相干光断层扫描观察玻璃体手术联合空气填充治疗特发性黄斑裂孔术后的光感受器细胞层改变  

Changes of photoreceptor layer on spectral domain optical coherence tomography in idiopathic macular hole after vitreous surgery combined with air tamponade

作　　者：贺峰[1] 于伟泓[1] 郑霖[1] 董方田[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2012年第12期1088-1092,共5页Chinese Journal of Ophthalmology

摘　　要：目的研究玻璃体切除手术联合空气填充治疗特发性黄斑裂孔的手术效果及其术后光感受器细胞层的改变。方法回顾性病例系列研究。选择2009年1月至2011年5月行玻璃体切除手术联合空气填充治疗的45例（45只眼）特发性黄斑裂孔患者，采用频域相干光断层扫描测量患者黄斑裂孔直径及光感受器细胞层破坏直径。术前与术后最佳矫正视力和黄斑裂孔闭合率的相关性分析，采用Bivariate过程的Pearson相关分析法。结果45例（45只眼）患者的术前最佳矫正视力为0．4至眼前手动，平均0．08；黄斑裂孔直径204—1616μm，平均827．4μm；光感受器细胞层破坏直径792—3444μm，平均1988．9μm。术后1个月，45例（45只眼）患者的黄斑裂孔闭合率为75．6％；最佳矫正视力为0．5至光感，平均0．13；光感受器细胞层破坏直径166～2553μm，平均1285．1μm。患者术后视力较术前显著提高，光感受器细胞层破坏直径显著减小。术前的黄斑裂孔直径和术后的光感受器细胞层破坏直径与术后视力显著相关（r=0．526，0．628，P〈0．05）。结论玻璃体切除手术联合空气填充治疗特发性黄斑裂孔安全有效。术前的黄斑裂孔直径和术后的光感受器细胞层破坏直径是预测术后视力的最敏感指标之一。Objective To evaluate the tamponade effect of sterilized air in vitrectomy for idiopathic macular hole （IMH） as well as changes of photoreceptor layer after surgery. Methods Forty-five eyes of 45 consecutive cases underwent vitrectomy and air tamponade. Surgical outcomes were retrospectively analyzed, consisting of logarithm of the minimal angle of resolution （logMAR） and SD-OCT findings including the size of IMH and the photoreceptor layer defect. Results Preoperatively, mean BCVA was 0. 08 （range, 0. 4 to HM） , mean hole diameter was 827.4 μm （range, 204 to 1616 μm）, and mean diameter of photoreceptor layer defect was 1988.9 μm （ range, 792 to 3444 μm）. The primary closure rate was 75.6%. One month after surgery, mean BCVA was 0. 13 （range, 0. 5 to LP）, and mean diameter of photoreceptor layer defect was 1285. 1 μm （range, 166 to 2553 μm）, both presenting a significant decrease. Preoperative hole diameter and postoperative diameter of photoreceptor layer defect were statistically significantly correlated with postoperative BCVA （ r = 0. 526,0. 628 ; P 〈 0. 05 ）. Conclusions Vitreetomy plus air tamponade is safe and effective for the treatment of IMH, and the time for face-down positioning is obviously shortened. Preoperative hole diameter and postoperative diameter of photoreceptor layer defect are major predictive factors of visual acuity.

关 键 词：视网膜穿孔 玻璃体切除术 空气 体层摄影术 光学相干 光感受器 

分 类 号：R779.6[医药卫生—眼科]