内界膜填塞联合空气填充术治疗大直径特发性黄斑裂孔

doi:10.3760/cma.j.cn115909-20200909-00362

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摘要目的：观察25G玻璃体切割联合内界膜（ILM）填塞及空气填充术治疗大直径特发性黄斑裂孔（IMH）的临床疗效。方法：回顾性系列病例研究。收集2018年10月至2019年3月兰州大学第二医院眼科收治的较大直径IMH（裂孔直径>700 μm）患者15例（16眼）的相关病例信息，每例患者均行25G玻璃体切割+ILM填塞及空气填充术治疗。术前，术后1周、1个月、3个月、6个月均行最佳矫正视力（BCVA）、频域光学相干断层成像（SD-OCT）、散瞳眼底、裂隙灯显微镜、MP-3微视野计等检查，比较患者手术前后BCVA、黄斑裂孔直径、视物变形程度、黄斑区平均视网膜敏感度（MS）值、固视稳定性及固视位置的变化。采用配对t检验、χ2 检验及Spearman相关对数据进行分析。结果：术后 6个月16眼黄斑裂孔均闭合（100%），无一眼视力下降，14眼术后BCVA较术前提高（占87%），手术前后BCVA差异有统计学意义（t=4.08，P=0.001）。所有病例在随访期间均无并发症，均无视物变形加重，10眼视物变形较术前明显改善，4眼视物变形完全消失。术前中心固视者7眼，术后中心固视增加为14眼，术前固视稳定者5眼，术后固视稳定增加为12眼，手术前后固视位置及固视稳定性比较差异有统计学意义（χ2 =9.000，P=0.029；χ2 =9.863，P=0.016）；术前MS为（13.7±2.8）dB，术后MS为（16.5±3.6）dB，术后较术前明显提高（t=16.072，P=0.003）；术前固视稳定性较好的5眼术后矫正视力提高明显（r=0.518，P=0.040）。结论：25G玻璃体切割+ILM填塞及空气填充术治疗IMH，能安全有效促进黄斑裂孔愈合，也能进一步改善患者视功能，对于较大直径IMH来说是一种值得推荐的微创手术方法。

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关键词 ： , 特发性黄斑裂孔, 内界膜填塞, 空气填充, 频域光学相干断层扫描, MP-3微视野计

Abstract： Objective: To evaluate the clinical effect of 25G vitrectomy combined with internal limiting membrane (ILM) transposition and air tamponade surgery in the treatment of large-diameter idiopathic macular hole (IMH). Methods: A retrospective analysis was conducted on 15 consecutive patients (16 eyes) with large-diameter IMH (hiatus diameter >700 μm) who were treated in the Ophthalmology Department of the Second Hospital of Lanzhou University from October 2018 to March 2019. All patients underwent 25G vitrectomy combined with ILM transposition and air tamponade surgery. Best-corrected visual acuity (BCVA), slit lamp microscopy, mydriatic fundus examination, spectral-domain optical coherence tomography (SD-OCT), and MP-3 microperimetry tests were performed preoperation and 1 week and 1, 3, and 6 months postoperation. The changes in BCVA, macular hole diameter, degree of visual deformation, mean retinal sensitivity (MS) in the macular area, fixation stability and fixation position before and after surgery were observed. Data were analyzed by a t-test, χ2 test and Spearman correlation analysis. Results: At the last follow-up, the macular hole was closed in all 16 eyes (100%) and the postoperative BCVA of 14 eyes was improved (accounting for 87%). No patient had a decreased visual acuity. Over all BCVA improved significantly compared to preoperative BCVA (t=4.08, P=0.001). No complications occurred in any patients during the follow-up period. The deformity in 10 eyes had significantly improved compared to preoperation, and had completely disappeared in 4 eyes. Seven eyes had central fixation before the operation and 14 eyes had central fixation after the operation. Five eyes had stable fixation before the operation and 12 eyes had stable fixation after the operation. Comparisons of fixation position and stability before and after surgery showed statistically significant differences (χ2 =9.000, P=0.029; χ2 =9.863, P=0.016). The MS before the operation was 13.7±2.8 dB and was 16.5±3.6 dB after the operation, which was significantly higher than that before the operation (t=16.072, P=0.003). Patients with better fixation stability before surgery had significantly improved postoperative corrected vision (r=0.518, P=0.040). Conclusions: 25G vitrectomy combined with ILM transposition and air tamponade surgery for the treatment of largediameter idiopathic macular hole can safely and effectively promote the healing of the macular hole and further improve the visual function of patients. It is a recommended minimally invasive surgical method for a larger idiopathic macular hole diameter.

Key words： larger idiopathic macular hole internal limiting membrane transposition air tamponade spectral-domain optical coherence tomography MP-3 microperimetry

收稿日期: 2020-09-09

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基金资助: 甘肃省自然科学基金（20JR5RA340）；兰州大学第二医院“萃英科技创新”计划项目（CY2018-BJ01）

通讯作者: 陶明（ORCID：0000-0002-9299-9362），Email：15002674603@163.com

引用本文:

雒文娟陶明李艳李芳兰田静. 内界膜填塞联合空气填充术治疗大直径特发性黄斑裂孔[J]. 中华眼视光学与视觉科学杂志, 2021, 23(4): 247-253. Wenjuan Luo, Ming Tao, Yan Li, Fanglan Li, Jing Tian. Treatment of Large-Diameter Idiopathic Macular Hole with Internal Limiting Membrane Transposition and Air Tamponade Surgery. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(4): 247-253. DOI: 10.3760/cma.j.cn115909-20200909-00362

链接本文:

https://www.cjoovs.com/CN/ 10.3760/cma.j.cn115909-20200909-00362 或 https://www.cjoovs.com/CN/Y2021/V23/I4/247

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