Preliminary observation of choroidal capillary flow area and density in patients with idiopathic macular hole before and after surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Han Xiaolei ,  Hao Yuhua , Zhou Nalei , Ding Enliang

Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding author：

Hao Yuhua, Email: yuhuasjz@sina.com

Keywords：

Retinal perforations/diagnosis; Tomography, optical coherence; Regional blood flow; Choroidal capillary flow area

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.014

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Objective To observe the changes of choroidal capillary flow area (CBFA) and density in patients with idiopathic macular hole (IMH) before and after surgery.Methods A prospective clinical study. Thirty patients (60 eyes) with unilateral IMH diagnosed in Department of Ophthalmology of The Second Hospital of Hebei Medical University from February 2017 to March 2018 and 30 age-and sex- matched normal controls were included in this study. All eyes were divided into group A (30 affected eyes), group B (30 fellow eyes) and group C (30 normal eyes of controls). Among 30 eyes in group A, there were 5, 14, 11 eyes with hole in stage Ⅱ, Ⅲ, Ⅳ, respecitvely. The eyes in group A were divided into two subgroups according to the diameter of the holes: group D: hole diameter less than or equal to 500 μm (11 eyes), group E: hole diameter over than 500 μm (19 eyes). All eyes in group A underwent vitrectomy. Spectral-domain OCT was used to observe the diameter size of macular hole and the closure of the hole after vitrectomy in eyes of group A. The CBFA and blood flow density of superficial choroidal capillaries were measured by OCT angiography before and 3 months after vitrectomy in groups A, B and C. Univariate analysis of variance and t test were used for statistical analysis.Results Before surgery, in group A, B and C, the CBFA were 2.84±0.35, 3.19±0.23, 3.26±0.24 mm², the blood flow density were (20.74±8.26)%, (35.18±5.20)%, (35.20±6.49)%, respectively. The CBFA and blood flow density in group A were significantly lower than those in group B and C (F=19.768, 45.583; P = 0.000, 0.000), but there was no significant difference between group B and C (F=19.768, 45.583; P=0.332, 0.994). The CBFA and blood flow density in group D were higher than those in group E (t=2.230, 2.202; P=0.034, 0.036). The diameter of macular hole was negatively correlated with CBFA and blood flow density (r=－0.377, －0.477; P=0.044, 0.009). Three months after surgery, the macular holes in group A were closed; CBFA and blood flow density in macular area were significantly higher than before surgery (t=－4.126, －4.912; P=0.000, 0.000).Conclusions CBFA and blood flow density decreased in the macular area of IMH. CBFA and blood flow density can be recovered after vitrectomy.

Citation： Han Xiaolei, Hao Yuhua, Zhou Nalei, Ding Enliang. Preliminary observation of choroidal capillary flow area and density in patients with idiopathic macular hole before and after surgery. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 588-592. doi: 10.3760/cma.j.issn.1005-1015.2019.06.014 Copy

1.	Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5): 629-639. DOI: 10.1001/archopht.1988.01060130683026.
2.	Kelkar AS, Bhanushali DR, Kelkar JA, et al. Spontaneous closure of a full-thickness stage 2 idiopathic macular hole without posterior vitreous detach ment[J]. Case Rep Ophthalmol, 2013, 4(3): 188-191. DOI: 10.1159/000356125.
3.	Sjaarda RN. Macular hole[J]. Int Ophthalmol Clin, 1995, 35(4): 105-122.
4.	Gass JD. Age-dependent idiopathic macular foramen: current concepts of the pathogenesis, diagnosis, and treatment[J]. Ophthalmologe, 1995, 92(5): 617-625.
5.	Reibaldi M, Boscia F, Avitabile T, et al. Enhanced depth imaging optical coherence tomography of the choroid in idiopathic macular hole: across-sectional prospective study[J]. Am J Ophthalmol, 2010, 151(1): 112-117. DOI: 10.1016/j.ajo.2010.07.004.
6.	陈迪, 李略, 杨治坤, 等. 频域光学相干断层扫描观察特发性黄斑裂孔患者脉络膜厚度[J]. 协和医学杂志, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.Chen D, Li L, Yang ZK, et al. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes of patients with idiopathic macular holes[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.
7.	冯程程, 孙艳, 刘菲, 等. 频域OCT扫描观察特发性黄斑裂孔的脉络膜厚度[J]. 中国实用眼科杂志, 2015, 33(4): 358-361. DOI: 10.3760/cma.j.issn.1006-4443.2015.04.008.Feng CC, Sun Y, Liu F, et al. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes with idiopathic macular holes[J]. Chin J Pract Ophthalmol, 2015, 33(4): 358-361. DOI: 10.3760/cma.j.issn.1006-4443.2015.04.008.
8.	林秋蓉, 高敏, 刘海芸. 特发性黄斑裂孔患眼黄斑中心凹下脉络膜厚度及毛细血管血流面积的频域光相干断层扫描观察[J]. 中华眼底病杂志, 2017, 33(3): 315-318. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.016.Lin QR, Gao M, Liu HY. The choroidal thickness and blood flow in the subfoveal area with idiopathic macular hole by spectral-domain optical coherence tomography[J]. Chin J Ocul Fundus Dis, 2017, 33(3): 315-318. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.016.
9.	王敏. 利用光相干断层扫描血管成像技术优势, 提升视网膜脉络膜血管疾病认知水平[J]. 中华眼底病杂志, 2016, 32(4): 349-352. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.003.Wang M. Evaluating retinal and choroidal vascular diseases with optical coherence tomography angiography[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 349-352. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.003.
10.	Teng YF, Yu M, Liu W, et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(5): 893-902. DOI: 10.1007/s00417-017-3586-0.
11.	Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole[J]. Am J Ophthalmol, 1995, 119(6): 752-759. DOI: 10.1016/s0002-9394(14)72781-3.
12.	中华医学会眼科学分会眼底病学组中国医师协会眼科医师分会眼底病专业委员会. 我国眼底相干光层析血管成像术的操作和阅片规范(2017)[J]. 中华眼科杂志, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn0412.4081.2017.10.003.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Siciety, Chinese Medical Association;Professional Committee of Fundus Diseases, Ophthalmologist Branch Chinese Doctors Association. Standards for operations and reading of coherent optical tomography angiography in China (2017)[J]. Chin J Ophthalmol, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn0412.4081.2017.10.003.
13.	Okamoto M, Matsuura T, Ogata N. Ocular blood flow before, during, and after vitrectomy determined by laser speckle flowgraphy[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(2): 118-124. DOI: 10.3928/23258160-20140306-04.
14.	Ahn SJ, Woo SJ, Park KH. Choroidal thickness change following vitrectomy in idiopathic epiretinal membrane and macular hole[J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(6): 1059-1067. DOI: 10.1007/s00417-015-3154-4.
15.	Kiel JW, van Heuven WA. Ocular perfusion pressure and choroidal blood flow in the rabbit[J]. Invest Ophthalmol Vis Sci, 1995, 36(3): 579-585.
16.	Lovasik JV, Kergoat H, Riva CE, et al. Choroidal blood flow during exer cise-induced changes in the ocular perfusion pressure[J]. Invest Ophthalmol Vis Sci, 2003, 44(5): 2126-2132. DOI: 10.1167/iovs.02-0825.

1. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5): 629-639. DOI: 10.1001/archopht.1988.01060130683026.
2. Kelkar AS, Bhanushali DR, Kelkar JA, et al. Spontaneous closure of a full-thickness stage 2 idiopathic macular hole without posterior vitreous detach ment[J]. Case Rep Ophthalmol, 2013, 4(3): 188-191. DOI: 10.1159/000356125.
3. Sjaarda RN. Macular hole[J]. Int Ophthalmol Clin, 1995, 35(4): 105-122.
4. Gass JD. Age-dependent idiopathic macular foramen: current concepts of the pathogenesis, diagnosis, and treatment[J]. Ophthalmologe, 1995, 92(5): 617-625.
5. Reibaldi M, Boscia F, Avitabile T, et al. Enhanced depth imaging optical coherence tomography of the choroid in idiopathic macular hole: across-sectional prospective study[J]. Am J Ophthalmol, 2010, 151(1): 112-117. DOI: 10.1016/j.ajo.2010.07.004.
6. 陈迪, 李略, 杨治坤, 等. 频域光学相干断层扫描观察特发性黄斑裂孔患者脉络膜厚度[J]. 协和医学杂志, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.Chen D, Li L, Yang ZK, et al. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes of patients with idiopathic macular holes[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.
7. 冯程程, 孙艳, 刘菲, 等. 频域OCT扫描观察特发性黄斑裂孔的脉络膜厚度[J]. 中国实用眼科杂志, 2015, 33(4): 358-361. DOI: 10.3760/cma.j.issn.1006-4443.2015.04.008.Feng CC, Sun Y, Liu F, et al. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes with idiopathic macular holes[J]. Chin J Pract Ophthalmol, 2015, 33(4): 358-361. DOI: 10.3760/cma.j.issn.1006-4443.2015.04.008.
8. 林秋蓉, 高敏, 刘海芸. 特发性黄斑裂孔患眼黄斑中心凹下脉络膜厚度及毛细血管血流面积的频域光相干断层扫描观察[J]. 中华眼底病杂志, 2017, 33(3): 315-318. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.016.Lin QR, Gao M, Liu HY. The choroidal thickness and blood flow in the subfoveal area with idiopathic macular hole by spectral-domain optical coherence tomography[J]. Chin J Ocul Fundus Dis, 2017, 33(3): 315-318. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.016.
9. 王敏. 利用光相干断层扫描血管成像技术优势, 提升视网膜脉络膜血管疾病认知水平[J]. 中华眼底病杂志, 2016, 32(4): 349-352. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.003.Wang M. Evaluating retinal and choroidal vascular diseases with optical coherence tomography angiography[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 349-352. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.003.
10. Teng YF, Yu M, Liu W, et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(5): 893-902. DOI: 10.1007/s00417-017-3586-0.
11. Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole[J]. Am J Ophthalmol, 1995, 119(6): 752-759. DOI: 10.1016/s0002-9394(14)72781-3.
12. 中华医学会眼科学分会眼底病学组中国医师协会眼科医师分会眼底病专业委员会. 我国眼底相干光层析血管成像术的操作和阅片规范(2017)[J]. 中华眼科杂志, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn0412.4081.2017.10.003.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Siciety, Chinese Medical Association;Professional Committee of Fundus Diseases, Ophthalmologist Branch Chinese Doctors Association. Standards for operations and reading of coherent optical tomography angiography in China (2017)[J]. Chin J Ophthalmol, 2017, 53(10): 729-734. DOI: 10.3760/cma.j.issn0412.4081.2017.10.003.
13. Okamoto M, Matsuura T, Ogata N. Ocular blood flow before, during, and after vitrectomy determined by laser speckle flowgraphy[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(2): 118-124. DOI: 10.3928/23258160-20140306-04.
14. Ahn SJ, Woo SJ, Park KH. Choroidal thickness change following vitrectomy in idiopathic epiretinal membrane and macular hole[J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(6): 1059-1067. DOI: 10.1007/s00417-015-3154-4.
15. Kiel JW, van Heuven WA. Ocular perfusion pressure and choroidal blood flow in the rabbit[J]. Invest Ophthalmol Vis Sci, 1995, 36(3): 579-585.
16. Lovasik JV, Kergoat H, Riva CE, et al. Choroidal blood flow during exer cise-induced changes in the ocular perfusion pressure[J]. Invest Ophthalmol Vis Sci, 2003, 44(5): 2126-2132. DOI: 10.1167/iovs.02-0825.

Chinese Journal of Ocular Fundus Diseases

Preliminary observation of choroidal capillary flow area and density in patients with idiopathic macular hole before and after surgery

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