特发性全层黄斑裂孔手术中消毒空气与全氟丙烷填充效果的比较

Comparative study of the effects of sterilized air and perfluoropropane gas tamponades on recovery after idiopathic full-thickness macular hole surgery

目的 比较消毒空气和全氟丙烷（C3F8）用于玻璃体切除术后眼内填充以治疗特发性全层黄斑裂孔的手术效果.方法 病例对照研究.选择2013年1月至2015年1月在北京协和医院确诊并行玻璃体切除术的特发性全层黄斑裂孔患者69例（73只眼）,53只眼使用消毒空气填充玻璃体腔（空气组）,其余20只眼使用10%C3F8填充（C3F8组）.两组患者间术前、后的最佳矫正视力（BCVA）、裂孔直径及光感受器细胞层破坏直径等进行比较,采用独立样本t检验;两组患者裂孔闭合率的比较采用χ^2检验.结果 空气组的术前最佳矫正视力平均（0.10±0.49）,黄斑裂孔直径平均（777.9±320.7）μm,光感受器细胞层破坏平均（1709.3±516.0）μm;术后1个月黄斑裂孔闭合率为90.6%（48/53）,最佳矫正视力平均（0.17±0.41）,光感受器细胞层破坏直径平均（820.5±598.0）μm.C3F8组的术前最佳矫正视力平均（0.07±0.50）,黄斑裂孔直径平均（853.9±355.0）μm,光感受器细胞层破坏平均（1480.5±429.9）μm;术后1个月黄斑裂孔闭合率为95.0%（19/20）,最佳矫正视力平均0.12±0.49,光感受器细胞层破坏直径平均（762.5±658.0）μm.两组间的闭合率（χ2=0.019）、手术前后的BCVA（t=-1.689）、裂孔直径（t=-0.837）及光感受器细胞层破坏直径（t=0.338）的差异均无统计学意义（P〉0.05）.结论 玻璃体切除手术联合消毒空气填充治疗特发性全层黄斑裂孔效果和安全性均与C3F8近似,即使在大直径裂孔中仍可得到满意效果.

Objective To compare the effects of sterilized air and perfluoropropane （C3F8） tamponades on recovery after vitrectomy for the treatment of idiopathic full-thickness macular hole （IFTMH）. Methods Case control study. Seventy-three eyes of 69 consecutive cases underwent vitrectomy with air （53 eyes） or 10% C3F8 gas （20 eyes） tamponade. Surgical outcomes were retrospectively analyzed between the two groups, including logarithm of the minimal angle of resolution （logMAR） and optical coherence tomography findings like the size of the macular hole and the photoreceptor layer defect. Results Preoperatively, the mean best corrected visual acuity （BCVA） was （0.10±0.49）, the mean hole diameter was （777.9±320.7）μm, and the mean diameter of the photoreceptor layer defect was （1709.3±516.0）μm in the sterilized air group, while in the C3F8 group, the mean BCVA was （0.07±0.50）, the mean hole diameter was （853.9 ± 355.0） μm, and the mean defect diameter was （1480.5 ± 429.9） μm. The primary closure rate was 90.6%in the sterilized air group and 95.0%in the C3F8 group. One month after surgery, the mean BCVA was （0.17±0.41）, and the mean diameter of the photoreceptor layer defect was （820.5±598.0）μm in the sterilized air group, while in the C3F8 group, the mean BCVA was 0.12±0.49, and the mean defect diameter was （762.5± 658.0）μm. There was no statistically significant difference in the closure rate （χ^2=0.019）, BCVA （t=-1.689）, hole diameter （t=0.837） and diameter of the photoreceptor layer defect （t=0.338） between the two groups（P〉0.05）. Conclusions Vitrectomy with sterilized air tamponade is safe and effective for the treatment of IFTMH and even cases with relatively large diameters.