不同分期特发性黄斑裂孔玻璃体切除联合内界膜剥离术治疗效果分析  

Efficacy of vitrectomy combined with internal limiting membrane peeling for idiopathic macular hole at different stages

作　　者：高朋芬[1] 张英瑜[1,2] 杨丽霞[1] 

机构地区：[1]南京军区福州总医院眼科 [2]福建医科大学福总临床医学院,福建福州350025

出　　处：《局解手术学杂志》2010年第6期488-490,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的总结分析不同Gass分期特发性黄斑裂孔(idiopathic macular hole,IMH)患者行玻璃体切除联合内界膜剥离手术结果,探讨IMH手术时机选择。方法回顾分析2006年1月至2009年12月在我院接受玻璃体切除联合内界膜剥离的IMH47例(48眼),术后随访6个月以上,用光学相干断层扫描(optical coherence tomography,OCT)观察术前、术后黄斑裂孔,统计术前、术后最佳矫正视力(best corrected visual acuity,BCVA),对结果进行统计分析。结果①根据Gass分期,Ⅱ期10眼、Ⅲ期20眼、Ⅳ期18眼,随着IMH分期进展,裂孔逐渐增大,术前BCVA逐渐下降,Ⅲ、Ⅳ期IMH直径显著大于Ⅱ期IMH,P<0.01,但Ⅲ、Ⅳ期IMH直径之间无显著性差异;术前BCVA与Gass分期之间呈负相关关系,r=0.42,P<0.05。②93.75%(45/48眼)IMH术后经OCT证实完全闭合,6.25%(3/48眼)IMH术后随访超过6个月始终未闭合,但孔径均较术前有所缩小。85.42%(41/48眼)术后BCVA提高,其余14.58%(7/48眼)术后BCVA无明显改变,无术后视力下降者。术后BCVA与术前相比明显提高,P<0.01。③随着IMH分期进展,IMH术后裂孔闭合率逐渐下降,分别是100%、95%和88.89%,但各组间无显著差异,P>0.05;3组术后视力提高率分别是90%、90%、77.89%,无显著差异,P>0.05;三组病例术后BCVA均明显高于同组术前,各组P<0.01。术后BCVA与Gass分期之间呈负相关关系,r=0.45,P<0.05。结论 IMH是进行性恶化性疾病,玻璃体切除联合内界膜剥离术是治疗IMH的有效手术方法,对Ⅱ期以上IMH应尽早手术治疗,对Ⅳ期以上的晚期IMH,手术仍有积极意义。Objective To summarize the efficacy of vitrectomy combined with internal limiting membrane （ ILM ） peeling for stage Ⅱ, Ⅲand Ⅳ idiopathic macular hole （IMH） and to discuss the time of the surgery. Methods Totally 48 eyes of 47 patients with IMH underwent vitrectomy combined with ILM peeling from January 2006 to December 2008 were retrospectively analyzed. The macular holes before and after the surgeries were observed by optical coherence tomography （OCT） and the best preoperative and postoperative corrected visual acuity （BCVA） were counted. The results were analyzed statistically. Results （1） According to Gass classification, 10 eyes were at stage Ⅱ, 20 eyes at stage Ⅲ and 18 eyes at stage Ⅳ. The hole size increased and preoperative BCVA decreased with progression of IMH stages. Hole size at stage III and IV was signifisantly bigger than that at stage Ⅱ （P 〈 0.01 ） , however, no significant difference of hole size was found between stage Ⅲ and Ⅳ. Preoperative BCVA was negatively correlated with the stage of IMH （ r = 0. 42, P 〈 0.05 ）. （2） According to the results of OCT, 93.75% （45/48 eyes） showed anatomic closure after the surgery; 6.25% （3/48 eye） showed smaller hole size before operation but expressed failure of anatomic closure during the follow- up; 85.42% （41/48 eyes） showed improved BCVA postoperatively and 14.58% （7/48 eyes） kept stable with no eye showed decreased vision. Postoperative BCVA improved statically compared with preoperative BCVA （P 〈0.01 ）. （3） The postoperative anatomical closure rate decreased with the progression of IMH stages （100% at stage Ⅱ, 95% at stage Ⅲand 88.89% at stage Ⅳ） and there were no statically difference among different stages （P 〉0.05）. Postoperative BCVA improved significantly compared with preoperative BCVA at three stages（90% , 90% and 77.89% at three stages respectively） （ P 〉 0.05 ）. （P〈0. 01）. Postoperative BCVA was negatively correlated with IMH stage.

关 键 词：特发性黄斑裂孔 玻璃体切除术 内界膜剥离术 光学相干断层扫描 

分 类 号：R774.5[医药卫生—眼科]