特发性黄斑裂孔玻璃体切割手术后的视功能

Visual function in patients with an idiopathic macular hole after vitrectomy

目的 :探讨特发性黄斑裂孔 (IMH)玻璃体切割手术后的视功能状况。方法 :复习并总结国内外相关文献资料 ,综合评述IMH玻璃体切割手术后视功能状况。结果 :多数患者术后视力较术前提高 2行或 2行以上 ,并且主观感觉的视物变形和暗点、辨色力、双眼融合功能和立体视功能也有所改善 ;术后视野光敏度较术前有所提高 ;注视性质由术前的偏心注视多数恢复为术后的中心注视。然而部分患者视力的改善提高不显著甚至出现视力下降 ,部分患者黄斑裂孔虽然获得解剖愈合 ,但仍遗留某些视觉缺陷。影响术后视力和其他视功能恢复的因素是复杂的 ,通常与术前视力和视功能状况的好坏、病程长短、裂孔分期早晚、手术方式、裂孔愈合状态以及手术合并症等诸多因素相关。结论 :黄斑裂孔收稿日期 :2 0 0 1-12 -0 3 ;修回日期 :2 0 0 2 -0 5 -10作者简介 :夏群 (195 6-) ,女 ,浙江人 ,主任医师 ,研究方向 :眼肌、弱视、屈光专业。通信作者 :夏群 (E -mail:tang @public .fhnet.cn .net)一旦发生 ,其裂孔自愈和视功能稳定的机会极少。因此多数学者主张若诊断明确应及早手术封闭裂孔。评价玻璃体切割手术治疗IMH的疗效 ,应在解剖形态愈合的基础上综合患者的视力、主观感觉及临床多项视功能进行全面评估。

Objective:To study the visual function of patients with idiopathic macular holes after vitrectomy.Methods:Recent internal and external references were used to compare preoperative and postoperative visual acuity and other changes in visual function in patients with idiopathic macular holes.Results:In most patients,visual acuity improved two or more lines postoperatively. Symptoms of distortion and conreal scotoma,color vision,and bilateral fusion functions improved over preoperative levels. Retinal sensitivity and stereoacuity improved postoperatively. Postoperative visual acuity was correlated with preoperative visual acuity,duration of symptoms,stage of macular hole,diameter of macular hole and surgical technique. Some patients felt that symptoms of distortion and central scotoma disappeared and light sensitivity,color vision and stereoacuity improved postoperatively. Other patients had paracentral fixation preoperatively and returned to central fixation. But visual acuity was unchanged for some patients who had defective vision.Conclusion:If macular hole occurs,there is little chance for the hole to heal on its own and visual function to stabilize. Most authors tended to close macular holes as soon as possible. Evaluating the results of vitrectomy in patients with idiopathic macular holes not only depends on the anatomic heal but also on visual function and the patient's subjective feelings.