is more attenuated, and the farther away from the zero delay, the lower the reflective light sensitivity, and the Fourier transform used by the traditional SD-OCT restricts the penetration of the light wave to some extent. It is concluded that the shortcomings of the traditional OCT can not scan the choroidal imaging is: (1) the resolution and resolution of the signal will follow the choroid membrane The increase in zero delay distance of scanning is reduced; (2) the maximum detection range of the traditional SD-OCT is reduced by Fu Liye conversion; (3) the wavelength and signal of the reflected light attenuates gradually in the process of light scattering; (4) the defocus of the light column is produced by the two sides of the image. The ordinary SD-OCT uses the infrared light around 800nm, and the wavelength is 1060. Nm's infrared light can penetrate into the choroid. Therefore, in order to make the deeper tissue imaging clear, people use the depth enhanced scan imaging technique, that is, the infrared light projection of the 1060nm is used to focus the light source in the deeper choroidal tissue. When the light signal reflected by the tissue is delayed to zero, the imaging is the most clear: on the contrary, the imaging is the most clear. In front of the retinal vessels and the nerve fiber layer, the time delay increases and the imaging is relatively blurred, and the latest optical coherence tomography (EDI) technique avoids the above shortcomings, which can make the traditional SD-OCT image of a clear choroid scan, and the image of the retina tissue is not affected by any effect.
The first part is to observe the changes of photoreceptor outer and outer segments before and after idiopathic macular hole surgery in frequency domain OCT.
Objective To observe the changes of inner and outer segments of photoreceptors in idiopathic macular hole before and after surgery by frequency domain optical coherence tomography (SD-OCT).
Methods the clinical data of 23 patients with idiopathic macular holes (25 eyes) diagnosed and treated with vitreous surgery were compared and analyzed. The difference between the diameter of IS/OS absence (DIOA) diameter (diameter of IS/OS absence, DIOA) was compared and analyzed by Topcon company Version3.21 type frequency domain OCT. T test for data and correlation (Pearson correlation analysis in Bivariate process).
Results after operation, 18 eyes were closed with macular hole. The rate of DIOA was (551~2900) m before 72%., and the average (1933.16 + 650.80) mu m. The range of DIOA in December was (412-2811) mu m, average (1329.20 + 780.13) mu m. After operation, the DIOA was reduced by about 604 mu by t test of paired samples. There was a significant difference before and after operation. Pearson correlation analysis showed that there was no significant correlation between preoperative DIOA and postoperative DIOA (r = 0.37, P = 0.069).
Conclusion the structure of IS/OS layer in the retina can be clearly observed in the frequency domain OCT. The diameter of the internal and external nodes of the photoreceptor in the patients with idiopathic macular hole is significantly lower than that before the operation, but there is no significant correlation between them.
The second part is to observe the relationship between photoreceptor outer segment and visual acuity before and after operation for idiopathic macular hole in frequency domain OCT.
Objective To observe the changes of photoreceptor internals and externals before and after idiopathic macular hole surgery by frequency domain coherence tomography and to explore the relationship between the changes and visual prognosis.
Methods the clinical data of 28 patients with idiopathic macular holes diagnosed and treated with vitreous surgery were prospectively compared. The best corrected visual acuity before and after the operation (converted into logMAR vision) and the straight diameter of diameter of IS/OS absence (DIOA) in the level direction photoreceptor were recorded respectively, and the two operations were analyzed. The difference between before and after (T test of paired data) and correlation (Pearson correlation analysis in Bivariate process).
Results after operation, 22 eyes were closed with macular hole. The rate of logMAR vision was 0.18-1.30 before 73.3%., the average was 0.99 + 0.37. The logMAR vision in December after operation was 0.10-1.60, the average was 0.75 + 0.46. The average decrease of DIOA was 551~2900 mu m before operation 12 months after operation, and the average of 1945.57 + 609.33 m before operation. DIOA was 412~28 in December after operation. 11 mu m, average 1357.07 + 772.67 mu m, 12 months after operation, the average decrease of 589 u M. by paired sample T test, 12 months after the operation, logMAR compared with preoperative logMAR significantly decreased (t=2.859, P=0.008), and 12 months after the operation, DIOA is significantly less than the preoperative DIOA, the difference has significant significance (t=3.94, P0001). N correlation analysis showed significant positive correlation between logMAR and DIOA before operation (r=0.895, P0.01), and there was also significant positive correlation between logMAR and DIOA after operation (r=0.921, P0.01).
Conclusion the diameter of visual acuity and photoreceptor internal and external missing area in the patients with idiopathic macular hole is significantly better than that before operation, and the diameter of the internal and external node missing area in the horizontal photoreceptor before and after operation is positively correlated with the logMAR vision, which is an important factor in evaluating the prognosis of the patients.
Part III Frequency Domain OCT Observation of the Relationship between the Subfoveal Choroidal Thickness and the Internal and External Segments of Photoreceptors before and after Idiopathic Macular Hole Surgery
Objective To observe the changes of the internal and external segment of the photoreceptor and the choroidal thickness of the central fovea before and after the operation of the idiopathic macular hole through the frequency domain coherent optical tomography (SD-OCT) and its depth enhanced imaging (EDI) and explore the relationship between the two.
Methods the clinical data (age, sex) of 35 patients with idiopathic macular holes with monocular diagnosis and vitreous surgery were recorded. After EDI mode scan, the diameter of diameter of IS/OS absence (DIOA) and the choroidal thickness under the recess (subfoveal chorodial thickness) were measured before and after the operation. (SFCT), to analyze the difference (T test of paired data) and correlation (Pearson correlation analysis in Bivariate process).
Results macular hole was closed in 29 eyes after operation, and the rate of closure was 83%. before DIOA.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R779.6

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