手术治疗外伤性黄斑孔的效果和优势

The outcome and advantage of vitrectomy for traumatic macular hole

目的观察玻璃体切除手术治疗外伤性黄斑孔的效果并探讨其优势。方法回顾性观察手术治疗的外伤性黄斑孔共11例（11眼）。排除视网膜脱离、脉络膜脱离、玻璃体积血、增生性玻璃体视网膜病变（PVR）、继发性黄斑孑L及视神经萎缩。观察视力恢复及黄斑孑L形态改变。结果患者年龄16-56岁，平均（36．00±12．61）岁。外伤时间1-12个月，平均（4．59±4．18）月。术前最佳矫正视力（Sellen表）0．02-0．15，平均LogMAR1．12±0．26，术后最佳矫正视力（Sellen表）0．02-0．8，平均LogMAR0．80±0．45。术后视力较术前显著提高（t=3．761，P=0．004）。术前黄斑孔最大直径336-1020μm，平均（671．36±220．87）μm。10眼术后黄斑孔闭合。1眼黄斑孔直径1020pm，未闭合。闭合时间5-30d，平均（17．42±10．44）d。40岁以上者视力提高0-2行，平均（1±1）行，黄斑孔闭合时间20-30d，平均（26．5±4．43）d；40岁以下者视力提高2-8行，平均（3．83±2．13）行，黄斑孔闭合时间5-28d，平均（14．8±8．47）d。结论玻璃体切除联合内界膜剥除术能够在较短的时间内促进外伤性黄孔愈合，并显著改善视力预后。黄斑孔大者闭合几率低。黄斑孔大和年龄大者视功能预后差。

Purpose To observe the clinical effect and the advantage of vitrectomy for traumatic macular hole （MH）. Methods Retrospectively study a series of 11 patients （ 11 eyes） of traumatic macular hole. Vitrectomy, inner limiting membrane （ILM） peeling and long-term gas temponade were performed. The vision outcome was statistically analyzed. OCT was used to observe the change of macular hole. Results The age was 16 -56 months（36± 12.61 ） yrs. The course from trauma to operation was 1 - 12（4. 59 ±4. 18） months. The pre-operative best corrected visual acuity （BCVA） was 0.02 -0.15, main （LogMAR 1.12 ± 0.26 ） and the post-operative one was 0.02 - 0.8, main （ LogMAR 0.80 ± 0.45 ） , which was statistically im- proved（t = 3. 761, P = 0. 004）. The size of macular hole was 336 - 1020 p,m, main （671.36 ± 220. 87 ）μm. The hole was closed in 10 eyes and it was still exist in 1 eye in which the size was 1020 μm preopera- tively. The time for macular hole close was 5 - 30 d, main （ 17.42 ± 10.44 ） d. The visual acuity was increased for 0 - 2 lines in the patients older than 40 years, mainly （ 1 ± 1 ） line, in which the hole closed in 20 -30 days （mean 26.5 ±4.43 d）. It was 2 -8 lines in patients of 〈40 years old, and the hole closed in 5 - 28 d （ main 14.8 ± 8.47 d）. Conclusion Vitrectomy combined with ILM peeling can successfully seal the traumatic macular hole in short time and significantly improve the vision outcome. The bigger hole is difficuhe to close, and the vision prognosis was poor in big hole and old patient.