中华眼底病杂志

中华眼底病杂志

单纯玻璃体腔注气手术治疗特发性全层黄斑裂孔疗效观察

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目的观察单纯玻璃体腔注气手术治疗特发性全层黄斑裂孔(FTMH)的疗效。方法前瞻性、非随机对照病例队列研究。临床检查确诊并行单纯玻璃体腔注气手术治疗的特发性FTMH患者26例26只眼纳入研究。其中,男性5例5只眼;女性21例21只眼。平均年龄(59.0±12.0)岁。均行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、眼底彩色照相、三维光相干断层扫描(3D OCT)检查。采用国际标准视力表行BCVA检查,统计分析时换算为最小分辨角对数(logMAR)视力。采用日本Topcon公司3D OCT-2000 测量裂孔直径,观察玻璃体黄斑交界面状态。将裂孔直径≤250 μm定义为小FTMH,裂孔直径>250 μm且≤400 μm定义为中FTMH,裂孔直径>400 μm定义为大FTMH。患眼平均logMAR BCVA为0.85±0.29。小、中、大FTMH分别为7、10、9只眼;存在玻璃体黄斑牵拉(VMT)10只眼。所有患眼均行单纯玻璃体腔注气手术。手术中注入0.2 ml C3F8;手术后保持头低位7~14 d。手术后随访1~23个月,观察手术后BCVA变化、FTMH闭合和并发症发生情况。手术后1个月FTMH未闭合眼行玻璃体切割(PPV)联合ILM剥除、C3F8填充手术。结果26只眼中,FTMH闭合17只眼,占65.4%;未闭合9只眼,占34.6%。手术前存在VMT的10只眼VMT均得到解除。FTMH未闭合眼行PPV联合ILM剥除、C3F8填充手术后FTMH均闭合。FTMH闭合的19只眼中,小FTMH 6只眼,占小FTMH患眼的85.7%;中FTMH 8只眼,占中FTMH患眼的80.0%;大FTMH 3只眼,占大FTMH患眼的33.3%。FTMH闭合、未闭合眼手术前FTMH直径分别为(307.8±122.8)、(431.6±128.4)μm,差异有统计学意义(t=−2.407,P=0.024);存在VMT者分别为6、4只眼,差异有统计学意义(t=−2.196,P=0.038)。治疗后患眼平均logMAR BCVA为0.51±0.36;与手术前平均logMAR BCVA比较,差异有统计学意义(t=4.758,P<0.05)。26只眼中,出现局限性视网膜脱离2只眼。行PPV后FTMH闭合、视网膜复位。结论FTMH直径小于400 μm、手术前存在VMT者单纯玻璃体腔注气手术疗效较好。

ObjectiveTo evaluate the efficacy of intravitreal injection (IVI) of expansile gas alone to treat idiopathic full-thickness macular hole (FTMH).MethodsThis is a prospective interventional case series. Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study. There were 5 males (5 eyes) and 21 females (21 eyes), with the mean age of (59±12) years. All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography and three-dimensional optical coherence tomography (OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon, OCT-2000). Based on the diameter, the holes were classified as small FTMH (equal or lesser than 250 μm), medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm). The mean BCVA was 0.85±0.29. There were 7, 10 and 9 eyes with small, medium and large FTMH. There were 10 eyes with vitreous- macular traction (VMT). All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days. The follow-up ranged from 1 to 23 months. The BCVA, FTMH closure and complications were observed. If holes failed to close at 1 month after IVI, vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.ResultsFTMHs was able to close in 17/26 eyes (65.4%) had hole closure, failed to close in 9 /26 eyes (34.6%). All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas. The eyes failed in the closure initially with IVI of gas alone, all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade. The closure rate of small (6 eyes), medium (8 eyes) and large FTMH (3 eyes) was 85.7%, 80.0% and 33.3% respectively. The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8±122.8), (431.6±128.4) μm respectively, the difference was significant (t=−2.407, P=0.024). VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group, respectively, the difference was significant (t=−2.196, P=0.038). The mean preoperative BCVA was 0.51±0.36. There was a significant difference between pre-and postoperative BCVA (t=4.758, P<0.05). Two eyes developed local retinal detachment, which achieved hole closure and retinal reattachment after vitrectomy.ConclusionIVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.

关键词: 视网膜穿孔/外科学; 玻璃体内注射; 惰性气体

Key words: Retinal perforations/surgery; Intravitreal injections; Noble gases

引用本文: 韩若安, 吴婵, 张潇, 陈欢, 张辰茜, 陈有信. 单纯玻璃体腔注气手术治疗特发性全层黄斑裂孔疗效观察. 中华眼底病杂志, 2017, 33(4): 368-372. doi: 10.3760/cma.j.issn.1005-1015.2017.04.010 复制

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