改良的黄斑中心凹下全氟化碳残留取出术的临床应用

Outcome of a new operative technique for retained subfoveal perfluorocarbon liquid

目的评价改良的视网膜黄斑中心凹下全氟化碳(perfluorocarbon liquid,PFCL)残留取出术的临床疗效。方法对15例(15眼)中心凹视网膜下PFCL残留的患者行手术治疗。术中使用自制26G针头于PFCL小泡上缘先垂直视网膜再斜向PFCL小泡中心进行穿刺造口,最后使用笛针缓慢将视网膜下PFCL取出。术后随访1~12个月,观察最佳矫正视力(best corrected visual acuity,BCVA)、OCT下中心凹内界膜与色素上皮层间(ILM-RPE)厚度。结果患眼术后1~12个月视力较术前提高(F=40.09,P<0.01),ILM-RPE厚度减少(F=130.15,P<0.01)。各时间段前后时间点BCVA和ILM-RPE厚度比较,术后1个月与术前、术后3个月与术后1个月、术后6个月与术后3个月相比差异均有统计学意义(均为P<0.05),而术后12个月与术后6个月相比差异均无统计学意义(均为P>0.05),患眼视力和ILM-RPE厚度于术后6个月趋于稳定。术后12个月BCVA(LogM AR):最佳0.22,最差0.82,视力较术前改善14眼(93.33%),1眼视力维持。有2眼术后12个月仍有不同程度的视物变形。术后4.5个月出现并发性白内障1例,已行超声乳化吸出并人工晶状体植入术。结论该手术方式治疗术后6个月患者视力及中心凹视网膜ILM-RPE厚度趋于稳定,此手术治疗黄斑中心凹视网膜下PFCL残留有效。

Objective To evaluate the outcome of a new operative technique for retained retinal subfoveal perfluorocarbon liquid （PFCL）. Methods Surgery was performed to remove the subretinal PFCL for 15 patients with 15 eyes which suffered from retained subfoveal PFCL. Intraoperative, the modified 26 G needle was used to make a small retinotomy at the superior border of PFCL bubble, first perpendicular to the retina,then towards the center of PFCL bubble. Finally, a silicone-tipped needle was used to slowly remove it. All patients＇visual acuity and thickness of foveal ILM-RPE were followed up at postoperative 1 month, 3 months, 5 months and 12 months, respectively. Results BCVA （Log MAR） in the postoperative period from 1 month to 12 months were lower than pre-operation, and visual acuity was improved significantly （F = 40.09, P 〈 0.01 ）. Between different time points during the fLrst 5 months of follow-up ,visual acuity levels had statistically significant differences （P 〈 0.05 ）. At 12 months after operation,the BCVA （Log MAR） was improved in 14 eyes （93.33%） ,and maintained in 1 eye. The thickness of foveal ILM-RPE was significantly decreased after operation, compared with pre-operation （F = 130. 15 ,P 〈 0.01 ）. There were significant differences in the foveal ILM-RPE thickness of OCT at different time points during the first 5 months of follow-up （ all P 〈 0.05 ）. Two eyes remained the poor visual quality at 12 months, and cataract appeared in 1 eye at 4.5 months, the phaco and intraocular lens implantation was given. Conclusion At postoperative 6 months, patients＇visual acuity and thick- ness of foveal ILM-RPE are tend to be stable. This method is an effective surgical technique for retained subfoveal PFCL.