玻璃体切除联合内界膜翻转填塞治疗大直径黄斑裂孔

Clinical efficacy of vitrectomy combined with internal limiting membrane tamping for big diameter macular holes

目的观察玻璃体切除联合内界膜翻转填塞治疗直径>500μm的黄斑裂孔(MH)的治疗效果。方法回顾性分析2017年1月至2020年5月本院眼科收治的18例直径>500μm黄斑裂孔患者,均行玻璃体切除联合内界膜翻转填塞术,随访3个月。所有患者均行手术前后最佳矫正视力(BCVA)检查,用频域光学相干断层扫描(SD-OCT)检查手术前后黄斑区视网膜结构变化,评估裂孔闭合率,比较手术前后BCVA、光感受器内外层缺失直径(DIOA)的变化。结果术后3个月黄斑裂孔闭合率为100%。术后3个月BCVA较术前明显改善。手术前后不同时间的BCVA总体比较差异有统计学意义(F=3.348,P<0.05)。术后1周、1月、3月DIOA较术前减小,差异均有统计学意义(P<0.05)。结论玻璃体切除联合内界膜翻转填塞术治疗大直径黄斑裂孔安全有效,提高裂孔闭合率,有效改善视力。

Objective To observe the effectiveness of vitrectomy combined with internal limiting membrane tamping for macular holes which diameter greater than 500μm.Methods Retrospective analysis was conducted in 18 patients with macular holes from January in 2017 to May in 2020.The patients were followed up for 3 months after vitrectomy combined with internal limiting membrane tamping.Mesure the best corrected visual acuity(BCVA).Observe the status of closure condition of macular holes.Diameter of inner segment/outer segment(IS/OS)absence(DIOA)before and after surgery were masured by spectral-domain optical coherence tomography(SD-OCT).Results MH complete closure in 100%eyes(18/18)at 3 months after surgery.BCVA was significantly improved at 3 months after surgery.The differences among various time were significant(F=3.348,P<0.05).DIOA reduced in 1 week,1 month,3 months after surgery,the difference was significant(P<0.05).Conclusion Vitrectomy combined with ILM tamping is safe and effective to close big diameter macular holes,increase closure rate of holes and improve vision.