富血小板纤维蛋白膜填塞手术联合空气填充在难治性黄斑裂孔中的应用  

Platelet-rich fibrin membrane packing and air filling in the treatment of refractory macular holes

作　　者：曾思雨 杜磊[1] 赵秋雅 杨娟[1] 邢怡桥[1] Zeng Siyu;Du Lei;Zhao Qiuya;Yang Juan;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285-288,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察并探讨富血小板纤维蛋白(PRF)膜填塞手术联合空气填充治疗难治性黄斑裂孔的可行性和有效性。方法回顾性临床研究。2019年1月至2020年1月于武汉大学人民医院检查确诊的难治性黄斑裂孔患者17例17只眼纳入研究。其中,男性7例7只眼,女性10例10只眼;年龄(55.18±7.91)岁。所有患眼均行23G微创玻璃体切割联合内界膜剥除、PRF填塞手术,手术完毕时行空气填充。手术前及手术后1周和1、3个月,患眼均行最佳矫正视力(BCVA)、光相干断层扫描血管成像检查。BCVA检查采用国际标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。以手术后3个月为疗效判定时间点,对比观察手术前后患眼BCVA、浅层视网膜血流密度(SVD)、黄斑中心凹无血管区(FAZ)面积以及中心凹视网膜厚度(CFT)等变化情况。手术前后各指标比较行配对t检验。结果17只眼中,巨大黄斑裂孔、高度近视黄斑裂孔、复发性黄斑裂孔分别为6、7、4只眼;裂孔直径(723.94±38.30)μm。手术后3个月,所有裂孔均闭合。与手术前比较,手术后3个月患眼BCVA(t=4.458)、SVD(t=2.675)提高,CFT降低(t=6.329),FAZ减小(t=4.258),差异均有统计学意义(P<0.05)。末次随访时,所有患眼均未见高眼压、视网膜脱离等并发症发生。结论微创玻璃体切割联合内界膜剥除、PRF填塞手术及空气填充治疗难治性黄斑裂孔可提高患眼裂孔闭合率,改善视力,提高视网膜血流灌注。Objective To observe and explore the feasibility and effectiveness of platelet-rich fibrin(PRF)membrane packing and air filling in the treatment of refractory macular holes.Methods A retrospective clinical study.From January 2019 to January 2020,17 patients with refractory macular hole(17 eyes)who diagnosed in Renmin Hospital of Wuhan University were included in the study.Among them,there were 7 males(7 eyes)and 10 females(10 eyes),with the age of 55.18±7.91 years.All eyes underwent 23G minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF packing,and air filling was performed at the end of the operation.The best corrected visual acuity(BCVA)and optical coherence tomography angiography were performed in all eyes before surgery and at 1 week and 1,3 months after surgery.The BCVA examination was performed using a international standard logarithmic visual acuity chart,which was converted into logarithm of the minimum angle of resolution visual acuity during statistics.Taking 3 months after surgery was as the time point to judge the efficacy,the changes of BCVA,superficial retinal vascular density(SVD),foveal avascular zone(FAZ)area and central foveal thickness(CFT)before and after surgery were compared.Paired t-test was used to compare the indicators before and after surgery.Results Among the 17 eyes,there were 6,7,and 4 eyes with giant macular hole,high myopia macular hole,and recurrent macular hole,respectively;the hole diameter was 723.94±38.30μm.Three months after surgery,all holes were closed.Compared with before surgery,the BCVA(t=4.458)and SVD(t=2.675)increased,and the CFT(t=6.329)and FAZ area(t=4.258)decreased at 3 months after surgery,and the differences were statistically significant(P<0.05).At the last follow-up,there was no complications such as intraocular hypertension and retinal detachment in all eyes.Conclusion Minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF tamponade in the treatment of refractory macular holes can increa

关 键 词：视网膜穿孔 玻璃体切除术 富血小板纤维蛋白 空气 

分 类 号：R779.6[医药卫生—眼科]