中华眼底病杂志

中华眼底病杂志

特发性黄斑裂孔患眼玻璃体切割手术后视力及裂孔闭合的影响因素分析

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目的 观察影响特发性黄斑裂孔(IMH)患眼玻璃体切割手术后视力及黄斑裂孔(MH)闭合的相关因素。 方法 临床检查确诊为IMH的89例患者89只眼纳入研究。其中,男性15例,女性74例;平均年龄(64.13±7.20)岁。所有患眼均行最佳矫正视力(BCVA)及光相干断层扫描检查。患眼BCVA为0.01~0.4,平均BCVA为0.12±0.09。MH分期为2~4期,平均MH分期为(3.56±0.77)期。MH基底直径为182~1569 μm,平均基底直径为(782.52±339.17)μm。所有患眼均行标准经睫状体平坦部三通道25G玻璃体切割联合白内障超声乳化及人工晶状体植入手术;其中,41只眼联合行内界膜剥除手术,48只眼联合行内界膜移植手术。手术后随访时间28~720 d,平均随访时间(153.73±160.95)d。以末次随访为疗效观察时间点,观察患眼手术后视力及MH闭合情况,并对可能影响其结果的因素进行分析。 结果 末次随访时,患眼BCVA为0.02~0.8,平均BCVA为0.26±0.18。89只眼中,视力提高45只眼,占50.56%;视力稳定44只眼,占49.44%。MH闭合86只眼,占96.63%;未闭合3只眼,占3.37%。IMH患眼手术前MH分期越小、基底直径越小,手术后视力提高越明显(t=2.092、2.569,P<0.05);手术前MH分期越小,手术后MH闭合率越高(t=−5.413,P<0.05)。IMH患眼手术后视力及MH闭合情况与年龄、性别、病程、不同手术方式、不同眼内填充物质、随访时间均无明显相关性(P>0.05)。 结论 手术前MH分期及MH基底直径是影响IMH患眼玻璃体切割手术后疗效的可能相关因素;而患者年龄、性别、病程、不同的手术方式、不同的眼内填充物质及随访时间与IMH患眼手术后疗效可能无关。

Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P<0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=−5.413, P<0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P>0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.

关键词: 视网膜穿孔/外科学; 玻璃体切除术; 影响因素分析

Key words: Retinal perforations/surgery; Vitrectomy; Root cause analysis

引用本文: 宋爽, 谷潇雅, 卢颖毅, 喻晓兵, 戴虹. 特发性黄斑裂孔患眼玻璃体切割手术后视力及裂孔闭合的影响因素分析. 中华眼底病杂志, 2017, 33(4): 346-349. doi: 10.3760/cma.j.issn.1005-1015.2017.04.005 复制

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