外伤性黄斑裂孔预后临床观察

ClinicalStudy on Prognosis of Traumatic Macular Hole

目的观察外伤性黄斑裂孔的自然病程和视力预后。方法 2007年1月-2011年1月北京同仁医院诊治的外伤性全层黄斑裂孔30例(30眼),随访6个月～4年,包括视力、彩色眼底照相和光学相干断层扫描(OCT)检查,对其临床资料进行回顾性分析。结果 30眼黄斑裂孔均由钝挫伤所致,其中28眼于外伤后即刻发生。随访过程中,3眼黄斑裂孔在外伤后3～12周自行闭合,视力提高;8眼黄斑裂孔扩大,2眼视网膜脱离,发生时间均在伤后3个月,此2眼均进行了手术治疗,手术后视力提高;2眼黄斑裂孔缩小;其余15眼黄斑裂孔大小无明显变化,视力稳定者,未做特殊处理,仍在继续观察中。结论外伤性黄斑裂孔有自行闭合可能,且发生多在伤后早期。因此对视力稳定、孔径无扩大者,可暂不手术而密切随访;外伤性黄斑裂孔视网膜脱离发生率很低,对孔径扩大、视力下降者,或者发生视网膜脱离时,手术治疗有利于黄斑裂孔的闭合和视力恢复。

Objective To observe the natural course of traumatic macular hole and the prognosis for recovery of vision recovery.Methods From Jan.2007 to Jun.2011,30 cases（30 eyes） of full-thickness traumatic macular hole were observed and some of them were treated.The following-up time was 6-48 months.The clinical data were analyzed retrospectively.Examinations included best-corrected visual acuity,fundus photography and optical coherence tomography.Results All of the macular holes were caused by contusion and most of them took place at the time of injury.During the follow-up,3（10.0%）of the macular holes closed spontaneously within 3-12 weeks after trauma and visual acuity increased.Macular holes enlarged in 8 eyes（26.7%） and retinal detachment occurred in 2 eye（6.66%）,all of them appeared in the early 3 months after trauma and received surgical treatment.After the surgery,the visual acuity was improved in some degree.2（6.66%） of the macular holes were decreased.The other 15 eyes（50%） remained unchanged in diameter of macular hole and stable vision were not treated.Conclusion The early time after trauma,spontaneous closure of traumatic macular hole is possible.For the patients with stable vision and unchanged holes,follow-up is more important than surgical repair.Retinal detachment is rare in traumatic macular hole.Otherwise,if macular holes become enlarged and vision decreased or retinal detachment occurred,surgical treatment is helpful for the closing of macular hole and improvement of vision.