黄斑孔视网膜脱离手术时机的探讨

The prognostic influence of surgery timing in patients of macular hole with retinal detachment

目的探讨黄斑孔视网膜脱离的最佳手术时机。方法黄斑孔视网膜脱离102例（105只眼），根据其发病至手术时间分为3组：A组（12只眼）为发病后3d内行手术者；B组（44只眼）为发病后4～7d手术者；C组（49只眼）为发病后8～30d行手术者。手术方式为玻璃体切除或玻璃体切除联合内界膜剥除术，术后随访4～7个月，观察黄斑孔闭合及视网膜复位情况，并分别记录术前及末次随访时的最佳矫正视力。结果三组患者术后黄斑孔均闭合，视网膜均复位。7d内手术者，A组和B组，术后末次随访最佳矫正视力（10gMAR）分别为0．38±0．39、0．59±0．44优于7d后手术者，C组的0．95±0．35，差异有统计学意义（t=0．68，0．27；P=0．00，0．oo），A组与B组比较术后最佳矫正视力差异无统计学意义（t=0．25，P=0．13）。结论黄斑孔合并视网膜脱离在中心视力丧失的7d内行手术治疗可获得较好的术后视力。

Objective To investigate the best surgery timing of macular hole with retinal detachment on visual outcome. Methods According to central visual acuity loss before surgical intervention, 105 eyes of 102 cases of macular hole with retinal detachment were divided into three groups. Group A, 12 eyes received surgical treatment with in 3 days after central visual acuity loss; Group B, 44 eyes received surgical treatment in 4-7 days after central visual acuity loss; Group C, 49 eyes received surgical treatment in 8-30 days after vision loss. All eyes treated by pars plana vitrectomy combined with internal limiting membrane peeling or not. Followed up for 4-7 months. The macular hole anatomic closure and retinal reattachment were evaluated, and the preoperative visual acuity （PVA） and final visual acuity （FVA） were recorded. Results The hole closed and retina reatached in all cases of 3 groups. FVA in group A and group B were 0.38 ±0.39, 0.59 ±0.44 （log MAR）, and in group C was （0.95 ± 0.35 ）, the difference of FVA was statistically significant （t = 0. 68,0. 27 ;P = 0. 00,0. 00）. But the difference in FVA was not statistically significant between group A and group B （ t = 0. 25, P = 0. 13 ）. Conclusion The surgery for macular hole with retinal detachment holds with duration in 7 days after loss of central vision may gain better FVA.