玻璃体切割联合视网膜填塞术治疗难治性黄斑裂孔的疗效观察

Clinical efficacy of vetrectomy combined with the retina tamping for refractory macular holes

目的观察玻璃体切割联合视网膜填塞术治疗难治性黄斑裂孔的临床疗效。方法回顾性分析2016年3月至10月就诊于首都医科大学附属北京友谊医院眼科,且诊断为难治性黄斑裂孔、并接受玻璃体切割联合视网膜填塞手术治疗的患者14例(14眼),术后随访3~13个月,使用频域光学相干断层成像评估黄斑裂孔闭合情况,比较术前术后视力。结果 14例(14眼)患者年龄38~73(62.71±8.94)岁,随访3~13(5.78±3.33)个月。其中特发性黄斑大裂孔8例,高度近视黄斑裂孔3例,外伤性黄斑裂孔2例,再次手术1例。行内界膜翻瓣术12例,内界膜移植术2例。术后视力提高者11例,视力提高率为78.57%。术后随访期间,14例(100%)患者黄斑裂孔完全闭合,且随访期内未见裂孔复发,但有2例患者为视网膜色素上皮裸露愈合,裂孔周围视网膜贴附良好。结论玻璃体切割联合视网膜填塞术可以达到理想的黄斑裂孔闭合率,并对视功能的改善有显著意义。

Objective To observe the effectiveness of pars plana vetrectomy （PPV） combined with retina tamping for treatment of refractory macular holes.Methods Retrospective analysis was conducted in fourteen consecutive patients （14 eyes） with refractory macular hole from March to October in 2016 in Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University.The patients were followed up for 3-13 months after PPV.The status of macular hole was evaluated by spectral-domain optical coherencetomography （SD-OCT）.Preoperative and postoperative visual acuity was compared.The main outcome measures used in this study were MH closure and best-corrected visual acuity （BCVA）.Results The age ranged from 38 to 73 （62.71±8.94）years.The follow-up time after surgery was 3-13 （5.78±3.33） months.The primary diseases in these patients included large idiopathic MH in 8 patients,traumatic MH in 2 patients,high myopic foveoschisis in 3 patients,and secondary surgery in 1 eye.There were 12 patients with the treatment of PPV with inverted internal limiting membrane （ILM） and 2 patients with ILM autologous transplantation.The postoperative BCVAs were significantly better than the preoperative BCVAs in 11 eyes （78.57%）.Macular holes were closed successfully in 14 eyes （100%）,while the retinal pigment epitheliums were bare （flat-open macular holes） in 2 patients.There were no ocular or systemic complications observed in all patients.Conclusion Vitrectomy combined with retina tamping is an effective and safe treatment for the refractory macular holes.