25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔疗效评估  

25G pars plana vitrectomy combined with peeling of the inner limiting membrane and air tamponade in idiopathic macular hole

作　　者：胡夏云[1] 张丽娜[1] 沈丽芳[1] 吴伯乐[1] 

机构地区：[1]浙江省丽水市人民医院眼科,浙江丽水323000

出　　处：《中国实用眼科杂志》2017年第4期400-404,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔的临床疗效.方法 回顾性分析2014年5月至2016年8月在丽水市人民医院眼科行25G玻璃体切割术的黄斑裂孔患者28例28只眼的临床资料,所有患者行25G玻璃体切割,在0.25 mg/ml亮蓝染色下剥除内界膜,玻璃体腔内消毒空气填充.术后主要观察手术时间、最佳矫正视力、眼压、裂孔闭合情况及手术并发症.术后随访3～24个月,平均（12.23.6）个月.结果 总手术时间为22～40 min,平均28 min,28只眼内界膜均顺利剥除,28例患者黄斑裂孔均闭合（100％）,21例患者术后视力较术前均有提高（75％）,无视力下降患者,平均视力为0.650.194,与术前相比显著提高（t=13.768,P=0.000）.术后1周平均眼压为（15.33.7） mmHg,与术前水平相近.8只眼剥除IMH时视网膜表面少量细小点状出血,4只眼术后随访期间发生核性白内障,3只眼发生一过性高眼压.所有病例在随访期内无其它严重并发症发生.结论 25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔,能促进裂孔愈合,提高术后视力,缩短手术时间,减少并发症,是一种安全有效的微创手术方法.Objective To evaluate the clinical effect of 25G pars plana vitrectomy with inner limiting membrane peeling and air tamponade for idiopathic macular hole （IMH）.Methods Retrospectively examined 28 patients （28 eyes） with IMH in whom 25G vitrectomy,peeling of the inner limiting membrane underwent 0.25mg/ml brilliant blue G（BBG）-assisted,and application of sterile air tamponade were performed.The main observations were the surgical time,best corrected visual acuity （BCVA）,intraocular pressure,the healing of macular hole and surgery complications.The follow-up period was 3-24 months （median 12.23.6 months）.Results The operation lasted for 22-40minutes,meanly 28minutes,28 cases were all successfully peeled of the inner limiting membrane,macular hole were closed in 28 eyes （100%）,visual improvement was achieved in 21 eyes （75%）,no eye was worse.The mean BCVA was 0.650.194 postoperatively,there was significant statistical differences compared with that before operation （t =13.768,P =0.000）.The mean intraocular pressure at postoperative 1 week was （15.33.7） mmHg,closed to preoperative level.Eight eyes had punctate retinal hemorrhage when peeling of the inner limiting membrane,4 eyes had nuclear cataract,3 eyes had transient higher intraocular pressure,no other serious postoperative complications were observed during the follow-up time in all cases.Conclusions 25G vitrectomy with inner limiting membrane peeling and air tamponade is an effective and safe minimally invasive surgical technique,it can promote healing of macular hole,improve visual acuity,shorten operation time,decrease complication.

关 键 词：25G玻璃体切割 特发性黄斑裂孔 内界膜剥除 

分 类 号：R774.5[医药卫生—眼科]