不同方法治疗特发性黄斑裂孔对黄斑区解剖结构和脉络膜厚度的影响

Clinical study of macular structure and choroidal thickness after different treatments

目的:探讨玻璃体切割分别联合内界膜移植、内界膜翻瓣、自体血填充治疗特发性黄斑裂孔(IMH)的效果及对黄斑区解剖结构和脉络膜厚度的影响。方法:回顾性分析2017-01/2019-12我院收治的IMH患者79例82眼的临床资料,所有患者均行标准玻璃体切割+内界膜剥除术及气液交换术,其中联合内界膜移植28例29眼(内界膜移植组)、联合内界膜瓣翻转26例28眼(内界膜翻瓣组)、联合自体血填充25例25眼(自体血填充组)。观察三组患者裂孔闭合情况、裂孔闭合形态;记录最佳矫正视力(BCVA)、椭圆体带(EZ)及外界膜层(ELM)缺损直径、黄斑中心凹无血管区周长(PERIM)、浅层毛细血管层(SCP)血流密度及黄斑中心凹下(SFCT)、颞侧(TCT)、鼻侧(NCT)脉络膜厚度。结果:三组患者均成功完成手术,术后3mo时内界膜移植组、内界膜翻瓣组BCVA优于自体血填充组,EZ层缺损直径、ELM层缺损直径低于自体血填充组(P<0.05)。三组间黄斑裂孔闭合率、椭圆体区闭合率、PERIM、SCP血流密度、SFCT、TCT、NCT脉络膜厚度比较无差异(P>0.05);但三组患者黄斑裂孔闭合形态分型有差异(P<0.05),其中内界膜翻瓣组患者U型比例最高。结论:玻璃体切割联合手术中内界膜移植术、内界膜翻瓣术及自体血填充治疗IMH均可较好地恢复黄斑裂孔闭合,但内界膜移植术、内界膜翻瓣术在恢复黄斑区解剖结构、提高视力方面优于自体血填充。

AIM:To explore the effects of internal limiting membrane transplantation,inverted internal limiting membrane flap and autologous blood filling in treatment of idiopathic macular hole(IMH)and the influence on macular structure and choroidal thickness.METHODS:Clinical data of patients with IMH who were treated in the hospital between January 2017 and December 2019 were retrospectively analyzed.All patients were treated with standard vitrectomy combined with internal limiting membrane stripping and gas-liquid exchange.On this basis,patients treated with internal limiting membrane transplantation(28 cases,29 eyes),inverted internal limiting membrane flap(26 cases,28 eyes)and autologous blood filling(25 cases,25 eyes)were included in the internal limiting membrane transplantation group,inverted internal limiting membrane flap group and autologous blood filling group,respectively.The situation of hole closure and shape of the closed hole were observed.The best corrected visual acuity(BCVA),hole photoreceptors inner segment/outer segment ellipsoid zone(EZ)and external limiting membrane(ELM)defect diameter,perimeter of foveal avascular zone(PERIM),superficial capillary plexus(SCP)blood flow density,subfoveal choroidal thickness(SFCT),temporal choroidal thickness(TCT)and nasal choroidal thickness(NCT)were determined.RESULTS:All patients in the 3 groups successfully completed the surgery.The BCVA of internal limiting membrane transplantation group and inverted internal limiting membrane flap group was better than that of autologous blood filling group at 3mo after surgery(P<0.05).There were no significant differences in macular hole closure rate and ellipsoid closure rate among the 3 groups(P>0.05).However,there were significant differences in morphological classification of the closed macular hole(P<0.05),and the proportion of U-shaped hole was the highest in inverted internal limiting membrane flap group.The diameters of EZ defect and ELM defect of internal limiting membrane transplantation group and inverted internal limiting membrane flap group were smaller than those of autologous blood filling group at 3mo after surgery(P<0.05).There were no significant differences in PERIM,SCP blood flow density,SFCT,TCT and NCT among the 3 groups before and after surgery(P>0.05).CONCLUSION:Internal limiting membrane transplantation,inverted internal limiting membrane flap and autologous blood filling can restore the closure of the macular hole.However,internal limiting membrane transplantation and inverted internal limiting membrane flap can better restore the macular structure and improve visual acuity,compared with autologous blood filling.