老年特发性黄斑裂孔玻璃体切割手术预后的多因素分析

Prognosis factors analysis of vitrectomy for idiopathic macular hole

目的评价多种因素与老年特发性黄斑裂孔玻璃体切割术后视力的关联情况。方法对109例行玻璃体切割术的老年特发性黄斑裂孔患者进行回顾性分析。分析术前矫正远视力、病程、黄斑裂孔的分期及孔径大小,术中是否剥除内界膜、是否使用血小板,术后裂孔是否闭合与术后视力预后的关系。结果术前远视力(P=0·016)、孔径(P=0·028)、是否使用血小板(P<0·05)这3个因素在不同的视力预后分组之间差异有统计学意义。术中使用血小板的患者术后视力相对较好(相关系数为3·106,P=0·014)。结论使用浓缩血小板封孔,可以增加老年特发性黄斑裂孔患者术后视力提高或者稳定的概率。

Objective Many surgical techniques have been used to improve the post-operative visual acuity for idiopathic macular hole during recent decade. This study evaluated the relationship between vitrectomy for idiopathic macular hole and the factors associated with post-operative visual acuity. Methods A retrospective review of a consecutive series of 109 patients （109 eyes） who underwent vitrectomy for macular hole surgery was performed. The multiple factors related with prognosis including preoperative visual acuity, duration of disease, stage and size of macular hole, internal limit membrane peeling technique, autologous concentrated platelet technique and postoperativve anatomic closure statues of the hole were analyzed. All the patients were assigned to three groups according to the difference of postoperative visual acuity from initial. The data was statistically analyzed using one way ANOVA,chi-square test and logistic regression. Results There were significant difference of pre-op visual acuity （P = 0. 016） , macular hole size （P = 0. 028 ） and autologous concentrated platelet technique （P 〈 0. 005 ） among the three groups. Patients who were performed autologous concentrated platelet technique gained better visual acuity after surgery （ r = 3. 106, P = 0. 014）. Conclusion Using autologous concentrated platelet in vitrectomy is helpful for the improvement of visual acuity in idiopathic macular hole patients.