外伤性黄斑裂孔玻璃体切割术联合空气填充观察分析  

Clinical observation of vitrectomy combined with room air-filled on traumatic macular hole

作　　者：李艳[1] 陶明[1] 李玉婷[1] Li Yah;Tao Ming;Li Yuting(Fundus Department,Ophthalmology Hospital of Lanzhou University,the Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院眼科医院眼底病科,兰州730030

出　　处：《中国实用眼科杂志》2017年第8期813-816,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 观察外伤性黄斑裂孔行玻璃体切割联合空气填充的手术效果.方法 采用回顾性分析方法,选择2013年1月至2016年1月手术治疗的外伤性全层黄斑裂孔患者17例（18只眼）,16只眼采用玻璃体切割联合内界膜剥离术治疗,术中采用空气填充玻璃体,嘱患者俯卧位,术后随访6-14个月,OCT观察黄斑裂孔情况,并记录患者最佳矫正视力、裂孔闭合情况、手术前后视物变形程度及术中、术后并发症情况.探讨空气填充在外伤性黄斑裂孔中的意义及应用价值.结果 （1）2只眼外伤性黄斑裂孔自然闭合;（2）至随访期末,手术治疗16只眼中,术后视力提高者15只眼,视力提高率为93.8％;视力提高2行以上者12只眼（75.0％）;（3）术后1个月内13只眼（81.25％）黄斑裂孔经OCT证实完全闭合,且随访期内未见复发;（4）术后俯卧位时间为（3.5±0.4）d;（5）患者术后视物变形明显改善;（6）所有患眼手术均顺利完成,未见严重术中、术后并发症发生.结论 玻璃体切割、内界膜剥离联合空气填充能够有效治疗外伤性黄斑裂孔,能够提高患者的最佳矫正视力;术后大部分患者能达到较好的裂孔闭合、视功能恢复、俯卧位时间较短且无严重手术并发症;空气填充是值得推荐的手术方式.Objective To observe the effects of vitrectomy combined with room air-filled on traumatic macular hole.Methods A retrospective comparative study included 17 patients （18 eyes） with traumatic macular hole treated by surgery between January 2013 and January 2016.Sixteen eyes treated with inner limiting membrane peeling with vitreous cutting operation and vitreous was filled with room air.Patients were asked to sleep in prone position.Macular hole was observed by OCT during the 6-14 months＇ follow up.The best corrected visual acuity,hole closure rate,the degree of visual distortion before and after surgery and complications during and after operation were recorded to discuss clinical significance and value about traumatic macular hole after room air tamponade.Results Spontaneous closure of traumatic macular hole was 2 eyes.At the end of the follow up,vision of 15 eyes in 16 eyes improved.The rate of visual acuity improvement was 93.8%.Vision of 12 eyes in 16 eyes improved 2 lines （75.0%）.OCT confirmed that macular holes in 13 eyes （81.25%） were completely closed in one month post-operation,and relapse didn＇t appear in the follow-up.The mean prone posturing period was 3.5±0.4 days.The degree of visual distortion reduced° significantly.All patients＇ surgery was successfully completed,no serious intraoperative and postoperative complications.Conclusions Inner limiting membrane peeling with vitreous cutting operation may effectively treat traumatic macular hole and improve the best corrected visual acuity.This study shows that room air tamponade can obtain good closure rate,recovery of visual functions,a short time in the prone position and no any serious surgical complications for traumatic macular hole.Room air tamponade is recommended way after vitrectomy in traumatic macular hole.

关 键 词：外伤性黄斑裂孔 玻璃体切割 空气 谱域OCT(SD-OCT) 

分 类 号：R774.5[医药卫生—眼科]