高度近视黄斑裂孔性视网膜脱离术后视功能及视觉相关生存质量分析
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摘要
目的评估高度近视黄斑裂孔性视网膜脱离患者术后视功能和视觉相关生存质量(visual-related quality of life,VRQo L),并分析VRQo L与视功能之间的相关性。方法回顾性分析2012年3月至2016年5月于上海交通大学附属第一人民医院行23G玻璃体切割联合内界膜剥除及硅油填充术的高度近视黄斑裂孔性视网膜脱离患者63例(63眼)术前及术后6个月的临床资料。记录主要观察指标,包括最佳矫正视力、对比敏感度。患者填写美国国家眼科研究院开发的视功能相关生存质量量表(visual function questionnaire-25,VFQ-25)中文版。比较患者手术前后VFQ-25总得分以及各维度得分,并分析其与视功能的相关性。结果 63例患者中60眼(95.24%)视网膜复位,术后6个月术眼平均logMAR视力(0.83±0.25)较基线log MAR视力(1.76±0.43)显著提高,差异有统计学意义(P<0.05)。术后术眼对比敏感度:1.5 c·d~(-1)为1.25±0.28,3 c·d~(-1)为1.27±0.31,6 c·d~(-1)为1.03±0.27,12 c·d~(-1)为0.71±0.23,18 c·d~(-1)为0.32±0.13。术后6个月患者VFQ-25总得分均值为(66.13±11.28)分,较术前[(50.07±14.42)分]显著提高,差异有统计学意义(P<0.05)。术后VFQ-25总得分和术眼最佳矫正视力无相关性,与双眼平均视力、术眼中空间频率(6 c·d~(-1)、12 c·d~(-1))对比敏感度呈正相关。结论高度近视黄斑裂孔性视网膜脱离患者术后视网膜复位率高,视力显著提高。术后患者VRQo L提高,并与双眼平均视力、术眼中空间频率对比敏感度相关,与术眼视力无显著相关性。
Objective To assess the visual function and visual-related quality of life( VRQoL) as well as their correlation after vitrectomy for macular hole retinal detachment( MHRD) in high myopia. Methods From March 2012 to May 2016,a retrospective case series review of 63 patients( 63 eyes),who were diagnosed as MHRD and underwent 23 G vitrectomy combined with internal membrane peeling and silicone oil tamponade at Shanghai General Hospital were collected. All patients were accorded with the definition of high myopia. Before and 6 months after surgery,best corrected visual acuity( BCVA) and contrast sensitivity( CS) were recorded. The Chinese version of 25-Item National Eye Institute Visual Function Questionnaire( VFQ-25) was employed to evaluate VRQoL. The total score of VFQ-25 and scores of each scale were calculated and their correlations with BCVA and CS were evaluated. Results The anatomical reattachment rate of 63 eyes approached to 95. 24%( 60 eyes). The logMAR BCVA improved from( 1.76 ± 0. 43) to( 0. 83 ± 0. 25) at 6 months after surgery( P < 0. 05). The postoperative CS was 1. 25 ± 0. 28( 1. 5 c·d~(-1)),1. 27 ± 0. 31( 3 c·d-1),1. 03 ± 0. 27( 6 c·d~(-1)),0. 71 ±0. 23( 12 c·d~(-1)),0. 32 ± 0. 13( 18 c·d~(-1)). The total score of VFQ-25 was( 66. 13 ± 11.28) points at 6 months after surgery,s ignificantly higher than pre-operation( P < 0. 05).The postoperative VFQ-25 score was positively correlated with weighted average logMAR visual acuity( WMAR) and median frequency CS( 6 c·d~(-1), 12 c·d~(-1)),but had no correlation with BCVA of operated eyes. Conclusion Vitrectomy combined with internal membrane peeling and silicone oil tamponade is safe and effective in treating MHRD with high myopia. The VFQ-25 scores improve after surgery. Postoperative VRQoL is correlated with WMAR and CS rather than BCVA of affected eyes.
Objective To assess the visual function and visual-related quality of life( VRQoL) as well as their correlation after vitrectomy for macular hole retinal detachment( MHRD) in high myopia. Methods From March 2012 to May 2016,a retrospective case series review of 63 patients( 63 eyes),who were diagnosed as MHRD and underwent 23 G vitrectomy combined with internal membrane peeling and silicone oil tamponade at Shanghai General Hospital were collected. All patients were accorded with the definition of high myopia. Before and 6 months after surgery,best corrected visual acuity( BCVA) and contrast sensitivity( CS) were recorded. The Chinese version of 25-Item National Eye Institute Visual Function Questionnaire( VFQ-25) was employed to evaluate VRQoL. The total score of VFQ-25 and scores of each scale were calculated and their correlations with BCVA and CS were evaluated. Results The anatomical reattachment rate of 63 eyes approached to 95. 24%( 60 eyes). The logMAR BCVA improved from( 1.76 ± 0. 43) to( 0. 83 ± 0. 25) at 6 months after surgery( P < 0. 05). The postoperative CS was 1. 25 ± 0. 28( 1. 5 c·d~(-1)),1. 27 ± 0. 31( 3 c·d-1),1. 03 ± 0. 27( 6 c·d~(-1)),0. 71 ±0. 23( 12 c·d~(-1)),0. 32 ± 0. 13( 18 c·d~(-1)). The total score of VFQ-25 was( 66. 13 ± 11.28) points at 6 months after surgery,s ignificantly higher than pre-operation( P < 0. 05).The postoperative VFQ-25 score was positively correlated with weighted average logMAR visual acuity( WMAR) and median frequency CS( 6 c·d~(-1), 12 c·d~(-1)),but had no correlation with BCVA of operated eyes. Conclusion Vitrectomy combined with internal membrane peeling and silicone oil tamponade is safe and effective in treating MHRD with high myopia. The VFQ-25 scores improve after surgery. Postoperative VRQoL is correlated with WMAR and CS rather than BCVA of affected eyes.
引文
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[8]MANGIONE C M,BERRY S,SPRITZER K,J ANZ N K,KLEINR,OWSLEY C,et al.Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire:results from focus groups with visually impaired persons[J].Arch Ophthalmol,1998,116(2):227-233.
[9]BERDEAUX G H,NORDMANN J P,COLIN E,ARNOULD B.Vision-related quality of life in patients suffering from age-related macular degeneration[J].Am J Ophthalmol,2005,139(2):271-279.
[10]RIUSALA A,SARNA S,IMMONEN I.Visual function index(VF-14)in exudative age-related macular degeneration of long duration[J].Am J Ophthalmol,2003,135(2):206-212.
[11]ZHANG L K,WANG X B,CHENG Z W.Comparative study of optical properties and visual quality of tw o diffractive multifocal intraocular lens[J].Rec Adv Ophthalmol,2017,37(5):445-449.张利科,王晓冰,陈正伟.两衍射多焦点人工晶状体的光学性能与视觉质量对比研究[J].眼科新进展,2017,37(5):445-449.
[12]HUANG J,LIU X L.Development and evaluation of Chinese Version Vision-related Quality of Life Questionnaire-25[J].Chin J Optom Ophthalmol Vis Sci,2016,18(11):660-664.黄江,刘晓玲.中文视功能相关生存质量量表-25的初步应用评价[J].中华眼视光学与视觉科学杂志,2016,18(11):660-664.
[13]OKAMOTO F,OKAMOTO Y,HIRAOKA T,OSHIKA T.Visionrelated quality of life and visual function after retinal detachment surgery[J].Am J Ophthalmol,2008,146(1):85-90.
[14]OKAMOTO F,SUGIURA Y,OKAMOTO Y,HIRAOKA T,OSHIKAT.Changes in contrast sensitivity after surgery for macula-on rhegmatogenous retinal detachment[J].Am JOphthalmol,2013,156(4):667-672.
[15]GINSBURG A P.Contrast sensitivity:determining the visual quality and function of cataract,intraocular lenses and refractive surgery[J].Curr Opin Ophthalmol,2006,17(1):19-26.
[16]KAWAMURA H,FUJIKAWA M,SAWADA O,SAWADA T,SAISHIN Y,OHJI M.Contrast sensitivity after pars plana vitrectomy:comparison betw een macula-on and macula-off rhegmatogenous retinal detachment[J].Ophthalmic Res,2016,56(2):74-78.
[17]PUT MAJVD,HOEKSEMA L,WANDERS W,NOLTE I M,HOOYMANS J M M,LOS L I.Postoperative vision-related quality of life in macula-off rhegmatogenous retinal detachment patients and its relation to visual function[J].PLoSOne,2014,9(12):e114489.
[18]NIXON D R,FLINN N A.Evaluation of contrast sensitivity and other visual function outcomes in neovascular age-related macular degeneration patients after treatment sw itch to aflibercept from ranibizumab[J].Clin Ophthalmol,2017,11:715-721.
[2]IKUNO Y.Overview of the complications of high myopia[J].Retina,2017,37(12):2347-2351.
[3]ORTISI E,AVITABILE T,BONFIGLIO V.Surgical management of retinal detachment because of macular hole in highly myopic eyes[J].Retina,2012,32(9):1704-1718.
[4]NISHIMURA A,KIMURA M,SAITO Y,SUGIYAMA K.Efficacy of primary silicone oil tamponade for thetreatment of retinal detachment caused by macular hole in high myopia[J].Am JOphthalmol,2011,151(1):148-155.
[5]XIE A,LEI J.Pars plana vitrectomy and silicone oil tamponade as a primary treatment for retinal detachment caused by macular holes in highly myopic eyes:a risk-factor analysis[J].Curr Eye Res,2013,38(1):108-113.
[6]MANCINO R,CIUFFOLETTI E,MARTUCCI A,AIELLO F,CEDRONEC,CERULLI L,et al.Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil[J].Retina,2013,33(3):586-592.
[7]PATEL A A,DONEGAN D,ALBERT T.The 36-item short form[J].J Am Acad Orthop Surg,2007,15(2):126-134.
[8]MANGIONE C M,BERRY S,SPRITZER K,J ANZ N K,KLEINR,OWSLEY C,et al.Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire:results from focus groups with visually impaired persons[J].Arch Ophthalmol,1998,116(2):227-233.
[9]BERDEAUX G H,NORDMANN J P,COLIN E,ARNOULD B.Vision-related quality of life in patients suffering from age-related macular degeneration[J].Am J Ophthalmol,2005,139(2):271-279.
[10]RIUSALA A,SARNA S,IMMONEN I.Visual function index(VF-14)in exudative age-related macular degeneration of long duration[J].Am J Ophthalmol,2003,135(2):206-212.
[11]ZHANG L K,WANG X B,CHENG Z W.Comparative study of optical properties and visual quality of tw o diffractive multifocal intraocular lens[J].Rec Adv Ophthalmol,2017,37(5):445-449.张利科,王晓冰,陈正伟.两衍射多焦点人工晶状体的光学性能与视觉质量对比研究[J].眼科新进展,2017,37(5):445-449.
[12]HUANG J,LIU X L.Development and evaluation of Chinese Version Vision-related Quality of Life Questionnaire-25[J].Chin J Optom Ophthalmol Vis Sci,2016,18(11):660-664.黄江,刘晓玲.中文视功能相关生存质量量表-25的初步应用评价[J].中华眼视光学与视觉科学杂志,2016,18(11):660-664.
[13]OKAMOTO F,OKAMOTO Y,HIRAOKA T,OSHIKA T.Visionrelated quality of life and visual function after retinal detachment surgery[J].Am J Ophthalmol,2008,146(1):85-90.
[14]OKAMOTO F,SUGIURA Y,OKAMOTO Y,HIRAOKA T,OSHIKAT.Changes in contrast sensitivity after surgery for macula-on rhegmatogenous retinal detachment[J].Am JOphthalmol,2013,156(4):667-672.
[15]GINSBURG A P.Contrast sensitivity:determining the visual quality and function of cataract,intraocular lenses and refractive surgery[J].Curr Opin Ophthalmol,2006,17(1):19-26.
[16]KAWAMURA H,FUJIKAWA M,SAWADA O,SAWADA T,SAISHIN Y,OHJI M.Contrast sensitivity after pars plana vitrectomy:comparison betw een macula-on and macula-off rhegmatogenous retinal detachment[J].Ophthalmic Res,2016,56(2):74-78.
[17]PUT MAJVD,HOEKSEMA L,WANDERS W,NOLTE I M,HOOYMANS J M M,LOS L I.Postoperative vision-related quality of life in macula-off rhegmatogenous retinal detachment patients and its relation to visual function[J].PLoSOne,2014,9(12):e114489.
[18]NIXON D R,FLINN N A.Evaluation of contrast sensitivity and other visual function outcomes in neovascular age-related macular degeneration patients after treatment sw itch to aflibercept from ranibizumab[J].Clin Ophthalmol,2017,11:715-721.