Objective: To analyze the changes in optical coherence tomography angiography(OCTA)-related parameters before and after idiopathic macular hole (IMH) internal limiting membrane (ILM) flap inversion surgery and assess their impact on retinal sensitivity. Methods: A retrospective case series study was conducted, collecting clinical data of 30 patients (30 eyes) diagnosed with IMH who underwent vitrectomy combined with ILM flap inversion surgery at Shanxi Eye Hospital, affiliated with Shanxi Medical University, between January 2020 and December 2021. Visual acuity and best-corrected visual acuity were examined preoperatively and at 1, 3, and 6 months postoperatively. Microperimetry measured retinal sensitivity (RS), and OCTA measured retinal thickness (RT) as well as vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Statistical analysis was performed using t-tests, repeated measures analysis of variance, and Pearson correlation analysis. Results: Thirty patients with IMH (30 eyes) were included, with 3 males (3 eyes) and 27 females (27 eyes). The mean age was (62.5±3.0) years, and the follow-up time was (96.3±1.3) days, with a 100% closure rate of macular holes postoperatively. RT in the macular was significantly lower at 1, 3, and 6 months postoperatively compared to preoperative values (F=46.21, P<0.001). The RT in the upper macular region showed statistically significant differences at different time points (P<0.001). VD in the SCP layer showed no significant differences between the upper and lower macular regions at various time points (F=3.21, P=0.601). VD in the upper region of the DCP layer increased at 1, 3, and 6 months postoperatively (P<0.001). RS in the macular was higher at 1, 3, and 6 months postoperatively compared to preoperative values (F=52.01, P<0.001). RS in the lower macular region increased at 3 and 6 months postoperatively (P<0.001), while in the upper region, it increased only at 6 months postoperatively (P<0.001). There was a positive correlation between RS and RT at 1 and 3 months postoperatively, but not at 6 months postoperatively in the upper macular region (r=0.40, P=0.071). In the lower macular region, there was a positive correlation between RS and RT at 1 and 3 months postoperatively (P<0.001). There was no correlation between RS in the upper macular region at 6 months postoperatively and preoperative RT (r=0.43, P=0.072), but there was a positive correlation with RT at 3 months postoperatively (r=0.58, P=0.041). Conclusions: After idiopathic macular hole internal limiting membrane flap inversion surgery, the OCTA-related parameters have changed. There are transient changes in deep vascular parameters and thinning of the retinal layers at the ILM inversion site, leading to decreased sensitivity.
目的： 分析特发性黄斑裂孔（IMH）内界膜翻转术前后相干光层析血管成像术（OCTA）相关参数变化及其对视网膜敏感度的影响。 方法： 回顾性病例系列研究。收集2020 年1月至2021年12月于山西医科大学附属山西省眼科医院诊断为IMH并行玻璃体切除联合内界膜翻转术的30例（30只眼）患者的临床资料。所有患者术前及术后1、3、6个月均行视力及最佳矫正视力检查，并使用微视野计测量视网膜敏感度（RS）、OCTA测量视网膜厚度（RT）及浅毛细血管丛（SCP）和深毛细血管丛（DCP）视网膜血管密度（VD）。采用t检验、重复测量方差分析及Pearson相关分析进行统计学处理。 结果： 共纳入IMH患者30例（30只眼），其中男性3例（3只眼），女性27例（27只眼）；年龄为（62.5±3.0）岁，随访时间为（96.3±1.3）d，术后裂孔闭合率为100%。患者术后1、3、6个月黄斑区RT低于术前，差异有统计学意义（F=46.21，P<0.001）。术前与术后1个月、3个月、6个月上方黄斑区RT［分别为（381±20）、（340±52）、（338±25）和（322±22）μm］差异均有统计学意义（均P<0.001）。患者SCP层上方黄斑区（术前、术后1个月、3个月、6个月分别为48.20%±1.03%、47.61%±2.11%、46.22%±0.63%和48.11%±1.55%）与下方黄斑区（术前、术后1个月、3个月、6个月分别为47.88%±1.22%、46.10%±1.36%、46.28%±1.14%和48.06%±1.31%）VD差异无统计学意义（F=3.21，P=0.601）。上方黄斑区DCP层 VD在术后1、3、6个月（分别为54.26%±1.08%、58.92%±1.31%、47.82%±1.12%）均较术前（45.28%±1.06%）增高（均P<0.001）。与术前相比，下方黄斑区VD在术后1个月增高（P<0.001）。患者术后1、3、6个月黄斑区RS高于术前，差异有统计学意义（F=52.01，P<0.001）。下方黄斑区RS术后3个月和6个月［分别为（25.28±1.24）和（28.31±1.06）dB］均较术前增高（均P<0.001），而上方黄斑区仅在术后6个月时［（25.08±0.12）dB］增高（P<0.001）。患者术后6个月上方黄斑区RS与术前无相关性（r=0.40，P=0.071），但与术后1个月和3个月时均呈正相关（r=0.66，P<0.001；r=0.71 P<0.001）。术后6个月下方黄斑区RS与术后1个月和术后3个月时均呈正相关（均P<0.001）。术后6个月上方黄斑区RS与术前RT无相关性（r=0.43，P=0.072），但与术后3个月RT呈正相关（r=0.58，P=0.041）。 结论： 特发性黄斑裂孔内界膜翻转术后，OCTA相关参数变化，内界膜翻转部位视网膜发生了短暂的深部血管改变，且厚度变薄，敏感度降低。.