黄斑裂孔性视网膜脱离的玻璃体手术

Vitrectomy for treatment of retinal detachment caused by macular hole

目的评价玻璃体手术、自体血清在黄斑裂孔性视网膜脱离治疗中的价值。方法对黄斑裂孔性视网膜脱离患者１９例（１９只眼），施行玻璃体手术及Ｃ３Ｆ８气体填压术，术后随访６～２４个月，失败病例进行残存黄斑上膜剥离术及自体血清留置治疗。结果首次手术１５只眼（８０％）裂孔闭锁，术后最佳视力０．０５～０．４；余４只眼失败，１只眼行残存黄斑上膜剥离术，另３只眼行自体血清滴注术，术后Ｃ３Ｆ８气体填压，裂孔封闭，视网膜全部复位，最终视力达０．１以上。结论玻璃体手术中充分剥离黄斑前膜是手术成功的关键。

Objective To evaluate the effect of vitrectomy and autoserum for treatment of retinal detachment caused by macular hole. Methods 19 eyes with retinal detachment caused by macular hole were treated with gas tamponade (C 3F 8). The follow up periods ranged from 6 to 24 months. In the case whose macular hole failed to heal, removal of the remains of prefoveal membrane and/or scratching at the retinal pigment epithelium (RPE) and placing autoserum for 7 minutes in the macular hole were performed. Results Closure of macular hole was obtained in 15 eyes (80%). The postoperative visual acuity was 0.05～0.4. Macular hole failed to heal in 4 eyes. In one eye the remains of prefoveal membrane were removed; in another 3 eyes, in the macular hole scratching at the retinal pigment epithelium (RPE) and placing autoserum were performed and C 3F 8 tamponade was used. Anatomical cure was obtained in all the 4 eyes. The final visual acuity was 0.1 or better. Conclusion The findings show that removal of prefoveal membrane is imperative. Scratch at RPE with placement of autoserum in the macular hole is effective for the macular hole which has failed to respond to conventional vitrectomy with air tamponade.