外伤性黄斑孔保守治疗的病程观察

The observation on the clinical course of traumatic macular hole under conservative therapy

目的探讨外伤性黄斑孔形态和视力的自然转归。方法对受伤后在我院行保守治疗的外伤性黄斑孔30例（30眼），定期行OCT及视力检查至伤后1年。追踪黄斑孔自发闭合与未自发闭合者各阶段的形态特征、视力变化并做统计学分析。结果保守治疗30例（30眼），伤后12个月9例黄斑孔自发性闭合，闭合率为30．00％。自发闭合者除1例在伤后6个月闭合外，其余8例裂孔在1—3个月之间闭合，平均（2．83±1．72）个月闭合，自发闭合者黄斑孔原来孔径平均为（250．67±61．53）斗m，其中6例合并少许玻璃体积血及视网膜小片状浅层出血，均无其他明显的眼部损伤。21例未闭合者黄斑孔直径平均为（464．0±157．79）Ixm，其中15例伴有外伤性白内障、前房积血、玻璃体积血和累及黄斑区的视网膜脉络膜挫伤等并发症。自发闭合组裂孑L直径小于未闭合组，组间差异有统计学意义（t：2．58，P=0．038）。自发闭合组，伤后12个月视力提高率77．78％（7／9），与伤后1个月视力差异有统计学意义（，=9．009，P=0．013）。未闭合者伤后12个月视力与伤后1个月差异无统计学意义（，=5．25，P=0．769）。未闭合者中有2例孔周624bLm视网膜神经上皮与色素上皮层间分离，4个月后分离区自行贴附，均未见玻璃体后脱离（PVD）。结论外伤性黄斑孔自发闭合者的共性是：黄斑孔直径较小、无其他明显的眼部损伤、无累及黄斑孔区视网膜脉络膜挫伤，黄斑孔自发闭合时间多在伤后1～3个月，闭合后视力明显改善。对于黄斑孔直径大，伴有累及黄斑孑L区的视网膜脉络膜挫伤及眼部其他组织损伤者，其孔较难自发闭合，视力无明显变化。

Objective To study the natural course of the morphology and visual acuity of traumatic macular hole. Methods Thirty eyes of 30 patients with traumatic macular hole treated with conservative therapy was observed. They were examined regularly by OCT and visual acuity. The Follow-up time was one year. The morphology of spontaneous closed macular hole and unclosed macular hole, and visual acuity changes were analyzed. Results In the 30 cases, the macular hole disappeared spontaneously in 9 cases in 1 to 3 months after injury, with an average of （2.83 ＋ 1.72） months, except for one case of 6 months after the trauma. The average diameter of the hole was （250.67 ＋ 61.53 ）ttm in those 9 cases. Besides mild vitreous hemorrhage and hemorrhage in the superficial layer of the retina occurred in 6 cases, there was no obvious injury on the eyeball. For the 21 cases of unclosed macular hole, the average diameter of the hole was （464.00 ＋ 157.79） i.~m. Traumatic cataract, hyphema, vitreous hemorrhage, and retino-choroid rupture near the macular hole occurred in 15 cases. The diameter of macular hole in the spontaneous closed group was less than that of unclosed goup, and the difference was statistically significant （ t = 2. 58, P = 0. 038）. The visual acuity in spontaneous closed group improved by 77.78% in rate 12 months after injury, and the difference was statistically significant when compared with that 1 month after injury （X2 = 9. 009,P = 0. 013 ）. The difference of VA between 12 months and 1 month after injury was not statistically significant （X2=0. 525, P = 0.769） in the macular hole unclosed group. Retina detachment about 624 p.m around the hole occurred in 2 cases, and it reattached without treatment 4 months later. No posterior vitreous detachment was found. Conclusion The traumatic maeular hole can close spontaneously, with characteristics of small diameter, absence of other eye injury, and no involving of retinoehoroid rupture in macular area. The macular hole mostly closed in 1 to 3 months after injury, with vision acuity improving. The big hole cannot close spontaneously and the visual acuity remain unchanged, especially when retinoehoroid rupture involving the maeula or other ocular injury existing.