眼部前后节联合手术治疗黄斑裂孔合并白内障的疗效及安全性研究

Efficacy and safety of combined anterior and posterior segment surgery for macular hole with cataract

目的探讨眼部前后节联合手术治疗黄斑裂孔合并白内障的临床疗效及安全性。方法选取肇庆市高要区人民医院眼科2018年1月至2020年6月收治的黄斑裂孔合并白内障患者47例(47眼)为研究对象。所有患者均经眼部前后节联合手术治疗,比较患者治疗前及治疗后3个月、术后6个月的视力恢复,视网膜厚度及黄斑区形态结构变化情况,并观察患者手术后并发症发生情况。结果患者手术前平均视力为0.23±0.04,明显低于术后3个月的0.30±0.10和术后6个月的0.45±0.12,差异均有统计学意义(P<0.05);术后6个月,有43例(91.49%)患者视力提高,其中提高2行及以上者34例(72.34%);所有患者术后6个月经检查发现黄斑区膜样反光全部消失;术后3个月、术后6个月患者部分恢复率分别为12.77%、8.51%,基本恢复率为76.60%、85.11%,均明显大于术前的0、0;扭曲率分别为10.64%、6.38%,明显小于术前的100.00%,差异均有统计学意义(P<0.05);手术前,患者黄斑区视网膜厚度为(484.34±42.73)μm,明显大于术后3个月及术后6个月的(294.34±25.43)μm,(275.32±23.39)μm,差异均有统计学意义(PP<0.05);患者在手术过程中,未出现晶体后囊膜破裂及医源性视网膜裂孔,有17例(36.17%)患者黄斑周围出现少许毛细血管性出血,无需治疗手术后均自行吸收。结论眼部前后节联合手术治疗黄斑裂孔合并白内障可促进患者视力恢复,改善视网膜厚度及黄斑区形态结构,临床疗效显著且安全性高,值得临床推广应用。

Objective To investigate the clinical efficacy and safety of combined anterior and posterior segment surgery in the treatment of macular hole complicated with cataract.Methods Forty-seven patients(47 eyes)with macular hole complicated with cataract were selected from January 2018 to June 2020 in Zhaoqing Gaoyao District People's Hospital.All patients were treated by combined anterior and posterior segment surgery.The visual recovery,retinal thickness,and macular area morphology were compared before and after treatment,and complications were observed.Results The average visual acuity before operation was 0.23±0.04,which was significantly lower than 0.30±0.10 at 3 months and 0.45±0.12 at 6 months,and the differences were statistically significant(P<0.05);at 6 months after operation,43 patients(91.49%)had improved visual acuity,of which 34(72.34%)had improved vision by 2 lines or more;in all patients,the membranous reflection in macular area disappeared 6 months after operation;the partial recovery rates were 8.51%and 12.77%at 6 months and 3 months after operation respectively,and the basic recovery rates were 85.11%and 76.60%,which were significantly higher than those before operation(0 and 0);the distortion rate(6.38%,10.64%)was significantly lower than that before operation(100.00%);the differences were statistically significant(P<0.05).Before operation,the macular retinal thickness was(484.34±42.73)μm,which was significantly higher than(294.34±25.43)μm and(275.32±23.39)μm at 3 months and 6 months after operation,and the differences were statistically significant(P<0.05).During the operation,there was no posterior capsule rupture and iatrogenic retinal hole,and there were 17 cases(36.17%)with a little capillary hemorrhage around the macula,which were absorbed by themselves after operation without treatment.Conclusion Combined anterior and posterior segment surgery in the treatment of macular hole with cataract can promote the recovery of visual acuity,improve the retinal thickness and macular morphology,with significant clinical efficacy and high safety,which is worthy of clinical application.