曲安奈德辅助内界膜剥离治疗特发性黄斑孔的效果观察  

Observation on the efficacy of triamcinolone acetonide assisted internal limiting membrane peeling during vitrectomy in the treatment of idiopathic macular hole

作　　者：严鑫 周明[1] 刘豪杰[1] 吴琪 Yan Xin;Zhou Ming;Liu Haojie;Wu Qi(Department of Ophthalmology,Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院眼科,大连116001

出　　处：《中华眼外伤职业眼病杂志》2024年第2期118-123,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察玻璃体切除术中曲安奈德辅助内界膜剥离治疗特发性黄斑孔的效果。方法回顾性病例系列研究。分析大连大学附属中山医院2019年1月至2022年12月45例(45眼)特发性黄斑孔患者的临床资料。所有患者均接受了玻璃体切除联合内界膜剥离手术,术中内界膜均在曲安奈德辅助下剥离,根据黄斑孔直径大小决定是否接受内界膜翻转填塞。所有患者术后至少随访6个月,观察比较术前、术后患者术眼的最佳矫正视力(BCVA,logMAR)、眼压、黄斑中心区厚度(CMT)、黄斑孔闭合情况、视网膜神经纤维层厚度(RNFL)及并发症。结果BCVA术后1个月1.0(0.6,1.0)、术后6个月0.7(0.5,0.9)与术前1.1(1.0,1.9)相比差异均有统计学意义(均P<0.001)。术后1个月和6个月,OCT显示黄斑孔闭合率100.0%(45/45),CMT术后1、3、6个月依次为267.0(250.5,279.0)、273.0(243.5,307.5)、188.0(163.5,228.5)μm,所有患者均未发生术后视网膜脱离。RNFL术后出现变薄16例,未变薄29例,其中颞上象限16例出现变薄,颞下象限5例变薄,颞侧变薄6例,鼻侧无变薄情况;其中颞上象限在术前和术后改变差异具有统计学意义(P<0.05)。手术前后眼压均在正常范围内。未记录到术前及术后其他并发症出现。结论玻璃体切除术中使用曲安奈德可提高内界膜的可视化程度,曲安奈德辅助下内界膜剥离并翻转填塞黄斑孔是安全有效的。Objective To observe the efficacy of triamcinolone acetonide assisted internal limiting membrane peeling during vitrectomy in the treatment of idiopathic macular holes.Methods This was a retrospective case series study.The clinical data of 45 eyes of 45 patients with idiopathic macular hole in Zhongshan Hospital Affiliated to Dalian University from Jan.2019 to Dec.2022 were analyzed.All patients underwent vitrectomy combined with internal limiting membrane peeling,which was assisted by triamcinolone acetonide.Considering whether the patients will accept flipped filling of ILM based on the size of the macular hole.All patients were followed up for at least 6 months.Best corrected visual acuity(BCVA,logMAR),intraocular pressure,central macular thickness(CMT),macular hole closure,retinal nerve fiber layer thickness(RNFL)and complications were observed and compared before and after operation.Results There were significant differences in BCVA among pre-operation[1.1(1.0,1.9)],1 month[1.0(0.6,1.0)],6 months[0.7(0.5,0.9)]after operation(all P<0.001).At 1 and 6 months after operation,OCT showed that the macular closure rate was 100.0%(45/45).CMT at 1,3,and 6 months after operation were 267.0(250.5,279.0),273.0(243.5,307.5),and 188.0(163.5,228.5)μm,respectively,and no postoperative retinal detachment occurred in all patients.There were 16 cases with RNFL thinning and 29 cases with non-thinning of RNFL,including 16 cases of superior temporal quadrant,5 cases of inferior temporal quadrant,6 cases of temporal thinning and no thinning of nasal side.The changes of superior temporal quadrant were statistically significant before and after operation(P<0.05).After surgery,the intraocular pressure remained within the normal range.No preoperative and postoperative complications were recorded.Conclusion The use of triamcinolone acetonide can improve the visualization of the internal limiting membrane during the operation,and it is safe and effective to peel off the internal limiting membrane and flip and plug the macular hole.

关 键 词：曲安奈德 内界膜 染色 特发性黄斑孔 视网膜神经纤维层厚度 

分 类 号：R779.6[医药卫生—眼科]