中华眼底病杂志

中华眼底病杂志

板层黄斑裂孔相关视网膜前增生膜填塞联合自体血覆盖治疗退行型板层黄斑裂孔的疗效观察

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目的 观察板层黄斑裂孔相关视网膜前增生膜(LHEP)联合自体血覆盖治疗退行型板层黄斑裂孔(LMH)的疗效。 方法 回顾性病例分析。临床检查确诊的LMH患眼28例28只眼纳入研究。其中,男例2例2只眼,女性26例26只眼;均为单眼。均行最佳矫正视力(BCVA)、医学验光、裂隙灯显微镜、间接检眼镜、频域光相干断层扫描、B型超声检查和眼轴长度(AL)测量。BCVA记录时换算为最小分辨角对数(log MAR)视力。28只眼中,退行型裂孔10只眼,占35.7%;均合并LHEP。牵拉型裂孔18只眼,占64.3%;均未合并LHEP。两组患眼logMAR BCVA、AL、中间视网膜水平裂孔直径、晶状体状态比较,差异均无统计学意义(P>0.05);内界膜(ILM)水平裂孔直径比较,差异有统计学意义(P<0.05);中心凹厚度(CFT)、椭圆体带完整性比较,差异有统计学意义(P<0.05)。根据手术方法分别将退行型、牵拉型裂孔患眼分为膜填塞组、常规组。膜填塞组患眼常规玻璃体切割手术(PPV)后不行ILM剥除,保留裂孔缘LHEP并填塞于裂孔处;气液交换后通过笛针注入自体全血覆盖于黄斑表面;气液交换后玻璃体腔注入C3F8。常规组患眼常规PPV后气液交换玻璃体腔注入C3F8。手术后随访3~14个月,观察两组患眼CFT、中心凹形态及logMAR BCVA改变。 结果 末次随访时,膜填塞组、常规组患眼logMAR BCVA分别为0.34±0.27、0.31±0.29;与手术前logMAR BCVA比较,差异均有统计学意义(Z=−3.519、−4.945,P<0.001)。膜填塞组、常规组患眼CFT分别为(200.10±58.78)、(226.61±70.49)μm。与手术前CFT比较,常规组患眼差异无统计学意义(Z=−1.455,P=0.146);膜填塞组患眼差异有统计学意义(Z=−2.798,P=0.005)。膜填塞组10只眼中,中心凹形态恢复9只眼,占90.0%;中心凹形态改善 1只眼,占10.0%。常规组18只眼中,中心凹形态恢复10只眼,占55.6%;中心凹形态改善8只眼,占44.4%。两组患眼LMH均闭合。 结论 PPV联合LHEP翻转填塞联合自体血覆盖手术可有效治疗退行型LMH。

Objective To observe the efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH). Methods Retrospective case review. Twenty-eight eyes of 28 patients with LMH were enrolled in this study. There were 2 males (2 eyes) and 26 females (26 eyes). Best corrected visual acuity (BCVA), medical optometry, slit-lamp biomicroscop, indirect ophthalmoscope, spectral domain optical coherence tomography, b-scan ultrasonography and axial length detection were performed on all patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. There were 10 eyes (35.7%) with degenerative type LMH (flap insertion group) and LHEP. There were 18 eyes (64.3%) with tractional type LMH (general group). The differences of BCVA, AL, horizontal hole diameter from retina and lens state between two groups were not significant (P>0.05). The differences of horizontal hole diameter of internal limiting membrane (ILM), central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P<0.05). LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group. Vitrectomy combined ILM peeling were used in eyes of general group. The follow-up was ranged from 3 to 14 months. The changes of CFT, central foveal form and logMAR BCVA were observed. Results At latest follow-up, the BCVA of flap insertion group and general group were 0.34±0.27, 0.31±0.29; which significantly better than the preoperative BCVA (Z=−3.519, −4.945; P<0.001). The CFT of flap insertion group and general group were (200.10±58.78), (226.61±70.49) μm. There was no difference between pre- and post-operative CFT in eyes of general group (Z=−1.455, P=0.146). There was significant difference between pre- and post-operative CFT in eyes of flap insertion group (Z=−2.798, P=0.005). In flap insertion group, regular recovery of the foveal contour occurred in 9 eyes (90.0%), improvement in 1 eyes (10.0%). In general group, regular recovery of the foveal contour occurred in 10 eyes (55.6%), improvement in 8 eyes (44.4%). The closure rate of LMH were 100% both in two groups. Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.

关键词: 视网膜穿孔/外科学; 玻璃体切除术

Key words: Retinal Perforations/surgery; Vitrectomy

引用本文: 吴越, 胡志翔, 胡旭颋, 厉芬芬, 雷祥, 宋宗明. 板层黄斑裂孔相关视网膜前增生膜填塞联合自体血覆盖治疗退行型板层黄斑裂孔的疗效观察. 中华眼底病杂志, 2017, 33(6): 616-620. doi: 10.3760/cma.j.issn.1005-1015.2017.06.015 复制

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