玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔疗效观察

A preliminary observation on vitrectomy combined with autologous platelet concentrate for the treatment of idiopathic macular holes

目的探讨玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔的临床疗效。方法玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔手术１４例（１５只眼），随访３～１６个月，对裂孔封闭情况及视力、视野中心阈值、Ａｍｓｌｅｒ方格表、荧光素眼底血管造影及手术并发症进行观察。结果８６．７％的手术眼裂孔完全闭合，视力增加２行以上者占８６．７％；Ａｍｓｌｅｒ方格表异常者术后视力全部改善；视野中心阈值手术前后差异无显著性（Ｐ＝０．３４）；荧光素眼底血管造影显示部分患眼术后黄斑孔处中央低荧光，其外围以窗样透见荧光环；术中主要并发症为视网膜裂孔，术后主要并发症为白内障加重。结论玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔可使大部分患眼裂孔闭合，视力改善，但尚需多中心。

Objective To investigate the efficacy of vitrectomy combined with autologous platelet concentrate for the treatment of idiopathic macular holes. Methods Fifteen eyes of 14 patients with idiopathic macular hole were treated. The follow up period ranged from 3 to 16 months. Postoperatively, visual acuity, macular threshold, Amsler grid, fluorescein angiography (FA) and complications were evaluated. Results Of the fifteen eyes, the closure of the holes was achieved in 13 eyes (86.7%), visual acuity improved for two lines or more in 12 eyes (80.0%). The postoperative visual acuities in patients with abnormal Amsler grid were improved. No significant differences were found in the macular threshold ( P =0.34). Postoperative FA showed that the blocked fluorescence at the site of the macular hole which was surrounded by a hyperfluorescence ring (window defect) in three eyes. The intraoperative complication was primarily the retinal hole, and the postoperative complication was chiefly the aggravation of cataract. Conclusions These results indicate that vitrectomy combined with autologous platelet concentrate can seal the macular hole well and improve the visual acuity in most patients. A large multicenter randomized prospective study and a longer period of follow up are needed to verify these results.