外伤性黄斑裂孔的随诊观察  

Follow-up study of traumatic macular hole

作　　者：李学伟[1] 卢宁[1] 张兰[1] 王文伟[1] 王莹[1] 严伟[1] 熊颖[1] 

机构地区：[1]首都医科大学附属北京同仁医院 北京同仁眼科中心,100730

出　　处：《中华眼科杂志》2008年第9期786-789,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨外伤性黄斑裂孔的自然病程和视力预后。方法系列病例报告。对2004年8月至2007年12月确诊的28例（28只眼）外伤性黄斑裂孔患者进行定期随诊。观察项目包括视力、眼底彩色照相及相干光断层扫描（OCT）情况。其中随诊时间不足3个月的患者排除。结果28例（28只眼）外伤性黄斑裂孔患者均符合入选条件，随诊时间在3个月以上，平均随诊时间14个月。28例（28只眼）中，有16例（16只眼，57．1％）同时伴有黄斑裂孔周围脉络膜视网膜损伤。在随诊中，9例（9只眼）黄斑裂孔变大；1例（1只眼）黄斑裂孔变小；3例（3只眼）黄斑裂孔自行闭合，闭合时间分别在随诊4．5、3．5及1．0个月后，闭合率10．7％（3／28），患者视力均提高，最终视力为0．5—0．7；2例（2只眼）发生视网膜脱离，发生率4．2％（2／48），经手术治疗后，视网膜复位，视力提高。结论外伤性黄斑裂孔的大部分患者在随诊期间视力稳定甚至有所提高。在发病后的4—5个月内，部分患者的黄斑裂孔可自行闭合，并恢复较好的视力，而发生视网膜脱离者较少。Objective To investigate the natural course and visual outcomes of traumatic macular hole. Methods This was a case series observation study. Patients with traumatic macular hole were followed-up for 3 months or longer from August 2004 to December 2007. Examinations included best-corrected visual acuity, fundus photography and optical coherence tomography. Results In a consecutive case series of 48 patients （48 eyes） with traumatic macular hole, 28 eyes of 28 patients were followed for more than 3 months, with an average of 14 months. Of the 28 patients （28 eyes）, 16 patients （ 16 eyes, 57.1% ）had traumatic choreidal or retinal changes surrounding the macular hale. The size of the macular hales changed in 16 （16 eyes） of 28 patients （28 eyes） during the follow-up period. Macular hale enlarged in 9 （9 eyes） of the 28 patients （28 eyes）, became smaller in 1 patient （1 eyes）, and closed spontaneously in 3 patients （3 eyes）. Macular hole closure occurred 4. 5, 3.5, and 1 month after the onset of macular hale, respectively. The closure rate was 10. 7% （3/28）. Visual acuity improved in all the patients with macular hale closure. Final best-corrected visual acuity ranged from 0. 5 to 0. 7. Retinal detachment occurred in 2 patients （2 eyes） and the occurrence rate was 4. 2% （2/48）. The retina re-attachod and visual acuity improved in these 2 cases （2 eyes） after surgical treatment. Conclusions Visual acuity remains stable or improves in most patients with traumatic macular hole. Spontaneous closure occurs in some cases 4 to 5 months after the onset of the macular hale with good visual recovery. Retinal detachment is rare in traumatic macular hale. （ Chin J Ophthalmo1,2008 , 44 ： 786-789）

关 键 词：眼损伤 视网膜穿孔 视敏度 视网膜脱离 随访研究 

分 类 号：R686[医药卫生—骨科学]