玻璃体手术治疗视网膜中央静脉阻塞伴黄斑水肿  

Clinical therapeutic effects of vitrectomy and radial optic neurotomy for macular edema secondarey to central retinal vein occlusion.

作　　者：李玉涛[1] 解鹏亮 刘淑伟[1] 

机构地区：[1]唐山市眼科医院,063000

出　　处：《中国实用眼科杂志》2010年第6期634-636,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的 观察玻璃体手术治疗视网膜中央静脉阻塞（CRVO）伴黄斑水肿的临床疗效.方法 取临床诊断为缺血性CRVO伴黄斑水肿的连续病例36例（36眼）.根据手术时间先后分为放射状视神经切开术（RON）组和玻璃体切除与周边视网膜光凝术（PPV/PE）组,随访（28.6±6.3）个月.对比观察各个时段的视力、视野、黄斑中心凹厚度及眼底改变情况.结果 1个月内RON组4只眼视力提高,PPV/PE组6只眼视力提高.1年以上追踪观察RON组8只眼视力提高,4只眼视力不变,2只眼视力下降,PPV/PE组12只眼视力提高.8只眼视力不变,4只眼视力下降,两组最好矫正视力均无≥0.5,≥0.1者占50%.两组1个月及一年时段视力提高≥0.1者对比差异无统计学意义（P〉0.05）,两组对黄斑中心凹的视网膜厚度经OCT测量均有持续明显的减轻.RON组4只眼视神经切开部位萎缩.结论 对于缺血性CRVO伴黄斑水肿的玻璃体手术的治疗,从视力改变及黄斑水肿减轻的角度出发,RON组和PPV/PE组无明显区别,且RON存在着视神经萎缩的并发症.临床应首选简单易行的PPV/PE手术.Objective To observe the clinical therapeutic effects of vitrectomy and radial optic neurotomy （RON） for macular edema secondary to central retinal vein occlusion （CRVO）. Methods Thirty-six consecutive patients （36 eyes） were identified duration of macular edema secondary to ischemic CRVO. According to the time of surgery, these patients divided into two groups, the radial optic neurotomy （RON） group, the Pars Planna Vitrectomy/Panretianl Endophotocoagulation （PPV/PE） group. The average follow-up periods were 28.6± 6.3 months. The changes in visual acuity （VA）, foveal thickness, visual fiPEd and the case of optic disc were observed and compared. Results The visual acuity （VA） of 4 eyes in the radial optic neurotomy （RON） group and 6 eyes in the Pars Planna Vitrectomy /Panretiani Endopbotocoagulation （PPV/PE） group improved at the first 1 month. Then clinical observation and follow-up more than 1 year, in the radial optic neurotomy （RON） group： visual acuity （VA） had improvement in 8 eyes, 4 remained the same, whereas 2 became worse. The Pars Planna Vitrectomy/Panretianl Endopbotocoagulation （PPV/PE） group： visual acuity （VA） had improvement in 12 eyes, 8 remained the same, whereas 4 became worse. None of both the groups were≥0.5 in BCVA, and 50% were ≥0.1. It was not statistically significant between the two groups which eyes were≥ 0.1 in BCVA at 1 month and 1 year of follow-up （P 〉0.05 ）. OCT showed that all patients were improved at their last follow-up when compared with preoperative foveal thickness. However,4 eyes had optic atrophy in RON group. Conclusions The improvement in visual acuity and macular edema between RON group and PPV/PE group has no statistically significant differences. However, optic atrophy is a major postoperative complication in the RON group. It＇s better to choose PPV/PE first.

关 键 词：视网膜中央静脉阻塞与治疗 黄斑水肿与玻璃体手术 

分 类 号：R774.1[医药卫生—眼科]