曲安奈德辅助玻璃体切除联合内界膜剥除治疗较大特发性黄斑孔的疗效探讨

The efficacy of triamcinolone - assisted vitrectomy and internal limiting membrane peeling for the treatment of large idiopathic macular holes

目的评价曲安奈德辅助玻璃体切除联合无染色内界膜剥除治疗Ⅳ期较大特发性黄斑孔的效果。方法对Ⅳ期特发性黄斑孔27例（27眼）常规行视力、眼压和光相干断层扫描（OCT）等检查确定黄斑孔的分期。手术采用曲安奈德染色玻璃体，行人工玻璃体后脱离术和无染色黄斑区内界膜剥除。手术后2周和3个月复查视力、眼压和OCT。对比手术前后视力、眼压和黄斑孔直径情况。结果手术前最佳矫正视力（10gMAR）1．7～1．0，平均为1．2±1．3，手术后3个月为1．6—0．8，平均为1．1±1．2，手术前后比较，差异有统计学意义（t=3．38，P=0．027）。手术后2周OCT检查显示，27只眼黄斑孔均闭合，达100％。所有患者均未发生眼压升高等并发症。结论曲安奈德辅助玻璃体切除术联合内界膜剥除术治疗Ⅳ期黄斑孔是一种安全有效的方法。

Objective To evaluate the effect of triamcinolone-assisted vitrectomy and internal limiting membrane peeling without dye for the treatment of large size stage IV idiopathic macular holes. Methods Twenty-seven eyes of 27 patients with stage IV idiopathic maeular holes were collected. All patients underwent triamcinolone assisted vitrectomy, posterior vitreous detachment and internal limiting membrane peeling without dye. The best-corrected visual acuity （BCVA）, intraoeular pressure （IOP） and size of the macular hole measured with OCT before and after the surgery were analysed. Results The BCVA （logMAR） was 1.7 - 1.0, average of the BCVA was （ 1.2 ± 1.3 ） before surgery. The BCVA （logMAR） was 1.6 - 0.8, average of the BCVA was （ 1.1 ± 1.2） at 3 months ＇after surgery. Compared with the preoperative level ,the difference was statistically significant （t = 3.38, P = 0. 027 ）. Anatomic macular hole closure was achieved in 27 eyes（ 100% ）at 2 weeks after surgeny,the difference in vision improvement was statistically significant （t = 3. 380, P = 0 . 027 ）. The postopertive BCVA increased in 25 eyes （92.6%） and kept unchanged in 2 eyes （7.4%）. No severe complications were noted. Conclusion Vitrious dyed by TA and vitrectomy ILM peeling without dye is an effective and safe surgical technique in stage IV idiopathic macular holes.