PURPOSE To assess the photoreceptor mosaic in patients with idiopathic full thickness macular hole (MH) before and after pars plana vitrectomy (PPV) with adaptive optics enhanced retinal imaging (AO). DESIGN Prospective case series. METHODS Prospective cohort study of patients who presented at the Kensington Eye Institute, Toronto, Canada with a diagnosis of macular hole treated with PPV. EXCLUSION CRITERIA secondary MH, high myopia (axial length >26.5 mm), media opacity precluding OCT or AO imaging, previous intraocular surgery except for cataract extraction. Imaging using an AO fundus camera (Imagine Eyes, RTX1) was performed preoperatively and 3-months following successful MH repair in both eyes. Cone density (CD), regularity, dispersion, regularity, dispersion, and spacing were measured at 2° and 4° of eccentricity in 4 quadrants (superior, inferior, nasal, and temporal) with pre- and postoperative values compared. RESULTS We included 18 eyes of 9 patients. At 2° there was significant reduction in CD and increase in spacing and dispersion and a non-significant change in regularity post-operatively. Comparison between preoperative and postoperative measurements at 2° mean (Standard Error= SE) were: CD: 14612 ± 3003 and 12280 ± 4632 photoreceptors/mm2 [95%CIs= -2413 to -702] p=0.0004, regularity: 88 ± 7% and 84 ± 12% [95%CIs= -4.67 to 0.04] p=0.054, dispersion: 19 ± 6% and 23 ± 10% [95%CIs= 0.5 to 4.24] p=0.013, spacing: 9 ± 1 microns and 10 ± 2microns [95%CIs= 0.40 to 1.27] p=0.0002; at 4° was: CD: 13377 ± 4339 and 12770 ± 4391 photoreceptors/mm2 [95%CIs= -1368 to 252] p=0.176, regularity:87 ± 9% and 86 ± 12% [95%CIs= -4.65 to 0.08] p=0.74, dispersion: 20 ± 8% and 20 ±9 % [95%CIs= -2.11 to 1.5] p=0.74, spacing:10 ± 2 microns and 10 ± 3 microns [95%CIs= -0.23 to 0.58] p=0.39. CONCLUSION Adaptive optics imaging allows quantitative assessment of the photoreceptor mosaic pre- and post-PPV in patients with MH. There was a significant change to the photoreceptor mosaic related to the MH at 2° pre- and post-operatively. AO imaging enables high-resolution investigation of the photoreceptor remodeling process following surgery, which may allow for a more thorough assessment of surgical outcomes.

中文翻译：

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黄斑裂孔手术前后感光器马赛克与高分辨率自适应光学成像的比较。


目的 使用自适应光学增强视网膜成像 （AO） 评估睫状体玻璃体切除术 （PPV） 前后特发性全层黄斑裂孔 （MH） 患者的光感受器镶嵌。设计 前瞻性病例系列。方法 对在加拿大多伦多肯辛顿眼科研究所就诊并被诊断为黄斑裂孔接受 PPV 治疗的患者进行前瞻性队列研究。排除标准 继发性 MH、高度近视（轴长 >26.5 mm）、排除 OCT 或 AO 成像的中层混浊、除白内障摘除外的既往眼内手术。术前和双眼 MH 修复成功后 3 个月使用 AO 眼底相机 （Imagine Eyes， RTX1） 进行成像。在 4 个象限 （上、下、鼻和颞） 的偏心率 2° 和 4° 处测量锥体密度 （CD） 、规则性、分散度、规则性、分散度和间距，并比较术前和术后值。结果 我们纳入了 9 例患者的 18 只眼。在 2° 时，CD 显着减少，间距和分散增加，术后规律性没有显着变化。在 2° 平均值（标准误差 = SE）下术前和术后测量值之间的比较为：CD：14612 ± 3003 和 12280 ± 4632 个光感受器/mm2 [95%CIs= -2413 至 -702] p=0.0004，规律性：88 ± 7% 和 84 ± 12% [95%CI = -4.67 至 0.04] p=0.054，离散度：19 ± 6% 和 23 ± 10% [95%CIs= 0.5 至 4.24] p=0.013，间距：9 ± 1 微米和 10 ± 2 微米 [95%CI = 0.40 至 1.27] p=0.0002;在 4° 时为： CD：13377 ± 4339 和 12770 ± 4391 个感光器/mm2 [95%CIs= -1368 至 252] p=0.176，规律性：87 ± 9% 和 86 ± 12% [95%CIs= -4.65 至 0.08] p=0.74，色散：20 ± 8% 和 20 ±9 % [95%CIs= -2.11 至 1.5] p=0.74，间距：10 ± 2 微米和 10 ± 3 微米 [95%CI = -0.23 至 0。58] p=0.39。结论 自适应光学成像可以定量评估 MH 患者 PPV 前后的光感受器嵌合体。术前和术后 2° 与 MH 相关的感光器嵌合体发生显着变化。AO 成像能够对手术后的光感受器重塑过程进行高分辨率研究，从而可以更全面地评估手术结果。