特发性黄斑裂孔合并早期白内障患者手术方式的探讨

The mode of surgery for idiopathic macular hole and early cataract

目的评价黄斑裂孔手术联合或不联合白内障手术治疗特发性黄斑裂孔合并早期白内障的疗效，探讨联合白内障手术的意义。方法对2004年1月至2008年12月接受手术治疗的特发性黄斑裂孔合并早期白内障的90例患者进行回顾性分析，其中41例患者一期手术仅行单纯黄斑裂孔手术（单纯黄斑孔手术组），49例患者一期行黄斑孔手术联合白内障摘除（联合手术组）。记录单纯黄斑孔手术组术后白内障进展情况以及两组患者术前、术后最佳矫正视力、裂孔闭合情况以及住院治疗的总费用。结果单纯黄斑孔手术组41例患者中，38例（92．7％）在术后随访过程中发现白内障核混浊明显加重，其中18例（43．9％）患者行二期白内障手术。两组患者术前最佳矫正视力分布无明显差异，术后两组患者视力均有不同程度提高，但最佳矫正视力分布无明显差异。两组黄斑裂孔闭合率的差异无统计学意义（P〉0．05）。单纯黄斑孔手术组已行二期白内障手术患者两次住院治疗的总费用高于联合手术组住院总费用，差异有统计学意义（P〈0．05）。结论特发性黄斑裂孔手术采用联合白内障手术与否均可得到相似的视力预后，但联合手术可使患者避免二次手术的痛苦，减少手术成本。

Objective To evaluate the functional and the anatomic outcomes of combined and uncombined surgeries for the treatment of concurrent idiopathic macular hole and early cataract, and to discuss the significance of the combined surgery. Methods Retrospective clinical study. Ninety patients （90 eyes） with an idiopathic macular hole and early cataract were operated between January 2004 and December 2008. Among them 41 eyes underwent macular hole surgery in stage I （the un- combined group） and 49 eyes underwent macular hole surgery and cataract surgery in stage I （the combined group）. The data collected included the cataract progression in the uncombined group, the preoperative and postoperative best-corrected visual acuity, the rate of closure of macular hole and the total cost of surgery in two groups. Results In the uncombined group, nuclear cataract progress distinctly in 38 eyes （92.7%） and 18 eyes （43.9%） underwent cataract surgery during the follow-up. The preoperative and postoperative best-corrected visual acuity, the rate of closure did not differ sig- nificantly between the combined group and the uncombined group. The total cost of the patients in the combined group was lower than that in the patients who underwent macular hole surgery and cataract surgery separately （t =10.66, P =0.000）. Conclusions The visual outcome of combined sur- gery is equivalent to uncombined surgery. However, combined surgery avoids a second surgery and reduces overall surgical cost.