背景:以前,黄斑裂孔(MH)手术后的神经胶质增生分为两种类型:即取代整个视网膜内层和仅涉及内中央凹的层。前一种类型的演变和预后在以前的研究中得到了阐述,但后者受到的关注有限。因此,本研究旨在探讨MH手术后不同级别的胶质细胞增殖的演变及其对中央凹显微结构和最佳矫正视力(BCVA)的影响。
方法:在这项回顾性研究中,我们回顾了196例成功接受特发性MHs修复的连续患者的202只眼.基于光学相干层析成像图像,胶质细胞增殖分为三种类型:A型,取代了整个卷烟层;B型,位于外界膜(ELM)的水平和上方;和C型,位于ELM上方。
结果:在参加1-的67只眼睛中,4-,和10个月的随访,A型,B型,C型,27例(40.3%)未发现胶质细胞增殖,17(25.4%),20(29.8%),和3只眼睛(4.5%),分别,在1个月。在10个月内,A型胶质细胞增殖的患病率显著降低(P<0.001),但B型的变化(P=0.261),C型(P=0.151),无胶质细胞增殖(P=0.492)。67只眼睛中的32只,胶质细胞增殖的程度逐渐提高,27只眼中有19只A型转变为B型或C型(70.4%),17眼中有11只B型为C型或无胶质增生(64.7%),20只眼中有2只C型逐渐消失(10.0%)。在参加至少一次随访的眼睛中(1M,202眼;4M,161眼;10M,97只眼睛),A型神经胶质增生的人表现出最有缺陷的视网膜外层,最差的BCVA,在所有随访时间点,与其他两种类型相比,中心凹最薄(P<0.001)。与B型神经胶质增生相比,C型神经胶质增生的眼睛表现出明显更好的光感受器层状态和BCVA。1个月时A型胶质细胞增殖,在10个月时与BCVA显着相关,可以通过截止值>547.5μm的最小线性直径来准确预测(P<0.001)。
结论:在10个月内,A型神经胶质细胞增殖基本消退,但B型和C型的患病率保持不变。B型神经胶质增生阻碍了光感受器的恢复并且损害了视觉恢复,尽管其位于内部视网膜内。
BACKGROUND: The glial proliferation after macular hole (MH) surgery was divided into two types previously: those replacing the entire intraretinal layer and those involving only the inner foveal layers. The evolution and prognosis of the former type were elaborated on in previous studies, but the latter one has received limited attention. Therefore, this study aims to investigate the evolution of glial proliferation with varying grades after MH surgery and its effects on foveal microstructure and best-corrected visual acuity (BCVA).
METHODS: In this retrospective research, we reviewed 202 eyes from 196 consecutive patients who underwent a successful idiopathic MHs repair. Based on optical coherence tomography images, glial proliferation was classified into three types: A-type, which replaced the entire intraretinal layer; B-type, located at the level of and above the external limiting membrane (ELM); and C-type, situated above the ELM.
RESULTS: Of the 67 eyes that attended the 1-, 4-, and 10-month follow-up, A-type, B-type, C-type, and no glial proliferation were identified in 27 (40.3%), 17 (25.4%), 20 (29.8%), and 3 eyes (4.5%), respectively, at 1 month. Within 10 months, the prevalence of A-type glial proliferation significantly decreased (p < 0.001), but the changes in B-type (p = 0.261), C-type (p = 0.151), and no glial proliferation (p = 0.492) were not significant. In 32 of the 67 eyes, the grade of glial proliferation gradually improved, with A-type transforming into B- or C-type in 19 of 27 eyes (70.4%), B-type into C-type or no glial proliferation in 11 out of 17 eyes (64.7%), and C-type gradually disappearing in 2 out of 20 eyes (10.0%). Among the eyes that attended at least one follow-up (1 M, 202 eyes; 4 M, 161 eyes; 10 M, 97 eyes), those with A-type glial proliferation showed the most defective outer retinal layers, worst BCVA, and thinnest central fovea compared with the other two types at all follow-up time points (p < 0.001). Eyes with C-type glial proliferation exhibited significantly better photoreceptor layer status and BCVA compared with those with B-type glial proliferation. A-type glial proliferation at 1 month, which showed significant association with BCVA at 10 months, could be accurately predicted by the minimum linear diameter with a cut-off >547.5 μm (p < 0.001).
CONCLUSIONS: Within 10 months, A-type glial proliferation substantially resolves but the prevalence of B- and C-type remains unchanged. B-type glial proliferation hinders the restoration of photoreceptors and impairs visual recovery despite being located within the inner retina.