视网膜脱离玻璃体手术后黄斑裂孔的发生机制  

Occurrence mechanism of macular hole formation after pars plana vitrectomy for rhegmatogenous retinal detachment

作　　者：陈倩茵[1] 张静琳[1] 汤云霞[1] 林慧敏 高汝龙[1] CHEN Qianyin;ZHANG Jinglin;TANG Yunxia;LIN Huimin;GAO Rulong(Department of Retina ＆ Vitreous,Guangzhou Aier Eye Hospital,Guangzhou 510060,China)

机构地区：[1]广州爱尔眼科医院眼底病科,广州510060

出　　处：《眼科学报》2018年第2期61-65,共5页Eye Science

基　　金：广东省医学科学技术研究基金(20177229227574);广州市卫生局医药卫生科技项目(2017A1332)~~

摘　　要：目的:探讨玻璃体手术治疗孔源性视网膜脱离后出现黄斑裂孔的临床表现并分析其原因。方法:回顾7例孔源性视网膜脱离患者行玻璃体手术后出现黄斑裂孔的病例资料和检查结果,对其视网膜脱离时裂孔的位置、性质进行归纳,分析术后黄斑部光学相干断层扫描(optical coherence tomography,OCT)特征,进一步推测黄斑裂孔形成的原因。结果:视网膜脱离玻璃体手术后的OCT图像提示黄斑区视网膜表面膜与黄斑裂孔形成密切相关。患者均行玻璃体切除联合内界膜剥离,术后黄斑裂孔解剖上闭合,5例(71.4%)视力较术前提高,6例(85.7%)术后视力>0.1。结论:玻璃体手术治疗视网膜脱离后出现的黄斑裂孔是罕见的并发症,推测视网膜表面膜是视网膜脱离玻璃体手术后黄斑裂孔形成的主要原因。Objective： To study the clinical characteristics and pathogenesis of macular hole（MH） formation after vitrectomy for rhegmatogenous retinal detachment（RRD）. Methods： We reviewed the medical records and optical coherence tomography（OCT） data of patients presenting with MH after RRD repair. Retinal breaks were described and foveal structure was examined by OCT, then the pathogenesis was postulated. Results： OCT images of the vitrectomized eyes showed macular hole with epiretinal membrane（ERM） over the inner layer, which was associated with macular formation. All patients underwent pars plana vitrectomy（PPV） combined with internal limiting membrane peeling and the macula was closed. Visual acuity was improved in 5 eyes（71.4%） and better than 0.1 in 6 eyes（85.7%）. Conclusion： MH developing after vitrectomy for RRD is rare. Presence of ERM is considered as the main cause of MH formation after vitrectomy for RRD.

关 键 词：黄斑裂孔 玻璃体切除手术 孔源性视网膜脱离 

分 类 号：R779.6[医药卫生—眼科]