富血小板纤维蛋白膜填塞联合空气填充治疗巨大黄斑裂孔的疗效观察  

The efficacy of platelet-rich fibrin membrane insertion combined with air filling for giant macular hole

作　　者：杨娟[1] 杜磊[1] 曾思雨 邢怡桥[1] Yang Juan;Du Lei;Zeng Siyu;Xing Yiqiao(Eye Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院眼科中心,武汉430060

出　　处：《中华眼底病杂志》2022年第4期280-284,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察富血小板纤维蛋白(PRF)膜填塞联合空气填充治疗巨大黄斑裂孔的疗效。方法前瞻性病例对照研究。2019年10月至2021年2月于武汉大学人民医院眼科中心检查确诊的巨大黄斑裂孔患者56例56只眼纳入研究。其中,男性17例17只眼,女性39例39只眼;年龄(64.23±9.30)岁。患眼裂孔最小直径(827.36±83.16)μm。所有患眼均行最佳矫正视力(BCVA)和光相干断层扫描血管成像(OCTA)检查。采用中文版视功能问卷NEI VFQ-25进行视觉相关生活质量问卷调查。按照随机分配原则将患者随机分为PRF组和内界膜(ILM)组,各28例28只眼。两组患者年龄(t=-1.588)、性别构成比(χ2=0.760)、BCVA(Z=-0.400)、裂孔最小直径(t=-0.604)、脉络膜毛细血管层血流面积(CBFA)(t=1.331)、NEI VFQ-25得分(t=0.921)比较,差异均无统计学意义(P>0.05)。患眼均行23G微创玻璃体切割手术,PRF组以PRF膜填塞裂孔,ILM组以ILM翻转填塞裂孔,充分气液交换后填充无菌空气。手术后随访时间≥6个月。采用与手术前相同的设备和方法行相关检查,对比观察两组患眼BCVA变化、裂孔闭合形态、CBFA以及视觉相关生活质量改善情况。组间比较,符合正态分布的数据采用独立样本t检验,非正态分布的数据采用Mann-Whitney U检验。组内比较,符合正态分布的数据采用配对样本t检验,非正态分布数据采用Wilcoxon秩和检验。结果手术后6个月,PRF组、ILM组患眼中,裂孔闭合分别为27(96.4%,27/28)、26(92.6%,26/28)只眼;BCVA中位数均为0.70;CBFA分别为(1.99±0.20)、(1.91±0.18)mm2;NEI VFQ-25得分分别为(81.36±12.39)、(78.39±10.12)分。与手术前比较,PRF组、ILM组患眼手术后BCVA(Z=-4.636、-4.550)、CBFA(t=-27.115、-31.135)均显著提高,NEI VFQ-25得分(t=-15.557、-10.675)显著增加,差异均有统计学意义(P<0.05)。两组患眼间手术后BCVA(Z=-0.167)、CBFA(t=1.554)、NEI VFQ-25得分(t=0.980)比较,差异均无统计学意义(P=0.726、0.126、0.Objective To observe the efficacy of platelet-rich fibrin(PRF)membrane tamponade combined with air filling for giant macular hole(MH).Methods A prospective case-control study.From January 2019 to February 2021,56 patients(56 eyes)diagnosed with giant MH from Eye Center of Renmin Hospital of Wuhan University were enrolled.Among them,there were 17 males with 17 eyes and 39 females with 39 eyes.The average age of the patients was 64.23±9.30 years old.The average MH minimum diameter was 827.36±83.16μm.The best corrected visual acuity(BCVA)and optical coherence tomography angiography(OCTA)examination were performed before surgery.The Chinese version of 25-item National Eye Institute visual functioning questionnaire(NEI VFQ-25)was used to investigate patient's visual-related quality of life.There were 28 eyes of 28 cases receiving PRF membrane covering,as PRF group,another 28 eyes of 28 cases receiving inverted internal limiting membrane(ILM)insertion into giant MH,as ILM group.The differences of the age(t=-1.588),sex ratio(χ2=0.760),BCVA(Z=-0.400),macular hole minimum diameter(t=-0.604),choriocapillary blood flow area(CBFA)(t=1.331)and NEI VFQ-25 score(t=0.921)were not statistically significant(P>0.05).All eyes underwent 23G minimally invasive vitrectomy.In the PRF group,PRF membrane was used to fill the hole,and in the ILM group,the hole was filled with ILM inversion,and filled with sterile air after full gas-liquid exchange.The follow-up time after surgery was≥6 months.The same equipment and methods as before surgery were used to conduct related examinations,and the changes of BCVA,the shape of hole closure,CBFA and the improvement of vision-related quality of life were compared between the two groups.For comparison between groups,independent samples t-test was used for data with normal distribution,and Mann-Whitney U test was used for data with non-normal distribution.For intra-group comparisons,paired-samples t-test was used for data with normal distribution,and Wilcoxon rank-sum test was used for non-normal

关 键 词：视网膜穿孔 玻璃体切除术 空气 富血小板纤维蛋白 内界膜 

分 类 号：R779.6[医药卫生—眼科]