中华眼底病杂志

中华眼底病杂志

玻璃体切割联合改良内界膜覆盖手术治疗复杂黄斑裂孔疗效观察

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目的观察玻璃体切割(PPV)联合改良内界膜(ILM)覆盖手术治疗复杂黄斑裂孔(MH)的疗效。方法回顾性病例研究。检查确诊并接受PPV联合改良ILM覆盖手术的MH患者20例21只眼纳入研究。其中,特发性MH(IMH)9只眼;高度近视MH 2只眼;高度近视MH视网膜脱离(RD)5只眼;孔源性RD(RRD)合并MH 3只眼;RRD手术后MH 2只眼。IMH 9只眼,MH基底径(BASE)为(1 188.3±155.1)μm,最小径(MIN)为(626.9±86.2)μm,最小分辨角对数(logMAR)最佳矫正视力(BCVA)为1.1±0.3。高度近视MH 2只眼,BASE为(696.5±232.6)μm,MIN为(259.0±69.3)μm,logMAR BCVA为1.3。高度近视MHRD 5只眼,logMAR BCVA为1.5±0.1。RRD合并MH 3只眼,logMAR BCVA为1.6。RRD手术后MH 2只眼,BASE为(1 606.0±69.3)μm,MIN为(909.0±387.5)μm,logMAR BCVA为1.6。均接受标准经睫状体平坦部三通道23G或25G PPV。手术中清除玻璃体后皮质膜后,吲哚青绿辅助染色黄斑区ILM,环形剥除血管弓内ILM,残留黄斑中心凹处约1.5个视盘直径ILM,部分撕松,重水辅助翻转上方或颞侧ILM覆盖于MH上,手术完毕时空气、C3F8或硅油眼内填充。手术后随访1~4个月,观察手术后BCVA变化、MH闭合情况。结果IMH 9只眼均为Ⅰ型闭合,其中U形、V形闭合分别为7、2只眼;高度近视MH 2只眼、RRD合并MH 3只眼、RRD手术后MH 2只眼均为Ⅰ型U形闭合;高度近视MHRD 5只眼中,Ⅰ型U形闭合3只眼,Ⅱ型W形闭合2只眼。IMH、高度近视MH、高度近视MHRD、RRD合并MH、RRD手术后MH患眼平均logMAR BCVA分别为0.8±0.3、0.9±0.2、1.4±0.1、0.7±0.3、0.9±0.2。IMH患眼平均logMAR BCVA较手术前提高,差异有统计学意义(P=0.02);高度近视MH、高度近视MHRD、RRD合并MH、RRD手术后MH患眼平均logMAR BCVA较手术前无明显变化,差异均无统计学意义(P=0.18、0.10、0.11、0.18)。结论PPV联合改良ILM覆盖有助于复杂MH患眼MH闭合,视力改善。

ObjectiveTo observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH).MethodsThis is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C3F8, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C3F8, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months.ResultsMH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠof U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18).ConclusionVitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function.

关键词: 视网膜穿孔/治疗; 玻璃体切除术

Key words: Retinal Perforations/surgery; Vitrectomy

引用本文: 刘海芸, 高敏, 杨名, 孙晓东. 玻璃体切割联合改良内界膜覆盖手术治疗复杂黄斑裂孔疗效观察. 中华眼底病杂志, 2017, 33(4): 354-358. doi: 10.3760/cma.j.issn.1005-1015.2017.04.007 复制

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