特发性黄斑裂孔术后面向下体位及端坐位疗效比较  

Comparison of the outcomes of face-down position and seated position after pars plana vitrectomy for idiopathic macular hole

作　　者：张楠[1] 朱冬梅[1] 张钊填[2] 宫卫锋[2] 

机构地区：[1]郑州人民医院眼科,河南450003 [2]中山大学中山眼科中心,广州510060

出　　处：《中国实用眼科杂志》2014年第6期708-711,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 比较特发性黄斑裂孔（IMH）术后分别行面向下体位及端坐位后在裂孔闭合率及视力恢复上的差别.方法 前瞻性随机对照临床研究.对2012年1～12月在郑州人民医院眼科连续接受微创玻璃体切割手术治疗的IMH患者46例（46只眼）纳入研究.其中,男性8例（8只眼）、女性38例（38只眼）;平均年龄（55.7±7.3）岁,平均病程（8.9±2.6）个月;术前logMAR视力为0.89±0.23,裂孔直径为（565±236） μm.均采用Snellen视力表行矫正视力（CVA）检查,以及验光、裂隙灯下眼底镜检查和光相干断层扫描（OCT）检查.将小数视力换算成最小分辨角对数（logMAR）视力用于统计学分析.患者按入院日期奇、偶数顺序被随机分为两组,一组（P0）在术后行面向下体位;另一组（P1）在术后行端坐位,各组分别为23例（23只眼）,持续时间均为7d,且不少于12 h/d.术后6个月时比较两组患者在裂孔闭合率及视力恢复上的差别.结果 P0组的裂孔闭合率为95.7％ （22/23）,P1组的裂孔闭合率为65.2％ （15/23）,两组比较差异具有统计学意义（x2=4.973,P=0.026）.P0组与P1组术后logMAR视力分别为（0.48±0.27）及（0.69±0.42）,两组比较差异无统计学意义（t=-2.010,P=0.052）.结论 对于裂孔直径＞400 μm的IMH患者,术后严格面向下体位是保证裂孔高闭合率的重要因素,对于裂孔直径较小的IMH患者,可以视患者具体情况将面向下体位改为端坐位.Objective To compare the difference of outcomes of macular hole closure rate and vision recovery of face-down position and seated position after pars plana vitrectomy for idiopathic macular hole.Methods Randomized controlled trial study.Consecutive 46 patients with idiopathic macular hole （IMH） from January 2012 to October 2012 in the department of ophthalmology in People＇s Hospital of Zhengzhou were included and equally randomized to two groups for different positions after the surgery by the date of admission.Group P0 was assigned to have face-down position and group P1 was assigned to have seated position,both remained 7 days after surgery,not less than 12h/D.The mean of patients＇ age,duration,logMAR visual acuity and macular hole diameter were 55.7±7.3 years,8.9±2.6 months,0.89±0.23 and 565±236μm.All the patients were required to come back 6 months after surgery.Main outcomes were macular hole closure rate and postoperative visual acuity.Results The closure rates of group P0 and group P1 were 95.7% （22/23） and 65.2% （15/23）,with statistical significance （x2=4.973,P =0.026）.The postoperative logMAR visual acuities of group P0 and group P1 were 0.48±0.27 and 0.69±0.42,without statistical significance （t =-2.010,P=0.052）.Conclusions For those patients with macular hole larger than 400μm,it is essential to remain enough face-down position in order to achieve ideal macular hole closure rate and vision recovery.But for those with smaller macular hole in size,seated position after surgery is permeable to have ideal prognosis.

关 键 词：特发性黄斑裂孔 面向下体位 端坐位 裂孔闭合率 

分 类 号：R774.5[医药卫生—眼科]