玻璃体切除联合扩大内界膜剥除及玻切头孔周按摩术治疗大孔径黄斑裂孔的效果观察

Vitrectomy combined with extended internal limiting membrane peeling and vitreous cutter perimacular hole massage for large macular hole

目的探讨玻璃体切除联合扩大内界膜剥除及玻切头孔周按摩术治疗大孔径黄斑裂孔的效果及安全性。方法2017年3月—2024年1月洛阳市第一人民医院诊治大孔径黄斑裂孔患者35例(35眼),均行玻璃体切除术联合扩大范围的内界膜剥除术,并采用玻切头按摩裂孔周围辅助裂孔闭合。术前、术后1周、术后1个月评估患眼最佳矫正视力(BCVA)并换算为最小分辨角对数视力(BCVA logMAR);应用光学相干断层扫描(OCT)测量术前黄斑裂孔直径,观察术后黄斑裂孔闭合情况;比较U型(Ⅰ型)闭合与V型(Ⅱ型)闭合患眼术前裂孔直径。术后1个月观察眼压增高、白内障等并发症发生情况及黄斑裂孔复发情况。结果术前、术后1周、术后1个月患眼BCVA logMAR(1.33±0.50、1.08±0.43、0.72±0.25)依次降低(F=20.193,P<0.001)。患眼术前黄斑裂孔直径(564.20±161.82)μm,术后1周裂孔闭合32眼(91.4%),其中Ⅰ型闭合28眼,Ⅱ型闭合3眼,Ⅲ型闭合1眼;Ⅰ型闭合患眼术前裂孔直径[(544.54±150.86)μm]与Ⅱ型闭合患眼[(534.67±117.99)μm]比较差异无统计学意义(t=0.134,P=0.903)。术后1个月,裂孔闭合32眼外层视网膜恢复良好,外界膜及椭圆体带均较术前有所恢复;其中3眼发生一过性眼压升高,2眼发生轻度白内障;黄斑裂孔均未复发。结论玻璃体切除联合扩大内界膜剥除及玻切头孔周按摩术治疗大孔径黄斑裂孔安全、有效,可促进黄斑区视网膜组织结构修复,视功能恢复良好。

Objective To evaluate the outcome and safety of vitrectomy combined with extended internal limiting membrane peeling and vitreous cutter perimacular hole massage in the treatment of large macular hole.Methods Thirty-five patients(35 eyes)with large macular hole were diagnosed and treated in the First People's Hospital of Luoyang from March 2017 to January 2024.All patients underwent vitrectomy combined with extended internal limiting membrane peeling,and were performed vitrectomy cutter perimacular hole massage to assist macular hole closure.The best corrected visual acuity(BCVA)was assessed before surgery,one week after surgery,and one month after surgery,and was converted to logarithm of minimal angle of resolution(BCVA logMAR).The macular hole diameter was measured before surgery and the closure of macular hole was observed after surgery using optical coherence tomography.The macular hole diameter before surgery was compared between U-shaped(typeⅠ)closure and V-shaped(typeⅡ)closure eyes.The incidence of complications as increased intraocular pressure and cataract,and recurrence of macular hole were observed one month after surgery.Results The BCVA logMAR decreased gradually before surgery,one week after surgery,and one month after surgery(1.33±0.50,1.08±0.43,0.72±0.25)(F=20.193,P<0.001).The macular hole diameter before surgery was(564.20±161.82)μm.One week after surgery,the macular hole was closed in 32 eyes(91.4%),with typeⅠclosure in 28 eyes,typeⅡclosure in 3,and typeⅢclosure in 1.There was no significant difference in presurgical hole diameter between typeⅠclosure eyes[(544.54±150.86)μm]and typeⅡclosure eyes[(534.67±117.99)μm](t=0.134,P=0.903).One month after surgery,the outer retinal layers recovered well in 32 eyes with macular hole closure,and external limiting membrane and ellipsoid zone were recovered compared with those before surgery,with transient intraocular hypertension in 3 eyes and mild cataract in 2.There was no recurrence of macular hole.Conclusion Vitrectomy combined with extended internal limiting membrane peeling and vitrectomy cutter perimacular hole massage is effective and safe in the treatment of large macular hole,which can promote the repair of retinal tissue structure in macular area and restore good visual function.