不同手术方法治疗老年性特发性黄斑裂孔的疗效观察

The observation of curative effect of different mode of surgery for the treatment of idiopathic senile macular hole

目的 观察单纯玻璃体切割、玻璃体切割联合血小板封孔、玻璃体切割联合黄斑区内界膜剥除、玻璃体切割联合血小板封孔及黄斑区内界膜剥除 4种手术方法治疗老年性特发性黄斑裂孔的疗效。 方法 回顾分析 ～ 期老年性特发性黄斑裂孔患者 86只患眼的手术疗效。以上述 4种手术方式分组的患眼数分别为 7、4 0、14、2 5只眼 ,手术后随诊 3～ 5 5个月 ,以手术后裂孔闭合、视力改变及手术并发症等作为疗效观察的指标。裂孔闭合判定标准为在检眼镜和 (或 )光相干断层成像术 (optic coherence tomography,OCT)检查时不能分辨黄斑裂孔缘。远、近视力提高 2行以上者计为视力改善。 结果 玻璃体切割联合血小板封孔组视力改善者占 80 .0 % ,优于其它 3种治疗方法 (P<0 .0 5 ) ;单纯玻璃体切割组裂孔闭合率最低 ,占 4 2 .9% ,与玻璃体切割联合血小板封孔组的裂孔闭合率 (87.5 % )、玻璃体切割联合血小板封孔及黄斑区内界膜剥除组的裂孔闭合率 (92 .0 % )比较差异有显著性意义 (P<0 .0 5 ) ;视物变形改善、手术并发症等情况 4组比较差异无显著性意义。 结论 玻璃体切割联合血小板封孔有助于老年性特发性黄斑裂孔患者手术后黄斑裂孔闭合及视力恢复 ;手术中使用黄斑区内界膜剥除技术可提高黄斑裂孔的解剖复位率 。

Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ Ⅳ idiopathic full thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate,change of visual acuity,findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups ( P <0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group (87.5%) or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)( P <0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant.