玻璃体切除联合内界膜翻转覆盖治疗特发性黄斑裂孔的临床疗效观察

Clinical outcomes of PPV and inverted internal limiting membrane flap technique in the treatment of idiopathic macular hole

目的应用玻璃体切除联合内界膜翻转覆盖法治疗特发性黄斑裂孔(IMH),观察术后黄斑裂孔解剖结构及视力的变化情况。方法选取临床确诊IMH患者31例(31只眼),其中男性8例(8只眼),女性23例(23只眼),患者年龄范围:42~82岁,平均(65.68±8.39)岁,行23G玻璃体切除联合内界膜翻转覆盖及注气术。于术后5 d,2周,1、3、6个月进行随访,所有患眼手术前后行最佳矫正视力(BCVA)、裂隙灯,眼底广角眼底照相,频域相干光断层扫描(SD-OCT)检查。观察手术后患者黄斑裂孔愈合率,手术前后BCVA变化情况,黄斑裂孔的愈合类型,翻转覆盖的内界膜与裂孔的位置关系,椭圆体区缺损直径的变化情况。结果术后黄斑裂孔愈合率为100%。手术前后BCVA有显著性差异(t=8.50,P<0.05),术后视力提高。30例裂孔呈"U"型愈合,1例裂孔呈"V"型愈合。29例内界膜瓣完全贴附于视网膜,2例内界膜未完全贴附视网膜并成桥样附着在裂孔正上方。术后椭圆体缺失直径逐渐减小。结论玻璃体切除联合内界膜瓣翻转覆盖术治疗IMH可以取得较高的解剖学复位率和裂孔愈合率,提高视力患者视力,是治疗IMH一种安全有效的手术方法。

Objective To observe the anatomical and visual outcomes of idiopathic macular holes（IMH） treated with pars plana vitrectomy（ PPV） and inverted internal limiting membrane（ ILM） flap technique. Methods Thirty-one IMH patients（31 eyes）,8 males and 23 females,were included. The age ranged from 42 to 82 with a mean of 65. 68 ±8. 39 years. All patients were treated with PPV and ILM flap technique. Best correct visual acuity（ BCVA）,slit-lamp examination,ultra-wide-field fundus photograph and spectral optical coherence tomography（ SD-OCT） were performed before the surgery and 5 days,2 weeks,1,3,and 6 months after the surgery. Results The closure rate of IMHs was 100%.Postoperative BCVA significantly improved（ t = 8. 50,P〈 0. 05）. U-type closure was found in majority of the patients（n = 30） and V-type closure was found in 1 patient. ILM flap attached to retinal completely in 29 eyes,and bridged IMH in 2 eyes. The diameter of ellipsoid zone gradually decreased postoperatively. Conclusions Vitrectomy combined with inverted ILM flap technique for the treatment of IMH can achieve a higher closure rate and better postoperatively visual outcomes.It is a safe and effective surgical method for the treatment of IMH.