不同手术方式治疗特发性黄斑裂孔一年临床观察结果

One year clinical results of different surgical methods in the treatment of idiopathic macular hole

目的观察玻璃体切割手术(PPV)联合或不联合内界膜(ILM)翻瓣及空气或C3F8填充治疗特发性黄斑裂孔(IMH)的疗效。方法回顾性病例分析。2015年12月至2016年12月于天津市眼科医院行PPV联合或不联合ILM翻瓣以及空气或C3F8填充治疗的IMH患者98例101只眼纳入研究。患眼均行BCVA、OCT检查。BCVA检查采用国际标准视力表,统计时换算成logMAR视力。根据裂孔最小直径(MLD)和手术中是否联合ILM翻瓣对患眼进行分组。MLD<400μm手术中联合无菌空气填充为A组;MLD≥400μm,手术中未联合ILM翻瓣为B组,联合ILM翻瓣且手术后OCT检查显示翻瓣成功者为C组。分别为41、39、21只眼。A组、B组、C组患眼logMAR BCVA分别为0.82±0.39、1.11±0.42、1.25±0.50.B组39只眼中,无菌空气、C3F8填充分别为16、23只眼;C组21只眼中,无菌空气、C3F8填充分别为7、14只眼。手术后1周以及1、3、6、12个月采用手术前相同设备和方法行OCT检查,观察裂孔闭合率及BCVA改善情况。结果A组、B组、C组患眼手术后BCVA逐渐提高,3个月时提高最明显,其后趋于稳定。手术后12个月时,A组、B组、C组患眼logMAR BCVA与手术前比较,差异均有统计学意义(t=-11.66、-7.52、-4.99,P<0.01、<0.01、<0.01)。A组与B组、A组与C组、B组与C组之间BCVA增加值比较,差异无统计学意义(t=0.77、-0.41、0.28,P=0.44、0.72、0.76)。101只眼中,裂孔闭合98只眼(97.03%),其中手术后1周内裂孔闭合96只眼(96.94%,96/98)。结论黄斑裂孔闭合主要发生于手术后1周内;视力提高主要发生于手术后3个月;手术中联合ILM翻瓣对于提高MLD≥400μm患眼视力未见优势。

Objective To observe the effect of 25G pars plana vitrectomy(PPV)combined with or without internal limiting membrane(ILM)flap and sterile air or perfluoropropane(C3F8)tamponade in the treatment of idiopathic macular hole(IMH).Methods A retrospective case analysis.From December 2015 to December 2016 in Tianjin Eye Hospital,101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade,were included in this study.All patients underwent BCVA and OCT examination.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The patients were divided into three groups according to preoperative minimum liner diameter of Hole(MLD)and surgical methods:MLD<400μm for the group A,41 eyes of 39 patients,MLD more than 400μm without ILM flap surgery as the group B,39 eyes of 38 patients,including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8,MLD more than 400μm with ILM flap as the group C,a total of 21 patients of 21 eyes,including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8.The logMAR BCVA of group A,B and C were 0.82±0.39,1.11±0.42,1.25±0.50,respectively.The follow-up times were 1 week,1 month,3 month,6 month and 1 year post operation,BCVA and OCT were performed at each follow-up time.The hole closure rate and BCVA improvement were observed.Results The postoperative BCVA of group A,B and C was improved obviously,the differences were statistically significant(t=?11.66,?7.52,?4.99;P<0.01).There was no significant difference in improvement of visual acuity between the three groups(A and B,A and C,B and C group:t=0.77,?0.41,0.28;P=0.44,0.72,0.76).96.94%macular hole closure occurred in 7 days post operation.The postoperative visual acuity improved significantly in 3 mouth after operation,Conclusions The macular hole closure occurred mainly in 1 week after operation,postoperative visual acuity increased mostly in the 3rd month post operation.There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400μm.