内界膜剥除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察

Efficacy of internal limiting membrane peeling and transplantation for the treatment of idiopathic macular hole

目的 对比观察内界膜剥除及其联合内界膜移植手术治疗裂孔形成因子（HFF）值小于0.6的特发性黄斑裂孔（IMH）的临床效果.方法 临床确诊为IMH并行玻璃体切割联合内界膜剥除手术治疗的40例患者40只眼纳入研究.所有患眼HFF值均小于0.6.其中,行常规玻璃体切割联合内界膜剥除手术20只眼（内界膜剥除组）,行玻璃体切割联合内界膜剥除及内界膜移植手术20只眼（内界膜移植组）.手术后随访时间3～6个月,平均随访时间4个月.对比分析两组患眼裂孔闭合率、最佳矫正视力（BCVA）、光感受器内外节连接（IS/OS）缺损直径及多焦视网膜电图（mfERG） P1波1环和2环振幅的变化情况.结果 手术后3个月,内界膜剥除组裂孔闭合14只眼,裂孔闭合率为70％.内界膜移植组裂孔闭合20只眼,裂孔闭合率为100％.两组裂孔闭合率比较,差异有统计学意义（x2=7.059,P＜0.05）.内界膜剥除组及内界膜移植组手术后BCVA均较手术前明显提高,差异有统计学意义（t=4.017、4.430,P＜0.05）.内界膜剥除组及内界膜移植组手术后BCVA提高率分别为80％、85％,BCVA显著提高率分别为35％、70％.两组手术后BCVA提高率比较,差异无统计学意义（x2=0.173,P＞0.05）;两组手术后BCVA显著提高率比较,差异有统计学意义（x2=4.912,P＜0.05）.内界膜剥除组及内界膜移植组手术前后IS/OS缺损直径比较,差异均有统计学意义（t=6.368、6.635,P＜0.05）.两组手术后IS/OS缺损直径比较,差异有统计学意义（t=2.261,P＜0.05）.内界膜剥除组及内界膜移植组手术前后mfERG P1波1环（t=2.833、4.235）及2环振幅（t=2.459、4.270）比较,差异均有统计学意义（P＜0.05）.两组手术后mfERG P1波1环振幅比较,差异无统计学意义（t=1.800,P＞0.05）.两组手术后mfERG P1波2环振幅比较,差异有统计学意义（t=2.282,P＜0.05）.结论 内界膜剥除联合内界膜移植手术较单纯内界膜剥除手术治疗HFF值小于0.6的IMH更能提高患者裂孔闭合率,改善患者视力.

Objective To compare the results of internal limiting membrane （ILM） peeling with and without ILM transplantation to treat idiopathic macular hole （IMH） with hole form factor （HFF）〈0.6.Methods Forty patients （40 eyes） of IMH with HFF〈0.6 who underwent pars plana vitrectomy （PPV） were enrolled in this study.20 eyes was performed PPV combined with ILM peeling （ILM peeling group）,the other 20 eyes was performed PPV combined with ILM peeling and ILM transplant （ILM transplant group）.The follow-up was ranged from 3 to 6 months with an average of 4 months.The changes of closing rate of hole,best corrected visual acuity （BCVA）,photoreceptor inner segment/outer segment （IS/OS） junction defect diameter and amplitude of wave P1 of ring 1 and ring 2 by multifocal electroretinogram （mfERG） were comparatively analyzed for the two groups.Results In 3 months after surgery,the IMH closing rate was 70% （14/20） in the ILM peeling group,and 100% （20/20） in the ILM transplant group,the difference between these two groups was significant （x2=7.059,P〈0.05）.Postoperative BCVA was improved obviously in the two groups compared to preoperative BCVA,the difference was significant （t=4.017,4.430; P〈0.05）.The rate of BCVA improvement in the IIM peeling group and ILM transplant group were 80% and 85%,the difference was not significant （x2 =0.173,P〉0.05）.The rate of significantly BCVA improvement in the ILM peeling group and ILM transplant group were 35% and 70%,the difference was significant （x2=4.912,P〈0.05）.IS/OS junction defect （t=6.368,6.635; P〈0.05）and amplitude of wave P1 of ring 1 （t=2.833,4.235） and ring 2 （t=2.459,4.270） by mfERG in the two groups were improved after operation.The differences of postoperative IS/OS junction defect （t =2.261,P〈0.05） and amplitude of wave P1 of ring 2 between the two groups were significant （t =2.282,P〈 0.05）,but the differences of postoperative amplitude of wave P1 of ring 1 between two groups was not different （t=1.800,P〉0.05）.Conclusion PPV combined with ILM peeling and ILM transplantation can significantly improve the closure rate and vision of IMH with HFF〈0.6.