内界膜剥除联合空气填充治疗中大直径特发性黄斑裂孔的临床观察

Clinical observation of medium and large diameter idiopathic macular hole in the treatment of internal limiting membrane stripping combined with air filling

目的:观察内界膜剥除联合空气填充治疗直径在250~600μm之间的特发性黄斑裂孔(IMH)临床疗效。方法:临床确诊为IMH并经过OCT测量黄斑裂孔最小直径在250~600μm之间的患者45例45只眼纳入研究,按照黄斑裂孔直径并将其分为中直径(250~400μm)裂孔组(M组)25例及大直径(401~600μm)裂孔组(L组)20例。两组患者术前均行眼压,裂隙灯显微镜,眼轴测量,双目间接检眼镜及OCT测量黄斑裂孔直径,观察术后两组黄斑孔闭合及BCVA情况。结果:手术后随访时间1~24个月,其平均随访时间为(12.5±6.1)个月。(1)黄斑裂孔闭合率M组与L组分别为100%和95%,差异无统计学意义(t=3.265,P=0.066)。(2)M、L组患眼平均logMAR BCVA分别为0.33±0.27、1.18±0.34。与手术前平均logMAR BCVA比较,M组患眼logMAR BCVA差异有统计学意义(t=2.786,P=0.016);(3)L组患眼术前术后logMAR BCVA差异无统计学意义(t=1.786,P=0.124)。结论:剥除内界膜联合空气填充治疗直径在250~600μm之间IMH闭合率高,对于250~400μm之间IMH患者术后视力改善明显;对于401~600μm之间的IMH,患者术后视力改善效果不理想。

Objective: To observe the clinical efficacy of internal limiting membrane stripping combined with air filling on a postsurgical idiopathic macular hole with a diameter of 250~600 μm. Methods: A total of 45 eyes of 45 patients with IMH whose macular hole were between 250~600 μm in diameter were included. Patients were divided into the middle diameter (250~400 μm) hole group(M group, 25 eyes)and large diameter (401~600 μm) hole group (L group,20 eyes). Intraoperative pressure, slit lamp microscope, axial measurement, binocular indirect ophthalmoscope and OCT were used to measure the preoperative and postoperative macular hole diameters, closure ratio and BCVA. Results: Minimum followed-up time was 1 month[average (12.5±6.1) months,1~24 months](1) The macular hole closure rate were 100% and 95% in group M and group L, and there was no significant difference between two groups(t=3.265, P=0.066).(2) The average logMAR BCVA in the M and L groups were 0.33±0.27 and 1.18±0.34. Compared with the preoperative mean logMAR BCVA in group M, there was statistically significant difference(t=2.786, P=0.016).(3)There was no significant difference betweenpreoperative and postoperative logMAR BCVA in group L(t=1.786, P=0.124). Conclusion: The method of stripping the inner limiting membrane filling combined with air filling has a high closure rate of IMH between 250~600 μm. The BCVA is improved significantly in the group of 250~400 μm. No significant improvement of postoperative BCVA has been observed in the group of 401~600 μm.