玻璃体切割联合内界膜移植术治疗大直径特发性黄斑裂孔的疗效评估  

Clinical efficacy evaluation of vitrectomy combined with autologous internal limiting membrane transplantation for large macular hole

作　　者：郝玉华[1] 席瑞洁 韩悠 田笑雨 戴丽[1] 史俊芳[1] 

机构地区：[1]河北医科大学第二医院眼科,石家庄050000

出　　处：《中华实验眼科杂志》2017年第11期1014-1018,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：河北省科技厅惠民计划项目（16277717D）;河北省医学适用技术跟踪项目（GL2014034）

摘　　要：摘要背景 大直径特发性黄斑裂孔（IMH）严重损害患眼视力，手术难度较大，如何选择和优化手术方法仍是研究热点。 目的 探讨游离内界膜移植术治疗大直径IMH的有效性和安全性。 方法 采用前瞻性系列病例观察研究方法，于2013年1月至2015年11月纳入在河北医科大学第二医院就诊的大直径IMH患者[平均直径为（814.31±112.95）μm]42例42眼。所有患眼均施行玻璃体切割联合游离内界膜移植＋体积分数12% C3F8填充术。分别于术前及术后1、3、6、12个月对患者进行最佳矫正视力（BCVA）（LogMAR）、裂隙灯显微镜检查和双目间接检眼镜检查，并采用频域光相干断层扫描（SD-OCT）仪检查手术前后黄斑中心区视网膜变化，评估裂孔闭合率，评估和比较手术前后患眼BCVA、光感受器内段/外段（IS/OS）缺损范围、外界膜缺损范围和中心凹视网膜厚度的变化。 结果 术后12个月患者黄斑裂孔闭合率为97.6%（41/44）。术后1、3、6和12个月患者BCVA较术前均明显改善，手术前后不同时间点BCVA总体比较差异有统计学意义（F＝28.032，P〈0.001）；术眼术前及术后1、3、6和12个月IS/OS缺损范围分别为（1 112.00±45.44）、（859.00±84.55）、（649.00±52.47）、（486.00±46.88）和（320.00±45.13）μm，总体比较差异有统计学意义（F＝38.761，P〈0.001），其中术后1、3、6和12个月术眼IS/OS缺损范围较术前均明显减小，差异均有统计学意义（均P〈0.05）；术眼术前和术后1、3、6和12个月外界膜平均缺损范围分别为（1 038.00±39.63）、（748.00±64.12）、（585.00±48.88）、（438.00±42.84）和（265.00±28.97）μm，总体比较差异有统计学意义（F＝36.459，P〈0.001），术后1、3、6和12个月外界膜缺损范围较术前均明显减小，差异均有统计学意义（均P〈0.05）。术后1个月黄斑中心凹厚度值大于术后3、6、12个月，差异�Background Giant idiopathic macular hole （IMH） severely affects visual acuity and increases operative difficulty during the surgery, so modifying or optimizing the operation method is helpful for improving the prognosis. Objective This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH. Methods A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter （814.31±112.95）μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12% C3F8 filling.The best corrected visual acuity （BCVA） （LogMAR）, inner segment/outer segment （IS/OS） defect range, external limiting membrane defect range, retinal thickness at macular fovea were measured with slit lamp microscope, indirect ophthalmoscope and spectral-domain optical coherence tomography （SD-OCT） before surgery and 1, 3, 6 and 12 months after surgery. Results IMH complete closure in 97.6% eyes （41/44） at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points （F=28.032, P〈0.001）. The IS/OS defect range was （1 112.00±45.44）, （859.00±84.55）, （649.00±52.47）, （486.00±46.88） and （320.00±45.13）μm before surgery and 1, 3, 6 and 12 months after surgery, showing a significant difference among different time points （F=38.761, P〈0.001）, and the IS/OS defect range was gradually shrinked after operation compared with that before operation （all at P〈0.05）. The mean defect range of external limiting membrane was （1 038.00±39.63）, （748.00±64.12）, （585.00±48.88）, （438.00±42.84） and （265.00±28.97）μm before surgery and 1, 3, 6 and 12 months after surgery, with a significant difference amo

关 键 词：视网膜裂孔/手术 黄斑 玻璃体切割术 基底膜/手术 疗效 内界膜移植 

分 类 号：R779.6[医药卫生—眼科]