玻璃体切割联合内界膜剥除和空气填充治疗特发性黄斑裂孔

Clinical Outcomes of Vitrectomy and Internal Limiting Membrane Peeling with Air Tamponade for the Treatment of Idiopathic Macular Hole

目的:观察玻璃体切割手术联合内界膜剥除和空气填充治疗特发性全层黄斑裂孔(IMH)的疗效。方法:回顾性系列病例研究。收集2017年1月至2018年1月在温州医科大学附属眼视光医院杭州院区确诊并行玻璃体切割术治疗的连续IMH患者32例(32眼),年龄47~78(60.7±12.2)岁,其中男9例,女23例。术中均采用消毒空气进行眼内填充。根据术后早期首次光学相干断层扫描(OCT)提示裂孔是否闭合分为闭合组和未闭合组,对2组患者术前、术后的最佳矫正视力(BCVA)、裂孔直径等采用秩和检验及独立样本t检验进行比较;2组患者裂孔闭合率及外界膜和光感受器连续性比较采用卡方检验。结果:术后末次随访时所有患者LogMARBCVA为0.40(0.30,0.73),较术前[0.80(0.70,1.00)]明显提高(Z=-3.439,P<0.001)。术后早期OCT扫描显示24例黄斑裂孔闭合,8例黄斑裂孔未闭合,予再次玻璃体腔空气填充治疗,术后1个月及术后末次随访所有患者黄斑裂孔均闭合。术后1个月OCT扫描外界膜(ELM)连续的患者有16例,无一例椭圆体层(EZ)连续;末次随访时18例患者ELM连续,6例EZ连续。未闭合组术前黄斑裂孔直径为(532±104)μm,明显大于闭合组黄斑裂孔直径[(352±180)μm](t=-2.656,P=0.013)。闭合组术后1个月ELM均存在连续性,末次随访ELM和EZ连续性均高于未闭合组,2组差异具有显著的统计学意义(χ^2=4.23,P=0.040;χ^2=3.89,P=0.048)。结论:玻璃体切割联合ILM剥除和空气填充治疗IMH具有较好的疗效,对于大于400μm的裂孔部分患者需要再次玻璃体腔空气填充治疗。

Objective:To evaluate the effect of vitrectomy and internal limiting membrane peeling with air tamponade for the treatment of idiopathic macular hole (MH).Methods:A retrospective study was performed on 32 eyes of 32 patients with idiopathic macular hole in our hospital from January 2017 to January 2018.There were 9 males (9 eyes) and 23 females (23 eyes),with amean age of 60.7±12.2 years (range from 47~78 years).Pars plana vitrectomy with internal limiting membrane peeling was performed,followed by fluidair exchange.According to the results of OCT scanning in the first postoperative follow-up,all patients were divided into two groups:MH closed ornot closed.The preoperative and postoperative best corrected visual acuity (BCVA) and diameter of the MH were compared between the two groups,using a Wilcoxontest and independent sample t test.The MH closure rate,the continuity of the external limiting membranes and photoreceptors were compared using a chi square test.Results:At the last follow-up,the LogMAR BCVA was 0.40 (0.30,0.73),which was significantly higher than the preoperative BCVA 0.80 (0.70, 1.00)(Z=-3.439,P<0.001).Early postoperative OCT scansshowed that 24 macular holeswere closed, while the macular holes in the other 8 eyes were not closed sofluid-air exchange was performed again. The macular holeswereclosed in all 8 patients one month after the second treatment or the last follow-up. Sixteen patients hadcontinuous external limiting membrane (ELM) but none with a continuous external zone (EZ) in the OCT scansone month after the operation.However,18 patients showed continuous ELM and 6 showed continuous EZ at the last follow-up.According to whether MH was closed or not at the first postoperative OCT scanning,all patients were divided into two groups.The mean pre-surgical diameter of the MH of the unclosed group was 532±104 um,which was significantly larger than that of the closed group (352±180 μm)(t=-2.656,P=0.013).The continuity of the ELM of the MH closed group was higher than the unclosed group at one month after the operation and at the last follow-up (P<0.05).The patients with continuous EZ at the last follow-up were all in the closed group,while the EZs in the unclosed group were discontinuous.There was a statistically significant difference between the two groups (χ^2=3.89, P=0.048).Conclusions:The results of this study indicate that vitrectomy combined with ILM peeling and air tamponade for the treatment of idiopathic macular hole has a good result.However,for those macular holes with more than a 400 um diameter,a second fluid-air exchange is needed.Early closure of the MH suggests a better prognosis after surgery.