两种手术方式治疗大孔径特发性黄斑裂孔的疗效比较

Therapeutic effect of two surgical methods on the treatment of large-aperture idiopathic macular hole

目的:评价自体血封闭应用于玻璃体切除+视网膜内界膜翻转填塞+玻璃体腔消毒空气注入术治疗大孔径特发性黄斑裂孔的效果。方法:选取大孔径特发性黄斑裂孔28眼病例,分为A组:玻璃体切除+视网膜内界膜翻转填塞+玻璃体腔消毒空气注入术,B组:在内界膜翻转填塞基础上行自体血封闭黄斑裂孔;2组各14例,14眼。术后随访6个月,记录术前及术后1、3、6个月的最佳矫正视力(BCVA)、裂隙灯检查、眼底镜检查及黄斑部光学相干断层扫描检查,比较2组疗效差异。结果:A组病人手术后1、3和6个月得分均较手术前下降(P<0.05~P<0.01);B组病人术后1、3和6个月得分均较手术前显著下降(P<0.01),术后6个月较术后1个月得分亦有所下降(P<0.05)。至复查结束A组裂孔闭合率为92.6%,B组100.0%。所有病人均未出现术后高眼压及视网膜脱离的现象。结论:2组病人术后视力均呈逐渐上升趋势,自体血封闭术后裂孔闭合率达100.0%,治疗大孔径特发性黄斑裂孔是安全有效的。

Objective:To evaluate the effects of par plana vitrectomy,inverted limiting membrane(ILM)packing and vitreous cavity disinfected air filling in the treatment of large-aperture idiopathic macular hole.Methods:Twenty-eight eyes with large-aperture idiopathic macular hole were divided into the group A and group B(14 cases each group).Group A was treated with PPV,ILM packing and vitreous cavity disinfected air filling,and group B was treated with autogenous blood blocking macular hole based on ILM packing.All cases were followed up for 6 months,the best corrected visual acuity,slit lamp examination,ophthalmoscopy and optical coherence tomography before operation and after 1,3 and 6 months of surgery were recorded.The difference of the curative effect between two groups was analyzed.Results:The scores in group A after 1,3,and 6 months of surgery decreased compared with those before surgery(P<0.05 to P<0.01).The scores in group B after 1,3,and 6 months of surgery significantly decreased compared with those before surgery(P<0.01),and which in group B after 6 months of surgery decreased compared with that after 1 month of surgery(P<0.05).The hole closure rates in group A and group B were 92.6%and 100%,respectively.No high intraocular pressure or retinal detachment occurred in all patients.Conclusions:The postoperative visual acuity in two groups increases gradually,the hiatus closure rate after autologous blood occlusion is improved compared with that of simple inner boundary membrane filling,and the treatment of large-aperture idiopathic macular hole is safe and effective.