Funktionelle und morphologische Korrelationen in der Makulaforamen-Chirurgie

Zusammenfassung

Hintergrund: Ziel der Studie ist die Korrelation von funktionellen und morphologischen Aspekten vor und 12 Monate nach Makulaforamen-Chirurgie. Methoden: In dieser prospektiven, interventionellen, konsekutiven Studie wurde bei 16 Augen von 16 Patienten nach Erstdiagnose und maximaler Symptomendauer von 2 Monaten eine erfolgreiche transkonjunktivale 23-gauge-Vitrektomie mit ILM-Peeling durchgeführt. Präoperativ sowie 3, 6 und 12 Monate postoperativ erfolgte die Bestimmung des bestkorrigierten Visus (logMAR), eine 10° Mikroperimetrie (MP-1) sowie eine Spektral-Domain basierte optische Kohärenztomografie (SD-OCT) Untersuchung. Die Photorezeptorenschicht (Inneres und Äußeres Segment, IS/OS) wurde anhand der SD-OCT-Bilder gewertet und mit den Daten der Mikroperimetrieanalyse in der fovealen und parafovealen Region korreliert. Ergebnisse: Nach 3 Monaten zeigte sich bereits eine Stabilisierung des bestkorrigierten Visus mit Regeneration der IS/OS-Linie sowie eine Besserung des Fixationsverhaltens als auch der Sensitivität im Makulabereich. Nach 12 Monaten kam es zu einer signifikanten Restitution der IS/OS-Linie. Die bestkorrigierte Sehschärfe, die mittlere Gesamtsensitivität sowie die Fixation verbesserten sich signifikant innerhalb des 12-monatigen Beobachtungszeitraums (p < 0,05). Ein Vergleich von Patienten mit einem Visusgewinn von mindestens 2 Zeilen und Patienten mit einem Visusgewinn von weniger als 2 Zeilen, 12 Monate nach der Operation, zeigte keinen statistisch signifikanten Unterschied hinsichtlich der Regeneration der IS/OS-Integrität in der Fovea (p = 0,433), dafür aber in der parafovealen Region. Ein postoperativer Visusgewinn von mindestens 2 Zeilen war signifikant häufiger zu sehen in Augen mit einer postoperativ durchgängigen IS/OS-Linie in den parafovealen Sektoren im Vergleich mit Augen mit persistierenden IS/OS-Defekten (p < 0.02). Schlussfolgerung: Korrelierende morphologische und funktionelle Verbesserungen können nach Durchführung einer erfolgreichen mikroinvasiven Makulaforamenchirurgie beobachtet werden. Das präoperative Ausmaß des IS/OS-Defekts, insbesondere der parafovealen Region, ist ein guter prädiktiver Parameter für die postoperativ gewonnene Makulasensitivität. Die Vorhersage des postoperativen Visusergebnisses sollte daher nicht anhand einer einzigen klinisch, anatomischen Befundung getroffen werden.

Abstract

Background: The purpose of this study is to establish the correlation between functional and morphological aspects before and 12 months after macular hole surgery. Methods: In this prospective, interventional, consecutive study 16 eyes of 16 patients were included. All eyes received a successful transconjunctival 23-gauge vitrectomy with ILM peeling after initial diagnosis and maximum duration of symptoms of two months. Preoperatively and 3, 6 and 12 months postoperatively determinations of best-corrected visual acuity (logMAR), a 10° microperimetry (MP-1) and a spectral-domain based optical coherence tomography (SD-OCT) examination were performed. The photoreceptor layer (inner and outer segment, IS/OS) was evaluated based on SD-OCT images and correlated with data assessed by microperimetry analysis in the foveal and parafoveal region. Results: After three months a stabilisation of BCVA with regeneration of the IS/OS line, an improvement of the fixation behaviour and the macular sensitivity could be observed. A significant restitution of the IS/OS line was observed after 12 months. Best corrected visual acuity, mean overall macular sensitivity and fixation improved significantly within the twelve month observation period (p < 0.05). Comparison of patients with at least two lines of visual acuity gain with patients having less than two lines of visual acuity gain 12 months after surgery showed no statistically significant difference in regeneration of the IS/OS integrity in the fovea (p = 0.433), but a difference was seen in the parafoveal region. A postoperative visual acuity gain of at least two lines was significantly more often seen in eyes with postoperative continuous IS/OS line in the parafoveal sectors compared to eyes with persistent IS/OS defects (p < 0.02). Conclusion: Correlations of morphological and functional improvements can be observed after successful micro-invasive macular hole surgery. The extent of the preoperative IS/OS defect, particularly in the parafoveal region, is a good predictive parameter for the postoperatively obtained macular sensitivity. The prediction of the postoperative visual acuity should not be made on the basis of a single clinical, anatomic finding.

Schlüsselwörter

Retina - SD-OCT - Makulaforamen - Photorezeptoren - Mikroperimetrie - IS/OS

Key words

retina - SD-OCT - macular hole - photoreceptors - microperimetry - IS/OS

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