曲安奈德二次染色辅助内界膜剥除治疗特发性黄斑裂孔观察  

Clinical observation on the treatment of idiopathic macular holeusing triamcinolone acetonide twice staining assisted internal limiting membrane peeling

作　　者：李志勇 

机构地区：[1]河北省眼科医院河北省眼科学重点实验室河北省眼科研究所,河北邢台054001

出　　处：《中国实用眼科杂志》2015年第6期657-659,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨曲安奈德（TA）二次染色辅助内界膜剥除治疗特发性黄斑裂孔的疗效及并发症。方法回顾性分析2012年1月至2014年2月在河北省眼科医院就诊的特发性黄斑裂孔21例21只眼，其中Ⅱ期裂孔5只眼、Ⅲ期裂孔12只眼、Ⅳ期裂孔4只眼。均先切除玻璃体核心部后，TA染色玻璃体，辅助玻璃体后皮质的剥离。然后将稀释TA再次注入，辅助内界膜剥除，联合14％C，F8气体填充。术后平均随访8．38个月，观察黄斑裂孔闭合情况、术后最佳矫正视力、眼压、手术并发症。结果黄斑裂孔闭合19只眼，占90．5％（19／21）；黄斑裂孔未闭合2只眼，再次手术后均闭合。随访期末，术后BCVA为0．1～0．6，平均logMAR视力为（0．602±0．262）logMAR。手术前后logMAR视力比较，差异有统计学意义（t=10．310，P〈0．05）。术后眼压升高8只眼，其中6只眼眼压升高不足30mmHg，2只眼眼压35mmHg，经局部点眼及口服醋甲唑胺治疗，3d后眼压降至正常。未发生视网膜脱离及感染性眼内炎等严重并发症。结论曲安奈德二次染色辅助内界膜剥除治疗特发性黄斑裂孔是一种安全、有效的方法。Objective To evaluate the clinical effects for tyiamcinolone assisted posterior vitre- ous detachment and internal limiting membrane peeling in the treatment of idiopathic macular holes. Methods A retrospective case study. The diagnosis of idiopathic macular hole in the study included 21 patients （21 eyes）. The stage II macular hole in 5 eyes; stage III in 12 eyes; stage IV in 4 eyes. All surgery involved TA-assisted PVD and ILM peeling. And 14% C3Fs was tamponaded. The average follow-up was 8.38 months after operation. Observation of macular holes closure, the best corrected visual acuity, intraocular pressure（IOP）, complication. Results Anatomic macular hole clo- sure was achieved in 19 eyes （90.5%） at the first surgery and in other 2 eyes after the second sur- gery. At the end of follow-up, the BCVA was 0.1-0.6 and the mean logMAR was （0.602±0.262）. Compared with the mean preoperative logMAR,the differences were significant （t =10.310, P 〈0.05）. Postoperative intraocular pressure increased in 8 eyes, 6 eyes IOP elevation was less than 30mmHg, 2 eyes after the first day of IOP 35mmHg.After treatment, IOP decreased to normal in 3 days. No serious complication of retinal detachment and infectious endophthalmitis were found. Conclusions TA-assisted PVD and ILM peeling is an effective and safe surgical technique in the idiopathic macu- lar hole.

关 键 词：特发性黄斑裂孔 曲安奈德 内界膜 

分 类 号：R774.5[医药卫生—眼科]