非俯卧位以及大范围内界膜剥除治疗特发性黄斑裂孔疗效观察  

No face-down positioning and broad internal limiting membrane peeling for idiopathic macular holes

作　　者：俞颂平[1,2] 应佳[1,2] 蓝淑琴[1,2] 陈战巧[1,2] 

机构地区：[1]浙江大学丽水医院 [2]丽水市中心医院眼科,浙江省丽水市323000

出　　处：《眼科新进展》2014年第10期943-945,共3页Recent Advances in Ophthalmology

基　　金：浙江省中医药科学研究基金资助(编号:2012ZA137)~~

摘　　要：目的探讨大范围内界膜剥除联合体积分数16%全氟丙烷（C3F8）玻璃体腔填充术后不采用俯卧位治疗特发性黄斑裂孔的效果。方法收集我院2010年3月至2013年1月63例（63眼）黄斑裂孔患者,所有特发性黄斑裂孔手术均由同一位手术医师完成,手术采取大范围内界膜剥除、体积分数16%C3F8玻璃体腔填充以及术后不采用俯卧位。手术方式均采用23 G睫状体平坦部玻璃体切割术。缓慢注射吲哚青绿（用50 g·L^-1葡萄糖溶液稀释成0.08 g·L^-1）染色内界膜约1 min,内界膜剥除至血管弓附近（直径约8000μm）,气-液交换,5 min后进行气体与体积分数16%C3F8交换。术后患者保持阅读位3～5 d,随访6个月。结果 63例（63眼）患者中8例8眼为复发性裂孔（12.70%）,距离前次手术1～3（1.3±2.1）a;20例（31.75%）2期,21例（33.33%）3期,22例（34.92%）4期。所有裂孔直径为（517.63±258.27）μm,其中4例裂孔直径超过1000μm。术前最佳矫正视力为0.16±0.18,术后为0.27±0.15。单纯裂孔封闭率100%,术中术后未见严重并发症发生。结论大范围内界膜剥除＋体积分数16%C3F8玻璃体腔填充及术后非俯卧位治疗特发性黄斑裂孔较以往的玻璃体腔气体填充以及俯卧位的治疗方式更加方便且有效。Objective To demonstrate the efficacy of broad internal limiting membrane（ILM） peeling and 16% perfluoropropane（C3F8） endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes（IMH）. Methods A total of 63 patients（63eyes） in our hospital from March 2010 to January 2013 recruited in this study. All IMH surgeries were operated by same one surgeon,broad ILM peeling,16% C3F8 endotamponade with no facedown positioning were performed. Surgeon method included 23-gauge pars plan vitrectomy. Indocyanine green dye（0. 08 g·L^- 1） was injected slowly,allowed to stain for 1 minute,and then removed. ILM was broadly peeled to the vascular arcades（ approximately 8000 μm in diameter）,followed by 2 fluideair exchanges,separated by 5 minutes,and the air-16% C3F8 exchanged. Patients maintained reading position for 3 days to 5 days and were followed up at least for 6 months.Results Eight patients（12. 70%） had recurrent IMH,and mean duration from previous surgery was（1. 3 ± 2. 1）years,ranged from 1 year to 3 years. 20 cases（31. 75%） were in stage 2,21cases（33. 33%） in stage 3,and 22 cases（34. 92%） in stage 4. IMH basal diameter was（517.63 ± 258. 27）μm,and four IMH had a basal diameter of more than 1000 μm. The preoperative BCVA was 0. 16 ± 0. 18,and the postoperative BCVA was 0. 27 ± 0. 15. The single-procedure IMH closure rate was 100%,and no serious complication was observed. Conclusion Macular hole surgery with broad ILM peeling,16% C3F8 gas,and no face-down positioning is more effective in the surgical treatment of IMH compared with gas endotamponade and face-down positioning.

关 键 词：黄斑裂孔 内界膜剥除术 非俯卧位 

分 类 号：R774.5[医药卫生—眼科]