早期特发性黄斑裂孔的手术效果与风险评估  

The effects and risks in the treatment of idiopathic macular hole in early stage with internal limiting membrane peeling

作　　者：赖铭莹[1] 唐仕波[2] 李加青[2] 邹玉平[2] 高艺[2] 

机构地区：[1]暨南大学医学院深圳眼科中心,深圳市眼科医院,深圳518001 [2]中山大学中山眼科中心

出　　处：《中国实用眼科杂志》2005年第10期1015-1019,共5页Chinese Journal of Practical Ophthalmology

基　　金：广东省科委社会发展计划重点项目基金(2004B30901005)

摘　　要：目的探讨内界膜剥除治疗早期特发性黄斑裂孔的疗效与手术风险。方法于2001年10月~2004年1月对在我院确诊为Gass分期为2期的特发性黄斑裂孔10例10眼,施行玻璃体切除联合内界膜剥除,气液交换,16%C3F8充填术,术后面向下体位1w^2w。比较其手术前后最佳矫正视力、多焦ERG,OCT检查黄斑裂孔闭合的情况以及观察术中、术后并发症。结果10例患者自述发生症状的病程为1m^3m,平均1.8m。术前最佳矫正视力0.5~0.8,平均0.6。术前黄斑裂孔直径为132μm^360μm,平均212μm±54μm。术中所有病例黄斑裂孔旁的内界膜均完整的剥除。术后随访2m^30m,平均随访13m。随访期间最佳矫正视力为0.5~1.0,平均0.7。术后OCT检查显示10眼黄斑裂孔全部闭合。5眼行多焦ERG检查,显示术后比术前黄斑区峰值大部分恢复。手术并发症包括术中剥除内界膜时,裂孔周围出现小圆点状出血3眼;术后一过性眼内压升高2眼;术后晶状体后囊下皮质混浊4眼。术后晶状体核硬化4眼。本组病例未发生黄斑裂孔扩大、晶状体损伤、视网膜脱离、眼内炎、后期黄斑裂孔再裂开、视野缺损等严重并发症。结论成功的早期手术干预,将可有效中止特发性黄斑裂孔病程,使裂孔关闭、视力提高或维持术前水平。但由于早期患眼视功能尚好,手术风险较大,术前应当与患者充分沟通。同时也要求手术者具有娴熟的玻璃体及黄斑部手术技巧,将手术风险降到最低。Objective To investigate the effects and risks in the treatment of idiopathic macular hole in early stage by using vitrectomy combined with internal limiting membrane peeling. Methods 10 eyes of 10 patients with idiopathic macular hole in stage 2 were treated by vitrectomy combined with internal limiting membrane peeling in Zhangshan Ophthomic center between January 2001 and April 2004. The best correct visual acuity was ≥0.5 in all cases. After operation, the best corrected visual acuity, mfERG and Optical coherence topography （OCT） were observed preoperatively and post-operatively. The complications of surgery were evaluated. Results The onset of symptom complained by patients was 1-3 months, average 1.8 month. Pre-operatively, the best corrected visual acuity was 0.5-0.8, mean 0.6. The diameter of macular hole was 180-260μm, mean 212 ± 54μm. The internal limiting membrane around macular hole was peeled successfully in all patients. The fellow-up was 2-30 months, mean 13 months. Post-operatively, the best-corrected visual acuity was 0.5-1.0, mean 0.7. The closure of the macular hole was confirmed by OCT in all patients. Compared with preoperatively Mf-ERG showed the improvement of apparently. The complications included small dots of retina bleeding around macular hole （3 eyes）, transient increasing of IOP （2 eyes）, feather-like opacity of lens （5 eyes）, necrosis of lens （4 eyes）. There were no serious complications such as lens damage, retinal detachment, endophthalmitis, reopening of macular hole, the defect of visual field. Conclusions The success surgery of idiopathic macular hole in early stage can interrupt the procession of macular hole, make the macular hole closed, and improve or maintain the visual acuity, but the risks should treated carefully.

关 键 词：特发性黄斑裂孔 手术治疗 视功能 玻璃体 视野缺损 视网膜脱离 

分 类 号：R774.5[医药卫生—眼科] R779.6[医药卫生—临床医学]